HomeMy WebLinkAbout03-0617 PETITION FOR PROBATE and GRANT OF LETTERS.
· (t e3
Estate of Russell T. Werner, ~_.~ No. /:~l-~-
also known as To:
Register of Wills for the
Social Security No. ] 62-28-510'6 Deceased. County of Cumberland
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execur
in the last wilt of the above decedent, dated ]~a r~h .5
and codicil(s) dated
in the
named
,19 97
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumber i and County, Pennsylvania, with
k. is last family or principal residence at 311 Candlelight Drive, Upper Allen
Tnwn~h~ p: M~aPh~n~ ~.~hnrg
(list street, number and muncipality)
Decendent, then 7 ] years of age, died .'r .... 2 .2003
at 311 Candlelight Dr., Upper Allen Tow~I~ip, Mechani'csburqrP.'A
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled i.n Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
pre~ented herewith and the grant of letters t e s t a me n t a r ¥
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
Mary Ellen Werner
311 Candlelight Drive
Mechanicsburq, PA 17055
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 3
COUNTY OF Cumberland ) ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the kfiowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the est~e according to law.
Sworn to or affirmed and subscribed ,-~'~c'x~_~ (2~~(, gx~~ ~
~ before me this .,, 29th day of [ ~ ~ ~ ' -' -- ~'
~ J ~ /;,.July, ~ ~ 2003, J ~ ~
~nna M. Ot'toilst ~tV/ ~,i~-~-~:_ ~ ~
egl ,er
No. 21-2003-617
Estate of RUSSELL T. w~.~.~: ~o~, ~,~ , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW July ~0~r~b~ ~ 2003, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated March 5, 1997
described therein be admitted to probate and filed of record as the last will of
Df. Russell T. Werner. .;
and Letters Testamentary
are hereby granted to Mary Ellen Werner
FEES
Probate, Letters, Etc .......... $. 18 o00
Short Certificates(3 ) .......... $ 9.00
R~4~...x.-.P.a.g .e.s..(1..4.) $. 42.00
JCP $. 10.00
TOTAL __ $ 79.00
Filed ..3..u.ly...3.0.~.h. ~ 299.3. ................
Call Attorney Sheely on 7/30/2003
Andrew C. Sheely, Esquire
ATTORNEY (Sup. Ct. I.D. No.)
127 S. Ma~rket St./P Box 95
Mechanicsourg, PA i~655
ADDRESS
(717) 697-7050
PHONE
ERT. NO.
Name of Decedent
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEAL'tH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
T 5419997
Russell
21-2003-617
T.
Middle
JUi t 0'3 2093
Date of Issue of This Certification
Wemer
Last
Sex Male
Date of Birth
Place of Death
Social Security No. 162-28-5106
April 17, 1932 Birthplace West Reading, PA
311 Candlelight Drive Cumberland
Date of Death June 2, 2003
Upper Allen Twp.
Pennsylvania
City Borough or Township
Race White Occupation Teacher
Decedent's
Marital Status Married Mailing Address
Informant Mary Ellen Werner
Name and Address of
Funeral Establishment
Armed Forces? (Yes or No)
311 Candlelight Drive Mechanicsburg
Number Street City or Town
Funeral Director Joseph D. Giles
Joseph D. Giles F. H., Inc., 21 Chestnut St., Mohnton, PA
No
PA
State
Part I:
Part I1:
Immediate Cause
(a) Metastatic Adenocarcinoma Unknown Primary Site
(b) __
(c)
(d)
Other Significant Conditions
Interval Between
Onset and Death
Manner of Death
Natural
Accident
Suicide []
Homicide
Pending Investigation
Could not be Determined
Describe how injury occurred:
Name and Title of Certfier
Robert A. Gordon, MD
Address
3912 Trindle Rd., Camp Hill, PA
(M.D., D.O., Coroner, M.E.)
This is to certify that the information here given is correctly copied from an original certificate
of death duly filed with me as Local Registrar. Th,,e original certificate will be forwarded to the
State Vital Records Office for permanent filir~// .. // /Cfi
_ June 2, 2003 7 Mansion Court East Bird.qboro
Dat~ Received by Loca~ Reg~st:ar Street Address City Borough, Township
· ". 5~57.~ tiRO:PAN ~0/08/96, ~0a0/96, 0~t2~/97 ', ",
LAST WILL AND TESTAMENT
OF
DR. RUSSELL T. WERNER
I, DR. RUSSELL T. WERNER, presently residing in Berks
County, Pennsylvania, declare this to be my will, hereby revoking
all prior wills and codicils made by me.
1. Tanqible Personal Property. I give all my tangible
personal property, including my clothing, jewelry, personal
effects, household goods, furniture and furnishings, and
automobiles, together with any insurance policies thereon, to my
wife, MARY ELLEN WERNER (hereinafter "Mary Ellen"), provided she
survives me by at least thirty (30) days. If Mary Ellen does not
survive me by at least thirty (30) days, I do then give all my
tangible personal property in shares as nearly equal as possible
to those children of mine who survive both Mary Ellen and me.
2. Bypass Trust.
a. If Mary Ellen survives me by at least thirty (30)
days, I give to Mary Ellen and my daughter, DIANNE T. BASSETTI,
and my son, RUSSELL T. WERNER, JR., Trustees, in trust, the
maximum amount which can pass free of federal estate tax in my
estate by reason of all credits available against such tax,
provided the use of the state death tax credit does not result in
an increase in state death taxes. For purposes of computing this
amount, the following shall be taken into account:
(i) Any other dispositions under my will;
-1-
'. 51,~57.z ~RO:PAN ~0108/96, ~0/~0/96, 0~/2~/97 ', '
(ii) Any other property interests includable in my
gross estate for federal estate tax purposes which pass outside
of my will; and
(iii) All charges to principal that are not
deducted for purposes of computing the federal estate tax in my
estate.
b. The amount distributed to the Trustees under this
Paragraph 2 shall be held and administered as follows:
(i) Trustees shall pay to Mary Ellen the income
from the trust in convenient installments, but at least
quarter-annually;
(ii) Trustees shall be fully authorized to pay to
Mary Ellen such sums from the principal of the Trust, as they
deem, in their sole discretion, necessary for her health and
maintenance in accordance with her accustomed standard of living.
(iii) Mary Ellen is hereby given the general power
to appoint from the principal of the Trust to herself, during
each calendar year, amounts up to, but not exceeding, the greater
of Five Thousand Dollars ($5,000.00) or five percent (5%) of the
aggregate value of the Trust principal as determined at the end
of each calendar year. Such amounts may be appointed during each
calendar year by written directions signed by Mary Ellen setting
forth the amount to be paid. Mary Ellen may designate such
amounts at any time or from time to time during each calendar
year, and Trustees shall pay the amounts designated upon receipt
of the written directions. However, Trustees may, in their
-2-
· 51457.1 I~RO:PAN 10/08/96, 10/10/96, 01/21/97 '.
discretion, postpone payment of any or all amounts appointed in
excess of Five Thousand Dollars ($5,000.00) in any one calendar
year until a reasonable time after the close of such year in
order that they may determine that the amounts appointed are
within the limitation described in this subparagraph. This power
shall lapse at the end of each calendar year as to all amounts
which could have been appointed during that year, but with
respect to which no written directions are received by Trustees
during such year.
(iv) Upon the death of Mary Ellen, all remaining
amounts held in trust shall be distributed to my children, DIANNE
T. BASSETTI, KIM L. DIEHL, SUSAN D. HUMPHREY, KELLY L. ADAMS, and
RUSSELL T. WERNER, JR., in equal shares, provided that if any of
my children are not alive at the time of distribution, the share
attributable to the deceased child shall be distributed to his or
her then living issue, per stirpes, or failing such issue, to my
then living issue, per stirpes, subject to the provisions of
Paragraph 5.
3. Estate Equalization. If Mary Ellen survives me, but
fails to survive me by at least thirty (30) days, I give to her
assets having a value equal to the smallest amount necessary to
reduce the federal estate tax payable as a result of my death and
her death to the lowest possible figure. In calculating this
amount, all other property which qualifies for the marital
deduction and all other deductions and credits which are taken
and allowed in the calculation of the federal estate tax in my
--3--
· ' 51,~57.1 I~RO:PAN 10/08/96, 10/10/96, 01/21/97
estate shall be considered first; however, credits shall be used
only to the extent that their use does not increase death taxes
on my estate.
4. Residuary Estate.
a. If Mary Ellen survives me by at least thirty (30)
days, I give the entire residue of my estate, both real and
personal, and wherever located, to her.
b. If Mary Ellen does not survive me by at least
thirty (30) days, I give the entire residue of my estate, not
otherwise distributed by the terms of Paragraph 3, to my
children, DIANNE T. BASSETTI, KIM L. DIEHL, SUSAN D. HUMPHREY,
KELLY L. ADAMS, and RUSSELL T. WERNER, JR., in equal shares,
provided that if any of my children are not alive at the time of
distribution, the share attributable to the deceased child shall
be distributed to his or her then living issue, per stirpes, or
failing such issue, to my then living issue, per stirpes, subject
to the provisions of Paragraph 5.
5. Minor's Trust.
a. Each share of my estate or a trust created
hereunder which is distributable to a beneficiary who has not
attained the age of eighteen (18) years shall be held by Trustees
in a separate trust according to the terms of this paragraph.
b. Trustees shall pay so much of the income and the
principal of the trust as they, in their sole discretion, deem
necessary for the maintenance, care, support and education of the
beneficiary. The term education as used herein shall include,
-4-
· ' 51457.1 BRO:PAN 10/0~/96, 10/10/96, 01121197
but not be limited to, all expenses associated with any
post-secondary undergraduate and graduate education and any
professional, technical or vocational training.
c. When the beneficiary attains the age of eighteen
(18) years, Trustees shall pay to the beneficiary the entire
principal and all accumulated income of the trust.
d. If the beneficiary dies before attaining the age
of eighteen (18) years, and is survived by issue, the entire
remaining balance of the trust principal and accumulated income
shall be distributed to his or her then living issue, per
stirpes, subject to the provisions of this paragraph. If the
beneficiary dies before attaining the age of eighteen (18) years
and is not survived by issue, the entire remaining balance of
principal and accumulated income shall be distributed in equal
shares to the beneficiary's surviving siblings, subject to the
provisions of this paragraph.
e. In the event more than one beneficiary is subject
to these trust provisions, Trustees shall administer each such
share attributable to said individuals as a separate trust and
shall in no event use the principal or income of such share for
the benefit of anyone other than the beneficiary thereof.
6. Funding Instructions.
a. Subject to the limitations contained in this
paragraph, my Executrix shall have the sole power and discretion
to distribute cash and/or property, real and personal, in
satisfaction of the gifts described in Paragraphs 2, 3 and 4.
' ' 51~57.1 BRO:PAN 10/08/96, 10/10/96, 01/21/97
b. My Executrix, in making distributions wholly or
partly in property to satisfy the equalization gift described in
Paragraph 3 or the residuary gift described in Paragraph 4a.,
shall distribute assets, including cash, fairly representative,
on the date or dates of distribution, of appreciation or
depreciation in the value of all property available for
distribution.
c. To the extent possible, my Executrix shall not
allocate to the equalization gift described in Paragraph 3 or the
residuary gift described in Paragraph 4a. any asset or the
proceeds of any asset which does not qualify for the marital
deduction for federal estate tax purposes or with respect to
which any estate or death taxes are paid to any foreign country
or any of its possessions or subdivisions.
7. Payment of Taxes.
a. With the exceptions set forth in subparagraphs b.
and c., I direct that all inheritance, estate, transfer,
succession and death taxes, of any kind whatsoever (including any
interest and penalties thereon) which may be payable by reason of
my death, but only with respect to property passing under this
will, shall be paid out of the amount distributed to the Bypass
Trust under Paragraph 2, or, in the event the Bypass Trust is not
funded, out of the principal of my residuary estate. These taxes
shall not be prorated or apportioned among beneficiaries, but
shall be paid in the same manner as an administration expense.
b. Notwithstanding the provisions of subparagraph a.,
-6-
· ' 51,~57.1 BRO:PAN 10/08196, 10/10/96, 01/21197
my Executrix shall not:
(i) Pay any generation-skipping transfer tax
payable due to a taxable distribution or taxable termination
resulting from my death; or
(ii) Pay any inheritance tax resulting from the
trust created by the provisions of Paragraph 2 of the will of
Mary Ellen.
c. In the event Mary Ellen survives me, my Executrix
shall have the right to determine, in her sole discretion,
whether or not to pay inheritance tax on assets passing pursuant
to Paragraph 2 or defer payment until Mary Ellen's death.
8. Trustee Powers. In addition to the powers conferred by
the common law, by statute or by other provisions of this will,
Trustees are hereby empowered as follows:
a. To hold, manage, lease, care for, and protect the
trust estate and collect the income therefrom, all in accordance
with their best judgment and discretion, being fully authorized
to cause any securities or other property, real or personal,
belonging to the trust estate to be held or registered in their
name or in the name of their nominees or in such other form as
they deem best without disclosing the trust relationship.
b. To enter into any leases which may commence at the
time of making or on a future day and may be for any period of
time Trustees deem best, although extending beyond the term of
the trust.
C.
To continue to hold any property or securities
--7--
· 51,~57.1 I~RO:PAN 10/0~/96, 10/10/96, 01/21/97
originally received by them or at any time transferred to the
trust as part of the trust estate although not of a type or
quality or constituting a diversification considered proper for
trust investments, and Trustees shall not be liable in any way
for any loss resulting to the trust estate by reason of
continuing to hold any such securities or property.
d. To invest and reinvest the trust estate in bonds,
stocks, mortgages, notes, common trust funds, participations, or
other property of any kind, real or personal, irrespective of any
statutes or rules of law limiting the investment of trust funds.
e. To sell at public or private sale and convey any
and all of the trust property and any reinvestments thereof from
time to time for such price and upon such terms as they shall see
fit.
f. To contract for financial, investment advisory,
legal, accounting and other services for the trust estate.
g. To borrow money, to extend or renew any existing
indebtedness, and to mortgage or pledge any property in the trust
estate; and no purchaser or mortgagee shall be obliged to see to
the application of any purchase or mortgage money.
h. To vote, either in person or by general or limited
proxy, or refrain from voting any corporate securities for any
purpose.
i. To exercise or sell any subscription or conversion
rights and avail themselves of any options or benefits under any
life insurance policies.
-8-
· 51457.1 BRO:PAN 10/08/96, 10/10/96, 01/21/97
j. To join in any voting trusts, reorganizations,
consolidations, mergers, foreclosures, and liquidations, and in
connection therewith, deposit securities with or under the
direction of any protective committee under such terms as they
may deem advisable and accept and hold any securities or other
property received through the exercise of any of the foregoing
powers.
k. To settle, compromise, contest, prosecute or
abandon claims in favor of or against the trust estate as they
may deem advisable, and for such purposes they may execute and
deliver all proper and necessary instruments and may give full
receipt and discharges.
1. To determine, in accordance with applicable
statues and rules of law, how all receipts and disbursements,
including Trustees' compensation, shall be credited, charged, or
apportioned as between income and principal, and their decision
shall be final and not subject to question by any beneficiary of
the trust.
m. Subject to the provisions of Paragraph 5, to
divide or distribute the trust property in undivided interests or
in kind, or partly in cash and partly in kind, and to sell such
property as they may deem advisable for the purpose of making
division or distribution, and the judgment of the Trustees as to
values for the purpose of such division or distribution shall be
binding and conclusive upon all persons.
9. Powers of Personal Representative. In addition to the
-9-
· ~1~S7.1 I~RO:PAN 10/0~/9~, 10/10/~, 01/21/97
powers conferred upon my Executrix by law, my Executrix shall be
authorized to:
a. In her sole discretion, claim items of deduction
in either the fiduciary income tax returns or the federal estate
tax return for my estate and to exercise any other options,
elections or allocations in determining and paying death taxes in
my estate, as she deems appropriate, including, but not limited
to, the allocation of all available exemptions provided under the
federal generation-skipping transfer tax to property in my
estate.
b. File a joint income tax return with Mary Ellen for
my last taxable period without requiring Mary Ellen to indemnify
my estate against liability to it for tax attributable to her
income.
c. Consent to have any gifts made by Mary Ellen
during my lifetime treated as made one-half by me for gift tax
purposes.
The decisions of my Executrix in the above matters shall
not require the consent of any beneficiaries of my estate, nor
shall such decisions be subject to question by any person or
beneficiary whatsoever.
10. Limitation of Powers. It is my intention to secure (to
the extent specified in this will) the marital deduction for the
equalization gift described in Paragraph 3 or the residuary gift
described in Paragraph 4 for federal estate tax purposes and,
therefore, Trustees and my Executrix are directed to exercise all
-10-
· ' 51457.1 BRO:PAN 1010gl96, 10/10/96, 01/21/97 ,' ~
powers conferred by law and in this will only in such a manner as
will qualify the assets funding such devise and bequest for such
deduction.
11. Accounting. The Trustees of the trusts created
hereunder shall provide the adult beneficiary or beneficiaries
then entitled to income from the trust estate with statements of
account of their receipts and disbursements as Trustees at least
semi-annually.
12. Resignation of Trustee.
a. Any Trustee acting hereunder may resign at any
time by thirty (30) days written notice to the remaining Trustee
or Trustees, or, if none, to the beneficiary or beneficiaries
then entitled to the income from the Trust. If any income
beneficiary is under a legal disability, including minority, the
notice for such beneficiary shall be delivered to his or her
parent or guardian, as the case may be.
b. In the event of the resignation, refusal, or
inability to act of a Trustee hereunder, the remaining Trustee or
Trustees, or, if none, the beneficiary or majority in interest of
the beneficiaries then entitled to the income from the Trust may
appoint a successor Trustee to occupy the vacated position. If
any income beneficiary is under a legal disability, his or her
parent or guardian may act on his or her behalf in appointing a
successor Trustee.
c. In no event may Mary Ellen act as sole Trustee;
there shall always be a Trustee serving with her.
-11-
' ' 514'57.1 BRO:PAN 10/0~/96, 10/10/96, 01/21/97
d. Any successor Trustee shall be clothed and vested
with all duties, rights, title and powers, whether discretionary
or otherwise, as if originally named as Trustee. No successor
Trustee shall be liable or responsible in any way for any acts or
defaults of any predecessor Trustee, nor for any loss or expense
from or occasioned by anything done or neglected to be done by
any predecessor Trustee, but such successor Trustee shall be
liable only for his, her or its own acts and defaults in respect
to property actually received by him, her or it as such Trustee;
and with the consent of the person or persons making the
designation of such successor Trustee, the successor Trustee may
accept the account rendered and the assets and property delivered
to him, her, or it by the predecessor Trustee, and shall incur no
liability or responsibility to any beneficiary under this my Last
Will and Testament by reason thereof.
13. Bond. No fiduciary acting hereunder shall be required
to post bond or give security in any jurisdiction for the
faithful performance of his, her or its duties.
14. Spendthrift Provision. The interests of all
beneficiaries in my estate and in any trust created by this will
shall not be subject to the claims of their creditors or others
or to legal process and may not be voluntarily or involuntarily
alienated or encumbered.
