HomeMy WebLinkAbout07-03-13 J 1505610143
REV-1500 Ex`°2.,,, �
PA De artment of Revenue OFFICIAL USE ONLY
P pennsylvania ca,mycoee v�r F�iaN�muer
Bureau of Individual Taxes °°'"TM°"�"�"�
PO BOX280601 INHERITANCE TAX RETURN 21 12 0858
Harrisburg,PA 17128-0601 RESIDENT DECEDENT '
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
07 10 2012 06 29 1915
Decedent's Last Name Su�x DecedenYs First Name MI
SMITH THRESSA E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's Firsl Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C 1. Original Return � 2. SupplemenWl Return � 3. Remaintler Retum(Dale ol Death
� Priorlo 12-13-82)
� 4. Limited Estete � 40. Fmure Inlereat Canpromiae � 5. Fetlerel ESWte Tax ReNfn Required
(tlate of tleeth etler 72-12A2)
g. DecaEenlDiBOTaNete � en tMeint�jnedBLivinqTrus� 0 8. TotalNumberofSafeDe ositBOxes
❑X (AtlechCOpyo(Wilp ❑ Ane Gopyo! mat) p
, 9. Liti etion Proceetls ReceiveC �p,S ui P v n ree t oa ot Deem ��.Election to tax unCer SeC.9173 A
9 ❑ c$n a��$-����a�d f-�-�S� ❑ �nnscn scneaura o) _} )
�� .,
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL T�I RMATIO I�SHOU��i�5 BFAIRECTED TO:
Name DayRpn�elepho�W7dum�er�"'
m ;,� . .
LINDA J OLSEN 7�9 �y5� 4332J' `�;
� � r' w
FOCf'�-a1�4.;E�2'OF WI6.LS IJ�SE-O,NLY
—:-
� - = r.�
Pirst Llne of Address " ��— _ =
�<7 F--� �::.;1
2000 LINGLESTOWN ROAD � —� F-.. e; r�
c:� '�n
Second Line of Address
SUITE 202
Cf or Post Office DATE FILED
Ty SWte ZIP Code
HARRISBURG PA 17110
corresPOndenrse-mauaddress: �olse��hazenelderlaw.com
Untler penallies of perjury,I tleGare that I have examined thia retum,inGutling accompanying schedules antl atalements,and to lhe best of my knowletlpe anC Eelief,
it is We,corteat and complete.Dedantion of preperer other than the personel representadve is basetl on all information ot whic�preparer has any knaxledge.
IGNATURE OF PER/SO'N R, SPONSIBLE R FIL NG RETURN DATE
W�� James W Smith ���? —/.3
r�OOaess � `
U
315 Robson Road. Dilisbum. PA 17019
SIGNA O�AREROTHER ANREPRESENTATNE DATE
�y� �M_ Linda J. Olsen, Esq. 7_ a_ �
��ADD SS
2000 Linglestown Rd. , Harrisburg, PA 17110
Side 1
L 1505610143 1505610143 J
�ti
J 150561U243
REV-1500 EX
DecedenPs Social Security Number
oa�a^m'aNema: Smith, Thresse E
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... t.
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 8 Miscellaneous Personal Property(SChedule E)............... 5.
6. Jointly Owned Property(SChedule F) ❑ Separate Billing Requested............ 6.
7. Intar-Vivos Transfers 8 Miscellaneous lyo�Probate Property
(Schedule G) U Separate eilling Requested............ 7, 19� 580 . 40
8. Total Gross Assets(total Lines 1 through 7)........................................................ g, 19,580 . 40
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 15 . 00
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)............................ 10.
17. ToW I Deductions(total Lines 9 and 10)................................................................ 11. 15 . 0 0
12. Net Value of EsWte(Line 8 minus Line 11).......................................................... 12. 19, 5 65 . 40
13. Charitable and Governmental BequestslSec 9713 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value 5ubject to Tax(Line 12 minus Line 13)............................................... �q, 19, 5 65 . 4 0
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of line 14 taxable
at the spousal tax rete,or
transfers under Sec.9116
(a)(12)X.00 15. 0 . 00
16. Amount ot Line 14 taxable
at iineai rete x .oa5 19� 565 . 40 is. 880 . 44
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collaleral rate X.15 � . �0 18. � . ��
19. TAX DUE................................................................................................................ 19. 88� . 44
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REPUND OF AN OVERPAYMENT. �
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-12-0858
DecedenYs Complete Address:
DECEDENT'S NAME
Smith,Thressa E
STREETADDRESS
Green Ridge Village
210 Big Spring Rd
CITY STATE ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 880.44
2. Credits/Payments
A. Prior Payments �
B. Discount
. Total Credits(A +g) (2)
3. Interest (3) 6.21
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (q�
Check box on Page 2,Line 20 to request a refund
5, If Line 1 +Line 3 is greater than Line 2,enter the differance. This is the TAX DUE. (5) $$6.65
Make Check Pa able 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 inwme of the property transferred:............................................................................... � �
b. relain the right to dry ignate who shall use tha property trensferred or its income:.................................. B x
c. relain a reversiona interest:or...............................................................................................................
d. receive the promise for life of either payments,benefits or care?............................................................ � �
2. It death occurred after Dec. 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 death9....... ❑ �
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a benaficiary designation7................................................................................................................... � ❑
IF THE ANSWER TO ANY OF THE ABOVE�UESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND PILE IT AS PART OF THE RETURN.
For dates of death on or after July 7, 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 aRer 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 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 percent[72 P.S.§9116(a)(1.2)].
. The tax rate imposed on the net value ot transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in
��2 P.s.gsi�s{a)(�)]
. The tax rete imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percant[72 P.S.§9116(a)(1.3). A
sibling is defned under Section 9102,as an individual who has at least one parent in wmmon with the decedent,whether by bloo�or adoption.
Rav-0610 EX+�OB-09)
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Smith,Thressa E 27-12-0858
This schetlule must be com0leteC antl f�letl if ihe anawe�lo any ol questions 1 lhmuBh 4 on pege�h�ee of lhe REV4500 ia yea.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S E%CLUSION TAXABLE
NUMBER TME DATE OF TRANSFRERSATfACN A COPV OF T�HE DE�ED FOR REAEES�E, VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Oil and Gas lease on real property located at East of 0.00 0.00
Bonnie Brook Rd.,Oakland Twsp., Butler Co., PA-
lease was signed Sept. 19, 2071 for five yeare. This is
a non-producing property, no royalties have been
received. See attached InheriUnce Tax Bulletin 2012
-01 isued July 10,2072 and revised July 13, 2012
regarding the valuation of Natural Gas Interests. This
is a leased,non-producing property with no flxed
future payments;therefore,the interests are being
reported as having zero value. This interest is being
reported on Schedule G, rather than Schedule E
because the lease was trensferred to DecedenYs son,
James W. Smith,within one year of date of death.
2 Real Property-East of Bonnie Brook Rd., Oakland 19,580.40 100.000% 19,580.40
Twsp., Butler Co., PA-Assessed value of land is
53,330; FMV is assessed value multiplied by Butler
Co. Common Level ratio of 5.88; transferred to
decedenYs son,James W.Smith on April 17, 2012.
TOTAL(Also enter on Line 7, Recapitulation) 19,580.40
Qf more space is neetle4 atlOiUOnal pages of the same siu)
Copyright(c)2009 farm soRware only The Lackner Group, Inc. Fortn PA-1500 Schedule G(Rev.08-09)
2012-09-07 11 :05 DPW Zetecom Unit 717-772 �4128 » n Etder �aw P 2t3
HUTLER ��EA SCHOOL DISTRICT
SITLY 1� 2012 TI-IRLT JUNE 3O, ZO13 % pQF7AX MIUSIRATE AMOUNT
sCfi00L 12EAi, ES'Z'ATE TAXE9 SCHt}OZP 91.804Q 3q5.fi9
� ACT 5 1 PC 5 .40 ,00
6ill Date: 08/Ol/2012 ' ACT 6� 9 HC 5.00 .00
PYOp6T'ty I.pC: E �F EONNI$HRflOK .Rp .
