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HomeMy WebLinkAbout03-0232REV-1500 EX + (6-00) CAPB HpRL EpIo CRAC voTK " ES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. Z80601 HARRISBURG, PA 171Z8-0601 Co" REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Crib Mary DATE OF BIRTH (MM-DD-YEAR) DATE OF DEATH (MM-DD-YEAR) 07/19/2002 08/29/1905 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 2t COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 171-28-2439 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS  1. OriginaIReturn 2. SupplementaIReturn 4. Limited Estate 4a. Future Interest Compromise (date of death after 1Z- 1Z-8Z) 6. Decedent Died Testate 7, Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) ~'~g, Litigation Proceeds Received L....J 10, Spousal Poverty Credit (date of death between 1Z-31-91 and 1-1-95) SOCIAL SECURITY NUMBER  (date of death 3. Remainder Return priorto 1Z-13-8Z) 5, Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes r--] 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME COMPLETE MAILING ADDRESS James D. Bo~ar Esquire FI RM NAM E (If Applicable) TELEPHONE NUMBER 717,/737-8761 One West Main Street Shiremanstown.,- PA 17011 2. 3. 4. R 5. E C A 6. P I T U 7. L A T 8. I O 9. N 10. 13. 14. C O M T I O N Real Estate (Schedule A) (1) Stocks and Bonds (Schedule B) (Z) Closely Held Corporation, Partnership or (3) Sole-Proprietorship Mortgages & Notes Receivable (Schedule D) (4) Cash, Bank Deposits & Miscellaneous Personal Proper'q/ (5) (Schedule E) Jointly Owned Property (Schedule F) (6) ~ Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) None None None None None 1,434.40 14,134.05 2,859.29 2,282.29 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) OFFICIAL USE ONLY (8) 15,568.45 5r141.58 (11) (lZ) (13) 10,426.87 (14) 10,426.87 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) x .0 0 16. Amount of Line 14 taxable at lineal rate 10,426.87 X .0 45 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 (15) 0,00 (16) 469.21 (17) 0.00 (15). 0.00 (19) 469.21 Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 120 South Filbert Street CITY Mechanicsbur5 STATE ?A ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C ) (2) 469.21 0.00 3. Interest/Penalty if applicable 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. Check box on Page 1 Line 20 to recluest a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 469.21 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 469.21 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? ................... Z. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ [] [] 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? ................................ r~ [~] 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 RETUR. Emma J. Kazor DATE 618 N. 2nd Street - 'SIGN'ATIJJREOFFREP~:~EF[OTH~THANREPRESENTATIVE/ // James D. Bogar Esquire ~A-~---- ~/ / '~/~- One West Main Street surviving spouse is 3% [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 0% [72 P.S. 9116 (a) (1.1) (ii)l 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 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 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(aX1)]. 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. 9116(aX1.3)]. 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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV- 1509 EX · (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Grib SS# 171-28-2439 SCHEDULE F JOINTLY-OWNED PROPERTY 07/19/2002 FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A.Emma J. Kazor Daughter Co 618 North 2nd St. Wormleysburg, PA 17043 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH include name of financial Institution and bank DATE OF DEATH DECD'S VALUE OF ITEM FOR JOINT MADE account number orsimllarldentl~ing number. NUMBER TENANT JOINT Attach deed forjointly-held realestate. VALUE OF ASSET INTEREST DECEDENT'S INTERE~ 1 A 10/04/88 Members 1st Federal Credit 25.35 50.00% 12.68 Union - Regular Savings Account No. 55822-00, date of death balance $25.35, accrued interest 0.00. 