HomeMy WebLinkAbout08-19-08 (2)i 'f
15056051047
REV-1500 EX (Oti-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
2
1
O ~_
S~
0
4
6
9
PO Box 2sosol RESIDENT DECEDENT ~.,:
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
0 4 1 9 2 0 0 8 0 7 2 0 1 9 2 1
Decedent's Last Name Suffix Decedent's First Name MI
C O N N O L L Y Decedent's First Name D O R O T H Y a
({f Applicable) Enter Spouse's Information Below
Spouses Last Name Suffix Spouse's First Name MI
Spouse's Social Securi Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
~ ~ ~ ~ REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Return U 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of U 5. Federal Estate Tax Return Required
death after 12-12-82)
_ 6. Decedent Died Testate ~~~ 7. Decedent Maintained a Living Trust 0 8. Total Number of SDB's
(Attach Copy of Will) (Attach a Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death U 11. Election to tax under Sec. 8113(A)
between 12-31-91 and 1-1-95) (Attach Sch O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHALL BE DIRECTED TO:
Name Daytime Telephone Number
R O N A L D E J O H N S O N 7 1 7 2 4 3 0 1 2 3
Firm Name (If Applicable)
line of address
Second line of
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Correspondent's a-mail address: relOhnSOnlQ~Da.net lL5
n er pena ies pequry, ec are a ave examme rs re um, me u rng accompanying s e u es an s a emen s, an o e es o my now a ge an ere , i rs rue, corre
and complete. Declaration of preparer other than the personal representative is based on all the information of which the preparer has an
:_ S~ l x'-08
c/o 78 West Pomfret Street, Carlisle,
Side 1
15056051047 15056051047 r~
i~
1 1
REV-1500 EX
Decedent's Name:
Real estate (Schedule A)
1 1 $0
0]
. . .
2. Stocks and Bonds (Schedule B) 2. $0.0]
ld Co
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(Schedule C)
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es 8 Notes Receivable {Schedule D)
a
4
Mort a $0
0]
g
.
g . .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. $0.00]
6. Jointly Owned Property (Schedule F) Q Separate Billing Requested 6. $23,790.00]
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Q Separate Billing Requested 7. $93,622.92
8. Total Gross Assets (total Lines 1-7) 8. $117,412.92]
9. Funeral Expenses & Administrative Costs (Schedule li) 9. $24,203.40,
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10. $0.00 l
11. Total Deductions (total Lines 9 $ 10) 11. $24,203.40
12. Net Value of Estate (Line 8 minus Line 11) 12. $93,209.52
13 Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) 13. $0.00
14. Net Value Subiect to Tax
TAX COMPUTATION -SEE II
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) x .0 _
16 Amount of Line 14 taxable
at lineal rate x .045
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
ne 12 minus Line 1
15056052048
20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15!156052048
Side 2
15. $0.00
16. $4,194.43
17. $0.00
18. $0.00
19 $4,194.43
15056052048
File Number
REV-1500 EX Page 3
Decedent's Complete Address:
Decedent's Name
Dorothy Connolly
STREET ADDRESS
39 Prickly Pear Drive
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1, Tax Due
2, Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discounts
(1) $4,194.43
Total Credits (A+B+C) (2) $~•0~
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total InterestlPentatty (D+E) (3) $0.00
4• If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Fi{I in oval on Page 2, Line 20 to request a refund
5- If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $4,194.43
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $4,194.43
Make Check Payable to: REGISTER OF WILLS, AGENT
__ ~_
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: yeS n0
a. retain the use or income of the property transferred:
b. retain the right to designate who shall use the property transerred or Rs income:
c. retain a reversionary interest: or
d. retain the promise for IIfe of either payments or care?
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?
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 disignation?
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Far 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% [72P.S. Sec, 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 . Sec. 9116(a)(1.1){ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements far 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:
Tha tax rate imposed on the net value of transfers from a deseased child twentyone 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. Sac. 9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedenYS lineal beneficiaries is 4.5%, except as noted in 72 P.S. Sec. 9116(1.2) j72 P.S. Sec.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. Sec.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.
LAST WILL AND TESTAMENT
OF c~ `~~'
DOROTHY M. CONNOLLY , ~- ~ ,
-.~- '~
`- n-~ r.~ _ ~ ..~
~~~
:.._7~j(7 t_.~ _
r+.