DfMJP: 250-1F14,7- 30AA-0660 � . . . � � � , "�
Make Chack Payable To:
SHERRY L. FII,GES, TAX COLLECTqR
PaYment Reqnesied At: au sgR $% orscaurrrnma,m 249.58 1
368 �YTH RC) OcnNo� , FaC@amcunt 305.69
BUTLER, PA 16002 PHONE 724-285-8181 0¢c0� 70� CENALT4Amonm 331i.26
OFFICE WALK-Zxs WEANESDAY 14AM-4HM P.I.SQ aecT �
SEP'i 28, pCT l, N4V 30. OTHER TIMEs
CALL FOR APPT OR MAIL PAYMENT_ RT 68 ,R�etum Thrs Portion With Payineqt
TURriY ON EYTH ROAD 5TH HOUSE ON RTGHT ,owner: ,2.MITH .7AME5 W
� DjMfPc�25d-IF24?- - 30AA-OOdQ
irnnr•rcr , r s - � y.3oF
, !F A RECEtPT fS 6ESIREO,RFiURN QFtYtftE F6RM AFFD R 5Elp�AD6RES$ STAMFEJ ENYEI,OPE WiTN FAYMEt^t'i'
�7ULY 1, 2612 TEII2iJ JUNE 30, 2013
SHE�RY L. FSLGES, 1'AX COI+T.ECT'OR NDpFTAX MILLSIF4ATE AMOUNT
368 EXTH R,D SCHOO 91.8000 305.69
SUTL8i2, PA 16442 pFI{}ATE 724-2&$-$181 ACT 5 2 PC 5.00 .00
ACT 6�9 PC S.pO 00
rroparcy Deae: 53.7,45 ACS . .
E OF B4P7�T�EHRQOR �2D
AssasaM VaWa: 3,3 3 Q
�/��p: 250-1F147- 30A}L-0000 , ;
ownera.dd�ess: SMSTH JAMES W AV¢�Sepi % DISCQUNTAmouM 249.58
315 ROBSON RD oc�-�cv ;] finceamou�rz 305.69
DILLBTTRG PA 17019 oaapi iQ�6 rEnnlrrnmow,c 336.25
R6Cvo a�:
DfMJ2�' 2$0-1Fi4'1- 3qAA-0000
Contr;ol Na. : {y5612-4} 1306
arrurUOn: REAL ESTA7E 7'AXES N07'PA1O BY p6C 31, 2Q72 LL BE RFTU17NE0 TQ TAX CLAfM �
�n.iiip i�g Ui i u iii qii iii i iii iii i ui iiii i ilim,z
F�p�F3 i:S62.0D i@:02Pfl
Midµl�lhnt�ite T2612001�it
Buti�r Gantv Fwo�t4� MtJNl�S V
THI��IEED
MADE Ute�day of_& K��._.__,2612,between
JAMES W. BhIITH, as attomey in fact for TFIRESSA E.SMITH, a widow,which Powec of
Attomey was e�cecuted on May 31,2005(the Cnankor"),
A
N
D
JAMES W.S14IITA,{#he"Gran#ee"}
WITNPSSB'TH,that tha Grantor, in consideration of the sum of One Dollaz($t.00)W ffiem n,ow
paid by the Cnaatce, do graat, bargain, sell and coavey unW the Grantee,�their hairs, executors,
successors em!assigps>
ALL t6at oertain pieca, parcel or tract of land situa[e in Oakland Township, 8utler County,
Pennsylvania,bounded and desozibal as fotlows,2awit
Begitauing at a point at the nort6west oomer of lot of G. Benson, being a point rivo
hundred and sixty-four feet(264)nar[hwazdly from the center of Legislative Routa 10125;thence
aiong Sands of AB.Gudenbur,Narth i°Q6' West a distance of one ihousand sevcn hundred and
ninety-four and seven-tenths (F„794.?} feet to a hub on ]ands of Rebecca Tay]or;thence along
lands of Rabxca Taylor, John Wciahey, North 89° 12' East a distanoe of one thousand ttvee
hundred riventy-two and lwenty-eight one hundredths(1322.28) feet to a point pn lands of W.J.
Hecnpling; thence along line of Hempling, 3outh 22°32' East a distance of eight hundred and
twsniy-six and ninety-six one hundredths{824.9fi}feet to a point an the north iine af a creek;
khence aloag said creek in a westetly direc[ion to a point; thence along line of lands of now or
fomierly Krabs Heirs, South 21°49' West a distance of tluee hundred and forty-two and eighty
one-hnndma3ths {342.80)�feet more or iess; thence wntinuing along lands of naw or foTmarly
Ksebs Aeirs South t° p0' Esst a distance of seven hundred and tcventy-one an8 twenty-thres
hundredtha(721.23)feet to a stona;thence along lands af St.Wendatin's Church,North 69°33'
W est a distance of foar hundred fifry-four and sixty-sevep one hundredtlu(454.6'7)feet ro a point
in ihe o�ter of a pubtic road knawn as Legislative Routc 10125;Useace atong the center of said
road a distance of thra hundred farty-two and fifty-seven one hun&edths(342.57}feet,mase or
less, to a point in the center of said road at the southeast oomer of lot of P. Fallacker; thence
along line of bt of P.Fallacker,North 1°6'Wast a distanco of two hundred and sixty-four(2b4)
feet ta a paint at ffie nortiseast comer of Iot of P.Fsitacker;ihence along Sots of P.Fallacker and
Benson, South 88°23' West a distance of fivd hundred and twenty-three and twenty-five one
hundredths (52325) feat to a point at the norkhwest corner of lot of G. Bensan, the place of
begnning.
A.NB containing 53.IA5 acres as per survay of Greenaugh, McMahon and t;reanough made
3eptember 6,1955.
ANS}BETNG the same iand conve}�ed by Martin Lcinenbach and I.ouisa I.einenbach,2�is wife,to
Eugene A.Smith and Tluessa E.Smith,his wife,dated September 24, 19i5 az�d r�orded'an the
Recorder of Deeds Office of Butler County, Pennsylvania in Deed$ook 675, Page 499. Said
, Eugene A. Smith having died on October 6, 1986 vesting full title in said land in'17uassa E.
Smith by opccatioa of law.
C,INDER AND SUBJ£CT TO:
a. Coal and coal bed methane gas and mining rights and all rights incident to the
extraction os devetopment of coat or coal btd metlrane gas heretofore conveyed, excepted and
res¢rved by instrumenLa of record;the right of sarfsce,iaterai or sub}aceat sugport;or any sw'face
subsideuca;acid
b. Oil, gas, and minerals, and rights incident to the extraction or development of oil,
gas or minerals heretofore conveyed,leased,excepted or reserved by instrumen[s of record.
BEING Ta�c Map Parce(No.250-IF147-30AA-0000.
The Grantor certifies,pursuant to Act 97 of 1980,enacted 7uty 7, 198Q Section 405,et seq.,
35 Pa.C.S.A.§6018.405 et seq,that no hazazdous waste is presetiUy being deposited by Ihem on or
in the land conveyed by Uris deed, nor has any hazatdous waste ever been deposited to their
]mowledge on or in the land conveyed by this deed. This pazagraph is being inserted in this deed
pursusnt to Sec6on 405 of said Act 97 of 198Q 35 Pa.C.S.A.§6018.405 et seq.
THIS CONVEYANCE IS FROM MOTHER TO SON AND EXEMPT FROM REALTY
TRANSFER TAXES.
With the appur[enances: To Have and To Hold the satne unto and fot the use of the Grantee,their
heus,executors,successors and assigns forever,
AND the Grantor for herself, her heirs, executors aud administrators covenant with the Grantee,
their heirs, executors, successors and assigns against all lawful claimants the same and every part
[hereof to Wazrant and Defe�d.
NOTICF THIS DOCUMENT MAY NOT SELL, CONVEY,TRANSFER, IIVCLUDE OR
aNSURE THE TITLE TO THE COAL AND RIGAT OF SUPPORT UNDERNEATA THE
SURFACE LAND DESCRIBED OR REFERRED TO HEREIN, AND THE OWNER OR
OWNERS OF SUCH COAL MAY HAVE THE COMPLETE LEGAL RIGHT �TO
REMOVE ALL OF SUCII COAL AND, IN THAT CONNECT[ON, DAMAGE MAY
RESULT TO THE SURFACE OF TF� LAND AND ANY HOUSE, BUILDING OR
OTHER STRUCTURE ON OR IN SUCH LAND. THE INCLUSION OF THIS NOTICE
DOES NOT EPILARGE,RESTRICT OR MODIFY ANY LEGAL RIGHTS OR ESTATES
OTHERWISE CREATED, TRANSFERRED, EXCEPTED OR RESERVED BY TAIS
INSTRUII�NT. ('This notice is set for[h in the manner provided in Section 1 of the Ac[of July
17,1957,P.L.984,as aznended,and is not intended as notice of unrecorded instrwnents,if any)
WITNESS the t�ands and seals of the Grantor.