2 A 10/04/88 Members 1st Federal Credit 2,843.43 50.00% 1,421.72 Union - Checking Account No. 55822-11, date of death balance $2,843.43, accrued interest 0.00. TOTAL(AlsoenteronlineB, Recapitulation) $ 1,434.40 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) Membersl FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1151 REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Created CHECKING ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Created 55822 -00 10/04/1988 $25.35 $.oo $25.35 Emma J. Kazor 10/04/1988 55822 -11 10/04/1988 $2,843.43 $.oo $2,843.43 Emma J. Kazor 10/04/1988 fv~MBERS 1sT.FED~REDIT Denise A. Anders Insurance Products Supervisor November 6, 2002 UNION Estate of: MARY GRIB Date of Death: 07/19/2002 Social Security Number: 171-28-2439 REV-lSd0 EX COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Crib SS# 171-28-2439 SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPER'IT 07/19/2002 FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is ),es. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THETRANSFEREE. THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER, NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABL~ 1 Real Estate - Ail those 28,268.10 50.00~ 14,134.05 certain two pieces or parcels of real estate, being Lot Nos. 29 and 37, having erected thereon a dwelling house being known and numbered as R.D.#3, Atlantic Plan of Lots, Derry Township, Westmoreland County. The Decedent's interest in said real estate is more fully set forth in the Deed dated September 23, 1963 and recorded in the Westmoreland County Recorder of Deeds Office in Deed Volume 1869, Page 28, a copy of which is attached hereto and incorporated herein. By virtue of said Deed, the Decedent herein acquired her interest in said real estate as a joint tenant with the right or incident of survivorship, and not as a tenant in common. By Deed dated November 10, 1976, said Deed being recorded in the Westmoreland County Recorder of Deeds Office in Deed Volume 2233, Page 934, a copy of which is attached hereto and incorporated herein, Mary Grib, the Decedent herein, conveyed her interest in the within described real estate to Emma Jane Kazor, her daughter. Attached hereto is a copy of the August 5, 2002 letter forwarded to Emma Jane Kazor from Charles W. Watson, Esquire. In said 0.00 TOTAL(Alsoenteronline7, Recapitulation) $ 14,134.05 (If more space is needed, insert additional sheets of the same s~.e) Estate of: Mary Grib Soc Sec #: 171-28-2439 Date of Death: 07/19/2002 Continuation of Schedule G (Inter-Vivos Transfers & Misc. Non-Probate Property) Item Description of Property Date of Death ~ Decd Value of Asset Intrst Taxable Value letter, Mr. Watson advises that, based upon his review of the pertient records at the Westmoreland County Courthouse, that by virtue of the above-referred to November 10, 1976 Deed, whereby Mary Grib conveyed her one-half (1/2) interest in said real estate to Emma Jane Kazor, Emma Jane Kazor became the owner of an undivided one-half (1/2) interest in said property as tenants in common with Elizabeth Blatnik and Frank Anthony Blatnik, husband and wife. Given that Mary Grib reserved to herself a life estate in and to her interests in said real estate, one-half (1/2) of the date of death value of the within described real estate is subject to the payment of Pennsylvania Inheritance Taxes. Tax Parcel Nos. of Real Estate: 45-29-12-0-027 and 45-29-12-0-034 The Westmoreland County Assessed Value multiplied by the Common Level Ratio Factor of 4.41 was utilized in determining valuation. The calculations for the valuations are as follows: Parcel No. 45-29-12-0-027 - $5,910.00 x 4.41 z $26,063.10; Parcel No. 45-29-12-0-034 - $500.00 x 4.41 - $2,205.00. MADE THE Z3rd day of September of our Lord one thousand, nine hundred Sixty-three (1963). in the year BETWEEN MARY CRIB, widow, of the Township of Derry, County of West- moreland and State of Pennsylvania, party of the first part, A N D MARY GRIB, widow, and ELIZABETH BLATNIK and FRANK ANTHONY BLATNIK, her husband, all of the Township of Derry, County of Westmoreland and State of Pennsylvania, as joint tenants with the right or incident of survivor- ship, and not as tenants in common, parties of the .,,cond part. WITNESSETH, that the said party of the first part, for and in consider- ation o/ the sum of One ($1.00) ............................................. ................................................................. -Dollars, la~t,f~d money of the United States of America unto them ?t'ell and truly paid by the said part ies of the second part, at and before the sealing a~d :lzlivery o/ these prescnls, thc receipt whereof is hereby acknowledged, has ~lranted, bargained, so/d. aliencd, e~tfeoffed, released, co~veyed