HomeMy WebLinkAbout12-31-09 (3)15056041158
.~ REV-1500 EX(DB-D6, ~,~~E~~y
PA DepaMnem dRSwr7ue (,~y(',pde ypr Flle Number
Bureau or IndMdur Taws
PO BOX 280807 INHERITANCE TAX RETURN 23 08 0658
HeMSbury, PA 17128-0807 RESENT DECEDENT
ENTER DECEDENT INFORMATION BLOW
Sodas Security Number Date d Death Date d BiN7
089-D2-7477 06112008 02251937
Decedent's Last Name Suffix Decedents First Name MI
SORGE SEYMOUR CYRUS
(If AppllcabN) Enter Surviving Spouas's Irdorrnatlon Below
Spouede Last Name Suffur Spouse's Fust Name M I
Spouse's Sodas Searily Number THIS RETURN MUST BE FILED IN DUPLICATE WRH THE
- - REGISTER OF WILLS
FILL IN APPROPRUITE BOXES BELOW
^ 7. Original Retum
^ 4. Limited Eabte
^ 8. Decedent Died Teabb
(Attach Copyd WIII)
^ g. Litlgatlon Proceeds ReCehred
2. Supplemental Refum
^ 4a.
7.
^ 7 0. Fubre Interest Carrgranlse (date d
death aNer 12-t2-82)
Decedent Malnbir7ed a Livklg Trust
(Attach Capy d Trust)
Spousal Poverty Credit ((date d death
between 12-31-97 and i-1-95)
^ 3. Remainder Raum (deb d dea97
pdor b 12-1392)
^ 5. Federal Estate Tax FteMn Requtred
8. 7dd Number d Safe Deposit Burma
^ 11. Electbn b tax under Sec. 9113(A)
(Attach Srh. O)
CORRESPONDENT . THIS BECrtON MUST E COMPLETED. ALL CORRESPONDENCE AND CONFlCEMrW. TAX INFORMATION aNOULD aE DatEOFW TO:
Name Daytime Telephma N1ll~her o -'. `
t o ~ ~ '
ELIZABETH P• MU LLAUGH
717-237-S~+J~ ~ "'
Firm Name (If ApplloWe)
MCNEES WALLACE
REOIBTER~ 0E
& NURICK LLC a-,;~ r,; ~ 7
First Ilne d address cy ~~ ~i ~ _
104 PINE STREET <) C,.
-~
--
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Second Ilne d adtlreas ~ ~' -i~j
O
P•0• BOX 1166
City or Post Office State ZIP Code OA7E FLED
HARRISBURG PA 37108-1166
Correspondem's efrtell eddreea: EMULLAUGHaMWN. COM
Untler pene8ln ~ 1 I deC Met reed tlda rotum, Inoludinp acaomparyeig ed7etlulea entl aubmeraa, aM to the beat d my knoMetlOa and Della(
it is tn», w dt an our IMa. D r athertlwn the personal raprewn7alM b Domed on all In/ormatlan or which pr4pwar riaq arty knavledpa .