Wilness: -%� �4�"` �w�
l� c—._ ..�.PK/W (SEAL)
�a E.Smith by Jaznes .Smith,P.O.A.
op @�s��aaa�sac-��aa8�
NOTICE THE UNDERSIGNED, AS EVIDENCED BY THE SIGNATURE(S) TO THIS
NOTICE APiD TAE ACCEPTANCE AND RECORDING OF THIS DEED, (IS, ARE)
FULLY COGHIZANI' OF THE FACT THAT THE UNDERSIGNED MAY NOT BE
OBTAINIIHG THE RIGHT OF PROTECI'ION AGAINST SUBSIDENCE, AS TO THE
PROPERTY HEREIN CONVEYED,RESULTING FROM COAL MINING OPERATIONS
AND THAT THE PURCAASED PROPERTY, HEREIN CONVEYED, MAY BE
PROTECTED FROM DAMAGE DUE TO MINE SUBSIDENCE BY A PRIVATE
CONTRACT W[TH THE OWNERS OF THE ECONOMIC INTEREST IN THE COAL.
THIS NOTICE IS INSERTED HEREIN TO COMPLY WITA THE BTT[1MINOUS MINE
SUBSIDENCE AND LAND CONSERVATION ACT OF 1966. �
I�,16-�u,v.—(' I �L-.•
COMMONWEALTHOFPENNSYLVAHIA .
ss.
COiJNTY OF DAUPf�NN
On this the ���" day of I I QR�I A.D. 2012, before me a notary
public the undecsigned officer, personally appeared, James W. Smtth, Imown to me (or
satisfactorily proven)to be the person whose narne as attomey in fect(agent)for Thressa E.Smith,
and acknow(edged that he e�cecuted the wiUiln document as the act of his pnncipal for the putposes
therein contained.
IN WITNESS WHEREOF,I hereunto set my hand and ofiicial seal.
�����l ��
II NotaryPublic
My commission exp'ues: ��I/y
eoM
. Hr�m.�+.a'w"°"°M'c�
�• .tt,mi�
CERTIFICATE OF RESIDENCE
I,do hereby certify that precise residence of[he Giantee is
James W.Smith
315 Robson Road
Dillburg,PA 17019
Wifiessmyhandthis ���` dayof ��'2�t ,2012. �
�,�''���---- -�
COMMONWEALTHOFPENNSYLVAI�IIA .
ss.
COUM'Y OF BUTLER .
Recorded on tlus day of A.D. 20_, in the Rxorder's
Office of Butla County,Pennsylvania,at Instrument No.
Given mder my hand the seal of the said office,the day and year aforesaid.
Recorder
j�Ne6yCER77FY
MAII.TO: ��N�y��lnux
Iaznes W.Smith RMaa+�omx
315 RobsonRoad '������
Dillburg,PA 17019
Michcic M.MuMlio-M1�'r'kr°f��s
� Shell Ex (oratian & Production
P
SYYEF/ t.P'
140 Thorn Hill Road
Warrendale, PA 15086
724.720.236b of�ice
724J20.3551 fax
#erence.estesC�2shel I.com
May 17, 2012
James W. Smith
315 Robson Raad
Dillburg, PA 17019
RE: Updated t�mership
lease# PA24087.001
Dear Lessor:
It has come fio aur aifienfion that the ail and gas inferest in the above-iisfied (ease has been canveyed to
you. This letter serves as confirmation that we have updated our records. Additionally, endosed
please Eind a W-9 tax form. For lega) and tax purposes we need to have fhis #orm signed and on file
wiffi the above referenced lepse. Please sign and return the form in the enveiope provided.
Should you have any q�estions, please give the undersigned a cpll a1 (724} 72{}-23bb.
Very truly yours,
/�."'
i`
Teri 'tes,,j0
te�s'e Analyst
enclosure
PAPAIDUPLEASE IIIIIIIIIIIIIIIIIIUIIIIIIIIIIIIII�IIIINII LeaseNo. �,9ayOd ��COI
Rev.06.09.2011 p�'��!�BH09]800]9628 oe�aenai�
v �1 F:S1B.60 3:60PM
Mleh�b �uat�llo i20H003]6%
Butl�r County P�cortl�r RP
MEMORANDUM OF LEASE
THIS hffiMORANDUM OF LEASE has been mede ro indicate the existence of en Oil and Gas Lease("I,wse")
deted�T Y' �qT���� by end between 7]� E S 'th 'd of�5 Rob_nn R ed
Dills6ure. PA 170I9 as Lessor end SWEPI LP, having an otiitt a[ 190 THORN HtI,L AOAD, WARRENDALE,
PENNSYLVANIA I5086,ae Lesxe. �
I.essor did gen4 d�m�sq leau and la ncclusively to Lusee,its successors end essigns,thc righb to e:cplorc,develop,
� produce and merket oil end gns Gom the premists described ydow subject[o the provisians conteineA in Ne Lease including Ne
following:
1.'ihe primery[erm of�he Lense is for a period of Five(5)yeers commrncing on Ne dete immediately set foM ebove end for so
long Mereatter as oil,gas or otha substences covered by Ihe I.ease are rapoble of being praduced in paying quanLtiu from Ne
leesed premises or fmm lends paoled Nttewi9�or Ne I.ease is oNelwise maintained or prolongeA pursuent to ihe provisions
contnined i�ihe Lease,including an extensioo ofwm contnined Nerein. Lessee may erztend Ne primary term of Ne Leese for en
eddifianal Five(5)years after N<end of the primery term,thereby contlnuing tlie rorsn of the Lease ro the rnd of Ne exlended
primery tefm.
2.All Naz certein trect of Iend siNeted iv the TownsAip of Oaklend.Counry of [I r Commonwealth of Pennrylveni0.e�nanlly
bowded now ar fom�aly es follows:
On the North by 250.1F147-0000029G-0000 RichW A Eakin
On Ne Esst by 290-1F102-OOOOOOIA-0000 Stwhen C.Melis
OnNeSoWhby SvntWrndelinRoed
On Ne Wes[by 250-0OOS4-0OOOOOOC-0000 Richerd A Eakin -
end for rcftrtna purposes aniy,beiug Cowry Tnx Pvicel No.250.1F147-000030M•0000.bemg N<seme VaM of Imd ecquimA
by Lessor by vitNe of a daument rerqrdW in Ne office of Ne Recordw of Dads in seid comry in Pmnrylvnnie,
Dad Book 6� end Pnge No. � end seipWavA ro coniniq for Ne pwpose ot calculeNng paymrnts,
�-1fi�ee md IS/100 f53.iS.ecra,more or lesx
This Memolendum of Leose Aes been executed for fie purpose of providing notice in Ne RecoMas Offi«of
Bueler CounTy, Commonwwlth of Pennsylvenie, of the ntistence ot Ne Lesse end sAell vot be wnsidered in eny way a
modification or alteretlon of the Lease. /� ���
The pertia have aeecuhd this Memorendum ofleese Nis��y of_� / 2011.
W{��� � SSOR: , `
�—T
W N•(
Yl I Mr1bY C6k11FY .
