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HomeMy WebLinkAbout10-02-09 (2)---~ REV-1500 150560712D EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 0 9 0 3 8 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 716097231 03122009 12241916 Decedent's Last Name Suffix Decedent's First Name MI SORG LOUIS H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number 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) ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® g Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust 8. Total Number of Safe De (Attach Copy of Trust) pOSit BOxeS ^ 9. Litigation Proceeds Received ^ 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 Daytime Telephone Number FRANCIS A ZULLI 7172321488 na Firm Name (If Applicable) WION, ZULLI AND SEIBERT First line of address 109 LOCUST STREET Second line of address City or Post Office State ZIP Code HARRISBURG PA 17101 ~~ 4,"~ REGISTER OF"1~LS USE~LY t r> r- "~ ` ,_~ t - - -;`-~ - ~„ - .. ' , ~ t ~, ... J .. ,: -< _.- -~ __._ -r- '~ :: DATE FILED ~ ~ ~-7 t _.-1 ~__.7 f+ f .._..~_} -. f'i _'~ i:;t Correspondent'se-mail address: wZS@mindSpring.COm Under penalties of perjury, I declare that I have examined this return including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal renresentahva ~~ hacari nn all infnrm~finn „r,.,ti~..ti ..~e.,~.o, ti.,~ ....,. ~......., ..,. ' `-e~,,,,t J ~~f ~1 ,,. ,~ ~ Cheryl L. Durham L)(~~ ~C1 `ADDRESS 6 16 South View Circle Shermans Dale PA 17 90 SIGN RE O R RE THER THAN ESENTA ATE Francis A Zulli L! ~ ~ ADDRES 10 o st Street, H ri urg, PA 17101 J / / Side 1 ~``~. 1505607120 1505607120 REV-1500 EX Decedent's Name: S O R G, LOUIS H 1505607220 Decedent's Social Security Number 716097231 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2 2, 5 0 0 0 0 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) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7• 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 2 2, 5 0 0. 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ................................ ......... 9. 1 , 9 3 6 . 7 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ....................... ......... 10. 1 4 , 7 2 6 . 3 1 11. Total Deductions (total Lines 9 & 10) ............................................................. ......... 11. 1 6 , 6 6 3.10 12. Net Value of Estate (Line 8 minus Line 11) .................................................... ......... 12. 5 , 8 3 6 . 9 0 13. Charitable and Governmental Bequests/Sec 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. 5 , 8 3 6 . 9 0 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 .00 15 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 5, 8 3 6. 9 0 18. 19. Tax Due .................................................................................................................... . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 875.54 875.54 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 09 - 0386 DECEDENT'S NAME Sorg, Louis H STREET ADDRESS 1033 Oyster Mill Road CITY Camp Hill STATE ZIP PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 875.54 3. Interest/Penalty if applicable Total Credits (A + g + C) (2) 0.0 0 D. Interest E. Penalty 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. (4) Check box on 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. (5) 875.54 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $ 75.54 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.............................. ^ b. retain the right to designate who shall use the property transferred or its income :.................................... ^ c. retain a reversionary interest; or .................................................................................................................. ^ ^ d. receive the promise for life of either payments, benefits or care? ................. . ................