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Side 1
15056041158 eax8as.asd 15056041158
_. __
.J 15056042159
REV-1500 EX
DecedenPS Sodel Security Number
089-02-7477
RECAPITULATION
1. Reel setae (Schedub A) . . ........................... 1. D • D D
2. Stocks andBOnds(SchedubB) .......................... 2. 190301.26
3. Closely Held Corporation, ParlrarsNp a Solo-Proprietorship (Schedule C)...... 3. 0 • D 0
4. Mortgages & Notes Receivable (Sdxdule D) .................... 4. 0 • DO
5. Cash, Bank Depodb & Msrcelleneous Personal Ropeny (Schedub E)........ 5.
100489.90
0. Jolnty Owned Prapeny (Shcedub F) ~ Separate BIIIIng Requested ..... 8. O • O 0
7. Inter•Vivoa Transiere & Misde9aneoua Non-Probate Progeny
(Schedule G) ~ Separate BIINng Requested ..... 7. O • OD
8. Totst Oraes Aessb (total Lines 1-7) ........................ B. q0 S91 1.6
9. Funeral ExpansesBAdminlaVatkreCoete(SdraddeH) ............... g. 16669.79
10. DetNa of Decedent, Mortgage LbMNOes, 8 Liens (Schedule p........... 10. 13 313 • 0 0
11. Total Deduetims (total ones 9 & 10) ...................... 11. 27 982.7 9
12. Net Value of Estate (Line 8 minue lJne 11) ................... 12.
26260$•37
13. Charitable and Governmental BOquestslsec 9113 Trusts for which
en eleGlon to tax has not teen madB (Schedule J) ................ 13. LOGO • O O
14. NetVelusSulyaetmTax(Linel2minusLinel3) ............... 14. 26608 37
TAX COMPUTATION • SEE INSTRUCTION8 FOR APPLICABLE RATES
15. Amount of Line 14 tazable
at the spousal tax rye, ar
transfers unQ~aor Sec. 9116
(ag1.z) x .otL p, p 0 15. 0.O D
16. Amount of Line 14 taxable
at lineal rateX.o4s 2sooo•oD ,e. 112s•Da
17. Amount of Line 14 laxaWe
at sibling rate X .12 O• D O 17• D• O O
16. Amount of Line 14 taxable
at cdlaterel rate X .15 2 3 66 0 8.36 15. 3 54 91.2 5
19. TAxDUE ................................... 19. 36616.25
20. FILL IN THE BOX IF YOU ARE REQUESTIND A REFUND OF AN DNERPAYMENT ~ -
Side 2
15056042159 ewae~azaos 15056D42159
REV-1600 EX Ppa 9 Fla Nembar
Decetient'sCom IeteAGdrtsss: 21 08 0658
DE(.EDQJfS NAME
STI~ETADORESS
C17Y STATE ZIP
B
Tax Payments and Credits:
1. Tax Due (Pape 2 LMe 79)
2. CroditelPaymeMa
A. Spousal Poverty Credtl ~ . ^0
B. Prior Payments ~ ~ $ 4 3.7
c. aecwnt 1780.56
(1) 3661~y•25
lam crooks (A+a+c) (2) 35624.31
3. InterestlPanalty b appllcabb
p. Irneraet 0.00
E. Penalty D . o^
Total lMaroYlPanWy(D+E) (3) Q.0^
4. If Line 2 is tgeatar man Line 1 + Una 3, enter the drference. This k the OVERPAYMENT.
FIII In box on Page 2, Line 20 to roqueat a rahrnd. (4) O . I] 0
6. If Line 1 + Line 3 is greater then Line 2, enter the dHferertce. Thte Is the TAX DUE. (5) 991 • 94
A. Enter the interest on the tax due. (sA) 4 0.36
B. Enter the total of Line 5 + 5A This ~ the BALANCE DUE (58) 10 32.30.
Make Check Payable to: ~STEROFWILLS,AQENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did dacstlent make a trensier and: Y No
a. retain the use or inwme d the property trarrsfenetl; , , , , , , , , , , , , , , , ~ - X
b. casein the right to designate who shall use the property banelemed ar ke Income; ....... ...
c. roteln a revorsbnary iMtxesl; or ................................. I}u~'I
tl, receive the promise fa life d either peymenb, berrefila or care? ................. ~ _
2. If tleath oxurrotl ever December 12, 1952, did decadent trenslar property with4r one year d dsegl
without receiving adequate canaMere11on7 ..................
3. Did decedent own an 9n trust for' or payable upon death bank atxount d secudry al Me or her deaM7 .
4. Did decedent own an Intllvidual Retlrement Account, annuity, or other ncn•prabae property which ^
contains a Denefidary deeignetlon7 .............. .
..................
IF THE AN9WER 70 ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND Fe.E R AS PART OF THE RETURN
For dates of deatlt on or after July 1, 1994 end before January 1, 1995, the tax rate imposed on the net value d eanslers b a for the use d the suMMnp spouse
IS three (3) Percent 172 P.S. §9118 (a) (1.1) p)].