41 wtY
hppdM nta
Raadd40�k�
de�WCQ1p1h• SWEPILP /�
pqWylvmu �i�✓/l��n�/�'
MkM1ekM.Mus�llo-RecmkrofDerd.a [ts; L4NQ' /CC�/'CSCl1{Af'/�6
'_
Stnvderd Aclnowledgemmt
COMMONWCAL7HOFPENNSriVeWIA )
cour+rr oe
�+.�-Vi2T } }u:
On Me ��day of ��YY1F�.� in ihe ar 20 ��befo�e my ihe wdersignW,a nauy public in
�'_"
,oa r���a�ma.v«m�ir wv�� �r�tS nl � '�i h
pe�sonally Imowv to me or proved a me on Ne besis of vtisfictory evidence to h the individusl(s)whose nnme(s)is(ece)
Nyscriped m the witltin inscument uW ecknowiedged m me tlut hNshN�heY ezecwd Ne smne in hivLWMe'v npocity(ies).md
Met by his/ha/their%ipfeWre(s)on Ne�ostlwnent���odividual(s)or�he person upon behalf oCwhich the individuel(s)acced,
eaewted the ivshnmrnt
M WITNESS WI�RLOF,I hneunto ttl my henA e9del�cie�ae�l.w..n
<—�.1'Y I l�tie�—�
�T�N T�P�$�ER NINmy Public
�uni oF rErx+sr�v�ww
wrwew
q NaWn.M.cw6NOWY�
BuIMrTwP.BJVCwmO'
� Ny CwmYMon 6@���W.1.�19
MYMaY.PM�l1�N MoGINA10!lebc
PA PAID UP LEASE Leese No.�/�?4Cli'r1
Rev.06.09.20ll '�>�
PAID Up
OIL AND GAS LEASE
7'his Leose Agrxment is mede and entered into Nis�"day of�('IlIOA�0.! ,201 t.
��.-.-�_
between _1Lrcsu E.Smith a widow of
313 Robson Rood
Dillsburg,PA 17019
ss Lessor,(w6ether one or mort), and SIVEPI LP, hrving �n oPoce �t 190 THORfY HILL ROAD,WARRENDALE,
PENNSYLVANIA 13086.m Lessee.
(1)LEASE-In considuntion of Ne bonus wnsideretion paid,ihe receipt of which is haeby acknowledged,and in
furthv consideaetion of Me wvenents and ageemmfs herein conhiveq Leyyor daes hercbY gan4 demise, lease nn0 let
w¢�usively to Lessee,its successors md txsigns,Ne lends hereefter described for the puryose of erploring for,developing
producing and meAceting oil,gas or othc roletW subsmnces p�oduttA in yssoc(etion NerewiN by all rtrctl�ods now Fnown or
hereetter known or hereefter discovercd,in end under 1he following described lend:
(2) DFSCRIPTIOIV - All Naz ce�bin pace of land simated in the Township of Oekland Butla Counry,
� CommoowealN ofPenaeylvani;generally bounded now or fo�malY%s follows:
On Ne North by 250-1P147-0000029G-pppp Richerd A.Eakin
On Ne Eest by 290-1FI02-OOOOOOlA-0000 Steohen C Malis
On the SouN bY Seint Wendelm Rood
On the West by 250.000S/-0OOOOOOC-0000 Ruchud A Eakin
. ond fir rcfnrnce purposes oniy,being Cowty Tax Peral No.250.1F147-000030M-0000 being the some tract of land ecqui�ed
by Lessor by virt�e of e documwt recordW in Ne office of Ne Rccordu of Deeds in seid cowry in Pennsylveniq
Dxd Book ¢75 end Pege No. � end stipulazed b wotain, for the purpou of eniwlating peyments,
FiRv-Three and 15/100 (53.IS ncres,mort or Iess,and hereinafttt ca11W"leosed premises".This leese includes dl necreted or
submerged Imds contlguous m We IeesN premises claimed or owned by Lessor.
(3)TER11f-S�bjat w NeWhw p�vvisions wntaineA hnsiq Nis leese shdl be in fo`ce for e primvy m�m of five(5)
yms md tor so long We�eafler es oil,gae ar ofic subsmvices wvered haeby ue capable of being proEuced'm paying quantlties
from Ne Itased premisa or from Inndy ppp�W tper�w�W ar this Imu is oNawise meininined puryumt to Ne provisions haeof.
If is wders[ood Nat so long ss tltis leau u extendW beyond We primery trm bY my provision of this lease.I.esm may
wmmace,mume,or mntinue Ne aevcise ofeny ofthe righfs,privilega or puryoses hweofduring such utrnsion.
EXTENSWN OF TERM: A[Lestte's optloR 1.essx mey ea�tend the primery hrm of Nis leau for an additio�l
period equal to the primuy term bY PaY�B or trndering W Leyyor en eztrnsion payment of
7Lree ThausvW end 00/100 Dollus(53.000.Wl per eca payable et eny rime prior to the«pintion of the primvy term.If
l.essee eeucisa iltis option,ihe primery term oCNU leose shall be considered w be continuous,commencing on Ne dero herwC
md continuing to Ne eod ofNe aetended primvy tvm
(4)AOYALTY PAYMENT-On oil aud gas,along witA ell hydrocarbon and non-hydrocarbon subsunces produced in
associaziov NerewiN,(ezcept rtonge gey)[,usee shell deliva m Lescoy ss roY�h fiftern percmt(IS%)ofihe proceeds Qess all
apPlicable ezcise bnes, inclWing proAuctioq xverenm md windfill pro5ts isees, end lea trmspo�tation, wmpressioo,
dehydntion md gNhreing coses,i(eny)renlized by Laue for thet produced eod merketed oRthe leesed pamises.
(5)LESSOR'S tIVTERE.ST•IfLessor owns en interest in the leased prtmisuc lus than Ne rntlrc md mMivided estate
hemin leaud,U��rn all payments herein pmvided shall be pvd by Lencee only in the proportiou to which Leawr's intere#bears to
tlw w6ole md uodivided eslnm. if Me leased prtnuses sM1all hereafter be su6divided,Ne leased p�emises shdl nevvThelw be
devdoped md opaazed as one leeu,and NI coyeldn azwing Ae�eunda shell be treemd u m enCuety,end shell be divided
among end paid to sufi upvnk owners in Ne propo�tiao Nat the acreage owned by each owner 6eses to the rntlrc Iwud
acrtage. Lessee ahall mt be bound by eny chmge in Ne ownership oftLe leaxA pmnixs or eny chenge of Ne eddrtss of Lessor
wtil fumished wit6 such documrnte[ion from Lessor ns Lessee mey reasonsble require.
(6) DIRECftON OF PAYMEN7'-All paymrnts haein may be direcled to the Leuw oc depovted co Lesmr s credi[
or W the crtdit ofl.essor's rtspective heirs or assigns by check payablc ro Me order uM add�ess as xt(orth ebove.
Lesue slWl not 6e obligated to alter peymmts as Airected above wlas wiN writtm notice by Lessor or I.cssor's heirs or aseigns
Ai�ect l.easee oMawise.
(7)CONTPIUINC OPERATIONS-If az the end ofthe primary tem�or my acknsion thaeofthis leese ia mt being
kePt iv force by eny oNa provision hamf but I.eax has rnmmrnced opentions tor drilling campleting,�eworkin8 WuiPV�6
or eny othv opention celcWekd to oblain pmduction on tlie Iw.vM pmnises or Innds pooled Ne�ewiM,Nis leax a1W1 mmain in
force ac Iong ar wch opere[ions art wuduchd in a reasonebly pludent muma. At eny tlme after the«pimtioo of Ne priniuy
Wm,this Ieace is not being kept in fo�a by any oNa provision M1weo[Lessor agees to�[end 1he ttrm one yur beyond Me
completion of plugging opvatlam of tl�e last well on IeauA pamises to pmnit Lessee ta deepen,rework or acomplem seid wdl
� or m cammmce operetions Por ihe diilling of onotha wdl end if such opantiaos asWt in the pmduc[ion of my subslence
covered hemby,this leave will be excmded ss long ihereafter es production conUnues in peyi�g quentitia.
� (8)POOLING&UNITIZATION-Lesuc is hercby pfnnted Ne right to pool or unitiu Me IeeuA prtmises,or any
pM Mereof,witM1 my oeher pmperty for the pmducrion of any subslence covered hertby,w as to aeate one or more drilling or
pradudion unim. Purthertnore,Lessee shall in�ro evrnt be requircd[a drill moa then one well on such wie Seid driliing or
PA PAID UP LEASE Lease No.
Rev.06.09.2011
produaion wits shail mt ezceed one Nousand hvo hwCmA eighry(1,2g0)acree or such siu as mey be pemtitted to conform Ia
Ne niles ond�egulations of any govemmrninl agency cleiming juriqAiaion.In the event Nis lease is so witized.the Leswr
agees to eccept in lieu of ihe royalry herein before recited, such proportion of Ne royelty above provided es the ecreege
wntribu[ed 6y this leese bears to Ne W W ecreege comprising the wit.