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................... ^ ^ .................................................................................... x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................ ^ ................................................................. . . . ... .......... 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. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (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. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Sorg, Louis H 21 - 09 - 0386 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 wilting 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 survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION Real Property situate at 1033 Oyster Mill Road, Camp Hill, East Pennsboro Township, Cumberland County, PA 17011. See attahhed Deed dated June 13, 1968 transferring title to Nova R. Sorg f/k/a Nova R. Richards, recorded on June 20, 1968 in book U22, Pg 970. The decedent had no issue and her parents predeceased her and she was survived by her husband, Louis H. sorg, Sr., who subsequently died on March 12, 2009. See attached deed from Janice Ream, Administratrix of the Estate of Nova R. Sorg to Cheryl L. Durham, Executrix for the Estate of Louis H. Sorg dated August 24, 2009 and recorded in the Recorder of Deeds Office of Cumberland County, PA to Instrument No. 200930683. Pursuant to the February 27, 2009 Last Will and Testament of Louis H. Sorg, Sr., recently probated at No. 2009-00386 with Register of Wills of Cumberland County, Mr. Sorg devised the real estate to his sister-in-law, Janice Ream. Mrs. Ream has a pending Sales Agreement with Scott C. Bendinsky to purchase the real estate for $22,500.00 which is in extremely poor condition. See the attached 2/27/09 Last Will and Testament of Louis H. Sorg, Sr. VALUE AT DATE OF DEATH 22,500.00 TOTAL (Also enter on Line 1, Recapitulation) I 22,500.00 SCHEDULE H FUNERAL E)CPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN A rV1AINlL+`rp/~T'N /L' !~/1~n+ RESIDENT DECEDENT F~LAY~ t~7 ~ IW ~ ~ YG l~lJ~7 ~ ~7 ESTATE OF Sorg, Louis H FILE NUMBER 21 - 09 - 0386 Debts of decedent must be reported on Schedule 1. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A• 1 Neill Funeral Home -Funeral Services 170.77 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Wion, Zulli & Seibert 750.00 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 94.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Service Oil -Heating Oil 799 84 TOTAL (Also enter on line 9, Recapitulation) 1 936.79 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sorg, LOUIS H 2 I PPL -Electric Schedule H Funeral F~enses & Adminishative Costs continued FILE NUMBER 21 - 09 - 0386 Page 2 of Schedule H 122.18 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sorg, LOUIS H FILE NUMBER 21 - 09 - 0386 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Golden Years Nursing Home 6,544.10 2 Pulmonary Care 26 28 3 Harrisburg Hospital Pathology 12.71 4 Harrisburg Hospital 205.06 5 Dr. Kanton 52.56 6 Federal Income Tax 7,278.00 7 Debbie Lupold TC Real Estate Tax 255.97 8 Comcast Cable 57.20 9 Verizon Phone Bills 139.08 10 Transport to Hospital 40.35 11 East Pennsboro Township Sewer 115.00 ~ TOTAL (Also enter on Line 10, Recapitulation) I 14,726.31 REV-1513 EX+ (g-00) ~~~ t '_ SCHEDULE J COMMO ERITANCE TAX RETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF I Sorg, Louis H FILE NUMBER 21 - 09 - 0386 NUMBER NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO DECEDENT SHARE OF ESTATE (Words) AMOUNT OF ESTATE RECEIVING PROPERTY Do Not List Trustee(s) ($$$) I, TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Cheryl L. Durham Daughter 0% 16 South View Circle Shermans Dale, PA 17090 2 Janice Ream Sister-in-Law Real Estate 324 Third Street New Cumberland, PA 17070 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O.OO 107-DEED-Quit Claim Executive Soles Co., 1211 Arch 51., Phila. 