Far tlatee d death on or after January 1, 1995, the tax rate Imposed on the net value d trerMero to or for Na u69 d the auMvkrg epees b.aero (Dj percent
[72 P.S §911 B (a) (1.1) (9)]. Tha statute does. not exemM a trerre(er to a survivkrg spouse from hx, end the statutory roquirsmeMS for diacbsure d assets end
filing a tau return ere stls applicable ever N the euMving spouse le the anyr benefN,lery.
For dates of death on a after Juy 1,2000:
The tax rata Imposed on the net value of trensfers from a deceased child twoMy-one years d age or younger at death to or for uw d s nature) i>areM, an
adoptive parent, or a nteppsrant d the child Is aero (D) percent p2 P.S. §9118(a)(1.2)J.
Tha tax rate Imposed on the net value of transfers to or far the use d the decedent's lineal banelicleriea Is four end one-had (4.5) percent, except ae noted in
72 P.9. X9118(1.2) [72 P.9.§8118(0)(1)].
The tax refs impwetl on the net value d transfero to a la the use d the tlecedem's siblings is twelve (12) percent [/2 P.S. (i9115(a)(1.3)]. Asiding Mdefined,
under Sedion 9102, as an indivitlual who hoe at least one parent in common with me decedent, whether by bbod or adoptlan.
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REV•7603IX, (e-09)
COMMONWEALTH OF PE?SJSYLVANIA
INHERI~3T~ T~~R~RN
SCHEDULE B
STOCKS & BONDS
S A OF FILE NUMBER
,g~,yy~our ~,g~s $orae 21 08 065$
All Droparty Joindyownsd wlfh rISM o(survNorehlp mug W dbcbead on Schedule F.
ITEM VALUE AT OATS
NUMBER OE9a71PPON ~ OFiY111
1. 4,630Sharae
AT6T Inc. 176,5$4.80
held at Computershare Investor Services
2 129.603192 Shares
eriaon Communications, Ina. q~470,Y7
held at Coaputershare Investor Services
3 6 Shares
Idearc, Inc. 22.20
held at Computershare Investor Services
Hans o£ America Investment Services Account
d 19 Shares -
AK 9tea1 Holding Corp. 1,359.55
5 100 Shares
Varizon Communications, Inc. 3,675.00
6 1 Share
Fairpoint Communications, Inc. 13.69
7 5 Shares
Idearc, Ina. 18.50
BNY Mellon Shareowner Serviaea Account
8 2 Shares
Fairpoint Communications, Ino. 15.62.
9 214 Shares ~ -
Qwest Communisations International Ina. ~ 0.00
Dividend accrued on 6/11/200$ 929.83
10 91 $haree
Voda£one Group, PLC 2,711.30
_. TOTAL (Mw enter on IN~e 2, RenpiWlaGOn) S , on , ~, .,~
sw~eae Lsao (Ii more space M needed, insert additlonel eneets d the sere eme)
SCHEDULE E
connloNwEn~n+oF rENNSV~vaNin CASH, BANK DEPOSITS, 8 MISC.
INHERITANCE TA% RENRN
sn.ww i.wu In more cVwe n gym, McM1 atltltlpnsl ~hsMS dM~ ~Nna Nu)
REV-1611 Ek a (700x) __
SCHEDULE H
COMAONWEALTH OF PENNSYLVANIA
IISiFAITANCE TAx RETURN FUNERAL EXPENSES 8t
ADMINISTRATIVE COSTS
RET3IDENTDECtAbTlT
EBTATE OF FILE NUMBER
9evmour_Cvrua Sorae OS OESQ
Dsbb of dacsdsnt must bs repMbd on SelwduN 6
REM
MJMBER DESCRIPTION AMOUNT
A. FUNERAL E)Q'ENSES:
t, Sinai Memorials
coat of headstone 1,065.00
Total from aontinttation achedulea .
9,381.00
S. ADIVENISTRATNE CO3T3:
t. Personal Rapresentatlte's Cartsnlaslara
Name d Personal Represamatlve(s)
Street Address
Cm' Stets Zip
Year(s) Commksicn Paitl:
2. Attorney Fees
5,600.00
3. Family Eumptlon: (It tlecetlent'e edtlresa ie not the same as Gelment's, atmch eaplanatbn)
Claimant
Street Adtlresa
Cily Stam Lp
Relatbnshtp of Claimant to Decedent
4. Protl8haF9ea
372.00
5. Accoumm~t's Fees
8. 7as RatumPreparer's Fees
7.
