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R;V.~500 EX. (6-00) REV-1500 OFFICIAL USE ONLY
. COMMONWEALTH OF
PENNSYLVANIA FILE NUMBER
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN
DEPT. 280601 RESIDENT DECEDENT II 06 0313
HARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER
DECEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I- Jefferies, Marian L I 198-18-9868
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w DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
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W 03-22-2006 09-23-1920 REGISTER OF WILLS
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w (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
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I [!] 1. Original Return
04. Limited Estate
[!] 6. Decedent Died Testate (Attach
copy of Will)
o 9. Litigation Proceeds Received
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o 3. Remainder Return (date of death pnorto 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
2. Supplemental Return
4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 Spousal PovertY Credit (date of death between
. 12-31-91 and 1-1-95)
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I.)
COMPLETE MAILING ADDRESS
1 NAME
Patricia R. Brown, Esq.
FIRM NAME (If applicable)
SALZMANN HUGHES PC
354 Alexander Spring Road, Suite 1
Carlisle, PA 17013
TELEPHONE NUMBER
717-249-6333
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(11)
8,292.63
159,308.01
0.00
12. Net Value of Estate (Line 8 minus Line 11)
(12)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
159,308.01
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z
0 .045 (16)
i= 16. Amount of Line 14 taxable at lineal rate 159,308.01 x
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a.. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0
0 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
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I- 19. Tax Due (19)
0.00
7,168.86
0.00
0.00
7,168.86
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Form REV-1500 EX (Rev. 6-00:
Copyright 2002 form software only The Lackner Group, Inc.
v
Decedent's Complete Address:
STREET ADDRESS
7 Richland Lane
CITY Camp Hill
ISTATE PA
I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
358.44
(2)
Total Credits (A + 8 + C)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
7,168.86
358.44
6,810.42
6,810.42
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?...................................................................................................................... [!] D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury. I declare that I have examined this retum, including accompanying schedules and statements. and to the best of my knowledge and belief, it is true. correct and
complete. Declaration ofpreparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RE ONSIBLE FOR FILING RETURN ADDRESS
Randal F. Leiby
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..................................................................................
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or..................................................................................................................
d. receive the promise for life of either payments, benefits or care?..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................................................................................................ ......
Yes
D
D
D
D
D
D
No
[!]
[!]
[!]
[!]
[!]
[!]
SIGNATURE F PREPARER OTHER THAN RE
Patricia R. Brown, Esq.
F~ '-If~
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P .S.
~9116 1.2) [72 P.S. ~9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is
defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
P.O. Box 259
Enola, PA 17025
ADDRESS
SIGNATURE OF P SON RESPONSIBLE FOR FIL
Barbara Campbell
322 Lincoln Street
Marysville, PA 17053
ADDRESS
354 Alexander Spring Road, Suite 1
Carlisle, PA 17013
DATE
L.(f&,!DL,
DATE
{Pll~/ bL
DATE
L:, / j{, I 0 t.p
Rev-1503 EX+ (6-98)
*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Jefferies, Marian L
FILE NUMBER
21-06-0313
ESTATE OF
All property joinlly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 IDS - SPS Advantage One 81.125.53
.tii' r .,.
;co
TOTAL (Also enter on Line 2, Recapitulation) 81.125.53
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev.15G8 EX+ (8-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Jefferies, Marian L
FILE NUMBER
21-06-0313
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 U.S. Savings Bonds - Series HH, issued March 1994 (list attached)
VALUE AT DATE
OF DEATH
11.500.00
2 1995 Mercury Sable
1.775.00
3 Miscellaneous personal property
895.00
,r!!;:
TOTAL (Also enter on Line 5, Recapitulation)
14.170.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev.1509 EX+ (6-98)
.
