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HomeMy WebLinkAbout08-10-11 (2)---~ REV-1500Ex`01-10) 1505610143 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT Of REVENUE Po Box.2sosoi INHERITANCE TAX RETURN 21 1 1 0 5 6 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 03 2010 12 20 1937 Decedent's Last Name Suffix Decedent's First Name MI GREGORY C E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI GREGORY ARLENE F 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 ^ qa. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® 8 Decedent Died Testate (Attach Copy of WII) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 °. Spousal Poverty Credit (date of death ^ 11, Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number PATRICIA C ZUCKER ESQ 717 724 9821 First line of address 1035 MUMMA RD STE 101 Second line of address City or Post Office State ZIP Code WORMLEYSBURG PA 17043 10~ormleysburg, PA 17043 Correspondent's a-mail address: pZUCkereU dZmmglaW.COm -,-r _; 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 representatroe Is based on all information of which preparer has anv knowledge. Patricia C Zucker Esq 1035 Mumma Rd., REGISTER 0~1NILLS USE ONLY _ -~ --- - - _~ ~,-=~~ ' •" . :t ~._ .~ J - . -' t ._, ;~ DA~'~ FRED r D/ Side 1 1505610 143 J 2121 ~uglas Drive, Car~le~A 17013 i 1505610243 REV-1500 EX Decedent's Social Security Number oe~eaer,~'s Name: G R E G O R Y C E D W A R D __ _ RECAPITULATION _ _ - ---- 1. Real Estate (Schedule A) ................................................................................. .... 1. 2 5 3, 9 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. 1 , 0 4 9 9 9 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 5 4, 9 4 9. 9 9 9. Funeral Expenses ~ Administrative Costs (Schedule H) ................................... ... 9. 9 . 8 8 7 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........................... .... 10. 11. Total Deductions (total Lines 9 & 10) ............................................................... ... 11. 9 , 8 8 7 0 0 12. Net Value of Estate (Line 8 minus Line 11) ....................................................... .... 12. 2 4 5 , 0 6 2 9 9 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. 2 4 5 , 0 6 2 9 9 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 .o0 2 4 4, 013.0 0 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate x .045 1, 0 4 9. 9 9 16. 4 7. 2 5 17. Amount of Line 14 taxable at sibling rate X 12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ........................................................................................................... ... 19. 4 7 2 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21 - 1 1 - 0566 Decedent's Complete Address: Gregory, C Edward ,STREET ADDRESS 2121 Douglas Drive CITY Carlisle STATE ZIP PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT 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 theTAX DUE. Total Credits (A + B) (1) 47.25 (2> 0.00 (3) 0.26 (4) (5) 47.51 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 :............................................................................. i__ x -~ b. retain the right to designate who shall use the property transferred or its income :................................ x °- -_ c. retain a reversionary interest; or ............................................................................................................ x ~~- d. receive the promise for life of either payments, benefits or care? ..............................................._.......... x L. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................. _ x ~i 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?_..........._........._. _ ............. ............,.,,., x ........... ............................... . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 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 21 ears 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 percent [72 P.S. §9116 (a) (y.