1 Cumberland County RegiaWr of W111s
Cost to file PA Inheritance Tax Return and Inventory 30.00
2 MaNeea 9Tallaoa 8 Nuriak LLC
Coats 14.30
Total from continuation schedules 207,gg
TOTAL (AWo enter on line 9, letldn S 16 :669.79
~waeAO 1.00o Of more apace la needed, Maert edditlonel slmom d the same eFm) -
Eatate o£: Seymour Cyrua Sorge
Sohedula H Part 1 (Page 2)
Item
No. Description
2 Myers Harner Funeral Home
Funeral Expanse
3 Sinai Chapala
Funeral Service in New York
4 Mt. Hebron Cemetery
Funeral 8xpanse
Total (Carry Forward to main aahedule)
21 08 0658
Amount
585.00
8,651.00
165,00
.9,381.00 I
Estate of: Seymour Cyrus Sorge
Schedule H Part 7 (Page 2)
3 MaNeea Wallace 6 Nuriok LLC
Costs
4 McNees Wallaoa & Nuriok LLC
Costa
5 McNees Wallaoa A Nuriok LLC
Costs:
Legal Advartieing $ 178.00
postage Expense 8.01
Photocopy Expanse 7.60
Telephone Charges .60
Total (Carty lorMardto main sahadula)
21.08 0658
7..76
5.74
194.01
207.49
_.
................... .
.__
~'. REV-1618 E%~(18LO)
~I pennsyivania SCHEDULE I
i o®earnEnrroF REVEME DEBTS OF DECEDENT,
~°""'~'^"'gTei" MORTtiA(iE LIABILITIES & DENS
vFaoe+rolr~r
ESTATE OF FILE NUMBER
Seymour Cyrus Sorge 21 08 0658
Report debts Ineurrad by the tlecaMnt prior to deaM that remalnsd unpaid n tlla tla0a d dastll, InGudln9 unnNmburNd madkal sxpansss.
iiEM VALUE AT DATE
RyMBER DESCRIPTION OF DEATH
~• Mobile X-Ray Imaging
Medical 3ervicea Rendered 268.31
2 East Penn Ambulance Service
Meolieal Service Rendered ~ 96.00
3 Albert Pharmacy
Medical Expense '729.84
4 Messiah Village
Nursing Home Expanse 5,060.76
5 Country Meadows
Nursing Home Expense 4,409.00
6 Capital Area Health Assoc. ~ ~ -
Medical Services Rendered 749.09
ewaenM z.ooo If more apace le needed, insert eddMioltel ahee4 d the same elm.
REV-1519 YX~ (ii-08)
Pennsylvania
OQiY0A8R OF AAENUE
INNERRANCE TAX RETURN
RE91DENrDECEDEM
SCHEDULE J
BENEFICIARIES
~+ rue
. REIATIONSH~ 70 DECEDENT AMOUNT OR SHARE
N MBER NOME ANDAfH1RE530F PERSON(3)RECEIVING PROPERTY Do Not List TnnW(a) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outaOM apaael EWIIbulhla,and Ilanaala antler
Sac. 2718 (a) (1.2).]
1. Robert B. Younq
1102 Tiverton Road
Mechaniasburq, PA 17050
One Half of Residue: 118,304.18 Nephew 118,304.18
2 Richard 8orga Young
318 North Hickory Drive
Hear, DE 19701
One Half of Reaidue: 118,304.18 Nephew 118,304.18
3 Benjamin Barton
6 Timber r.a^e
Darien, CT 06620-2024
General Bequeata: 25,000.00 Son 25,000.00
ENTER DOOM AA10UN18 FOR D131PoBUIION98HOWNABOVE ON UNE81BTaiWOH 1 80E REV•1600 COVER BHEfT, AS APP ROPRIATE.
II NOtFTA%Aa.E DISTRIBUTONS:
ABPOUBAL DNRWBUTION8 UNOERSECTON 2119 FOR WHICH AN ELECTON TO TAX IS NOT TAKEN -
1.