7, Pa. ~ a ~ © _ `. } 1% ~" ` s r~R ~~'` ~ y ~._ , „llacle t7ze ~ 3 ~ daJ of ~ , in the near .1'i2aeteen hundred and sixty-eight (1968) ((// a g g~4>~$~ RAY R. REII,LY, single man, of Washington, "D. C., GRANTOR 11 ~~ N D - NOVA R. SORG, formerly Nova R. Richards, of East Pennsboro Township, Cumberland County, Pennsylvania, GRANTEE. ~'' - , ~_ ~; ~ ~ _ S ~, ~ ~, -- _ 7 "' _ c: C~ ~~~< ., ~~ =: C'~ '~Tl t~ -O ' ~cC -.^e~ t'~ _ J -r1 U. .-1 1, G7 rn 1!' $~Il~$~~v°~~T That in consideration of ________________________________ One Dollar ($1.00) and other good and valuable considerations /IJ~~7~yS~$/, i in hand paid, t7ze receipt whereof is 7zereby ackrzowledsed, the said srantor do es lzereby release urzd Uzcit-Claim to the said ~ra.ntee, her heirs and assigns, I ~`~ that tract or piece of land situate in East Pennsboro Township, Cumberland County, Pennsylvania, bounded and described as follows: BEGINNING at a point along a public road and line of land now or formerly of George McCormick; thence in an easterly direction along line of land now or j t formerly of the said George McCoxsnick, two hundred five (205) feet, more or less, ! to a point at the low water mark of the Conodoguinet Creek; thence along the ~ I f I course of the said creek in a nox•therly direction, one hundred (100) feet to a point at the corner of said creek and land now or formerly of Allen Walters; i thence in a westerly direction along the line of land now or formerly of the said Allen Walters, two hundred (200) feet to the aforesaid public road; thence along f ~' the road in a southerly direction., one hundred ten (110) feet to a point, the Place of BEGINNING. , i i i HAVING THEREON ERECTED a one story stone and wood siding dwelling house known j 1 and numbered as 1033 Oyster Mill Road. BEING the same premises which Edward B. McGlone, widower, by his deed dated i ~' 8~0~ ~~PAGf 97O i~ ~' ~~ ~~ ~, - ' the 21st day of August, 1950, and :recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book "M", Vol. 1l~, Page 134, granted and conveyed unto Nora R. ]Richards. The said Nora R. Richards conveyed i a portion of said premises to Ray ]~.. Rei11y by deed dated December 19, 1950, `li and recorded in the Office of the :Recorder of Deeds aforesaid in Deed Book "P", - I Vol. 11t, Page lll. Under date of August 20, 1951, Ray R. Reilly reconveyed the -,~) last mentioned tract to Nova R. Richards, now Nova R. Sorg; said deed being f ' ii recorded in the Office of the Recorder of Deeds aforesaid in Deed Book "V", Vol. 1Lt, Page 32. Said conveyance, however, contained an erroneous description. This deed is given for the purpose of correcting said error and to release the inter-est~'of Ray R. Reilly in the above described premises. No consideY~ation passed between the parties for this conveyance. I , ~ooKU 22PAC~ 971 ' _- ~I C~'~~ ~G~~~~B~$=~'*•• C`~'~~~~":L"t~tt7~j said srantor has hereunto set his hand . and seal the day and year first above written. ~u~~s~~, ~s~sDs~ ~~~ ~1,ag~t~8gs~r T Iif Aa$ 4fl~r ~~s~eag,c~ ~k' I - i I RECEIVED, on the day of the date of the above Indenture, of the above-named i I i -7 ~ , ('1 ~~r.. `i /f I On this;the /.3 -~ day of lL~,~ 11nno Domini 1~8, before me, ~ asN'p~~x~`j3PuYrdi`€~ ~.n and for said County nd State, ' ~Ts47nally. ¢ptt~'a`~ec$ ~e above named RAY R. REILLY, single man, d~.r_..~e-ors ~'~Y '': w, sdaz~dY~u~y.» off' ~ui rzclcnozuledyed the above TNDF.NTURE to be hiS_ ;`,~~~s~;dr~ y,•de~d:u~~ ~esited flee s¢me mi6lzt be recorded ¢s such. ^~7. tq'•••.:.. ,~J ,~ rYR7TNESS my Tzand ¢nd notarial seal the day ¢nd year aforesaid. i ::~^ CC:r s:^~~_1 ~Z~S R.