Lessee shell crwte ihe wit by eaecuting m inswmmt idrnti(ying end describing the pooled ar.reege and shell mvl a
wpy thereof[o the Lessor's Ins[Imown eddrtss.Lessee she11 have the rtcurring right m�evise any mit folmed hoeunder eiNer
before or afttt com�¢eacemeo�of production.N Ne evrnt of a revivoR 1.rs+m sM1dl amcute e written instrument ducribing Ne
reviud unit and statlng the effec[ive dete of the revisian.Lessce sLdl meil a wpy Neceof ro the Lessor's lost l�nown addmss and
ihe proportion of unit prodvcrion on wAich royeltla ere pnyeble hereundv shdl Neroafter be Wjus[ed according�y.Lesya may �
m�minem Ne unit by filiog of record a writtm decleretion describing the wit and sfating Ne dete oftenninetion.
Commrncemmt of opentions far drilling, compledng reworking equippiug or any other opuazion celculeted ro
obtain productiw,or productlon mywhero oo e unit which includes W or eny part of the leased pamises shei�,ezcept for�y� -
paymrnt of royelties,be VsateA ey if it wea wmmmcun�vt af openfions for Arilling completing,reworking,rquipping or m
otl�w operetlon calculated W obtain production,or production on Ne Ieesed pamises.
���
(l0)ANCII.LARY RICH15-Lessor grants to t6e Lessee ihe right of ingress and<grtsv over,wder end Nrough said
lenud prcmisa wiM Ne exclurive right to conduct mch opentions on Me leased prcmises as mey be necessery for Ne
explontion end produc[ion of oi4 gas or other rcleted subslmcev covaed here6y,including but not limited ro geophysical
opm[iaas,Ne drilling of welle,end�he constluction and uve af ronds,pipelioes,Lnks,water welis,disposd well;injecUon
welLs,Pits.electric and telephone lines,and mha fncilities necessary.useful or wnvmimt m produce,save.take care o�vea4
p�ocess,atorc end tron.ryon oil,gnv eod oWv producb with tlw rigM1t m trwport by pipelines or oNerwix,oi4 geR wexr md
thtir constimenis 5rom Ne leased premises md othu lends�egardlqy of ihe source of wch mbsbnces md Ne uclusive right of
�l�g w�4��brinF gas end oWw fluids ioto subswface strata Lesece sM1all elso have Me rigM1t of plaun6 elxtric ond
mlephone lines ova Ne leeud p�emises;the right m aect naessary buildings,tmks,towers,slniions or otha strucnues iherwo;
Ne righ[ro use 5ec from roydty sufficirnt oil,gas md weter produced from ihe leaved prtmises for all operetions ihereon
(provided it finds watu az its own ezpense). .
71k mrm"ges"as used M1aeio iticluda helium,<arbon dioxidG 6esmus sWfiv compomdv.melLme produad from
coil fo�mations and alhw commerciel gaus,yq wep es oom�el hydrocvbon gesu including cesingheed gaz.
I.essee m my timq and from time m timc.may smander Nis leax ns to ali or any put Neaof by rtcardiog an
apP���s��t of wrtender in We p�oper couoty md Nereupon fhis leex and ihe rights,rrnmis and obligatioos ot Ne
panies M1uewda shall tuminete u to Ne pnrt so surtendered:provided 6owevey Nu upon ench surtrnder as to enY Part of Me
lease,Lesxe shell mainmin such eauments righis to Ne swnudertd poNon ss mny h eppropriate m its mjoYmrnt of Me
portion mt Su�rrndertl �
When requested bY li�r in wrtting Luesee�hall bury ib pipelina belaw plow AepW in orcas utiliuA for(arming
ope2tiooa No well shell be locaced within hvo hundred(200)feet from any house now on Me leaud prcmixs without LessoPs
conseot end Lessee sholl pny for rnsoneble damage ceusW by ib opaatiore ta gowing crops and marketnble timbet�hertnn.
Le¢vee sM1WI Itave Ne right[o temove ib fixtures,equipment end niatvial;includin6 well casing from the leesed prtmises
during We tum ofNis lease and wifhin a rmsoneble time thercafter.
(I I)SHUf-➢V ROYALTY—If eRer Me primary tam of Nis Iease,all wells on Ne Iwsed prtmixs or witltin a wit
ihat includes dl ar a pert of Ne Imud premisa,ue shu6in,suspended or othmviu�rot produciog for ony reawn whetvoevu foc
a period of twelve(12)coosecutive monW,md ihae is no curtent pmduction of oil aM gss a opentioos on aeid IeavM
premises wfficient to keep Wis Iase in force and this Iwe is not othawise kept in farce by oMa pmvuions of Nis leave,Lessee
maY����lease in effec[bY�dering to Lesmr as shu4in royalty.a aum equal m 5ve dallars(55.00J per ape.Said shut-
in royelry ahall be paid or tmdertd to Me Lessor ou or 6efore Ne next eosuing yearly enniversery of Ne date of Nis lease,and
ihawfter on or bePo�e each yurly anoivasery of the date 6etwf witile ihe wells me shubin ar praduction Naefrom is not bung
merketed by Lesue.Upon paymm[ot 0e shut-in royelty ss provided herein,Nis leese will conHnm in fome during W of Ne
[ime a times while sucM1 wells are shubin but feilure to properlY VeY�u4in roY�ties shdl rmda Lexvx liable onty far Ne
amount due end sM1all not opertte to h�mimte this leau.
(1])TAXES—Subjec[m penpeph tow(4)ebove regardin6 P�'V�uction costs dl bzu aswsseA or payable on Ne
oil md gav i�IWing any ad valorem,productioq xvpenee,busineu,oecuperion or Whw eccue tnd or any inerteu in Me real
esWe taxes,or tnus iu liw of rtal eslnte taxes impottd because of Ne oil and ps apaetlons under Nis leese shell bc peid by Ne
perties he�em in proportion to tl�dr interert.
(13)LiENS-Le.ax meY.�ib optio0.peY+nd diuAuge eny past due mzeg monpges,judgmrnts,and/w otha Iims
and eocumbrenas on or ngaiost eny land m interest included in Me Leauhold Lessx shall be rntiUed m recovn my sucM1
emouvb peid from I.essor,wit6legN int<rcst enC cosrs,by dWuction from my[vw�e payviarts w 1<asor or by any oNer lewful
mans.
(14)FORCE MAJEO1tE—SMuld Lncsee be prevmceA from complyiug wiN any ezprtased or imv����+�t of
Nis lease,from eo�Wucting drilling,or rowo�king opentions ihereon or from producing oil and gas or o�ha subsmnas bY�v
of swciry of or ioebiliry to obvin or use equipmrn4 mrn ar material,or by opention ottorce majewe such as stolm flood,Cve,
or dha ecls o(God,wer,rcbelliaM insu�.tia�,rioS sn'ikes,dif&rences wiN xrorkmui or feilure of cartias a tronsport or
furnish�cilida for transportfltioo,or es a result of s lawsuit or same law,ocder m�egulation of 4w goveninwn4 or es n maWt af
shomge in mataid or equipmen4 or as a result of any<ause whersoeva btyond the control of rhe LesseF�wM1ile so
- p�evenfW,Lessee's abligation m comply wiih such covenent slWl be suspmded for sa long as complimce is Mm prcvrnkd a�d
for sit(6)montLs Ne�eatter.
2
PA PAm UP LEASE Lease No.
Rev.06.09.20(1
(15) DEFAOLT-No de�ult shell be dxlared egejnsc Ne�ssse� for feilure ro meke paymem or peRorm any
conditlons pmvidW�frr herein wless the Lesue shell rtfuse or neglwt Io pey or perfonn ihe seme for sixty(60)days after
heving rcceived written notice firom Lessor.
(16)SIICCESSORS AND ASSIGNS-All covmmts ond conditions betwern�e par[i<s heab sMll eztend W Meir
heirs,<zecumrs,sucassors aM essignc md the[.esaor hereby grnerelly wvronb and agrees ro detend Ne tiLe to Ne leesed
premises,bu[no cM1ange or diviqion in ownersitip of Ne leased pamises shall operete to enlarge Ne obiigetions or diminish Nc
rights of the I.essee.