I, DOROTHY M. CONNOLLY, of Lee County, Florida, deGlare~`this;=,~'-!
to be my Last Will and Testament, and I revoke all former ~lls~'~-'
and Codicils. I dispose of my property in the following manner:
ITEM I
I may leave a written statement or list disposing of certain
items of my tangible personal property not otherwise disposed of
herein. In the event that more than one such written statement
or list is found by my Personal Representative, then the written
statement or list with the latest date after the execution of
this Will shall control. Such statement or list shall be
determinative with respect to all devises made therein only i.f it
specifically refers to this Will, is signed by me, is dated and
describes the items and devisees therein with reasonable
certainty. If no written statement or list is found and properly
identified by my Personal Representative within thirty (30) ~9ays
after my Personal Representative's qualification, it shall. be
presumed that there is no such statement or list and any
subsequently discovered statement or list shall be ignored.
ITEM II
I give all of the remainder of my property to the Successor
Trustee under that certain Revocable Trust dated the 31st day of
May, 1989, between DOROTHY M. CONNOLLY as Grantor and DOROTHY M.
CONNOLLY as Trustee and SUSAN LEE DAVIS as Successor Trustee.
ITEM III
I hereby nominate and appoint my said daughter, SUSAN LEE
DAVIS, Personal Representative hereof, but if he shall not act or
continue to act, I appoint my son, RAYMOND JOHN CONNOL.LY, as
Alternate Personal Representative of this, my Last Will and
Testament. I authorize my Personal Representative to serve
without bond. I hereby give to my Personal Representative full
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power and authority, at any time or times, to sell, mortgage,
pledge, exchange or otherwise deal with or dispose of the
property comprising my estate, upon such terms as shall be deemed
best; to set~le and compromise any and all claims in favor of or
against my estate as shall be deemed advisable and for any of the
foregoing purposes to make, execute and deliver all deeds,
contracts, mortgages, bills of sale or other instruments
necessary or designate therefore. My Personal Representative is
expressly authorized to postpone final distribution of my estate,
pending final determination of tax liabilities in connection
therewith.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
-~,
this _'+~`~° :~~day of ~,'.- ~ •~% 1989.
- - - _~.
Dorothy M, Connolly •- __ ~..
The foregoing typewritten instrument was, on the date
thereof, signed by the said DOROTHY M. CONNOLLY, in our presence
and by her declared to be her Last Will; and we, at her request
and in her presence, and in the presence of each other, have
hereunto set our names as attesting witnesses thereto.
' '~ /'+ /
. ~_
~~
.-~-
STA'PE OF FLORIDA
COUNTY OF LEE _
~j _. ` ._
WE, DOROTHY M. CONNOLLY, ~-Yi.,71t? ~. ~-~ ~-~=~c:i r~"~7!'r.~ and
7
_~~~/ ~+;/fJ,~_,1y7jF~' , the Testatrix and Witnesses
respectively, whose names are signed to the attached or foz•egoing
instrument, being first duly, sworn, do hereby declare to the
undersigned officer that the Testatrix signed the instrument as
her Last Will and that she signed voluntarily (or directed
another to sign for her and did so voluntarily) and that each of
the witnesses in the presence of the Testatrix at her request,
and in the presence of each other signed the Will as a witness
and that to the best of the knowledge of each witness the
Testatrix was at that time twenty-one (21) or more years oi: age,
of sound mind and under no constraint•or undue influence.
~.
Testatrix ;.r -._"_.......__` _ ,:
SWORN TO and subscribed before me this ~~! da:y of
ii'?c~.~ 1989.
My commission _expires:
`7f-'~ '~
~,.