B. CwWRABIEAND GOVERNMENTAL D18TRIBUTIONB
I. Bee Attached
TOTAL OF PART II-ENTERTOTAL NON-TAXABLE DISTWBUTIONS ON UNE 130E REV-1600 COVER SHEET. {~ 1 000.00
ewww z.wu .. ... _._ .-..-.... w,.~,o, m, w,ew~,a u~o erne sea.
Estate o£: Seymour Cyrus Sorge
Sahadule J Part 28 (Page 1)
I tam
No. Description
1 Cornell University, School of Veterinary Medicine
A. Bradford Carruth, Trust Of£iaar
130 Banana Straat, Sta. 400
Ithaca, NY 14850
Spacifio Cash Bequest 1,000.00
21 08 0658
Aaount
1,000.00
_..
.,
iP
LAST WILL AND TESTAMENT OF
Seymour Cynn Burgs
and dlspoai~ng m~gldr a d me~s~ A nrsident of Las Vapae, Garlcc County, Nevada, being of sound
marrbd or a member of ths~ d forces t ~Ur~ StaOes or a) mbar of an auxRlary of~t~
armed foroas of the UMted State w a member of the rrtarlRms saute of the Unlrod States, and
not being aclwtW by arty durosa, menace, fraud, mistake, w undue IMlusnoe, do make, publlah,
and declare ih(a to be my Isst WUL hereby expn»sy revoking all Wine and Codidts prevlouaty
made by ma.
I. EXECUTOR: 1 appdnt Rdttsrt F. Yaun®, t5aquire, of Hanisburg, Pennsylvania, Zo serve as
Executor of this my Last WE and Testament and provide H this Execraor is unable or unwRRng to
serve then 4 avpoMt Rkhard S. Young of tvHddatoertr, l>elawaro as ensnare Executor. My
Executor she be authwlaW to carry out all provietona o} ihts WIR and pay my Just debts,
oblpetions and funeral expenses.
II. 81MULTANEOU8 DEATH OF BENEFICIARY: If any berrefldaty of this W8, including any
dktribWbn oT amytysatate, Ih~ d~cfaro thatRl ahe~ 6e drnedOW hWave wnivad such person, a
III. BEQUESTS:
I will, give, and bequeath umo the parsons named below, if ha or she survives me, the property
deecribed below:
Name: Camep University, School of Veterinary Medicine
Adtlroas; Ithaca, NY
RelanonaMp: none (My poodle Rutry was treated by them many years ago)
Property: One Thousand Dollars (51,000.00)
Name: Benjamin "Samey' Batton
Address: Darien, Connecticut
Relationanip: son
Properly: Twenty-flue Tnousand Dollars (525, 000.00)
If a named ttenaflckry m this WU! predscesea me, Ms bequest to such person shall lapse, antl
the property shall pass under the other provlebns of thk WRI, H 1 do.not powsss w own any
property listed above on tlra date of my death, the bequest of that property shag lapse.
N. ALL REMAtNINO PROPERTY; RESIDUARY CLAUSE: I give, devise, end bequeath all ~
the roar, residua, and remainder of my sabers, a whatever klrM and character. and wherever
bated, equaly to my neptsawa Robert Frank Young of HaRisblrrg, PenneyNanta and Richard ,~
Sorge Yourg Of Mkldlelown, Oelavrara, provided that ore or both survives me. If neither survives
me, than I gNe, devise, and tequeath art of the rest, residua, and romaintlsr W my eslete, of
whatever kind and character, and wherever loafed, equally to the estates of Robert Fronk Young
and Richard Sorge Young as alternate.
V. ADDI17061AL POYYERS OF THE EXECUTOR: My Executor ahaR have rite folic
addl6onel powers with tespeot to my estate, (0 be exeroissd from tkne 10 lime at my
dlacroeon without further Cx:enee w order of any rbrtrt
,:
it
VI. WAIVER OF BOND, INVENTORY, ACCOUNTING, REPORTING AND
APPROVAL: My Executor aad alternate Exavtor shall servo without aay bond, and I
heroby waive tho necessity of preparing or flung arty iaveWwy, accounting, appraisal,
reporting, approvals or Coral appraisement of my estate. I direst that no expert appraisal be
made of ray estate anlesa required by law.