~e ~19.d2G9 -°" ' - ~,onnn~n~mas3an~s~t~~~ m~ ~~¢aamr~~~icrmtnaaa~ • ~~-., I~ffianaa&~ ~~" ,. ~ On this the day of .g~z~zo Domini 19 ,before me, personally appe¢red the above rz¢med and in due form of law ack~zozuledaed the above INDENT URE to be act ¢nd deed, and desired the .r¢me mi6lzt be recorded as such. WITNESS my hand and se¢l the day arzd year aforesaid. flGOK ~ ,22PAGE 9~2 i~ ~i ~~~~~~~~~~~3~ ~~ ~~1~~~~~1L~.:~xa~~~. J ~a ~ ~. x~gff~ ~~ S On this day of /lnno Domini I9 , before me, the subscriber, ¢ in and for said ComnzonwealtTx and County, j personally appeared `` who acknowled~sed himself to be the I Corporation, ¢nd that he as such ~ °~ executed the foreeoin~' instrument or th,e being' authorized to do so, ! ! ~ f purposes therein cont¢ined by sisnins the name of the Corporation by himself as WITNESS my h¢nd and the day and year aforesaid. i i 4 ;1 c ~^ ~,~~ . ~~~~ js~A'•'~lt~~ that the precise address of the srarttee herei:z is 1033 Oyster: Mill Road, Camp Hill, PE:xmsylvania. - •.~ • ~ ^t• ~1~f.~, a a, m ~, r us~u-' ~ n W~ \ ~ yI ~ ~ ~ t'~1 ~ `~ w ~ `~ a . a ~~~ ~ O D ~~o ~ss~sa~~r in the Office for Recordins of Deeds in and for ,.~~„~ _. •.~_-_y 1.~,~ in Deed Book '.9 JV'o..~ pass, f~7b Etc. . ~$aas~~ my haJad and seal of Ofj"ace this c~D~--' day of C~ . .grxrzo Domini 19 ~ ~ -., BOCK V 2~PAGE 973 ('1 ,~~ . ~ ~, Recorder ADMINISTRATRIX' DEED THIS INDENTURE, made this v~~/~ day of ~UGt1dT , 2009, between JANICE M. REAM, ADMINISTRATRIX FOR THE ESTATE OF NOVA R. SORG, late of East Pennsboro Township, Cumberland County, Pennsylvania, party of the first part, Grantor AND CHERYL L. DURHAM, EXECUTRIX FOR THE ESTATE OF LOUIS H. SORG, late of East Pennsboro Township, Cumberland County, Pennsylvania, party of the second part, Grantee WITNESSETH: WHEREAS, the said Nova R. Sorg became in her lifetime seized, of and in certain tracts and parcels of land lying and being in East Pennsboro, Cumberland County, Pennsylvania, which are more particularly described hereafter; and being so thereof seized, Nova R. Sorg, died intestate on July 23, 1995. Letters of Administration for the Estate of Nova R. Sorg were duly issued to Janice M. Ream by the Register of Wills of Cumberland County on July 15, 2009 to Estate No. 2009-00652. NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in consideration of the sum of ONE ($1.00) DOLLAR to her in hand paid by the said Grantee at or before the sealing and delivery hereof, receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released and confirmed, and by these presents does grant, bargain, sell, alien, release and confirm unto the said Grantee, her heirs and assigns, ALL that tract or piece of land situate in East Pennsboro Township, Cumberland County, Pennsylvania, bounded and described as follows: BEGINNING at a point along a public road and line of land now orformerly of George McCormick; thence in an easterly direction along line of land now or formerly of the said George McCormick, two hundred five (205) feet, more or less, to a point at the low water mark of the Conodoguinet Creek; thence along the course of the said creek in a northerly direction, one hundred (100) feet to a point at the corner of said creek and land now or formerly of Allen Walters; thence in a westerly direction along the line of land now or formerly of the said Allen Walters, two hundred (200) feet to the aforesaid public road; thence along the road in a southerly direction, one hundred ten (110) feet to a point, the Place of BEGINNING. HAVING THEREON ERECTED a one story stone and wood siding dwelling house known and numbered as 1033 Oyster Mill Road. BEING the same premises which Ray R. Reilly, single man, by his Deed dated June 13, 1968 and recorded June 20, 1968, in the Recorder of Deeds Office of Cumberland County, Pennsylvania in Deed Book U, No. 22, Page 970, granted and conveyed unto Nova R. Sorg. THE said Nova R. Sorg died intestate on July 23, 1995 and on July 15, 2009, the Cumberland County Register of Wills granted Letters of Administration to Janice M. Ream to Estate No. 2009-00652. Nova R. Sorg was survived by her husband, Louis H. Sorg, Sr. and Nova R. Sorg had no issue and her parents had predeceased her. Pursuant to intestate succession, Nova R. Sorg's real estate transferred to her husband, Louis H. Sorg, Sr., who subsequently