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Jefferies, Marian L
FILE NUMBER
21-06-0313
ESTATE OF
If an asset waa made Joint within one year of the decedent's date of death, It must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Barbara E. Campbell
ADDRESS
RELATIONSHIP TO DECEDENT
daughter
322 Lincoln Street
Marysville, PA 17053
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DESCRIPTION OF PROPERTY %OF DATE OF DEATH
DATE
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 10/22/2003 M& T Bank - checking account 1.721.28 50.000% 860.64
2 A 4/10/1992 M& T Bank - savings account 4.853.04 50.000% 2.426.52
3 A 5/23/1994 M& T Bank - certificate of deposit 5.012.12 50.000% 2.506.06
4 A 10/12/1994 M& T Bank - certificate of deposit 7.677 .57 50.000% 3.838.79
TOTAL (Also enter on Line 6, Recapitulation) 9.632.01
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
Rev-1510 EX+ (6-98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Jefferies, Marian L
FILE NUMBER
21-06-0313
ESTATE OF
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes,
ITEM DESct-<IPTION OF Pt-<OPE:RTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER, ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Thrivent Financial for Lutherans - IRA contract 62,673.10 62,673.10
#3657696
.' ""."." ,',.ff""
TOTAL (Also enter on Line 7, Recapitulation) 62,673.10
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV.-1151 EX+ (1'2.99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Jefferies, Marian L
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-0313
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 1,239.35
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees SALZMANN HUGHES PC 5,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 302.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 506.55
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 7,047.90
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev,1502 EX+ (tr.98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jefferies, Marian L
FILE NUMBER
21-06-0313
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Hoss's - funeral luncheon
338.50
2
Myers Funeral Home
858.50
3
Pealers Flowers
42.35
Subtotal
1,239.35
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev,1502 EX+ (6-98)
*'
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jefferies, Marian L
FILE NUMBER
21-06-0313
ITEM
NUMBER DESCRIPTION AMOUNT
1 Amy Leiby - apartment cleanup 200.00
2 Cumberland Law Journal - estate notice publication 75.00
3 Ray A. Lecrone Auctioneer - appraisal fee 50.00
4 Register of Wills - filing fee 30.00
5 The Sentinel - Legal - estate notice publication 151.55
Subtotal
506.55
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev,1512 EX+ (6.98)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jefferies, Marian L
FILE NUMBER
21-06-0313
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Bank of America - Visa account
2 Comcast
3 Holy Spirit Hospital
4 Moffitt Heart Vascular Group
5 Olga Caldwell - nursing/home care
6 PP&L
7 UGI
8 Willow Mill Vet - pet expenses
VALUE AT DATE
OF DEATH
111.69
4.61
124.00
14.32
500.00
37.18
138.33
314.60
TOTAL (Also enter on Line 10, Recapitulation)
1,244.73
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (9-001
ESTATE OF
NUMBER
I.
..
SCHEDULE .J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Jefferies, Marian L
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
Clistributions, and transfers
under Sec. 9116(a)(1.2)]
FILE NUMBER
21-06-0313
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
RELATIONSHIP TO
DECEDENT
Do Not List Trusteels)
1
Barbara Campbell
322 Lincoln Street
Marysville, PA 17053
Christopher Leiby
312 S. Broad Street
Mechanicsburg, PA 17055
Christopher M Leiby
P.O. Box 259
Enola, PA 17025
Daughter
1/2 remainder
2
Grandchild
5,000.00
3
Grandchild
5,000.00
4
Danielle Leiby
905 Thornton Drive
Mechanicsburg, PA 17055
Hunter Leiby
905 Thornton Drive
Mechanicsburg, PA 17055
Grandchild
5,000.00
5
Grandchild
5,000.00
See continuation schedule attached Continuation
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
20,000.00
40,000.00
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
.;f.". ,."" .
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TOTAL OF PART 11_ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule J (Rev. 6-98)
SCHEDULE ..
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Marian L Jefferies 198-18-9868 03/22/2006
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
6 Jaiden X.J. Leiby Grandchild 10,000.00
c/o Barbara Campbell, Trustree
322 Lincoln Street
Marysville, PA 17053
7 Randal F. Leiby Son 1/2 remainder
P.O. Box 259
Enola, PA 17025
8 Timothy Leiby Grandchild 10,000.00
905 Thornton Drive
Mechanicsburg, PA 17055
Total 20,000.00
1
LAST WILL AND TESTAMENT
OF
MARIAN L. JEFFERIES
I, MARIAN L. JEFFERIES, a resident of and domiciled at 7 Richland, Camp Hill, Cumberland
County, Pennsylvania, being of sound mind and disposing intent, do hereby make, publish and declare this to
be my Last \'Vill and Testament, hereby revoking all \'Vills and Codicils at any time heretofore made by me.
ITEM I
I direct that all my debts, secured and unsecured, including those associated with my final illness and
death, and the administration of my estate be paid as soon as practicable.
ITEM II
. I have purchased a pre-arranged funeral and service to be held at the Myers Funeral Home in
Mechanicsb~rg, with viewing, at the discretion of the funeral home. Burial shall be in the plot where my
husband, Joseph W. Jefferies, is interred, in Woodlawn Memorial Gardens, Harrisburg, Pennsylvania.
ITEM III
I direct that all Estate, inheritance, succession, death or similar taxes assessed with respect to my Estate
herein disposed of, or any part thereof, or any bequest or devise contained in this my Last Will (which term
wherever used herein shall include any Codicil or Directive hereto), or on any insurance upon my life or on any
property held joindy by me with another or on any transfer made by me during my lifetime or on any od1er
property or interests in property included in my Estate for such tax purposes, be paid out of my residuary Estate
and shall not be charged to or against any recipient, beneficiary, transferee or owner of any such property or
interests in property included in my Estate. Should any real property pass under my Will, it shall pass subject
to any mortgage or lien thereon.
Page I of 8
ITEl\I IV
I have two step-children, JeanJ. Grandon andJoseph W. Jefferies Jr., who were amply provided for
in the will of their father, Joseph W. Jefferies, Sr.
ITEM V
I direct that the personal property listed in the Directive to this Will, with the exception of the final
paragraph thereof which refers to the disposition of my savings bonds and is hereby deleted, be distributed by
my Executors as indicated therein.
ITEM VI
a) I give the sum of Five Thousand ($5,000.00) Dollars to my grandson, CHRISTOPHER MILES
LEIBY, if he survives me.
b) I give the sum ofTen Thousand ($10,000.00) Dollars to my grandson, TIMOTHY LEIBY, ifhe
survlves me
c) I give the sum of Five Thousand ($5,000.00) Dollars to my great-grandson, HUNTER LEIBY, if
he survives me.
d) I give the sum of Five Thousand ($5,000.00) Dollars to my great-grandson, CHRISTOPHER
LEIBY, if he survives me.
e) I give the sum of Five Thousand ($5,000.00) Dollars to my great-granddaughter, DANIELLE
LEIBY if she survives me.
If any beneficiary shall not survive me, then the gift to such beneficiary shall lapse and be distributed
. as part of my residuary estate.
ITEM VII
Ifmy great-great-grandson,JAIDENXAVIERJOSEPH LEIBY, bornJanuary 15, 2001,is less than
twenty-three (23) years of age::~;-l!J;~~,~.;?rmy death, I direct that the sum of Ten Thousand ($10,000.00)
Page 2 of 8
Dollars be placed in trust to my daughter, BARBARA CAMPBELL, "'lith the following conditions and
provls1ons:
A. Trustee shall hold the principal of this trust for the benefit of my great-great-
grandson and shall distribute the principal and income in such proportions as Trustee shall
determine, for his health, maintenance, support and education, including college, graduate level
or professional education after considering the beneficiary's age, aptitudes, interests, abilities and
needs. Any income directly distributed to my great-great-grandson shall only be done after his
education, medical and maintenance fees have been paid. Education shall be defined broadly
to include trade school and other similar training. In the event the income of the Trust shall be
insufficient to provide the beneficiary with adequate maintenance, support, welfare or education,
the Trustee may invade the principal of the Trust for this purpose. The Trustee, in exercising
her discretionary authority with resp~ct to the payment of income or principal of the Trust
estate to the beneficiary, shall take into consideration any income or other resources available
from sources outside of this Trust that may be known to the Trustee. The determination of the
Trustee with respect to the necessity of making payment out of income or principal to the
beneficiary shall be conclusive on all persons however interested in the Trust. The Trustee shall
accumulate and add to principal any net income of the Trust not paid out in accordance with
the discretion hereinabove conferred on the Trustee.
B. Should the beneficiary die, without issue, before attaining the age of distribution, all
remaining unapplied principal and income shall be distributed as part of my residuary estate.
C. The beneficiary of this Trust shall not have any right to alienate, encumber or
hypothecate his interest in the principal or income of the Trust in any manner, nor shall his
Page 3 of8
interest be subject to claims of his creditors or liable to attachment, execution or other process
of law.
'D. In order to carry out the purposes of this Trust established by this Will, the Trustee,
in addition to all other powers granted by this Will, or by law, shall have the follm.ving powers
over the Trust estate, subject to any limitation specified elsewhere in this \'Cill:
1) To retain any property, real or personal, received by the Trust estate
for as long as the Trustee considers it advisable.
2) To spend funds for the maintenance and repair of real property.
3) To sell at public or private sale, exchange or lease for a period of
time, any real or personal property and give options for sale of the lease.
4) To execute and deliver any deeds, assignments or other instruments
as may be necessary to carry out the provisions of this Trust.
5) To borrow money and to mortgage or pledge any real or personal
property.
6) The Trustee shall maintain accurate records and accounts showing
receipts and disbursements of principal and income no less frequently than
annually. The Trustee shall receive fair and reasonable compensation for
administration of this Trust, not to exceed five (5%) percent of annual income.
7) To distribute property in kind.
8) To do all other acts that are in her judgment necessary or desirable
for the proper management, investment and distribution of the Trust estate.
Page 4 of 8
E. The Trust estate for the beneficiary shall be administered until said beneficiary is
twenty-three (23) years of age, at which time the Trust will terminate and Trustee shall distribute
the remaining principal and accumulated interest to the beneficiary.
F. Not withstanding the age limitations stated in the foregoing trust paragraphs,
Trustee shall have the absolute power, with her discretion, to determine the age and amount of
distribution of income and/ or principal to the beneficiary.
ITEM VIII
I give, devise and bequeath all of the remainder of my estate, real or personal, and my property of every
kind and description (including lapsed legacies and devises), wherever situate and whether acquired before or
after the execution of this Will, after the Directive attached to my \V'ill has been honored, to my children,
RANDAL F. LEIBY and BARBARA CAMPBELL, equally, and to their issue, then living, per stirpes. In
the event that my daughter, BARBARA CAl\tIPBELL, does not survive me, nor leave issue who survive me,
I direct that her share of my estate be. given, devised and bequeathed to my son-in-law, ALVIN CAMPBELL,
if he survives me.
ITEM IX
I hereby nominate, constitute and appoint as Co-Executors of this, my Last \'Vill and Testament, my son,
RANDAL F. LEIBY, and my daughter, BARBARA CAl\tlPBELL, or either of them. By way of illustration
and not of limitation and in addition to any inherent, implied or statutory powers granted to executors generally,
my Executors are specifically authorized to and empowered with respect to any property, real or personal, at
any time held under any provision of this my Will, to allot, allocate between principal and income, assign,
borrow, buy, care for, collect, compromise claims, contract with respect to, convey, convert, deal with, dispose
of, el1ted.gto, exchange, hold, improve, invest, lease, manage, mortgage, grant and exercise options with respect
-,.:- ,. ',,- .;-,->....;.. ~;' i ,'.-, ..+ ,-"."- :...'., .~.
Page 5 of8
to, take possession of, pledge, receive, release, repair, sell, sue for, to make distributions in cash or in kind or
partly in each without regard to the income tax basis of such asset, even though distribution shares may as a
result be composed differently, and in general to exercise all of the powers in the management of my Estate
which any individual would exercise in the management of similar property owned in his own right, upon such
terms and conditibns as my Executors may seem best, and to execute and deliver any and all instruments and
to do all acts which my Executors may deem proper or necessary to carry out the purposes of this my \X'ill,
without being limited in any way by the specific grants of power made, and without the necessity of a Court
Order.
ITEM X
I direct that no executor, trustee or any fiduciary under this instrument shall be required to give bond
for the faithful performance of their duties in any jurisdiction.
IN WITNESS \'VHEREOF, 'l have hereunto set my hand and affixed my seal this
'F t~t~
day
ofSy,--:t ,2005.
,t'.
"f7""(' .- v> .....) ': 1 .' -
./ VD,.;:~"'}L. oZ. . \,+ l/fl-/:?,./2"'.-.C:~LD
MARIAN L. JEFFPlt-&S
SIGNED SEALED PUBLISHED and DECLARED bv the above Testatrix as and for her Last Will,
, , , ~
in the presence of us, who thereupon at her request, in her presence and in the presence of each other, have
hereunto subscribed our names as witnesses.
/i:J,fL~ --fAi41d a /lCtJ2
/
Address
'l~.~____'Y(: ~'Y'l~
(L.~CA~A. vL:;
Address
;.,:.. W~tness .
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Page 6 of 8
STATE OF PENNSYLVANIA
SS
and PATRICIA R. BROWN the
TestatrL,( and the witnesses, respectively, whose names are signed to the foregoing instrument, being frrst duly
sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument
as her Last \Vill and that she signed willingly, and that she executed it as her free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed
the \Vill as witnesses and that to the best of each witness' knowledge and belief the Testatrix was at that time
eighteen years of age or older, of sound mind and under no undue constraint or influence.
(I
c... ,'1_
/ ~vt/~'~'4u~
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71/ t:Z---~~,-
Testatrix
/- ..\
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? - '- ./c:...)l' ". (I f-,' z...-L-L.-3
tf" t/j:--
\Vitness
'n-~~ \R .r~,~r.-J'
\Vitness
Subscribed, sworn to and acknowledged before me by MARIAN L. JEFFERIES, the Testatrix and
,~ p ')
subscribed and sworn to before me by V ireV'! e... ' G}5e(,( andP ATRICIA R. BROWN, witnesses,
this t, tl. day of ,J~t~tt:Y2005.
"
1 /)
0~4L '/J.
Notary Public
NOTARIAL SEAL
ANN B. SENSENICH, NOTARY PUBtlC
CA~~SLE BORO., CUMBERLAND COUNTY
MY "OMMISSION EXPIRES MAY 13 2007
J? . 1
/(W'J(>2.c..yUL~
Page 7 of8
Page 8 of8
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tiiL-fGL-) ~L....cr/L/2.i.<} 1:- cL-Y (. t't;;
l! M&fBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
May 1, 2006
Salzmann Hughes PC
Attorneys At Law
354 Alexander Spring Road, Suite 1
Carlisle, Pennsylvania 17013
Re: Estate of" Marian L Jefferies
Social Security: 198-18-9868
Date of Death: March 22,2006
Dear Sir or Madam:
Per your inquiry dated April 19, 2006, please be advised that at the time of death, the above-named decedent had on deposit
with this bank the following:
1.
Type of Account
Checking Account
Account Number
9834691132
Ownership (Names of)
Barbara E Campbell *
Marian L Jefferies *
Opening Date
10/22/03
Balance on Date of Death
$1,721.28
Accrued Interest
$ 0.00
Total
721.28
2.
Type of Account
Savings Account
Account Number
015004208628428
Ownership (Names of)
Barbara E Campbell *
Marian L Jefferies *
Opening Date
04/10/92
Balance on Date of Death
$4,853.04
$ 0.44
Accrued Interest
Total
$4,853.48
VV Thrivent Financial
for Lutherans™
March 29, 2006
Estate of Marian L Jefferies
7 Richland Ln Apt 7T6
Camp Hill PA 17011-2405
Subject: Estate of Marian L Jefferies IRA Contract 3657696
To Whom It May Concern:
Thrivent Financial for Lutherans is required by the Internal Revenue (IRS) to report the contract value as
of the date of death to the estate of Marian L Jefferies. The IRS form 5498 will be sent to the above
address in January of next year. Form 5498 will report the fair market value of the IRA plan to Marian L
Jefferies's estate.
This letter should be retained for income tax purposes when filing the decedent's income tax return:
Date of Death:
Contract Value as of Date of Death: ,
03/22/2006
$62,673.10
~
'?
If you have any questions regarding the above information, please contact your Financial Associate,
MARK SNOVER, whose telephone number is 717-730-9611. You are also welcome to call Thrivent
Financial for Luthera'ns at 800-847-4836.
Sincerely,
Death Claims
Death Claims & Services
Product Services Department, FSO
Cc : MARK SNOVER 0165 03068 00
-~~---"':~ -'.:::: :'>;: .', : ': :--
, :'i:~~.~{.;:,4~':~=i,: i:<i.:_€;;-~.-~--'::';:;
Marian L Jefferies, deceased, Contract # 3657696, CIF # 501928269 .
04/21/200609:41 AM
To: Wayne A Logue/FieldIWH/AEFA@AMEX
cc:
Subject: Marian Jeffries, client id 20626521 7001, date of death values
Joe Roedl
IDS Life Insurance Company
RiverSource Funds
Ameriprise Certificate Company
Ameriprise Brokerage
70100 Ameriprise Financial Center
Minneapolis, MN 55474
April 21, 2006
WAYNE ALLEN LOGUE
STE 200
342 N FRONT ST
WORMLEYSBURG, P A 17043-1112
Dear WAYNE ALLEN LOGUE:
Thank you for your recent inquiry regarding MARIAN L JEFFERIES's accounts. These are the values of the
accounts as of 03/22/2006.
SPS Advantage ONE Features
Account Number
00060599396 3 021
Total Value
$81125.53
4-
~
~
Client Name: MARIAN L JEFFERIES
Date of Death: 3/22/2006
Account:
Valuation Date:
60599396 3 021
3/22/2006
Estimated Values
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,
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The date of death values provided are for estate taX 'purPoses and are not a value to be paid. Accounts may be
subject to market fluctuation as governed by each product. Please note that the values indicated for any Life
Insurance product(s) reflect the gross death benefit at date of death, not the cash value. Values for any proprietary
()
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