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 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 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. SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN ~.. RESIDENT DECEDENT ___ ___ FILE NUMBER ESTATE OF Gregory, C Edward 21 - 11 - 0566 __ _ _ __ - -- _ - --- All real property owned sole)y or as a tenant in common must be reported at fair market valu~air market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither bein compelled to buy or sell, both having reasonable knowledge of the relevant facts.Real property which is jointly-owned with right o~ survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold. Include a copy of the deed showing decedent's interest if owned as tenant in common. __ __ __ ___ ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH __ - _-_ 1 Real Estate located at 2121 Douglas Drive, Carlisle, North Middleton Township, Cumberland 253,900.00 County, Pennsylvania titled in decedant's name and transferred to spouse on May 11, 2011 (see copy of Deed transfer attached) __. TOTAL (Also enter on Line 1, Recapitulation) 253,900.00 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PCGG~ONA1 P~OPEpTv INHERITANCE TAX RETURN GR~7 /1L R I RESIDENT DECEDENT FILE NUMBER ESTATE OF Gregory, C Edward 21 - 11 - 0566 __ __,__ Include the proceeds of litigation and the date the proceeds were received by the estate411 property jointly-owned with the right of survivorship must be disclosed on schedule F. __ __ ---- ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH _. --- 1 Hunting rifles and Taurus Judge handgun 1,049.99 TOTAL (Also enter on Line 5, Recapitulation) I 1,049.99 SCHEDULE H COMMONWEALTH OF PENNSYLVANIA ~~~ /w ~..1 ~ INHERITANCE TAX RETURN A1'1A AIANC~Tp/~TI~/L ~nt+TC '.. RESIDENT DECEDENT F1LArll~rh7 ~ IW ~ ~YG \IW ~ ~7 _. _ __ __ ESTATE OF Gregory, C Edward FILE NUMBER 21 - 11 - 0566 __ _ _! -- Debts of decedent must be reported on Schedule I. ITEM __ __ __ __ _- NUMBER ', FUNERAL EXPENSES: DESCRIPTION AMOUNT - _ _ -_ A• 1 Cummings Funeral Service, Inc., 320 John Street, Clayton, NY 13624 8,130.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Daley Zucker Meilton Miner & Gingrich, LLC, legal 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 of Cumberland County 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 .The Paxton-Herald, advertise Estate Notice 1,257.50 376.50 48.00 - __ TOTAL (Also enter on line 9, Recapitulation) 9,887.00 Schedule H Funeral E~er>ses & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN /QC~11inIS'h'rtiVe Costs continued RESIDENT DECEDENT ESTATE OF Gregory, C Edward - - _- - - _- 2 'Cumberland Law Journal, advertise Estate Notice FILE NUMBER 21 - 11 - 0566 -- _ _- 75.00 --- Page 2 of Schedule H REV-1513 EX+ (11-08) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT __. __ - _ _ _ ESTATE OF Gregory, C Edward FILE NUMBER 21 - 11 - 0566 i RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT I (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) j __ __ __ _ ___ _ - __ --_ __ ___ _- I, TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Arlene F. Gregory Wife 100% 2121 Douglas Drive Carlisle, PA 17013 2 Brian A. Gregory Son 1,049.99 149 Cedar Street Carlisle, Pa 17013 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEII 0.00 LAST WILL OF C. EDWARD GREGORY I, C. Edward Gregory, now domiciled. in Cumberland County, Pennsylvania, declare this to be my Last Will. I revoke all other wills and codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Page One of Five Article III I give, devise, and bequeath, all my property, real, personal, and mixed, to my beloved wife, Arlene F. Gregory, provided she survives me by thirty (30) days. If my wife fails to survive me by thirty (30) days, I give, devise, and bequeath any real estate that I may own to my two beloved children, Brian A. Gregory and M. Karen Lickle. Any guns that I own at the time of death I give, devise, and bequeath to my son, Brian A. Gregory. All the rest, residue and remainder of my estate, real, personal and mixed, I give, devise, and bequeath in equal shres to Brian A. Gregory, M. Karen Lickle, Kimberly M. Dailey, Michele R. Gibb and Melissa M. McCurdy, provided they survive me by thirty (30) days. In the event that any beneficiary fails to survive me by thirty (30) days, his or her interest shall be paid to his or her living