died testate on March 12, 2009 and on August 13, 2009, the Cumberland County Register of Wills granted Letters Testamentary to Cheryl L. Durham to Estate No. 2009-00386. THIS transfer is tax exempt because it is a transfer based on an intestate succession. TOGETHER with all and singular, the buildings, improvements, ways, streets, alleys, passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever, thereunto belonging or in any wise appertaining and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of her, the said Nova R. Sorg, at and immediately before the time of her decease, in law, equity, or otherwise howsoever, of, in, to or out of the same. 2 TO HAVE AND TO HOLD the said lot or piece of ground above described, with the buildings and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and intended so to be, with the appurtenances, unto the said Grantee, her heirs and assigns, to and for the only proper use and behoof of the said Grantee, heirs and assigns, forever. AND, the said Grantor, does covenant, promise and agree to and with the said Grantee, her heirs and assigns, that she, the said Grantor, has not heretofore done, committed or knowingly or willingly suffered to be done or committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part hereof, is, are, shall or may be impeached, charged, or encumbered in title, charge, estate of otherwise howsoever. IN WITNESS WHEREOF, the said Grantor has hereunto set her hand and seal, in her fiduciary capacity as aforesaid, the day and year first above written. WITNESS: ~~ ~ ~~ J 'ce M. Ream, Administratrix for the state of Nova R. Sorg 3 STATE OF PENNSYLVANIA ) COUNTY OF .l~AUPtII/'l ) ss: On this, the a ~~ day of f~ uGu~T , 2009, before me, a Notary Public, the undersigned officer, personally appeared Janice M. Read, Administratrix for the Estate of Nova R. Sorg, known to me (or satisfactorily proven) 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 thereon contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. r, ' r `, ..,_ __} Notary Public -~ :Y~- .~' ~ ~+ COMMONVYE"Ai.Tt~ ~OF rttvNSYLVANIA M commission ex fVOTARIAI SEAL Y P ~fiRBARA A. SHADEL, Notary Public (SEAL) City of Harrisburg, Dauphin County My Commission Expires March 23, 2011 I HEREBY CERTIFY the precise residence of the within named Grantee to be: 16 Southview Circle Shermansdale, PA 17090 111. REV-183 EX (11-04) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 26D603 HARRISBURG PA 17128-0603 REALTY TRANSFER TAX STATEMENT OF VALUE See Reverse for Instructions S USE ONL State Tax Paid I Book Number Page Number Date Recorded Complete each section and file in duplicate with Recorder of Deeds when (1) the full valuelconsideration is not set forth in the deed, (2) when the deed is without consideration, or by gift, or (3) a tax exemption is claimed. A Statement of Value is not required if the transfer is wholly exempt from tax based on: (1) family relationship or (2) public utility easement. If more space is needed, attach additional sheet(s). A. CORRESPONDENT -All inquiries may be directed to the following person: Name Telephone Number: Jill M. Wineka, Esquire (717) 234-4178 Street Address City State Zip Code 1719 N. Front Street Harrisburg PA 17102 B. TRANSFER DATA Date of Acce tance of Document Grantor(s)/Lessor(s) Janice M. Ream, Administratrix Grantee(s)/Lessee(s) Cheryl L. Durham, Executrix fo for Estate of Nova R. Sorg Estate of Louis H. Sorb Street Address Street Address 324 Third Street 16 Southview Circle City State Zip Code City State Zip Code New Cumberland PA 17070 Shermansdale PA 17090 C. PROPERTY LOCATION Street Address City, Township, Borough 1033 Oyster Mi11 Road East Pennsboro Townshi Gounty School District Tax Parcel Number Cumberland East Pennsboro 09-18-1308-003 D. VALUATION DATA 1. Actual Cash Consideration 2. Other Considerafion(antlClpated 3. Total Consideration 1.00 + 22,500.00 (sales rice) =.. 