and confirmed, ami by these presents does grant, bargain, sell. alien, enfeoff, release, convey and confirm unto the said parties of the second part. their heirs, and assigns in joint tenancy with the right or incident of survivorship, and not in tenancy in common. ALL those ceztain pieces or parcels of land situate in Derry Township, West- moreland County, Pennsylvania and being known and designated as Lot No. 29 and Lot No. 37 in Atlantic Plan of Lots laid out by Morris Ramsay, Engineer, July 31, 1945 and which said plan is recorded in the Recorder's Office of Westmoreland County in Plan Book 6 Pages 126 and 127, and separately bounded and described as folows, to wit: FIRST: Lot No. 29 - Beginning at a point on the Southerly side of Second Street where this lot corners with Lot No. 28 in said plan; thence along said Second Street on a course North 71° 00' East a distance of 67.20 feet to Lot No. 30' thence along the dividing line between Lots Nos. 29 and 30 on a course South 19© 00' East a dis- tance of 100.20 feet to an alley; thence along said alley on a course South 71° 00' West a distance of 67. 20 feet to Lot No. Z8~ thence along the dividing line between Lots Nos. 28 and 29 on a course North 19© 00' West, a distance of 100.20 feet to Second Street, the place of beginning. Having thereon erected a two-story frame dwelling house. SECOND: Lot No. 37- Beginning at a Point on the Northerly side of Third Street where this lot corners with Lot No. 38 in said plan; thence along said Northerly side of Third Street on a course South 71© 00' West a distance of 71.90 feet to Lot No. 36; thence along the dividing line between Lots Nos. 36 and 37 on a course North 19° 00~ West a distance of 284.80 feet to an alley; thence along said alley on a course North 71© 00' East a distance of 71.90 feet to Lot No. :]8; thence along the dividing line between Lots Nos. 37 and 38 on a course South 19© 00' East a distance of 284.80 feet to the place of beginning. No improvements. Excepting and reserving thereout and therefrom all the stone coal, together with the mining rights as heretofore conveyed by a predecessor in title. Also, excepting and reserving out of and from the said lots above described water lines, and power lines now installed in said plan of lots, with the right of ingress, egress and regress for the purpose of inspecting, repairing and re- newing the same. BEING the same premises granted and conveyed to Michael Grib and Mary GrAb, his wife, by deed of Atlantic Crushed Coke Company, dated the 5th of October, 1945 and recorded in Westmoreland County, Pennsylvania in Deed Book Volume 1208, l~age 99. Michael GrAb, having died and departed this life on August Z1, ;946, a complete fee simple title and estate in and to the withing described premises became vested, at his death, in Mary GrAb, party of the first part herein, the survivor of the tenancy by the entireties. The purpose of this conveyance is to create and establish in Mary GrAb and her daughter, Elizabeth Blatnik and the latter's husband, Frank Anthony Blatnik, a joint tenancy in the within described premises with the right or incident of survivorship, and not a tenancy in common. vo.:. 1869 PACE C'<:~ 7'OGETIIER with all and singular, the said property/, improvemcnt~, way:~, wulcrs, cobh'scs, rights, liberties, privileges, heredita~ents and appz~rte~mn~'cs v'hotso~.'cr i].:rc,u~, longing, or in anyw~e appertaining, and the reversions and remai~zdcrs, ~ ents, issuc.~' omi thereof, and all the estate, r~ght, title, interest, pro~rty, claim aud dcma~d wh.t,~o~.~cr, vi tb~ part y o~ the first part, i~ law, equity or otherwise howsoever, of, in a?~d ~o ff~c ~amv every part thereof, TO HAVE AND TO HOLD the said property, the hereditaments and premises hereby granted or mentioned, and intended so to be, with the nonces, unto the said part ie6 of the second part, their heirs and (~..~'ig~s, to and [or the only proper use and behoof o[ the said part ies of the seco?Td part, their heirs and assigns/orever~ in joint tenancy with the right or incident of survivorship and not in ~nancy in common. AND the said part y of the first part, for herself, her heirs, e.~ecutors and administrators, do es by these presents covenant, grant and agree to a?~d with the said part ie6 of the second part, their heirs and assigns, that they the said part y of the first part, and her' heirs, all and si~zgular thc hel'edita- ments and premises herein above described a~d granted or mentioned, a?