HomeMy WebLinkAbout95-00973
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If line 18 I, greol.r Ihon lino 19, enler ,hll difference on lIno 21. Thi, h the TAX DUE.
A. Enle, theln,.r..' on ,hll balanc. dUll on line 21A.
B. Enler thelolal allln. 21 Dnd 21A on line 218. Thlt it the BALANCE DUE.
Malle Checlc Pa~abl. tOI Reall.er 0' Willi, Aglnl
I BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH
~nd.r penulti., of perjury. I dodor. thot I hc.... uominlld thit tolurn, induding ouompanling Ich.dull' and ,10111 men". and 10 ,hll bel' 01 my "-nowl.dgll and belie',
Ill, 'rull, C eel a completll. I declor. thai all ,eol..to'lI hOI bllln '.pOltee 01 trUII marko' value. Declaralion of prepare' olh.r Ihon the p,nonel 'opt.lenlati.... i.
balld 0 I in' lion 01 which pr'pOl.' hOI any t..nowllldge.
"ON" "-_. - O:'''"10a''~~'oa:~''I/5-;rJ::;:i1:L/J/_LC-'MJ)!Ii~7iJ7~t'L--_ D~(ZE8ftS-
!.ICiNATUllt O' i'll".uIlOIHIA hlMj .".nlt~IA11...1 AD081!l~ - - ~_.- - - DA!f -
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fOA DAIISOf DEATH AnlR 12/31191 CHECK HIRE
INHERITANCE TAX RETURN ~o~::~yUmDIT IS CLAIMED I 1
RESIDENT DECEDENT fill NUMBER
(TO BE FILED IN DUPLICATE 1. I I qq 5 q 7 3
WITH REGISTER OF WILLS) l(ou~ly COOL n.. <<UMBrA
I)IiI/'t'-~'IJI'il/;)\~+ I c~k7ltAV~
CMsJ.v~, C~,eZ".llC,I"A /7or3
("..Ia.~f:~~~,e.."
...
as
lil
lrl
Q
(O"'\lOt~w( AIIH 0' f'IIW':l'fIVAt"A
UI'ARlMIUI 01 ''''HUlI
flIf'll1MIlI
I4A1lIlI~I\JRG 'A1111l0hOl
[lIClllltll!l Il''''IIL'~ 'I.~ AlllI ",,/JIlLI ,tll' A'I
[)AVM R,ICIIA/!/)
,o7';i:''3''O.'':.tJ''''I7 ]"'11;8/'~S" ]~Sl;~/ 01-
~''';;:..:-'-''~'''''''''''' "..,,,,, ,." ...,. '" ,,'.., 1"" ","""," .",.,"
~ t Oliginal Relurn ! I '} !tIlPf)l.m.ntnl R.tuln
{] A. limil.d hlot. [ J An ruluI. Inl"..1 Complomiu,
I'or dot.. of d.ath alt., t,}.I,}.811
[] b O."denl Di.d tellal. p< 1. Dec.d.nt Maintain.d 0 living r'u,1
(Alla,h copy of Will) (AttQch copy of TruIl1
ALL CORRESPONDINCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
..,. €rd!. (}, ~ rJ/3e!.. co.""' 7?SE'L/~N ;:X/dE
__8 _______.2)...______________ --.-----------
:;'J)7~~7n___~t~'{9f/~!;t('l-:-Z!~;Jy~~, _~'c~:s!l&~~tJ~1~,,(?t?~~:_f~ff!~c-~,
l. R.ol fltal. (Sch.dul. Al 11) ---. --- ... - -
2. 5'0,1, o,d Bo,dl(5,h.d,'a B) (2) _.. 1'0 0'/ ~'i
3. Cia Illy U.ld Slo(~/Parln.,.hlp Inlere'115ch.dule q 131
.t. MorlBog" ond Nol., R.c.i"abl. IS,h.dul, 01 (4 )
.s, Co.h, 8an" C.polill & Mile.llon,oul P.llanol Prop.rly (.s) --~__-~~1... :!'Zz ~-- ~L1 '-..
(5,had,'. EI
b. Jainlly Own.d Prop.rly IS,h.dul, f)
7. T,on,f,,1 ISc.hdul. GlISch.dul, LI
8. Toto\ Gran Au.l, (Ialolll".. 1.7)
q. Fun"al hpenl.l. Adminhlrotin COI". Mi".l1on,ouI
hp.n... 15chedule HI
10. D.btl, Morlgag. lIobilili... lI.nl (5ch.dul. I)
11. Tolal Deductionl llatallln.. 9 & 101
12. Nel Valu. 0' Ellol. (lln. 8 minUI L1n. 11)
13. Chalilabl. and Governmental B.qu.", 15th.dul. J)
IA. Nel Value Subi.d 10 To. (lin. 12 minUIlin. 131
15. Spoulol Tron,I.,1 (for dalel of d.ath ah., 6.30.941
Sit InlltuClionl for Applicabl. Perunlage on RIV.n. (IS)
Sid., (Indud. volu.' from S,h.dul. K 0' Sch,dul. M.I
lb. Amounl of L1n. 14 IOll.obl. 016% ral.
(Indud. valu.. from Sch.dul. K or S,h.dul. MI
17. Amount of lIn. 14 lall.o'Jl. 01 1 S% ral.
Ilndude volu.. from Sch.dul. K or Sch.dul. M,)
lB. Principal loll. due (Add loll. from linel IS. 16 and 17.)
19. Cfldill Spoulal Poverly Credit Prior Paymenll OilcountS'! Inletell
______ + _.________. +_$3.s:.'_ -______
[ ! 3
I I ~
.0_8
Remainder R.lurn
Ifor dol'l of d.ath pfiol to 12.' 3.8'}1
fttderol hlol. fa. R.Mn R.quiled
folal Numb., of Sof. Oepo,it BO.'I
..
Q
5
~
..
u
w
..
161
(71
1 B I _L~'L$9'LL!?J___u_.
(9) ____6___~_~f:..__ I'/_
If ~l..~_,_/t/_
10_ 9S~~!3.___
L 7~~~(L,-3.'?___
1101
1111
(12)
(131
(14)
I ?a-~3o-!_~i-
___M..____
(161 .11)1' ~3o . 32
10 7/7 .
'iJ2.
M 06.
117)
._l< ,IS a
..
Q
~
...
i
:II
Q
U
(1B) .lI~_.Jj7... Jj'_?-'_u
20. Illino 19 i, gr,ol" Ihon lIn. 18. onl.r Iho dill.rence on line 20. Thil il .h. OVERPAYMENT.
eo
(19)
(20)
____5;56'. 8'f._
_'-~_LIJ I_,__q~_
jO_La{o_~2_
~
...
ChlKk here if you Ofl' .oquelling 0 .olund of your ove.pavment.
21.
(21)
(21AI
(2181
Act '48 of 1994 provld.. for the r.ductlon of the tax rat.. Impo..d on the n.t volu. of tran.f.,. to or for
the u.. of the .pou... Th. rat.. a. pr..crlb.d by the .tatut. will b.1 .
. 3% (.03) will b. appllcabl. for ..tat.. of d.c.d.nll dying on or aft.r 7/1/94 and b.for. 1/1/96
. 2% (.02) will b. appllcabl. for ..tat.. of d.c.d.nll dying on or aft.r 1/1/96 and b.for. 1/1/97
. 1% (.01) will b. appllcabl. for ..tat.. of d.c.d.nll dying on or aft.r 1/1/97 and b.for. 1/1/98
. Spou.al transf.,. occurring on or aft.r 1/1/98 will b. .x.mpt from Inh.rltanc. tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (.....) IN THE APPROPRIATE BLOCKS.
1. Old d.cedent make a transler and:
a. retain the use or Income 01 the property translerred, .......................................................
b. retain the right to designate who shall use the property transferred or Its Income, ...............
c. retatn a reversionary Interest; or ...................................................................................
d. receive the promise lor lIIe 01 either payments, benellts or co rei .......................................
2. II death occurred on or belore December 12, 1982, did decedont within two years preceding
death transler property without receIving adequate conslderatloni II death occurred alter
December 12, 1982, did decedent transler property within one year 01 death without receiving
adequate consideration'.................................. .... It........,....... ........ ........ ..... ,... II.........,......