22 500.00 4. County Assessed Value 5. Common Level Ratio Factor 6. Fair Market Value 69,300.00 x 1.26 = ~7.3~R_~n E. EXEMPTION DATA 1 a. Amount of Exemption Claimed 100% 1 b. Percentage of Interest Conveyed 100% 2. Check Appropriate Box Below for Exemption Claimed ® Will or intestate succession Estate of Nova R. Sorb 2009-00652 (Name of Decedent) (Estate File Number) ^ Transfer to Industrial Development Agency. ^ Transfer to a trust. (Attach complete copy of trust agreement identifying all beneficiaries.) ^ Transfer between principal and agent. (Attach complete copy of agency/straw party agreement.) ^ Transfers to the Commonwealth, the United States and Instrumentalities by gift, dedication, condemnation or in lieu of condemnation. (If condemnation or in lieu of condemnation, attach copy of resolution.) ^ Transfer from mortgagor to a holder of a mortgage in default. Mortgage Book Number ,Page Number ^ Corrective or confirmatory deed. (Attach complete copy of the prior deed being corrected or confirmed.) ^ Statutory corporate consolidation, merger or division. (Attach copy of articles.) ^ Other (Please explain exemption claimed, if other than listed above.) Under penalties of law, I declare that I have examined this Statement, including accompanying information, and to the best of my knowledge and belief, it is true, correct and complete. Signature of Correspondent or Responsible Party _ Date I Ji11 M. Wineka, Esq. ~t Z~ f d 9 FAILURE TO MPLETE THIS FORM PROPERLY OR ATTACH APPLICABLE DOCUMENTATION MAY RESULT IN THE RECOR R'S REFUSAL TO RECORD THE DEED. ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE, PA 17013 717-240-6370 Instrument Number - 200930683 Recorded On 9/1/2009 At 1:07:22 PM * Instrument Type -DEED Invoice Number - 51537 User ID - AF * Grantor - SORG, NOVA R * Grantee - SORG, LOUIS H * Customer - PURCELL KRUG & HALLER * FEES STATE WRIT TAX $0.50 STATE JCS/ACCESS TO $10.00 JUSTICE RECORDING FEES - $12.50 RECORDER OF DEEDS PARCEL CERTIFICATION $10.00 FEES AFFORDABLE HOUSING $11.50 COUNTY ARCHIVES FEE $2.00 ROD ARCHIVES FEE $3.00 EAST PENNSBORO SCHOOL $0.00 DISTRICT EAST PENNSBORO TOWNSHIP $0.00 TOTAL PAID $49.50 * Total Pages - 6 Certification Page DO NOT DETACH This page is now part of this legal document. I Certify this to be recorded in Cumberland County PA cF cuye ,4 ~ ~ ~ ~o ~_ ray ~ ~,9 ~ / - - RECORDER O D EDS ,,, ~7 7Y~ * -Information denoted by an asterisk may change during the verification process and may not be reflected on this page. IIVIINII~IIIIIIR ?~rzst dill ttnc~ ~E~Y~inenY OF LOUI5 H. SORG I, LOUIS H. SORG, of East Pennsboro Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament hereby revoking all other Wills and Codicils by me at any time heretofore made. ITEM L I direct that all of my just debts and currently due debts and funeral expenses shall be paid from my estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II: I give and bequeath my clock inscribed "Louis H. Sorg" to my son, LOUIS H. SORG, JR. TTEM III: I give and bequeath all of my tangible personal property, including my household furniture, furnishings, and other similar items, in equal shares, to my son, LOUIS H. SORG, JR., and my daughter, CHERYL L. DURHAM. If my son, Louis H. Sorg, Jr., should predecease me, then I give and bequeath his share of my tangible personal property to my daughter, Cheryl L. Durham In the event that my daughter, Cheryl L. Durham, should predecease me, then her share shall pass to her surviving issue. ITEM N: I give and devise my real estate located at 1033 Oyster Mill Road, Camp Hill, Pennsylvania, but not my personal property contents therein, to my sister-in-law, JANICE REAM, only if she survives me. In the event that Janice Ream does not survive me, then I give and devise my real estate located at 1033 Oyster Mill Road, Camp Hill, Pennsylvania, to my daughter, CHERYL L. DTJRIIAM, per stirpes. TTEM V: I give, devise and bequeath all of the rest, residue and remainder of my estate, whether real or