~_d inte~ded so to be, with the app~rtenances, unto the said part ies of the second part, their heirs a~d oss~g.s against her the said part y of the first part and her heirs, and agai~tst all and every other person or persons whomsoever lawfully claiming, or to claim thc same or ~tny part tkereof shall and will warrant a~d /orcver defend. IN WITNESS WHEt~EOF, the said part y of the first part ha $ to ghe,~c prcsc?~f.~ her ha~ a~ seal Dat~ the day and year first above w~itten. THIS DOCU. ME.N'T .]£dlI* ,MOT SELL, CO.~'I'EI; TR. 4.~SFER, L~'CI. UI)E (]R l.~q'l'l,'E TIlE T[TL~ TO THE CO~L .4~'D RIGHT OF SUPPORT [5~'DER,~'E. 4TH TIlE NI*L'I.~ I('k' L./.~'/~ DESCRIBED OR REFERRED TO HERELY. ,4.a~D THE OI[2,~*ER 01; ~II]VEI,'S iq.' ,~'i'r'// C(ZtL .,~[,dI' H~I'E THE CriJIPLETE LEG, iL RIGHT TO 1,'E,MOI'E ,4LL ~F ,~'~'r'lt ~vt. ~'D, I~ TH~T CO.M~'ECTItLF, D.d~,,4GE JL4I* RESULT TO TItE S~ViEgCE ~)I.' TIlE k, J~'D ~'~ HOUSE, BUILDL~G OR ~)THER STllUCTU]?E O.,V OR ~.V SUCH J..L~7). . . ~ ~RY GRIB ~ ll'it~ess~ State o~ PENNSYLVANIA 83. County of WESTMORELAND On tMs, the Z3rd ~y of September the umlersigned offi~r, perso~mlly appeared Mary Grib, widow, ,19 , before me : known to vie (or satisfactorily proven) to be the person~ whose name is subscribed to the with- in instrument, and acknowledged that she executed same for the purposes therein contained. I'u witness whereof, I hereunto set my hand and official seal. State of County of On this, the the undersigned officer, personally appeared known to ?ne (or satisfactorily proven) to be the person whose name subscribed to the with- in instramc,nt, and acknowledged that executed same for the purposes therein contained. In witness whereof, I hereunto set my ha?zd and official seal. .................................................................................... (SEAL) Title of Officer. We do hereby certify that the p?'ecise residence of the within named grantee is Township of Derry, Coanty of Wsstmoreland and St~t~ of Pennsylvania. P.O. Address: Box 3, New Derry, Pennsylvania. (Atlantic ~ 2)/)f~'-' Se tember ~3 19 ........... ~.-....),.,..~..,?Q-.~ .- p a , o, Of ~'~d~;'"~'"~'~'i~'~ .............. y' ................. Attorne~ for '' } COMMO2~ It EALTH OF PENNSYLVANIA ~ . Westmoreland ss. ~'oanty o! ........................................................................................... RECORDED on this .................... 3..Q.~...h. .............. day of ............. ~?.t~..~.. ................... A. D. 19.6...~......, in the Recorder's Office of said County, in Deed Book Vol .......... .~.~6.? .............. Page ............ .~.8.._ ..................... Given under my hand a,nd~e seal of th~'to4'd offiee, the date above ............ ........................................ :.....:./..'... .................................... Recorder. 201-AT--Warranty Deer[ Short Form, Act of 1909. Henry Ha , nc., nd aha, Pa. of our Lord o~e thousand nin~ hundred and seventy-six (1976) in the yewr BETWEEN MARY GRIB, an unremarried widow, of R. D. #1, Box 59, Derry, Westmoreland County, Pennsylvania, EMMA JANE KAZOR, daughter of the Grantor herein, of Wormleysburg, C~%~,)~ County, Pennsylvania, Grantee WITNESSETH. that ~ consideration o/ One and 00/100 ($1.00) Dolla ~, ~ ha?~d p~d, the recent where& ~ hereby ack~wIedge~ the s~d grantor d~s hereby g~nt and ~nvey ~ ~e said grantee , ALL the undivided one-half interest in those certain pieces or parcels of land situate in Derry Township, Westmoreland County, Pennsylvania, and being known and designated as Lot No. 29 and Lot No. 37 in Atlantic Plan of Lots laid out by Morris Ramsay, Engineer, July 31, 1945, and which said Plan is recorded in the Recorder's Office of Westmoreland County, in Plan Book 6, Pages 126 and 127, and separately bounded and described as follows, to-wit: FIRST: Lot No. 29- BEGINNING at a point on the southerly side of Second Street where this lot corners with Lot No. 28 in said plan; thence along said Second Street on a course North 71 degrees 00 minutes East a distance of 67.20 feet to Lot No. 30; thence along the dividing line between Lots Nos. 29 and 30 on a course South 19 degrees 00 minutes East a distance of 100.20 feet to an alley; thence along said alley on a course South 71 degrees 00 minutes West a distance of 67.20 feet to Lot No. 28; thence along the