Notary Public
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
FILE NUMBER
Dorothy Connolly 2I-08-046
if an asset was made joint within one year of the decedent's death, it must be reported on Schedule G
Surviving Joint Tenant (s):
NAME ADDRESS RELATIONSHIP TO
DECEDENT
A Susan Lee Davis 39 Prickly Pear Drive, Carlisle, PA 17013 daughter
B Raymond J. Connolly 6 Willow Trails, Collinsville, IN b2234 son
Jointly-owned property:
ITEM NUMBER LETTER FOR
JOIMI TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF
MSTITUTION AND BANK ACCOUNT NUMBER OR
SIMILAR IDENTIFYING NUMBER. ATTACH DEED
FOR JOINTLY•HELD REAL ESTATE TOTAL VALUE OF
ASSET DECD'S % 7NT. DOLLAR VALUE OF DECEDENT'S
INTEREST
1 A&B 01-Sep-b? checking account no. 407917
M&T Bank $23,638.25 113 $7,879.42
(see letter attached}
2 A&B 20-Aug-93 Savings account no.
015004200117338-M&T Bank $47,731.73 1/3 $15,910.58
(see letter attached)
TOTAL (also on line 6, Recapitulation) $23,790.00
p ~s~
499 Mitchell Road, Millsboro, DE ]9966 Mail Code DE-MB-]2
Andrews & Johnson
Attorneys At Law
78 West Pomfret Street
Carlisle, Pennsylvania 17013
Phone (888) 502-4349
Fax (302)934-2955
June 2, 2008
Re: Estate of Dorothy M Connally
Date of Death: April 19 2008
Dear Sir or Madam:
Per your inquiry dated May 21, 2008, please be advised that at the time of death, the above-named decedent had on deposit
with this bank the following:
1. Type ofAccount Checking Account
Account Number 407917
Ownership (Names ofJ
Opening Date
Balance on Date of Death
Accrued Interest
Total
2. Type ofAccounf
Account Number
Ownership (Names o~
Opening Date
Balance on Date of Death
Accrued Interest
Total
Dorothy M Connolly, Susan Lee Davis, Raymond J Connolly
09/01/67
$23,637.70
$ 0.55
------------------------------------ -- -- --- --
$23, 638.25
Savings Account
015004200117338
Dorothy M Connolly, Susan Lee Davis, Raymond J Connolly
08/20/93
$47, 704.17
$ 27.56
$47, 731.73
Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information
above, you believe there are additional accounts not referenced, please provide us with an account number and/or
name of any possible joint account holder. For any additional information on the above accounts, including
ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Stonehedge Office #
717-240-4524.
Sincerely,
Jy
} .' -~
i
Nancy Clagett
Records Management
SCHEDULE G
TRANSFERS
ESTATE OF
FILE NUMBER
This schedule to be completed and filed if the answer of the question on the reverse of the cover is ves.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF TH£ TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT
AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. TOTAL VALUE
OF ASSET DECD.%
INT EXCLUSION
(if applicable) TAMABLE
VALUE
1 Annuity -The Lincoln National Life Insurance
Company. Contract/Policy No. JP5190090. $34,942.74 100.0% 0.0% $34,942.74
Contract issued June 27, 2001
Beneficiary: Susan L. Davis (daughter)
2 Annuity -Western Southern Life Assurance
Company. Contract no. W0020570691. Contract $22,010.27 100.0% 0.0% $22,010.27
issued November 15, 2000
Beneficiary: Raymond J. Connolly (son)
3 Annuity -Western Southern Life Assurance
Company. Contract no. W0020570692. Contract $36,669.91 100.0% 0.0% $36,669.91
issued November 15, 2000
Beneficiary: Susan L. Davis (daughter)
(see letters attached)
TOTAL (also online 7, Recapitulation) $93,622.92
u
Western-Southern Life
July 14, 2008
RONALD E JOHNSON
78 WEST POMFRET ST
CARLISLE PA 17013
Subject: Annuity Contract #W0020570691 AND W0020570692
To Whom It May Concern:
Thank you for contacting Western-Southern Life. We recently received your request for
information regarding the annuity referenced above. The information you have
requested is listed below:
W0020570691
Value as of April 19, 2008 $22,010.27
Contract Date 11-15-2000
W0020570692
Value as of April 19, 2008 $36,669.91
Contract Date 11-15-2000
If you have any questions, please contact our Annuity Operations Department at 1-800-~
926-~1~, a representative will be happy to assist you.
Si
J.
Ad rrii n i stra~.,~~----
Operations Department
Western-Southern Life Assurance Company
Member, Western & Southern Financial Group®
400 Broadway • Cincinnati, Ohio 45202-3341 • (513} 629-1800
C~ Lincoln
Financial Group®
July 10, 2008
RONALD E JOHNSON
ATTORNEY AT LAW
78 WEST POMFRET ST
CARLISLE PA 17013-3216
RE: Dorothy M. Connolly
The Lincoln National Life Insurance Company,
Contract/Policy Number JP5190090
Claim Number 579145
Dear Mr. Johnson:
Lincoln Financial Group
PO Box 21008
Greensboro NC 27420
bus 336 691 3000
We are in receipt of your request as received from Susan L. Davis, Executrix, for the value as of
the date of death of Ms. Connolly and also the date the contract was issued.
The value as of the date of death, April 19, 2008, was $34,942.74. The contract was issued June
27, 2001.
Thank you for the opportunity to be of service. If you have any questions, please contact us in
writing or call toll free (800) 487-1485, ext. 8584.
Sincerely,
~ ~~~'~~
Karen H Srown
Claims Examiner
Greensboro Clairns Department
Enc.
cc: SUSAN L DAVIS
39 PRICKLY PEAR DRIVE
CARLISLE PA 17013
www.LFG.com
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.
SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
A.
B
ESTATE OF
FILE NUMBER
Dorothy Connolly 21-08-0469
_
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
Funeral Expenses:
1 Hoffinan-Roth Funeral Home $10,285.86
2 Carlisle Memorial - $3,416.50
3 Ewing Brothers Funeral Home -burial plot $1,790.00
4 Ewing Brothers Funeral Home -footer $550.00
5 Donna Hurley -hairdresser $50.00
6 Georges Flowers -funeral flowers $212.00
7 Sunnyside Restaurant -funeral luncheon $488.63
Administrative Costs:
1 Personal Representive Commissions
Name of Personal Representative(s)
Social Security Number of Personal Representative:
Street Address:
City: State: Zip:
Year(s) commissions paid:
2 Attorney fees to Andrews & Johnson $1,800.00
3 Family Exemption
Claimant
Street:
City: State & Zip
Relationship of Claimant to Decedent:
4 Probate Fees to Register of Wills $298.00
5 Accountant Fees to Patricia Rosendale, CPA
6 Tax Return Preparer's Fees
7 Register of Wills - PA Inheritance Tax Return -filing fee $15.00
8 Sarah Todd Memorial Home -nursing home $4,825.79
9 Millenium Pharmacy $400.00
10 2007 personal taxes $36.00
11 Embarq -phone bill $26.74
12 Disover Card -balance due $8.88
13
TOTAL (also on line 9, Recapitulation) _ _ _ $24,203.40
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUM~3ER
Doroth Connoll 21-08-01469
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE
NUMBER Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (includc outright spousal distributions, and transfers undo Sa. 9I IG(aj(1.2j]
1 Susan Lee Davis, successor Trustee of the Dorothy M.
Connolly Trust. Distribution under the terms of the Trust
is as follows:
Raymond John Connolly son 1!2
6 Willow Trails, Collinsville, ILL 62234
Susan Lee Davis daughter ll2
39 Prickly Pear Drive, Carlisle, PA 17013
II
(See copy of Trust Agreement attached)
)N-TAXABLE DISTRIBUTIONS:
SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 fOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
Charitable and Governmental Bequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation) $0
THE DOROZ"tiY" iw. COi~T4~~OLLY itEVUCAoLE r.US'.^c
DATUD I~ItY 3l., 19it9
MiaGe on Niay .ii, itits9, between DOR43•ia1 ?i. CJNi4CJLLY, a~
liarrtor, ct rort ~iyzrs, i:ee County, Florida, and DCRCTIdY ;" .
~u'.~1CiLt Y, as Trustee, nrxd S{IS~ti 7.8~ UAVIS, as Succassor `Lra:stc--::.
~i:r iOnVCRicnC@, Lrle 'i'rll:i'teL'S arE Called `!'rliStc@ or 'lru5tc2,a,
riiiiC'il t2rrii anall refer to whomever snail ua acting as Prustee
is:;u~r Liil~ inatrw;,i:nt.
T'li`s+f I
ST~'!'E6;B[dT Ol' PUxPUSG: 6GI~7EF3.CIhiclr5
X,. Grantor Hera astat,iis»zri tnio trust in order to prcvia~: u
Beans for ti;e tuaztage,Tlent of certain of Grantur's properti~s5, ..i:e
;ranae.Itent oz such fart»er property interests as rtay be deaosit;u
;aita 'i'ru5tae oy Grantor, ana for the itiaintenancs, comfort afzd
support oY Grantor during Grantor's lifer any dispc5itian after
the daat» oz the Grantor, all in tha r,:annar hareai:ter provid,zri.
u. Grantor has created this trust Dy azpo~iting :aiti~
"~'Y=.iv tcE ti'i t' ,NrC)p2rLf* J. C':>Cr1U2Q In SCtli:dule H, 54t1iCi7 i3 ar1IlEs:i: Ci.
i'YOiu tlRiir LG thud dclil~itlOiial prOp2rty, perttap5 inciudiug i;G3.icias
or ill:c ;nsurance, ,ztay ne aapvsltad with Trustee ii accep`~ed ~1
~1'r:.ataa for ad;~,il;>.stratiorz under this instru:uznt. GranLOr, ay
Gra.:LOr'~ riiil, may dirzct tnat a part of dll of vraliltOT'S agitate
ar;~li :,2 iiClivarcd to 't'rustee YGr d~Zi1RlStrat1G11 by 1'r us tae ur,:iez
tats agr€ea+Ent aitzr the azatiz of Grantor.
C. 'rre uepoait of anaiticrlai prop=rty uittt Truer=ere an[i tEIL
vassing ai_ proi~atty to 'Prustae under t»e tarllls Gi i:rantur's rill
shall be erf2ctiva regardless oi: t»e jurisdiction in wt,icii
Gra:ita: :r:uy be than dcsl:i;:ile:I, un;Y all G1 that property rec:<:iv:a
Ly Trustee shall be addad to sn3 administered as a part of t»@
L'1'ii5t.
T'I' Ei-1 T I
RE:CETPi' tliv'~ COVH<9AtV1'S QY' i'i?U'P~"*.:
!.. !'rustec ::c;~[.o:~ledyea recaipt of tn~ Nroperty sa.~cribyu
lfi Sl:uCituic A.
/s/ Dorothy M. Connolly
B. Trustee will manage, invest and reinvest the property
described in Schedule A and will rold 'any policies of life
inaurancG deposited: with Trustee, and will receive, manage,
invent and reinvest the proceeds and will hold, manage, invest
and reinvest such additional property as may be deposited with
Trustee and accepted by Trustee, and all of the proceeds of that
property, uNon the uses and for the purposes hereafter set forth.
C. Trustee will accept and will administer as part of the
treat estate whatever property is to be delivered co Trustee
under the provisions of Grantor's Will to ba so administered.
ITEM III
COVENNcVT RY GRANTORS of FORTflER r"1SSUftr~N<;,S
vrantur agrees with Trustee that upon request Grantor .,ill
execute nut! deliver 3uci-i furti,er instrument or lr,strunlants as the
TYUdteB may seem necessary or desirabie hereafter to vest the
title at the crust property in Trustees or to evidence "loyal
title.
ITN.iN IV
l~IFETIf~fE RESERVhTIc?cJ5
A. During Grantor's life, the Grantor shall have the righc
to be exercised from time to time by writing or writings signed
an6 acknowledged by Grantor to be effective when delivered to L-he
Trustee or to any beneficiary of it if for any reason there shall
be no Trusteee
A.l. To revoke this instrument entirely and to receive fr~n
Trustee all of the trust property remaining after making payment
or provision for payment of all expenses connected with the
s:L,--iiniatration or tni~ roust.
a.e. From time to time to amend thin instrument in any and
every yattlcuiar.
A.3. rroni time to time to change the identity or number, or
uoth, o= ti;e Trustee.
A.4. From time to tune to withdraw from the operation o
tt,iy trust any part of all or the trust property.
/s/ Dorothy M. Connolly
S, pith respect to all policies of life insurance at any
tirn2 depoaite3 with Trustee by Grantor and made subject to the
tc:ra~s or this trubt, Grantor zeserves the right and autrlority to
ue zxarci,ea by Grantor's act alone in the manner and during the
period state3 in Paragrapr2 A of this item and without tr,e consent
oY approval of Trustee:
1~.1. To sell, assign or hypothecates any or all of those
policies.
E.2. ~'o e:cercise any option or privilege granted by the
policies, including the right to change the beneficiaries of any
policy.
8.3. To borrow any sum from the insurer or any individual,
partnership, corporation or association, and to pledge the
policies as security fcr those loam ,
8.~1. I'o receive all payments, dividends, surrender values,
benefits or privilegas of any hind that may accrue on account of
tna policies.
ii.7. To in&pact freely and to withdraw frol:i the trout any
of ail Oi the policies.
C. During the life of Grantor, Trustee shall pay over to
tha Grantor whatever part or parts or all of the income a.nci o2
the principal oP the trust fund that Grantor shall direct frola
tide to time in writing.
C.1. Tf the Grantor, in the opinion of two t2?dice=used
physicians, one <13 of which may be the family physician, becaraes
incompetent and incapable of u~anaginq her affairs, then the
Grantor hereby appoints SUSAN LEE DAVYS as Trustee anti Guardian
over the property of the incompetent Grantor and shall have the
same duties :;a3 obligatiol;s as provided above to provide for th::
genaral welfare of the ineoulpetent Grantor.
ITEM V
AllASItiIST'RiyTIO'ai AFTL'R GE2AYv'TdR' S DEH'i'H
F-fter cne death of the Grantor, then tree trust zsi:ate shall
oe u~anaged dIlc! dlatributed in tna fo1lo;aing manner:
/s/ Dorothy t1. Connolly
A. Gift of Rasiduary Trust Estate. The rest of the trust
estate, hereinafter called the Rasiduary Trust Estate, together
with any and all property received frau the surviving Grantor's
i+till and all other property received by the Trustee, shall be
adre~inistered and its principal and incoa;e, if any, shall be
distributed in the following manner:
A.l. 'Phe said Residuary trust Estate shall be distributea
to SOSAN LBE DAVIS, as Successor Trustee hereunder, and in trust,
nevertneless, ror the following aces and purposes:
A.l.a, ply 'i•rustee is directed to distrioute all truest
assets in equal snares to itr~Y:~OtvD JOriN COh1NuLLY ans SiiSAT3 LEE
DAVl9 outright free of any trust. Should any of the icreyoing
Rut bl1rVlVe me, thG srSare Qf 3a1C1 b6neflClary ~t)ali Le
distributed to the lineal descendants of paid beneficiary per
stirpes.
B. While in the hands of my firustee, and to the extent
permitted by law, neither the principal ncr the income c;f tha
trust created hereunder shall be liable fur the debts of any
beneficiary hereunder, nor shall the same be subject to s~aizurs
or atta:.hment by any creditor or any beneficiary undar a;ny writ
or proceadinq at law ur in equity, and no beneficiary heraunder
shall nave any por~er to sell, assign, ancuu~ber or in any ~z~annzr
to anticipate or dispose of his or hest interest in any trust or
in ~ciie incomes praduced therevy, or ~ucn interest scull terminate
anti pass as ii such person predecaased the Grantor.
ITEM VI
TRUS!'6;G' S POWERS Af~D DISC72E't IONS
In addition to the powers conferred by law, s,y fiduciaries
named herein or any successor therato shall have tha following
discretionary powers:
A. To retain any invvstwents and property received by it in
kind, including any stock; to purchase invest and reinvest, and
otherwise aoyuira security anti investinant, investrtient companies,
investment trust or any other property, real or personal, of
/s/ Dorothy M. Connolly
wnatsaever nature ana wheresoever situate, without duty to
divarsiiy and without being confined in its ci~oice at investment
to su-Callao legal investment for trust funds under any present
or future applicable law, rule of court or court decision.
ii. 2c deposit funds in the commercial or savings department
in a bank or savings ana loan association witY,aut li.a~it as to
duration.
C. `PO sell at public or private sale, exchange, mortgage,
lease with or Without statutory or other limitation as tc
duration, partition, grant options on, alter, improve, demolish
ouildings or otherwise deal with property, real or personal, as
fully as I iniyht and upon any terms and whether for cash or
Cre:llt.