personal, or wheresoever the same maybe situate or located, in equal shares, to rriy son, LOUIS H. SORG, JR, and my daughter, CHERYL L. DURHAM. In the event that my son, Louis H. Sorg, Jr., should predecease me, then I give, devise and t bequeath his share of the residue of my estate to my daughter, Cheryl L. Durham, per stirpes. In the event that my daughter, Cheryl L. Durham, should predecease me, then I give, devise and bequeath her share of the residue of :my estate to her surviving issue. ITEM VIc I nominate, constitute and appoint my daughter, CHERYL L. DURHAM, as Executrix of this my Last Will and Testament. In the event that she is unable or unwilling to serve in this capacity, then I nominate and appoint my attorney, FRANCIS A. ZULLI, ESQUIRE, as Executor of this my Last Will and Testament. ITEM VI3: It is hereby directed that my Executor/Executrix shall pay all inheritance, estate, succession and legacy taxes to which my estate for the transfer of any property hereunder maybe subject, and to charge such taxes as a part of the expense of the administration, payable out of my residuary estate. ITEM VII[: I direct that no ExecutorBxecutrix or other fiduciary named, nominated or appointed in this my Last Will and Testament shall be required to post any bond or give any security of any type for any purpose whatsoever, any law or rule of the Court of the Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwithstanding. P IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~ day of February, 2009. (,~ J /~- v f - LOUIS H. 5ORG Signed, sealed, published and declared by the said LOUIS H. SORG, the above named Testator, as and fbr his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses hereto. ,~~, ~~~~~ Residing Residing .~v~ ~~ 2 Commonwealth of Pennsylvania ' : SS County of ~ €~ i`~/''^' a /J We, Louis H. Sorg, ~ ~G~ ~` ~U'd J f ,and ~F1:~''~ b~' ~~~`' ~-t3'~, the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do hereby declare to the undersigned authority that we were present and saw the Testator sign and execute the instrument as his Last Will and Testament and that he signed willingly (or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, acid that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of his or her knowledge the Testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence, and I, the said Testator, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. Subscribed, swom to and acknowledged before me by Louis H. Sorg, the Testator, and subscribed anal swom to before me by e .2fr~ ~i< 3?. Zit ~) i ,and. J ~i"~.=5 ~ . ~t~~~~,rr~.. witnesses, this ~~ day of February, 2009. Notary ivrvvvtALTH OF PEM7dSYLVAP;1 NO"fARIAL SEAL DEBBI SUE MIDDAUGH, Notary Public City of Harrisburg, Dauphin County ~ i' a _..3 LAW OFFICES Purcell, Krug ~ Haller HOWARD B.KRUG 1719 NORTH FRONT STREET HERSHEY LEON P.HALLER HARRISBURG, PENNSYLVANIA 17102-2392 (717) 533-3836 JOHN W. PURCELLJR. TELEPHONE (717) 234-4178 JILL M. WINEKA FAX (717) 783-4939 JOHN W PU R CELL(192 4-2009) NICHOLE M. STACEY O'GORMAN LISA A. RYNARD JOSEPH NISSLEY (191 0-1982) October 1, 2009 Register of Wills n :v ~ -=4j Cumberland County Court House ;-~ o _dt~'h -,, One Courthouse Square ~.~ -~ -`~-+ ` Carlisle, PA 17013 ~ =~ ~ ~ ,_r r. I Re: Estate of Louis H. Sorg ~ ~~ ~ ~ ;` 2109-0386 No ~; J . _: ~ Dear Register of Wills: na ~ Enclosed for filing, please find two original Pennsylvania Inheritance Tax Returns, along with two copies of the Return. I am also enclosing a check payable to the Register of Wills in the amount of $15.00 for the filing fee. I have also enclosed another check payable to the Register of Wills, Agent in the amount of $875.54 as payment for the inheritance taxes due. Please return two date-stamped copies of the Return to my attention in the enclosed stamped, self-addressed envelope. Thank you. Sincerely, J 1i I M. Wineka JMW/bas Enclosures cc: Janice M. Ream w/o enc. Francis A. Zulli, Esq. w/o enc.