VII. OPTIONAL PROVI3ION3: I have plaid my initials aext to the provisions
below that i adopt as part of tbia Will. Any umnarkad provision is not adopted by mo and
is not a part of this WiU.
nahdary bo this 1MII is indebted to me at the dms of my death, and the
trenaflciary evidenose ttds debt by a vNld Promissory Note payable to ms, then such '
/,~_~pemo~'s portion of my estate shall be dimiMshed bi' the amount of such debt.
~Rny and all debts of my estate shall fast be pall trom my roslduary estate. A~ry+ debts
on any teal Property bequeathed pr this VVIB shall be assumed bf the person to reeelve
real properly and not paid by my Executor.
1 desire to be buried in the Mount Hebron cemetery in Flushing, New York.
VIII. CONSTRUCTWN: Tha term YestaMr' es uad In thle WYI Is cleaned to Include me as
Tastabr w Testatrix. The pronouns used in thk W81 slwdl IncIW e, where appropriate, either
gender or troth, singular and plural.
IX. SEVERABILITY AND 8URVNAL: If any part o/ thle 1Nf11 is deolered im~alid, Illegal, w
inopsrethro for erry txaaon, tt is my intent that the remaining garb shad ba effective and tuNy
operative, arrd that any Court SD interpreting this 1MII and any provision in h eonstrue in favor of
survival.
IN WITNF.Bti WHEREOF, I, Seymour Cyrus Sorg , by sat my hand to Chia last Witt, on each
Page of whkh I have plsoed my Inltlab, on drn~ day of January, 2007 at 2121 East
Charlestown Rd., Las Vegas, Claris County, S o vede.
f~;~--
21~East Ch~artea~WHms
Lea Vegas. Nevada
,~
V
o,a;efator
and the witnesses rsspecttvey, whose names are aipned to tnstrume in tltoN
hereby dad~ueu dsralynaC~euthoriHuund~l~ensib ~ Wdury dtat~ths t~sstator dedared,o
71yMd, and executed tM kuttrumsnt u Msrher Isst wiM; tielahs sgned ft wilripy or wlllhtyly
directed ano8>ar to slyn for himfier; hehche execu0ed k as hklMr hea and vduntary act for die
purposes thereh expresesd; end each ~ tl» wMrtasea, ~ dw request of the ts~stor, M hk or her
hearing and preeencs, and in the pressrge d each oUbr, efyned the wit as vNtnees and that to
the tot hk W hM knowledge the testator wee atthat tlme elyhteen (18) yeeta of aye os older.
and nkW d uMlet no catstrsint or undue Influence.
~SipMture of Testator[
~ ntsd or typetl name of Testator)
Wdress otTeatator, Line 7]
lddress oT Testator, fins 2]
>igMhx'e of Wilnesa It ]
'rkttw or typed name of Witness #1 [
Wdress of Weneas st, LiM 1]
mdrees of Witness 1N, UM 2)
~-
,~..~ •r~c.J [spMture of Witness *2j
~...,,.r ,ex ,~ ]Pdnkd or typal Mme W Wllnesa #Zl
[AddrMS or Wltnas rz, une ~]
J Q~ ~ oa.- (Address o} Witnaaa 82, L'pte 2]
,u'Ot~P'== (Signature of uYilnaes Osj
~rrrff [Printed or typed name of Witness it3]
[Addroas o} WNnessl3, Line 1j
[Address of Witness tl"3, Llns 2]
tiubacritred, sworn, and adcnow before me,
Q¢Nt~ ~ R/l6rV . a notary Pubtl0. 6
.,~ 67[ee. the testator, and y
and
1M witnesses, this
(NOTARIAL3FALj < [ifit)rEE.At19JJR, o
M'Mf097iiss /(~jJ_~
`-~~, +•~a t 152007 ~~I'"
nekl
county of
My commission Expurs:
~'
~r
tMT1VE8SE8
The foregoing instrument, Conaletlttg of ~ pages, Including Mis page, was afpned in our
proaencs by Seymour Cyrus Sorge and declared by trim b ba hk kst WW. We, at the roquast
end in the presence of him end In the presence of each other, have subscribed our names trelaN
as witnesses. We dedsro that we aro of sound mintl and of the proper ape b witness a wiN, that
b the best of our knoarbdga the testator is of the age ~ maJwiry, w ie othervdea kpaMy
competent b make a wM, and eppearo of sound mind end urKbr no undue IrMuartar w
Under panalry of perjury, we dschre these statemsnm are true and cwrad on this ~r _ day
of January, 2007 at 2121 Fast Charleston, Lae Vegas, Chtk County, f3late of Nevada.