15. Personal Representative. I appoint Mary Ellen
Executrix of this will; provided, however, that if she is unable
or unwilling to act in such capacity, I appoint my daughter,
-12-
· 51457.1 BRO:PAN 10108196, 10/10/9~, 01/'2119'7
DIANNE T. BASSETTI, and my son, RUSSELL T. WERNER, JR., Executors
in her place and stead.
IN WITNESS WHEREOF, I hereunto set my hand and seal this
day of March, 1997.
DR. RUSSELL T. WERNER
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named
DR. RUSSELL T. WERNER, as and for his Last Will and Testament, in
the presence of us, who at his request, and in his presence, and
in the presence of each other, have hereunto subscribed our names
as witnesses thereto.
-13-
5145"/.1 BRO:PAN 10108196, 10/10/96, 01121197
COMMONWEALTH OF PENNSYLVANIA:
e
COUNTY OF BERKS :
SS.
I, DR. RUSSELL T. WERNER, Testator, whose name is signed to
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
DR. RUSSELL T. WERNER, Testator
Sworn or affirmed to and acknowledged before me, by DR.
RUSSELL T. WERNER, the Testator, this c~ day of March, 1997.
Notary Publ~i~ b~
· ~1457.1 BRO:PAN 10~0~/~, 10110196, 01/2U97
COMMONWEALTH OF PENNSYLVANIA:
:
COUNTY OF BERKS :
SS.
witnesses whose names are signed to the ~ttached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw Testator, DR. RUSSELL T. WERNER,
sign and execute the instrument as his Last Will; that he signed
willingly and that he executed it as his free and voluntary act
for the purposes therein expressed; that each of us in the
hearing and sight of the Testator signed the Will as witnesses;
and that to the best of our knowledge the Testator was at that
time 18 or more years of age, of sound mind and under no
constraint or undue influence.
~itness
Sworn or affirmed to and subscribed to before me by
witnesses, this ~/~ day of March, 1997~.'
LAST WILL AND TESTAMENT
OF
DR. RUSSELL T. WERNER
DATED: MARCH ~ 1997
JAMES H. MURRAY, ESQUIRE
BRIAN R. OTT, ESQUIRE
b~ILL~-~ AND b~UR~A¥
ATT[31~N~-YS AT LAW
READING, PENNSYLVANIA 196n3-~942
(61~) 3'76-6651
Teleph ..... (717) 097-7050
ANDREW C. SHEELY
ATTORNEY AT LAW
127 South Market Street
P.O. Box 95
Mechanicsburg, Pennsylvmnia 17055
Fax: (717) 097-7005
July 31, 2003
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
RE: Estate of Dr. Russell T. Werner
Date of Death: June 2, 2003
Dear Register of Wills Agent:
You are hereby authorized to change the Petition for Probate
and Grant of Letters from ~E~ss~-~ Russell T. Werner, Sr. to
the ~Dr. Russell T. Werner.
Thank you for your time and consideration in this matter.
Very truly
C
ANDREW . SHEELY ~
ACS/bmk
c: Mary Ellen Werner, Executrix
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
NAME OF DECEDENT:
Date of Death:
Will No. 2003-00617
To the Register:
Dr. Russell T. Werner
June 2, 2003
Estate No. 21-03-0617
I hereby certify that Notice of Beneficial Interest required
by Rule 5.6(a) of the Orphans Court Rules was served or mailed to
the following beneficiaries of the above-captioned Estate on
September 16, 2003.
Dianne T. Bassetti
Susan D. Hunphrey
Daughter
Daughter
Russell T. Werner, Jr. Son
Kim L. Diehl
Kelly L. Adams
Mary Ellen Werner
Daughter
Daughter
Wife
30 Flint Ridge Drive
Shillington, PA 19607
220 John Glenn Avenue
Reading, PA 19607
1779 Spring Willow Drive
Mechanicsburg, PA 17055
1702 N. Main Street
Bethlehem, PA 18018
2316 Abbey Lane
Harrisburg, PA 17112
311 Candlelight Drive
Mechanicsburg, PA 17055
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except: NONE
Date: November 19, 2003
P.O. Box 95
127 S. Market Street
Mechanicsburg, PA 17055
717-697-7050
Counsel for Personal Representative,
Mary Ellen Werner, Executrix
Estate of Dr. Russell T. Werner
IN RE: ESTATE OF
DR. RUSSELL T. WERNER
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21-03-617
ORDER APPROVING JOINT PETITION TO TERMINATE MARITAL BY-PASS
TRUST PURSUANT TO PA. C.S.A. SECTION 6102(a)
/
AND NOW, this"~'¢~ day of~:./~~ , 2004, after
consideration of the Joint Petition to Terminate Marital Bypass Trust
pursuant to Section 6102 (a) of the Probate, Estates and Fiduciaries
Code of 1972, as amended, and following a hearing thereon, and it is
Ordered and Decreed that the Marital Bypass Trust established under
paragraph 2 of the Last Will and Testament of Dr. Russell T. Werner,
is hereby TERMINATED. It is further Ordered and Decreed that any
vested or non-vested, minor beneficial rights, entitlements, inter-
ests or claims in the Marital Bypass Trust established under para-
graph 2 of the Last Will and Testament of Dr. Russell T. Werner, are
hereby EXTINGUISHED.
BY ~,.
Andrew C. Sheely, Esqulr~'.~; -
Attorney for Petitioners
IN RE: ESTATE OF
DR. RUSSELL T. WERNER
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21-03-617
JOINT PETITION OF EXECUTRIX AND TRUSTEES TO TERMINATE MARI-
TAL BYPASS TRUST AND EXTINGUISH RIGHTS
OF BENEFICIARIES IN MARITAL BYPASS TRUST
TO THE HONORABLE, JUDGES OF SAID COURT:
Mary Ellen Werner, Executrix of the Estate o~ Dr. ~ssel!l ..T.
Werner, deceased, and Dianne T. Bassetti and Russe(~"l T. ~rne~..llJr.,
Trustees of a Marital Bypass Trust created by the Last Wi~_l
Testament of Dr. Russell T. Werner dated March 5, 1~7, ~y and
through counsel of Andrew C. Sheely, Esquire, hereby file this Joint
Petition for termination of a marital bypass trust and beneficial
interests created therein in accordance with 20 Pa. C.S.A. §6102 (a),
and respectfully state as follows:
1. Petitioner, Mary Ellen Werner, is the surviving spouse of Dr.
Russell T. Werner, and Executrix of the Estate of Dr. Russell T.
Werner, having been granted Letters Testamentary by the Register of
Wills of Cumberland County, Pennsylvania at the above-captioned
docket number.
2. Dianne T. Bassetti and Russell T. Werner, Jr. are natural
children of Dr. Russell T. Werner and named Trustees of a Marital
Bypass Trust created by paragraph 2 of the Last Will and Testament of
Dr. Russell T. Werner dated March 5, 1997.
3. Dr. Russell T. Werner died on June 1, 2003.
4. At the time of his death, Dr. Russell T. Werner was the sole
owner of an IRA with Merrill Lynch which maintained date of death
value of $151,336.00.
5. The named beneficiary of the IRA was a Marital Bypass Trust
created and established by paragraph 2 of the Last Will and Testament
of Dr. Russell T. Werner dated March 5, 1997.
6. As of March 1997, Dr. Russell T. Werner individual and joint
gross assets were subject to potential Federal Estate taxes and
therefore prudent estate planning warranted the creation of a Marital
Bypass Trust in Decedent's Last Will and Testament so as to minimize
Federal Estate (death) taxes.
7. Subsequent to the execution of the Decedent's Last Will and
Testament, Congress enacted legislation intended to phase out the
Federal Estate tax under the 2001 Tax Act and thereby eliminated the
necessity for a Marital Bypass Trust as Decedent's individual and
joint gross estate assets were no longer subject to Federal Estate
taxes.
8. Subsequent to the execution of the Decedent's Last Will and
Testament, Decedent's IRA with Merrill Lynch sustained significant
losses in value due to decline of the stock market and in the assets
comprising such IRA.
9. As a result of the 2001 Tax Act and the decline in the value
of the assets comprising such IRA, the creation of a Marital Bypass
Trust serves to defeat the purposes of the Marital Bypass Trust,
namely minimizing Federal Estate Taxes and allowing a trust for the
benefit of a surviving spouse.
10. In addition, establishment and creation of a Marital Bypass
Trust as directed by Paragraph 2 of the Decedent's Last Will and
Testament would:
a. Inflict unnecessary annual accounting costs for
trust administration and income tax consequences upon distri-
butions therefrom; and
b. Inflict unnecessary practical and liability
burdens upon the Trustee's and the surviving spouse who do
not wish to administer a trust in light of the trust limita-
tions and the current value of such IRA; and
c. Inflict unnecessary costs associated with the
employment of experts to assist with performing the fiduciary
responsibilities associated with Trust administration; and
c. Limit the ability of the surviving spouse to
perform proper estate planning considerations and opportuni-
ties associated therewith; and
d. Impose an inheritance tax of several thousand
dollars upon the Estate, recognizing the life estate inter-
ests of the surviving spouse and remainder interests to the
issue of the decedent; and
e. Thwart the intended purposes of the decedent by
3
leaving less estate assets for his intended beneficiaries.
11. No adverse impact will be imposed upon any named benefi-
ciary as a result of the termination of the Marital Bypass Trust
and extinguishment of any beneficial interests created thereby.
12. Termination of the trust is not intended to nor will
materially prejudice the rights of any creditor of a named benefi-
ciary of the Trust or Estate.
13. Termination of the Marital Bypass Trust is consistent
with paragraph 10 of the Decedent's Last Will and Testament as the
decedent specified that the purpose of the Will was to obtain a
marital deduction for Federal Estate tax purpose, an impossibility
in light of the 2001 Tax amendments and the decline of the value
of Decedent's IRA.
14. All named beneficiaries of the Marital Bypass Trust
created by Paragraph 2 of the Decedent's Last Will and Testament
have disclaimed their interests under said Trust and as created in
the Decedent's Last Will and Testament as evidenced by their
disclaimers docketed to the above-captioned matter and as attached
hereto as Exhibit "A".
15. All named beneficiaries of the Marital Bypass Trust
created by Paragraph 2 of the Decedent's Last Will and Testament
hereby consent to termination of the Marital Bypass Trust as
evidenced by their consents hereto attached as Exhibit "B".
16. The natural parents of all non-vested minor beneficia-
ries have consented to termination of said trust as evidenced by
their consents and disclaimers executed on behalf of the minor
beneficiaries recognized therein, all as attached hereto as Exhib-
it "C".
WHEREFORE, Petitioners respectfully request that this Honor-
able Court enter an Order of Court terminating said Marital Bypass
Trust as established by Paragraph 2 of the Decedent's Last Will
and Testament, and further extinguishing any rights of named,
vested or unvested, beneficiaries therein.
February ~/, 2004
Respectfully submitted,
Attorney for Petitioners
127 South Market Street
P.O. Box 95
Mechanicsburg, PA 17055
(717) 697-7050
(717) 697-7065 (fax)
VERIFICATION
I, Mary Ellen Werner, Executrix verify that the statements
made in the foregoing Petition are true and correct to the best of
my knowledge, information and belief.
Date: February,), 2004
Mary ~n_.~e~e~, Executrix
EXHIBIT "A"
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, KIM L. DIEHL, the undersigned, of 1702 North Main
Street, Bethlehem, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russell T.
Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Rug~ell T. Worner
Disclaimer of Kim L. Diehl
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this
day of JOufA , 2004.
K%m L. Diehl
STATE OF PENNSYLVANIA
COUNTY OF
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kim L. Diehl, known to me
(or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. EUSSELL T, WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, Kristin A. Diehl, the undersigned, of 1702 North Main
Street, Bethlehem, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed t his%t
(SEAL)
STATE OF PENNSYLVANIA :
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kristin A. Diehl, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, SUSAN D. HUMPHREY, the undersigned, of 220 John Glenn
Avenue, Reading, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russell T.
Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania,s laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Susan D. Humphrey
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this 30~day of ~~
, 2004.
Susan D. Humphrey
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Susan D. Humphrey, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
seal. IN WITNESS WHEREOF, I have hereunto set my hand and official
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, RUSSELL T. WERNER, JR., the undersigned, of 1779
Spring Willow Drive, Mechanicsburg, Pennsylvania, a designated
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and contingent residual
beneficiary as named in the Last Will and Testament of Dr. Russell
T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russell T.
Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby ~ully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this day of ~>~'~ , 2004.
Russell T. Werner, Jr./~
/
SEAL)
STATE OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
On this, the~ day of ~x~¢¢~/ , 2004, before me, the
undersigned officer, personally appeared Russell T. Werner, Jr.,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
seal.
IN WITNESS WHEREOF, I have hereunto set my hand and official
N'o~ary Public '~
My Commission Expire~:
I u... ..
I
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, DIANNE T. BASSETTI, the undersigned, of 30 Flint Ridge
Drive, Shillington, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russell T.
Werner; and
c. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Dianne T. Bassetti
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this 31 day of ~7~QO~
, 2004.
Dianne T. Bassetti
(SEAL)
STATE OF PENNSYLVANIA
COUNTY OF
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Dianne T. Bassetti, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, Dea N. Basse%ti, the undersigned, of 30 Flint Ridge
Drive, Shillington, Pennsylvania, a contingent, non-vested
bene£iciary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this
day of '~-OdU~'~"' ,
2004.
Dea N. Bassetti
(SEAL)
STATE OF PENNSYLVANIA :
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Dea N. Bassetti, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND ~ENUNCIATION OF INTEREST IN ESTATE
I, Michael T. Bassetti, the undersigned, of 30 Flint
Ridge Drive, Shillington, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this -~/ day of
~o~ , 2004·
Michael T~.r Bass--etti
(SEAL)
STATE OF PENNSYLVANIA :
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Michael T. Bassetti,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISC?.&IMER AND RENUNCIATION OF INTEREST IN ESTATE
I, KELLY L. ADAMS, the undersigned, of 2316 Abbey Lane,
Harrisburg, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russell T.
Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Kelly L. Adams
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this2"~
STATE OF PENNSYLVANIA :
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kelly L. Adams, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF' INTEREST IN ESTATE
I, Kady L. Adams, the undersigned, of 1702 North Main
Street, Bethlehem, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of-the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Wern~r
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
day of , 2004.
Kady L. ~dams -
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kady L. Adams, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
EXHIBIT "B"
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Kelly L. Adams, the undersigned, a designated
beneficiary in the above-captioned Estate as created by the Last
Will and Testament of Dr. Russell T. Werner, hereby consent to the
termination of a marital bypass trust created therein, and waive
any of my interests or rights thereunder without further notice or
hearing.
Executed this 2 ?d~ay ~~0
of 4.
STATE OF PENNSYLVANIA :
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kelly L. Adams, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Kady L. Adams, the undersigned, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation.of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby consent to the termination of said
marital bypass trust and waive any of my interests or rights
thereunder without further notice or hearing.
Executed this ~"J day of ~~
, 2004.
Kady L. A~ams
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kady L. Adams, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Susan D. Humphrey, the undersigned, a designated
beneficiary in the above-captioned Estate as created by the Last
Will and Testament of Dr. Russell T. Werner, hereby consent to the
termination of a marital bypass trust created therein, and waive
any of my interests or rights thereunder without further notice or
hearing.
Executed this ~0 day of ~~
, 2004.
S6san D. Humphrey
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Susan D. Humphrey, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Kim L. Diehl, the undersigned, a designated beneficiary
in the above-captioned Estate as created by the Last Will and
Testament of Dr. Russell T. Werner, hereby consent to the
termination of a marital bypass trust created therein, and waive
any of my interests or rights thereunder without further notice or
hearing.
Executed this~ i
day of ~l~ , 2004.
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kim L. Diehl, known to me
(or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Russell T. Werner, Jr., the undersigned, a designated
beneficiary in the above-captioned Estate and Co-Trustee of a
marital bypass trust as created by the Last Will and Testament of
Dr. Russell T. Werner, hereby consent to the termination of said
marital bypass trust and waive any of my interests or rights
thereunder without further notice or hearing.
Executed this ~ ~
day of ~C~_ , 2004.
Russell T. Werner, Jr.
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
On this, the ~
day of ~4nuoc~ , 2004, before me, the
undersigned officer, personally appeared Russell T. Werner, Jr.,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
seal.
IN WITNESS WHEREOF, I have hereunto set my hand and official
No£a~y Public - - ~--~
My Commission ExplTes:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Kristin A. Diehl, the undersigned, a contingent, non-
vested beneficiary in the above-captioned Estate as a result of
the creation of a marital bypass trust and a contingent, non-
vested residual beneficiary as named in the Last Will and
Testament of Dr. Russell T. Werner, hereby consent to the
termination of said marital bypass trust and waive any of my
interests or rights thereunder without further notice or hearing.
Executed this~
day of
(SEAL)
STATE OF PENNSYLVANIA :
COUNTY OF CUMBERLAND :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kristin A. Diehl, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Dianne T. Bassetti, the undersigned, a designated
beneficiary in the above-captioned Estate and Co-Trustee of a
marital bypass trust as created by the Last Will and Testament of
Dr. Russell T. Werner, hereby consent to the termination of said
marital bypass trust and waive any of my interests or rights
thereunder without further notice or hearing.
Executed this 3i day of ,.jO~)O~, 2004.
Dianne T. Bassetti
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Dianne T. Bassetti, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Michael T. Bassetti, the undersigned, a contingent, non-
vested beneficiary in the above-captioned Estate as a result of
the creation of a marital bypass trust and a contingent, non-
vested residual beneficiary as named in the Last Will and
Testament of Dr. Russell T. Werner, hereby consent to the
termination of said marital bypass trust and waive any of my
interests or rights thereunder without further notice or hearing.
Executed this 3{ day of ~?~~ , 2004.
%.,
Michael T~assetti
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Michael T. Bassetti,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Dea N. Bassetti, the undersigned, a contingent, non-
vested beneficiary in the above-captioned Estate as a result of
the creation of a marital bypass trust and a contingent, non-
vested residual beneficiary as named in the Last Will and
Testament of Dr. Russell T. Werner, hereby consent to the
termination of said marital bypass trust and waive any of my
interests or rights thereunder without further notice or hearing.
Executed this ~/ day of ~~
, 2004.
Pea N. Bassetti-
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Dea N. Bassetti, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
EXHIBIT "C"
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREIN
We, Kelly L. Adams and Jon R. Adams, the natural parents of
Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James Adams (D.O.B.
09/10/93), minor grandchildren of the Decedent, hereby affirm and
acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Jessica Rae Adams
(D.O.B. 07/12/87) and Samuel James Adams (D.O.B.
09/10/93) are a non-vested, contingent beneficiaries in
the Estate of Dr. Russell T. Werner as a result of the
creation of a marital bypass trust, and, further that
the Jessica Rae Adams (D.O.B. 07/12/87) and Samuel
James Adams (D.O.B. 09/10/93) are non-vested contingent
residual beneficiaries under the terms of the Last Will
and Testament of Dr. Russell T. Werner; and
C. We acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93) to request and receive more
specific information concerning the value of all assets
titled solely or jointly in the name of Dr. Russell T.