children. In the event that any beneficiary who fails to survive me by thirty ( 30 ) days does not have living children his or her interest in my estate shall be paid to my remaining living beneficiaries. Article IV In addition to the powers conferred by law, I authorize my Executor, in his absolute discretion: Page Two of Five (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, and (i) to conduct along with or with others, any business in which I am engaged in or have an interest in at the time of my death. Page Three of Five Article V I nominate, constitute, and appoint Arlene F. Gregory Executrix of my Last Will and Testament. In the event of her renunciation, death, resignation, or inability to act for any reason whatsoever as my Executrix, I nominate, constitute, and appoint M. Karen Lickle to act as my Executrix. I hereby relieve my Executrix, whether original, substitute., or successor, from the necessity of posting security in connection with her duties as such in any jurisdiction in which she may be called upon to act so far as I am able by law to do so. My Executrix shall receive reasonable compensation for services rendered to my estate. IN WITNESS WHEREOF, I, C. Edward Gregory, hereby set my hand to this my Last Will, on this -~ 7 day of C~-r~~ 19 %_~ at Harrisburg, Pennsylvania. C. Edward Gregory,; es ator In our presence, the above-named Testator signed this and declared this to be his Last Will and now at his request, in his presence, and in the presence of each other, we sign as witnesses. _cI /fir ~e FouL ~~ r lve I, C. Edward Gregory, Testator, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by C. Edward Grego~y, the Testator, this ~ day, of _ 194). NOTARIAL SEAL C . Edward Gregory, Te to r PATRICIA A. PATTON. Notary Public Lamer Pax~r~~,,Q., ~~~ ed witnesses who signed the foregoing M omfnission x Tres une instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subs r' e,~ t - befc e e by ~~~~ ~ (. ~~~ ~~t. (la //~,. and ~ witne ses t '.s ` ~/ da//y/'~~~of1 ~ - ,~ /19 ~f ) . NOTARIAL SEAL PATRICIA A. PATTON, Notary Public age Five of Five Lower Paxton Twp., Dauphin Co. PA Commission Expires June 20, 199II 13~~ DEED THIS INDENTLRE made this J ~~'day of ~ p IIBI~i~IN Parcel No. 29-15-1249-007 201 ~ BETWEEN ARLENE F. GREGORY, Executrix of the ESTATE OF C. EDWARD GREGORY, of Carlisle, Cumberland County, Pennsylvania, (hereinafter called the Grantor), of the one part and Pennsylvania, ARLENE F. GREGORY, widow, of Carlisle, Cumberland County, (hereinafter called the Grantee), of the other part, WITNESSETH That in consideration of the sum of ONE DOLLAR and NO/ 100 ($1.00), in hand paid, the receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey unto the said Grantee, her heirs and assigns, ALL THAT CERTAIN tract of land with the improvements thereon erected situate in North Middleton Township, Cumberland County, Pennsylvania, bounded and described as follows: BEING Lot 14 on the Plan of Creek View Heights, as recorded in the office of the Recorder of Deeds in and for Cumberland County in Plan Book 22, Page 152; containing 90 feet along the West along Douglas Drive; containing 238.91 feet along the North along Lot No. 15 on said Plan; containing 1=12.60 feet along the East along the Conodoguinet Creek; and containing 28.59 feet along tree South along Lot No. 13 on said Plan. SUBJECT to a 20 foot sanitary sewer easement. BEING improved with a two story residential dwelling and two car garage known and numbered as 2121 Douglas Drive, Carlisle, Pennsylvania 17013. SUBJECT, nevertheless, to the Building and Use Restrictions, as recorded in the office aforesaid in Miscellaneous Record Book 197, Page 1050. BEING the same premises which Loraine D. Gregory by her deed dated August 4, 1992 and recorded August 7, 1992 in the Office of the Recorder of Deeds in and for Cumberland County in Deed Book U35, Page 1155, released any marital claim that she may have had to the subject real estate. WHEREAS, C. Edward Gregory departed this life on September 3, 2010, leaving a Last Will dated October 27, 1995, which Last Will was probated in the Office of the Register of Wills in and for Cumberland County, Pennsylvania on May 11, 2011, by which Arlene F. Gregory, widow of C. Edward Gregory, was appointed Executrix. 