D. I'o u,ok8 distribution oJ: my Residuary Z'rust Estata ana
trust to any person entitled th.reto in kind, in cash o.r partly
in klnd ana Qartly in ease, as aeemeci advisanle, and to this end
allocwtion of assets In kind shall be in the sole discrs:tion ci
wy fiduciary.
... Io register or carry any investments held hereunder in
their own name or in the name of a nominee; provided, however,
that all such investments shall be so designated upon the reccrd
of my fiduciaries that the trusts or estate to which said
investments belong shall appear clearly at all times,
F. Ro vote by person or proxy any and all stock he 1,3 in my
trust or the trusts created herein and to participate in any
reorganization or uieryer of cowpanies cr corporations chose stock
i~ so held.
u. To oorrow from any source, which si,all include ti,e
authority to vorrow frog any trust created herein, and a::
security for repayment to hold or pledge the whole or any part or
u;y trust e~tata.
,y, eta person in any spanner dealing with .z,y fiuuciaries or
with the trusts e~tablisheci hereunder shall be required to
/s/ Dorothy M. Connolly
inqul rc 1ntG the FIUtnOYl.ty Gr the r1dUC larlr?a tG E'n tc.l' 1rit0 ar,:.'
tTdnaa: tlOR Or t0 account tGY the appl lCatlGn O)` auy 810 t]lt'3 ~ dliJ
by rty fi~uciarie3 on any account.
7. 'ply tiduciaria,> shall 'nave the pacaar tG :leteraiik]e,
1rYCa~; c:Ct1V2 OZ statutory rule OT laW, f14W all r°Cr1PL"5 :nr:ice
iSiaiiurSE:GIPr.tS 41 till LL'tid L' 6tataUll&hed hereon Ger, Or any .a SiaL~~.o
L'rt~r tut, lACI UCIlYi .~. dYky Lt::UC1a:iY le.a' is GYii ~i~li6a~t2i7n, 3i]nll ut:
crt3iten, charted or apportioned as bztWe2n income sad p.rinci~~al
c,'il ii "L"i;2 ucC 161011 UY ttk :; 13.QUClary Hndll Dl': ili]dI cind r1G"t'". SUU~E3Ct
to YuEotia[i by any ::eneficlary hereof.
3. TG carry on for such ti~:e as tYley si;all d~eia attvisabia
during the aami:]istrai:iGn of the trust established hereu.ndcr axis-
r,s~inass conducted by us at the ti;lte of Seats].
I'PEyi VII
`PRUSTEE'S CERTIFICA`PE`
A certiTicate siynetz by tt]e Trustee under this inatruluant
and act.nowledgad by it uefore a notary puhllc stall ue conclusive
ev1::2ncz upon all persons and i4r aii uurpGSea oC thE: iact:,
st;lced in cn= certificate respecting "the t~r.Iu of L"ilifi inatruale;]t
iiAu tlc l~lei]tl L"y JI= tf'!c `Yrti:S Ct;@ WriO LrJi:1 t1A`tc L.U i.lfstd l:: 'i t'Y v'i:i~
U:iudr it.
I'1'S:1i VII I
r'1vi~10A L~iW CihuSE
This lnstruluent i,a;. begin prepared and ai;NCLLte3 iki the at3ta
OT L'lOr lOa, and isr:intGZ' an:i Trlle tc~. ilr2 r251~~ritS OT ''IGY i!:1.
:111 ~ueatiol]s concerning the weaning and intention of the terms
of t:~is inatrul~ent anu COI1C2ri]1F1CJ its validity snd ail gaasci.uns
relating to i;_ricrr.;ance under it shall ez judg•~d anal r~sGlved in
accordance with the Iaws o= Floriaa.
