HomeMy WebLinkAbout03-06-08 (2)
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REV-1500
t::: ~ COMMONWEALTH OF
.1- ".' PENNSYLVANIA
"('~"' . .: DEPARTMENT OF REVENUE
. DEPT. 280601
~. " HARRISBURG, PA 17128-0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
GUINIVAN, THOMA
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
Ju~e 8, 2007 Se tember 15, 1917
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
~ 1. Original Return
D 4. Limited Estate
rn 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale 01 death alter 12.12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12.31.91 and 1.1.95)
FILE NUMBER
1-- L -9 _.1_
COUNTY CODE YEAR
_9.. _~.. I._ 3
NUMBER
SOCIAL SECURITY NUMBER
187 - 03 ~ 9709
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (dale of dealll pnor 10 12-13.82:
D 5. Federal Estate Tax Return Required
-.0 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec 91'13:A) ,(.i\.,<:' See, J
NAME
COMPLETE MAILING ADDRESS
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Geor e W. Porter
FIRM NAME (If Applicable)
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717-533-7130
909 East Chocolate Avenue
Hershey, PA 17033
TELEPHONE NUMBER
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
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1,066,851.15
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5,190.00
53,379.92
(1 )
(2)
(3)
(4)
(5)
(6)
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(7)
107,718.71
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(9)
(10)
13,931.11
26.20
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental BequestslSec 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x .0 _ (15)
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16. Amount of Line 14 taxable at lineal rate
1,121,647.87
17. Amount of Line 14 taxable at sibling rate
x .12
18 Amount of Line 14 taxable at collateral rate
x .15
19 Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF I\,tl O\fERPAYMENT
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1,233,13Q.7R
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1,.~19,182.47
97,534.60
(14)
1,121,647.87
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(17) _____._Q_.___..... ..__.__..____
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(19)
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Decedent's Complete Address:
[ STREET-ADDRESS -
_____________ _____._____ ._____Th..Qm.as__~_G.uin.i van
_______._ _ 513__Al.b..r.i q h t Drive
CITY
Mechanicsbur
STATE
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit N / A
B. Prior Payments 8 / 21 /07
C. Discount
(1 )
-----1
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ZIP 1 7055
50,474.15
45,000.00
2,250.00
. Total Credits ( A + 8 + C ) (2)
47,250.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
4.
TotallnterestJPenalty ( 0 + E ) (3)
If Line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
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. (SA)
5.
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3,224.15
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B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 3 , 224 · 15
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOLLOWING QUeSTIONS BY PLACtNG AN..'X" IN THE APPROP'RIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c, retain a reversionary interest; or..... ........... ........................................................................... ............................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................. ......................................... .................. ................. ......... ........ 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...... .............................................. ......... ......... ....................... ................ ..... ...... I!I
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
DATE
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2804 West Linden Avenue
Nashville, TN 37212
SIGNATU
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ADDRESS 2432 Rock s Road
Forest Hill, MD 21050
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
If- /.., (J J;:
ADDRESS
909 East Chocolate Avenue, Hershey, PA 17033
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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 PS 99116 (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. 99116 (a) (11) (ii)].
The statute does not exemDt 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. 99116(a)(1.2)].
The tax rate :rnposed 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. 99116(1.2) [72 P.S. 99116(a)(1)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)J. 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.
REV-1503 EX. (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
THOMAS W. GUINIVAN
FILE NUMBER
21-07-0573
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Wienken & Associates account:
a. Washington Mutual Investors.~'Fund -
A #132439809
b. New Perspective Fund - A #191086745
c. American Balanced - A 951527962
d. Capital World Growth & Income - A 951527962
e. Oppenheimer Funds - PA Municipal Fund -
A 740-7400075295
VALUE AT DATE
OF DEATH
234,001.67
215,984.61
155,172.91
275,614.12
175,956.84
2.
Wachovia Securities account: #3759-0533
a. 10,000 PA Housing Finance 5% @ 100.605
b. accrued interest
10,060.50
60.50
TOTAL (Also enter on line 2, Recapitulation) $ 1, 066 , 851 . 15
(If more space is needed, insert additional sheets of the same size)
THOMAS W. GUINIV AN
Date of Death: June 8, 2007
SSN: 187-03-9709
DATE OF DEATH VALVES
Non-Qualified Accounts
AMERICAN FUNDS ACCOUNT # DATE OF DEATH
VALUE
Washington Mutual 132439809 $234,001.67
Investors Fund- A
New Perspective Fund-A 191086745 $215,984.61
Alnerican Balanced-A 951527962 $155,172.91
Capital World Growth & 951527962 $275,614.12
Income-A
OPPENHEIMER FUNDS
P A Municipal Fund-A 740-7400075295 $175,956.84
Non-Qualified Annuitv
MASS MUTUAL ACCOUNT # DEA TH BENEFIT
VALUE
Odyssey Fixed Annuity ODY15262803 $ 97,718.71
WachOVid.;,ef'UI':r.es. LLC
.3 Len 1oyn,., Dllve
Len1lJvoe, PA 11043
~~
Tel 717 7617344
Fax 71/ q75-8426
800 468-8685
.
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AuguSl 2.0, 2007
Ceorge W. Porter
')09 I:asl Chocolale Avenue
llershey, P^ 17033
l{' ':: I;sl<t((' of Thomas V\l. Guinivan
June X, 2.007
Dear Mr. Porter:
l.isted below is the date of death value for the above mentioned estate:
10,000 P A Housing Finance 5</:) Due 10/01/2017 $100.605
The account was opened May 21, 1997 in single name.
III can he of further assistance, please give ll1e a call at 717-975-8411.
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'/ I yn K. Neff'
Senior Administrative .'sistant to George A. Sneed
Member NYSE/ SIP(
WACHOVJA SBCGIU 'I' ll<~S
$10,060.50
REV-1507 EX. (1-97) ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
FILE NUMBER
21-07-0573
THOMAS w. GUINIVAN
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
united Methodist Church - loan to church
$5,190.00
TOTAL (Also enter on line 4, Recapitulation) $ 5, 190 . 00
(If more space is needed. insert additional sheets of the same size)
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COMMONWEAL TH OF PLNN~jY:.'v'ANI/\
iNHERnANCE TM'. RETURN
____~~~_i)E~i'gr:N r
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
THOMAS W. GUINIVAN
FILE NUMBER
21-07-0573
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
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
DESCRIPTION
Credit Union' - Acct. #22396-00
Credit Union - Acct. #22396-11
Credit Union - Investment Savings
Credit Union - accrued interest
Members 1st Federal
Members 1st Federal
Members 1st Federal
Members 1st Federal
Cash on hand
Refund - Genworth - refund of premium
Refund - AAA premium
Refund - Erie Insurance
Refund - IRS - tax refund
Refund - Bethan Village
Refund - Verizon
United Methodis Church - death benefit under pension
Cumberland County Veterans Assoc. - death benefit
\
1
VALl.JE A.T OA T::
OF JEA:r
27.03
1,949.44
46,761.00
20.00
1,525.32
1,337.94
22.68
163.00
537.05
433.52
2.94
500.00
100.00
TOTAL (Also enter on line 5, RecapitUlatiOn)
(If more space is needed, insert additional sheets of the same size)
~53,379.92
REGULAR SAVINGS ACCOUNT:
Account Number/ Suffix
Date Account Established
Principal Balance at Date of Death
Accrued I nterest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CHECKING ACCOUNT:
Account Number/ Suffix
Date Account Established
Principal Balance at Date of Death
Accrued I nterest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued I nterest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
VISA:
Account Number/Suffix
Date Account Established
Balance at Date of Death
Name of Joint Cardholder
Estate of: THOMAS W. GUINIVAN
Date of Death: June 8,2007
Social Security Number: 187 -03-9709
tv 1~
MEMBERS 1st
FEDERAL CREDIT UNION
INSURANCE DEPARTMENT
5000 Louise Drive
P. O. Box 40
Mechanicsburg, PA 17055
1-800-283-2328 or (717) 697-1161
22396-00
07/31/1979
$27.03
$.00
$27.03
None
22396-11
01/06/1982
$1,949.44
$.00
$1,949.44
None
22396-05
10/01/1985
$46,761.00
$20.00
$46,781.00
None
4121449998223965
01/29/1992
$.00
Irene Guinivan (deceased 12/11/1996)
BERS 1 ST EEDERAi CREDIT UNION
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Danielle A. Kline
Insurance Services Specialist
June 28, 2007
5000 Louise Drive · PO. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · www.memberslst.org
REV-"" ",. "'" '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
ESTATE OF
FILE NUMBER
THOMAS W. GUINIVAN
21-07-0573
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
NUMBER
1.
DESCRIPTION OF PROPERTY
INCLUOE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.
ATTACH A COPY OF THE OEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
%OF
DECO'S
INTEREST
EXCLUSION
IIF APPLICABLe)
TAXABLE VALUE
2.
MassMutual - Contract #ODY15262803 -
Annuity - Beneficiaries: Thomas Lee
Guinivan - son; and Ann Lenore Cover,
daughter.
MassMutual - Contract #19890300 -
Beneficiaries: Thomas Lee Guinivan,
son; and Ann Lenore Cover, daughter.
97,718.71
100%
97,718.71
10,000.00
100%
10,000.00
TOTAL (Also enter on line 7, Recapitulation) $ 107 , 718 . 71
(If more space is needed. insert additional sheets of the same size)
-'"~''''' *
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECED NT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
21-07-0573
THOMAS W. GUINIVAN
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11. . .
12.
DESCRIPTION
FUNERAL EXPENSES:
Hoover Funeral Home - balance of funeral expenses
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
N/A
Name of Personal Representative (s)
Social Security Number(s) J EIN Number of Personal Representatlve(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
Attorney Fees: George W. Porter, Esquire
Family Exemption: (If decedenfs address is not the same as c1aimanfs. attach explanation)
Claimant
Street Address
N/A
City
Relationship of Claimant to Decedent
State
Zip
ProbateFees: cumberland County Register of Wills - letters
Register of Wills - file inventory
!~n~~~ of Wills - file tax return
Final 1040 for 2007 - estimated
.
TaxRetumPreparer'sFees Fiduciary income tax returns - 1041
estimated fee
Cumberland Law Journal - advertise letters
The Sentinel - advertise letters
Bethany Village - final bill
Register of Wills - short certificate
Members 1st Federal Credit Union - checkbook printing
George W. Porter - miscellaneous expenses
AMOUNT
876.48
10,000.00
730.00
15.00
250.00
350.00
75.00
134.68
1,432.00
4.00
13.95
50.00
TOTAL (AI$o enter on line 9, Recapitulation) $ 13, 9 31 . 11
(If more space Is needed, Insert additional sheets of the same size)
REV-1512 EXt (12-03)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
THOMAS W. GUINIVAN
FILE NUMBER
21-07-0573
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Jackson Siegelman Gastroenter. - bill
$26.20
TOTAL (Also enter on line 10, Recapitulation) $ 26 . 20
(If more space is needed, insert additional sheets of the same size)
REV. 1513 ex .ll.gn
*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
THOMAS W. GUINIVAN
FILE NUMBER
21-07-0573
RELA TIONSHfP TO DECEDENT AMOUNT OR SHARE
Do Not Lilt Trustee(s) OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I . TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Thomas Lee Guinivan
2432 Rocks Road, Forest Hill, MD 21050
son
46% residue
2. Ann Lenore Cover
2804 West Linden Avenue, Nashville, TN
37212
daughter
46% residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
-----...
1. -___.__
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. United Methodist Home for the Aging, Inc. -
32~ Wesley Drive, Mechanicsburg, PA 17055
2. Lebanon Valley College
101 College Avenue, Annville, PA 17003
3. United Theological Seminary
4501 Denlinger Road, Troutwood, Ohio 45426
4. Bethesda Mission
2001 North Front Street, Harrisburg, PA 17102
$24,000.00
24,000.00
24,000.00
24,000.00
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 96,000. 00
(If more space Is needed. insert additional. sheets of the same size)
LAST WILL
(F (() ~'\?
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OF
THOMAS W. GUINIV AN
I, THOMAS W. GUINIV AN, presently of Lower Allen Township,
Cumberland County, Pennsylvania, do hereby declare tms to be my Last Will, and
do hereby revoke all prior Wills and Codicils heretofore made by me.
1. I hereby give and bequeath to my children, THOMAS LEE
GUINIV AN and ANN LENORE COVER, in equal shares, if they survive me, my
entire interest in and to any and all furniture, clothing, jewelry, household goods,
utensils and supplies, books, automobiles, implements, and tools that may be in, at
or about my home at the time of my death, and all of my other tangible personal
property, together with all policies of insurance thereon.
2. All of the rest, residue and remainder of my property and estate, of
whatsoever nature and wheresoever situate (hereinafter referred to as "my
residuary estate"), I hereby give, bequeath and devise as follows:
a. Ninety-two percent (92%) to be divided equally among my wife,
IRENE L. GUINIV AN, my son, THOMAS LEE GUINIV AN, and my
daughter, ANN LENORE COVER. If my said wife predeceases me, her
share of my residuary estate shall be divided equally between my said
children. If either of my said children should predecease me, his or her
share of my residuary estate shall be distributed to said deceased child's
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(Pf-:Y
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issue, per stirpes, and if none, then to my surviving child or his or her
living issue, per stirpes.
b. Two percent (2%) to The United Methodist Home for the Aging, Inc.,
or its legal successor, for deposit in the Care Assurance Fund of Bethany
Village Retirement Center;
c. Two percent (2%) to Lebanon Valley College, Annville,
Pennsylvania, or its legal successor;
d. Two percent (2%) to United Theological Seminary, Dayton, Ohio, or
its legal successor; and
e. Two percent (2%) to Bethesda Mission, Harrisburg, Pennsylvania, or
its legal successor.
3. Any property, either of income or principal, which is payable or
distributable to a minor under this Will shall be transferred to the guardian of
such minor to be held pursuant to the provisions of the Pennsylvania Uniform
Transfers to Minors Act with said guardian being hereby nominated as the
custodian thereof.
4. Except as otherwise required by law, in the administration of my
estate, the fiduciaries serving under this Will shall have the following powers,
which may be exercised without leave of court, in addition to those powers as my
said fiduciaries may have by law:
: . 11 .J...-
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(a) To sell, exchange, grant options upon, or otherwise dispose of
any property, real or personal, tangible or intangible, or mixed, or interests
therein, wheresoever situate, at any time held by them, at public or private
sale, for cash or upon credit, in such manner, to such persons, and at such
price, terms and conditions as they may deem best, and no person dealing
with them shall be bound to see to the application of any funds paid to
them.
(b) To distribute in cash or in kind, or partly in each, and in
shares different in kind from other shares, upon any division or distribution
of any property which they hold.
(c) To make from time to time partial distributions in varying
amounts to the beneficiaries hereunder prior to final settlement and
distribution of my estate, an~ in connection therewith to determine in their
discretion the time or times when such partial distributions may require
recomputation of said beneficiaries' proportionate interests hereunder for
the equitable allocation of income or on account of changing asset values
pending final distribution.
(d) In general, to exercise all powers in the management of the
assets and property held by them which any individual could exercise in
the management of similar property owned in his or her own right, u pan
such terms and conditions as to them may seem best, and to execute and
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deliver all instruments and to do all acts which they may deem necessary or
proper to carry out such management and their duties under this Will.
5. I hereby appoint my children, THOMAS LEE GUINIV AN and ANN
LENORE COVER, to serve together as executor of my estate hereunder. Should
either of my said children be unwilling or unable, fail to qualify or cease to act as a
co-executor, then the surviving child shall act alone as the executor of my estate.
6. My executors shall not be required in any jurisdiction to file, enter or
post any bond or other security for the faithful performance of their duties
hereunder, and shall not be liable for the acts, omissions or defaults of any agent
appointed by them with due care.
7. I direct that all estate, inheritance, legacy, transfer, succession and
death taxes, whatsoever nature or kind and by whatsoever jurisdiction imposed,
and all interest and penalties that are on, which may be payable or assessed in the
consequence of my death, whether or not with respect to the property passing
under this Will, shall be paid out of and charged against the principal in my
residuary estate in the same manner as are general administration expenses of my
estate so that all property subject to such taxes shall pass free and clear thereof,
without apportionment of or reimbursement for such taxes, interest or penalties
among any beneficiaries, transferees or other persons interested in such property
and without any right of any estate or executor to contribution, recovery or
collection for the same.
, I
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4
TW(}
On this 2.G;,~day of ~~u.~1- /1996/ THOMAS W. GUINIVAN
declared to us, the undersigned, that the afore going instrument was his Last Will,
and he requested us to act as witnesses to the same and to his signature thereon.
He thereupon signed said Will in our presence, we being present at the same time.
We now, at his request, in his presence, and in the presence of each of us, hereby
subscribe our names as witnesses thereto and have placed our initials at the
bottom of each of the preceding pages. By so doing, each of us declares that he or
she believes this testatrix to be of sound mind and memory.
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residing at _r~::x j))d! il-( ....'d
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Re..
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COMMONWEALTH OF
COUNTY OF {~a/{j bultu-JC(
85.
I, THOMAS W. GUINIV AN, testator, whose name is subscribed to the
attached foregoing instrument, having been duly qualified according to law, do
hereby acknowledge that I signed and executed such instrument as my Last Will,
and that I signed and executed it willingly and as my free and voluntary act for
the purposes therein expressed.
Sworn or affirmed to and acknowledged before me, by THOMAS W.
GUINIV AN, the testator, this J.~ 1k day of ~~ / 1996.
~.Yt. A~~rA~
THOMAS W. GUINIV AN
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If _ ,.{~ .\ /-t t. {c;..l' ; /
Not P lic
My Commission Expires:
--.----..,
Notarial Seal ~
Nancy J. Turner'"Notal)' Public \
Worl1"lleysburg Boro, CumberJand county \
My Commission Expires Jan. 5, 1998
M".,.,hpr. P"'nr'~\lhl~.ni::1 Af...<;od<:':\ti0r: o~ Nc!::!i(~
COMMONWEALTH OF
COUNTY OF CLfI/1 fti/il^Jll
ss.
I
We,: ,.'l.F. {rt. lid /\ 1 ~~ C.. Y:A., '^:~,:./_l6,\ r..". ..'e' ,.','. ,_,:
the witnesses whose names are signed to the attached foregoing instrument, being
duly qualified according to law, do depose and say that we were present and saw
THOMAS W. GUINIV AN, the testator, sign and execute such instrument as his
Last Will; that such testator signed such instrument willingly and executed it as
his free and voluntary act for the purposes therein expressed; that each of us in the
hearing and sight of such testator signed such Last Will as a subscribing wih"less
thereto; and that to the best of our knowledge, such testator was at that time 18 or
Inore years of age, of sound mind and under no constraints or undue influence.
...-_._ Sworn or affirJ;t1ed to an~ subscribed before me by (~1 :. "j D,
r (~r ~ ,.; i I; .~ II 1 . I .
c.---........ "" \::A_{i.-;/I c. '-tt~I.,U.LI"'CJ.. I Witnesses, this
A~\.I.') d- I 1996.
/. ) .I;; , :
2~~ day of
WITNFSSES:
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{,./UJ,i.l /, /-~. :._. .
J
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-1;-1. -I1.v" () .:,.:( i '" ' ,'. "
My Commission Expires:
\" Notarial Seal -
Nancy J. Turner. Notary Public
Wormleysburg Bora, CumberJand County
My Commission Expires Jan. 5. 1998
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