14_N.J the said CTr~ntnr does .:;hereby. covenant tc? and with the said Grantee that she, the said Grantor, SHALL AND WILL specially Warrant and forever Defend the herein above described premises, with the hereditaments and appurtenances, unto the said Grantee and assigns, against the said Grantor and against every other person lawfully claiming or who shall hereafter claim the same or any part thereof, by, from or under or any of them. IN WITNESS WHEREOF, the said Grantor has caused these presents to be duly executed, the day and year first above written. COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAiJPHIN >< ~G , Arlene F. Gregory, Executrix of e Estate of C. Edward Gregory ss: On this, the ll~'day of i'~ Q y , 201 I before me, Susan M. Hudson, the undersigned officer, personally appeared Arlene F. Gregory, Executrix of the Estate of C. Edward Gregory, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal. N~TgR1Al SEAL ~~~ ,n ~ ~ - ~~~~,,~,,~~1 al~~ / % ; _ SUSkN M rUl)SON NOTARY PUBLIC --:~ ~ '~ Notary PuDhc _ f_ i.OWER PAXTON TWP, DAUPHIN CNTY - -~ INy Commission Expires Oct 12, 2014 ,r.. 4 .: ~-~, . I hereby certify that the precise address of the Grantee herein is: 2121 Douglas Drive Carlisle, P.A 17013 ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE, PA 17013 717-240-6370 Instrument Number - 201113872 Recorded On 5/13/2011 At 10:56:02 AM * Instrument Type -DEED Invoice Number - 86854 User ID - MSW * Grantor - GREGORY, C EDWARD * Grantee -GREGORY, ARLENE F * Customer - DALEY ZUCKER MEILTON * FEES STATE WRIT TAX $0.50 STATE JCS/ACCESS TO $23.50 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 CARLISLE AREA SCHOOL $0.00 DISTRICT NORTH MIDDLETON TOWNSHIP $0.00 TOTAL PAID $63.00 * Total Pages - 5 Certification Page DO NOT DETACH This page is now part of this legal document. I Certify this to be recorded in Cumberland County PA ~ c~ C°'~e .~ F ,D o= 9~z ° ~ ° RECORDER O r~so * -Information denoted by an asterisk may change during the veriTication process and may not be reflected on this page. umii~n~~uum REV-183 EX (oq-io) ~ - pennsylvania c~'~. DEPARTMENT OF REVENUE Bureau of Individual Taxes PO BOX z8o6o3 Harrisburg, PA 1~iz8-o6o3 REALTY TRANSFER TAX RECI State Tax Paid STATEMENT OF VALUE Book Number See reverse for instructions. Nage Number uaTe rcecoroed Complete each section and file in duplicate with Recorder of Deeds when (1) the full value/consideration is not set forth in the deed, (2) 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 family relationship or public utility easement. If more space is needed, attach additional sheets. A. CORRESPONDENT -All inquiries may be directed to the following person• Name Telephone Number: Patricia Carey Zucker, Esq. 717-724-9821 Mailing Address City State ZIP Code 1035 Mumma Road, Suite 101 Wormleysburg PA 17043 B. TRANSFER DATA C. Date of Acceptance of Document ~rancorls~/~essorlsl Arlene F . Gregory, Exec . Grantee(s)/Lessee(s) of the Est. ofd C. Edward Gregory Arlene F. Gregory Mailing Address Mailing Address 2121 Douglas Drive 2121 Dou las Drive City Carlisle State PA ZIP Code 17013 _ City Carlisle _ State ZIP Code ~ PA 17043 D. REAL ESTATE LOCATION - Street Address City, Township, Borough 2121 Douglas Drive Carlisle, North Middleton Township County School District Tax Parcel Number Cumberland Carlisle Area School 29-15-1249-007 E. VALUATION DATA -WAS TRANSACTION PART OF AN ASSIGNMENT OR RELOCATION? ^ Y ^ N 1. Actual Cash Consideration 2. Other Consideration 3. Total Consideration $1.00 -{- $0 - $1.00 4. County Assessed Value 5. Common Level Ratio Factor 6, Fair Market Value $253,900 X 1.00 = 253 900 F. EXEMPTION DATA la. Amount of Exem lion Claimed lb. Percents e of Grantor's Interest in Real Estate lc. Percentage of Grantor's Interest Conveyed p 9 1008 1000 ~nn~ Check Appropriate Box Below for Exemption Claimed. ® Will or intestate succession. C _ Edward ,r ~r 2 01 1 -0 0 5 6 6 (Name of ecedent) (Estate'File Number) ^ Transfer to a trust. (Attach complete copy of trust agreement identifying all beneficiaries,) ^ Transfer from a trust. Date of transfer into the trust If trust was amended