ITRAi IX_
StiCCESSOR TRDSTEES
Should StJSA~v :.RE DAVIS not act or cantinLe to act a.;
J11CCE5.iO"s ~.i`t i1SLc3U, 1 a~pOlnt ~tiYP3Q"f ~+ .S `ti)f5~ ail ~I ?~i E_]i 1.iY d5 SUCCt-'S:; <: 1"
Prilnt:t, WI:C 3Cid1L e,Vc all [~Gw+~rs UL 'PrU:;teN a~ he2'Clfi
conerr~u.
ild +41`!'LUC.~S waER$GP', OOxtO'S'.iSi' ti. C6vli\:UL;.,Y .;ci.-, 5i~i^a2d i:i:..~
1:,~Ci U:GCi,t cto i~L'aIl'tvY, 2tik it l7O.t U'L''si~ k+l. i:; l7 ~iNOS. i+l iinu bil :7 t~l ~+ i...~
/s/ Dorothy M. Connolly
~ •
Gr.VIS nave slynad thin inatrun;ent a5 'Pr us tae and SllCC:LbdOr
'T`rustee to evidence their acceL cance of the trust.
1 Jlidii i.n the pr23ellCe aL
/s/ Janice B. Stanford
/s/ Beth Ann Daniels
/s/ Janice B. Stanford
/s/ Beth Ann Daniels
/s/
Dorothy i$. Connally, Grantor
/s/
Dorothy i+~. Cennoily, 'Pru~tee
Susan Laa Ja-vi:s, Succeasur
Trustee
'!'he iOregCiln[j :dr1.tL'en ].n5LY11iCivrit Wh1Ch CGilalStS UY C131ci rage
ant six tu) other tyi;ewritten paares (excluding tiie page
dasiynate3 as 5enedule A) wan suuscribed at the eau ~~i' the
urantar td:erein naue3, and her signature was acknowledged. i;y ner
aria in the presence of aach of us, wrto were aii _}rr?ser.t at the
same (ilia; anti tlien we, anti each of us, at her raquast, in r,~r
~~r c'~s ::n f.e tlnci in thr ~DX~.3 nCc Qf UnB an Ot neY, L11 Cj at ti3St y~;i~l
Cri15L 3nq subseribea OIIr ndri~eu thcret0 d3 W1tne93c3 s7 rl tii= Icy
an~:i year at~ove written as the irate or this instrument.
fs/ Janice B. Stanford rESiallig at Fort Myers, Florida
/s/ Beth Ann Daniels reyi~li.lg at Fort Myers, Florid
S'i'asC Or' r'LORIDA
~O:,N'PY OF LE:N
six, DiikU3•tiY ii. CG:d[vOuLi,. Janice B. Stanford ann
Beth Ann Daniels the ;:~runtor and witn2~~as
r~::r;::ctiveiy, whose rainaa are :~lynacl tc the a:.tacneu or toreyoi:iy
11i:1i.Ztlal~'nt, i;E1nG LiT~t tXLtly 5'wOrn, do iie.r~:uy ticcltsl'~. tC t13~
undersigned o€ficar that the Grantor signed the i.;st,ruaner,z a„
t;ai; t,e si~n2ci voluntarily (or directed -another to siy^ r"or ;er
and did eo voluntarily) and that each of tine wirneases in tia
presence of the rrantor, at liar re~ueat, and in the ~~ra~enca of
teach other signed the trus*_ as a witness an3 that to tiie i;est or
triz knoNle~3ye at each witness, the Grantor •.ras at tl;e ti:r,e
twenty-one (11) or ~aora years of age. of so3,ic1 lciridc.c,Ci uriaer ric
constraint or undue niluenca.
/s/ Dorothy ~4, Connolly
Dorothy ~. Connolly, C:ra:,tur
/s/ Janice B. Stanford
witness
/s/ Beth Ann Daniels
witness
S'~r'OR'J TO and subscribed before ire this 31 _ aa_~ of
aY , 1989.
/s/ ~9illiam E, Shenko, Jr..
Notary Public
ziy cca,l:;lssion _.c„iraa:
~ r
LCli$'DULE "A"
Ttte ?'YU5tee of the AG1tGTHY ~i. CGAEr~GLLY P.~'VOCiis~:.E'; "PkGST
acxnowledgea receipt from the Grantor the following i+.ea~~ untier
the terns of the rru~t ?~c~reement slated ~aav 31 _, 19dy.
';tie real ~~roperty descrioed in the unit Cl.dllt, Jee~'„ a
copy or which i5 atL-ached hereto, and sll ~ers~anal
property iccaLea therei~i.
/s/
Dorothy f',. Curinoliy. ~'ru:;cae