(17) ACCEPTANCE - 7tu lease conteins ell of ihe egeemenrs end wderstending af Ne Lessor e�d Lessee
�espating rhe mbject metter haeof md no'unplied covenonis or obligetions,ar verbel repre,votntions or➢romisu havc been �
mede or rolied upon by Lessor or I,essa suppiementing or modifying this leese or ss an inducemrnt Nettro.
(18)WAIVER IN WRITING-The feilure of eiNa perry m enfarce or weercise eny provisian of Nu leau shall not
constimte or be considwed as�e wvver of the provision in Ne fuNre uNess Me seme is expressed in writing end signeA by tM1e
�espective perties.
See tt hed dd d f dd't' I 'i
IN WITNRSS WHEREOR,Ne pettiu have herouow set Neir hends md o0'icid scels Ne dete fvst written ebave.
W'17'NESS: LESSOR:
�S a.��—�rT W ro�.i.(�'l
��" ����°`�� P C7TasuE.Smith �
hone R:
�t: Print
P6ane q:
Shnderd Acknowledgemrnt
COhII.10NNBALTHOFPENNSYLVAMA )
COUNiYOF
�u-Fler } �59
Onthe�dayof ,mVW inc-Weyev20,�befortme,NewdersigneQanoterypublicin
ena ror sa;a sbre.wxnal�r aPaurcd- - l.�.m2S l t�..IYA��-�h,
personally lnown W me or proved to me on Ne besis of satufaewry evidrnce to be ihe individuel(s)whose name(s)is(ea)
substribed to the within instlument and�owled6ed to me Naz MlahdNry exauxd Ne same in hislher/thrir ce�ucity(ies),end
that by his�ha/the'v signeture(s)on ihe instrument,the individuei(s)or We person upon behalf of which the individual(s)aned,
acecuted Ne inswmene '
M WITNF_55 WIIEREOF,I hertunm sU my hend md oBciel seel.
� `�YI�.��.-�---
Ndary Public
� t}IOFPENNSYLVIWIA
. HppilYBwi
HoYYAMae�+k�Y� . �
���'���]p13
NyCamiwb^ �
3
. �
I,eese No.
ADDENDUM
Atteched to and mede a part ofthat certaiu Oil and Ges Leese
Dated: Ln7 /� �!/
,��i
By and between:Thressa E Smith a widow
Md
SWEPI LP
In addition to provisions proviously set forth in the attached Oil and Ges Lease,it is hereby agreed that:
1. Co�fik[ofTneu: InihecmtMswnflictau�cpuietmr,ybetxeenNeprinocdtwuofNuleeumdMisetlAendum,NepnnhdWms
ofMis eddmdum slWl�onlrol�vA be dxmed m aupsnde Me prinMA am�v ofNe letu.
2. Loptlm Comulhtloe:laue epees b coneult wilA tLe aurfece owner rtgvding IM1e plecement ofdl wsll sita.meES.fiow md pipe
lioev.tedcbYlaia.mG otlw aNSWrtf.aW m loctle tll ofNem LL such loceeons tlut will minimitt iiw inxrWena wiN tlrc smtece ux
oflLeleod.
3. DEPCmWi�eee:Laue'sapeleliwuonseidWMshellbeinrtoNnawiNrtgWRiwuset[oMbythePen�veylvmieDepenmentof
Enrimommbl PMeGian.
4. W�hrTMIK:I.asmfM1tlltatLeum'sdonwticwo[ersupplynmquditypnormmmmaicemema(endfollawingOrillingopw�ims
ae aeid laed in wda ro ensurt thN ssid wets sWPIY u nM tivwsdy eRwtd by said oP�ors. In the evmt rt u ddn�nined Mss uid
ape�atiau Mw Wvauly a0'atW uid water suP01Y���ussw.&ib own eKpen,ve.shell bke ell a[eps naesury m rtum seid wekr
suppty m�m v masmebty possibk ro prt-0rilling conEitions.
5. Misimiu Sail Ewbe:Loxe shdl wvwc[or insull dl well siln,uws roWS and pipelia righanf aY in e mw�er which would
minimia my mlmW mil wsim. Funher,my rtlehd surLace rtclemeGan shell be Eone i�e mmoer which wsmrts seid IeM ss nwly ro
origind canmun m�eaw�ubly pmsibk.
6. Red�n Feem:Leum ilWl p�omptly rtplece eny(encq ead ga[cs mnovcd by I.usa Ewing i6 operrtimu on aeiE lend end RuWcr,sM1ell
mnehwt gtta au dl mros meds an seiA lend upov writlen rcqupt bY�sor.
'I. Goveromenal P�vv�mo:Lasee�grm ihM ifriy pmdry,ro0bark or rtcapaue o[hrc oba[anenh wee4H m imposW unOa my
govanmmW pag'm�sudi n.bu[no[IimihE b CREP.CRP md pmn nE Orten Nu is levied on[,esw��olelY n e iesWt ofisvsee's
apa�liw an leoed pmoizs,lesue will rtimbwx Lessor upon wndm tequat md rtttipt of s copY ofMc prnalry ndia.
8. WeIlLontlae&AamRo�dFn:UpwLeasor'suecuti000PaRelwefarindiviWelWtllSih,Lesseeeg'ea�WpryLpforalocebon
fa in�he want MFitIm�7lwusenA Ddlw md 00/100(fI5.W0.00)tw uch pW cauo-uchE m tlw rvrfxe of Nc leaved Vmnixs end
uu r�w�o.ao)cae�rrvdea m usocimm Mercv.;m ror u,e v��oea�nma nonzo�w 3+�»'��:.
9. HalENoolw:LcueslWliodemniCyuMMldLawrhumlasLammyanddlli�bility,liw,demndv,jnd�mnqauiqenddums
o[anY kind a eLUaGa miaiegaw aC in ewnWion wN4 a rtWwB ro l.axe'e opvniom uMa Me�.ims o[tlde Geeu.inGUOin&DN�
IimixE m.envimnmmbl uwa.cleim[ar injury ro or daW o(mY P�^s,w dwqe,bp a Cutruqim ofnY P�Y.�^�
pemonel.laxe fuMa covuunn ud e&�m deR�W ny swb bou�[egeiml l.aeor m mr cleinu.eW w MY�Yi�e��ee�
LeamrtsWtiegfrommysuilorwitserising5omlusa'sapvtlimawdathelumsofNulaes. Lasor.ifitmelech,shdlhsvetlie
ri�t ro puticip[e.Y iu sde upenu,m ih detwim in mY auit m sWb m wltich i[msy be s pany,witlwulNieving Leeeee o(ihe
obliem��m defmd Leswr. It u the io�tion Mlssue uW Lawr IAaz Lessx slWl m[be Ii�bk m Lasor in RaPal of(uM Ne[aegoing
iid�nnnY�1 rot covc)ury claim m Ne eKhnl tlx seme rtsulmd from tlx grov oegligmce,willfW miacaNua or beA fiN�ofMe
Les�w.
10. NotieeofBreaeh: IfCwseeviolNa,Bibroperfam:wbmachesmY��V��.��^�.amMiGwuintltisleue,Levwshdl
odi(yLrsaeeinwriliogo[md�viohton,failurt,arb�each. LaveesM1tllMveaperioEOfsiby(fi0)drysGomWed�rootibrtxiptof
I.amiswrittmvdke.inwhiMm�e�oedyl�emahriNVioltlion.bilurt.abrtacM1. VLeesee9ilsor�efiuesromoedYtlrcmYeriel
violalion.bilwe.m b«¢M1 wilAin ihe pmaibeE time perioQ Leuor vuy.e�ib sde apGan.mmiinek ihis Lwe u ro dl o[Me Iwc
pmveius.