attach a copy of original and amen e trust. - ------ ------- ^ Transfer between principal and agent/straw party. (Attach complete copy of agency/straw party agreement.) ^ Transfers to the commonwealth, the U,S, and instrumentalities by gift, dedication, condemnation or in lieu of con- demnation. (If condemnation or in lieu of condemnation, attach copy of resolution.) ^ Transfer from mortgagor to a holder of a mortgage in default. (Attach copy of mortgage and note/assignment.) ^ Corrective or confirmatory deed. (Attach complete copy of the deed to be corrected or confirmed.) ^ Statutory corporate consolidation, merger or division. (Attach copy of articles.) ^ Other (Please explain exemption claimed.) Under penalties of law, I declare that I have examined this statement, including accompanying information, and to the best knowledge and belief, it is true, correct and complete. Si ure of C on nt e Party i Date ~~~ ~~ URE TO COMPLET H S FORM PROPERLY OR ATTACH REQUESTED DOCUMENTATION MAY R ULT IN THE RECORDER'S REF S TO RECORD THE DEED. ER'S USE ONLY RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 GREGORY C EDWARD * DUPLICATE Receipt Date: 5/11/2011 Receipt Time: 12:28:50 Receipt No.: 1065581 Estate File Nc.: 2011-00566 Paid By Remarks: ARLENE GREGORY CJ ------------------- ----- Receipt Distribution ----- ------- Fee/Tax Descripl=ion Payment Amount Payee Name FETITION LTRS TEST 260.00 CUMBERLAND COUNTY GENERAL FU WILL SHORT CERTIFICATE x.5.00 3.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FU FU JCS FEE AUTOMATION FEE 23.50 5 00 BUREAU OF RECEIPTS & CNTR M. . ----- CUMBERLAND COUNTY GENERAL FU Check## 2504 ----------- $311.50 Total Received..... .... $311.50 THE P~XT~N HERALD rn. onno~ H.~b • ~oia ~.i o.:.., wa.~,w~ a. rn is • smash Fax (717) 657-3523 East Shore Office & Plant - (PO Box 6310) 101 Lincoln Street (717) 545-9540 Harrisburg, PA 17112 (717) 545-8762 PROOF OF P BLI ATION STATE OF PENNSYLVANIA COUNTY OF DAUPHIN Before me, the subscriber, a Notary Public in and for the said County, personally came Lisa M. Carnes who, being duly sworn, doth depose and say that she is CLERK of THE PAXTON HERALD, a newspaper of general circulation published in Harrisburg, Pennsylvania; That THE PAXTON HERALD was established on the 28th day of June, 1960, and has been published continuously since that date; That the advertisement, of which a copy is attached hereto, was published in the advertising columns of THE PAXTON HERALD in all respects as ordered in the issue(s) of ~j-/ ~, ~J'~S ~,T- f ,~ ()(~ , Affiant finrther deposes that she is not interested in the subject matter of the aforesaid notice or advertisement, and that the allegations in the foregoing statement as to the time, place and character of publication are true. f J-- ( ature of the Affiant) Sworn and subscribed before me this day of ~~ / ~ / A.D. ESTATE NOTICE- NOTICE IS HEREBY. GIVEN that letters testamentary or of administration have been granted in the following Es- tate. All persons indebted to the said Estate are.required to make payment, and those hav ing cal ims ,or -demands to present the-same without. delay to the administrators, ex- ecutors,-or their attorneys named below...... ; ESTATE OF C. Edward Gregory, late of North Middle- ton'TTownship, Cumberland County, PA. Died: September 3, 2010.- Executrix: rlene_ F: Gregory. Attorney Patricia Ca Zucker, Esquire DALEY ZUCKER MEILTON MINER & GINGRICH, LLC 1035 Mumma Road, Suite 10T Wormleysburg, Pennsylvania 17043 5-18, 5-25, 6-1 NOTARIAL SEA± DAVID ~.1. GOLDSTEIIV, Natarr Pu~fic City of Harrisburg, Dsuph;n County My Commission Expires May 26, 2014 PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, May 27 June 3 and June 10 2011 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. \ ~~ vt- ~--_ Li~a M rie Coyne, Editor SWORN TO AND SUBSCRIBED before me this 10_ of June. 2011 Notary Gregory, C. Edward, deed. Late of North Middleton Town- ship. Executrix: Arlene F. Gregory. Attorneys: Patricia Carey Zucker, Esquire, Daley Zucker Meilton Miner ~ Gingrich, LLC, 1035 Mumma Road, Suite 101, Worm- leysburg, PA 17043. DEBORAH A COLLINS Notary Public CARLISLE BOROUGH, CUMBERLAND COUNTY My Commission Expires Apr 28, 2014