e Of Witness #1]
~r typed name of Witness #1j
of Witness fit, Line 1J
of Witness #1, Lure 2j
a ~~
`"~'`jSw~''~~-4-~'~';~.~L'~-~ [f3ignatureofWftneas#2j
,CJn,,l.diE f': rc~'Cr [Prnted w typed frame of Witness ttzJ
~/?~ W Cflpr..V~Tu.~, rs~_ [Address of Witness #Z, Line 1j
l..a's ~ A~ ,~ ~ / X9/0 7..- [Address of Witneaa #2, Line zJ
~//
~~"" ' . [Signature of Witdrteas #sJ
c c N hl~ a S d vrJ [Printed or typed name of Wiolesa #3j
f r r Zf rse 4 (Address of Witness #3, une 1J
ji,4 !b L '1 U1t~ ~ ~ ~' ~ (Addros6 of Witness #3, Line 2j
(Nob: The araY iwxtaNow k,wr a Cart ol~nlMpaya anE~ b~ ~ a~n~allono~
purpoNa ony, You ahouW not InoAata a
p Ynr M ma NebWl•)
About this Self-Proving Affidavit Form: AlOwuph a 3elf•Pro+ring AfiWavit is not a requirement
in Me State of Nevada, it is an axca/Mnt Itlse b sign one when exapltfng s WiU. It can greatly
reduar the difflWlty assoolaled with probating the WIII wltsn the time comes. The testator, along
with three wlbresNS, must sign the AffidavR together in Me preaenar of a nopry puDltc. The
Affidavit b then attached to the Wa. Its D»ic purpgss fs to efBnn Mat me Wig Is that of the
testator and Mat Ms will was signed and wlMesssd In acrzrdanar wlM all applicable elate
requlromanta
To make a self-proving 1MI1, a teitatw should toflow this proceduro: (t j The testator should ~"'
sign the WAl in the proeenar Of Me witnesses and have tiro wllneiaea sign as well: (2)A notary
Wdk should be present ettha time the WIII is signed DY Me.tesasbr, topstlter wMh a71 the
wlMnacrue- f;{1 Thn haefwfnr ^hrxriA nmvNq fhw Monk Rn1f.Prrnrinn AMMrve Mrm hMrnw M Mn :.., ,
• _ __ _ __
COMMONWEALTH OF PENNSYLVANIA
March 19, 2009
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG, PA 17128-0601
Telephoire
David E Gruver
100 Plne Street
P O t3ox 1186
Harrisburg, Pa 17108
717 783.8893
Fax 717 772-D412
Re: Estate of Seymour Cyrus Sorge
File Number 2105-0853
Dear David Gruver:
This is in response to your letter of March 3, 2009 concerning the Inheritance lax return
due in the above referenced estate.
Since ft is apparent that you will be unable to file a tax return In the near future, the
estate record will be pieced in an informal hold status for an additbnal period of six (8) months
so that the department will initiate no enforcement activity. At the end of that period we would
ask that you contact us to provide an updated statue for our fde. The return may be flied at any
time during the informal hold period.
Kindly note that this action will avoid the imposition of a penalty for failure to make e
timely return. However, it does not prevent Interest from accruing on any tsx remalMng unpaid
after the delinquent date.
Thank you for your cooperation, and, if I may be of any further assistance, please feel
free to contact my office.
ncarely, (~
''"., \
Laurel Fulmer
Supervisor
Inheritance Tax Division
Ifu lmert~state. pa. us