Werner, including but not limited to the above-
described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Jessica Rae Adams (D.O.B. 07/12/87) and
Samuel James Adams (D.O.B. 09/10/93), either as a non-
vested, contingent beneficiaries as a result of the
creation of the marital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last Will and Testament of Dr.
Russell T. Werner, without further hearing or notice;
and
Estate of Russell T. Werner
Disclaimer of Jessica Rae Adams
and Samuel James Adams
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93) under Pennsylvania's laws of
intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.C.S.A. Section 2101, et
seq, as amended, or any other law, without further hearing
or notice; and
G. Jessica Rae Adams (D.O.B. 07/12/87) and
Samuel James Adams (D.O.B. 09/10/93) have not received
any direct or indirect interest from the Estate of Dr.
Russell T. Werner prior to execution of this written
Disclaimer and renunciation on their behalf; and
H. This Disclaimer, executed on behalf
Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93), has been not executed for the
purpose of materially prejudicing the rights of any
creditors, heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Jessica Rae Adams (D.O.B.
07/12/87) and Samuel James Adams (D.O.B. 09/10/93) in
the Estate of Dr. Russell T. Werner, Jr. may be
submitted to the Court of Common Pleas of Cumberland
County and filed as part of a Joint Petition to
Terminate Marital Bypass Trust, and we further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
our choosing and that we are completely satisfied with
the terms herein.
Executed this~~
day of
Jon " / .... (SEAL)
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREIN
We, Kelly L. Adams and Jon R. Adams, the natural parents of
Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James Adams (D.O.B.
09/10/93), minor grandchildren of the Decedent, hereby affirm and
acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Jessica Rae Adams
(D.O.B. 07/12/87) and Samuel James Adams (D.O.B.
09/10/93) are a non-vested, contingent beneficiaries in
the Estate of Dr. Russell T. Werner as a result of the
creation of a marital bypass trust, and, further that
the Jessica Rae Adams (D.O.B. 07/12/87) and Samuel
James Adams (D.O.B. 09/10/93) are non-vested contingent
residual beneficiaries under the terms of the Last Will
and Testament of Dr. Russell T. Werner; and
C. We acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93) to request and receive more
specific information concerning the value of all assets
titled solely or jointly in the name of Dr. Russell T.
Werner, including but not limited to the above-
described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Jessica Rae Adams (D.O.B. 07/12/87) and
Samuel James Adams (D.O.B. 09/10/93), either as a non-
vested, contingent beneficiaries as a result of the
creation of the marital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last Will and Testament of Dr.
Russell T. Werner, without further hearing or notice;
and
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kelly L. Adams and Jon R.
Adams, known to me (or satisfactorily proven) to be the persons
whose names are subscribed to the within instrument and
acknowledged that they executed the same for the purpose therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREI!
I, Susan D. Humphrey, the mother and guardian of Amanda
Ashley Humphrey (D.O.B. 10/19/87) and Alexander James Humphrey
(D.O.B. 04/24/90), minor grandchildren of the Decedent, hereby
affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I acknowledge that Amanda Ashley Humphrey
(D.O.B. 10/19/87) and Alexander James Humphrey (D.O.B.
04/24/90) are a non-vested, contingent beneficiaries in
the Estate of Dr. Russell T. Werner as a result of the
creation of a marital bypass trust, and, further that
the Jessica Rae Adams (D.O.B. 07/12/87) and Samuel
James Adams (D.O.B. 09/10/93) are non-vested contingent
residual beneficiaries under the terms of the Last Will
and Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive the non-vested, contingent rights
of Amanda Ashley Humphrey (D.O.B. 10/19/87) and
Alexander James Humphrey (D.O.B. 04/24/90) to request
and receive more specific information concerning the
value of all assets titled solely or jointly in the
name of Dr. Russell T. Werner, including but not
limited to the above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on
behalf of Amanda Ashley Humphrey (D.O.B. 10/19/87) and
Alexander James Humphrey (D.O.B. 04/24/90), either as a
non-vested, contingent beneficiaries as a result of the
creation of the marital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last Will and Testament of Dr.
Russell T. Werner, without further hearing or notice;
and
Estate oX Russell T, Werner
Disclaimer of Amanda Ashley Humphrey
Alexander James Humphrey
Page 2
F. I hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Amanda Ashley Humphrey (D.O.B. 10/19/87) and Alexander
James Humphrey (D.O.B. 04/24/90) under Pennsylvania,s laws
of intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.C.S.A. Section 2101, et
seq, .~s amended, or any other law, without further hearing
or notice; and
G. Amanda Ashley Humphrey (D.O.B. 10/19/87)
and Alexander James Humphrey (D.O.B. 04/24/90) have not
received any direct or indirect interest from the
Estate of Dr. Russell T. Werner prior to execution of
this written Disclaimer and renunciation on their
behalf; and
H. This Disclaimer, executed on behalf Amanda
Ashley Humphrey (D.O.B. 10/19/87) and Alexander James
Humphrey (D.O.B. 04/24/90), has been not executed for
the purpose of materially prejudicing the rights of any
creditors, heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. I understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Amanda Ashley Humphrey (D.O.B.
10/19/87) and Alexander James Humphrey (D.O.B.
04/24/90) in the Estate of Dr. Russell T. Werner, Jr.
may be submitted to the Court of Common Pleas of
Cumberland County and filed as part of a Joint Petition
to Terminate Marital Bypass Trust, and I further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
our choosing and I am completely satisfied with the
terms herein.
Executed this ~ day of ~~. ~04i~~
Su~an D. Humphre~
(SEAL)
2
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Susan D. Humphrey, known
to me (or satisfactorily proven) to be the person whose names is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF I have hereunto set my hand and official
seal. '
Notary Public
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREIN
We, Kim L. Diehl and Daryl Diehl, the natural parents of
Lauren Elizabeth Diehl (D.O.B. 01/04/88), a minor grandchild of
the Decedent, hereby affirm and acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Lauren Elizabeth Diehl
(D.O.B. 01/04/88) is a non-vested, contingent
beneficiary in the Estate of Dr. Russell T. Werner as a
result of the creation of a marital bypass trust, and,
further that the Lauren Elizabeth Diehl (D.O.B.
01/04/88) is a non-vested contingent residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. We acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Lauren Elizabeth Diehl (D.O.B. 01/04/88) to request
and receive more specific information concerning the
value of all assets titled solely or jointly in the
name of Dr. Russell T. Werner, including but not
l'~imited to the above-described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Lauren Elizabeth Diehl (D.O.B. 01/04/88),
either as a non-vested, contingent beneficiary as a
result of the creation of the marital bypass trust
therein or as a non-vested, contingent residual
beneficiary as established by the Last Will and
Testament of Dr. Russell T. Werner, without further
hearing or notice; and
E~tat~ of Russell T. Werner
Disclaimer of Lauren Elizabeth Diehl
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
oX Lauren Elizabeth Diehl (D.O.B. 01/04/88) under
Pennsylvania's laws of intestacy, including but not
limited to any rights, entitlement or interest afforded in
the Estate of Dr. Russell T. Werner granted by 20
Pa.C.S.A. Section 2101, et seq, as amended, or any other
law, without further hearing or notice; and
G. Lauren Elizabeth Diehl (D.O.B. 01/04/88)
has not received any direct or indirect interest from
the Estate of Dr. Russell T. Werner prior to execution
of this written Disclaimer and renunciation on her
behalf; and
H. This Disclaimer, executed on behalf Lauren
Elizabeth Diehl (D.O.B. 01/04/88), has been not
executed for the purpose of materially prejudicing the
rights of any creditors, heirs or beneficiaries of the
decedent or the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Lauren Elizabeth Diehl (D.O.B.
01/04/88) in the Estate of Dr. Russell T. Werner, Jr.
may be submitted to the Court of Common Pleas of
Cumberland County and filed as part of a Joint Petition
to Terminate Marital Bypass Trust, and we further
hereby waive formal notice of any future hearing
concerning termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that we are completely satisfied with
the terms herein.
Executed this ~ ~ day of ~/K, , 2004.
DarylO'iehl
(SEAL)
(sEw)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kim L. Diehl and Daryl
Diehl, known to me (or satisfactorily proven) to be the persons
whose names are subscribed to the within instrument and
acknowledged that they executed the same for the purpose therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
~ONSENT OF BENEFICIARy TO TERMINATE NON-~rESTED, CONTINGENT
~NTEREST OF MINOR BENEFICIARY IN MARITAL B~PASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREIN
We, Russell T. Werner, Jr. and Constance j. Werner, the
natural parents of Veronica Rose Werner (D.O.B. 04/25/98) and
Reagan Hope Werner (D.O.B. 07/28/00), minor grandchildren of the
Decedent, hereby affirm and acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Veronica Rose Werner
(D.O.B. 04/25/98) and Reagan Hope Werner (D.O.B.
07/28/00) are a non-vested, contingent beneficiaries in
the Estate of Dr. Russell T. Werner as a result of the
creation of a marital bypass trust, and, further that
the Veronica Rose Werner (D.O.B. 04/25/98) and Reagan
Hope Werner (D.O.B. 07/28/00) are non-vested contingent
residual beneficiaries under the terms of the Last Will
and Testament of Dr. Russell T. Werner; and
c. We acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Veronica Rose Werner (D.O.B. 04/25/98) and Reagan
Hope Werner (D.O.B. 07/28/00) to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Veronica Rose Werner (D.O.B. 04/25/98) and
Reagan Hope Werner (D.O.B. 07/28/00), either as a non-
vested, contingent beneficiaries as a result of the
creation of the marital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last Will and Testament of Dr.
Russell T. Werner, without further hearing or notice;
and
Estate of Russell T. Werner
Disclaimer of Veronica Rose Werner
and Reagan Hope Werner
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Veronica Rose Werner (D.O.B. 04/25/98) and Reagan Hope
Werner (D.O.B. 07/28/00) under Pennsylvania,s laws of
intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.C.S.A. Section 2101, et
s_9_q, as amended, or any other law, without further hearing
or notice; and --
G. Veronica Rose Werner (D.O.B. 04/25/98) and
Reagan Hope Werner (D.O.B. 07/28/00) have not received
any direct or indirect interest from the Estate of Dr.
Russell T. Werner prior to execution of this written
Disclaimer and renunciation on their behalf; and
H. This Disclaimer, executed on behalf
Veronica Rose Werner (D.O.B. 04/25/98) and Reagan Hope
Werner (D.O.B. 07/28/00), has been not executed for the
purpose of materially prejudicing the rights of any
creditors, heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Veronica Rose Werner (D.O.B.
04/25/98) and Reagan Hope Werner (D.O.B. 07/28/00) in
the Estate of Dr. Russell T. Werner, Jr. may be
submitted to the Court of Common Pleas of Cumberland
County and filed as part of a Joint Petition to
Terminate Marital Bypass Trust, and we further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
our choosing and that we are completely satisfied with
the terms herein.
' , 004.
Executed this ~day of
~. Werner, j~.
-~~cc. ~~m (SEAL)
Constance J.'werner --'
2
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
unaersignea officer, personally app , 2004, before me, the
and e~red Russell T. Werner, Jr.
Constance j. Werner, known to me (or satisfactorily proven) to
be the persons whose names are subscribed to the within instrument
and acknowledged that they executed the same for the purpose
therein contained.
seal.
IN WITNESS WHEREOF, I have hereunto set my hand and official
Notary Publi~ C/ --
3
BUREAU OF ZNDZVZDUAL TAXES
TNHERZTANCE TAX DTVZSTON
DEPT. Z80601
HARRZSBURG, PA 171Z8-0601
ANDREN C SHEELY ATTY
1Z7 S HARKET ST
PO BOX 95
HECHANICSBURG
COHHONNEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTZONS AND ASSESSNENT OF TAX
'04 ti?R 20
DATE
ESTATE OF
DATE OF DEATH
FZLE NUHBER
..JO COUNTY
ACH
REV-l$47 EX AFP (01L~03)
04-19-Z00~
NERNER
06-OZ-ZO05
21 05-0617
CUNBERLAND
101
Amoun~ Remi~ed I
RUSSELL T
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGTSTER OF NTLLS
CUHBERLAND CO COURT HOUSE
CARLTSLE, PA 17015
CUT ALONG THZS LZNE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR
DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX
ESTATE OF NERNER RUSSELL T FZLE NO. 21 05-0617 ACN 101 DATE 0~-19-Z00~
TAX RETURN #AS: (X} ACCEPTED AS FZLED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: OR/GZNAL RETURN
1. Reel Es~e~e (Schedule A) (1)
2. S~ocks end Bonds (Schedule B) (2)
$. Closely Hold S~ock/Per~narsh/p Zn~eras~ (Schedule C) ($)
~. Hor~gages/No~es Receivable (Schedule D) (~)
5. Cash/Bank Depos/~s/H/sc. Personal Proper~y (Schedule E) ($)
6. Jo/n~ly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTZONS AND EXEHPTZONS:
9. Funeral Expenses/Ada. Cos~s/Hisc. Expanses (Schedule H) (9)
10. Debts/Hot,gage Liab/1/~/es/L/ans (Schedule I) (10)
11. To,al Deduc~/ons
12. Na~ Value of Tax Re~urn
00
O0
O0
O0
O0
O0
151 z556 O0
(8)
.0O
.00
NOTE: To /nsura proper
credi~ ~o your account,
sube/~ ~he upper por~/on
of ~h/s form w/~h your
~ax payment.
13.
1~.
NOTE:
ASSESSHENT OF TAX: 15. Aeoun'l: of L/ne 1~ a~ Spousal ra~e
16. Aeoun~ of L/ne lq t:axabla a~ L/neal/Class A ra~e
17. Aeoun~ of L/ne lq a~ S/bllng ra~a
18. Aeoun~ of L/ne 1~, ~axebla a~ Collateral/Class B ra~e
19. Principal Tax Due
TAX CREDITS:
PAYMENT
DATE NUHBER ZNTEREST/PEN PAZD (-)
151,556.00
(11) . DO
(la) 151,536. O0
Chari'cable/Governeen~cal Bequests; Non-elected 911:3 Trusts (Schedule J) (15)
Ne~ Value of Es~a~e Subject: ~o Tax (lq)
Zf an assessment ~as issued previously, lines 14, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
.00
151,356.00
18 and 19 will
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUZRED.
ZF TOTAL DUE 1S REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SZDE OF THZS FORN FOR INSTRUCTZONS.)~_ .
ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL /NTEREST.
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
ANOUNT PAZD
· °°I
.00
.00
.00
(15). 151,556.00 x O0 : .00
(16) .00 x 045= .00
(11). .00 x 12 = .00
(28) .00 x 15 = .00
(19)= . O0
RESERVATION:
PURPOSE OF
NOTICE:
PAYNEHT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decadents dying on or ba~ora December 1Z, 19BZ -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after tho expiration of any estate for
1ifa or for years, the Coamonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at tho lawful Class B (cella:ara1) rate on any such future interest.
To fulfill tho requirements of Section 11~0 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S.
Sac:ion 91~0).
Detach tho top portion of this Notice and submit with your payment to the Register of Hills printed on tho reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office
of the Register of Hills, any of tho Z3 Revenue District Offices, or by calling the special Zq-hour
answering service for forms ordaringc 1-800-36Z-Z0501 services for taxpayers with special hearing and / or
speaking needs: 1-800-~47-$010 (TT only).
Any party in interest not satisfied aith the appraisement, alloaanca, or disalloaancs of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to tho PA Department of Revenue, Board of Appeals, Dept. 181021, Harrisburg, PA 1711B-1011, OR
--election to have the aa:tar determined at audit of tho account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should ba addressed in arittng to: PA Department cf Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. Sea page 5 of tho booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax duo is paid within three (3) calendar months after tho decadent's death, a five percent (SI) discount of
tho tax paid is a11oaad.
Tho 15Z tax amnesty non-participation penalty is computed on ~':e total of tho tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of tho tax amnesty period. This non-participation
penalty is appealable in the same manner and in tho tho same time period as you would appeal tho tax and interest
that has been assessed as indicated on this no:ica.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .000164. Al1 taxes which became delinquent on and after
January l, 19BI will bear interest at a rate ahich will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZO0~ ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ ZOX .0005~8 '~'~'~-1991 llZ .000301 ~ 9Z . O00Zq?
1983 16Z . 000~38 1991 91 . O002~7 ZOOZ 61 . 00016~
1984 111 .000301 1993-1994 7Z .000192 Z003 5Z .000137
1985 131 .000356 1995-1998 9Z .000247 2004 qZ .000110
1986 101 .000274 1999 7Z .000192
1987 IOZ . OOOZ7q ZOO0 71 .000192
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
(717) 697-7050
ANDREW C. SHEELY
ATTORNEY AT LAW
127 South Market Street
P.O. Box 05
Mec!aanicslourg, Pm~nsylvania 17055
F~x: (717) 007-7005
May 25, 2004
Glenda Farner Strasbaugh
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
RE: Estate of Dr. Russell T. Werner
Estate No. 21-03-617
Date of Death: June 2, 2003
Dear Glenda:
Enclosed please find the Status Report for the above
captioned estate,
Please call if you have any questions.
ACS/bmk
Enclosure
c: Mary Ellen Werner, Executrix
ANDREW C. SHEELY/~
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Dr. Russel I q'. W~_rnar
Date of Death: 06/02/03
Will No.: 21-03-617 Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~ No [~
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
ao
Did the personal representative file a final account with the Court?
Yes _ No []
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? Yes [] No ['-]
Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the. Orphans' Court
this rep .
and may be attached to ~~
Andrew C. Sheely, Esquire
Name
127 South Market Street
P.O. Box 95
Mechanicsburg, PA 17055
Address
(717) 697-705~i'.' cf
Telephone No.
Capacity:
[-~ Personal Representative
IX] Counsel for personal representah'ge
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, Kristin A. Diehl, the undersigned, of 1702 North Main
Street, Bethlehem, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested b~fefici~ry
in the Estate of Dr. Russell T. Werner as a ~ult~f
the creation of a marital bypass trust under~he terms
of the Last Will and Testament of Dr. Russel~ T. W~ner
and further that I am a contingent, non-vested res~ual
beneficiary under the terms of the Last Will ~nd
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of vagus
financial information and correspondence relatl~ng tq9
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Kim L. Diehl
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this
day of JQuf% , 2004.
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kim L. Diehl, known to me
(or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, KIM L. DIEHL, the undersigned, of 1702 North Main
Street, Bethlehem, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and f.u~,~her that
I am a contingent residual beneficiary under~ t~s
of the Last Will and Testament of Dr. Russel~T,
Werner; and ~ ·
C. I acknowledge the receipt of valle°Us ~3~
financial information and correspondence rela~ing to
the value of a Merrill Lynch IRA account 898-~3~02 ~ ~'~'_
titled in the name of Dr. Russell T. Werner; .a~ ~ ~c~
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. i hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Kim L. Diehl
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this
day of JOPPA , 2004.
(SEAL)
STATE OF PENNSYLVANIA :
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kim L. Diehl, known to me
(or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, SUSAN D. NUMPNREY, the undersigned, of 220 John Glenn
Avenue, Reading, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the ~st Will
and Testament of Dr. Russell T. Werner and f~.~ther~hat
I am a contingent residual beneficiary underneaths t~rms
of the Last Will and Testament of Dr. Russel~ :T.
Werner; and
C. I acknowledge the receipt of va~ious
financial information and correspondence rel.~ing t~
the value of a Merrill Lynch IRA account 898-~902
titled in the name of Dr. Russell T. Werner; ~d
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Susan D. Humphrey
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this 30~day of ~~
, 2004.
Susan D. Humphrey
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Susan D. Humphrey, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, RUSSELL T. WERNER, JR., the undersigned, of 1779
Spring Willow Drive, Mechanicsburg, Pennsylvania, a designated
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and contingent residual
beneficiary as named in the Last Will and Testament of Dr. Russell
T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. RUssell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estat~iOf D ·
Russell T. Werner as a result of the creatio~ ~f a
marital bypass trust under the terms of the ~st Will
and Testament of Dr. Russell T. Werner and f~-~'rther ~hat
I am a contingent residual beneficiary under i~he te~ms o
of the Last Will and Testament of Dr. Russel~.~T,
Werner; and .o
C. I acknowledge the receipt of va~s
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this ~-~day of ~~
, 2004.
Russell T. Werner, Jr./~
/
(SEAL)
STATE OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
On this, the~ay of ~u~¢~/ , 2004, before me, the
undersigned officer, personally appeared Russell T. Werner, Jr.,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
seal.
IN WITNESS WHEREOF, I have hereunto set my hand and official
N6~ary ~ ~ublic ~
My Commission Expire~/:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, KELLY L. ADAMS, the undersigned, of 2316 Abbey Lane,
Harrisburg, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russel~3!~.
Werner; and
C I acknowledge the receipt of v~lous
financial information and correspondence relating
the value of a Merrill Lynch IRA account 898~83902~
titled in the name of Dr Russell T Werner;~nd
D. I waive my right to request and~cei~
more specific information concerning the valUe-of
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Kelly L. Adams
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this2"~
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kelly L. Adams, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, Kady L. Adams, the undersigned, of 1702 North Main
Street, Bethlehem, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
· I acknowledge the receipt of va~.~us _.
financial information and correspondence relying ~
the value of a Merrill Lynch IRA account 898~3902
titled in the name of Dr Russell T. Werner; ~and
D. I waive my right to request and~ecei~
more specific information concerning the val~ilof a~l
assets titled solely or jointly in the name 6~Dr. ~
Russell T. Werner, including but not limited~ th~
above-described Merrill Lynch IRA; and ~
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this~~
Kady L. ~dams -
( SEAL )
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kady L. Adams, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, Michael T. Bassetti, the undersigned, of 30 Flint
Ridge Drive, Shillington, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner;~..d
D. I waive my right to request an~.~cei~e
more specific information concerning the val~ of a~l
assets titled solely or jointly in the name 61f Dr. ~
Russell T. Werner, including but not limitediii.~o thy
above-described Merrill Lynch IRA; and ~'~..
E. I hereby fully and completely~cla~
any interest in the Estate of Dr. Russell T.~'rne~
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this -~/ day of
~tJ~~ , 2004.
Michael ~. Bassetti
( SEAL )
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Michael T. Bassetti,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, Dea N. Bassetti, the undersigned, of 30 Flint Ridge
Drive, Shillington, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of v~us
financial information and correspondence relying
the value of a Merrill Lynch IRA account 898~-8~902
titled in the name of Dr. Russell T Werner;!~!.~and
D. I waive my right to request and~recei~
more specific information concerning the val~ of a~l
assets titled solely or jointly in the name ~f~"Dr.
Russell T. Werner, including but not limited~.
above-described Merrill Lynch IRA; and oo
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this
day of ~'OrluO~- 2004
Dea N. Bassetti
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Dea N. Bassetti, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED,
CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREIN
We, Kelly L. Adams and Jon R. Adams, the natural parents of
Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James Adams (D.O.B.
09/10/93), minor grandchildren of the Decedent, hereby affirm and
acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Jessica Rae Adams
(D.O.B. 07/12/87) and Samuel James Adams (D.O.,~
09/10/93) are a non-vested, contingent benef~arie~
the Estate of Dr. Russell T. Werner as a res ~ii of
creation of a marital bypass trust, and, furtSer tha~
the Jessica Rae Adams (D.O.B. 07/12/87) and ~muel
James Adams (D.O.B. 09/10/93) are non-vested ~ontin~nt
residual beneficiaries under the terms of th%~ast W~ill
and Testament of Dr. Russell T. Werner; and : (7.
C. We acknowledge the receipt of v~us
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93) to request and receive more
specific information concerning the value of all assets
titled solely or jointly in the name of Dr. Russell T.
Werner, including but not limited to the above-
described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Jessica Rae Adams (D.O.B. 07/12/87) and
Samuel James Adams (D.O.B. 09/10/93), either as a non-
vested, contingent beneficiaries as a result of the
creation of the marital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last Will and Testament of Dr.
Russell T. Werner, without further hearing or notice;
and
Estate of Russell T. Werner
Disclaimer of Jessica Rae Adams
and Samuel James Adams
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93) under Pennsylvania's laws of
intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.C.S.A. Section 2101, et
seq, as amended, or any other law, without further hearing
or notice; and
G. Jessica Rae Adams (D.O.B. 07/12/87) and
Samuel James Adams (D.O.B. 09/10/93) have not received
any direct or indirect interest from the Estate of Dr.
Russell T. Werner prior to execution of this written
Disclaimer and renunciation on their behalf; and
H. This Disclaimer, executed on behalf
Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93), has been not executed for the
purpose of materially prejudicing the rights of any
creditors, heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Jessica Rae Adams (D.O.B.
07/12/87) and Samuel James Adams (D.O.B. 09/10/93) in
the Estate of Dr. Russell T. Werner, Jr. may be
submitted to the Court of Common Pleas of Cumberland
County and filed as part of a Joint Petition to
Terminate Marital Bypass Trust, and we further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
our choosing and that we are completely satisfied with
the terms herein.
Executed this~ ~ ' '/
day of ~~~004.
. Adams ~ (SEAL)
2
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREIN
I, Susan D. Humphrey, the mother and guardian of Amanda
Ashley Humphrey (D.O.B. 10/19/87) and Alexander James Humphrey
(D.O.B. 04/24/90), minor grandchildren of the Decedent, hereby
affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I acknowledge that Amanda Ashle~mph~ey
mph
10/19/87 ) ·
(D.O.B. and Alexander James Hu r (D.f~B
f~ia ie~% i
04/24/90) are a non-vested, contingent bene r n
the Estate of Dr. Russell T. Werner as a resqlt of ~e
creation of a marital bypass trust, and, fur er t
the Jessica Rae Adams (D.O.B. 07/12/87) and S~Uel
James Adams (D.O.B. 09/10/93) are non-vested ~0~t~n~nt.
residual beneficiaries under the terms of th~ ~ast W~ll
and Testament of Dr. Russell T. Werner; and ~t t5 o_~
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive the non-vested, contingent rights
of Amanda Ashley Humphrey (D.O.B. 10/19/87) and
Alexander James Humphrey (D.O.B. 04/24/90) to request
and receive more specific information concerning the
value of all assets titled solely or jointly in the
name of Dr. Russell T. Werner, including but~not
limited to the above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on
behalf of Amanda Ashley Humphrey (D.O.B. 10/19/87) and
Alexander James Humphrey (D.O.B. 04/24/90), either as a
non-vested, contingent beneficiaries as a result of the
creation of the marital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last Will and Testament of Dr.
Russell T. Werner, without further hearing or notice;
and
Estate of Russell T. Werner
Disclaimer of Amanda Ashley Humphrey
Alexander James Humphrey
Page 2
F. I hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Amanda Ashley Humphrey (D.O.B. 10/19/87) and Alexander
James Humphrey (D.O.B. 04/24/90) under Pennsylvania's laws
of intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.C.S.A. Section 2101, e__t
seq, as amended, or any other law, without further hearing
or notice; and
G. Amanda Ashley Humphrey (D.O.B. 10/19/87)
and Alexander James Humphrey (D.O.B. 04/24/90) have not
received any direct or indirect interest from the
Estate of Dr. Russell T. Werner prior to execution of
this written Disclaimer and renunciation on their
behalf; and
H. This Disclaimer, executed on behalf Amanda
Ashley Humphrey (D.O.B. 10/19/87) and Alexander James
Humphrey (D.O.B. 04/24/90), has been not executed for
the purpose of materially prejudicing the rights of any
creditors, heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. I understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Amanda Ashley Humphrey (D.O.B.
10/19/87) and Alexander James Humphrey (D.O.B.
04/24/90) in the Estate of Dr. Russell T. Werner, Jr.
may be submitted to the Court of Common Pleas of
Cumberland County and filed as part of a Joint Petition
to Terminate Marital Bypass Trust, and I further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
our choosing and I am completely satisfied with the
terms herein.
Su~an D. Humphrey
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREIN
We, Kim L. Diehl and Daryl Diehl, the natural parents of
Lauren Elizabeth Diehl (D.O.B. 01/04/88), a minor grandchild of
the Decedent, hereby affirm and acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Lauren Elizabeth Diehl
(D.O.B. 01/04/88) is a non-vested, contingent
beneficiary in the Estate of Dr. Russell T. Werner as a
result of the creation of a marital bypass trust, and,
further that the Lauren Elizabeth Diehl (D.O.~,~
01/04/88) is a non-vested contingent residua~ ~,~"
beneficiarY under the terms of the Last Will ~d ~
Testament of Dr. Russell T. Werner; and ~ ....
C. We acknowledge the receipt of v~ious ~o
financial information and correspondence rela~ing t~
the value of a Merrill Lynch IRA account 898~-~902 -~
titled in the name of Dr. Russell T. Werner; ~d ~3
D. We waive the non-vested, contingent rights
of Lauren Elizabeth Diehl (D.O.B. 01/04/88) to request
and receive more specific information concerning the
value of all assets titled solely or jointly in the
name of Dr. Russell T. Werner, including but not
limited to the above-described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Lauren Elizabeth Diehl (D.O.B. 01/04/88),
either as a non-vested, contingent beneficiary as a
result of the creation of the marital bypass trust
therein or as a non-vested, contingent residual
beneficiary as established by the Last Will and
Testament of Dr. Russell T. Werner, without further
hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Lauren Elizabeth Diehl
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Lauren Elizabeth Diehl (D.O.B. 01/04/88) under
Pennsylvania's laws of intestacy, including but not
limited to any rights, entitlement or interest afforded in
the Estate of Dr. Russell T. Werner granted by 20
Pa.C.S.A. Section 2101, et seq, as amended, or any other
law, without further hearing or notice; and
G. Lauren Elizabeth Diehl (D.O.B. 01/04/88)
has not received any direct or indirect interest from
the Estate of Dr. Russell T. Werner prior to execution
of this written Disclaimer and renunciation on her
behalf; and
H. This Disclaimer, executed on behalf Lauren
Elizabeth Diehl (D.O.B. 01/04/88), has been not
executed for the purpose of materially prejudicing the
rights of any creditors, heirs or beneficiaries of the
decedent or the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Lauren Elizabeth Diehl (D.O.B.
01/04/88) in the Estate of Dr. Russell T. Werner, Jr.
may be submitted to the Court of Common Pleas of
Cumberland County and filed as part of a Joint Petition
to Terminate Marital Bypass Trust, and we further
hereby waive formal notice of any future hearing
concerning termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that we are completely satisfied with
the terms herein.
Executed this ? ~ day of
~ 0~q&. , 2004.
Daryl O±ehl
(SEAL)
(SEAL)
2
Estate of Russell T. Werner
Disclaimer of Veronica Rose Werner
and Reagan Hope Werner
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Veronica Rose Werner (D.O.B. 04/25/98) and Reagan Hope
Werner (D.O.B. 07/28/00) under Pennsylvania's laws of
intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.C.S.A. Section 2101, et
seq, as amended, or any other law, without further hearing
or notice; and
G. Veronica Rose Werner (D.O.B. 04/25/98) and
Reagan Hope Werner (D.O.B. 07/28/00) have not received
any direct or indirect interest from the Estate of Dr.
Russell T. Werner prior to execution of this written
Disclaimer and renunciation on their behalf; and
H. This Disclaimer, executed on behalf
Veronica Rose Werner (D.O.B. 04/25/98) and Reagan Hope
Werner (D.O.B. 07/28/00), has been not executed for the
purpose of materially prejudicing the rights of any
creditors, heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Veronica Rose Werner (D.O.B.
04/25/98) and Reagan Hope Werner (D.O.B. 07/28/00) in
the Estate of Dr. Russell T. Werner, Jr. may be
submitted to the Court of Common Pleas of Cumberland
County and filed as part of a Joint Petition to
Terminate Marital Bypass Trust, and we further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. We have had the opportunity or.have
reviewed the terms of this Disclaimer with counsel of
our choosing and that we are completely satisfied with
the terms herein.
Executed this ~'~y of ~ ~ , 2004.
ssell T. Werner, J~.
Constance J.
(SEAL)
(SEAL)
2
IN RE: ESTATE OF
DR. RUSSELL T. WERNER
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21-03-617
ORDER APPROVING JOINT PETITION TO TERMINATE MARITAL BY-PASS
TRUST PURSUANT TO PA. C.S.A. SECTION 6102(a)
/
AND NOW, this rC ~ day of~:~/~~ , ,
2004 after
consideration of the Joint Petition to Terminate Marital Bypass Trust
pursuant to Section 6102 (a) of the Probate, Estates and Fiduciaries
Code of 1972, as amended, and following a hearing thereon, and it is
Ordered and Decreed that the Marital Bypass Trust established under
paragraph 2 of the Last Will and Testament of Dr. Russell T. Werner,
is hereby TERMINATED. It is further Ordered and Decreed that any
vested or non-vested, minor beneficial rights, entitlements, inter-
ests or claims in the Marital Bypass Trust established under para-
graph 2 of the Last Will and Testament of Dr. Russell T. Werner, are
hereby EXTINGUISHED.
. ,,..%j,~ ~ -"
Andrew C. Sheely, Esqulr~-J-
Attorney for Petitioners
IN RE: ESTATE OF
DR. RUSSELL T. WERNER
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21-03-617
JOINT PETITION OF EXECUTRIX AND TRUSTEES TO TERMINATE MARI-
TAL BYPASS TRUST AND EXTINGUISH RIGHTS
OF BENEFICIARIES IN MARITAL BYPASS TRUST
TO THE HONORABLE, JUDGES OF SAID COURT: .~
Mary Ellen Werner, Executrix of the Estate o~.Dr. ~ssei!i
Werner, deceased, and Dianne T. Bassetti and Russe(l'l T. ~rne~]'i?Jr.,
Trustees of a Marital Bypass Trust created by the La~t Will a~
Testament of Dr. Russell T. Werner dated March 5, 1~7, ~y and
through counsel of Andrew C. Sheely, Esquire, hereby file this Joint
Petition for termination of a marital bypass trust and beneficial
interests created therein in accordance with 20 Pa. C.S.A. §6102 (a),
and respectfully state as follows:
1. Petitioner, Mary Ellen Werner, is the surviving spouse of Dr.
Russell T. Werner, and Executrix of the Estate of Dr. Russell T.
Werner, having been granted Letters Testamentary by the Register of
Wills of Cumberland County, Pennsylvania at the above-captioned
docket number.
2. Dianne T. Bassetti and Russell T. Werner, Jr. are natural
children of Dr. Russell T. Werner and named Trustees of a Marital
Bypass Trust created by paragraph 2 of the Last Will and Testament of
Dr. Russell T. Werner dated March 5, 1997.
3. Dr. Russell T. Werner died on June 1, 2003.
4. At the time of his death, Dr. Russell T. Werner was the sole
owner of an IRA with Merrill Lynch which maintained date of death
value of $151,336.00.
5. The named beneficiary of the IRA was a Marital Bypass Trust
created and established by paragraph 2 of the Last Will and Testament
of Dr. Russell T. Werner dated March 5, 1997.
6. As of March 1997, Dr. Russell T. Werner individual and joint
gross assets were subject to potential Federal Estate taxes and
therefore prudent estate planning warranted the creation of a Marital
Bypass Trust in Decedent's Last Will and Testament so as to minimize
Federal Estate (death) taxes.
7. Subsequent to the execution of the Decedent's Last Will and
Testament, Congress enacted legislation intended to phase out the
Federal Estate tax under the 2001 Tax Act and thereby eliminated the
necessity for a Marital Bypass Trust as Decedent's individual and
joint gross estate assets were no longer subject to Federal Estate
taxes.
8. Subsequent to the execution of the Decedent's Last Will and
Testament, Decedent's IRA with Merrill Lynch sustained significant
losses in value due to decline of the stock market and in the assets
comprising such IRA.
9. As a result of the 2001 Tax Act and the decline in the value
of the assets comprising such IRA, the creation of a Marital Bypass
Trust serves to defeat the purposes of the Marital Bypass Trust,
namely minimizing Federal Estate Taxes and allowing a trust for the
benefit of a surviving spouse.
10. In addition, establishment and creation of a Marital Bypass
Trust as directed by Paragraph 2 of the Decedent's Last Will and
Testament would:
a. Inflict unnecessary annual accounting costs for
trust administration and income tax consequences upon distri-
butions therefrom; and
b. Inflict unnecessary practical and liability
burdens upon the Trustee's and the surviving spouse who do
not wish to administer a trust in light of the trust limita-
tions and the current value of such IRA; and
c. Inflict unnecessary costs associated with the
employment of experts to assist with performing the fiduciary
responsibilities associated with Trust administration; and
c. Limit the ability of the surviving spouse to
perform proper estate planning considerations and opportuni-
ties associated therewith; and
d. Impose an inheritance tax of several thousand
dollars upon the Estate, recognizing the life estate inter-
ests of the surviving spouse and remainder interests to the
issue of the decedent; and
e. Thwart the intended purposes of the decedent by
3
leaving less estate assets for his intended beneficiaries.
11. No adverse impact will be imposed upon any named benefi-
ciary as a result of the termination of the Marital Bypass Trust
and extinguishment of any beneficial interests created thereby.
12. Termination of the trust is not intended to nor will
materially prejudice the rights of any creditor of a named benefi-
ciary of the Trust or Estate.
13. Termination of the Marital Bypass Trust is consistent
with paragraph 10 of the Decedent's Last Will and Testament as the
decedent specified that the purpose of the Will was to obtain a
marital deduction for Federal Estate tax purpose, an impossibility
in light of the 2001 Tax amendments and the decline of the value
of Decedent's IRA.
14. All named beneficiaries of the Marital Bypass Trust
created by Paragraph 2 of the Decedent's Last Will and Testament
have disclaimed their interests under said Trust and as created in
the Decedent's Last Will and Testament as evidenced by their
disclaimers docketed to the above-captioned matter and as attached
hereto as Exhibit "A".
15. All named beneficiaries of the Marital Bypass Trust
created by Paragraph 2 of the Decedent's Last Will and Testament
hereby consent to termination of the Marital Bypass Trust as
evidenced by their consents hereto attached as Exhibit "B".
16. The natural parents of all non-vested minor beneficia-
ries have consented to termination of said trust as evidenced by
their consents and disclaimers executed on behalf of the minor
beneficiaries recognized therein, all as attached hereto as Exhib-
it "C".
WHEREFORE, Petitioners respectfully request that this Honor-
able Court enter an Order of Court terminating said Marital Bypass
Trust as established by Paragraph 2 of the Decedent's Last Will
and Testament, and further extinguishing any rights of named,
vested or unvested, beneficiaries therein.
February ~"/, 2004
Respectfully submitted,
Attorney for Petitioners
127 South Market Street
P.O. Box 95
Mechanicsburg, PA 17055
(717) 697-7050
(717) 697-7065 (fax)
VERIFICATION
I, Mary Ellen Werner, Executrix verify that the statements
made in the foregoing Petition are true and correct to the best of
my knowledge, information and belief.
Date: February,), 2004
Mary 5xl~n~.~~, Executrix
EXHIBIT "A"
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, KIM L. DIEHL, the undersigned, of 1702 North Main
Street, Bethlehem, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russell T.
Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Ru00oll T. Worn0r
Disclaimer of Kim L. Diehl
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this~i
day of JOufA , 2004.
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kim L. Diehl, known to me
(or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, Kristin A. Diehl, the undersigned, of 1702 North Main
Street, Bethlehem, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament oX Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed t his%t
day of~~. , 20i~
Krlstln A. DJ ;hl
(SEAL)
STATE OF PENNSYLVANIA :
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kristin A. Diehl, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, SUSAN D. HUMPHREY, the undersigned, of 220 John Glenn
Avenue, Reading, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russell T.
Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania,s laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Susan D. Humphrey
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this 3OT~day of ~~
, 2004.
STATE OF PENNSYLVANIA :
:
COUNTY OF :
Susan D. Humphrey
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Susan D. Humphrey, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
seal. IN WITNESS WHEREOF, I have hereunto set my hand and official
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, RUSSELL T. WERNER, JR., the undersigned, of 1779
Spring Willow Drive, Mechanicsburg, Pennsylvania, a designated
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and contingent residual
beneficiary as named in the Last Will and Testament of Dr. Russell
T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russell T.
Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this day of , 2004.
Russell T. Werner, Jr./'~
SEAL )
STATE OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
On this, the~ay of ~~c~/ , 2004, before me, the
undersigned officer, personally appeared Russell T. Werner, Jr.,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
seal.
IN WITNESS WHEREOF, I have hereunto set my hand and official
tary Public
My Commission Expire~.
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATF,
I, DIANNE T. BASSETTI, the undersigned, of 30 Flint Ridge
Drive, Shillington, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russell T.
Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Dianne T. Bassetti
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this 31 day of ~O~%QO~
, 2004.
Dianne T. Bassetti
(SEAL)
STATE OF PENNSYLVANIA
COUNTY OF
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Dianne T. Bassetti, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, Dea N. Bassetti, the undersigned, of 30 Flint Ridge
Drive, Shillington, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this
day of '~-0~(3~9~'~..'~' , 2004.
Dea N. Bassetti
(SEAL)
STATE OF PENNSYLVANIA
COUNTY OF
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Dea N. Bassetti, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, Michael T. Bassetti, the undersigned, of 30 Flint
Ridge Drive, Shillington, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this -~/ day of
~~~ , 2004.
Michael T~. Bassetti
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Michael T. Bassetti,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, KELLY L. ADAMS, the undersigned, of 2316 Abbey Lane,
Harrisburg, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a beneficiary in the Estate of Dr.
Russell T. Werner as a result of the creation of a
marital bypass trust under the terms of the Last Will
and Testament of Dr. Russell T. Werner and further that
I am a contingent residual beneficiary under the terms
of the Last Will and Testament of Dr. Russell T.
Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Kelly L. Adams
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this2"~
STATE OF PENNSYLVANIA :
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kelly L. Adams, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER AND RENUNCIATION OF INTEREST IN ESTATE
I, Kady L. Adams, the undersigned, of 1702 North Main
Street, Bethlehem, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of-the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
in the Estate of Dr. Russell T. Werner as a result of
the creation of a marital bypass trust under the terms
of the Last Will and Testament of Dr. Russell T. Werner
and further that I am a contingent, non-vested residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amende___ d, or
any other law, without further hearing or notice; and
Estate of Russell T. WQrn~r
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
day of , 2004.
Kady L. -
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kady L. Adams, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
EXHIBIT "B"
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Kelly L. Adams, the undersigned, a designated
beneficiary in the above-captioned Estate as created by the Last
Will and Testament of Dr. Russell T. Werner, hereby consent to the
termination of a marital bypass trust created therein, and waive
any of my interests or rights thereunder without further notice or
hearing.
of 04.
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kelly L. Adams, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Kady L. Adams, the undersigned, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation.of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby consent to the termination of said
marital bypass trust and waive any of my interests or rights
thereunder without further notice or hearing.
Executed this
day of ~~'- , 2004.
Kady n. A~ams
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kady L. Adams, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Susan D. Humphrey, the undersigned, a designated
beneficiary in the above-captioned Estate as created by the Last
Will and Testament of Dr. Russell T. Werner, hereby consent to the
termination of a marital bypass trust created therein, and waive
any of my interests or rights thereunder without further notice or
hearing.
Executed this ~0 day of ~~
, 2004.
S~san D. Humphrey
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Susan D. Humphrey, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Kim L. Diehl, the undersigned, a designated beneficiary
in the above-captioned Estate as created by the Last Will and
Testament of Dr. Russell T. Werner, hereby consent to the
termination of a marital bypass trust created therein, and waive
any of my interests or rights thereunder without further notice or
hearing.
Executed this~ (
day of ~]~l~ , 2004.
kim L. Diehl '--
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Klm L. Diehl, known to me
(or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Russell T. Werner, Jr., the undersigned, a designated
beneficiary in the above-captioned Estate and Co-Trustee of a
marital bypass trust as created by the Last Will and Testament of
Dr. Russell T. Werner, hereby consent to the termination of said
marital bypass trust and waive any of my interests or rights
thereunder without further notice or hearing.
Executed this ~ ~
day of ~Cil~WL , 2004.
R · Werner, Jr.
( SEAL )
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
On this, the L~
day of ~nuOC7 , 2004, before me, the
undersigned officer, personally appeared Russell T. Werner, Jr.,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
seal.
IN WITNESS WHEREOF, I have hereunto set my hand and official
No{a~y Public- ~--~
My Commission ExplTes:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Kristin A. Diehl, the undersigned, a contingent, non-
vested beneficiary in the above-captioned Estate as a result of
the creation of a marital bypass trust and a contingent, non-
vested residual beneficiary as named in the Last Will and
Testament of Dr. Russell T. Werner, hereby consent to the
termination of said marital bypass trust and waive any of my
interests or rights thereunder without further notice or hearing.
Executed this~
day of
)~C. , 2 0 0 4.,.--"'----~
I<r±s~:±'l~ A. Diehl
( SEAL )
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kristin A. Diehl, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Dianne T. Bassetti, the undersigned, a designated
beneficiary in the above-captioned Estate and Co-Trustee of a
marital bypass trust as created by the Last Will and Testament of
Dr. Russell T. Werner, hereby consent to the termination of said
marital bypass trust and waive any of my interests or rights
thereunder without further notice or hearing.
Executed this 3i day of ~Qf~, 2004.
Dlanne T. Bassetti
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Dianne T. Bassetti, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Michael T. Bassetti, the undersigned, a contingent, non-
vested beneficiary in the above-captioned Estate as a result of
the creation of a marital bypass trust and a contingent, non-
vested residual beneficiary as named in the Last Will and
Testament of Dr. Russell T. Werner, hereby consent to the
termination of said marital bypass trust and waive any of my
interests or rights thereunder without further notice or hearing.
Executed this 31 day of ~O~c~ , 2004.
Michael T.~./Bassetti
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Michael T. Bassetti,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE TRUST
I, Dea N. Bassetti, the undersigned, a contingent, non-
vested beneficiary in the above-captioned Estate as a result of
the creation of a marital bypass trust and a contingent, non-
vested residual beneficiary as named in the Last Will and
Testament of Dr. Russell T. Werner, hereby consent to the
termination of said marital bypass trust and waive any of my
interests or rights thereunder without further notice or hearing.
Executed this ~/ day of ~~
, 2004.
~ea N. Bassetti
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Dea N. Bassetti, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
EXHIBIT "C"
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREIN
We, Kelly L. Adams and Jon R. Adams, the natural parents of
Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James Adams (D.O.B.
09/10/93), minor grandchildren of the Decedent, hereby affirm and
acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Jessica Rae Adams
(D.O.B. 07/12/87) and Samuel James Adams (D.O.B.
09/10/93) are a non-vested, contingent beneficiaries in
the Estate of Dr. Russell T. Werner as a result of the
creation of a marital bypass trust, and, further that
the Jessica Rae Adams (D.O.B. 07/12/87) and Samuel
James Adams (D.O.B. 09/10/93) are non-vested contingent
residual beneficiaries under the terms of the Last Will
and Testament of Dr. Russell T. Werner; and
C. We acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93) to request and receive more
specific information concerning the value of all assets
titled solely or jointly in the name of Dr. Russell T.
Werner, including but not limited to the above-
described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Jessica Rae Adams (D.O.B. 07/12/87) and
Samuel James Adams (D.O.B. 09/10/93), either as a non-
vested, contingent beneficiaries as a result of the
creation of the marital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last Will and Testament of Dr.
Russell T. Werner, without further hearing or notice;
and
Estate of Russell T. Werner
Disclaimer of Jessica Rae Adams
and Samuel James Adams
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93) under Pennsylvania's laws of
intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.C.S.A. Section 2101, et
seq, as amended, or any other law, without further hearing
or notice; and
G. Jessica Rae Adams (D.O.B. 07/12/87) and
Samuel James Adams (D.O.B. 09/10/93) have not received
any direct or indirect interest from the Estate of Dr.
Russell T. Werner prior to execution of this written
Disclaimer and renunciation on their behalf; and
H. This Disclaimer, executed on behalf
Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93), has been not executed for the
purpose of materially prejudicing the rights of any
creditors, heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Jessica Rae Adams (D.O.B.
07/12/87) and Samuel James Adams (D.O.B. 09/10/93) in
the Estate of Dr. Russell T. Werner, Jr. may be
submitted to the Court of Common Pleas of Cumberland
County and filed as part of a Joint Petition to
Terminate Marital Bypass Trust, and we further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
our choosing and that we are completely satisfied with
the terms herein.
Executed this~~ day of 004.
. Adams ~
STATE OF PENNSYLVANIA :
:
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kelly L. Adams and Jon R.
Adams, known to me (or satisfactorily proven) to be the persons
whose names are subscribed to the within instrument and
acknowledged that they executed the same for the purpose therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
~NTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREI:~
I, Susan D. Humphrey, the mother and guardian of Amanda
Ashley Humphrey (D.O.B. 10/19/87) and Alexander James Humphrey
(D.O.B. 04/24/90), minor grandchildren of the Decedent hereby
affirm and acknowledge that: '
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I acknowledge that Amanda Ashley Humphrey
(D.O.B. 10/19/87) and Alexander James Humphrey (D.O.B.
04/24/90) are a non-vested, contingent beneficiaries in
the Estate of Dr. Russell T. Werner as a result of the
creation of a marital bypass trust, and, further that
the Jessica Rae Adams (D.O.B. 07/12/87) and Samuel
James Adams (D.O.B. 09/10/93) are non-vested contingent
residual beneficiaries under the terms of the Last Will
and Testament of Dr. Russell T. Werner; and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive the non-vested, contingent rights
of Amanda Ashley Humphrey (D.O.B. 10/19/87) and
Alexander James Humphrey (D.O.B. 04/24/90) to request
and receive more specific information concerning the
value of all assets titled solely or jointly in the
name of Dr. Russell T. Werner, including but not
limited to the above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on
behalf of Amanda Ashley Humphrey (D.O.B. 10/19/87) and
Alexander James Humphrey (D.O.B. 04/24/90), either as a
non-vested, contingent beneficiaries as a result of the
creation of the marital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last Will and Testament of Dr.
Russell T. Werner, without further hearing or notice;
and
Estate of Russell T. Werner
Disclaimer of Amanda Ashley Humphrey
Alexander James Humphrey
Page 2
F. I hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Amanda Ashley Humphrey (D.O.B. 10/19/87) and Alexander
James Humphrey (D.O.B. 04/24/90) under Pennsylvania's laws
of intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.C.S.A. Section 2101, et
seq, as amended, or any other law, without further hearing
or notice; and
G. Amanda Ashley Humphrey (D.O.B. 10/19/87)
and Alexander James Humphrey (D.O.B. 04/24/90) have not
received any direct or indirect interest from the
Estate of Dr. Russell T. Werner prior to execution of
this written Disclaimer and renunciation on their
behalf; and
H. This Disclaimer, executed on behalf Amanda
Ashley Humphrey (D.O.B. 10/19/87) and Alexander James
Humphrey (D.O.B. 04/24/90), has been not executed for
the purpose of materially prejudicing the rights of any
creditors, heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. I understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Amanda Ashley Humphrey (D.O.B.
10/19/87) and Alexander James Humphrey (D.O.B.
04/24/90) in the Estate of Dr.Russell T. Werner, Jr.
may be submitted to the Court of Common Pleas of
Cumberland County and filed as part of a Joint Petition
to Terminate Marital Bypass Trust, and I further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
our choosing and I am completely satisfied with the
terms herein.
Executed this ~0 day of ~~ , 2004.
Su~an D. Humphrey'
SEAL )
2
STATE OF PENNSYLVANIA :
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Susan D. Humphrey, known
to me (or satisfactorily proven) to be the person whose names is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
seal. IN WITNESS WHEREOF, I have hereunto set my hand and official
Notary Public
3
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREIN
We, Kim L. Diehl and Daryl Diehl, the natural parents of
Lauren Elizabeth Diehl (D.O.B. 01/04/88), a minor grandchild of
the Decedent, hereby affirm and acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Lauren Elizabeth Diehl
(D.O.B. 01/04/88) is a non-vested, contingent
beneficiary in the Estate of Dr. Russell T. Werner as a
result of the creation of a marital bypass trust, and,
further that the Lauren Elizabeth Diehl (D.O.B.
01/04/88) is a non-vested contingent residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. We acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Lauren Elizabeth Diehl (D.O.B. 01/04/88) to request
and receive more specific information concerning the
value of all assets titled solely or jointly in the
n~me of Dr. Russell T. Werner, including but not
I~ited to the above-described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Lauren Elizabeth Diehl (D.O.B. 01/04/88),
either as a non-vested, contingent beneficiary as a
result of the creation of the marital bypass trust
therein or as a non-vested, contingent residual
beneficiary as established by the Last Will and
Testament of Dr. Russell T. Werner, without further
hearing or notice; and
E~tatQ of Russell T. Werner
Disclaimer of Lauren Elizabeth Diehl
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Lauren Elizabeth Diehl (D.O.B. 01/04/88) under
Pennsylvania's laws of intestacy, including but not
limited to any rights, entitlement or interest afforded in
the Estate of Dr. Russell T. Werner granted by 20
Pa.C.S.A. Section 2101, et seq, as amended, or any other
law, without further hearing or notice; and
G. Lauren Elizabeth Diehl (D.O.B. 01/04/88)
has not received any direct or indirect interest from
the Estate of Dr. Russell T. Werner prior to execution
of this written Disclaimer and renunciation on her
behalf; and
H. This Disclaimer, executed on behalf Lauren
Elizabeth Diehl (D.O.B. 01/04/88), has been not
executed for the purpose of materially prejudicing the
rights of any creditors, heirs or beneficiaries of the
decedent or the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Lauren Elizabeth Diehl (D.O.B.
01/04/88) in the Estate of Dr. Russell T. Werner, Jr.
may be submitted to the Court of Common Pleas of
Cumberland County and filed as part of a Joint Petition
to Terminate Marital Bypass Trust, and we further
hereby waive formal notice of any future hearing
concerning termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that we are completely satisfied with
the terms herein.
Executed this ~ ~ day of ~/~, , 2004.
Dary)l~. eh'~ -
(SEAL)
(SEAL)
STATE OF PENNSYLVANIA :
COUNTY OF :
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Klm L. Diehl and Daryl
Diehl, known to me (or satisfactorily proven) to be the persons
whose names are subscribed to the within instrument and
acknowledged that they executed the same for the purpose therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
~ONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST ANI~
DISCLAIMER OF MINOR'S BENEFICI&L INTEREST THEREI!
We, Russell T. Werner, Jr. and Constance j. Werner, the
natural parents of Veronica Rose Werner (D.O.B. 04/25/98) and
Reagan Rope Werner (D.O.B. 07/28/00), minor grandchildren of the
Decedent, hereby affirm and acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Veronica Rose Werner
(D.O.B. 04/25/98) and Reagan Hope Werner (D.O.B.
07/28/00) are a non-vested, contingent beneficiaries in
the Estate of Dr. Russell T. Werner as a result of the
creation of a marital bypass trust, and, further that
the Veronica Rose Werner (D.O.B. 04/25/98) and Reagan
Hope Werner (D.O.B. 07/28/00) are non-vested contingent
residual beneficiaries under the terms of the Last Will
and Testament of Dr. Russell T. Werner; and
C. We acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Veronica Rose Werner (D.O.B. 04/25/98) and Reagan
Hope Werner (D.O.B. 07/28/00) to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Veronica Rose Werner (D.O.B. 04/25/98) and
Reagan Hope Werner (D.O.B. 07/28/00), either as a non-
vested, contingent beneficiaries as a result of the
creation of the marital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last Will and Testament of Dr.
Russell T. Werner, without further hearing or notice;
and
Estate of Russell T. Werner
Disclaimer of Veronica Rose Werner
and Reagan Hope Werner
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Veronica Rose Werner (D.O.B. 04/25/98) and Reagan Hope
Werner (D.O.B. 07/28/00) under Pennsylvania's laws of
intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.C.S.A. Section 2101, e~t
seq, as amended, or any other law, without further hearing
or notice; and
G. Veronica Rose Werner (D.O.B. 04/25/98) and
Reagan Hope Werner (D.O.B. 07/28/00) have not received
any direct or indirect interest from the Estate of Dr.
Russell T. Werner prior to execution of this written
Disclaimer and renunciation on their behalf; and
H. This Disclaimer, executed on behalf
Veronica Rose Werner (D.O.B. 04/25/98) and Reagan Hope
Werner (D.O.B. 07/28/00), has been not executed for the
purpose of materially prejudicing the rights of any
creditors, heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Veronica Rose Werner (D.O.B.
04/25/98) and Reagan Hope Werner (D.O.B. 07/28/00) in
the Estate of Dr. Russell T. Werner, Jr. may be
submitted to the Court of Common Pleas of Cumberland
County and filed as part of a Joint Petition to
Terminate Marital Bypass Trust, and we further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
our choosing and that we are completely satisfied with
the terms herein.
Executed this ~'~'/~a
y of ~ , 2004.
Russell T. Werner, j~.
Constance J.'~erner
(SEAL)
(SEAL)
STATE OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS.
On this, the~day of ~~C~ , 2004, before me, the
undersigned officer, personally appeared Russell T. Werner, Jr.
and Constance J. Werner, known to me (or satisfactorily proven) to
be the persons whose names are subscribed to the within instrument
and acknowledged that they executed the same for the purpose
therein contained.
seal.
IN WITNESS WHEREOF, I have hereunto set my hand and official
otary Publi~ L/
3
~ r ' ' ~ COMMONWEALTH OF
~ PENNSYLVANIA
~~~:~m. DEPARTMENT OF REVENUE
¢'~'~',~,~ ~ DEPT. 280601
'~~,~-~ HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
COUNTY CODE YEA~
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z Werner, Russell T. Dr. 162- - 28 - 5106
iii DATE OF DEATH (MM-DD-YEAR) DATE OF 81RTH (MM-DD-YEAR)
~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
U.I 06/02/03 O4/17/32 REGISTER OF WILLS
U.I
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Mary Ellen Werner
[~--~ 1. Original Return
r-'-] 4, Limited Estate
[~6. Decedent Died Testate (Aftach copy of Will)
~---"~ 9. Litigation Proceeds Received
NAME
Andrew C. Sheely,
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717-697-7050
[~]2. Supplemental Return L_J 31 Remainder Return (date of death prior to 12-13-82)
['-'-] 4a. Future interest Compromise (Mate of death after 12-12-82) [~ 5. Federal Estate Tax Return Required
[~7. Decedent Maintained a Living Trust (A~ach copy of Trust) 8. Total Number of Safe Deposit Boxes
[~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~--~ 11. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
Attorney
Andrew C. Sheely, Attorney
127 S. Market Street, P.O. Box 95
Mechanicsburg, PA 17055
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[---1 Separete Billing Requested
7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
151,336.00
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
OFFICIAL USE ONLY
.~c ('~
Co O
(8)
(11)
(12)
(13)
151,336.00
(14)
15.
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Amount of Line 14 taxable at the spousal tax 1 5 1,3 3 6.0 0
rate, or transfers under Sec. 9116 (a)(1.2)
x .00 (15)
0.00
0.00
16. Amount of Line 14 taxable at lineal rate x .0 __ (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
FILE NUMBER 2 1 - 0 3 - 0 6 17
ESTATE OF
DR. ItUSSELI~ T. WER~ER
~leted and filed if the answer to any of questions 1 throu§h 4 on the reverse side of the REV-1500 COVER SHEET is yes.
-~ % OF
~ DESCRIPTION OF PROPER~
INCLU~ THE NAME OF T~ T~N~E~E, T~IR RE~T~SHIP'rO DECEDENT A~ T~ DATE OF T~ER. DATE OF DEATH )ECD'S EXCLUSION TAXABLE VALUE
ITEM ATT~ A C~ OF THE DEED FOR ~ ESTATE. VALUE OF AS~T iNTEREST ~~
NUMBER
1.
Z. ~e~i1 ~y~ch-ZR~ Account ~898-83902 ~5Z,336.0C
[5[~336.00
TOTAL (Also enter on line 7, Recapitul~m) $
(If more space is needed, insert additional sheets of the same size)
Prtvate Client Group
96 South George Street
York, Pennsylvania 17401
717 843 0011
800 937 0638 Toll Free
FAX 717 771 0026
Merrill Lynch
Andrew C. Sheely
Attorney at Law
127 South Market Street
P. O. Box 95
Mechanicsburg, PA 17055
Re: Estate of Dr. Russell T. Wemer
Dear Mr. Sheely:
Regarding your letter dated September 16, 2003 requesting date of death values for the
Estate of Dr. Russell T. Wemer. I have enclosed the values of the accounts on June 2"d,
2003.
898-83902
Dr. Russell T. Wemer Sr. IRA
800 General Electric $23,200
500 J P Morgan Chase 16,960
1813.942 Pioneer High Yld 20,044
2632.294 Pimco Pea Growth 37,246
1263 Pimco Total Return 13,905
3233.810 Pimco Pea Value Fd 39,290
691 ML Bank USA 691
Total
$151,336
898-67767 Dr. Russell T. Wemer Sr. and Mary Ellen Wemer JTWROS
44.1517
CNH Global NV
$376
Total
$376
If you have any questions regarding these values, don't hesitate to call. Thank you for
your time and consideration in this matter.
Sincerely,
Stacey Noll Fears
Registered Client Associate
~ am providing the above Information as you requeste~
The tnfonnatlon is provided as a service to you and
obtained ~om data we believe is accurate. Howevo~,
.......... ..~,,.,~,~,0 umlr mnnthlv statomonta
Imm, ~.~lu, ,,~,,,~.-,-, ......... ·
tO be the offlolal dooumentatlon of all transactions.
REV-1513 EX* (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
DR. RUSSELL T. WERNER 21-03-617
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
! TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Mary Ellen Werner
311 Candlelight Drive
Mechanicsburg, PA 17055
* Decedent's Last Will and Testament is attached hereto.
Decedent owned an IRA with Merrill Lynch which is
identified on Schedule G. The IRA was intended to fund a
marital bypass trust for the benefit of Decedent's spouse,
with balance to children upon death of spouse. All surviving
children and granchildren have disclaimed all testate and
intestate rights as indicated by the attached disclaimers,
and the trust as well as any minor's interest have been
terminated by Court Order dated February 24, 2004, a copy
of which is also attached hereto. Therefore, Mary Ellen
Werner, surviving spouse of the decedent, is the sole
beneficiary of the Estate of Dr. Russell T. Werner. These
matters were reviewed in advance of filing this return by J.
Paul Dibert, Pennsylvania Department of Revenue.
Spouse
1 OO%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
· ~ , - 5~1457.1 BRO:PAN 10108196, 10110196, 01/21/97
LAST WILL AND TESTAMENT
OF
DR. RUSSELL T. WERNER
I, DR. RUSSELL T. WERNER, presently residing in Berks
County, Pennsylvania, declare this to be my will, hereby revoking
all prior wills and codicils made by me.
1. Tanqible Personal Property. I give all my tangible
personal property, including my clothing, jewelry, personal
effects, household goods, furniture and furnishings, and
automobiles, together with any insurance policies thereon, to my
wife, MARY ELLEN WERNER (hereinafter "Mary Ellen"), provided she
survives me by at least thirty (30) days. If Mary Ellen does not
survive me by at least thirty (30) days, I do then give all my
tangible personal property in shares as nearly equal as possible
to those children of mine who survive both Mary Ellen and me.
2. Bypass Trust.
a. If Mary Ellen survives me by at least thirty (30)
days, I give to Mary Ellen and my daughter, DIANNE T. BASSETTI,
and my son, RUSSELL T. WERNER, JR., Trustees, in trust, the
maximum amount which can pass free of federal estate tax in my
estate by reason of all credits available against such tax,
provided the use of the state death tax credit does not result in
an increase in state death taxes. For purposes of computing this
amount, the following shall be taken into account:
(i) Any other dispositions under my will;
~145,7.1 BRO:PAN 10108196, 10/10/96, 01121197
(ii) Any other property interests includable in my
gross estate for federal estate tax purposes which pass outside
of my will; and
(iii) All charges to principal that are not
deducted for purposes of computing the federal estate tax in my
estate.
b. The amount distributed to the Trustees under this
Paragraph 2 shall be held and administered as follows:
(i) Trustees shall pay to Mary Ellen the income
from the trust in convenient installments, but at least
quarter-annually;
(ii) Trustees shall be fully authorized to pay to
Mary Ellen such sums from the principal of the Trust, as they
deem, in their sole discretion, necessary for her health and
maintenance in accordance with her accustomed standard of living.
(iii) Mary Ellen is hereby given the general power
to appoint from the principal of the Trust to herself, during
each calendar year, amounts up to, but not exceeding, the greater
of Five Thousand Dollars ($5,000.00) or five percent (5%) of the
aggregate value of the Trust principal as determined at the end
of each calendar year. Such amounts may be appointed during each
calendar year by written directions signed by Mary Ellen setting
forth the amount to be paid. Mary Ellen may designate such
amounts at any time or from time to time during each calendar
year, and Trustees shall pay the amounts designated upon receipt
of the written directions. However, Trustees may, in their
-2-
~i14,57.1 BRO:PAN 10108196, 10/I0/96, 01/21/97
discretion, postpone payment of any or all amounts appointed in
excess of Five Thousand Dollars ($5,000.00) in any one calendar
year until a reasonable time after the close of such year in
order that they may determine that the amounts appointed are
within the limitation described in this subparagraph. This power
shall lapse at the end of each calendar year as to all amounts
which could have been appointed during that year, but with
respect to which no written directions are received by Trustees
during such year.
(iv) Upon the death of Mary Ellen, all remaining
amounts held in trust shall be distributed to my children, DIANNE
T. BASSETTI, KIM L. DIEHL, SUSAN D. HUMPHREY, KELLY L. ADAMS, and
RUSSELL T. WERNER, JR., in equal shares, provided that if any of
my children are not alive at the time of distribution, the share
attributable to the deceased child shall be distributed to his or
her then living issue, per stirpes, or failing such issue, to my
then living issue, per stirpes, subject to the provisions of
Paragraph 5.
3. Estate Equalization. If Mary Ellen survives me, but
fails to survive me by at least thirty (30) days, I give to her
assets having a value equal to the smallest amount necessary to
reduce the federal estate tax payable as a result of my death and
her death to the lowest possible figure. In calculating this
amount, all other property which qualifies for the marital
deduction and all other deductions and credits which are taken
and allowed in the calculation of the federal estate tax in my
-3-
~4~7.1 BRO:PAN 10/08/96, 10/10/96, 01/21/97
estate shall be considered first; however, credits shall be used
only to the extent that their use does not increase death taxes
on my estate.
4. Residuary Estate.
a. If Mary Ellen survives me by at least thirty (30)
days, I give the entire residue of my estate, both real and
personal, and wherever located, to her.
b. If Mary Ellen does not survive me by at least
thirty (30) days, I give the entire residue of my estate, not
otherwise distributed by the terms of Paragraph 3, to my
children, DIANNE T. BASSETTI, KIM L. DIEHL, SUSAN D. HUMPHREY,
KELLY L. ADAMS, and RUSSELL T. WERNER, JR., in equal shares,
provided that if any of my children are not alive at the time of
distribution, the share attributable to the deceased child shall
be distributed to his or her then living issue, per stirpes, or
failing such issue, to my then living issue, per stirpes, subject
to the provisions of Paragraph 5.
5. Minor's Trust.
a. Each share of my estate or a trust created
hereunder which is distributable to a beneficiary who has not
attained the age of eighteen (18) years shall be held by Trustees
in a separate trust according to the terms of this paragraph.
b. Trustees shall pay so much of the income and the
principal of the trust as they, in their sole discretion, deem
necessary for the maintenance, care, support and education of the
beneficiary. The term education as used herein shall include,
-4-
5~45,7.1 BRO:PAN 10108196, 10/10/96, 01/21/97
but not be limited to, all expenses associated with any
post-secondary undergraduate and graduate education and any
professional, technical or vocational training.
c. When the beneficiary attains the age of eighteen
(18) years, Trustees shall pay to the beneficiary the entire
principal and all accumulated income of the trust.
d. If the beneficiary dies before attaining the age
of eighteen (18) years, and is survived by issue, the entire
remaining balance of the trust principal and accumulated income
shall be distributed to his or her then living issue, per
stirpes, subject to the provisions of this paragraph. If the
beneficiary dies before attaining the age of eighteen (18) years
and is not survived by issue, the entire remaining balance of
principal and accumulated income shall be distributed in equal
shares to the beneficiary's surviving siblings, subject to the
provisions of this paragraph.
e. In the event more than one beneficiary is subject
to these trust provisions, Trustees shall administer each such
share attributable to said individuals as a separate trust and
shall in no event use the principal or income of such share for
the benefit of anyone other than the beneficiary thereof.
6. Fundinq Instructions.
a. Subject to the limitations contained in this
paragraph, my Executrix shall have the sole power and discretion
to distribute cash and/or property, real and personal, in
satisfaction of the gifts described in Paragraphs 2, 3 and 4.
-5-
~ , J14f7.1 BRO:PAN 10108196, 10110196, 01/21197
b. My Executrix, in making distributions wholly or
partly in property to satisfy the equalization gift described in
Paragraph 3 or the residuary gift described in Paragraph 4a.,
shall distribute assets, including cash, fairly representative,
on the date or dates of distribution, of appreciation or
depreciation in the value of all property available for
distribution.
c. To the extent possible, my Executrix shall not
allocate to the equalization gift described in Paragraph 3 or the
residuary gift described in Paragraph 4a. any asset or the
proceeds of any asset which does not qualify for the marital
deduction for federal estate tax purposes or with respect to
which any estate or death taxes are paid to any foreign country
or any of its possessions or subdivisions.
7. Payment of Taxes.
a. With the exceptions set forth in subparagraphs b.
and c., I direct that all inheritance, estate, transfer,
succession and death taxes, of any kind whatsoever (including any
interest and penalties thereon) which may be payable by reason of
my death, but only with respect to property passing under this
will, shall be paid out of the amount distributed to the Bypass
Trust under Paragraph 2, or, in the event the Bypass Trust is not
funded, out of the principal of my residuary estate. These taxes
shall not be prorated or apportioned among beneficiaries, but
shall be paid in the same manner as an administration expense.
b. Notwithstanding the provisions of subparagraph a.,
-6-
51457.1 BRO:PAN 10/08/96, 10/10/96, 01/21/97
my Executrix shall not:
(i) Pay any generation-skipping transfer tax
payable due to a taxable distribution or taxable termination
resulting from my death; or
(ii) Pay any inheritance tax resulting from the
trust created by the provisions of Paragraph 2 of the will of
Mary Ellen.
c. In the event Mary Ellen survives me, my Executrix
shall have the right to determine, in her sole discretion,
whether or not to pay inheritance tax on assets passing pursuant
to Paragraph 2 or defer payment until Mary Ellen's death.
8. Trustee Powers. In addition to the powers conferred by
the common law, by statute or by other provisions of this will,
Trustees are hereby empowered as follows:
a. To hold, manage, lease, care for, and protect the
trust estate and collect the income therefrom, all in accordance
with their best judgment and discretion, being fully authorized
to cause any securities or other property, real or personal,
belonging to the trust estate to be held or registered in their
name or in the name of their nominees or in such other form as
they deem best without disclosing the trust relationship.
b. To enter into any leases which may commence at the
time of making or on a future day and may be for any period of
time Trustees deem best, although extending beyond the term of
the trust.
C.
To continue to hold any property or securities
5145,7.1 BRO:PAN 10/08/96, 10/10/96, 01/21/97
originally received by them or at any time transferred to the
trust as part of the trust estate although not of a type or
quality or constituting a diversification considered proper for
trust investments, and Trustees shall not be liable in any way
for any loss resulting to the trust estate by reason of
continuing to hold any such securities or property.
d. To invest and reinvest the trust estate in bonds,
stocks, mortgages, notes, common trust funds, participations, or
other property of any kind, real or personal, irrespective of any
statutes or rules of law limiting the investment of trust funds.
e. To sell at public or private sale and convey any
and all of the trust property and any reinvestments thereof from
time to time for such price and upon such terms as they shall see
fit.
f. To contract for financial, investment advisory,
legal, accounting and other services for the trust estate.
g. To borrow money, to extend or renew any existing
indebtedness, and to mortgage or pledge any property in the trust
estate; and no purchaser or mortgagee shall be obliged to see to
the application of any purchase or mortgage money.
h. To vote, either in person or by general or limited
proxy, or refrain from voting any corporate securities for any
purpose.
i. To exercise or sell any subscription or conversion
rights and avail themselves of any options or benefits under any
life insurance policies.
-8-
5~45,7.1 BRO:PAN 10/08/96, 10/10/96, 01/21/97
j. To join in any voting trusts, reorganizations,
consolidations, mergers, foreclosures, and liquidations, and in
connection therewith, deposit securities with or under the
direction of any protective committee under such terms as they
may deem advisable and accept and hold any securities or other
property received through the exercise of any of the foregoing
powers.
k. To settle, compromise, contest, prosecute or
abandon claims in favor of or against the trust estate as they
may deem advisable, and for such purposes they may execute and
deliver all proper and necessary instruments and may give full
receipt and discharges.
1. To determine, in accordance with applicable
statues and rules of law, how all receipts and disbursements,
including Trustees' compensation, shall be credited, charged, or
apportioned as between income and principal, and their decision
shall be final and not subject to question by any beneficiary of
the trust.
m. Subject to the provisions of Paragraph 5, to
divide or distribute the trust property in undivided interests or
in kind, or partly in cash and partly in kind, and to sell such
property as they may deem advisable for the purpose of making
division or distribution, and the judgment of the Trustees as to
values for the purpose of such division or distribution shall be
binding and conclusive upon all persons.
9. Powers of Personal Representative. In addition to the
-9-
' 5~45,7.1 BRO:PAN 10108196, 10/10/96, 01/2119'7
powers conferred upon my Executrix by law, my Executrix shall be
authorized to:
a. In her sole discretion, claim items of deduction
in either the fiduciary income tax returns or the federal estate
tax return for my estate and to exercise any other options,
elections or allocations in determining and paying death taxes in
my estate, as she deems appropriate, including, but not limited
to, the allocation of all available exemptions provided under the
federal generation-skipping transfer tax to property in my
estate.
b. File a joint income tax return with Mary Ellen for
my last taxable period without requiring Mary Ellen to indemnify
my estate against liability to it for tax attributable to her
income.
c. Consent to have any~'gifts made by Mary Ellen
during my lifetime treated as made one-half by me for gift tax
purposes.
The decisions of my Executrix in the above matters shall
not require the consent of any beneficiaries of my estate, nor
shall such decisions be subject to question by any person or
beneficiary whatsoever.
10. Limitation of Powers. It is my intention to secure (to
the extent specified in this will) the marital deduction for the
equalization gift described in Paragraph 3 or the residuary gift
described in Paragraph 4 for federal estate tax purposes and,
therefore, Trustees and my Executrix are directed to exercise all
-10-
51~45q.1 BRO:PAN 10108196, 10/10/96, 01121197
powers conferred by law and in this will only in such a manner as
will qualify the assets funding such devise and bequest for such
deduction.
11. Accounting. The Trustees of the trusts created
hereunder shall provide the adult beneficiary or beneficiaries
then entitled to income from the trust estate with statements of
account of their receipts and disbursements as Trustees at least
semi-annually.
12. Resignation of Trustee.
a. Any Trustee acting hereunder may resign at any
time by thirty (30) days written notice to the remaining Trustee
or Trustees, or, if none, to the beneficiary or beneficiaries
then entitled to the income from the Trust. If any income
beneficiary is under a legal disability, including minority, the
notice for such beneficiary shall be delivered to his or her
parent or guardian, as the case may be.
b. In the event of the resignation, refusal, or
inability to act of a Trustee hereunder, the remaining Trustee or
Trustees, or, if none, the beneficiary or majority in interest of
the beneficiaries then entitled to the income from the Trust may
appoint a successor Trustee to occupy the vacated position. If
any income beneficiary is under a legal disability, his or her
parent or guardian may act on his or her behalf in appointing a
successor Trustee.
c. In no event may Mary Ellen act as sole Trustee;
there shall always be a Trustee serving with her.
-11-
· 51'45,7.1 BRO:PAN 10108196, 10110196, 01121197
d. Any successor Trustee shall be clothed and vested
with all duties, rights, title and powers, whether discretionary
or otherwise, as if originally named as Trustee. No successor
Trustee shall be liable or responsible in any way for any acts or
defaults of any predecessor Trustee, nor for any loss or expense
from or occasioned by anything done or neglected to be done by
any predecessor Trustee, but such successor Trustee shall be
liable only for his, her or its own acts and defaults in respect
to property actually received by him, her or it as such Trustee;
and with the consent of the person or persons making the
designation of such successor Trustee, the successor Trustee may
accept the account rendered and the assets and property delivered
to him, her, or it by the predecessor Trustee, and shall incur no
liability or responsibility to any beneficiary under this my Last
Will and Testament by reason thereof.
13. Bond. No fiduciary acting hereunder shall be required
to post bond or give security in any jurisdiction for the
faithful performance of his, her or its duties.
14. Spendthrift Provision. The interests of all
beneficiaries in my estate and in any trust created by this will
shall not be subject to the claims of their creditors or others
or to legal process and may not be voluntarily or involuntarily
alienated or encumbered.
15. Personal Representative. I appoint Mary Ellen
Executrix of this will; provided, however, that if she is unable
or unwilling to act in such capacity, I appoint my daughter,
-12-
~1,457.1 BRO:PAN I0/08196, 10/10/96, 01/21197
DIANNE T. BASSETTI, and my son, RUSSELL T. WERNER, JR., Executors
in her place and stead.
IN WITNESS WHEREOF, I hereunto set my hand and seal this
~3 day of March, 1997.
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named
DR. RUSSELL T. WERNER, as and for his Last Will and Testament, in
the presence of us, who at his request, and in his presence, and
in the presence of each other, have hereunto subscribed our names
as witnesses thereto.
-13-
.5,1457.1 BRO:PAN 10/08/96, I0/10/96, 01/21/97
COMMONWEALTH OF PENNSYLVANIA:
:
COUNTY OF BERKS :
SS.
I, DR. RUSSELL T. WERNER, Testator, whose name is signed to
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
DR. RUSSELL T. WERNER, Testator
Sworn or affirmed to and acknowledged before me, by DR.
RUSSELL T. WERNER, the Testator, this ~$~ day of March, 1997.
Notary Pub l~i~ ~/ -~'
i i~,.aCmg, l:.er!:s Co., PA
· , ' 5'1457.1 BRO:PAN 10108196, 10/I0/96, 01/21197
COMMONWEALTH OF PENNSYLVANIA:
:
COUNTY OF BERKS :
SS.
witnesses whose names are signed to the ~ttached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw Testator, DR. RUSSELL T. WERNER,
sign and execute the instrument as his Last Will; that he signed
willingly and that he executed it as his free and voluntary act
for the purposes therein expressed; that each of us in the
hearing and sight of the Testator signed the Will as witnesses;
and that to the best of our knowledge the Testator was at that
time 18 or more years of age, of sound mind and under no
constraint or undue influence.
Witness
Sworn or affirmed to and subscribed to before me by
/~/~/~'7~; ~., ~L"C ~ and
witnesses, this ~ ~ , day of March, 1997~?
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 06~7
MARY ELLEN WERN~.R, EXECUTRIX
~ISCLAIME~ AND ~I~UNCIATION OF ~~
I, DIANNE T. BASSETTI, the undersigned, of 30 Flint Ridge
Drive, Shillington, Pennsylvania, a designated beneficiary in the
above-Captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T Werner, hereby affirm
and acknowledge that .. '
O ~ · ~A I have received and '
-- Lao~._Wi ~:~ reviewed a copy of the
!~ ~..~,~and Testament of Dr. Russell T. Werner as
~:.~:~ pr =te~.~ record in the above-captioned Estate; and
~.~ ......~4 ii~{i"]'i:?~. I am a beneficiary in the Estate of Dr.
.... Werner as a result of the creatlo
u:l. ~arltal '~'~ass t ............ ' n of a
u~ ~ '..~ ~u~u unoer t~e terms of the
an es ': ~nt of Dr. Last Will
~.l: ~ .... Russell T. Wet
':~' I a ~ingent resid =~ ~-~-. her an~ further that
u~ ~amulary un,er the terms
of the Last Will and Testament of Dr Russell T.
Werner; and '
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania,s laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by Z0 Pa.C.S.A. Section 2101, et. se~, s~, or
any other law, without further hearing or notice; and
Es a e of Russell erner
Disclaimer of Dianne T. Bassetti
Page 2
G. I have not received any direct or indirect
interest from the Estate of D
to executio . . . . r~ Rusmell T. Werner prior
n of th~s written Dimclai~er and
renunciation; and
material1 ~'re I have ~ot executed for the
~_~__ ~ P Judicing the r~-~ .... purpose of
~=~s or beneficiaries ~ ~,=~ om_~ny creditors
beneficiaries; and o~ ~..= uecedenc, ~Yself or Ay
I. I have had the opportunity or have
reviewed the terms 'of this Disclaimer with Counsel of
my choosing and that I am co~oletely satisfied wi~h the
terms herein.
, 2004.
STATE OF P~NNSYLVANIA
COUNTy OF
u~.anne T. Bas set~ ..... -~' (SEAL)
SS.
On this, the day of , 2004, before
undersigned officer, persona
to. me (or sat lly appeared D' me, the
· isfactoril aanne T. ~as
subscribed to the ..-~ ~ro~e~) to be the ~er~ .... settl, know~
executed ~ ____ ~"~ ~nstrument and a~= -~,, wno~? name is
t.,~ ~ ~or t~e P~rDose ~ .... ~nowledged ~nat she
=- ~-~z~ln contained.
seal. IN WITNESS WHEREOF, I have hereunto set ~y hand and official
My Commission Expires~
ESTATE OF DE. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN W~,RNER, EXECUTRIX
I, SUSAN D. HUMPHR~E, the undersigned, of 220 John Glenn
Avenue, Reading, Pennsylvania, a designated beneficlar in t
above-captioned Estate as a reo,,~ -~ ~ . '. Y ' he
~ u~ =ne creation oi a marital
bypass tr~st and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werne
a~ ackn .~ed~m~(that: r, hereby affir~
~?:,~ ~ ::D ~. I have r~eived and rev
::~ .=Las Wil ~" _ _ ie~d a copy of the
~~ [~[~ record in eh~ ~ .... - ...... - .... ~ ~
..... r:. - ..... -~v= uaptloned ~state; and
:. ~:~::~,. ,::.::, ~. I am a beneficiary in the ~stat~ of Dr.
~:~;,~:?Rus~ll ~'~rner as a result of the creation of a
~:?: maria1 ~ss trust under the terms of the Last Will
and Test~nt of Dr. ~ussell T. Werner and further that
I ~ a contingent residual beneficiary under the ter~
of ~he Last Will and Test~ent of Dr. RuSsell T.
Werner ~ and
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898~83902
titled in the name of Dr. Russell T. Werner; and
D. I waive ~y right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the na~e of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
P. I hereby fully and completely disclaim
any interest in the Estate of.Dr. Russell T. Werner
under Pennsylvania,s laws of ~ntestacy, including but
not li~%ited to any rights, entitlement or interest
afforded in the Estate of Dr. RuSsell T. Werner granted
by 20 Pa.c.S.A. Section 2101, ~k~, a_~~, or
any other law, without further hearing or notice; and
~St&~e Of Russell T. Werner
Disclaimer o~ Susan D. ~umphrey
Page 2
G. I have not reCeived any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
tO execution of this wr±t~e~ Disclaimer and
renu~ciation~ and
H. I have not executed for the Purpose of
materially prejudicing the r~ghts of any creditors,
heirs or beneficiaries of the decedent, mYself or my
beneficiaries~ and
reviewed t~ I have had the opportunity or have
terms of this Disclaimer with Counsel of
my uhoosing and that I am completely satisfied with the
ter~m herein.
, 2004.
STATE OF PENNSYLVANIA
COUNTy O~
On this, ~he. day of , 2004, before me, the
undersigned officer, personally appeared Susan D. ~umPhrey, known
to me (or s&tisfautorily proven} to be the person whose name is
subscribed to ~he ~ith/n instrument and acknowledged that she
executed the sa~e for the ~urpose therein conta/~ed.
seal. have hereunto set my hand and official
Notary ~ub ic
My Commission Rxpires~
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSFLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN W~RNER, ~XECUTRIX
I, KIM L. DIEHL, the undersigned, of I702 North Main
Street, Bethlehem, Pennsylvania, a designated beneficiary in the
above-captioned Estate as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named in the
Last Will and Testament of Dr. Russell T. Werner, hereby affirm
and acknowledge that:
~ ~ · I have received and revle
~ A
~5~ Las~ Wi~ And Te-~ ...... ' ~d a copy of the
~ Pr~te~ recollecting,Or ~r. Russell T. Werner as
?~' :..::.~ ~u zn ~ae above-captioned Estate; and
? ~"~ Rus~, ~ ~[ am a beneflcla~ in the
? ~[~ ~.~_T ~srner as a result of the Cr.~e~ 3~ pr_
-.~ ~an~ ~est~.t of ~ __ =~.tn~ ~s ol the Last Will
~'?"~Z i~ ~.' m~. ~ussela T. werner
'.~ _~._a ~ngent residual ben~f~-- an~ further that
uz ~ne Last Will a~d Testa---//--T~ur~un-er the ter~
Werner; and m~nt oI Dr. Russell T.
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania,s laws of intestacy, including but
not 1//aited to any rights, entitlement .or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, 9~_~, ~L~~D_~, or
any Other law, without further hearing or notice; and
Estate of RumsQll T. W~rner
Disclaimer of Kim L. Diehl
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
ExeCuted this ~[ day of
J(k~ , 2004.
K~m L. Diehl
STATE OF PENNSYLVANIA
: SS.
CO[~TY OF :
On this, the day of
undersigned officer, personally appeared' 2004, before me, the
Klm L. Diehl, known to me
(or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the sa~e for the purpose therein contained.
seal. IN WITNESS WHEREOF, I have hereunto set my hand and official
Notary Public- --
My Commission Expires:
CUMBERLAND COUNTY, P~NNSYLVANIA
ESTAT~ NO. 21 - 03 - 0617
MARY ~LLEN W~RNER, EXECUTRIX
I, KELLY n. ADAMS, the undersigned, of 2316 Abbey Lane,
~arrisburg, Pennsylvania, a designated beneficiary in the
above-oa~tioned Esta=e as a result of the creation of a marital
bypass trust and contingent residual beneficiary as named ia the
Last Will and Testament of Dr. Russell T. Warner, hereby affirm
and acknowledge that~
A. I have received and reviewed a Copy of the
Last Will and Testament of Dr. Russell T. Warner as
probated of record in the abo~e-captioned Estate; and
B. I am a beneficiary
RUSSell T. Warner as a result o in the Estate of Dr.
=a Tee t ~der the terms or t
'f':'":~ fi nci~l-~Of a Merrill Lyn~r~P?ndence relating to
ti=led~ account 898-8
ur. auSSell T. Werner; a~~
D. ~ waive my right to request and r~ceive
more sl~e~ific information concerning the ~alue of all
assets titled solely or Jointly in the name of Dr.
RUSsell T. Warner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completel dis
any interest in the ~st
either as a ~ ...... ate of Dr. Ruo.-,. ~ claim
and Testament of Dr. RusSell T. Warner, Without further
hearing or notice; and
. P- I hereby fully
~_lnterest in the Est a~d completely disclaim
un,er ~e~ns , ate of Dr. R
not 1~-~--ylvania s laws -~ ,-- USsell T. Wern,~
by 20 ~a.C.S.A. SeCtion 2101, e__ ~. ~rner granted
or
any other la~, Without further hearing or nOtice; and
~s=ate of Russell T. Werner
DisClaimer of Ke11¥ L. Adams
Page 2
G. I have not received any direct orindirect
interest ~romthe Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights o4 any creditors,
heirs or beneficiaries of the deuedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and 'that I am completely sa=is£1ed with the
terms herein.
Executed this
2004.
STATE OF P~NN8YLVANIA
COUNTY
SS.
On this, the day of , 2004, before ~, the'
undersigned officer, personally appeared Kelly L. Adams, known %o
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
sea/. IN WITNESS WHEREOF, I have hereunto set my hand and official
Notary ~Ubl'ic
My Commission Expires=
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
I, RUSSELL T. WERNER, JR., the undersigned, of 1779
Spring Willow Drive, Mechanicsburg, Pennsylvania, a designated
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and contingent residual
beneficiary as named in the Last Will and Testament of Dr. Russell
T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
~ ~ B. I am a beneficiary in the Estate of Dr.
R~sel~. Werner as a result of the creation of a
ma~ita~ ~pass trust under the terms of the Las.t Wil.1
ang~ Tenant of Dr. Russell T. We.rner and further that
I ~ a ~o~tingent residual beneficiary under the te~s
of~he ~t Will and Testament of Dr. Russell T.
~ "~ ~C. I acknowledge the receipt of various
fi~nci~nformation and correspondence relating to
the value of a Merrill Lynch I~ account 898-83902
titled in the n~e of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any'interest in the Estate of Dr. Russell T. Werner,
either as a direct beneficiary as a result of the
creation of the marital bypass trust therein or as a
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, e~ ~eq, as a~ende~, or
any other law, without further hearing or notice; and
E tate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
beneficiaries; and
I. I have had the o~ortunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms.herein.
Executed this ~day of ~~ ,
STATE OF PBNNSYLVANIA
200¢.
Russell T. weft, er, ~%
(SEAL)
~ SS.
COUNTY OF ~E~D ~
On this, the~+~ay of~a~6~c~/ ,2004, before ,, the
undersigned officer, personally appeared Russell T. Werner, Jr.,
known to me (or satisfactorily proven) to be the person whose na~e
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein contained.
seal.
IN WITNESS WHEREOF, I have hereunto set my hand and official
N-o~-~Ubli~ ..........
My Ccammission Expire~
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
AND REHUNCIAT]~OI~ OF IH~.ERIEST. IN ,~STATE
I, Michael T. Basse%2i, the undersigned, of 30 Flint
Ridge Drive, Shillington, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that;
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
~ ~B. I am a contingent, non-vested beneficiary
~3_~ in'~%he~ate of Dr. Russell T. Werner as a result of
~ th~cr~i~n of a ~rital bypass trust under the terms
.%?~. of~he ~t Will and Test~nt of Dr. Russell T. Werner
o an~fur~r that I am a contingent, non-vest~ residual
.%'[ ;~:;~ Te~amek~'~f Dr. Russell T. Werner; and
,:~,'I: ~ ~ ~C. I acknowl~ge the receipt of various
.r': fi~anci~nfor~tion and correspondence relating to
the value of a Merrill Lynch I~ acuount 898-83902
titled in the n~e of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, as amended, or
any other law, without further hearing Or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution o~ this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or ny
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I a~ completely satisfied with the
terms herein.
Executed this ~/ day of
~~~ , 2004.
Miehaei''
(SEAL)
STATE OF PENNSYLVANIA
COUNTY OF
SS.
On this, the day of , 2004, before ~e, the
undersigned officer, personally appeared Michael T. Bassetti,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he
executed the same for the purpose therein con=ained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public ~
My Commission Expires:
~STATE OF DR. RUSSELL T. WEaNeR
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
DISCLAIMER .AND RENUNCIATI. ON OF INTEREST IN ESTATE
I, Dea N. Sassetti, the undersigned, of 30 Flint Ridge
Drive, Shillington, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of 'the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
pr .~ate~ record in the above-captioned Estate; and
'~13~6B.~-- I am a contingent, non-vested beneficiary
in ~he ~%$ate of Dr. Russell T. Werner as a result 'of
th~rea~'~n of a marital bypass trust under the terms
of~e 5a~ Will and Testament of Dr. Russell T. Werner
an~fur~ that I am a uonti,gent, non-vested residual
be~ic~ under the terms of the.Last Will and
Te~me~$~f Dr. Russell T. Werner, and
C. I aukn~ledge the receipt of various
financial info~ation and correspondence relating to
the value of a Merrill Lynch I~ account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. I waive my right 'to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
resid;~al beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, ~S amende~, or
any other law, without further hearing or notice; and
Estaze of nssell T. erner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to exeuution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries o~ the ~ecedent, myself or my
beneficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this
day of ~[~7,qUOr~ , 2004.
STATE OF PENNSYLVANIA
COUNTY OF
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Des N. Bassetti, known to
me (or satisfactorily proven) %o be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the sa~e for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Publi~-~
My Commission Expires,
CUMBERLAND COUNTY, pENNSYLVANIA
ESTATE NO. 21 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
Kristin A. Diehl, the undersigned, of 1702 North Main
I, .......... ~vania, a contingent, non-vested
street, Be ..... ~--.~_eantioned Estate as a result of the
beneficiazy in ~n~ =~ ~ =
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last will and Testament of
Dr. Russell T. Warner, hereby affirm and acknowledge that~
A. I have received and reviewed a copy o~ the
Last Will and Testament of Dr. Russell T. Werner as
probated o£ record in the above-captioned Estate; and
B. I ama contingent, non-vested beneficiary
Estate of Dr. Russell T. Weaner as a result of
i9 t~ ---~ -~ ~ marital bv~ase trust under th~ terms
~ t~e ~ea=_.~_~.=__~ ~ot~t of Dr. Russell T. Werne~
o f t~e L ~ll~ u~ ~ vested residual
'~ ~_~,4,~=~l}m,~nder the terms of the Last Will aha
C~i.~ ~est~Ment ~.i.~ Dr. Russell T. Warner, an
~!..i.'!~. ~ J :" knowled e the receipt of ~ar~ous _
~'r..--T~ i~-~.~o name of Dr. Russell T. werner,
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or Jointly in the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Warner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation o~ the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Warner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Warner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Warner granted
by 20 Pa.C.S.A. Section 210~, 9~ se~, ~9_~~, or
an~ other law, without further hearing or notice; and
Estate of Russell T. Werner
Disclaimer of Russell T. Werner, Jr.
Page 2
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent, myself or my
b~eficiaries; and
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am completely satisfied with the
terms herein.
Executed this%\
day of ~~.~.
Krlstln A. Dlehl
(SEAn)
STATE OF PENNSYLVANIA
COUNTY OF
SS.
On this, the day of , 2004, before me, the
undersigned officer, personally appeared Kristin A. Diehl, known
to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that she
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
Notary Public
My Commission Expires:
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
I, Kady L. Adams, the undersigned, of 1702 North Main
Street, Bethlehem, Pennsylvania, a contingent, non-vested
beneficiary in the above-captioned Estate as a result of the
creation of a marital bypass trust and a contingent, non-vested
residual beneficiary as named in the Last Will and Testament of
Dr. Russell T. Werner, hereby affirm and acknowledge that:
A. I have received and reviewed a copy of the
Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I am a contingent, non-vested beneficiary
.
in t~e E~te of Dr. Russell T. Werner as a result of
the~ereat.~.n of a marital bypass trust under the terms
of ~e L~ Will and Testament of Dr. Russell T. Werner
and~?rt-~ that I ~ a contingent, non-vested residual
ben~lci~ under the terms of the Last Will and
Tes~n~.~f Dr. Russell T. Werner; and
, ~ . ~. I acknowledge the receipt of v~ous
zi~ncz~formatlon and correspondence relating to
the val~e of a Merrill Lynch I~ account 898-83902
titled in the n~e of Dr. Russell T. Werner; and
D. I waive my right to request and receive
more specific information concerning the value of all
assets titled solely or jointly in 'the name of Dr.
Russell T. Werner, including but not limited to the
above-described Merrill Lynch IRA; and
E. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner,
either as a direct or contingent, non-vested
beneficiary as a result of the creation of the marital
bypass trust therein or as a contingent, non-vested
residual beneficiary as established by the Last Will
and Testament of Dr. Russell T. Werner, without further
hearing or notice; and
F. I hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner
under Pennsylvania's laws of intestacy, including but
not limited to any rights, entitlement or interest
afforded in the Estate of Dr. Russell T. Werner granted
by 20 Pa.C.S.A. Section 2101, et seq, ~5_~, or
any other law, without further hearing or notice; and
Estat~ of Russell T. Wern~r
Disclai/~er of Russell T. Werner, Jr
Page 2 '
G. I have not received any direct or indirect
interest from the Estate of Dr. Russell T. Werner prior
to execution of this written Disclaimer and
renunciation; and
H. I have not executed for the purpose of
materially prejudicing the rights of any creditors,
heirs or beneficiaries of the decedent myself or my
beneficiaries; and '
I. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that I am co~letely satisfied with the
terms herein.
Executed this day of , 2004.
Kady L. ~ams
_(s~)
STATE OF PENNSXLVANIA
COUNTY OF ~ SS.
On this, the day of , 2004, before me. the
undersigned officer, personally appeared Kad L.
me (or satisfactoril~ ~ro,,~, ...... Y . Adams, know~ to
Z ~ V~AAI UU oe =ne. ers
subscribed to the wit ' · _ P . on_whose name is
bin instrument and acknowledged that she
executed the sa~e for the purpose therein contained.
seal. IN WITNESS WHEREOF, I have hereunto set my hand and official
~otary Public
My Commission Expires:
~ ESTATE OF DR. RUSSELL T. WERNER
· w c0u T , PE NS v i
~ ~ ~..~ r ESTATE NO. 21 - 03
o~; ~ - 0617
~ .~ ~ ~a~ ELLEN WE~R, EXECUTRIX
I, Susan ~:~:HU~hrey, the ~ther and guardian
Ashley Humphrey (D.O.B. 10/1
(D.O.B. 04/24/90% ~___ 9(87) and Alexanao~ - of ~anda
affirm and ,, ,,~uu~ grandchildren of +~i~_ca~es Humphrey
acknowledge that: ~',= uece~ent, hereb~
A. I have received and reviewed a copy of the
Last Will and Testa~nt of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. I acknowledge that ~anda Ashley Humphrey
(D.O.B. 10/19/87) and Alexander James Humphrey (D.O.B.
04/24/90) are a non-vested, contingent beneficiarie
the Estate of Dr. Russell '
creation of a ~=~_~ . T. Werner a ~ ~ .... ~ _ s in
~a~ a~a~s (D.O.m nn).../T' u;/Iz/S7) and ~ ...... hat
residu ~ ~-_ ~ .~..u~/iu/g3) are _ ~,,ue~
and ~sta~nt of Dr. Russell T. Werner; and
t .... ~'~= ~ the Last Will
C. I acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch ~ account 898-83902
titled in the n~e of Dr. Russell T. Werner; and
D. i waive the non-vested, contingent rights
of ~anda Ashley Sumphrey (D.O.B. 10/19/87) and
Alexander James Humphrey (D.O.B. 04/24/90) to request
and receive more specific information concerning the
value of all assets titled solely or jointly in th~
name of Dr. Russell T. Werner, including but not
li~ted to the above-described Merrill Lynch I~; and
E. I hereby fully and completely disclaim any
interest in the Estate of Dr RUSsell T
behalf of ~nda Ashley Hump Werner on
Alexander ~rey (D.O.B~ 10/19/87) and
James Sumphr~y (D.O.B. 04/24/90), either as a
non-vested, contingent beneficiaries as a result of the
creation of the ~rital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last Will and Testa~nt of Dr.
Russell T. Werner, without further hearing or notice;
and
Estate of Russell T. Werner
n'
lsclalmer of Amanda Ashley Humphrey
Alexander James Humphrey
Page 2
F. I hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Amanda Ashley Humphrey (D.O.B. 10/19/87) and Alexander
James Humphrey (D.O.B. 04/24/90) under Pennsylvania,s laws
of intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.c.s.A. Section 2101, et
~eq, ~, or any other law, without further hearing
or notice; and --
G. Amanda Ashley Humphrey (D.O.B. 10/19/87)
and Alexander James Humphrey (D.O.B. 04/24/90) have not
received any direct or indirect interest from the
Estate of Dr. Russell T. Werner prior to execution of
this written Disclaimer and renunciation on their
behalf; and
H. This Disclaimer, executed on behalf Amanda
Ashley Humphrey (D.O.B. 10/19/87) and Alexander James
Humphrey (D.O.B. 04/24/90) has been not executed for
the purpose '
~o~ mater~ally prejudicing the rights o any
creditors, nears or beneficiaries of the decedent ~r
the minor beneficiary; and
I. I understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Amanda Ashley Humphrey (D.O.B.
10/19/87) and Alexander James Humphrey (D.O.B.
04/24/90) in the Estate of Df.Russell T. Werner, Jr.
may be submitted to the Court of Common Pleas of
Cumberland County and filed as part of a Joint Petition
to Terminate Marital Bypass Trust, and I further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. I have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
our choosing and I am completely satisfied with the
terms herein.
~U~an D. Humphrey' ~';,~~ ( )
2
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WER}~ER, EXECUTRIX
CONSENT OF BENEFIC.~ARY,,TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR,,,,B~NEFICIARY IN, MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEF. ICIAL. INTER'ST THEREIN
We, Kim L. Diehl and Daryl Diehl, the natural parents of
Lauren Elizabeth Diehl (D.O.B. 01/04/88), a minor grandchild of
the Decedent, hereby affirm and acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Lauren Elizabeth Diehl
(D.O.B. 01/04/88) is a non-vested, contingent
beneficiary in the Estate of Dr. Russell T. Werner as a
result of the creation of a marital bypass trust, and,
further that the Lauren Elizabeth Diehl (D.O.B.
01/04/88) is a non-vested contingent residual
beneficiary under the terms of the Last Will and
Testament of Dr. Russell T. Werner; and
C. We acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Lauren Elizabeth Diehl (D.O.B. 01/04/88) to request
and receive more specific information concerning the
value of all assets titled solely or jointly in the
n~me of Dr. Russell T. Werner, including but not
l~mited to the above-described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Lauren Elizabeth Diehl (D.O.B. 01/04/88),
either as a non-vested, contingent beneficiary as a
result of the creation of the marital bypass trust
theL~in ~as a non-vested, contingent residual
~6 =~bene~ici...~as established by the Last Will and
~Tes~n~)o~{ Dr. Russe~ll T. Werner, without further
.~'~hearing 9.N~otice; ano
-
Estate of Russell T. Werner
Disclaimer of Lauren Elizabeth Diehl
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Lauren Elizabeth Diehl (D.O.B. 01/04/88) under
Pennsylvania's laws of intestacy, including but not
limited to any rights, entitlement or interest afforded in
the Estate of Dr. Russell T. Werner granted by 20
Pa.C.S.A. Section 2101, 9~ seq, a.s amended, or any other
law, without further hearing or notice; and
G. Lauren Elizabeth Diehl (D.O.B. 01/04/88)
has not received any direct or indirect interest from
the Estate of Dr. Russell T. Werner prior to execution
of this written Disclaimer and renunciation on her
behalf; and
H. This Disclaimer, executed on behalf Lauren
Elizabeth Diehl (D.O.B. 01/04/88), has been not
executed for the purpose of materially prejudicing the
rights of any creditors, heirs or beneficiaries of the
decedent or the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Lauren Elizabeth Diehl (D.O.B.
01/04/88) in the Estate of Dr. Russell T. Werner, Jr.
may be submitted to the Court of Common Pleas of
Cumberland County and filed as part of a Joint Petition
to Terminate Marital Bypass Trust, and we further
hereby waive formal notice of any future hearing
concerning termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
my choosing and that we are completely satisfied with
the terms herein.
Executed this TM ~ day of ~u~t. , 2004.
Daryl~iehl
(SEAL)
~STATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CO F C Y 0 0 - X C N
I R ST 0 C PS R '
_DS R OF I O 'S F
We, Kelly L. Adams and Jon R. Adams, the natural parents of
Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James Adams (D.O.B.
09/10/93), n%inor grandchildren of the Decedent, hereby affirm and
acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Jessica Rae Adams
(D.O.B. 07/12/87) and Samuel James Adams (D.O.B.
09/10/93) are a non-vested, contingent beneficiaries in
the Estate of Dr. Russell T. Werner as a result of the
creation of a marital bypass trust, and, further that
the Jessica Rae Adams (D.O.B. 07/12/87) and Samuel
James Adams (D.O.B. 09/10/93) are non-vested contingent
residual beneficiaries under the terms of the Last Will
and Testament of Dr. Russell T. Werner; and
C. We acknowledge the receipt of various
financial information and correspondence relating to
the value of a Merrill Lynch IRA account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93) to request and receive more
specific information concerning the value of all assets
titled solely or jointly in the name of Dr. Russell T.
Werner, including but not limited to the above-
described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Jessica Rae Adams (D.O.B. 07/12/87) and
Samuel James Adams (D.O.B. 09/10/93), either as a non-
yes,d, g~ingent beneficiaries as a result of the
~cre~ion~the marital bypass trust therein or as a
~non~estq~jcontingent residual beneficiaries as
~esta~-lis~ by the Last Will and Testament of Dr.
oRuss~1 ~'i~,z~erner, without further hearing or notice;
S~t~te of Russell T. Werner
Disclaimer of Jessica Rae Adams
and Samuel James Adams
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Werner on behalf
of Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93) under Pennsylvania,s laws of
intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Werner granted by 20 Pa.C.S.A. Section 2101, e~t
seq, ~_~, or any other law, without further hearing
or notice; and
G. Jessica Rae Adams (D.O.B. 07/12/87) and
Samuel James Adams (D.O.B. 09/10/93) have not received
any direct or indirect interest from the Estate of Dr.
Russell T. Werner prior to execution of this written
Disclaimer and renunciation on their behalf; and
R. This Disclaimer, 9xecuted on behalf
Jessica Rae Adams (D.O.B. 07/12/87) and Samuel James
Adams (D.O.B. 09/10/93), has been not executed for the
purpose of materially prejudicing the rights of any
redltors heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Jessica Rae Adams (D.O.B.
07/12/87) and Samuel James Adams (D.O.B. 09/10/93) in
the Estate of Dr. Russell T. Werner, Jr. may be
s
ubmltted to the Court of Common Pleas of Cumberland
County and filed as part of a Joint Petition to
Terminate Marital Bypass Trust, and we further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with counsel of
our choosing and that we are completely satisfied with
the terms herein.
Executed this~DF ~.~'
day of 2004.
Adam --~ .... ( SEAL )
2
ESTATE OF DR. RUSSELL T WER
CUMBERLAND C ....... ' NER
ES mm~ ,,~vu~'~, PENNSYL~ .IA
CO S N OF
......
,,.,. ,,
' Ct~benanO ~.,
We RUSsell T. Werner, Jr. and Constance j. Werner, the
natural parents of Veronica Rose Werner (D.O.B. 04/25/98) and
Reagan ~ope Werner (D.O.B. 07/28/00), minor grandchildren of the
~cedent, hereby affirm and acknowledge that:
~. We have received and re '
the Last ~11 and Testa~nt of ~ _ v~ewed a Copy of
probated . ~- a~ssell T. Weaner as
uz record ~n the above captioned Estate, and
B. We acknowledge that Veronica Rose Werner
(D.O.B. 04/25/98) and Reagan Hope Werner (D.O.B.
07/28/00) are a non-vested, contingent beneficiaries
the Estate of Dr. RUSsell T. Werner as a result of the
creation of a marital bypass trust, and, further that
the Veronica Rose Werner (D.O.B. 04/25/98) and Reagan
Hope Werner (D.O.B. 07/28/00) are non-vested contingent
residual beneficiaries under the terms of the Last Will
and Test~ent of Dr. Russell T. Werner; and
C. We acknowledge the receipt of various
financial info~ation and correspondence relating to
the value of a Merrill Lynch i~ account 898-83902
titled in the name of Dr. RUssell T. Werner; and
D. We waive the non-vested, contingent r
of Veronica Rose Werner D
Hope Werner ~n ~ .... ( .O.B. 04/25/qR~ ~_~ ~ ights
more specific in~ ...... 28/00) to request nd r
assets title eoncernin, ec iv
~ ~y or ~ointlv ~, f~_"= ~ue o~ all
Russell T. Werner, including ~ ~" u-~ n~e of Dr.
above-described but not li~ted to the
Merrill Lynch i~; and
, E. We hereby fully and completely discla~
~a~t~ri~.the Estate of Dr. Russ -..
Rea~- ~ ..... onzca Rose Werne ell Tl.Wernez o
=~" *zuYe werne r (D.O.B. 0~ n
vested. 0o,~__ ~ JD.ObB. 07/28/00~ . /~5/98) and
creat~- ~9enc oene~iciari ,, e~h~r as a non-
___ ~- uz ~ne marita~ ~ ..... e~ as a result of
~un-vested, co~tin~e_~_u~ss_trust therein t~e
established by theS~~9ual beneficiari~°~as a
Russell T. Werner, Without further hearing or notice;
and
Estate of Russell T. Warner
Disclaimer of Veronica Rose Warner
and Reagan Hope Warner
Page 2
F. We hereby fully and completely disclaim any
interest in the Estate of Dr. Russell T. Warner on behalf
of Veronica Rose Warner (D.O.B. 04/25/98) and Reagan Hope
Warner (D.O.B. 07/28/00) under Pennsylvania,s laws of
intestacy, including but not limited to any rights,
entitlement or interest afforded in the Estate of Dr.
Russell T. Warner granted by 20 Pa.C.S.A. Section 2101, e_~t
seq, ~, or any other law, without further hearing
or notice; and
G. Veronica Rose Warner (D.O.B. 04/25/98) and
Reagan Hope Warner (D.O.B. 07/28/00) have not received
any direct or indirect interest from the Estate of Dr.
Russell T. Warner prior to execution of this written
Disclaimer and renunciation on their behalf; and
H. This Disclaimer, executed on behalf
Veronica Rose Warner (D.O.B. 04/25/98) and Reagan Hope
Warner (D.O.B. 07/28/00), has been not executed for the
purpose of materially prejudicing the rights of any
creditors, heirs or beneficiaries of the decedent or
the minor beneficiary; and
I. We understand and acknowledge that this
Disclaimer and request to terminate the non-vested,
contingent interests of Veronica Rose Warner (D.O.B.
04/25/98) and Reagan Hope Warner (D.O.B. 07/28/00) in
the Estate of Dr. Russell T. Warner, Jr. may be
submitted to the Court of Common Pleas of Cumberland
County and filed as part of a Joint Petition to
Terminate Marital Bypass Trust, and we further hereby
waive formal notice of any future hearing concerning
termination of said Trust.
J. We have had the opportunity or have
reviewed the terms of this Disclaimer with Counsel of
our choosing and that we are completely satisfied with
the terms herein.
Executed this ~day of J~ , 2004.
~ussell T. Warner, ~.
Constance J./Werner
~(SEAL)
_(SEAL)
IN RE: ESTATE OF
DR, RUSSELL T. WERNER
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21-03-617
ORDER APPROVING JOINT PETITION TO TERMINATE MARITAL BY-PASS
TRUST PURSUANT TO PA. C.S.A. SECTION 6102(a)
consideration of the Joint Petition to Terminate Marital Bypass Trust
pursuant to Section 6102 (a) of the Probate, Estates and Fiduciaries
Code of 1972, ~_~, and following a hearing thereon, and it is
Ordered and Decreed that the Marital Bypass Trust established under
paragraph 2 of the Last Will and Testament of Dr. Russell T. Werner,
is hereby TERMINATED. It is further Ordered and Decreed that any
vested or non-vested, minor beneficial rights, entitlements, inter-
ests or claims in the Marital Bypass Trust established under para-
graph 2 of the Last Will and Testament of Dr. Russell T. Werner, are
hereby EXTINGUISHED.
BY THE COURT,
Andrew C. Sheely, Esquire
Attorney for Petitioners
ESTATE OF DR. RUSSELL T. WERNER
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE NO. 21 - 03 - 0617
MARY ELLEN WERNER, EXECUTRIX
CONSENT OF BENEFICIARY TO TERMINATE NON-VESTED, CONTINGENT
INTEREST OF MINOR BENEFICIARY IN MARITAL BYPASS TRUST AND
DISCLAIMER OF MINOR'S BENEFICIAL INTEREST THEREIN
We, Russell T. Werner, Jr. and Constance J. Werner, the
natural parents of Veronica Rose Werner (D.O.B. 04/25/98) and
Reagan Hope Werner (D.O.B. 07/28/00), minor grandchildren of the
Decedent, hereby affirm and acknowledge that:
A. We have received and reviewed a copy of
the Last Will and Testament of Dr. Russell T. Werner as
probated of record in the above-captioned Estate; and
B. We acknowledge that Veronica Rose Werner
(D.O.B. 04/25/98) and Reagan Hope Werner (D.f~,~.
07/28/00) are a non-vested, contingent benef~iarl~ in
the Estate of Dr. Russell T. Werner as a res~l"{ of the
creation of a marital bypass trust, and, fur~h~er t~t
the Veronica Rose Werner (D.O.B. 04/25/98) and Rea~,n
Hope Werner (D.O.B. 07/28/00) are non-vested~Conti~ent
residual beneficiaries under the terms of th~?~ast Will
and Testament of Dr. Russell T. Werner; and
C. We acknowledge the receipt of var~ous~
financial information and correspondence relating to
the value of a Merrill Lynch I~ account 898-83902
titled in the name of Dr. Russell T. Werner; and
D. We waive the non-vested, contingent rights
of Veronica Rose Werner (D.O.B. 04/25/98) and Reagan
Hope Werner (D.O.B. 07/28/00) to request and receive
more specific information concerning the value of all
assets titled solely or jointly in the name of Dr.
Russell T. Werner, including but not. limited to the
above-described Merrill Lynch IRA; and
E. We hereby fully and completely disclaim
any interest in the Estate of Dr. Russell T. Werner on
behalf of Veronica Rose Werner (D.O.B. 04/25/98) and
Reagan Hope Werner (D.O.B. 07/28/00), either as a non-
vested, contingent beneficiaries as a result of the
creation of the marital bypass trust therein or as a
non-vested, contingent residual beneficiaries as
established by the Last. Will and Testament of Dr.
Russell T. Werner, without further hearing or notice;
and