11. NaFmh�Plotli�a:WiWaWSeepv&exridma�mnentpipelinn.uap[PorMweuseCmtrwportoiluWwguGomawell(e)
drilkd m lessd V��sa a ludf P�IM Wa<witM1.shell tKKEe canwucmd on tl¢IwW Ma^isa.
t3. PuehCLUee:lotlwwmtaV�4wYwimitlereuiemWVun�wrtrothe[emuofNUlwewhichenmmPnsalmWbcekdabi0etlw
IenW qania.s md eonr but�wl$of ihe Iwed prtmieu u iecludeq tlrce i[u wduaboE W rgrtW tlw ihe drilling ar mwking
opmUaw oe rc pmdudim ffam�wdl IoratW W^^sud�P��wi[e1W1 antume Mu knc m fWl fotw�ed eBact wder as hmu bW
aoly o m ihY pwtian of tlrt I�nM Rmiiva conYind wiU�in eucl�poolW wiR Fa tlut po�tim otMe kue oot includW in i wd a
anmAed M mY ahv Provuion ot Me leau�[Me md of Uw P^��Y�R leawe msY uo-M tlw primu�'tam far an WtivaW perioE
rywl b Me V�^�Y tam DY rtWaMYmB ar tmAerinB W Lnmt.P�m M Me oWimiao of Ibe Mu^v3'tam,m wension MY��t aP 7Na
HYIIQICQ NQ������Y/\+"^.���YCIC. ��.C98G0 EXOfC�B tl115 OpIIOQ 1hC pf1YY1)'k.illl O�Ib19�M9E 9�1W bE LORf1�IC4 b bC
caYinuuu.cawumcn8 an ihe e6ectiva dtle afNis Isas mM caiYOUmero Ihe aW OLMe oVmded P�m�Y bm. Ifisaee e�ech M b
G[QClft tllli Oph00.1�101 LL IhC Nd Of tllt pl11MI}'WIII NQ OP011 Wfidtll MIKG 0��.61W.�159CE 6�W�9UIRIIQV 9YG1 Wp��0[ICl%C
pfE1011b M{�W��10 p00�IINb.
13. C��Smnu:NawitlumdinBmyMingmtlwmntr+rycowi�linNclssu,Cwxeuwtg�dMViY^BhtwM1ncaevamusewc
IuuEdd.m nY O�a^�+mC tre P+�WNm�.If Lawrwishrs b wkr iko o epwnm�iqrElo68�+s�a4�uvin8 Mc
IwN p�emius wiM sN'vG MnY.Leswr ilW15rrt 6ive Icfeeewritlm�w0a o[IEe iJm�ib ofMe MiN O�Y.tle P�a m Ne
emsiCVUian fa whitl�Ne tltiN V�Y u V�WVed ro oBa.Ne eHective ENe nd ebeNg d@e oftlic 6wctia�n0 mY dlv intamwbn
ropectio`tlw trw�cUm xfiid�Lnece bdieves xoWd be mete+itl m Ne amciu o[NC oBr+in6.lnwr Em haebY 9a^�Iseue Ne En[
option W ripjrtb Pb���8+4���^�b bY mYCM1ie6 uM iWerinB m Me Lessor anY WiM P�7's oMcri�.NaNin6 in tlus
Pm&Wh rt9uirts luwrlo 8&ve aradl suc6 slaa8�rippb.
14. RavdtlaWlehoutDedvNOe:RoydtiashallbePeiEwillwi�tONudimvforNemslsMVraducinb6���&smri^6YPe�&
���Nin&d�yyN'v�g comprtumg tlmspoNing,or othmxix vuking ihe oil uW/m gsv proGuaE hom ihe kue prtmius rtdy for iNe or
Lease No.
use. AlloiluWOtgavmyNryylWlbeGelivaedfieeofwtinbtheluikorpipcline(foroil)enEinmNepipelivc(forgay),wiNNe
exceplion o[Ipaw's prore4G slwe Muxa,memurM by vdume,w Ne ail uWor gas royeity.
I5. l7meer Clrvx: Louc m0 Lessm egrze Nu prim b�he rtmovel ofany enG tll mvkGWle limbc rcsul[ing from Leuee's openUOm
under Me hmu ofMu lare,m epp'eisel shell be coMucteA by a quelifleA Umd perty faruhr enG tsssa slWl pey l.essm Ow said
oppniW wluePrio�bhuvMin6.
16. Pcoce Pmdurine Welle:UW�writtrn rtquen Ran f.enm.l.eua shell:(e)fuia ell producinB welle.Mk betleriw.Pih.s^PVa[ors.dnp
slauere.PwW�^9^s.mW otlwr MuiV�M+��PIecM on Me kave Pmnixs.wiN e frnu eqitlle of lumiu6 ficT.B�,md cetlle:@1 kap
tlx(enw on Me Icta premius in good mpeir,and(c)kap W gna md[mca ebxd et tll tlmp,m iv lieu of pta,i�utall cW<guards.
1]. Rtlrort Pmoiw to P�e:Hllee foeditlOO�: On comp�pim Of Ny opwetlm,Lcssee NNI mtoR Ne kstt prtmisc ss neuly ip
migintl mutuvs ss rtvw�bly possiblq rtmove dl debriv,epuiPmeu,md pasontl p�opuly wM1ich Levee plwW on the lemc pmmisu
(uapl6r equipmrnt nadea[or Ne ppRe(ian ofproduung xolln.which sbell h fertwvM wiMin six(6)moMu I�eUa pamitting)eRa
a xell pxmuxntty cesya ro p�odua).
I8. W�mntvNTitle: kuwdusWadNRLessorwymnbtiNero�eidPpPr+�Y�YN�P��a�ti0eia800droNepctoflxssor's
knuw��de�eod Laae apees Net�w clsims will be vude egvvl Lessor pertainin6[o wsrtamy of title.
i9. NatleeofAWeemeoto(I.eLe:l.esseeyAel�oop{y�,p���o�itingi[LesswsssipuWorapa4ono(Wulesse,menundividedinkrcst
Ihe¢in,betlmdputy. PmviAed,M1oweva,Mrt�wtimwiheLeesorsMllnabeayui�ed'mNeevento[musi�mm�byCesvm:
G f0 N�1&Q 9Ybf��Yy.IX IOfEeOl�pBfh1ER:
b. 1p�YGKE O�l f11OgCI M G�It�QlIIIBhqI�IN
c Mellwwbelu�tld1ye11ofihusdsrosthiNpvty
20. 5 rnr ShuMs Iimlt:Nmwithsf�nding mylhing W Ne conlmy ryp�yq a u wWuslooC nd agaG Ou[Ihis ka wy not be meinbined in
fatt far any wntinuoua Wiod Mlime laneatlw 8ve(5)mmecuGve Y�Wm Me aP'uetion o(tlw VrlmuY mmi IuxmfsoldY bY ihe
povuimo(Mefhut-mmyYrycleuee. LeseaslWi[mdereetlditloodpaymentoff25pereaeutlwmdoftheNikysarandarliyeer
tbnwfler while Me IeaqeE prtmias ve shuFin
21. OII&Gu Oeh: ITiq I.ene fhdl cover oN oil riE af uW rtlahd M1
dM1er minwals.includio&bu[no[limihd b.lig�ix.cwl,umiwn,sW w�Y���Y�v��������1 bpe:�nd tll
ph gmel.coppa.ubmebNcortserenotioclWeaintliisluae.
22. AAV�brcmT.�n:NMempnyurtuaGUnycinPawylvutiamccodethtlprovidaPormi�w�ewcindvelwummmdtriWpbkro
or mWtine���seeuiuR ofoil mE gss due m oil md�u pmEuUion 5qo yk lessed premisa.Leuor uW I.axe ogee tp NiCe by
Nrc law aM pry Neu MeV�iond sAve aaordingly.
23. Releau Luse: Upw tuminetion,c�iNion w su�rtnda ofihis Ipec in wlwle w in pan md upon wnthn requat by I.usor,Lessa shW
proviAe Lwa�with ncopy ofan eppmprieh rtlenve of leau.
21. No Centni Prvewlee F�tllirv: I.esue egrtp tyY ihe Isped phmius dmeribed herein will wt h useE u e cmvel pmweiv6 faciliry
ar slaye vn for equW��[end mYUiLLS ezapt wAen�eia equiW�md mw+iWt ue bem6 uxE in MiIGO6 nd ryWuction opvatims
mNeLeawCPrtmuoakMspeqledlhnewith NtlxevootLessmnaNbi�uWlcaoPrmsioninwdcromaketNepslrommYwell
iWt vuy be eiWekO upao ihe LruW Rcmim or IuWs puobA ihwewith,Cma is�ankE Wc right wAV tFU Leau a i�uWl�wellheed
camP�wearunilforMewlspmpweofveirtinewiMtlwproAuetlonGamwG�wdlwrvdboNY. NmwentisLesseeO��Nenehlro
iMNI e lugv mgiaoel wmpmwr�ile upon Ne haew LesqM prtmiea if tlut compmsor u lo be utilixd Lm otlw well sita tpt sitwhd
upon ihe M1ertin Leaved Premisa rn IenQ�pooled ihertwiN without Cust having negotimN e upuale canprtasw srte e�mivnt from ihe
Lessor.