dividing line between Lots Nos. 28 and 29 on a course North 19 degrees 00 minutes West, a distance of 100.20~ feet to Second Street, the place of beginning. Having thereon erected a two-story frame dwelling house. SECOND: Lot No. 37- BEGINNING at a point on the northerly side of Third Street where this lot corners with Lot No. 38 in said plan; thence along said northerly side of Third Street on a course South 71 degrees 00 minutes West a ~istance of 71.90 feet to Lot No. 36; thence along the dividing line between Lots Nos. 36 and 37 on a course North 19 degrees 00 minutes West a distance of 284.80 feet to an alley; thence along said alley on a course North 71 degrees 00 minutes East a distance of 71.90 feet to Lot No. 38; thence along the dividing line between Lots Nos. 37 and 38 on a course South 19 degrees 00 minutes East a distance of 284.80 feet to the place of beginning. No ~mprovememts. EXCEPTING AND RESERVING thereout and therefrom all the stone coal, together with the mining rights as heretofore conveyed by a predecessor in title. AND the said grantor hereby covenants and agrees that generally the property hereby conveyed. she will warrant Pursuant to the Act of July 17, 1957, P. L. 984, as amended, and for no other purpose, the following paragraph is made a part hereof: THIS DOCUMENT MAY NOT SELL, CONVEY, TP~NSFER, INCLUDE OR INSURE THE TITLE TO THE COAL AND RIGHT OF SUPPORT UNDERNEATH THE SUP~ACE LAND DE- SCRIBED OR REFERRED TO HEREIN, AND THE OWNER OR OWNERS OF SUCH COAL MAY HAVE THE COMPLETE LEGAL RIGHT TO REMOVE ALL OF SUCH COAL, AND, IN THAT CONNECTION, DAMAGE MAY RESULT TO THE SURFACE OF THE LAND AND ANY HOUSE, BUILDING OR OTHER STRUCTURE ON OR IN SUCH LAND. THE INCLUSION OF THIS NOTICE DOES NOT ENLARGE, RESTRICT OR MODIFY ANY LEGAL RIGIITS OR ESTATES OTHERWISE CREATED, TRANSFERRED, EXCEPTED OR RESERVED BY TttIS INSTRUMENT. 'IN WITNESS WHEREOF, said grantor the day and year first above written. has hereunto sst her hand~ a~td seals .................... THE i:i~LC~, C RESIDEI~CE OF WITHIN GRANTEE IS State o! Pennsylvania County o/ ~ ~ ss. On this, the / day of November , 1976 , before me, the undersigned officer, personally appeared MARY GRIB, an unremarried widow, known to me (or satisfactorily proven) to be the person whose ~me i s s~,bseribed to the within instrument, and acknowled~;ed that s he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. / .... : .... /,,] ,.. .......... M~ c...,,,m. [.,,,,, M.y ~4. ,~?, Title of ALSO Excepting and reserving out of and from the said lots above described water lines and power lines now installed in said plan of lots, with the right of ingress, egress and regress for the purpose of inspecting, re- pairing and renewing the same. ALSO excepting and reserving unto the Grantor herein a life estate for and during the term of her natural life, in and to the premises herein conveyed. BEING the same premises which Mary Grib, the same person as the grantor herein, conveyed unto herself and Elizabeth Blatnik and Frank Anthony Blatnik, husband and wife, by her deed dated September 23, 1963, which Deed is of record in the Recorder of Deeds of Westmoreland County, Pennsylvania in Deed Book Volume 1869, Page 28. The purpose of this conveyance is to convey the one-half undivided interest of the grantor to the grantee herein, and to thereby establish a tenancy in common between the grantee herein and the aforesaid Frank Anthony Blatnik, surviving husband of the said Elizabeth Blatnik, deceased. N 0 TI C E: Grantee (hereinaf/er. one or more. called "Grantee"} hereby states that he krlows th~l he may not b~ obtaining the righ~ o[ p~ot,~ction fij~ainst subsidence resulting from coal hm.n~; o~c.'aho~s and that the purchased property sidence by $ prJvale contracl with the o,.vners of c~.'liti,}~ th,~t th,~ ce~ [JJJcgtJGi1 j3 iH d c.;ior contrasting l~'.elve Foim lyl;e pJeceded by the ~a[d "llotic~,~ p~iilk~d A11 twellly, four ~oilit ....... , County o[ On this, the day of the undersigned officer, personally appeared , 19 , before me, l~zown to ~ne (or satisfaeto~'ily proven) to be the person whose ~lame subscribed to the within instm~ment, amd acknowledged that he executed the same for the pu?7~oses therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Title of Officer. of the within named grantee is ~ hereby eertify thatthe preeiseresideneeandoompletepostoffic~address 618 North Second Street, Wormleysburg, PA 17043. ........... : ~. ~ ............. ~5 . Charles W. Watson A tto~ ior COMMONWEALTH OF PENNSYLVANIA, ~qestmorel~nd I' ss. County of ........................................ RECORDED on this ........ .2_.9_%._h_... day o/ ..... .N_C!E. .................................... A. D. 19.7..6.. .... in the Reeorde'Fs Office of said County, in Deed Book ............ 37.2L Page ..... ..... .... WATSON U il)ORFF RO01(5 SEPI¢ LAW Charles W. Watson, J.D. c-watson@wmblaw, com Gretchen A. Mundorff, .I.D. mundorff~wmbiaw, com Mark D. Brooks, J.D. mbrooks@wmblaw, com August 5, 2002 Douglas S. Sepic, J.D. dsepic@wrnblaw, com MRS EMMA JANE KAZOR 618 NORTH SECOND STREET WORMLEYSBURG PA 17043 Dear Mrs. Kazor: In Re: Mary Grib, Deceased Our File No. 66221 I have reviewed all of the documents which ),our daughter, Beth, recently sent to ~ne. As I assume you are aware, your mother, Mary Grib, initially deeded tine property on September 23, 1963 to herself and to Elizabeth and Frank Blatnik. This deed established co- ownership and provided that if any of the parties' died, the surviving parties would own the property. In response to your mother's instructions, we prepared a deed on November 10, 1976 whereby your mother conveyed her one-half (1/2) interest in tine property to you. The result of this deed is that you owned an undivided one-half (1/2) interest in the property together with Mr. and Mrs. Blatnik. This deed established a tenancy in common. This means that if you would have died, your one-half (1/2) interest in the property passes to your heirs, and if the Blatniks' die, their one-half (1/2) interest in tine property will pass to their heirs. Your mother did reserve to herself' a life estate in and to her interest in the property. This means that during the term of her life, she reserves an interest in an undivided one-half (1/2) portion of the property. It is my understanding that you have retained an attorney to represent the Estate of your mother. That attorney, I am certain, is in the process of accumulating information to file an appropriate Inheritance Tax Return. Although the Estate of your mother has no legal interest in this property since it would have terminated upon her death, we believe that the one-half (1/2) interest is subject to Pennsylvania Inheritance Taxes. I am certain tine attorney representing the Estate will discuss this matter with you and will make arrangements to pay the appropriate inheritance taxes. Mrs. Emma Jane Kazor August 5, 2002 Page 2 The other documents which you sent to me relate to a utility easement which was recently placed against the property. The scope of the easement is shown by the survey plat which you sent to me. The check which your mother received represents the condemning authority's estimate of the harm to the property caused by the ease~nent. Basically, your mother is entitled to the difference in the value of the property of its worth prior to the easement as compared to the worth after the easement. If there is a decrease in value, your mother is entitled to receive compensation for her loss. I have no way of assessing whether or n-.~ the payment receive~ by your :n,~tber is fair and equitable. If she h~.!'.'e:,es that her damages are in excess of the amount of ~noney received, she should retain counsel and appraisers to pursue her interests. As a result, I assume you do not wish for me to take fi~rther action in the matter. During our telephone conversation, you indicated that you believed that some legal work must occur in Westmoreland County to perfect your mother's interest in the property. As I have explained, it is unnecessary. The estate attorney will report the property interest on the Inheritance Tax Return filed in connection with your mother's estate and resolve that issue. Thank you for giving us the opportunity to review this matter. I have enclosed our Invoice for our services. CWW:cm Enc. Very truly yours, l.&_.