3. Old decedent awn an 'In trust lor' bonk account at his or her deoth"'....................................
YES NO
x
X
,(
X ItA
x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
". J
,,~~.~C\
-i97J.A.:
,COMMOI~wrALTH Of '(NNSYlVAHIA
INIIU"AN(f IAI 'If TURN
RUIO(Nf D~~.!.ofN~
ESTATEOf
l SCHEDULE B
STOCKS AND BONDS
__~_-===~~=o=~~~~ =~FItE NUMBER-~~-
Rlc~ J)11()8Gf...
(All proporty lolntly.ownod with Right of Sur.lvorlhlp mu.1 bo dlulo..d on Schodulo F.)
ITEM
NUMBER DESCRIPTION
I.
,z.
:3.
t.f.
0:
POl1J tJ"'7E~ /..(6)VII> ASS€; ~<>
(P.
1.
FMNK(jN ,04 TAX 11<'s; ~"'E.. !tJAJ/J
8AAlm,.J #J&fE $~/e.5
r:t!i ~ eKJ/1 i1J1... Gt>veWlJtOVr ~t/(;€:r
ia::~ !OAl!) .Jt tJA1!ei jJ ALS
7Cu l/)tJ ~ 1XtJ.H' ~2.
J1cqpJ tJ 11!a Ii'.f 6tJV T t3ECS 71ft) J;r
TOTAL (Aho enler on lin, 2. Reca Itulation
(II more .poce i. ne.d.cJ. in..,t additional ,h..ts 0' lame a11..J
VALUE AT DATE
OF DEATH
.18
1f17'13.8()
3q 00'1. 80
17 d'H'I. oz.
~ b se.s: tfo
/'1 {pI. 7:5
IS" z.cf/. L/c..
S ~ ,p{.1. ~e
-
. IIYUOl~t If I"
~j~
COMMONW(AlTH 0' P(NN"tyANIA
IHHnl1AHCI TAX InUIN
11110' Nt DletDINT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
PI.a.. Print or l .
FILE NUMBER
ESTATE OF
-.E Icl#lf.b [)lIuf>c/(
(All prop.rty lolntly..own,d wllh tho Righi of SurvlvD"hlp mu.t tI. dlscl...d on Schedule '1
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
/.
:(.
t!.Ilsl{ IN 4Jl9urr
IJtElttIx:V n'Lff h.~ dGtJ) T dAJtt:JAi-
(~,qV(AJ"r)
( 'S c;/ee d.4-tI h)q.I)
,.
~ 11# ~e(~r c/N1t1fZ1.
lC~~)
~ s: 5"S"
~"J.3
o?'Cf
. .!J I
Sb
3.
,
I
.11 'Z:. ~~. 5"/
s ,Z 0/ o.u... t.(:3
(Attach additional BYaH )( 11- .h.." if mot. .pac.it n..tted.1
. Uwl\lI 'n [1"1
~
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
CQMIoIONwlAlIH Of PI rm!ol'tVAWA
It4tH.nArKI ,.... IllhJllr~
Rl!olOltH D'ClD''''
ESTATE OF
__8i~ 2;1J<!8i3:j(
ITEM
NUMBER
PI. a,. Prln' or Typ.
rENUMBER. ....... ._.
. .. . ..---.--..----- ----_.
A.
1.
;z.
J
"
5"
~
"1
f
B.
1.
4.
C.
1.
2.
3.
4.
S.
6.
7.
8.
DESCRIPTION
Fun.ral Expen,.sl
;;IJI/IJU ~'?JIoU /v,,;19t;fc.. #-",e.
~ 7. f1.mc;u::r .:. ,",kit ;I}t;f' S
-:;r.IA1IC1ul t?1l44.oJilr
j:"IJ,fN4 ~Q~71 Mv! AMSf
'IUJ.<'/U M~M~IC/;fc. JtXI!ltE 4MtI& ~~.dc
7~sI,;;r.. Gf ~J'E:1
~cJ.().IM- .I'~" .:>r ./R';;l)c.t:J (!@(C';l3(y
R-,MJI;If!J
Admliililrallv. Co,I"
Perianal Reprelentative Comminlonl
Social Security Number of Perianal Roprelentotlve: ___
Year Comminionl paid ___._"._._______4~___
2. Allorn.y F... ~
3. Family Ex.mption
Claimant
2.o~. ()O _____ R.lotion.hlp :7ct1U(Qe:C'U~
Addren of Claimant at decedent'l dealh
5tr..t Add,... _lI5(>_~dAl o,ti"v'a
Cily __CM..td~._____5tol. 7A . Zip Cod. (')0.."
Probolo Foo. t\Jt)AJ€
Mlsc.llaneou. Expen.e'l A. ~ ..,.. ,
~~..; ,tJfflte hJ4 ~~ "€7f8(J~~/V,Q'l?~
(.11 7!S. (y- If' 17. U
~7ACC (t.A~EhttdUN; :l> oi1EASt:71r,)
7l=.I..EHN (flni fi ~4H'h - "".tt.9..J6~Alev7~ e72)
kAtdiJ& ~ I~N/tt- 17O+1J C. /8;fJJ( &M:'J)
ulaa #;;U~ ~ €d1lh""f- u'b,ld ~ €1-PW
Iil'JdJ I rAt" /GubJ E.7C. "C:)(~J@ $-..GS;~
AMOUNT
7"5". ..
lodJd'D
~tS'.-
I (c."
I 0 7$". ".
5""c. :f'c:>
--I~o.~
4fS". c:b
ZL)oo."~
15'0. 5'2.
95. '/-0
I '7tf. ~4
~~. 3'-
I o<JO. (JD
TOTAL (AlIa onlor on lin. 9, Rocopitulation) 5 t:., .3S-. 71
(If more 'pac. I. no.dod, In,.rl additional .h.o" of ,am. ,In.)
.
, .
'IVUUI'.ltlll'
Ib'
~' .~
~.
. (OMMON....'AllH 01 't~NUIV.NI...
INHllltAHCI f.x "'U'III
. -..-- ~~!~~~~, ~~~.~~~! ".....
SCHEDULE J
BENEFICIARIES
L
ESTATE OF
FILE NUMBER
ITEM
NUMBER
NAME AND ADDRESS DF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
1.
A. Toxobl, elque.":
PfTE(. J. '/dhJMl.
11.0 L! AJ,J "De/lie
~~/A
(O!b No J[l:4N/J sr
;5MJ;loJ€ I ~
~N
lis'
2..
DIE:.nt ~~
'fo,.J
lis-
3.
~ -'VMel
c:])~
~l..IO G:--y~
:M1Itco:I V ((..(.E I NY
])~6#
lIs-
1.
f2..[~ ]:J4u&JZ-
/a!/~I ~-thA w
~u~A,cA
SoAl
//~
~.
'JMd/"/)'J J4J1JB( $"Ie. tf. iJt.:M.-(!L.(
fdou~ ~.7l.1.-
tb,.)
I/r
ITEM
NUMBER
NAME AND ADDRESS DF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Beque,ts:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Allo .nl.' on lin. 13, Recopllulollon) S
(If more Ipac. II n..ded, In..,t additional ,h.... 0' lam. 1111)
.
.IVUIJ".."'''....'9.
SCHEDULE I
CO....l,lONYwU'I>l 01 P1w+\m""ll,l. DEBTS OF DECEDENT,
"";:::~,"~\,,,',~.,::::;". MORTGAGE LIABILITIES AND LIENS
..m ..... ... . . . . ... ..... ..... Ploo.o Print or .Tvpo
~;;;~/LMQ~,{...... .. ............._________rLENUMBER ---
N~TJ.~ER C--.----.-... .--..... H.~;~~;I;;;~~..-.---.__ AMOUNT
1. C~(J/;' CAIW -j)jii;, CIl;(sr CARbT---- Cf7. e:>o
oz.. ~.iHM!,!"l.L (S~US &UJN'1) 1,;,/.'1'~
.3. ~I h91f.it ,#()YE (IkYE ~AJtZ7) il.P(j(). De>
l/. lGTu.w ~ ~lr/l. &i:A:.tM''''/'''''AlBlJi (st;:?' '7&') a73. Co
!. ir.?,QtJI.,U ~ ~y~ 7i/JA (dU f'':::NStr','/{Sd''1S') 2.0/, ~g
to. €. /V~;ffi;r~ wr~t9l~ &'t..... 3$. Of
7. '11t?L.~~~ jlli/tf!,)~Ai,J6 /lui*~ /J.;L.c.J 130,5"
(?'?~ oz. _.r;'f,,,,,, -' -st/.Gl0
~. /J..I<E 1ft>.JI'l'77n- (lU-AJiPf ./'L/P.(. "P ~7./'7fir/9J;
r. orlY!. A<~~L,1.,,'U.I I *
~ket)(udvaiiJ€ c:IoLGet<;c:;Cc!9J~ IA-
-(!Attc../t-cE: bUMH.A7Ju[
- KtAX!. 611U~~ jJ;~..h(u'MJ
- Mul~ ~'Uh- edA~A-il(;N
("-1.79 _.r .:5?'Si9)
-~c.1 tU .:zMA~f.J4 .4-.r~~n;:!
:if t)fRi " At:-<.. 4t~' e;;t-t. ~ cA..!' Ar€!e' ~
,.udk~ I /77'/) A7lJd ~fE'~.I'.l
~~ v"',/4.€tLJ
TOTAL (Aho enler on line la, Aecapitulatlonl
III mar" space js neuded, inse,' oddifionol ,hultll of same sile.)
7/(,., '2.2.
71,~o
S,".7'
(7. ,/-1.(
'-19. ~7
I. 92.
$ 3/8. il/.-
"
W.13
~l3t ~iI1l1nb Wrst1111lrnt
KNOW ALL MEN BY TIlESI' PRESENTS: Thall.
oflhlc{.yrrownof - Carlisle
Ind SIIIO 01 - Pennsylvania
Richard
DAUBeR.
r.UIlIberlund
. Counly 01
. being 01 wund Ind di.po.ing mind .nd memory. do make. publi.h and
declare Ihe lollowing 10 be my LAST WILL AND TESTAMENT. hereby revoking .11 lormer Will. by me al Iny lime
herelolore mlde,
FIRST: 8)' the cJtcculion of one: or more .cparate inler \'Iyo~ trusl insuumenls. I have made provision (or the non-probate
distribution of my ancll I' the time of my death. Thl. instrument is intcnded lolely 10 specify the dhtribullon of any forgolleo
or unanlicipatcd IUC" not coyered by such inler vivos trUl,t imlrumcnU..
SECOND: I direct my Executor. herelnafler named. acting in ,ooeen with the Trulotcc:rrruslccs of luch inler vivos tru,..,
10 PlY all my funeral expenses, admlnsultion upen5u of my CUBiC. including inheritance and iucccnion taxes, state or
federal. which may be occasioned by the plna,e of or 5uccc"lon 10 any inleresl in my cslate under Ihe lerms of either Ihl,
inSlrument or the .foruli'd Inler vivos lrust InMruments. Ind III my jusI debts. uccplln(!. mort(!.a,c notes sccured by monSlses
upon real cllale.
THIRD: Alllhe reS!. re.ldue Ind remlinder 01 my e.lale, bolh rell Ind pellonal. 01 whal.oever kind or chlrlcler Ind
wheresoever siluated. I ,h'c. devise and bequeath 10 my chlldn:n. nalural or adoptcd. In equallhares. per stirpes.
FOURTII: I reque'l Ihal
(Nlmel
N/A
. of
(Addre..)
Numbtr
SlrUI
Cil,\'
Slalt'
Z/I'
be Ippolnled gUlrdian 01 luch of my children a. .halllhen be minD..,
P t F n h ::'SN n".;().(NiS
FIF7I1: I mike. con.llrule and Ippolnl e Ell'. R 11 R to .
"' E..culorlI;...ulri- pf Ihi. my LAST WILL AND TESTAMENT, II helofte .hould be unable or unwilling 10 .erve. I herehy
Ippoinl Tnp;rid P a u b e r "' .ucht/",,J./r1E.eculrh, Any E.eculorIE.ecutri. .hall
KrvC wilhout bond. .
IN WITNESS WHEREOF. I h8\'e hereunlo,o )' hand and .e.I.1 /f11't',(~,(,II("sj(/,l'q It?,
IhlS It #.' dae or 'tq<.L 19K.c.J (i
, '(.ignhm) . ~'d~eJ ;o~~;> L,S,
Signed, sealed. publi.hed and declared 10 be hlWher LAST WILL AND TEST AMENT h)' Ihe wilhin named Te.lalorl
Ta,lllIi. in Ihe pre.ence of U', who in hlslhfl presence and al hi"llM requeS!. and in Ihe pre..nce 01 each olher. have hereunlo
subscribed our names as wiln~t.ses:
(I) ~-:~ afP-
(2) it 'A'Ltk '
01
(Y\r.~~~ I...~l,...,
City .
01 /Jkr/p"''r~bM.,
Ciry ,
('PO
SIOIt
;:JrI
StOlt
(3)
or
Ciry
SIOIt
Yt . .
.....~~:.~_.:....~.. t' :;.,.... .' :. ,'4 . ..~.,. ~:'._ ... _~. ~ ... '.. . "a~...:~::/.~...:.... : ~.
AFFIDAYIT
PENNSYLVANIA
~ Cily
or
Town
lilY';""".",!
Ind (3)
Atf't'III.v";,;.{W1 /J.
STATE OF
COllNn' OF CUMBERLAND
Penonllly Ippelred (I) < Y;"H .I
(2) .Ilr'_v/"", 4" ";':'.1' (
who beln, duly Iwom, depose Ind uy thllthey lun,ed the uld Will Ind they lubscribed the ume It the request and In the
presence 01 thellld Telll,orlUlll,r;. Ind In Ihe presence 01 elch olher, Ind Ihe uld TellllorlHlMlti.II,ned uld Will In their
presence Ind Icknowled,ed thlt heloM hid Il,ned uld Will Ind decllred ,he ume 10 be hlllltw LAST WILL AND
TESTAMENT, Ind depone nil fur1her 1IIIe Ihll lithe lime 01 the ..ecullon 01 uld Will the uld Tell"lorr-r..,".ria Ippelred to
be 01 Ilwlull,e In~ sound mind Ind memory Ind Ihere WI' no evidence 01 undue inOuence, The deponen.. mike thil affidavit
lithe requell 01 the TeIlIIOr~et"l<iI. t
(I) &,-t\ :i f\Zr-.
(2)1 i ;'N!;;t k.' ff
(3)
Subscribed and Iwom 10 belore mothll
trll..
, 192I:
dlyol
(NDI.ry St.l)
.
p..,.~ .'e:. .,
"h-:f~ F .~ ~.', .", ~~ ~:"i' Pl.t!:
H;\'1'f~-_ '~"..~.~ ,'~,; ~"'~(;:vt,.
f.t,Cc.Ttll.;.;.,.'11:,. :z"~i::7.1J','G
tA~)t,;illoJ'~.......:.c11.Mlot'~
. .
;. .\
o
DT.l0S
.Errhmrtioll of 'ffirust
H1cfinrd U A U B k H .
WIlEREAS, I,
C6y, To...n ol--CRrll "1,,
I or the
,Coun') 01 -CumbeI'luncl.. SIa.. of
p..IlRayl-Yttft-lu
am the owner or one or morr checking or IIvinF' Iccount, or ['c"Welle, or dCl'<nl1 In ban~in~ InstHulion., lUch Iccount.
.ubject 10 thb Oecl.rlllon being idcntiflw h)' Ihe (ollowan~ lonn or ITI"t'Dllon:
Hichnrd II a u b 0 r ,Tn,,'.. uldll da,.d f. .T1In.. 1995
NOW, THEREFORE, KNOW ALL MEN IIY THESE PRESENTS, Ihal I do hmb) .c~nn"l.d~, and declal< tho. I hold
and will hold ..id bank aceoun" and all m) riKh., lill, and Inl<rUI In and '0 ..id accoun" IN TRUST
J. For the we and benefil 01,
(Nam,)
(Add"..)
Petor F.
pnubor
Carlisle
Cil}
1701)
Zip
.01
1150- Linn l'rive
Numbtr StUrI
Penn"y]vAnl"
Slare
If because or my ph)'sicat or mental ioelpach)' ccnlfied in ",,'rillng by . physician. the Succcuor Tru51ec herein.her named
ah.J1auumc ICII\'c adminilolrlllon of Iht. crUll durin~ m)' lifetime, luch Succcuor Tnu,lcc ,hall be rull)' luthoriud to invest.
rtln\lcu and olhel"A'h.e man.ge the truil', .ueHs) as he shall dcem approflriate, paying 10 me or di5bursin~ on m)' behalf
luch ,urns (rom income or principal I' ma)' .ppelr necenary or desirable for my comfOr1 or welfare. Upon my dealh, unlns
the beneficial')' ,hall predccC'lse me or unleu we both shall die as. a rcsuh of. common Iccidtnt or disaster, my Successor
Trustee is. herehy directed fonhwith to transfer lIid ban~ ICcounlts) and all ri~hl, Iille and tnterell in and to laid .ccQunth)
unto the beneficiary absolutely and Ihereby lenninale thb lruilll; pro\'idcd. however. lh.1 If Ihe beneficiary hereunder .hall
nol hne all.lned the lIte of 21 ycan. Ihe Succeuor Truuee .hall hold the lrust auetl in conlinulng lrull uncil luch beneficiary
.hall hl\'e aHalned the Ii!e of 21 ycats, During .uch period of continuing truslthe Succeuor Trulolec. in his absolute dis.crclion.
m.)' relain the specific b.nk IcC'ounHs) herein deflcribed if he belle\'es. It 10 be in the besl interesls of Ihe beneficial')' 10 do
10. or he mlY lenninalr' h. investinf: and reinvesting the proceeds 15 he mil)' deem approprlale, Prior Iu Ihe dalc upon which
luch beneficial')' analn. Ihe Ii!e of 21 yean. Ihe Succeuor Trustee may 8pr!)' or expend any or all of Ihe incomc or principal
directly (or the malnlenance. education and sUPJ'O" of the beneficiary wilhoulthe Intervention of any Buardian and ",,'lahout
.pplicllion 10 Iny coun, Such payment. of income or principal may be made 10 the parents of such beneficiaf')' or 10 the
pC'Bon v.'ith whom the beneficiary is liVing without an)' liabilJt)' upon the Successor Trustee 10 Ke 10 the IpplieDlion Ihereof,
J( such beneficiar)' survlvcs me but dies before '"linin, Ihe age or 21 ycan. at his or her death Ihe Succc5Ior Truslee .hall
ulnsfer. pa)' o\'er and deliver the lru!:1 propcny 10 luch beneficial')"s penonal rcpresentati\le. ab!looluleJ)',
2. The beneficiary hereunder ,hall be liable lor his proponionate ,hare 01 .n)' I.... levied upon the Sell lor', lot.ltauble
ella:r by rea,on 01 Ihe Senior', dealh, .
3, All inlerell5 of a beneficia')' hereunder ,hall be Inalienable and lree Irom anticipation, a..ignment, allachment, pledge or
control by creditors or a pr..ent or f~rmer 'POUle 01 ,uch b.n.ficia')' in an)' proceeding, a,la,,' or In equit)'.
4. This tru,t is created with the ..pre" undemanding thai the bank al which the account i, main.ained ,hall be under no
liabilil)' whatlOe\'er 10 ~e 10 iu proper administration. On the conlra!)', upon the transfer of the risht. tllle and interest in and to
luch account by any trustee hereunder I nid bank shall conclusivel)' Ucatthe Iranderee as the sole owner of uid account. Unlil
Ihe b.nk shall recei"e from some person inlereSl.d in thi, truSl, wrillen notice of an)' death or other e"enl upon which Ihe right
10 receive may d'pend, tbe bank ,hall Incur no liabilit)' 101 payment' mode in good laith to person' whOle intere'" shall ha"e
been .fleCled b)' ,uch e"en\. The bank .hall be protected in acting upon any notice or other inSlrument or document belie"ed b)'
it 10 be genuine .nd to have been ,igned or pr..ented by Ihe proper part)' or pani..,
S. Iteserve unlo mr.selllhe power and righlto collect any InlereSl or other income which may accrue from Ihe lrull propeny
and, in my IOle discrel on II Tru..... either to accumulale .uch Inler.,t or Income IS an addition to thetrusl a,,". being held
hereunder or pay .uch Intere.. or Income to my..1I a. an individual. I .hall be exclusively entitled 10 all income accruing Irom Ihe
lru.t propeny during my liletime, and no b.neficiary named herein shall have .ny claim upon .ny such Income dillributed to m.,
6, I reserve unto myselllhe power and right a. any lime during my Illetime 10 amend or revoke in whole or in pan Ihe lrull
bereby cre.led wlthoullhe necenlty 01 obtaining Ihe con..nl 01 Ihe beneficiary and "ithout giving nOlice 10 Ih. beneficiary. The
withdlawal by me of the whole or any pan of Ihe bank account held hereunder shall con51itule a. 10 such whole or pan a
revocalion 01 Ihl. lrust,
7. The death during my lifetime, or in a common accid.nl or dillller with me. of Ihe beneficiary d..ignated hereunder sholl
revoke such d..lgnallon, and in Ihe former event. I re..rvethe right 10 d..ignate a new beneficiary, Should I for any re.son loil
10 designate .uch new beneficiary, Ihi. lrull .hall terminate upon my death and Ihe lrull propeny shall revert to my ellate.
8. In the evenl 01 my physi""l or mental In""pacity or my death, I hereby nominale and appoint IS SuccelSOr Tru51ee
bereunder whosoever shallatlhatlime be benefici.ry hereunder, unle" such beneficiary .hall not have altained the age 0121
yea" or Is otherwise leg.lly incapacilated, In which event I hereby nominate and appoint
Peter F. P 8 U b e r .
Drive Carlisle
Slrttl Cil)'
I
(Name) il"
(Add....) - 1150 Linn
Numbtr
,01
Pennsylvania
Slalt
1701)
Zip
10 be Sucte.lOr Trustee.
9. This Declarallon 01 Trust shall utend to and be blndlns upon the heiR, uecutoR. admlnlslrlloR and usl&ns 01 the
undenl&ned and upon the SucceSSOR to the Trustee.
10. The Trullee and his successon shall serve wilhoUI bond.
II. This Declarallon nl TNlI shan be conlllued and enlorced In acoordance with the \aWl 01 Ibe Stale
pennsylvania
IN WI11'/E.Ss WHE~F. I have hereunto sel my band and Ita! Ibis 6/j."
day 01 ~LltL .19'lJ;h..
(s,nlorsl,. It",) ~t v4 f?/AHI
01
9~,
I. tbe undenlgned lesa! spouse ollhe abo.e Sell lor , hereby wal.e all community properlY riShll which I may have In the
herelnat>o.e-desc:ribed accounl and Ii.e my usenl to Ihe provisions ollhe lrust and 10 Ibe inclusion In II 01 Ibe sald
Iccount.
(SpOW' II,. It",)
L.5.
~
/
W\lness: (2)
Cily
or
Town
Wllne,,: (I)
STATE OF
coUNTY OF
/v!t'(,;{/lNIt'S"'~" G,
. 19K. pertOnally appeared
Onlhe
CUMBERLAND
tJl.
i.
dayol
1(/'''''''';
known 10 me 10 be the Indivlduatt;) who ueculed Ihe loregolng Instrumenl. and acknowledged Ihe same 10 be IS h- free
ael and deed, belore me.
.t\<
(Nora,>, S,all
. Pub/l
u~,.:...It:,:,1
Mc1rt!i P~;;f: N:;;..'J. f\::&
HanlpCkm T..\o. Curr!:. .Jr, ',. ("urt,v
MyCorfvntt"~onE.9rosJu'I:.!:.I\ojO
, llMS)llanla~"'Nol.lr.e:l
L.s.
"
o
DT.I09
WHEREAS, I,
a~rro"" 01
~rdllrlltian of Wrust
Riohard D ^ U B ~ H .
Carl1ule ,Countyol- Cumburland.
,ollh.
,Sllleol-pennevlvenie,-
am the o"".r 01 cenlln &eCllritlellncludlns alnunon and p..ferr.d lIocb, bondi, d.benturu and mUlul1 fund Ihar<l;
NOW, 1llEREFORE, KNOW ALL MEN BY lllESE PRESE/IITS, Ihlt I do h.r.hy IcknawledS' and d..llre Iblll hold
and ...w hold IIid ICCIlritiellnd all my riabl, Iitle Ind inl<tell in Ind 10 ..Id ..curiliellN TRUST
I. For Ibe u.. and benefil of:
(Name)
(Addre..) - 1150 Linn
Numb"
Peter r .
Drive
Srrttl
D 8 U b e r .
. Carliele
City
, of
Penneylvllnle
Statt
l?01J
Zip
If becaule of my phYlfcal or m.nlll InClpacUy cenified in wrilina by I phYllclln, Ih. Succe..or Tru.t.e ,hall I..um.
ICII.e Idmlnlslralian of Ihl. trull durina my IIfeUm., luch Succe..ar 1l'ullee .hall be fully IUlharized 10 In"II, ..In.. II .nd
olh.rwl.. mlnlll' Ih. lrull', ....11 IS h. Ihall d..m .pproprial', paylnala m. or dllburuns an my behalr luch lum. from
Incom. or principal ., may .ppear n.....ary or d..lrabl. far my comran or wellare. Upon my dClth, unle.. the ben.nciary
"'all predec.... m. or unl... w. both Ihall dl. .s . ..lull of. cammon .ccid.nl or db..l.r, my Succ...or Trull.. 15 h.r.by
direcl.d fonhwith 10 lrIn.r.r 1.ld ..curili., and all riShl, 1111. and Inl...,1 in and 10 ..Id ..curiti" unto the ben.nciary
.blolut.ly and th.r.by I.rmln.t. IblstrUlI; oro.ld.d, how...r, 1b.1 Ir the ben.ficlary h...und.r Ihall nal ha.. .1l.ln.d lb.
.S. of 21 y.arl, Ih. Succ...ar Trull.e Ih.1I hold Ih. trull ....11 In conlinulns lrull unlllluch ben.ficlary Ihall ha.. all.incd
the .s. of 21 )lears. DurinSluch period or cantlnulns trUlI the Succ...or Trull'.' in hb .blalul. diIC"llan, may "\lin the
,peclfic aceurill., h.reln d.,cribed If h. bell..., 1110 be In the bell inl...1I or the ben.nciary ID 10 do; or h. may I.n or
oth.rwls. dilpol' of .ny or .11 or th.m, In,.,Uns.nd ..In.<llinSlh. proc..dl .1 h. may d..m .pproprial', Prior 10 the dat.
upon which luch ben.ficl.ry .Il.inllh. .S. or 21 y.an, the Succ...ar Trull.. may apply or upend any or.n of Ih.lncom.
or principal of the trUll dir.ctly far the malnl.nanc., educaUon .nd luppon or the ben.ficlary wilhaul the InI.",.nllan of
any suardian and wllhoul .ppllcaUan 10 .ny 'aun. Such paym.nll or incom. or principal may be mad. 10 the par.nll or such
ben.ficlary or 10 the person with wham the ben.ficlary II 1I.lnS wilhaUI .ny Iiabillly upon the Succ...or Trull.. 10 IC. 10
the .ppllc.tian Ih.r.ol. If luch ben.ficiary lu",I"1 m. bUI dl., beror. .Il.inlns Ih. .s. or 21 y.an, .1 his or h.r d.alh the
Succ<lsor Trull<< ,halllrll1.r.r, pay o..r and d.II..r the trull propeny 10 luch ben.ficlary', personal ..p....nIlU'., .b,
IDlul.ly.
2. For PUrpo'.1 of lpeclfic Id.nUnc.llan, the ....11 h.ld pursu.nllo thlllrulllhall be .lIlhol. aceuritl.. ..slll.r.d in the
Dime 0(:
..
Rioherd D8ub~r
6 June 1995
, Trusltt uldl/ (or" V.A: ")
daltd
..
.
tOS.lh.r with .ny un..gist.r.d ..curiti.. bearinS . c.nific.l. lpeclfically id.nliryins th.m .. ....11 of Ihl. lru.\.
3. Th. ben.ficiary h.r.und.r Ihlll b. Iiabl. lor hi. ptoponional. Ihlr. 01 .ny I.... l..i.d upon Ih. S.lllar'l 10111 Wlbl.
calal. by r...on of Ih. Selllar'l d..lh.
~. All inlerel.. 01. ben.ficiary h.r.und.r Ihlll be Inall.nabl. .nd fr..from .nliciplllon, ...I811m.nl, ."Ichm.nl, pl.dS' or
oonlrol by cr.diIO" or . pr...nl or farm" lPOU" olluch ben.ncilry In .ny prace.dIDsllllaw or In .quily.
S. Thi. lrull II creal.d upon Ih. upr." undenllndinS Ihll Ih. I"u.r, lran.l.r IS.nl or cullodiln 01 any securiU.. h.ld
b.r.und.r "'.11 be und.r no Iiabillly whllsoe..r 10 ...10 it. proper .dministrIUon, Ind Ibll upon Ih. trlOlI., ollh. riShl, litl.
and Inl.r.llln and 10 uld securille! by any Trull.. h.r.und.r, uld I..u.r, tr.n.l.r as.nl or cullodiln ,hall conclu.I..ly tr..1 the
transf.r.. IS the IDI. own.r oluld ..curitl... In Ih. ...nllbal .ny Ihlr.., ...h or olh.r propeny Ih.1I be dinributlble .t any
time under the 1enns of said Kcurilies. the &aid issuer. transfer Alenl or cuslodian is fully authoriud to transfer. pay over and
d.Ii..r Ihe 1IIll' 10 who.oe..r Ihall th.n be Trull.. h...und.r, and Ihall be und.r no liability 10 lee 10 th. proper .ppllc.tian
thereof. Unli1the inuer. transrer Alenl or cuslodian ,hall receive from IOme penon inleresled in this trull wrinen notice of any
de.lh or other e..nt upon which Ihe risht 10 r.cei.e m.y d.pend, Ih. uid I"uer, transler as.nl or cullodi.n Ih.lllncur no
Ii.bllily lor p.ymenlS m.de In load lailh 10 penon. whose inter.... "'III h..e be.n .1l.Cled by luch ...nl. The I"uer, Ir.n.ler
.Ienl or cullodlan ,bill be proteC1.d in .ctinS upon Iny notice or olher Inslrument or documenl belie..d by It 10 be senuln. and
to b..e been alsned or pr...nled by the proper piny or parli...
6. J r...",e unlo mysclllbe riShllo pledse any 01 lb. securilies held b.reunder IS alll.t.rallor . loan.
. '7. I .......... unlO mYI.1f Ihe power .nd riabllo colleCI any di.idends, Inl."", capilli saln dlllribullans or olher Income
whJch m.y accru. from Ih. lrull propeny durina my Iil.time .nd 10 pay luch Incom. to my..1f .. an individual. .nd nn
beneficiary nam.d h...ln Ihall ha.e any claim upon .ny such Incom. .ndlor pronlS dlnribut.d 10 m..
8. I ....."'. unto my..11 the power .nd risht .1 .ny lime durinl my Iil.lime 10 amend or ...oke in whole or in plrllhe lrull
bereby created withoullhe necessily 01 Obl.lnins the aln..nl ollhe ben.ficilry Ind wilhaut gi.;nl nollce 10 Ih. beneficiary. Th.
..Ie by me of Ihe whol. or any pan ollbe ponlalio 01 ..curilies held hereund.r ,hili alnllilUle I' to luch wbole or pin.
",.ocation 01 this tru'l.
.
"
~
DT.IIJ
Jardnrntion of Wmsl
WHEREAS. I. it R i c h /I r d - n I. " R 1-' R .oflh.
CiryfTownof -0 a r 1 i s 1 e .Counlyof Cumbl,rl,md .SI.,.of PennnYlvania
am lb. own.r of. brok.r... .ccounl wilh lb. firm of Denn -Wittort-Hevnold" - In" _
Joc:aledinlb.CilylTo...nof Harrisburg . Counlyof nn"phl n .ndSI.I.
of Pennsylvania
NOW.1HEREFORE. KNOW AU MEN BY mESE PRESENTS.lh.1 J do h.r.by .ckno..l.d~. .nd d.c1.r. ,h.,. hold
and will hold ..Id brok.r... .llCXlunl and .11 my ri.hl. Ihl. .nd Inl.r..1 in .nd 10 ..Id .ccounl .nd all cuh .nd ,""rili.. h.ld In
au.b .ccounllN TRUST
1. For lb. use and ben.fit of:
(Nlm.)
(Addr.ss) - 11.50 Linn
Numbtr
Petor F.
Drive
Slrttl
llauber.
CarliR'"
elf)'
PennsvlvAni..
SIDIt
. of
17011
Zip
If beClU'. of my phYlit.1 or m.nl.llnc.p.chy c.nlfi.d In ...rilln. by . phYllci.n. Ih. Succ.ssor Tru..u h.reln.lI.r n.m.d
Ihall assume ,clivt administration of thi. trUiI during my lirelime. luch Succcuor Trullee Ihall be fully authorized to invest.
re1nVC11 and olherwiie rnanlJlc the trU51" aneU I' he ,hall deem appropriate. plyl", 10 me or disbunlng on my behalf
luch lums from income or principal I' ma)' appear necenary or dCllrablc for my camlan or Vr'clfuc. Upon my dealh. unlen
the beneficiary shill predcccnc me or unlcn we both ,hall die" a ruull or I common accident or diluter. my Succeuor
Trull.. " h.reby direcl.d fonh..i1h 10 Ir.nlf.r ..Id brok.r.,. .ccounl and .11 ri.hl. tlllc and 101.rellln and 10 ..Id .ccounl
unlo lb. ben.ficilf)' .blOlulely and Ib.reby l.rmln.l. thll lrull; nrnvld.d, ho...v.r. 1b.1 If Ih. ben.ficllf)' hcreund.r Ih.1I
nol h.v. .n.ln.d lb. ..c of 21 y..... Ih. Succ.ssor Trullcc Ih.1I hold Ih. \rU.1 .sscu In conllnulnglru.1 unlllAUch ben.ficlary
,hall have aruined the Ise or 21 years. During luch period or continuing trustlhe Succeuor Tn.lltee. in hl,ablolute dilcrction,
mlY "lIln lb. specific brok.r... .ccounl h.rcln d.lcribed If h. bell.v.. i1ln lb. bell In1erC1I1 of Ih. ben.ficllf)' 10 10 do.
or he may tcnnlnale h, inveltlns and relnvesllns the proceedl II he may deem appropriatc. Prior to the date upon which
luch ben.ficl.ry .1l.ln. lb. ... of 21 y.an. lb. Succ.ssor Trull.. m.y .pply 0' ..pend .ny or .11 of lb. income or princlp.1
direclly (or the maintenance, education and luppon or Ihe beneficiary without the intervention or InY guardian and without
.ppllc.llon 10 .ny coun. Such p.ym.nu of incom. or princip.1 m.y be mid. 10 Ihc p.r. nil of luch bencficl.ry or 10 Ih.
penon ...ilb ..hom Ih. ben.ficl.ry h living ...llhoul .ny IilbllilY upon Ih. Succ.uor Trull.. 10 I.. 10 Ih. .ppllc.lion Ih.reof.
If luch ben.ficl.ry lurvlvcl m. bUI dl.. before .Il.inln,'hc ..' of 21 y..... .1 hi. or h.r dealb Ihc Succ.ssor Trull.. ,h.1I
tranlrer, pay over Ind deliver the I"," propcny 10 such beneficiary'I penonal reprelentalive._bloolutely.
2. Th. ben.fici.ry h.r.und.r "'"II be Ii.blc for his proponlonll. Ih.r. of .ny tU.I l.vi.d upon the S.nlor'l tOI.1 tu.bl.
.11.1. by r...on of the Settlor'l d.alh.
3. All inl.r.11I of. ben.fici.ry h.r.und.r Ih.1i be In.lI.n.bl. .nd fr.. from .nllcip"llon. wi.nm.nl. .n.cbm.nl. pl.d.. or
control by cr.dllon or. pr.senl or form.r lpouse of luch ben.ficilry in .ny proce.d,".s .t I... or In .quity.
4. This lrull il creal.d upon the ..pr.ss undcnt.ndin. Ihll n.llh.r the brok.r... firm .1 ..hich Ih. .ccounlls maintain.d
nor the ilSu.r or tr.nlf.r ...nt of Ih. securill.. h.ld h.r.und.r Ih.1I b. und.r .ny Ii.bilily ..h.llo...r 10 ... 10 lu proper
.dmlnlltr.Uon. .nd th., upon the tr.n.f.r of the ri.hl. till. .nd Inl.r.llln .nd 10 Ih. .ccounl by .ny Trust.. h.r.und.r. IIld
brok.r... firm. lIsu.r or tr.nd.r ...nllh.U conclul;..ly 'r..llh.'r.nlfcr.. .llh. 101. own.r of ..Id .ccounl. In the ...nllb.1
any Ih.r.l. cuh or olh.r propeny Ih.1I be dillribul.bl. .1 .ny time undcr Ih. I.rm. of uid securill... lb. uid brok.r... firm.
lIsu.r or u.nlf.r ...nl 11 fully .ulhoriud 10 u.nd.r. p.y over .nd d.II..r Ih. ..m. 10 ...hosoe..r Ih.1I Ib.n be Tru....
b.reund.r. .nd Ih.1I be und.r no li.bUlly 10 see to the proper .pplicallon Ih.r.of. Unlillh. brok.r.,. linn or lb. lIsu.r or
Irllllf.r ...nl"'all recel.e horn 10m. penon inl.resl.d in Ibillrull. ..rill.n noli a: of .ny d..lh or olb.r .'.nl upon ...blch lb.
ri&hllo recelv. m.y d.pend.lh. brok..... firm. issu.r or tr.n".r ...nl shill incur no li.bililY for paym.nu m.d. in.ood failh
to penonl ...hose lnl.r.1I Ih.1I h.v. be.n .ff.ct.d by luch .vcnl. Th. brokcr.g. firm. Issuer or ITlnsf.r ...nt "'.11 be prol.ct.d
in .ctin. upon any nolice or olb.r inllrum.nl or docum.nl beli.vcd by il to be ..nuin. and 10 h.v. be.n daned or present.d by
the proper p.ny or pani.l.
5. I reserve unto myself Ih. po....r and ri.hllO coll.ct any divid.nds. Inl.r.ll or other incom. ..blcb m.y .ccru. from lb.
UusI propeny and, in my 101. d.ICT.Uon .. Trull... .llh.r 10 .lXUmulal. luch incom. II .n .ddillon 10 lb. IrUII useU beln.
bel~ b.r.under or pay such incom.lo myself II .n indlvidu.1. 'lh.1I be ..cluliv.ly .ntill.d 10 all incom. .a:ruin. from lb. trult
propeny dllrin. my lif.tim.. and no ben.fici.ry lIIDl.d b.r.ln Iball b... any claim upon any IUch incom. andlor profiu
distribul.d 10 10.,
6. I reserve unlO myself the po....r and ri&hl .1 .ny Um. durin. my lIf.lim. 10 am.nd or ...ok.in ...bol. or in pan lb. trusl
bereby ....I.d wilhout lb. o.a:sslly of oblalnin. Ih. consenl of Ih. ben.ficilry and wilhout .ivin. noUce 10 lb. beo.ficilf)'. Th.
III. by m. of th., ...bol. or any pan of lb. IIId brok.r... .aount b.ld b.r.und.r lbaU conslllUl. II to Illeb ...bol. or pan .
revocaUon of this trust.
7. Th. dealh durin. my lif.lim.. or in. common .ccid.nt or di.....r wilh m.. of Ibc ben.ficilf)' d.dan.ted b.reund.r Iball
revoke IUch d.dan.Uon. and In Ih. form.r ...nt. I reserv.lb. ri.hllO d..I.n.,.. n.... ben.fici.ry. Sbould I for any r.ason fail
10 delian.l. sueb D.... ben.fic:ilf)',lbb trust "'allt.rmin.l. upon my d..,h .nd Ih.lrull propeny Iball r...n 10 my estal..
8, In Ihe evenl of my phy.lcal or m.nlallncaplclly or my d.a'h, I h.reby nomina Ie and .ppolnl IS Succc..or TN"ee
her.under who",..er .hall .llhalllme be ben.fici.ry hereunder, unle.. .ueh ben.ficlary .hall nol h.ve .1I.lned Ihe ase 0121
yean or 15 olherwi..l.sally Incapacll.led, In which evenll herehy nomin.'. .nd appolnl
(Nlm.) Peter F. D a u b e r
(Addr...) _ 1160 - Linn drl VU - Carl1s1o
Numb.r Slrttl Ciry
,01
ennsy1vanla- 17013
SIal. lip
10 be Succc...,r TN.,.e.
9. Thl. D.c1.ra,lon of TN.I .hall e'l.nd 10 .nd be blndlns upon Ih. h.ln, e.eCUlon, admlnhlralon .nd ""lpI' ollhe
und.nisn.d .nd upon Ih. Su=.",n 10 Ihe Tru.lee.
10. Th. Tru.I.. and hh .u=""n .hall ..rve wilhoul bond.
II. Thl. D.clar.llon of I Tru.1 .hall be con"ru.d .nd enforced In .cr:ord.nte wilh Ihe I.ws of Ihe St.le
or 'P'L'fJJS\./l~"k"llA- .
I
IN WITNESS WHEREcrl I have h.reunlO ..I my hand .nd ".'Ih~.lr
day of fin} _,19 'A'")f(Jvfd
fSmlor Jlgn her.)
L,S.
1,Ihe und.nlgn.d ,.sal .pou.. of the .bove Sclllor, h.reby walv. .11 communlly properly riShlS which I may have In Ihe
hereln.bov.-d...ribed .cr:ounl and give my ....nl to Ihe provl.lon. of Ihe tN.1 .nd to Ihe Inclusion In II ollh. ..Id
.ccounl.
fSpow, Jign h.,,)
Ii/A
L.S.
'-
Witn...: (I)
,.:/..... ,i
Wlln...: (2)
) CilY /l
T'owh. /.If'~/,p.;yIr'~,I,,:',rM /l7.
day 01 -Jif-l /(,' , 19 f':r penonallyappeared
/0t'/. #1'(/ J)~,)fi,..".
known 10 m. 10 be the Indivldua~ who e..cu,.d Ihe for.solng In"rum.nt, and ·
.<1 and d..d, b.fore me. .
STATE OF
COUNTY OF
p~tJ"J~VI VAMIA
"'UI"let..~:t2I~LJ
On the
.A/.~
free
" u.'i:..
(No/ary S.al)
N:.'J'i1\ISIl"
M:1.1fn F-ir! :'/'1. :~~"l'" Plibf.c
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M~'Corr~l'o:'. l,)4:L',' : ;.'..J~.1.1~../\
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D NO. AA 082452 COMMO~~~~~~~T~: R~~~~:YLVANIA
"''''"'1'''' OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATETAX
~b
RECEIVED FROM:
i
ACN
ASSESSMENT Ii'
CONTROL ...
NUMBER
AMOUNT
PETER F DAUBER
101
el0.1Bl.93
1 H50 LINN DRIVE
CARLISLE, PA 17013
IOU)"",
ESIAIE INFORMAIION:
a FilE NUMBER 21-1993-0973
EJ NAME OF BlWl!ttR AftlHARD
II DAlE OF PAYMENI
iii 12/28/93
~ POSIMARK DATE
1:.1 0100100
COUNIY CUMBERLAND
SSN 124-30-0497
(FIRSII
(Mil
DAlE OF DEAIH
09/28/93
REMARKS PETER F DAUBER
f:1 TOTAL AMOUNT PAID
el0,181 .93
VZ'
SEAL
CHECK" 133
RECEIVED B)) it'> " L=
" 5IuNA.U..
MARY C. LEWIS
REGISTER OF WIL
.
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,
, '/ 'I I..~) ._(.''.;,
REGISTER OF WILLS
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REV-1547 EX AFP [12-95*
CQHHOHWEAlTH OF PENNSVlVANIA
DEPARTttEHT OF REYEHUE
BUREAU OF INDIVIDUAL TAXES
DEPT. ZI16D1
HARR1SIURG, PA I1UI-D6Dl
NOTICE OF INHERITANCE TAX
APPRAISENEHT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIDNS AND ASSESSNENT OF TAX
ACH 101
DATE 04- 08-96
S 0 FILE NO.
DATE OF DEATH 09-28-95 COUNTY CUMBERLAND
NOTEI TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORN WITH YOUR TAX
PAYNENT TO THE REGISTER OF WILLS, NAKE CHECK PAYABLE TG "REGISTER GF WILLS, AGENT"
REMIT PAVMENT TO:
PETER F DAUBER
1150 LINN DR
CARLISLE
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PA 17013-1429
A.OW\t R_l tt.d
1000~.ol
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
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CumbtlljElnd Cu., PA
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O'J::AA. '.;"~1l2106(~C()MMQNWEALT~.Of PENNSYLVANIA' '... '.
~O::..; }}'"."-,,,: ,~,;h<~::..1~ :,.DlrARTMINTO',.avINUI.' . .. . '.
'.';"t;.t'~~ ; " '~.:' c. O'''CI~L RleIIPl' . PENNSYLVANIA INHIRITANCI AND ISTATI TAX
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m AMOUNT
RECEIVED FROM:
i
ACN
ASSESSMENT
CONTROL
NUMBER
"
PETER F DAUDER
IvJ
.1I!O _ 0 1
11:50 LINN DRIVE
CARLIGLE, PA 17013
'OiOH'"
ESTATE INfORMATION,
1:'1 fiLE NUMBER
Y 21-1995-0973
1:'1 NAME Of DECEDENT (LAST)
IIiiiI DAU R RICHARD
II DATE Of PAYMENT
EJ POSTMARK
COUNTY
SSN 124-30-0497
(fiRST) (Mil
MBERI.AND
DATE Of DEATH
'"
m TOTAL AMOUNT PAID
$120.01
CW
REMARKS
PETER F DAUBEn
SEAL
fJ-J' (' ,..' .
RECEIVED BY //2.-.~ /I_~ '" ,. ,-; l'(ff . ,..J -, 'J
/1 SIONATURrf i""'. . /, . .
r. r: "". _ ,-jl./. J
MAR V C. LF.WIS ,,- ' :.n.... I ,I
REGISTER OF WILLS
CHECKtl 1'10
REGISTER OF WILLS
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REV-1547 EX AFP 112-95*
CDMttOHWUl III Of PENNSYlYANIA
Dl:P""Ttt(NT or R[VU'J[
IUA[AU Of INDIVIDUAL IAM[S
or:PT. ll0601
fIARAISIUlJG, PA 17111-0601
ESTATE OF DAUBER RICHAR
DATE OF DEATH 09-28-95
FILE NO.
COUNTY
CUMBERLAND
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR OISALLOWANCE
OF OEOUCTIONS AND ASSESSHENT OF TAX
ACN 101
DATE 04-08-96
./
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF TNIS FORN WITN YOUR TAX
PAYNENT TD THE REgISTER OF WILLS. NAXE CHECX PAYABLE TD "REgISTER OF WILLS, AgENT"
REMIT PAYMENT TO:
PETER F DAUBER
1150 LINN DR
CARLISLE
PA 17013-1429
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
AltOunt R..Bt.d
CUT ALONG THIS LINE ~ RETAIN LOIIER PORTION FOR YOUR RECORDS .....
iii\i:is4j-EX-Af'i.--n2=9ifj-NOYicE--ciF--fliHEiiii'AHCE-;:Ain-ppR'AisEHENT-,--m.-ciiiAHCE-iiJi-----------------
DISALLOIIANCE OF DEDUCTIONS ANO ASSESSMENT OF TAX
RICHARD FILE NO. 21 95-0973 ACN 101
TAX RETURN WAS' ( I ACCEPTED AS FIlEO ( XI CHANgED SEE
APPROVED DEDUCTIONS AND EXEMPTIONS:
4,635.79
9. funeral E~p.n.../Adn. COltl/HiIC. Expan... ISc~dul. HI I'.
10. Debt,/Horta.ge LiablllU../Llana (Schedule IJ (10) 4.318.14
1\. Total Deductions (111
12. Hat Valu. of Ta. R.turn 112.
U. Char1tabla/Govarn..enhl Blqul.t. (Schedule J) US)
14. Net Valu. of eat.t. Subject to T.. (14)
NOTEI If an assessment was issued previOUSly, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ALL returns assesssd to date.
ASSESSMENT OF TAXI
IS. Aaount of Line 14 at Spous.l ~.te (15)
16. A.ount of Line 14 tex.ble .t Lin.el/Cl... A ~.te (16)
17. A~unt of Lin. 14 t.xable at Collate~el/Cl... D ~ate (17)
1&. Principal Tax Due
ESTATE OF
DAU8ER
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R.al Eatat. (Sch.dule A) (1)
2. stock. and Bond. (Schedule B) (2)
3. Clo..ly Held Stock/Pa~tn.~ship Inte~e.t (Schedule C) (3)
~. Ho~tgaga./Hota. Receivabla (Schedula D) (4)
S. C..h/Bank Depo.it./Hi,c. Parsonal Proparty (Schedula E) (5)
6. Jointly Owned P~op.rty (Schedula f) (6)
7. T~an.f.r. (Schadul. 0) (7)
&. Total A.,.t.
.00
160.061.88
.00
.00
29.522.43
.00
.00
IBI
.00 X .00.
180,630.38 X.06.
.00 X .15.
I1BI
TAX CREDITS I
PAYNENT
DATE
12-28-95
RECEIPT
NUNBER
AA082452
DISCOUNT ('1
INTEREST I-I
535.89
ANOUNT PAID
10,181.93
PAYMENT MUST 8E MADE 8Y 06-29-96_.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
DATE
ATTACHED
04-08-96
NOTICE
189,584.31
R .'l~:'l q:'l
180.630.38
.00
180.630.38
.00
10.837.83
.00
10.837.83
10,717.82
120.01
.00
120.01
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN '1, NO PAYNENT IS REQUIRED.
IF TDTAL DUE IS REflECTED AS A "CREDIT" (CRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. I
,
RESERVATION. [.t.t.. of dec.dent, dylno DO D~ be'or. Oec.-ber II, ,.., .. If ~v lutur. Int.r..t In the I.l.t. I, ttentf.tted
In po.....lon or .nJo~t to el.,. . (coll,'.r.l) ~flcl.rl.. of the dec~t .,t.,. the ._plt.llon of en., ....t. for
l1f. or for YI.t., the Co.aonw..lth h.r.by I.pt..llr r...rve. the right to eppr.I.. ~ ...... tten.,.r Inherlt~. ,....
.t the l..'ul CI... . (coll".r.l) r.t. on en., such future Int~..t.
P\JRPOSE IIf
HOTICtt To fulfill the r~Jr.-.nt. of Section 2140 of the Inherlt~ ~ E,'a', 'a. Act, Act IZ of 1991. 71 P.'.
SecUon nu.
PAYMEN" DetKh 1M top po,.Uon of thh Not!u Met .ut.!t "lth .... ".,.ent 10 the R.aht.r of Willi printed on ttw ,ft.,... slde.
.."_. cMck or MMMlY ord.r p.rMll. tOI REGISTER OF IfILLS, AaEHT
All p.penh rec.lved m.1l first b. eppllad to MY Int.r..t .....Ich ..y be due with 11I11 r...lnder eppU-.I to the ....
REFUND (CRh A r.'und of . 'IX cndlt, which .... not r~.t_ en U. fa R.turn, ..., be ,...,..led by coapl.Ung In -"'lIc.tlon
for R.fYnd of Penn'Ylvenl. Inherltenc. ~ Estlt. 'ex- (REV-ISIS). Appllc.tlon. .r. IVlllabl. .t the Dfllc.
of the R.gl.t.r of Will., ~v of the 2S R.venue District Olfle.s, or bv c.lllng the .p.cl.1 Z~-hour
In.werlng ..rvlc. nueblr. lor for.. orderlngl In Penn,Ylvanl. .-100-S62-2051, out. Ide penn.vlvenl. ~
within loc.1 Kerrl.burg .r.. (717) 717-1094, TOO' (717) 172-2152 ("-.rlng IIP.lr.d only).
Oa.IECTlCIHSI Any p.rt)' In Int.r..t not ..thfled with thl eppr.l__t, .Uo..anc. or dls.llowanc. of deduction., or ............
of t.. (Including dl.count or Int.r..t) .. .hown on thl. Not Ie. au.t object within .I.ty (60) dly. 01 rae.lpt of
thh Hatlc. byl
--written prot..t to the PA O.p.rtllnt 01 Rlvanua, Jaard of .....1., Dept. 211021, H.rrlsburg, PA 17.21-102., OR
--.Ieatlon to h.v. the ..tt.r d.t.r.lnld at .udlt .f the ICCDUftt 0' the p.r.onal repr..antatlvl, OR
--.....1 to thl Orphan.' tour t.
lDHIN
ISTRlTlYE
CDRR(CT IDHS I
INTEREST.
Factu.. .rror. dl.cov.rld on thl. ......eent .hoUld be ~r..18d In wrltlno tOI PA Dap.rtaent of R.venut,
luraau of IncHvldul1 hu., ATTNI Post A..........t RIVI... \kilt, Dapt. ZI0601, It.rrllburg, PA 1712'-0601
Phone (717) 7.7-6505. S.. p-a' S of thl bookl.t -Instruction. for Inherltanc. T.. R.turn lor I R..ldant
Decadent- (REV-l 50.) lor an ..plan.tlon of adllnlltratlvaly ~rlCtlbl. .rror..
If any t.M due I. p.ld within thr.. (3) c.land.r aanth. .ft.r the decadent'. d..th, I Ilv. p.rc....t (52. dl.count of
the t'M p.ld I. .llowed.
Int.r..t I. chargld b.glnnlng with flr.t dlv of delinquency, or nine (,) eonth. ~ one (1) d.y Iroa thl data 0'
de.th, to the data 0' PI~t, T.... which bac... delinquent before January I, l'IZ belr Int.r.st at thl r.ta of
.1. (6X) parcent par ~ c.lcul.t.d at . d.lly r.t. 0' .000164. All t.... which bee... d.llnquent on and .ft.r
Janulry 1, 1'12 will ~Ir Int.r..t .t a rat. which will vary 'ru. calandar y..r to cllandlr y..r with that r.t.
announced by the PA a.part.ant of A.v.nu.. The ~llcabl' Int.r..t r.t.. lor 1'.2 through 1996 Ir.,
DISCOUNT I
'!!!! Intlnst Rat. a.llv Int.ra.t Factor !!!!' Inter..t A.t. D.lly Inten.t Factor
.'Il ZOX .OQDSU In7 OX .DDDZU
1913 lOX .DDDUe 1'11-1991 llX .0Dnn
I'" IIX .000501 199Z OX .000247
nl5 I3X .00Q5S6 19'9)01994 n .010192
1916 lOX .OOQZ7~ 1"5-1996 OX .UOZ't7
nlntar..t I. c.lcul.t.d .. foUowu
INTEREST. BALANCE OF TAX UNPAID X IIUIlBER OF DAYS DELINllUEIlT X DAILY IIfTEREST FACTDII
--Any HDtlC' Inued .fter the t.x beco... d.lInquent .UI reflect an lnternt cllculltlon to f1ft"'" CUI dI,.
beyond thl d.te 01 the ......eent. If ply.ant I. IIda .ft.r the Int.r..t coaputltlon dl" .hown on thl
Notice, MldIHanal Int.r.st au.t be c.lculatld.
~
.
INHERITANCE TAX
EXPLANATION
OF CHANGES
I 1(\'.1"0111"11
~
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
BUREAU Of INDIVIDUAL TAKES
D!PT. 2B0601
HARRISBURG, PA 17I2B.0601
DECEDENT'S NAME
filE NUMBER
Richard Iloubcr
AC
u
SCHEDULE
ITEM
NO.
EXPLANATION OF CHANGES
II
83
nle clllla for the fllclly 8110r.lptlon hils ~OC/l dfBallowed. The c1a1P11nt. Io1Ust
bo a paront, II spouso or II child l1vlnr. in tho Slll'le household 8B tho dece-
d'!nt llB of tho dete oC doath.
-
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TAK EKAMINER:
Chllr.1c.s-1/r.4lhL--
PAGE ___
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