25. AY914: Luuec(urther yanro W Lesfor Ne rigM1t uinuellY b exwine.wA4 ar impect books.memOS.uW ecwwh of Lesrce Pr+�iornl m
the puryou of vaityiog tlw sccdw7 of IAe rtpmts�od abkmmb fumishd m Lusw.end(br G�vJdng Me niwmu of OaY�ls lew[u0y
due tlie I.euar w0er the�amt otMn eganwnt In uertising ihis righ4�<esurMW B�'e rtcoiuble iwlia m I,essee of ib intrnEeE wEi[
vb wtA wdit shdl be canduckd dming narmel bminm Aours et tlw oifim ofCeaa.
Thu eddeedwn slWl na NFmI tlrc cums md m�kians stt(onh in Me attachd Isme in eny mumer except u sct fMh huein.
� � penn�ylvan�a
. '� pEPARTMENT OF qEYENUE
INHERITANCE TAX BULLETIN 2012-01
Issued: Juty 10, 2012
Revised: July 13, 2012
Taxation and Valuation of Mineral Rights and Na#urai Gas Interests far
Pennsylvan�a Inheritance Tax
Under provisions of the Inheritance and Eskate Tax Act af 1991, (72 P.S. §§ 9102, 9121),
the Secretary of the Deparkment af Revenue {"Department"j arrnounces that khe
Department has clarified existing pepartment policy concerning the taxakion of mineral
rights and natural gas interests for Pennsylvania inheritance tax purposes. All mineral and
natural gas rights shail be reparted on Inherrtence Tax Schedule E (REV-ISQ8) as Cash,
Bank Depasits &"Misc. Personat Property. The Department cfarifies its policy as foilows:
(1) Tt�e taxaBle value of minerat rights shall be deCermined using Che same
methodology used to vatue any reai property ar tangi6le personal property
interest. Taxable value is established by determining the actuaF monetary
warth of the interest determined by either a bona fide sale or, if the transfer
is for na or naminai consideration, computed value {based on the common-
level ratio applied to the assessed value of khe mineral right). In khe event
thak there is no sale and no computed value, then the taxable value is the
interest's actuai monetary worth, based upon the best avatlable evider�ce.
(2) The taxable value of natural gas rights shall be determined using the
same methadoiogy used to vafue any reai property or tangibie parsonai
property interest. Taxable vaiue is most ciearly established by determining
the actual monetary worth af the interest determined by a bona fide sale. If
there is no bona fide sale, naturai gas rights can be determi�ed frpm an
appra(sa[ or other credtb{e avidence. A computed ualue using assessed value
cannot be accomplished because natural gas rights do not have assessed
values. Therefore, absent a bona fide sale, an appraisal or other
credibFe evidence to the contrary, vaiue shaii be determined as foliows:
(i) For leased and producing properties, an estate shall value
naturat gas rights at an amaunt equai to any amounts received
that were attr3butable ta actuai production of the naturai gas
interests at issue during the twelve months prior to the
decedent's date of death, multiplied by two.
(ii) For Ieased, non-producing properties, i�terests shali be
reported at a value of zero unless, at the time of death, the
properCies were part of a conCrackuel arrangement whereby ttre
properties generated flxed future payments, in which tase the
Bureau aF individual Taxes E P.O. Sax 280641 j Har{isburg, PA 1?iZ8-0601 i 7ll.787.8327 � www.reverzuestate.pa.us
Page 1 of 2
natural gas rights shall be calculated by reducing the fixed
future payments to present value as of the decedent's date of
death using established Internal Revenue Service actuarial
tables as found in IRS Publication 1457 Actuarial Values Table
B, Section 3 Annuity, Income, and Remainder Interests For a
Term Certain.
(iii) For non-leased, non-producing properties, interests shall
be reported at a value of zero.
CONTACTINFORMATION
PA Department of Revenue
Bureau of Individual Taxes
Inheritance Tax Division
P.O. Box 280601
Harrisburg, PA 17128-0601
TEL: 1.717.787.8327
www.revenue.state.oa.us
Bureau of Individual Taxes I P•O. Box 260601 � Hamisburg, PA 17128-0601 � 717.787.8327 I www•revenue.state.pa.us
Page 2 of 2
cbMMONwEAtTN Of PENN5YlVANiR ftEV-1762 fX{7 Lq$}
OEPARTMENT OF REVfNUE
BUREAU OF INDIVIDUAL TAXE$
DEPT,280601
HABHISBURG,PA 1112&-0861
PENNSYIVANIA
RECEIVEp FROM: INHERITANCE ANp ESTATE 7AX
OFFICIAL RECEIPT
NQ. CD 017839
SMITH JAMES W
315 ROBSON RQAD
DILLSBURG, PA 17019
ACN
ASSESSMENT AMOUNT
C�NTROL
NUMBER
-'."'_ mie -'-'_--'
101 � 5886.65
ESTATE INFORMATION: ssta: (
FILE NUMBER: 2112-0858 �
DECEDENT NAME: SMITH THRESSA E �
DATEOFPAYMENT: 07/05/2013 �
POSTMARK DATE: 07/Q2/2d13 �
C4UNTV: CUMBERLAND (
DATE OF DEATH: 07/1 Q/2012 �
�
TOTAL AMC}UNT PA(D. 5886.65
REMARKS: RCPT TO ATTY
CHECK# 1014
INITIALS: D61
SEAI RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
�'� r.�.���' LAW Estate Planning • Elder Law •Special Needs P[anning
20pp Linglesti�wn Road res.: (717j 54tW332
Suite 202 ens: (71'n 540-4313
Harrlsburg,PA 17ll0 www.HazenEiderLaw.com
luty z, �al�
Regiscer of wiils
Cumberiand County Courthouse
One Courthouse Square
Cazlisle,PA 17013-33$7
Re: Estate of Thressa E. Smith
File No.: 21-22-085&
Supplemental Inheritance'Tax I2eturn
To: The Register of Witls:
Enclosed for filing please find the original and one copy of the above-referenced
3apglemental InheriEance Taac Return, along with a capy of the first page of the
Tnheritance Tax Return. Please date stamp the first page of the return and return it to my
affice in the enclosed self-addressed envelope.
Aiso eneiased is check#1015 for the filin� fee in the arnount of$15.p0 and check
#1014 in the amaunt of$8$6.65 for the tax due.
Tf you have any questions or require any additional information, piease do not
hesitate to contact me.
�
Sincerely, c a `'' rn ,,-"',
� A G '+7 q
���.,�.P ����1��
Corinne Eggers V�o°'dki�Yase.z, � �
Paralegal �, o -�,� � _ -"
Enctosures � � ,--� r= n;
�a James Smith,Ex. q � � cn �
.w,r � __ __ _
�I � �•'
� ���.
m� .��
�,
�� °�
~o _�>
� iaa -,,:.
�"���il� r rc
:>,�-
��
a ou
� � u��>ir�i
� � ��_.�
�
�S031Mn o<i�
� d
u. N ,"� F-
O -F � �s � O
�" �. � O CJ G�
i.:_ � ,,.- Z
'..r_ �G N Q
:, ,� r..- z ,.�
M � sw �
- U- m
�s_� ' _ —' cG � G,
_��� "�":�". � � '� q
r:� �y � V O
U� u- �
v^... � N
� O � �
e3e C� '-' ti U � �
�) � � _' � � °
�. 3 �'�' 3 t^ � '-'
o Q �
^C � `�' p" � o o ¢
'_' ,� °� b0 � U � a
W � � � N � � N
C C V] .p •� � p ..-�
�il � („) i.
xo '� � U °' U
° '�', O
o 'a
N �
i.
N
�
�
�
O �
F-
(
�
i
i
i
.