(.., 6',/,';.,",?. "'"'"--' Charles W. Watsou REV- 1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Grib SS# 171-28-2439 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 07/19/2002 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION FILE NUMBER 1 2 3 4 FUNERAL EXPENSES: Patriot News Co. Pealer' s Flowers Shaffer Memorials St. Mary's Byzantine Funeral Notice Funeral Arrangement Monument Lettering Church - Funeral Luncheon ADMINISTRATIVE COSTS: 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: Attorney's Fees James D. Bogar Esquire 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 Probate Fees Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Charles W. Watson, Esquire - Real Estate Opinion 79.20 203.41 150.00 301.68 TOTAL (Also enter on line 9, Recapitulation) 2,85 9.29 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc, Form REV-1511 EX (Rev. 1-97) 125.00 250.00 RESERVES: Costs to conclude administration of Estate including filing fee for PA Inheritance Tax Return and related expenses AMOUNT 1,750.00 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Grib SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SS# 171-28-2439 07/19/2002 FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 Howard Roy Cohen, M.D. Medical-final illness Pinnacle Health Hospitals - Medical-Final Illness Pinnacle Health Hospitals Medical-Final Illness 40.62 1,956.82 284.85 TOTAL (Also enter on line 10, Recapitulation) $ 2,282.29 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-151Z EX (Rev. 1-97) REV-1513 EX + (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Grib SS~/ 171-28-2439 07/19/2002 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and FILE NUMBER II. transfers under Sec. 9116~1.Z)] Ann Greenberg 48 S. Stratford Road New Britain, CT 06051 Emma J. Kazor 618 North 2nd Street Wormleysburg, PA 17043 Note: Irene Pietrowitz, daughter, predeceased Decedent, having died on April 15, 1990. Mary Baker, daughter, predeceased Decedent, having died on April 19, 1994. Daughter Daughter One-half (1/2) of entire estate of every nature One-half (1/2) of entire estate of every nature ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) Z000 form software only The Lackner Group, Inc. Form R£V-1513 EX (Rev. 9-00) LAST WILL AND TESTAMENT OF MARY GRIB I, NARY'GRIB, of Derry, Westmoreland County, PennsYlvania, declare this to be my Last Will and revoke all Wills and codicils previously made by me. ITEM I I direct that all my debts and funeral expenses, in- cluding my gravemarker, shall be paid from my residuary estate, as soon as practicable after my decease, as a part of the expense of the administration of my estate. ITEM II I devise and bequeath my entire estate of every nature and wherever situate to the following of my children and step- children l~ving on the thirtieth (30th) day following my death in equal shares, per capita, share and share alike: ANN GREENBERG, IRENE PIETROWITZ, MARY BAKER, and EMMA JEAN KAZOR. ITEM III I direct that each devisee and legatee shall bear the Estate or Inheritance tax attributable to his distributive share. ITEM IV My personal representative and her successors shall have the following powers in addition to those vested in them by law and by other provisions of my Will, applicable to all propert! whether principal or income, exercisable without Court approval, and effective until actual distribution of all property: 1. To retain any or all of the assets of my estate, real or personal, without regard to any principle of diversifica- tion, risk or productivity. 2. To invest in all forms of property without restric- Page 1 of a 3-Page Will presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witness~. COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF FAYETTE : witnesses, whose names are signed to the attacheO or £oregoJl]g instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her ), and that she ex- ecuted it as her free and voluntary act for the purp~,ses therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the Will willingly and that to the best of her knowledge the testatrix was at that fime eighteen (18) years of age or older, of sound mind, and under no constrain or undue influence. Sworn to and subscribed before me this /~ay Notar~ Public WILMA A. PETROW~K~, Notary Public Conne/Isville, I:ayette Co., Pi. My C~mmJ~slo~ Expl~el M~y ?4, ?~/~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 28O601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 002300 BOGAR JAMES D ESQUIRE 1 W MAIN STREET SHIREMANSTOWN, PA 17011 ........ fold ESTATE INFORMATION: SSN: 171-28-2439 FILE NUMBER: 2103-0232 DECEDENT NAME: GRIB MARY DATE OF PAYMENT: 03/17/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/19/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $469.21 REMARKS: TOTAL AMOUNT PAID: JAMES D BOGAR ESQUIRE 8469.21 SEAL CHECK# 6662 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS