HomeMy WebLinkAbout02-1035Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of William Thomas Moore No. 21-02-1035
also known as William T. Moore
Deceased Social Security No. 203-34-7411
Petitioner(s), who is/are 18 years of age or oltler, apply(ies) (or:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the executor named in the Last Will of the
Decedent, dated September 8, 1999 and codicil(s) dated
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
~I~ti~
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente liter durance absentia: tlurante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following
Decedent, then 79 years of age, died November 5, 2002, at Claremont Nursing Home, Middlesex Township, Cumberland
County. PA
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property ....................................... $ 625,000
(If not domiciled in PA) Personal property in Pennsylvania ............................. $
(If not domiciled in PA) Personal property in County .................................. $
Value of real estate in Pennsylvania ........................................................... $
Total ........................................................................... $ 625,000
Real Estate situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Si nature T ed or tinted name and residence
~~-~~ ~? ;~'Y]~,~~-~
/ ~ Jane E. Moore
1099 Country Club Road
Cam Hill, PA 17011
~ y.
/ Elizabeth Moore Calcagno
,r-,v/~i t~ C~~~~~~'''
~
~ ,'_ ,, m 1101 Country Club Road
,
~~
V ~v . - vanr run, r ~ r r v r
Form RW-t Page 1 of 2 (Dauphin County -Rev. 9192)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at
1099 Country Club Road, Camp Hill, PA 17011 (East Pennsboro Township)
(list street, number and municipality)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing
Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as
personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate
according to law.
Sworn to and affirmed and subscribed
before me this 20th day of
~,
NOVEMBER ~7~ 2~~2 ( v~
/`
~~i~1S~
DECREE OF REGISTER
Estate of William Thomas Moore Deceased No. 21-02-1035
also known as William T. Moore
Social Security No: 203-34-7411 Date of Death: November 5 2002
AND NOW, NOVEMBER 21 , 2002, in consideration of the Petition on the reverse
side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ®Testamentary ^ of Administration
are hereb ranted to c~ ~ a., d.b.~.~ t.: Pe~ae„r~ i~~a; d~~a~~~ abse~~»: a~~~~te m,~o~~~A~>
Y g Jane E. Moore and Elizabeth Moore Calca no
in the above estate and that the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........................... $ 410.00
Short Certificate(s) (~1... $ 6.00 RegiGter of Wills ~J~O~~ Q~~~
Renunciation O.......,..,, $ " 7
Affidavit ( ) .................. $
Extra Pages ( )....,,,,,,. $ 48.00
-_
Codicil ........................... $
JCP Fee ................ $ 10.00 Attorney: El se E. Ro ers
Inventory & Tax Forms... $ ~
---_ I.D. No: 41274
Other ............................ $ Address: 415 Fallowfield Rd. Suite 301
Camb Hill, PA 17011
TOTAL ................ $ 474.00 Telephone: 717-612-5801
DATE FILED:
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e, va7 CUMMONWEALTH OF PENNSVLVANtA • DEPARTMENT Of HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENTIF:rsl Middle. _estl
---"'"-- ---- cTATE aiIE NUMBEN
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AGE lLesl BulndaY) UNDER 7 YEAR SEx j5 .(,IAL JEl,UR17r f UMBER ---~-- -- - ------ _ __ ----.
1 DATE OF DEATH ,M U,Uay rear)
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WAS DECEDENT OF HISPANIC ORIGIN?
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RESIDENCE --
-Die ncl_}(rea. tlecWem lived In
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FATHER S NA. E IFust. Middle. Lasp ownsnlp? No, aecederd Ines
,7e. counry_
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m actual hmrts al
MOTHER'S NAMEIFny( M"Idle. Maiden ~',ananel crty/DOro
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INFORMANT nn tliYPelPruttl ,
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,~.. Jane MOOre INFORMANT'SM I11- N~GAUDp ESSISueal,GtyRUwn glare LipCcw¢~
- METHOD Of DISPOSITION
_ IF''qq lob. 1099 Count Club Road Cam Hill
DATE OF DISPOSITION
P
Bunal LS Cromallm ^
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Removal Irom Slate ^
PLACE OF DISPOSITION ~ Name of Cemalery, Cremat
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a 17011
LOCATIO
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SIG FUN LSERVICE IICENSF~Oq PER~NACTING AS SUCH
310 1,,--.~~°_ ~1t' _~f Hf-?r'1\71~n
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pnyslnan a not avallalea al bme of death io
cenlty cause of death.
_ Items 2a~26 must W completed q'
1 Person wDO pronounces deatD.
~27. PART L Enter the diseases. in(uries or co
List only one cause on earn line.
IMMEDIATE CAUSE (F~nal
disease or condnron
~ewlling In tleaml ~-s s _,
SeQuenhally hsi fArtditgne D __
it any, leading W Immediate
muse. Entw UNDERLYING
CAUSE IDISease or ,n)ory c,_
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rewaing m death) LAST
a
WAS AN AUTOPSY WERE AUTOPSY FINC
PERFORMEDT A
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DEATH/,(,,(,(jJ/ ~/ ~ / a'S 4c-Yl [l F'4v ~/V 2]b. ~~ 7~~
DATE ]OUNCED DEAD IMOndi. Day, Year)
l z 55 ~ rrt / ~ / WAS CASE REFERRED TO MEDICAL E%
M. 2a. ~7 J~ Z~ 7 rea L~
caused Ina tleatD Do nor enter the moos at dying, such as tarmac or resplratnry aiasL srwcx or mart laaiue I X
I Approximate PART 11: Oth
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DUE TO IOR AS A
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1 contliliww con~lirg to dea1D, DW
IW urttlerlying cause given .n PART I.
VAILABLE PRIOR 10 DATE OF INJURY TIME OF INJURY INJURY AT
COMPLETION OF CAUSE IMOnm. Day. near) WORK?
OF DEATH7 Natural ~~ Hom~cWe ^
Acmdenl ~~ Penning Investigation ^ V ^ Na ^
Yas ^ No>~ Ves ^ No ~ SuicMe ^ Could norWdetermined ^ 7M_ Job. M,
PUCE Of INJURY ~ '-- 2a' T.-
AI Dome, farm, 5ne91, factory, oflioe iL(k"Ipnnu
2M' 28b. 29. Dwlding, etc ISt'lecitvl
DERTIFIEA ICnecN only Ime) Mb.
'CERTIFYING PHYSICIAN IPnysKlan ceaWy~nn cause of <:eam weer anolner onv;ican nos ulonoulx:ed death ono ctxnpleled ?lean 2:i1 _
To the Wet of my knowledge, death occurred due m tM cauae(al end manner n staled ............................................
'PRONOUNCING AND CERTIFYING PHVSICIANIPhys - tt`au,.r,,,w„J .aetn and cell lyngm.
To the lroel of my knowledge, dealn occurred at the tl ,dare, and place, and dw to Ina cause a - I deeml
( land manner as stated... ..... i_ -~
'MEDICAL E7(AMINER/CORONER I
On the besia of eaammation andlor investi anon, in m o I
9 y pinion, death occurred al the time, date, and place, and due to the causelsl and
manner as stated .............................. ...................
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ATURE ANO TI CF~pTIF1ER i
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`I$ECiDMBE % ATE IGNE~ Dinh. D'Y yeah
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AND ADDRESS OF PERSON WHO COMPLETEDCAUSE OFDEAT~
I71 Type or Print
f ca 17013 .
FILE D.MUnm Bey, yeaU --
7__~/~~_v~OG 'i
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OF
WILLIAM THOMAS MOORE, M.D.
I, WILLIAM THOMAS MOORE, M.D., of East Pennsboro Township,
Cumberland County, Pennsylvania, do make, publish and declare this to be my Last
Will and Testament, hereby revoking all Wills and Codicils by me at any time made.
ITEM I: I direct that all inheritance and estate
taxes becoming due by reason of my death, whether payable by my estate or by any
recipient of any property, shall be paid by the Executor out of the residue of my
estate, as an expense and cost of administration of my estate. The Executor shall
have no duty or obligation to obtain reimbursement for any such tax so paid, even
though on proceeds of insurance or other property not passing under this Will.
ITEM II: I direct the Executor to pay the expenses
of my last illness and funeral expenses from the residue of my estate as an expense
and cost of administration of my estate.
ITEM III: If I die before my wife, JANE E. MOORE,
I give to her all of my household furniture and furnishings, books, pictures, jewelry,
silverware, automobiles, wearing apparel and all other articles of household or
personal use or adornment and all policies of insurance thereon. If I do not die before
my wife, I may leave a written list in my safe deposit box or elsewhere disposing of
certain items of my tangible personal property. The Executor shall dispose of items
of my personal property as specified in the written list. If no written list is found in
Page 1 ~~" ~
my safe deposit box or elsewhere and properly identified by the Executor within
thirty (30) days after the probate of my Will, it shall be presumed that there is no
other statement or list. Any subsequent discovered list shall be ignored. Any
property not listed in the written statement I give and bequeath to my daughter,
ELIZABETH MOORE CALCAGNO. If she does not survive me, I make this gift to
her children living at the time of my death, to be divided between them as they shall
agree, the Executor to represent any minors in the division of this property. If the
Executor thinks any property to which a minor child would become entitled is
unsuitable for the child's use, the property shall be sold and the proceeds shall be
added to the share of my residuary estate held for the benefit of that child. The
Executor may deliver any property to which a minor is entitled and which is not sold
to the person with whom the child resides or who has the care or control of him
(without bond), and the receipt of that person shall be a complete release of the
Executor.
ITEM IV: I give, devise and bequeath all the rest,
residue and remainder of my estate, not disposed of in the preceding portions of this
Will, to my wife, JANE E. MOORE, and my daughter, ELIZABETH MOORE
CALCAGNO, as Trustees (hereinafter collectively referred to as "Trustee"), IN
TRUST NEVERTHELESS, to be further divided into two parts, each of which shall
be held in trust and constitute a separate Trust Fund to be known as "Trust A" and
"Trust B".
"Trust A": There shall be placed in "Trust A"
that fraction of my residuary estate of which the numerator shall be a
sum equal to the largest amount that can pass free of Federal estate tax
under my Will by reason of the applicable credit amount and the state
death tax credit (provided that the use of this credit does not require an
r~ ~~-.
Page 2
increase in state death taxes) allowable to my estate but no other credit
and after taking account of dispositions under other items of this Will
and property passing outside of this Will which do not qualify for the
marital or charitable deduction and after taking account of charges to
principal that are not allowed as deductions in computing my Federal
estate tax and of which the denominator shall be the value of my
residuary estate. For purposes of establishing such fraction, the values
finally fixed in the Federal estate tax proceeding relating to my estate
shall be used. I recognize that the numerator of such fraction may be
zero (0), in which case no property shall pass under "Trust A" and that
said numerator may be affected by the action of the Executor in
exercising certain tax elections.
"Trust B": The balance of my residuary estate
not placed in "Trust A" shall be placed into "Trust B" to be held,
administered and distributed in accordance with ITEM VI of this Will.
ITEM V: The following provisions shall apply to the
"Trust A":
(a) The Trustee shall pay the net income arising from the
principal of this Trust in convenient, at least annual installments to my
wife, JANE E. MOORE, during her lifetime.
(b) During the lifetime of my wife, the Trustee shall pay to or
for the benefit of my wife so much of the principal of this Trust as may
be necessary, in the sole discretion of the Trustee, for the proper
support, maintenance and medical care of my wife.
Page 3 ~-~ ~ ~"'`~
(c) Upon the death of my wife, or upon my death if she
predeceases me, the remaining principal shall be divided into as many
equal shares as there are then living children of mine and then deceased
children of mine represented by then living issue. For purposes of
making this division, the Trustee shall add (if I survived my wife,
JANE E. MOORE, but not otherwise), the fair market value of my
residence which has passed by operation of law to my daughter,
ELIZABETH MOORE CALCAGNO, to the balance available for
distribution. The Trustee then distribute this hypothetically augmented
balance into equal shares as provided above, an equal share to be paid to
each living child or set apart for the issue of each deceased child, there
being credited against the share of my daughter, ELIZABETH MOORE
CALCAGNO, the fair market value of that residence as of the date of my
death. Should the fair market value of my residence exceed the value of
her share, she shall have no obligation to my estate or this Trust for the
excess.
(d) The Trustee shall further divide each share set apart for
the issue of a deceased child into a separate per stirpital share for each
issue, and shall administer and distribute each share as follows:
(i) The Trustee shall pay to or for the benefit of
the issue (hereinafter referred to as the "Beneficiary" of his
or her Trust) so much of the net income as may be
necessary to maintain the Beneficiary in the proper station
in life, including proper support, maintenance, medical
care, and college or higher education.
Page 4
(ii) The Trustee shall also distribute so much of
the principal of the Trust as, in the discretion of the
Trustee, maybe necessary. to maintain the Beneficiary in
the proper station in life, including proper support,
maintenance, medical care, and college or higher
education.
(iii) Upon the attainment of the age of thirty-five
(35) years by the Beneficiary, the Trust shall terminate,
and the Trustee shall distribute to the Beneficiary all the
assets of the Trust.
(iv) Should the Beneficiary die before final
distribution of the assets of the Trust, but be survived by
then living issue, the Trustee shall quarterly pay the net
income from the Trust to or for the benefit of the issue, per
stirpes, living at each time of quarterly distribution; as
soon as any one of the issue attains the age of twenty-one
(21) years, and in no event later than twenty (20) years
following the death of the Beneficiary, the Trustee shall
pay over all of the then assets in the Trust to the then
living issue of the Beneficiary, per stirpes. Should the
Beneficiary die before final distribution and not be
survived by then living issue, the provisions of
subparagraph (v) herein shall obtain.
(v) If, before final distribution of the assets of
any Trust established for issue of a deceased child, there is
Page 5 ~~ .' = ~^~~. .
no living Beneficiary of that Trust, it shall terminate. The
principal of the Trust shall be added to the other Trusts
created under this Will for the benefit of the other issue of
my deceased child, in the same proportions in which the
Trusts were originally funded. If any Trust created for
issue of deceased children had previously been terminated,
the beneficiaries who received the principal of that Trust
shall collectively be considered a "Trust" for the purpose of
this paragraph, and one share shall be paid directly to each
Beneficiary in the same proportion by which each received
the principal of the Trust. If any beneficiary is deceased,
the share of the deceased Beneficiary shall be paid to his or
her then living issue, per stirpes.
ITEM VI: The following provisions shall apply to
"Trust B":
(a) Trustee shall have, hold, manage, invest and reinvest the
assets of this Trust, collect the income and beginning at my death pay
over the net income in convenient, at least annual, installments to my
wife, JANE E. MOORE, during her lifetime.
(b) The Trustee shall also, from time to time, pay to my wife
so much of the principal of this Trust as the Trustee deems necessary
for the proper support, maintenance and medical care of my wife.
(c) Upon the death of my wife, the Trustee shall pay all
accrued income and all income accumulated but undistributed to the
Page 6 ~"`J
estate of my deceased wife and shall thereafter transfer the then
remaining principal of this Trust to "Trust A" to be held, administered
and distributed in accordance with the provisions of ITEM V of this
Will.
(d) If my wife should not survive me, then the provisions of
"Trust B" shall be void and the part of my estate which would have
constituted "Trust B" shall be added to "Trust A" to be disposed of in
accordance with ITEM V of this Will.
(e) The Executor shall be authorized in the Executor's sole,
exclusive and unrestricted discretion to determine whether to elect
(under Section 2056(b)(7) of the Internal Revenue Code of 1986 as
amended, or any corresponding provision of the Federal estate law), to
qualify all, none or a fraction of "Trust B" for the Federal estate tax
marital deduction. The decision of the Executor with respect to the
exercise of the election shall be final and conclusive upon all persons
whose interests in my estate are directly or indirectly affected by the
election. Only property which is fully eligible for the marital deduction
under Federal estate tax law shall be assigned to this Trust.
Notwithstanding anything to the contrary contained in this Will, the
Trustee of this Trust shall not retain beyond a reasonable time any
property which may at any time be or become unproductive, nor shall
Trustee invest in unproductive property. Notwithstanding the
provisions of subparagraph (c) of this Item, the Trustee shall pay to the
Executor of my wife's estate, out of the principal of this Trust upon the
death of my wife, an amount equal to the estate, inheritance, transfer,
succession and other death taxes ("death taxes"), Federal, state and
W ~t '`1~
Page 7
other, payable by reason of the inclusion of the value of Trust property
in my wife's estate. Such payment shall be equal to the amount by
which (1) the total of such death taxes paid by my wife's estate exceeds
(2) the total of such death taxes which would have been payable if the
value of the Trust property had not been included in her estate. The
determination by my wife's Executor of the amount payable hereunder
shall be final. I direct the Trustee to pay such amount promptly upon
written request of my wife's Executor. The final determination of the
amount due hereunder shall be based upon the value as finally
determined for Federal estate tax purposes in my wife's estate. After
payment of the amount finally determined to be due hereunder, the
Trustee shall be discharged from any further liability with respect to
such payment. My wife may waive her estate's right to payment under
this subparagraph by Will, executed after my death, in which she
specifically refers to the right to payment hereunder given to her estate.
ITEM VII: No part of the income or principal of any
Trust created by this Will shall be subject to attachment, levy or seizure by any
creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary prior
to his or her actual receipt of income or principal distributed. The Trustee shall pay
the net income and the principal to the beneficiaries specified by me, as their
interests may appear, without regard to any attempted anticipation, pledging or
assignment, and without regard to any claim or attempted levy, attachment, seizure
or other process against the beneficiary.
ITEM VIII: The Executor and the Trustee shall each
possess the following powers, each of which maybe exercised without court approval
and in a fiduciary capacity only:
~~''~ .
Page 8
(a) To retain any investments I have at my death, including
specifically those consisting of stock of any bank even if I have named
that bank as the Executor or Trustee.
(b) To vary investments, and to invest in bonds, stocks, notes,
real estate mortgages or other securities or in other property, real or
personal, without being restricted to so-called "legal investments", and
without being limited by any statute or rule of law regarding
investments by fiduciaries.
(c) In order to divide the principal of a Trust or for any other
purpose, including final distributions, the Executor and Trustee are
authorized to divide and distribute personal property and real property,
partly or wholly in kind, and to allocate specific assets among
beneficiaries and Trusts so long as the total market value of each share
is not affected by the division, distribution or allocation in kind. The
Executor and Trustee are each authorized to make, join in and
consummate partitions of lands, voluntarily or involuntarily, including
giving of mutual deeds, or other obligations, with as wide powers as an
individual owner in fee simple.
(d) To sell either at public or private sale real and personal
property severally or in conjunction with other persons, and to
consummate sale(s) by deed(s) or other instrument(s) to the
purchaser(s), conveying a fee simple title. No purchaser shall be
obligated to see to the application of the purchase money or to make
inquiry into the validity of any sale(s). The Executor and Trustee are
authorized to execute, acknowledge and deliver deeds, assignments,
~ ~ ~-
Page 9
options or other writings as necessary or convenient to any of the power
conferred upon the Executor and Trustee.
(e) To mortgage real estate, and to make leases of real estate.
(f) To borrow money from any person, including the Executor
or Trustee, to pay indebtedness of mine or of my estate, expenses of
administration or inheritance, legacy, estate and other taxes, and to
assign and pledge assets of my estate or any Trust established by this
Will. This paragraph shall not be construed to authorize borrowing
from "Trust B".
(g) To pay all costs, taxes, expenses and charges in connection
with the administration of my estate or any Trust established under this
Will. If any death taxes are payable with respect to my estate, these
taxes shall be paid from "Trust A".
(h) To make distributions of income and of principal to the
proper beneficiaries, during the administration of my estate, with or
without court order, in such manner and in such amounts as the
Executor deems prudent and appropriate.
(i) To vote shares of stock which form a part of my estate or
any Trust established under this Will, and to exercise all the powers
incident to the ownership of stock.
Page 10 ~ ~ ~~/'~-
(j) To unite with other owners of property similar to property
in my estate to carry out plans for the reorganization of any company
whose securities form a part of my estate.
(k) To disclaim any interest in property which would devolve
to me or my estate by whatever means, including but not limited to the
following means: as beneficiary under a will, as an appointee under the
exercise of a power of appointment, as a person entitled to take by
intestacy, as a donee of an inter vivos transfer, and as a donee under a
third-party beneficiary contract.
(1) To prepare, execute and file tax returns of any type
required by applicable law, and to make all tax elections authorized by
law.
(m) To employ custodians of property, investment or business
advisors, accountants and attorneys as the Executor or Trustee deems
appropriate, and to compensate these persons from assets of my estate
or trust, without affecting the compensation to which the Executor and
Trustee are entitled.
(n) To divide any Trust created in this Will into two or more
separate Trusts so that inclusion ratio for purposes of the generation-
skipping transfer tax shall be either zero or one, in order that an
election under Section 2652(a)(3) of the Internal Revenue Code may be
made with respect to one of the separate Trusts, or for any other reason.
Page 11 ~~~''~
(o) To allocate administrative expenses to income or to
principal, as the Executor or Trustee deems appropriate. However, no
allocation to income shall be made if the effect of the allocation is to
cause a reduction in the amount of any estate tax marital deduction or
estate tax charitable deduction.
(p) To do all other acts in their judgment necessary or
desirable for the proper and advantageous management, investment and
distribution of the estate and Trusts established under this Will.
ITEM IX: The Trustee is authorized to distribute
principal and/or income in any one or more of the following ways if the Trustee, in
the sole discretion of the Trustee, considers the beneficiary unable to apply
distributions to the beneficiary's own best interests, or if the beneficiary is under a
legal disability:
(a) Directly to the beneficiary;
(b) To the legal guardian or conservator of such beneficiary;
(c) To the Trustee, or to another person selected by the
Trustee, as custodian under the Pennsylvania Uniform Transfers to
Minors Act as to a beneficiary under the age of twenty-one (21) years;
(d) To a relative of the beneficiary, to be expended by that
relative for the benefit of the beneficiary; or
Page 12 ~ ~ ~'~'`~
(e) By directly applying distributions for the benefit of the
beneficiary.
This power shall not apply to any distributions to my spouse from any trust which
has qualified for the marital deduction in my estate.
ITEM X: Should my wife, JANE E. MOORE, by Will
or Agreement of Trust, establish Trusts similar to the Trusts I have established for
the benefit of my issue, the Trustee of each Trust created in this Will shall have the
right to merge it with the similar Trust created by my wife for the same beneficiaries.
If merged, the Trustee shall operate the merged Trusts as a single Trust.
ITEM XI: Any person who has died within thirty
(30) days of my death, or under such circumstances that the order of our deaths
cannot be established by proof, shall be deemed to have predeceased me. Any person
(other than myself) who has died at the same time as any beneficiary under this Will,
or in a common disaster with that beneficiary, or under such circumstances that the
order of deaths cannot be established by proof, shall be deemed to have predeceased
that beneficiary.
ITEM XII: In the absence of actual knowledge of a
breach of trust, or information concerning possible breach of trust that would cause a
reasonable person to inquire, a successor Trustee is under no duty to examine the
accounts and records of a predecessor Trustee, or to inquire into the acts or omissions
of the predecessor, and is not liable for any failure to seek redress for any act or
omission of the predecessor. The successor Trustee shall have responsibility only for
property which is actually delivered to him or her by the predecessor and shall have
all of the powers conferred upon a Trustee hereunder.
Page 13 ~!~ ~"~-
ITEM XIII: The Trustee, on an annual basis, shall
provide each income beneficiary who has attained the age of eighteen (18) years, and
the Guardian of the person of any income beneficiary who has not attained the age of
eighteen (18) years, statements showing transactions each Trust established for the
benefit of that beneficiary. The beneficiary, or the Guardian of the person of such
beneficiary, may waive this right to receive an annual accounting. The Trustee may,
at any time, settle any account, or questions concerning the administration of any
Trust established under this Will, by agreement with the then current income
beneficiaries of the Trust, if legally competent, or if not legally competent, with the
Guardian of the person of the beneficiary, the legally competent spouse of the
beneficiary, or the oldest legally competent relative of the beneficiary who would take
a portion of the estate of the beneficiary were the beneficiary to die at that time
intestate under the laws of the Commonwealth of Pennsylvania. Any settlement
made in accordance with this Item shall bind all persons who have an interest in the
Trust, and shall constitute a release and discharge of the Trustee with respect to
transactions specified in the settlement.
ITEM XIV: I hereby nominate, constitute and appoint
my wife, JANE E. MOORE, and my daughter, ELIZABETH MOORE CALCAGNO, to
be the Executrixes, herein referred to as "Executor". In the event of the death,
inability or refusal of both of them to serve as Executor, or in the event of the death,
inability or refusal of both of them to serve as Trustee, MENTOR TRUST
COMPANY shall serve Executor or Trustee, or both. The Executor and Trustee are
specifically relieved from the duty or obligation of filing any bond or other security.
IN WITNESS WHEREOF, I have set my hand and seal to this, my Last
Will and Testament, consisting of this and the preceding thirteen (13) pages, at the
Page 14 ~'-~ ~- ~^"--~
end of each page of whigll I have also set my initials for greater security and better
identification this ~ day o~~~, 199,
L'`)~,-,-,~ .. ~ -.`~`-`..' ~ (SEAL)
WILLIAM THOMAS MOORE, M.D.
We, the undersigned, hereby certify that the foregoing Will was signed,
sealed, published and declared by the above-named Testator 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 set our hands and seals the day and year
first above written, and we certify that at the time of the execution thereof, the said
Testator was of sound and disposing mind and memory.
(SEAL)
(SEAL)
(SEAL)
Residing at ~ ~S~
2 loS
Residing at ~~ ~ • ~~¢-Q~ ~fi
-~
Y~1 ~c.~~ ~ ~7a55
R.Pair~inor at ~~ ~ ( F~ , e. l~-~OM , L-~.
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
(~'' ) SS:
COUNTY OF1_l,!~(: ~~. ~.~,-~ )
I, WILLIAM THOMAS MOORE, M.D., 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
and Testament; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
~ ~~~ ~~~s~AL>
WILLIAM THOMAS MOORE, M.D.
Sworn to and ubscribed before
me thi < a of
No ary Public
My Commission Expires:
Notarial Seal
(SEAL) Pvlarg8ret L. Boyd, Notary Public
Susquehanna 1'wp., Dauphin County
lvly Comm+ss4r..n Expires June 27, 2000
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF ~~ ~~{ ~L `~ ~Ml )
We, ' ~i ~ ~}' RTD ~ I E ~~~~$/-and
~ ,the Witnesses whose names are signed to the attached
or for ing instrument, being duly qualified according to law, do depose and say that
we were present and saw Testator, WILLIAM THOMAS MOORE, M.D., sign and
execute the instrument as his Last Will and Testament; that Testator signed willingly
and that he executed said Will 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
eighteen (18) or more years of age, of sound mind and under no constraint or undue
influence.
Witness
Witness
~P
Witness
Sworn to and,ssubscribed before
met is ~ ~~`day of
No ary Public
My Commission Expires:
(SEAL)
i Notarial Seal
f\lsrgaret L. Boyd, Notary Public
Susquehanna T,up., Dauphin County
hey rnrnmission Expires June 27, 200() d
151417_
V\
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: William T. Moore
Date of Death: November 5, 2002
Will No. Admin. No. 21-02-1035
To the Register:
I certify that notice of estate administration required by Rule 5.6(a) of the
Orphans' Court Rules was served on or mailed to the following beneficiaries of the
above-captioned estate on
Name
Address
Jane E Moore 1099 Countrv Club Road Camp Hill, PA 17011
Elizabeth Calcagno 1101 Countrv Club Road Camp Hill, PA 17011
Daniel W Moore MD 611 Campbell Hill Street, Marietta, GA 30060
James T Moore MD 2175 Terwood Road Huntingdon Valley, PA 19006
John E. Moore MD P.O. Box 1487 Anaconda Montana 59711
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
~'~~ J i F
Date: •~ ;.~ ' ~~. t `t ~ ~i; //~ ~
Signature.__....__a
Elyse E. Rogers, Esquire
Name
415 Fallowfield Road, Suite 301
Camp Hill, PA 17011
Address
_(717) 612-5801
Telephone
Capacity: Personal Representative
X Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
ROGERS ELYSE E ESQUIRE
415 FALLOWFIELD ROAD
SUITE 102
CAMP HILL, PA 1 701 1-4906
-------- fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: ssN: 203-34-~4~ ~
FILE NUMBER: 2102-1035
DECEDENT NAME: MOORE WILLIAM THOMAS
DATE OF PAYMENT: 01 /31 /2003
POSTMARK DATE: 01 /29/2003
couNTY: CUMBERLAND
DATE OF DEATH: 1 1 /05/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 ~ S 16, 000.00
TOTAL AMOUNT PAID:
REMARKS: ELYSE E ROGERS ESQUIRE
CHECK# 1006
INITIALS: AC
SEAL RECEIVED BY:
DONNA M. OTTO
S 16,000.00
DEPUTY REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 002109
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.28b601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
ROGERS ELYSE E
415 FALLOWFIELD ROAD
SUITE 102
CAMP HILL, PA 1 701 1-4906
fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SS-v: zo3-34-~41 i
FILE NUMBER: 2102-1035
DECEDENT NAME: MOORE WILLIAM THOMAS
DATE OF PAYMENT: 08/05/2003
POSTMARK DATE: 08/04/2003
couNTY: CUMBERLAND
DATE OF DEATH: 1 1 /05/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 ~ 59,680.79
TOTAL AMOUNT PAID:
REMARKS: ELIZABETH MOORE CALCAGNO
C/O ELYSE E ROGERS ESQUIRE
CHECK# 1013
SEAL
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
59,680.79
DEPUTY REGISTER OF WILLS
REV-1162 EX(11-961
NO. CD 002869
REGISTER OF WILLS
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of William T. Moore
also known as
No. 2102-1035
Date of Death 11 /05/02
Deceased Social Security 203-34-741 1
No.
Elizabeth Calca no and Jane E. Moore
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.
I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made
subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney: Elyse E. Rogers 1P ~
I.D. No.: 41274
Address 415 Fallowfield Road, Suite 301
Camp Hill, PA 17011
Telephone 717-612-5801
Personal Representative: ~ ,w, ,, nn
Jane E. Moore ~/~/~ ~ Gl/~~'
Elizabeth Calca~rlb
Dated:
DESCRIPTION VALUE
1. Evergreen Money Market Account #9070241520
2. Wachovia Securities Money Market Account #57751803
3. Payments re: Buck County Court
4. Social Security Benefit
5. Supplemental Medicare Reimbursement of Premium
6. See attached.
TOTAL
$ 4,694.94
$ 1,206.66
$ 26,473.00
$ 255.00
$ 727.89
$ 620,982.75
$ 654,340.24
(Attach Additional Sheets If Necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, i ncludethe value of each item,
but such figures should not be extended into the total of the Inventory.
Form RW-7 (Dauphin County) -Rev. 9/92
REV-1503 EX + (7-971 '~,
~' SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN I~
RESIDENT DECEDENT
iTATE OF FILL NUMHtK
21-2002-1035
Moore, William T.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION
NUMBER
.Fidelity Advisor Municipal Inc. - Wachovia Securities Account
#9070241520 owned as tenants in common with decedent's
surviving spouse, Jane E. Moore
Total shares 3,161.287
2 Franklin High Yield Tax Free Income Fund C1 C - Wachovia
Securities account #9070241520 owned jointly with decedent's
surviving spouse, Jane E. Moore
Total shares = 50,177.253
3 Franklin PA Tax Free Inc Fd C1 II - Wachovia Securities
account #9070241520 owned as tenants in common with decedent's
surviving spouse, Jane E. Moore
Total shares = 50,327.302
4 Franklin Strategic U.S. Long-Sht Fd - Wachovia Securities
account #9070241520 owned as tenants in common with decedent's
surviving spouse, Jane E. Moore
Total shares 259.378
5 Franklin Util's C1 C - Wachovia Securities Account #9070241520
owned as tenants in common with decedent's surviving spouse,
Jane E. Moore
Total shares = 3,904.834
6 Hartford Capital Appreciation Fund
Wachovia Securities Account #57751803
7 Hartford Mut Fds Dividend & Growth - Wachovia Securities
account #9070241520 owned as tenants in common with decedent's
surviving spouse, Jane E. Moore
Total shares = 2,782.876
8 Hartford Mut Fds Inc Cap Apprec Fd C1 C - Wachovia Securities
account #9070241520 owned as tenants in common with decedent's
surviving spouse, Jane E. Moore
Total shares = 2,110.832
9 Hartford Mut Fds Inc Cl C - Wachovia Securities account
#9070241520 owned jointly with decedent's surviving spouse.,
Jane E. Moore
Total shares = $1,856.107
VALUE AT DATE
OF DEATH
20,311,27
258,9L4.63
261,953.60
2,091.88
15,912.20
5, 96U.46
19,229'.67
21,224 .42
12 , 57 5.12
Total from continuation pages.... 2,8U9.50
TOTAL (Also enter on line 2, Recapitulation) I $ 620 , 982:.75
2wasss s.ooo (If more space is needed, insert additional sheets of the same size)
Estate of: Moore, William T.
Schedule B -- Stocks & Bonds
Item
No. Description
10 Microsoft Corp - Wachovia Securities Account #9070241520 owned
as tenants in common with decedent's surviving spouse, Jane E.
Moore
Total shares = 100
Page 2
21-2002-1035
Value at
Date of Death
2,809.50
TOTAL. (Carry forward to main schedule) 2,809.50
REV-1500 EX (6-00)
OFFICIAl... USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21
COUNTY CODE
20~ _103L __
YEAA NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ Moore, William T.
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ 11/05/2002 07/17/1923
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
C
Moore, Jane E.
SOCiAl SECURITY NUMBER
203-34-7411
THIS RETURN MUST BE FilED IN OUPlICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
W
I-
,,<l:U)
",","
w"-'"
::E:~O
Uo..a
!1i:
00,
D4
00 6.
D9
Limited Estate
Original Retum
D 2. Supplemental Return D 3. Remainder Return (dale Of death prior to 12-13-82)
D 4a. Future Interest Compromise (date 01 death after 12-12-82) 00 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a Living Trust (Allach copy QfTrust) .....!.. 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (dale of death belween 12-31.91 ard 1-1-95) D 11. Election to tax under Sec. 9113(A)(AltaCh&hO)
Decedent Died Testate (Attach copy QfWiII)
Litigation Proceeds ReceiVed
I-
Z
W
C
Z
o
"-
'"
ll!
..
8
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE foMlLlNG ADDRESS
Elyse E. Rogers, Esquire
FIRM NAME (If Applicable)
Keefer Wood Allen & Rahal, LLP
TELEPHONE NUMBER
415 Fa11owfie1d Road,
Camp Hill, PA 17011
Suite 301
717-612-5801
, 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)
, Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
Z .
0 6. JD' Owned Property (Schedule F) (6)
>= Separate Billing Requested
:5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
:> (Schedule Gar L)
l-
ii: 8. Total Gross Assets (total Lines 1-7)
()
W 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
II<:
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
d
L'"
0.00
620,982.75'1 :
0.00:
0.00
33,357.49
0.00
OFFICIAL USE ONLY
("
C'
I
Ul
:::::-;
549,132.04
'Cl
1,203,472.28
(8)
56,179.46
10,415.81
(11)
66,595.27
12. Net Value of Estate (Line 8 minus Line 11)
13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(13)
1,136,877.01
0.00
(12)
14. Net Value Subject to Tax (Line 12 minus line 13)
(14)
1,136,877.01
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax 547,479.55
Z rate, or transfers under Sec. 9116 (a)(1.2) x.OO_(15)
0
;:: 16. Amount of Line 14 taxable at lineal rate 589,397.46 x ,045-- (16)
<l:
I-
::> 0.00
"- 17. Amount of Line 14 taxable at sibling rate x.12 (17)
::E
0 0.00
'" 18. Amount of Line 14 taxable at collateral ra1e x .15 (18)
S 19. Tax Due (19)
0.00
26,522.89
0.00
0.00
20.
D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
26,522.89
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
2W46451,OOO
Decedent's Complete dress:
STREET ADDRESS
1099 Country C1ub Road
CITY J STATE I ZlP
Camn Hill PA 17011
Ad
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
26,522.89
0.00
16,000.00
842.10
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
16.842.10
0.00
0.00
TotallnterestfPenalty (D + E) (3)
0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
9.680.79
A. Enter the interest on the tax due.
(5A)
0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 9.680.79
Make Check Pa.~ab/e to: REGISTEROFWlLLS,AGENT
lilIIUlIllllllllllililll\\\llIlllill!IIIIIIIIIIIIl1!IIII!I!\11111Il\\11111111\lllml\II\I\lI\\\I\lI\IIII~.uI11\\I.\lIIII.1111\\I\I\\11111I\1\\I\\\\I\\\\II\\\\\\III\\\I\\\\\II\\\I\\\\\II~\\WIIIIl\\\I\I
II\\m1\\\I\lllllllllIlI\\\\\\\\\I\IIIII\I\\\I\\\\\I_
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
000
000
000
000
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . D IX]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 [XJ
4. Old decedent own an IndIVidual Retrrement Account, annuity, or other non-probate property which
contains a benefiCIary deSignation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., [Z] 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1 . Did decedent make a transfer and:
a. retain the use or income of the property transferred;. . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments, benefits or care? . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
Declaration of preparer other than the personClI representcltive is based on all information ofwl1ich preparer has BfI'Il<.nowledge
3
DATE
AOORE
/~
Camp
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value oflransfers 10 or for the use of the surviving spouse is 3%
172 P.S. ~ 9916 (01 (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (il}l
The stalute does not exempt a Iransfer 10 a surviving spouse from tax, and the s\a\utory requirements for disclosure of assets and filing a tax return are slill applicable even If
the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death 10 or for the use of a natural parent, an adoptive parent,
or a stepparent of the Child is 0% [72 P.S. ~ 9116(a){1.2)).
The tax rate imposed on the net value of transfers to or for Ihe use oflhe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S.@9116(1.2) [72 P.S. @9116(a)(111.
The 1ax rate imposed on the net value of transfers to or for Ihe use of the decedent's siblings is 12% {72 P.S.@9116(a)(1.3)1. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
2W464t11.000
Estate of, Willi~ T. Moor,
203-34-7411
Executrix
Elizabeth Calcagno
1101 Country Club Road
Camp Hill. PA 17011
Estate of William T. Moore
SSN 203-34-7411
Pennsylvania Inheritance Tax Return
Calculation of Shares of Beneficiary
Item IV of the Last Will and Testament of William T. Moore provides for the division of
the residue of his estate on a fractional share basis. Both fractional shares are to be
retained in trust. The numerator of Trust A is a sum equal to the unified (applicable)
credit amount and the state death tax credit (provided that the use of this credit
does not require an increase in state death taxes) allowable to Decedent's estate but
no other credit and after taking account of dispositions under other items of the Will
and property passing outside of the Will which do not qualify for the marital or
charitable deduction, and also after taking account of charges to principal that are
not allowed as deductions in computing the Federal estate tax. The denominator is
the value of the residuary estate. The balance of decedent's estate is to be distributed
to Trust B.
Total Gross Estate
Less Deductible Charges:
Schedule H
Schedule K
Net Value Subject to Tax
Divided Among:
Moore QPRT
Jane Moore, IRA
Moore Trust A
$
1,203,472.28
$
$
(56,179.46)
(10,415.81)
$
1,136,877.01
$
$
$
182,345.18
366,786.86
587,744.97
Allocation to Beneficiaries:
Property Passing to Spouse:
IRA
$ 366,786.86
$ 9,394.42
$ 171,298.27
$ 547,479.55
Moore QPRT Income Interest:
Moore Trust A Income Interest:
Total to or for Spouse
Calculation of Moore QPRT Interests:
Includible Value, Moore QPRT
Decedent's spouse is to receive the net
income of the Trust, of which one-half is
attributable to Decedent. The income is
to be paid until July 21,2004. As of
Decedent's death, the right to receive the
income from the fund until July 21,2004 is
(using the average of a 1 year term and a
2 year term)
Balance, Daughter and Grandchildren
Calculation of Moore Trust A Interests
Value, Moore Trust A
Life Estate - Jane Moore
Remainder - Issue
$ 182,345.18
$ 9,394.42
$ 172,950.76
$ 587,744.97
$
$
171,298.27
416,446.70
Annuity, Life Estate, and Remainder Factors
Estate of William T. Moore
Life Estate and Remainder Caiculation
Moore Trust A
Factor:
Value:
Transfer Date:
!l7520 Rate:
Calculation Type:
Principal:
Lives:
Ages;
Life Estate
0.29145
$171,298.27
Page 1
11/2002
3.60%
Life
$587,745
1
76
7/27/2003
Remainder
0.70855
$416,446.70
REV-1503 EX.. (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Moore, William T.
FILE NUMBER
21-2002-1035
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPllON
1. Fidelity Advisor Municipal Inc. - Wachovia Securities Account
#9070241520 owned as tenants in common with decedent's
surviving spouse, Jane E. Moore
Total shares 3,161.287
VALUE AT DATE
OF DEATH
20,311. 27
2 Franklin High Yield Tax Free Income Fund Cl C - Wachovia
Securities account #9070241520 owned jointly with decedent's
surviving spouse, Jane E. Moore
Total shares = 50,177.253
258,914.63
3 Franklin PA Tax Free Inc Fd Cl II - Wachovia Securities
account #9070241520 owned as tenants in common with decedent's
surviving spouse, Jane E. Moore
Total shares = 50,327.302
261,953.60
4 Franklin Strategic u.s. Long-Sht Fd - Wachovia Securities
account #9070241520 owned as tenants in common with decedent's
surviving spouse, Jane E. Moore
Total shares 259.378
2,091.88
5 Franklin Uti1's Cl C - Wachovia Securities Account #9070241520
owned as tenants in common with decedent's surviving spouse,
Jane E. Moore
Total shares = 3,904.834
15,912.20
6 Hartford Capital Appreciation Fund
Wachovia Securities Account #57751803
5,960.46
7 Hartford MUt Fda Dividend & Growth - Wachovia Securities
account #9070241520 owned as tenants in common with decedent's
surviving spouse, Jane E. Moore
Total shares = 2,782.876
19,229.67
8 Hartford Mut Fds Inc Cap Apprec Fd Cl C - Wachovia Securities
account #9070241520 owned as tenants in common with decedent's
surviving spouse, Jane E. Moore
Total shares = 2,110.832
21,224.42
9 Hartford Mut Fds Inc Cl C - Wachovia Securities account
#9070241520 owned jointly with decedent's surviving spouse,
Jane E. Moore
Total shares = $1,856.107
12,575.12
Total from continuation pages....
2W46963.000
TOTAL (Also enter on line 2. Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,809.50
620,982.75
Estate of: Moore, William T.
Schedule B -- Stocks & Bonds
Item
No. Description
Page 2
21-2002-1035
Value at
Date of Death
2,809.50
10 Microaoft Corp - Wachovia Securities Account #9070241520 owned
as tenants in common with decedent1s surviving spouse, Jane E.
Moore
Total shares = 100
TOTAL. (Carry forward to main schedule) . . . . . .
2,809.50
Estate of: W~::ian_ _" Moore
Item
No.
Descript:ion
, Fidelity Advisor Municipal
Inc. r Wachovia Secu~ities
Account #9070242520 owned as
tenants in common with
decedent1s surviving spouse,
Jane E. Moore
Total shares 3,~61.287
2 Franklin High Yield Tax Free
Income Fund Cl C - Wachovia
Securities account
*9070241520 owned jointly
with decedentls surviving
spouse, Jane E. Moore
Total shares = SO,l77.253
3 Franklin PA Tax Free Inc Fd
Cl II - Wachovia Securities
account #9070241520 owned as
tenants in common with
decedent1s s~rviving spouse,
Jane E. Moore
Total shares = 50,327.302
4 Franklin Strategic u.s.
Long-Sht Fd - Wachovia
Securities account
*9070241520 owned as tenants
in common with decedent's
surviving spouse, Jane E.
Moore
Total shares 259.378
5 Franklin Utili s Cl C -
Wachovia Securities Account
*9070241520 owned as tenants
in common with decedent's
surviving spouse, Jane E.
Moore
Total shares = 3,904.834
6 Hartford Capital
Appreciation Fund
Wachovia Securities Account
*5775:1.803
7 Hartford Nut Fds Dividend &
Growth - Wachovia Securities
account #907024~520 owned as
tenants in common with
decedent r.s survivi.ng spouse,
Jane E. Moore
Total shares = 2,782.876
Hartford Mut Fds Inc Cap
Apprec Fd Cl C - Wachovia
Securities account
SchedulE: ::f, -- StockE" and Bonds
Uni:: Val.
CUSIP
1:.85
10.32
10.41
16.13
8.15
20.11
13 .82
20.11
TOTAL. (Carry forward to main schedule)
Alternate
Val. Date
Al ternate
Value
Page
203 -34 -7411
Value at
Date of Death
20/ 3lJ... 27
258,9:1.4.63
26:1.,953.60
2,09:1..B8
:1.5 ,n2 .20
5,960.46
19,229.61
21.,224.42
605,598.13
Estate 0=: Wi::iarr: ~. Moore
It"'"
No.
Description
Value at
Da te of Dea ~b
8 #9070242520 owned as tenants
in common with decedentts
surviving spouse, Jane E.
M.oore
Total shares = 2,220.832
9 Hartford Mut Fds Inc Cl C
Wachovia Securities account
#907024~520 owned jointly
with decedentls surviving
spouse, Jane E. Moore
Tota~ shares = $1,856.107
20 Microsoft Corp - Wachovia
Securities Account
#9070241520 owned as tenants
in common with decedent1s
surviving spouse, Jane E.
Moore
Total shares = 100
Schedule B -- Stocks anc Bonds
Unit Val. Alternate
CUSIP Val. Date
13 .55
56.19
TOTAL. (Carry forward to main schedule)
Alternate
Value
Pagt:
203-3';-7411
12 , 575 .12
2 , 809 .50
15 , 384 . 62
FAHIX. CS\
"Historical stock prices provided bv C5:=, Inc. Historical mutual fund ana lnaus~ry
prices pravlded by Media General Fi~ancial Services."
"Fi de 1 i ty Advi sar Muni ci pal lnc T (FAHIX)"
Daily prices (11/5/2002 to 11/5/2002)
DATE.HIGH,LOW,CLOSE,VOLUME
11/5/2002,12.850,12.850,12.850,0
page 1
FHYIX.C5V
l'Historical st:ock prices provided by csr, Inc. Hlstorlcai mu'tua~ fund and inaus-rry
prices provided by Medic Genera"1 Financial services."
"Franklin High Yield Tax-Free Inc C (FHYIX)"
Daily prices (11/5/2002 to 11/5/2002)
DATE,HIGH,LOW,CLOSE,VOLUME
11/5/2002,10.320,10.320,10.320,0
page 1
FRUSX.CSV
"Historica-: stock prices provided b) CSI, Inc, Historical mut:ual fund and industrv
prices provided by Media General Financial services,"
"Franklin utilities C (FRUSX)"
Daily prices (11/5/2002 to 11/5/2002)
DATE,HIGH,LOW,CLOSE.VOLUME
11/5/2002.8,150,8.150,8.150,0
page 1
FRPT\.C5V
"Historical stock prices provided b\ (52:, Inc. Historical mutual, fund and indus-:ry
prices provided by Medic: Genera") Financial Services."
"Franklin PA Tax-Free Income C (FRPTX)"
Daily prices (11/5/2002 to 11/5/2002)
DATE,HIGH, LOW,CL05E,VOLUME
11/5/2002,10.410,10.410,10.410,0
page 1
FUSLX. CS\
"Hi stori ca I stock pri ces provi ded by CS1, Inc. Hi stan ca mutual fund and i ndust ry
prices provided by Media General Financial Services."
"Franklin U.S. Long-Short (FUSLX)"
Daily prices (11/5/2002 to 11/5/2002)
DATE,HIGH,LOW,CLOSE,VOLUME
11/5/2002,16.130,16.130,16.130,0
page 1
HDGCX.CSV
"Hi stari ca 1 stock pri ces provi ded b\ CSl. Inc, Hi sto ri ca 1 mutual func and i ndust ry
pri ces pravi ded by Medi a General Fi nanci al Servi ces. "
"Hartford Dividend & Growth C (HDGCX)"
Daily prices (11/5/2002 to 11/5/2002)
DATE,HIGH, LOW,CLOSE,VOLUME
11/5/2002,13.820,13.820,13.820,0
page 1
HCAC\. CS\
"Hi stori ca I stoCk pri ces provi ded bv CSl. Inc. Hi sto,i ca I mutua I fund and i ndust ry
p ri ces pravi ded by Medi a General Fi nanci a 1 servi ces. "
"Hartford capital Appreciation C (HCACX)"
Daily prices (11/5/2002 to 11/5/2002)
DATE,HIGH,LOW,CLOSE,VOLUME
11/5/2002,20.110,20.110,20.110,0
page 1
HSFCX.CSV
"Historical stocl: prices provided by csr, Inc. Historical mULual func! and industry
prices provided by Media Genera"' Financial Services."
"Hartford Stock C (HSFCX)"
Daily prices (11/5/2002 to 111512002)
DATE,HIGH, LOW,CLOSE,VOLUME
11/5/2002,13.550,13.550,13.550,0
Page 1
MSFT.CSY
"Historical sLock prices provided by CSl. Inc. Historical mutual fund and industry
pri ces provi oed by Medi a General Fi nanci a I Servi ces . "
"Mi crosofL corporati on (MSFT) "
Daily prices (11/5/2002 to 11/5/2002)
DATE,HIGH,LOW,CLOSE,VOLUME
11/5/2002,56.800.55.580,56.680,38329100
Page 1
REV-1508EX+(1-97}
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE Of
Moore, William T.
FILE NUMBER
21-2002-1035
Include the proceeds of litigation aOO the datetl1e proceeds were raceived by the estate. All property jolnUy-owned with the right of survivol'$hlp must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
1. Evergreen Money Market #9070241520 owned as tenants in
with decedent's surviving spouse, Jane E. Moore
Total value = $9,389.88
cormnon
VIILUE liT DIITE
OF DEATH
4,694.94
2 Wachovia Securities Money Market Account #57751803
1,206.66
3 Payments re: Bucks County Court
26,473.00
4 Social Security Benefit
255.00
5 Supplemental Medicare Reimbursement of Premium
727.89
2W46AD2,OOO
TOTAL IAlso enter on line 5 Recaoitulation) $
(If more space is needed, insert additional sheets of the same size)
33,357.49
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REV-1510 EX+ (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Moore, William T.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21-2002-1035
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBEF;
1.
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO
DECEDENT MOTHE DATE OF TRANSFER. ATTACH A COPY OF THE
DEED FOR REAL ESTATE
Wachovia Securities IRA
Account #5775-1801
Beneficiary: Jane Moore
DATE OF DEATH
VALUE OF ASSET
366,786.86
%OF
DECO'S
INTEREST
100.00
EXCLUSION
IF APPLICABLE)
0.00
TAXABLE VALUE
366,786.86
2
William T. Moore and Jane E.
Moore Qualified Personal
Residence Trust
See attached.
182,345.18
100.00
0.00
182,345.18
TOTAL (Also enter on line 7, Recapitulation) $
549,132.04
2W46Af2.000
(If more space is needed, insert additional sheets of same size.)
Estate of William T. Moore
SSN 203-34-7411
Pennsylvania Inheritance Tax Return
Schedule G
Item 2, William T. Moore and Jane E. Moore Qualified Personal Residence Trust
Decedent and his spouse jointly created a qualified personal residence trust ("QPRT")by
agreement dated July 22, 1998, a copy of which is attached to this return.
The residence which had been transferred to the QPRT (and which had been jointly
owned by Decedent and his spouse) was sold prior to Decedent's death, and consistent
with the terms of the QPRT, it converted to a grantor retained annuity trust. The
Annuity Amount, as defined in the QPRT, had been paid to Decedent and his spouse, as
required by the terms of the QPRT, until Decedent's death, and the Annuity Amount has
continued to be paid to the Decedent's spouse from the time of his death.
As of decedent's death, the fair market value of the assets included in the QPRT was
$364,690.36. One half that amount is $182,345.18. This amount is attributable to
Decedent and reported here.
Annuity, Life Estate, and Remainder Factors
Factor:
Value:
Transfer Date:
!F520 Rate:
Calculation Type:
Principal:
Term:
Income Interest
0.068291
$12,452.53
Page 1
11/2002
3.60%
Term
$182,345
2
7/27/2003
Remainder
0.931709
$169,892.65
Annuity, Life Estate, and Remainder Factors
Factor:
Value:
Transfer Date:
97520 Rate:
Calculation Type:
Principal:
Term:
Income Interest
0.034749
$6,336.31
Page 1
11/2002
3.60%
Term
$182,345
1
7/27/2003
Remainder
0.965251
$176,008.87
,:al'" CT1S~'
WL....UAr,' THOMAS MOOR:=: IR.--
::-2:; A;::; :::USTODIAI
UiH DTl! 04122/9'[
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DartroUr. Assets
'\r
C 1'" e,.l'm:;' c-;-:~;::-l ',~ _.1 ~',';:_'"',c e~"l ':: : ~'c::'. r ; ',C:' .
T-,- l;.~.L' ,,,' SC~IJ;i,,, ~,: "r I 'S;;;,~fT:" ~ C'8S:,d (y,
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~:'r;t~i,,) .,-ma I,,::" ~il~~ i ?y,. \2\'
~. u~;e;:;:;:~:::_~' ,l~'1:;~IIC,~ori ...,
'ell:"
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ue~crro:::
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7:
tow,.._'! Pe'Jo~ '....0'/0, . 12.'~1/C
lotal casi, and mon!)'f rnari(('l Tund.s
S-5,050.7~
Stocks and options
Slock~,
l.ta~tnp:lc~
['LlT'.", ei'lE-Rtr"SOR"
Symo:
#O'$r'1areb
Curren' JUlTer t~:. .(l.nr ~S\,MK,
sharnDnC( ma'KeIV8JU, I~ct'm; vIe:: 7;'
$19,740C S;~.3t;S.2'1 ;<4_ vi , .,~ $1E:: .6~ 5.5"
--:2. ,
:7.33OC' $252.9: ,Ilj NIl', N'i
$
$11.380c. $',:\36.00 :;, 'I':, G~ $.<\0.00 3,5'
$109,0 $8,100.51 riG; , ~ ~) Nt;". Ni~,
rJ ' :,.\ ,J v
I
$'9.210(: $3,13v.<lf , ~.::..., C) -) " ~3:.75 1.04
d , \""::i
$12_7200 $3.D52.SC 3 Sl.2_A-e. O.4l-
d i I J;:o
,
Si~,74:!..9!O S2n.9:2 1~,
Si4.7~2.!le :\\27::.92 7.a,
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1"0RtI MTR CG D::.!..
COMPAR$(),C1
GU)Bf',l lMAGIN3 SYSTEMS
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lOW,:
,70.6340:
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AiVEF1i\IDFcOSI-:-C;P'fR"GEiC-'-
Total Stocks
10m) Slocks and option!>
(\1;))'
162.96ooD
Sf'Y
24D
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DA T". HIGH. ,-OV" C,-OSE. VO,-UM:
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DAT~.HIGH.LO~.CLOSE.VO~UME
l2. '5 '200= ,IS, 170,1:- .460, It:, 000, 1350700C
page 1
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Dai-i) Dei ces (11/5 '200:' to L;, '5 '2002,
DAT~,HIGH,LO~,CLOSE,VOLUME
E/5,'2002, 34.570,34,570,34.570,0
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QGALWIED PERSOl\iAl RESIDENC'" TRLT8T
On this). 2-dav of \iML~, ' 1998. thiE trust was created by
, \
\VILLLW T MOORE and JA....O,m E MOOP,E of ?lumstead Township, Bucks
County, Pennsylvania (collectively the "GrantorE"i and ELIZABETH MOORE
C.ALCAGNO (the "Trustee"). on the follo\i\wg terms andconclitiollE:
...AJtTICLE I:
Trust Created and Purposes -
(a) Trust Created-Grantors declare this trust, which shall
qualify- as a "qualified personal residence trust:f-' ("QPRT".'! "VVit~~n the
meaning of Section 2702(al .of the Intemal.Revenue Code of 1986, as
amended (the "Code") and Treasury.Regulations s25.2702-5(c). In
considecation of the covenants set forth in thisA="Teernent, Grantors
assign and convey to the Trustee the real property listed on Schedule
A, (the "Residence") to be administered according to the tems of tr~s
instrument. 'Nith theconsem of the Trustee, Grantors CLnd anyone
else may transfer additional property to the Trustee, to be held and
administered according to the Trust's tems. The Gra..TltocE retain no
right, title or interest in any Trust property except as specifically
provided in A...rticle III.
(b) Purposes - This inst,ument shall be construed
consistently with the following pm-poses:
(i) Grantors intend to make a completed gift to their
daughter, ELIZ/u3ETH MOORE CALCAGNO, of a vested
remainder in the Trust property Eubject only to the Grantors'
retention of a right to the use or the Residence and the income
from the TrUSt for six (6) years. Grantors! interest in this
r~;us- 311a:L :2:1\;; tll'2D OIL!- i.:1..lU,":'. :T:l1;.- \':IlJ:;~ U-,.-.. 07"(llIl':::i.=-11~.
aSS{JelaT.'2( "\YltI (1:: lIlCOnl~ Int'~:r::::.:;;. E '- t;:-US". TCr ~.. "L~m>-I01-
vea:"'~-
i,ll ~nC- \...;r:-anlO:',l" llllenc. tIla-. tilE ~-!"us-, c:onSti.:.utf c
Q?r:~ pursuan',- 1(' tn,;: a:ppii:::ar.)i~ TegTIla-r;ion::..: oj. tn:=:' i....."":.5_
:Jeparcmenl- of the Treasu::.\- promulgateo v.itn respec: t.()
Se:;tioD :::70::: of the Code. and an term,", used In tills Agreemem
shall have the same meaning- as the,- de in ];he Code and the
applicable regulations
ARTICLE II; Irrevocability - This Trust is irrevocable.
Granto:-s have no power to alter, amend, revoke, or terminate any Trust provision
or interest, whether uncle:- this J'.-ooreementorany statute or rule of law.
.A.RTICLE III: Dseof the Residence - Trustee shall hold the
Residence for the Grantors' exclusive personal use and benefit. The folloliving
nues shall apply until the fusl to occur of Ii) the death of the slli-vivor of the
Grantors, or (ii) the;e~piration of sa (6') years from the commencement of this
Trust:
(a) Grantors's Use - Grantors shall use the Residence
without rent or other chaJ,'ge, a..'1d the Trustee shall maintain the
Residence from the Trust .fa.TJ.ds, including 3-t'1Y rental income received
by the Trustee.
(b) Expenses - The Trustee shall notify the Grantors of any
e1.penses inclL'Ted by the Trust for maintenance of the Residence,
which expenses exceed the Trust's cash assets. The Grantors may
pay such expenses directly, ",ithout any right to reimbursement from
the Trust.
(c) Rent - The Trustee may rent the Residence on terms
and conditions as the Trustee shall deem app:-opriate, but solely for
use as a residence. The Trustee may rent the Residence only with
the Grantors' permission.
n
- .:. -
i,( r}ls:?:"iou~ioL () .lIlCOm~ _ >0-_ In~Orrti- C :E. ~_~U~~ nlLl.':
D!:-:- OlSt::"'l[)UleC v 1Jl~ ;~-;::=-anl,o:~ au:. t. trl' su-",::r,'o:-- C -':::11- _.:'anLO:-~
no-.. J~3:~ freauentJ:- t:Gar. annualr
\ f' C)the~ Dist~ioutionF - ~nc ~:-U3l:.~~ fie):::- no: QlS-C=-lDUT~ 1.r120rr1.~
O~ COIUUE IX anvoDc othe~ tnaL tht ':;::-amo:::E
(1' Limitation on 'r~st Plo.ssets ~ E::r.cept as prO\71U8C II:
paragraph i,g J. the T!"usteE' may hold in fni~ ~ruBT oriiy thE' f~esid en:.:e and
improvements to the Residence that do not ~nange Its s~atus as a per-sonal
residence of the Grantors.
19) Cash -
(i) The Trustee shall "at no time acceptaddition.s of or
hold more cash or cash equivalent (when added to amOlL.","ts
already held in such account) than is :reasonably required for:
(:..'-:..) The payment, ofTruste~:.penses (inclu~~g
any mortgage paym.ents) alreaqyincurred or reasonably
expected to be inclL.--yedv.:-:ithin the next six (6) months
follo"Wing the date on which the addition of cash is made:
(El Improvements to the Residence to be paid
Viithin the next six (6) months folloViing the date on
which the addition of cash is made; and
(e) Purchase by the Trustee of a residence to
replace the Residence, within three (3) months of the
date of the addition to the Trust of the cash, but only if
the Trustee has pre"\iously entered into a contract to
purchase a replacement residence before the addition of
the cash to the Trust.
(iiJ The Trustee shall determine not less frequently
than quarterly the amounts of cash that the Trustee may hold
n
,:, -
UilCl'.~' :UL D8.:-2.=:-(1)l ane. ':;lldi Q.L::;t~WUl' cllY "~:::'::::5. '..:a.s~ L
tll~ u::':J.Ilt07:".' Inmle.lliaT~.!~ Iol,\\lY'111~ su:.:. U~~L.C':::TIlln8.:.JOL
;,111 ~ne ~'yuste'::- sllat nUlL a1 ~a.sL~ ill1.~: cas!
equJ\'c.l1enLS IE ar: ac:::oun-, IT. ~rE' narll-::' 0:: tlJ.7 ~:-1LC;~_
(1'1' Sale of the Residence ' ':::'h~ 'Imsce;- ma:' sel ;;hE
F~esidence and ma" hoid au" proceeds fron: th, sale of th" Flesidencc
(including: any income or gain.s the~eon ir; 2- separatE account fo~ a
period noi to exceed tvVo (21 years -rrOIr.c -;.;he date 0:' sale. Th~ T'rust,8e
shall use the proceeds (and ali income and gains thereon' to buy
another residence to be used as a personal residence of the GrantorE
(also referred to as the "Residence"),
(i) Insurance Proceeds - The Trustee may hold one (1, 0:-
more policies of casualty insurance on the Residence.
(i) The Trustee shall hold ill a separaLe aCCOlL.""lL the
pr-oceeds oraDY insurance paid to the Trust as a result ,of the
damage to or'destruetion of:the P...esidence (includLl.g, for
purposes of this Trust, any amount received by the Trustee as
a result offhe involuntary conversion of the Residence <within
Lhe meanL.'1gof Code (;1033) fora period not to exceed two (2)
years.
(iD The TTus1ee shall expend all proceeds (including
any gaL.'1S or income earned 1hereon) for the purchase,
construction, reconstruction, and/or repair of a personal
residence for the Grantors, to be held and owned by the Trust
as a replacement for the Residence (also referred to as 1he
"Residence"). Such expenditures must be made wi1hill two (2)
years from the date on vrhich the Trustee receives the proceeds
of the invollLTltary conversion of the Residence,
(j) Trust Term - The te= of this Trust begins on the date
of the first transfer to this Trust. The interest of the Grantors shall
- 4 -
"i.J2=-r111I..:.av OL tn, ea~~ll~~-- LL t11' u~;(:r~l O. l11'- .sU--"'T';,'C' C' tlE ~-;--'-'an\.D~:
O~." tll~- e:'::VI:-at.lor O~ Sl=~ Il< ?sa:r,' T~-on_ tn.. ::omr:n~n:::8n1eD-c () ::;11.1.'
r~u.s-..... aIle till:: t~us-, sna1 -r;e::-rrunaI>- a~ -ell: tlnl~ Irrn"",cl0l2C IT ~c-Jt.l:::_L:'
T\
_L..t~TI;8LE T\;":
'I ernrinatioL 0:" ~rus:: - 'I"l:li~ ,="YUS-; slla.:L
terminate at an:,rtirne aite:- thE" death of t.hE': SUTy'ivo:- 0::' tnE C;-rantors. aE
decermmed by tne 'I:mscee The 'Trustee shall. within huny (30 dav" of tile
termination 01 Granton,'E term incerest. distribme to the G:-amorE an,. cash held
bv the Trust and not needed to pay expenseE then due and pavable J'iller the
expiration of the Grantors. te= interest, and until termination of the Trust, the
Truscee shall continue w hold the balance of the assets in the Trust aE Truscee.
for the benefic of Grantors' daughcer, ELIZl<.BETH MOORE CALCAGNO , if she iE
then hvine:. If she is not living at that time, the Trustee shalLcominue to hold L'le
balance of the assets in the Trust as Truscee, for the beneiitnr the issue of
Grantor's daugher, ELIZllliETH MOORE CALCAGNO, as provided in
i\RTICLE Y
ARTICLE V: Provisions for a Child or Grantors' - T'ne
rollovving provisions shall apply to this Trust afterthe expiration of Grantors' te=
interest and until termination of this Trust:
(a) Income - The Trustee shall pay to or for the benefit or
Grantors's child, ELIZlillETH MOORE Ci\.LCAGNO, in convenient,
at least quarterly installments, all of the net income.
(c) Principal Invasion - The Trustee shall distribute sa
much or the principal of this Trust as Trustee, in the sole discretion
of the Trustee, considers necessa.ry to maintain Grfu'1.tors' child,
ELlZiillETH MOORE CALCAGNO, in tne proper station in life,
including prDper support, maintenance, medical care and education.
(d) Termination - The T:-ustee may terminate this Trust at
any time after the expiratiDn of the Grantors' term interest, as the
Trustee deems appropriate. Upon termination, the Trustee shall
distribute to ELIZ.6"BETH MOORE CA.LCAGNO, iflivi.TJ.g, the assets
"
<.> -
C ~ll~ t~-US'~ -;-":C=~I=-:)..~\I'''='~~ h~ _ -"}-~=_
nc-, lr-UL 0..- :u-
nn-l'~ O. "C'2:'JlllT.:..atlOL. Ill; as s '2-:'.:.
c- tnl.'
r
":":-US'
.snell
[F IJillC
t., ~.)_C_
'~.i'~:":.f~C;-l\l'~ a.~ ': ~USle.-:. :1\ r:='I:":},=-'':: Ie IF. aC1nUIllSle;:-t;.:. Clue
distriout-'8C: fE Iollenv:::
',"
DP.. ,\'Trl C}-:~__/~~'A..,"JN:= ~ -eriE. l!~:-usle.::~" shaI
di-'iriciE' tnf assets of tIu:: 'Irus: lnic as man:;- equal par:::::
as there are then hY'l_n[ childrer::. oi" :C:"J2.A.EET3
MDOP.E CA.LCAGNO, and shall hoid each share as a
separate Trus'C for the benefit of eacn at her :::hildren.
'ii,' In each Trust established fora living child
of ELIZABETH MOORE C~I).LCAGNO I the "Benenciary"r
A, Trustee shall pay to o!' for the
benefit of the Beneficiary so muel:; of the net
income of his or her Trust as the Trustee, ill
the sole disc!'etion of ,he Trustee, deems
appropnate.
B. Trustee shall also pay to or for
the benefit of the Beneficiary so much of the
principal as the Trustee, in the sole
discretion Dfthe Trustee, considers
necessary tomain,ain the Beneficiary in the
proper station in life, including support,
maintenance, medical care and higher
education.
C. Upon the attainment of the age
of w'enty-nve (25) years by the Beneficiary,
the Trust shall terminate and the Trustee
shall pay to the Beneficiary the assets of his
or her Trust.
- 6-
SnnUlC -ell. ~_):;ll~ll:':i~l-"" cu
neror:- una Qlsr:-U1LlI:lOI o. tlL ;:.L~~2l_~ Ci rn,
0:'- ne:-" ~rus-~_ 1:11:- ~:-us~ s:nal. te:nnnal' arE
L;lJ~ ~:7:"uste<; snaL 1:)8~ fnt- a8sel~- 0: l:Ll-- ~-::u,s:
tc' tnt trier.:. lrvin~- lSSUt, 0:- -en,: BeneiiC:la~~'.
pel' stI!:"pez. ..t1Qwe,re:-. 1: any lSSUf l1a5: no:
attained thf' age ort\ven7,~;--orE- ;,-:':~ ' :vearE a:
the time of distribution. the ~:rustee snaIl
hold th~ share ror that issue (the "issue": aE
a separate Trust. The 'Trustee shall
quarterl:\' pay to or ror the benent of the
issue all of the net income and so much of
the principal as the Trustee, in the
discretion of the Trustee, considers
necessary to maintain the issue h'l the
proper station in life, including proper
support, maintenance, medical care, and
college or higher education. The Trus-r shall
terminate when the issue actains the age 0:
twenty-one (21)_ye.ays,but in no <event later
-rhan twenty yearsaiter the death of the
Beneficiary. The Trustee shall distribute
the assets of the Trust to che issue at the
time of termination.
E. If at any time before final
distribution of the assets of any or the
Trusts established for children or
ELIZP-..BETH MOORE C".u,CAGNO, there
are no livL.'lg beneficiaries of -rhe Trust, the
Trust shall terminate, and its assets shall
be added to the other- then existing TrustCs!
created under tbis Agreement for the
benefit of ELIZABETH MOORE
C.u,CAGNO's children or their issue, in the
same proportion by which the 'Trusts were
7 -
IunU~ .~~
--
:lnY.'~Y'<,'~,::~
J~ aI"
: ~u:.;:-
"'-'
."~
"LernllIl8.Lt;C [\- I)a_--;Ynlen~_ 0 r::.- n:-Ul:'..TU0. v 1L
[lenen:;laTH~.:.. tn'- i)eIleil:;la:-lf::.~ \'.'1:l( r~':.:e~"(,'~:.
-erlt-, pnnSllH:L 0': tna~ ~7"US~ snal :,;uEeS:Tvei'
ij~' conSlOerec:' 3r Te:.G5tm; '::_TUS',:' 10:' tl1~
puTpos::- of tillS pa:-a~ap}-~. and tl1>: sha::-E:
\vniCD vvoulc nav,;:, bBer: aodec tll tna"t 7rusl
shall be paid dlrectj,- to the benencia:cieE
V\"no received thE assetE in the same
proportioIJ by vvbich they received thE- assets
of the 'Trust. If any beneficix-y is deceased._
the share of that beneficiaT}- shall be paid to
the then living issue of that beneficiary, per
stirpes_
_t\RTICLE '\'1: Cessation of QPRT Status - This 'I:rust shall cease
to be a QPRT on the following dates and to ];he follov;ing enent:
(ar Ownership afOther Assets - With respect tome
entire TrusL fund, the Trust shall cease to be a QPRT on che date
that t;he 'Irusc first owns any property other than one (11 personal
:-esidence of the Grantors and such incidental amounc5 of cash and
casualty insuranceothen;ise permissible under _iIrticle III, regardless
of the reason for such Trust ownersbip_
(bl Sale of the Residence - With respect to the proceeds of
the sale of the Residence, the Trust shall cease to be a QPRT the
earlier of the date two (2) vears after the date on which the Trust
sells the Residence and the date all which the Gr8-Tltors's interest in
the Trust ter=inates, unless a new residence is bought by the
Trustee_
(c) Involunta-'J' Conversion of the Residence - With
respect to those proceeds of the involuntary conversion of the
Residence to the extent that the conversion renders the Residence
unusable as a residence, the earlier of the date two (2) years after the
- 8 -
Gar'" cr tlF 11'V(Hlln~a""'-. COTl1Ji:yrslol an~ Ill' CUll- 0:: \':11..1::: :,1)-
Jra.nLor.~. ID:"7'~T~5~ lL tn~ ~>-U3: l~--:nllIlale.:: UIlL::::.'3,' n:-1(;" ::n-=,::~.~'l'
:'enla::enlen-, O~ O~- ::-eVUlr.': II tn~ heSIClenc.<:- aT':- 2:()nJ.1J.l~te: 0"'" ~^ n~\-
reUlacenlsn; reS1ClSllC:- 1~;: a~C~Uliec iT':' tn~ ~ ~us:..
19'"1':'ICLE ~-r:Il:
Conve.:-sion tc GF~;...T' -
\ a I Cessation Date - Thl2 date on whidl the Trust cease.::: to
be a QPRT under the previous aTtde shalJ be known as the
"Cessation Date."
(b I Conversion to a Grantor Retained i\nnuity Trust
Within thirty (301 days from the Cessation Date, the Trustee shall
convert the Trust to a Grantor Retained Annuity Trust ("GR"'-T").
The date of such conversion shall be referred to as the "Conversion
Date."
(el Annuity A,mount -From theConve~sioI'. Date lL'ltiJ the
termir"atioD of this 'I rust, the Trust shall function exclusively as a
GRAT. Du...'ingsuch term, the Trustee shall pay to the Grantors, and
to the su...rvivor of the Grantors, an "lumuity -",mount."
(i) The A,nuuity l'unount will be determined by
dividing the lesser of the value for federal gift purposes of all
interests retained by the Grantors in property transferred to
'this Trust (as of the date of such transfer) or t..'lJ.e value of the
Trust assets on the Conversion Date, by the annuity facwr for
the initial term of the Grantors' interest in 'the T:ru.st,
determined under Code &7520 (as of the date of the transfer).
(ii) If only a portion of the Trust terminates because a
portion of the Trust continues to be a QPRT, then the i'~'lc"lUity
Amount shall be a fraction of the amount determined in
paragraph (i) above.
- 9 -
~.
_,.1.1.- nunl ~~-'alo> (j ::'ua- r::a::JG: .3l.<.::l_~
tJ': U17 ~x:~~::;. O~ ;:n~ leU:- nla:T~e-, "',CatU'. O~: tll~ _:"'US.
. -
asset;;.: OL tn' ~iOD"v~:-31nL .Jell' (1';8" 1::11': an1()1...1I'~.
llnCluciln~ asquiSI:;lOl: coSt,::. i~. LlJJ:,. re1l1'_Test~c Ir.
:11:" n~v, reSlaen~7 O~. e::uenoec 10~' TeDal=-~ Q~ tll'::
eXlstin; r~esiden::~.
(B The denominator 0; tha: f:-actioL silall
be the fair market \'alue of the Trust asse" or, :he
Conversion Date.
(dl Commencement of Annuitv . The Trustee shall begin
- ~. ~
paying the Annuity j\mount not later than thirty (30) days mer the
Conversion Date.
Ci) The Grantors entitlement to the Annuity A.mOlli"'lt
shall begin on the ,Oessation Date,
(ll) .f;:ny .b...'1Iluity iUD.O\LTlt deferred until after ths
Oessation Date shall be paid together with interest, computed
at a rate equal to the interest rate assumed ror noncha.-itable
interests underOode si520 on the Cessation Date, adjusted by
the amount of any income actually distributed by the Trust to
the Grantorsrluring the dererral period betvveen the Cessation
Date and the date on which the .f;:nnuity lunount is paid.
(e)
Annual Pavments - The P..nnuitv iunount shall be paid
" " .
in equal fu'Ulual installments from income and, to the e~tent income
is insufficient, from principaL If greater than the ilnnuity.<\moli..'1t,
all income of the Trust must be paid to the Grantors not less
frequently than annually.
CD Proration - In determining the iumuity .<\mount, the
Trustee shall prorate the ,il,nnuity ?...mount on a daily basis for short
taxable years.
- 10 -
,r- .....rlCO~eC: ::Jete:nuI~ar.i(n-_ ~- ::11- lIlli:lc lE:~-, la~-
ma:-l;.e- ~:a1U' 0_: t,111- ~,__rus'" aSSP:L L In~:O:-'t"~~:.:tf< Cl:~-"e:-r:Dn::( rr- :n;
~-:ruSV,~:.. tner \',TitUIL c T8asonaOl: perlCJ(. arLe~ tn,:- DIlLL ueLe:-rmna-~lOr
oi tIH" ::'~O:-T"eC7 -.'>>alu~, in\:-' T;-ust~:' shaJ) PO,T,- tl tll~_' i=-~:-anLors_ n. cas:- 0:
aL UIlaer,TaluatloL. OT thf GrlliltO:i5-- sllal va:- tc tn~ ~'".:UsLeL_ IL tn':':
caSf-' 0= ar: C1V87:\.'aiuatlOL. aD aIIloun-, ~qua tc tnf- difference be7:\V~eL
the ...J\nnUl"'CY _Lunoun: properlY pa::abi7 and thE }~nurt.y ..p.unoun"L
actuall,~ DaId
(hi Certain Investment Limi~ations - The investment
limitations contained in _~'l:ic1e III shall nor apply when the Trust IS
a GRP5 under this AJticle.
(ii
after it is
Additions - No additions may be made to this Trust
a GR."T, nOh'i'ithstanding any other provisions of this
.'C~greement.
'J! Construction - The Grantors intend that the :p:mvisions
under this ar...icle create a Trust the Grantors'interest in ",;hich
would be a qualified interest, from the Cessation Date and all
pronSlOns of trnsA..greement shal1 be construed consistently voich this
intent.
A.RTICLE VIII: Commutation - The Grantors' interest in this
Trust may not be co=uted.
ARTICLE IX:
empowered to do the fol1owing:
Trustee's Powers - The Trustee is exclusively
\a) Hold Real Property - To hold and retain any real
property received that constitutes a personal residence of the
Grantors, regardless of the source of such property and without
regard to diversi.fication~
- 11 -
It'
IVlana~emen: 0::' ~asr
(tS'\)US: _ ....u~~ lLlTlCl.
ten1jJo:-a:'"LL'- II. aD~-- [;Omnle::-Cl8.. Inle::'::S~ 1)~;:l:-1l1; .s::l~:lllg-.. 0- Sf!_,TIU;::.:::-
ane loar a::::COUllV:
\ ~', Bo~o,ving.- - 'Ie tlorrOY' nl0Il0)Y to:- an:;- reasonaol';:- T=-us-~
purpost:c ana u,poe sucrj te:-ms. includin~- (bu: no: lin1.it.ec -co lnteres:
rates. se::'~ll.,.--ity: and loan duratIon. af ttH:" Trustee deem acivisa-ols.
td, Selling Trust Assets - ';:'0 sell or DtneY1'\'ise dispose of
Trust assets, including (but nOL limited to i Trus~ real property, for
cash or credit, at public Dr private sale, and with such WEL-YTanties or
indemniiications as the Trustee deem advisable. Notwithstanding
any ather provision of this _'\,oyeemem, the Trustee is specifically
prohibited from selling or transferring the Residence directly or
ind:irectly to the Grantors (or either of them), any spouse of a
Grantor, or to an entity controlled by either Grantors or a .spouse of
either Grantor either during the te= interest of ohe Grantors in this
Trust, or at anytime aiterthe expiration ,nf that interest if, ,at the
time, this Trust is a grantor trust as de:6nedby applicable provisions
ofehe Internal Revenue Code of 1986 and the regula"tions
appu.rtenant thereto.
(e) Dealing with TrusLf;$sets - To improve, develop,
manage, lease, or abandon any Trust assets, as the TrLlStee deem
advisable, consistent with the purposes of this Trust.
(f) Paying Expenses - To pay and advance money for the
protection of the Trust and for all e:Lpenses, losses, and liabilities
sustained in its administration.
(g) Legal Actions - To prosecute or defend any action for
the protection of the Trust, the Trustee in the performance of the
Trustee's duties, or both, and to pay, consent, or settle any claim by
or against the Trust or the Trustee in the performance of the Trustee'
duties.
1:2 -
\L
Lm~IJ10~rm::: ~"e=.son.~
~1l11J((1' ~)~_:':-::[)n...: p'(,r~: J_. LlEP
a:;:-' a3.s0~laH~l. y,'l:'L tn~' ~_~U3112t.. v a(1~.-lS" U- ;:l2.slS~ Ul~ ~''''''--U.stP':' 11' en:
D8:iO:TIlan~t- O~' tllE f1'::US1.:::;f:' autl.e;:,
I; Dis;;ribu:ang Trus', Assev '}, ciis:nnULl '=rus; ass"",
lL l:lnd or lr~ casr.:.. vntnou: reg-arc t( th.~ Incom<::- ":3.:': baS1E oi an,'\;' asseT
SO distributed.
(i ,I Si1;US of Trust ~ To change the situs of thf' TiUS"':: as the
Trustee in its sole discretion ID2Y detennins
(}:' Principal and Income - To allocate receipts and
disbursements to principal or income, in accordance with applicable
local law and practice. except that in the .absence of any specific local
law, the Trustee may allocate expenses as the Trustee deems
appropriate, consistent with the purposes of this Trust.
01 Documents -To execute andaeliver any instr1.1ments
necessa.y'" or usefalin the exercise 01 any of these povve:.:-s.
(m) A:mendment of Trust -To amend this _~areement, but
only for the sDle purpose of qualifying this Trust as a qualified
personal residence trust under applicable provisions of the Internal
Revenue Code of 1986 and the regulations appurtenant thereto.
ARTICLE X:
The Trustee -
(a) Naming Co-Trustee - A Trustee may designate any
individual or institution as a co-Trustee, by a written instrument.
Any co-Trustee or successor Trustee may, without liability, accept
Vlithout examination or review the accounts rendered and 1.'1e
property delivered by any predecessor Trustee. Each successor
Trustee has the same title, powers and duties as the Trustee
succeeded, without any additional conveyance. iony reference to a
"Trustee" refers equally to any successor co-TTUstee.
- 13 -
I, t, =-'ele~a~lOI:: 0= h.Ut1l0;:"I~: _-'-U) , ~~ ~USl~',- lll~~~ I~UI:> ~nlF-
V nI11~ Clele;:-aV tr an:,- ofne~' ~-TUSI:-:'~ f)"" V.':l.:'-L~=~ lI"ls:~um::~n: <J.D' 0::-
at 0" suer '~'-:--uste:::':: pCr\.V9r;:: ~U::l U'.::;1~=a010I. n12~- !)~ lenlTlora:--, O~
pe::TI1anen-,-. an(~_ i:' t~mpo:-aT:'-_ IDa'- 0'2' IO::-- anI' QU~atioL O~. tlllH- O~
unti: any even: sDeciiieo D:' thf.: cieie;:atln;- 'I-rustes _Lill.'- persor:
dealinf iT:. gooc: Iaitb -\'\-rith an.r TTust~E:' rna:^ :rei:' \",;Titnou'. inqui:r:' UDOL
the T~le~'s ce::-tincate \vith respe::l. tCi any desi~':natioIl
(c} Bond - No TTUStee shalJ be required to provide suyety aT
other seclLrity on a bond.
(dl Resignation and Vacancies - .tiny Tmstee may resign
by giving written notice specifying the effective date of the
resignation to the Grantors or her legal guardian. Whenever there
shall be a vacancy in the office of 'Trustee. a successor Trustee shall
be named by the Grantors or her legal guardian.
(el No Cou..Ti: Supervision - No Trustee shall be required
to obtain the order of any court to exercise any power or discretion
under this Trust.
(f) Accountings - No Trustee shall be required to file any
accounting with any public official. The 'Trustee must, however,
maintain accurate records concerning the Trust. Each year,
furthermore, the Trustee shall flL.'"Ilish an aTI...TJ.ual accounting of the
Tru.st's condition, including receipts and disbursements, to the
Grantors, the sunivor of the Grantors, or to the legal guardian of
either Grantor. This required accounting may be satisfied by a copy
of the Trust's federal income tax return, if one is required.
(g) Compensation - A Tmstee shall be entitled to
reasonable compensation for services in administe:ri..'1g this Trust 8....'l.d
to reimbursement for expenses. If a Grantor is Trustee of this Tmsi,
helshe ",rill be entitled to no compensation but he/she will be entitled
to reimbursement for expenses,
14 -
fJ:~i:;~}:
~--;
"~,
IVi.1s~'eL.aneou, .
let C:;noic~ 0:' ~a-v;- ~nL ~'-rus~ 3113.1: tF~(l'I"Je:T'-~C o~, anc
cons::Llec a~:;oTciln~ tc t:n~ la\'- 0=- tH7' C,ornmonVJSaltl-, 0 ~ennS~T!~,-am2-.
eb Genae, and Nu.moer- - v'l.Tnenever the conte:~7 Df tms
'IrusI reqUlres. the masculme gender includes the ieminiu2 or neuter.
and vice versa, and the singular number includes the plural. and Vlce
versa.
IN WITl'o"ESS "'nEREOF, the Grantors and Trustee have hereunto
set their ha..."lds and seals, all as of the day and year nrstabove ,,'Titten.
GRAJ\TTORS
/'
/
Or"~) o--~
~,;,
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----.. .'
;,- 7", \i
~
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Q-'
Ww r{J. - -l....~ ~~~ -.~'t'
WILLIAM T MOORE
I oCr S
, ,.-I-('.~- ~
(pJ1 \
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,
'7
I
((; J;~ '-- ,
V\ ~,.+'i
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) v.-
J~~ E. MOORE
"___~L.CC
'--
TRUSTEE:
A:::I:l\.T .:tV~:C:) G I\E!..-.,r:
~,=H\II\'I,~rf\:v~?E_~~:E Jf ?:cr-Ti'~3:.~...."\~;'.J\i~_
S~.
COlJl\~- OF
.~- " "'"
On this <',' cia~' of
-=,..,.(.[..' -
191:;. before mt' a Nm;ary Publi2. the
undersigned officer, personSlly appeared "VILLIAlVi T MOORE. known 1;0 me I.or
satisfactorily proven) to be the person whose name is subsctibed to the within
Agreement, and acknowledged that he execuwd the same for the purpose therein
contained.
IN WITNESS v''HEREOF, I have hereunto set my notarial seal.
~,
)4,--;". :.,r
,'. ,",,,.,_~;,,rj.,j
~ r. ~ ._,-r;f-
- ~ .".';;'r;:.-;. ,,,-,/,. -/
No~ary Public
No~ans.\ S6a~o~ary ouP\~~
KeDwortl3.':!" \..1011\(1 COLl;;"""
\'''haroa~-et\l!l;.,..,~ 1-..0'1(..' 0~c.eo'-_ 2S. .-.D'~'
(\I' - . ..8''''c '~. tre-"-'
SUSq~\!S.<;\.f\ ::;'';(0. -..,' Notane.'~
WyGOI!"" ~ \' 1\550':;\0.'\\OC Vi
, 'Defl,!\S,;IIJB.n"
\1I<",oe...
~L\. :1::3\) C\'~'~.-JI:DGI\CC!'~
CDl\IM::')N'V\'L~~~' ()T DLNNS-~~Y:U\lc
s.::
.~ () T,.JN~- () F
;, -' ,-^-, " ~'
On this
.,-"
"
19,~"~~"beiore m~' a 1'4o-cary Public. the
da~- of
~.........,_._'__c-
undersigned officer, personally appeared ;U\.1\["E L MOORE, known to me (Or
satisfactorily proven) to be the person whose name is subscribed to the within
Agreement, and acknowledged that she executed the same ,for the purpose therein
contained,
IN WITNESS whEREOF, I have hereunto set my notarial seal.
.'........",
)l',1
", ~.
.-:.2l~-;itu.'~--//:" , ':-'J[.-,,'l-c' ~u-;/: '"
,: Nota."}' Public
II
~v
\
'""'8(1\ PiJ,'D\\C \
~O\a.n5\::l . ~Qta~~'''''O\Jn\~ \
. r. "":"B{'.\l'Jor'trga.U?\'"\I'(\;e. 2\)t/'
~e\l",. '"'i'>1-l?: ~ c,e'P\ - . .
\'J\arg'0 el;'l.afln3 ,;"--'f.tl\re~ - , ~C\\?l\~:::
SIJSQ\) I1'\S.';;.\.0 - "\'3,,\)'i\ (\1 .'
W'! corfl r\\C !>-.sstl....
~{\{\"''!\\I(\
w-re.(\'\,'Oet, \-'
_4..CIJ\T-~lV--.-.J:C:J -8 M.ET\~
C~)I\Il\I:J~T\VEf~~:] or ?EI\[l'{S~~.-...:-\-_sl'~~:
s:-:.
COT,-11\~- ':J::-
-: -f...'-
On tlus <n,n cia,. of
,
-..00....' ~ .'_,,,,
, 1ft ,:.beforE' me a _~ otary fublic the
undersigned officer, personallyoappeared ELIZABETH MOORE C,IGCAGNO,
known to me \ or satisfactorily proven) to be the person 'whose name is subsc:::-ibed
to the vlitlun ,'\".<>reement, and acknowledged that she executed the same ror ehe
purpose therein contained.
IN WITl\i""ESS ViHEREOF, I have hereunto setmy notarial seal,
-"'~ .. .., \ I I'
/.1.-;' /" \ ,,-,.:. )..';, i;':__..: /?"
".' .; '::,( >('1it't...l.L ..- (! .....1./ _.-<-, a--.--.~-!':.~~
Notary Public/'
ft'
"e' ::;e8.\ \ 'Ouol\C \
No'l:a'n rthV. NOi3f)~oLlnlY
. N' y:.e.o-.NO bau'::ii\\fI ':-;., _ ?OD!
.-N'\aWar8' ~na lW?. ::c seDL.....C -
~us'OLlen'3- .~ ;:::'I!.p\Te~ . ",r.."'neS
~ . 'S<;l \' - . ~ (I' \",,]C'
..hi cn1i\\1'l. - .' ~D"'\2,~\DL< .
"""J nle fl..S:> v
?"nnS\IW3
MemtleL "
s =.'T::,,,:"p=!~_-~=~ ..~-~
_:.~~
fT';. "
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ullcllvloec 2-~_3~<llz, pe~' cen: IDteres: ir ane tc ttl,:- hn~n8G :::OmlYIOI; eienlenc O~
Sale ConoonuDluIL a5 morE- parn:::warly lcientiiieC: anQ cie5~:i1Jed IT: 2 ce:-:mn
I~iaste:- ~):::eQ of BeacrL A:venuf::' CondoTIuniuIIJ ciate(~ _t\pril 2,,4:, 198(: aIle: r~~oTdsc or:.
_~pri] 30th. 19~,1 ill the Cap~ lvlay Count}- Cleri:'f Offic~, in Book 01 :Jeecis l~o.
:14 73. Pag~ 43-;:, as said l\iaste:- Deed ma:- Trom time tc: 1:im~ b~ laVirfcll:z" amendei.
BEING situaee on Lots 20 and ::L Biod: 1115. as ShOWL on the Official
Map of the Cie\" of Cape May, l\iew Jersey.
rr,,,...-
~c-...:-,--
SUbJECT' to conditions~ restrictions, :cov,enants, rese..'r'\:>:atiolli anci easements
of recora..
STiPTH'-C7. th to. " ..d','r:>. ~'.;..' c. :1,-;1..c::"Li;::;.~_"':>1'Cl"'''D.n .;....,p'l\.~a.-,
'~..LhJ~ '_ to ..e .....rIll... aD.....onal"lon... O~_,.v.......~""'1.'_''-''~ .J-~.,,-,l,""......'-:!... ...n~":''\J,-,iA
Jersey Condornini1.1In__~ct~ its supplements 3..:.'"ld .:am..endrrlent~, 8....11d ',a8 -co :h'2
conditions; '!"es:nc:ions, .-covenants;-and '~~eements::set forch in L,ne '.};laste:- Deeel,
including by By-Laws of Beach Avenue Condomi.'1ium, and any aIDe!lnrnen~s
thereto.
BEIl\fG ehe same land and premises which V\'iiliam Thomas Moors and ,Jane
Moore, his .wife, by deeddatedJ.uly 2, 1986, and recorded in ehe Office of the
Clerk of Cape lv.Iay County, :In,Deed Bool: 16.57: Page 1068, granted arId conveyed
unto Vhlliam Thomas Moore and Ja.'1.e Moore, his wife, Grantors herein.
l4.188t; }
REV-1511 EX + (1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21-2002-1035
ESTATE OF
Moore, William T.
S h d I I
Debts of decedent must be reDorted on c e ue .
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAl EXPENSES:
1. Olga " Co, funeral expense 1,299.98
2 Cleaning help after funeral 300.00
3 Office of Catholic Cemeteries 450.00
4 Myers Harner Funeral Home 6,956.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions 27,500.00
Name of Personal Representative(s) See Schedule attached
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Name: Keefer Wood Allen " Rahal, LLP 15,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00
Claimant Moore, Jane E.
Street Address 1099 Country Club Road
City Camp Hill State PA Zip 17011
Relationship of Claimant to Decedent Spouse
4. Probate Fees 474.00
5. Accountant's Fees 0.00
6. Tax Return Preparer's Fees 0.00
7. Cumberland Law Journal, legal advertising 75.00
8 Wachovia #9070241520 interest expense 1.85
11/27/02-12/26/02
9 The Sentinel, legal advertising 122 . 63
TOTAl (Also enter on line 9, Recapitulation) $ 55,679.46
2W46AG2.000
(If more space IS needed, Insert additional sheets of same size)
Estate of: Moore, William T.
Schedule H, Part B -- Personal representatives. Commissions
Item
No.
Description
J.
Name: Elizabeth Calcagno
Social security number:
Address: J.J.OJ. Country Club Road
Camp Hill, PA 1701J.
Year(s) commissions paid: 2003 and 2004
2
Name: Jane E. Moore
Social security number:
Address: J.099 Country Club Road
Camp Hill, PA J.70J.J.
Year(s} commissions paid: 2003 and 2004
TOTAL. (Carry forward to main schedule)
Page 2
21-2002-J.035
Amount
13,750.00
J.3,750.00
27,500.00
REV-1512EK+{1-97}
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Moore, william T.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FilE NUMBER
21-2002-1035
Include unreimbursed medical eXDenses.
ITEM
NUMBER
1. Diocese of Harrisburg
DESCRIPTION
AMOUNT
3,206.50
2 Claremont Nursing & Rehab
7,209.31
2W46AH2_000
TOTAL (Also enter on line 10, Recaoitula\\on) $
(If more space is needed, insert additional sheets of the same size)
10,415.81
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Moore
NUMBER
I.
Wil'iAm T.
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (al (1.2)]
Moore, Jane E.
1099 Country Club Road
Camp Hill, PA 17011
FILE NUMBER
21-2"0'-1"3
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Spouse
Daughter
AMOUNT OR SHARE
OF ESTATE
547,479.55
172,950.76
416,446.70
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
2Wol.6AI Ul'OO
2
Calcagno, Elizabeth
1101 Country Club Road
Camp Hill, PA 17011
3 Moore Trust A
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 1\. 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)
$
0.00
REV-1649EX+(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FilE NUMBER
Moore, William T. 21-2002-1035
Do not complete this schedule unless the estate Is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust (marital, residual, A, B, By-pass, Unified Credit, etc,)
li a trust or S'lmilar arrangement meets the requirements of Section 9113(A), and:
a. The trust or similar arrangement is listed in Schedule 0, and
b. The value of the trust or simllar arrangemenlls entered in whole or in part as an asset on Scl1edule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or
similar properly treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the
personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to
the amount of the trust or similar arrana8ment included as a taxable asset on Schedule Q. The denominator is equal to the total value of the trust or similar arranQement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
survivina soouse under a Section 9113(A) trust or similar arranaement.
DESCRIPTION
1 Moore Trust A
See Attached Calculation
VALUE
587,744.97
Part A Total $ 587,744.97
PART B: Enter the descriDtion and value of all interests included in Part A for which the Section 9113 A\ election to tax is beinn made.
DESCRIPTIO N
VALUE
Moore Trust A
See Attached Calculation
Total from cont1nuation pages....
2W46E21 000
Part B Total $
(If more space is needed, insert additional sheets of the same size)
587,744.97
587,744.97
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or
\'iTILloIAJ\-J THOMA.S MOORE M.D
1. \VILLLI\M THOMAS MOORE. M.D.. of East Pennsooro To,vnship
Cumberland County, Pennsylvania. do make, publish and declare thiE 'to be my Last
Will and Testament, hereby revoking all Wills and Codicils by roe at any time made.
ITEM I:
I direct that all inheritance and estate
taxes becoming due by reason of my death, whether payable by my estate or by any
recipient of any property, shall be paid by the Executor out of the residue of my
estate, as an expense and cost of administration of my estate. The Executor shall
have no duty or obligation to obtain reimbursement for any such till: so paid, even
though on proceeds of insurance or other property not passing under this Will.
ITEM II:
I direct the Executor to pay the expenses
of my last illness and funeral expenses from the residue of my estate as an expense
and cost of administration of my estate.
ITEM III:
If I die before my wife, JANE E. MOORE,
I give to her all of my household furniture and furnishings, books, pictures, jewelry,
silverware, automobiles, wearing apparel and all other articles of household or
personal use or adornment and all policies of insurance thereon. If I do not die before
my wife, I may leave a written list in my safe deposit box or elsewhere disposing of
certain items of my tangible personal property. The Executor shall dispose of items
of my personal property as specified in the VYTitten list. If no written list is found in
Page 1
G~/j-: vV' ,
Dl.' saie nenUSI; -nox elsewherE: ane pl'open." identihec: I '.' tn~ Execuur \-vitnl1
tlll"[\ ; :-j() aav~ afre~' We pronate 0' m, WiL i; snaL be presumec ttla; tller,- E 1)(
othe:' SLatemel11 0:' ils; An, subsequen;. discoverec1lis; shal' bE ifITlorec: lill'
property no; listed in tlw writter- stawmen: 1 giVE and bequeath H. my daugnt8:'.
ELIZABETH MOORE C.IlliCAGNCJ. Ii she does not survive me, ~ make this gif; to
her children living at the time of my death. tu be divided beT-ween them as rhev sha]]
agree, the Executor to represem any minors in the division of thIs property. If the
Executor thinks any property to which a minor child would become entitled is
unsuitable for the child's use, the property shall be sold and the proceeds shall be
added to the share of my residuary estate held for the benefit of that child. The
Executor may deliver any property to which a minor is entitled and which is not sold
to the person with whom the child resides or who has the care or control of him
(without bond), and the receipt of that person shall be a complete release ofthe
Executor.
ITEM IV: I give, devise and bequeath all the rest,
residue and remainder of my estate, not disposed of in the preceding portions of this
Will, to my v,~fe, JANE E, MOORE, and my daughter, ELIZlillETH MOORE
CALCAGNO, as Trustees (hereinafter collectively referred to as "Trustee"l, IN
TRUST NEVERTHELESS, to be further di\~ded into two parts, each of which shall
be held in trust and constitute a separate Trust Fund to be known as "Trust A" and
"Trust E",
"Trust A": There shall be placed in "Trust A"
that fraction of my residuary estate of which the numerator shall be a
sum equal to the largest amount that can pass free of Federal estate tax
under my Will by reason of the applicable credit amount and the state
death tax credit (provided that the use of this credit does not require an
Page 2
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increasf-' ill SIatt: aeatl taxe~ allov.rablt t.c, ill," estau. lTLn Ill" 01:ne:" (~recii~
anci after takmc accoun; of dlSDositlOns llllCle' otr!e" item~ 0" tlll" Wir
'- , -..' ", ~
and propert'. passin:; outsiae 0:' thif Wil' wnicn d(l nOl qualify fo:' tJ1E'
mariwl or charitable; deduction and ahe:' taking account 01 chargeE W
principal that are not allowec~ as dedUCtIOns in computing- my Federal
estate tax and of which the denominato:' shall be the value of mc'
residuary estate. For purposes of establishing such fraction, the valueE
finally fixed in the Federal estate tm: proceeding relating to my estate
shall be used. I recognize that the numerator of such fraction may be
zero (0), in which case no property shall pass under "Trust An and that
said numerator may be affected by the action of the Executor in
exercising certain tax elections.
"Trust Bl':
The balance of my residuary estate
not placed in "Trust A" shall be placed into "Trust. B" t.o be held,
administ.ered and distributed in accordance with ITEM V1 of this WilL
ITEM V:
The following provisions shall apply to the
"Trust A":
(al The Trustee shall pay the net income arising from the
principal of this Trust in convenient, at least annual installments to my
wife, JANE E. MOORE, during her lifetime.
(b) During the lifetime of my wife, the Trustee shall pay to or
for the benefit of my ",ife so much of the principal ofthis Trust as may
be necessary, in the sole discretion of the Trustee, for the proper
support, maintenance and medical care of my wife.
Page 3
I ,T-- Vv~
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\~. ,I L)PI._J. tilt-. ueatr: O!' 111: \ViiL. O~' UPOl ill,' uea::;1: 1 snE.
predeceases ll1l. thE:' renlainin; p~_~inciDaj snaL Ot' olvluec 1TII(, a~' TIUl.1l."'-
equai shares as there are ther livll1f2 cnildren of mine ane: theI! cieceasec:
cnilarer 0; mine represented rn- ther: living issue. F 0" purDose6 of
making this division, the 'Trustee snaIl add iifI survived my wile.
Jl\.NE E. MOORE. but not otherwise). the lair markel value oimy
residence which has passed by operation oflaw tel m:' daughter,
ELIZABETH MOORE CALCAGNO, to the balance available for
distribution_ The Trustee then distribute this hypothetically augmem;ed
balance into equal shares as provided above, an equal share to be paid to
each living child or set apart for the issue of each deceased child, there
being credited against the share of my daughter, ELIZABETH MOORE
CALCAGNO, the fair market value of that residence as of the date of my
death. Should the fair market value of my residence exceed the value of
her share, she shall have no obligation to my estate or this Trust for the
excess.
(d) The Trustee shall further divide each share set apart for
the issue of a deceased child into a separate per stirpital share for each
issue, and shall administer and distribute each share as follows:
(i) The Trustee shall pay to or for the benefit of
the issue (hereinafter referred to as the "Beneficiary" of his
or her Trust) so much of the net income as may be
necessary to maintain the Beneficiary in the proper station
in life, including proper support, maintenance, medical
care, and college or higher education.
Page 4
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~_ - .,'t,
Page 5
(Ii 'Tnt r:ITUStB/;:' shuL alS(; distrinuu. 0i mU2l: 0'
thE pnnclpa' 0' thE 'frus: a~. In the dJSCretlOl' 0 tm
Trustee. mH" bE' necessary LC mamtain thE Beneficia",' II.
the proper station in lifE. includmg prover suppon.
maintenance, medica] cane, and colJege OJ' highe:'
education.
(iiii Upon the attainmem of the age ofthirty-five
(35) years by the Beneficiary, the Trust shall terminate,
and the Trustee shall distribute to the Beneficiary all the
assets of the Trust.
(iv) Should the Beneficiary die before fmal
distribution of the assets ofthe Trust, but be survived by
then living issue, the Trustee shall quarterly pay the net
income from the Trust tel or for the benefit of the issue, per
stirpes, living at each time of quarterly distribution; as
soon as anyone of the issue attains the age of twenty-one
(21) years, and in no event later than twenty (20) years
following the death of the Beneficiary, the Trustee shall
pay over all of the then assets in the Trust to the then
living issue of the Beneficiary, per stirpes, Should the
Beneficiary die before final distribution and not be
survived by then living issue, the provisions of
subparagraph (v) herein shall obtain,
(v) If, before final distribution ofthe assets of
any Trust established for issue of a deceased child, there is
r \- 1..-1;
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11(., l1vinf Beneficla~.\' 0:' tna; r:r rus',. i; silal te:--nllnatt, Tn~
principal or th~' 'l'rus; snat U~' i:ldde(~ 1.( tht other r:J.'ruSt~
created unde:' thif Wi\' iOT tlk benei): 0; tl1P other issue o'
my deceased child, 1li the same proportions in which the
Trusts were originally funded, If any Trust, created for
issue of deceased children had previously been terminated,
the benefIciaries who received the principal of that Trust
shall collectively be considered a "Trust" for the purpose of
this paragraph, and one share shall be paid directly to each
Beneficiary in the same proportion by which each received
the principal of the Trust If any benefIciary is deceased,
the share of the deceased Beneficiar:r shall be paid to his or
her then living issue, per stirpes,
ITEM VI;
The following provisions shall apply to
"Trust B";
(a) Trustee shall have, hold, manage, invest and reinvest the
assets of this Trust, collect the income and beginning at my death pay
over the net income in convenient, at least annual, installments to my
wife, JliNE E. MOORE, during her lifetime.
(b) The Trustee shall also, from time to time, pay to my wife
so much of the principal of this Trust as the Trustee deems necessary
for the proper support, maintenance and medical care of my wife.
(c) Upon the death of my wife, the Trustee shall pay all
accrued income and all income accumulated but undistributed to the
Page 6
,
, '
~I
;'SLak 0' m:~ ClelO;,asec wilt~ ane saaL tnereahe:' transie" tlE tiler.
r;,mainm[:'prmlOlPui anilE ';rus: u "Trus: A' LC (W nelc... aammisLereL
and dlsl;ribute(~ m accordance with tnt provisions o~ ITEM \' 0;' tiu~
WilL
\d' If my wife should not survive me, then the provJsionF of
"Trust B" shall be void and the pan of my estate which would have
constituted "Trust B" shall be added to "Trust A" to be disposed of in
accordance with ITEM IT of this Will.
(e) The Executor shall be authorized in the Executor's sole,
exclusive and unrestricted discretion to determine whether to elect
(under Section 2056(b)(7) of the Internal Revenue Code of 1986 as
amended, or any corresponding provision of the Federal estate law), to
qualify all, none or a fraction of "Trust E" for the Federal estate tax
marital deduction, The decision of the Executor with respect to the
exercise of the election shall be final and conclusive upon all persons
whose interests in my estate are directly or indirectly affected by the
election. Only property which is fully eligible for the marital deduction
under Federal estate tax law shall be assigned to this Trust.
Notwithstanding anything to the contrary contained in this Will, the
Trustee ofthis Trust shall not retain beyond a reasonable time any
property which may at any time be or become unproductive, nor shall
Trustee invest in unproductive property. Notwithstanding the
provisions of subparagraph (c) of this Item, the Trustee shall pay to the
Executor of my wife's estate, out of the principal of this Trust upon the
death of my wife, an amount equal to the estate, inheritance, transfer,
succession and other death taxes ("death taxes"), Federal, state and
1.I\{tI
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Page 7
otne;". pavabl" tn' reason 0' tilc' H1ClUsiOl 0' till' value O"'.':TUS; Dropen.:,
n:: ill:'- \viE-:<;:; estatE::. Suet pEi?nlen~ snaIl t)"-: equal t\ tht" anlOUIli h:,-
\vhicli,l .' th~ total of suet!. death ta.'{e::: paicL n:~ nl~- wife ~ estatE:" exceed.;::.
~:?' the total of'such death taxeE which would have been pa:vablt if thb
value ofthe Trust propert.y had not been included in he;" estaL8. Tht'
deLermination by my wife'E ExecutOJ' ofthe amount pa:vablt hereunder
shall be final. I direct the Trustee to pay such amoun'L promptly upon
written request of my wife's Executor. The final determination of the
amount due hereunder shall be based upon the value as finally
determined for Federal estate tax purposes in my wife's estate. Aher
payment of the amount finally determined to be due hereunder, the
Trustee shall be discharged from any further liability with respect to
such payment. My wife may waive her estate's right to payment under
this subparagraph by Will, executed after my death, in which she
specifically refers to the right to payment hereunder given to her estate.
ITEM VII: No part of the income or principal of any
Trust created by this Will shall be subject to attachment, levy or seizure by any
creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary prior
to his or her actual receipt of income or principal distributed. The Trustee shall pay
the net income and the principal to the beneficiaries specified by me, as their
interests may appear, ",>ithout regard to any attempted anticipation, pledging or
assignment, and without regard to any claim or attempted levy, attachment, seizure
or other process against the beneficiary.
ITEM'ilIH: The Executor and the Trustee shall each
possess the following powers, each of which may be exercised without court approval
and in a fiduciary capacity only:
Page 8
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Page 9
\U cetau" an.', inVeStrrlenL~ 11l8Vt:' a; nJl (Ie-alL. lTIClUGln;'
specifical1,,- thOSl' c;onsisbnf 0' SUlCL 0' an', banL even i:' J i12v, namec
Iha; bank at the Execllto" 0,' 'Tl'UStee:.
(b, To vary investments, and 10 invesr ie bondE, stocks, notes,
Teal estate mortgages or other securities or in other property, real OT
personal, witham being restricted to so-called "legal investments", and
without being limited by any statute or rule of law regarding
investments by fiduciaries,
(c) In order to divide the principal of a Trust or for any other
purpose, including final distributions, the Executor and Trustee are
authorized to divide and distribute personal property and real property,
partly or wholly in kind, and to allocate specific assets among
beneficiaries and Trusts so long as the total market value of each share
is not affected by the division, distribution or allocation in kind, The
Executor and Trustee are each authorized to make, join in and
consummate partitions oflands, voluntarily or involuntarily, including
giving of mutual deeds, or other obligations, 'with as wide powers as an
individual owner in fee simple,
(d) To sell either at public or private sale real and personal
property severally or in cDnjunction with other persons, and to
consummate sale(s) by deed(s) or other instrument(s) to the
purchaser(s), cDnveying a fee simple title. No purchaser shall be
obligated to see to the application of the purchase money or to make
inquiry into the validity of any sale(s), The Executor and Trustee are
authorized to execute, acknowledge and deliver deeds, assignments,
I~~~
optlon~ 0:" other vv::~i1nlg:::; at nesessa~",:" or eOnvSDlel1", II any 0." Lilt., powe:"
conferreo UPOlc the' ExecuteJ:' and 'I-rUStel',
le i '1\1 n10YtgagE' rea] estate, and t(1 make leases 0:' real estatE::.
(fi To borrow mone!- from any person, including th~ Executor
or Trustee, to pay indebtedness of mine or of my estate, m;penses of
administration or inheritance, legacy, estate and other taxes, and to
assign and pledge assets of my estate or any Trust established by this
WilL This paragraph shall not be construed to authorize borrowing
from "Trust B",
(g) To pay all costs, taxes, expenses and charges in connection
with the administration of my estate or any Trust established under this
WilL If any death taxes are payable with respect to my estate, these
taxes shall be paid from "Trust A",
(h) To make distributions of income and of principal to the
proper beneficiaries, during the administration of my estate, with or
without court order, in such manner and in such amounts as the
Executor deems prudent and appropriate,
(i) To vote shares of stock which form a part of my estate or
any Trust established under this Will, and to exercise all the powers
incident to the ovmership of stock.
Page 10
1..J\:1J''l
I.l 'It< umtp witt otne:' oWner~ o"prope,lY Slmlla:' t( propen.'
lL ill' eScatt' te! carry out plans io,' tn8 reorganizaciOT! 0" any compan:
\\'hose securities forn} a parr, of' ITl.'- e.statt,
(I: I To disclaim any interesl. in property which would devolve
to me or my estate by whatever means, including bUl not limited to the
following means: as beneficiary under a will, as an appointee under the
exercise of a power of appointment, as a person entitled to take by
intestacy, as a donee of an inter vivos transfer, and as a donee under a
third-party beneficiary contract.
m To prepare, execute and file tax returns of any type
required by applicable law, and to make all tax elections authorized by
law.
(m) To employ custodians of property, investment or business
advisors, accountants and attorneys as the Executor or Trustee deems
appropriate, and to compensate these persons from assets of my estate
or trust, without affecting the compensation to which the Executor and
Trustee are entitled.
(n) To divide any Trust created in this Will into two or more
separate Trusts so that inclusion ratio for purposes of the generation-
skipping transfer tax shall be either zero or one, in order that an
election under Section 2652(a)(3) of the Internal Revenue Code may be
made with respect to one of the separate Trusts, or for any other reason.
\ \,.,--
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Page 11
\(1 TCi allocatE:-: adrrllI11sttat1Vt' expensef tCI lne()nl~~ O~' t(
prmcmaL a~ tilt, Executa:' or Trllsr,et' deemE appropriate Howeve:', Il(
allocaLl0!1 to mcome shall bf.- mad" ii tiw efiecl 0;' thE' allocatioL i~ te,
cause a reduction in the amoum 0:' an\' estate ta;: marita', deductIOn 0:-
estate ta, charitable deduction,
\p \ To do all other acts in their judgment necessary or
desirable for the proper and advantageous management, investment and
distribution of the estate and Trusts established under this WilL
ITEM IX:
The Trustee is authorized to distribute
principal and/or income in anyone or more of the following ways if the Trustee, in
the sole discretion of the Trustee, considers the beneficiary unable to apply
distributions to the beneficiary's own best interests, or if the benefIciary is under a
legal disability:
(a) Directly to the beneficiary;
(b) To the legal guardian or conservator of such beneficiary;
(c) To the Trustee, or to another person selected by the
Trustee, as custodian under the Pennsylvania Uniform Transfers to
Minors Act as to a beneficiary under the age of twenty-one (21) years;
Cd) To a relative afthe beneficiary, to be expended by that
relative for the benefit af the beneficiary; or
Page 12
U~
~ I ....
}'"- ~".".....'.,
teE." dlrectl:. appl,vinr dlS::::,i[lutioIl~-~ in~' tn(~ uenefi: or thf
beneficia~c .
Tlli:c Dower shall no, apply to an'" disrributiom' to my SpOUSe' from any truSt which
has aualified fOe" the marital deduction in m:" estate.
ITEM X: Should my wife, JANE E. MOORE, by Will
or Agreement of Trust, establish Trusts similar to the Trusts I have established fOY
the benefit of my issue, the Trustee of each Trust created in this Will shall have the
right to merge it with the similar Trust created by my wife for the same beneficiaries.
If merged, the Trustee shall operate the merged Trusts as a single T'rust.
ITEM XI: iillY person who has died within thirty
(30) days of my death, or under such circumstances that the order of our deaths
cannot be established by proof, shall be deemed to have predeceased me. il.ny person
(other than myselD who has died at the same time as any beneficiary under this \/iTiIl,
or in a connon disaster with that beneficiary, or under such circumstances that the
order of deaths cannot be established by proof, shall be deemed to have predeceased
that beneficiary.
ITEM XII: In the absence of actual knowledge of a
breach of trust, or information concerning possible breach of trust that would cause a
reasonable person to inquire, a successor Trustee is under no duty to examine the
accounts and records of a predecessor Trustee, or to inquire into the acts or omissions
of the predecessor, and is not liable for any failure to seek redress for any act or
omission of the predecessor. The successor Trustee shall have responsibility only for
property which is actually delivered to him or her by the predecessor and shall have
all of the powers conferred upon a Trustee hereunder.
Page 13
c~~ :NL.
ITEM XIII
r:rlH: ~Tustes, or- aL annua: tJaSli:, snal
provlU8 eac!: mcome beneficia,,~ wh(. 1mb at1amec tm. age 0" eWhteen .18 vean. ane:
the Guardian of the person 0;' am meomE: beneficiary wh(, hab no~, attame( tlw ag,' of
eighteen 18; veal's. statements showin; transactions each 'Trus; estabhsl1ec1 fm the
benefi! of thar beneficiary. The beneficiary. Q;' the Guardian of tiw person or such
beneficiary: may waive this right to receive an annual accounting. The Truster! mm.
at any time, settle any account, or questions concerning the administration of any
Trust established under this Will, by agreement with the then current income
beneficiaries of the Trust, if legally competent, or if not legally competent, with the
Guardian of the person ofthe beneficiary, the legally competent spouse of the
beneficiary, or the oldest legally competent relative ofthe beneficiary who would take
a portion of the estate of the beneficiary were the beneficiary to die at that time
intestate under the laws of the Commonwealth of Pennsylvania. 1my settlement
made in accordance with this Item shall bind all persons who have an interest in the
Trust, and shall constitute a release and discharge ofthe Trustee with respect to
transactions specified in the settlement.
ITEM XIV: I hereby nominate, constitute and appoint
my wife, J~"L~E E. MOORE, and my daughter, ELIZABETH MOORE CA.LCAGNO, to
be the Executrixes, herein referred to as "Executor". In the event of the death,
inability or refusal of both of them to serve as Executor, or in the event ofthe death,
inability or refusal of both ofthem to serve as Trustee, MENTOR TRUST
COMPANY shall serve Executor or Trustee, or both. The Executor and Trustee are
specifically relieved from the duty or obligation of filing any bond or other security.
IN WITNESS VV'HEREOF, I have set my hand and seal to this, my Last
Will and Testament, consisting of this and the preceding thirteen (13) pages, at the
Page 14
(~~'\:0.C
elld or each pagE~ o~. "v~iGL I havt' alS{1 se., ill:"" initiaL. fo~' g-reate~' securiT,," ane tJeu:e:
IdellLifi~ation thi~
" .'
day of
. Ift'~
/
I....../~';,....._-~ ~-.....v-.-. ~'~----c..::~-.:.- (SE_s.L
WILLIAM THOMAS MOORE. rVI.D
We, the undersigned, hereby certify that the foregoing Will was signed,
sealed, published and declared by the above-named Testator 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 set our hands and seals the day and year
first above WTitten, and we certify that at the time of the execution thereof, the said
Testator was of sound and disposing mind and memory.
0'(\ / 1 \ /Y.fl--4-
r\~jUJd. ~d (SEiili) Residingat
,,~1Oft; Uk/~rJtJ~J /
~
u-
(SEAL)
Residing at ~() ~ o711Ji;-kJ JI-.
mecJf/I'vU'~ fA f1o~5
IS j / ()
Residing at '::X:J'f Cei.t;..Jh.c )L.z. hJ
/7k 6 ..., 9" /
/1'i,' , (" 1)/) '. -.-
/f'/J!L 1AICr ~/~(> r/i'/ j \
{ Cy
(SEAL)
ACKN (J\NLEIlGME1\,rr
COMMOl\TV\TEALTH OF PENNSYLVANIA
S5.
COUl\'TY OF /
/, "
I, \VILLL4.M THOIvL.<\S MOORKlYI.D., 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 Wil1
and Testament; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein e1."pressed.
I ,.c i
'--C) ~~G iru._--/l1/"""",',..!TSEALl
vVILLL.c\M THOM.A.S MOORE, M.D.
Sworn to and subscribed before
me this ? O<dayof
j, /9, 19ft. /
. , I
'"~i '-"'fj' , /e- ."? /
it.!i(i ( ?ltZ>U,/;" ...::tV {C
, I L J
No,tary Public
My Commission Expires:
(SK4..L)
,--
I Notarial Seal
, I'vYargaret L.BOYd, Notary PublIc
SusquBhal1o" Twp., Dauphin County I
l~~\I'I~' Co'~rnisSjCI) E:xplms June 27, 2000 '
AFH'IDiI \,'IT
COIvllvlC}[\TVlEALTH OF PENNSYLVANiA
CC'
....J/.J.
COUI'fry OF i"
r
I ) / . / /; / n . I
__ We,j;'/-4r/v'/!{;"u!5f1i//;', (Y!{}kJZ)((f[: .a<!:JCfj]/U-and
(JA./ ,e f k/OC}{JI\ ,the Witnesses whose names are signed to the attached
\ . )
or foreg:€\ing instrument, being duly qualified according to law, do depose and say that
we were present and saw Testator, \VILLIAM THOM..I\S MOORE, M.D., sign and
execute the instrument as his Last Will and Testament; that Testator signed willingly
and that he executed said Will 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
eighteen (18) or more years of age, of sound mind and under no constraint or undue
influence.
~!J1.vddi~
Witness
~/!ClJJlrM" !~/jd~
! I 1 Witness
o cC/\
c0'j ~- fJ'Z:'")
Wltness,~
Sworn to and;subscribed before
me t):1is / D'dayof
) , /:'1 1-, 19yf'
.....-;:.'/....7[/1 { , I
.) . i
) ...,
. .' ..-' " .... /' '
'. .' _ '_. , .' . ",~', l, l. .. ,/
-I~ if (( . ( v1ZCC/ (;-f .~/V~(
Noiary Public '
My Commission E1>.'])ires:
(SEAL)
Notarial Seal I
\\'iBrQan:;~ L. Boyd, Notary Public
SUSLluehanna Twp., Dauphin County
M~' Ccrnrlllssron Expires June 27, 2000 l
...._.._-,...,~-- '
:15.1417_
COMNONNEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. ZSO601 NOTICE OF DETERMINATION AND
HARRISBURG, PA 171Z8-0601
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LETTER ,EV-TUEXAF, m-,2~
R~'¥'~ ' DATE Oq-19-ZOOq
t~i~ ESTATE OF MOORE WILLIAM T
DATE OF DEATH 11-05-2002
FILE NUMBER 21 02-1055
'C~ ~P~ 20 :~','ii :ji3 COUNTY CUMBERLAND
ELYSE E ROGERS ESG ACM 202
KEEFER ETAL Amoun~ Remi~ed
q15 FALLOHFIELD RD ~0~
CAMP HILL PA
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form wi~h your ~ax payment.
CUT ALONG THIS LINE ~'~ RETAIN LOgER PORTION FOR YOUR FILES
REV-736 EX AFP (01-02) ~ NOTICE OF DETERMINATION AND ASSESSMENT
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER
ESTATE OF MOORE HILLIAM T FILE N0.21 02-1055 ACM 202 DATE 0~-19-200~
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified .00
2. Pennsylvania Inheritance Tax Assessed 25,680.78
(Excluding Discount and/or ~nterest)
5. Inheritance Tax Assessed by Other States .00
or Territories of the Un,ted States
(Excluding D~scount and/or Interest)
q. Total [nhergtance Tax Assessed 25z680.78
5. Pennsylvania Estate Tax Due .00
6. Amount of Pennsylvania Estate Tax Prevgously Assessed
Based on Federal Estate Tax Return .00
7. Addgt~onal Pennsylvania Estate Tax Due .00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUEI .00
INTEREST AND PEN. .00
TOTAL DUE . O0
~ZF PAID AFTER TH/S DATE, SEE REVERSE SIDE (/F TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS RE;iUZRED
FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)~
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 9/24/2004
ROGERS ELYSE E
415 FALLOWFIELD ROAD
SUITE 102
CAMP HILL, PA 17011-4906
RE: Estate of MOORE WILLIAM THOMAS
File Number: 2002-01035
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 11/05/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
STATUS REPORT UNDER RULE 6.12
Name of Decedent: William Thomas Moore
Date of Death: November 5, 2002
Will No. Admin. No. 2002-01035
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 X 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:
a. Did the personal representative file a final account with the Court?
Yes No X
b. The separate Orphans' Court No. (if any) for the l~r~nal
representative's account is:
c. Did the personal representative state an account informal~ to the
parties in interest? Yes X No__
d. Copies of receipts, releases, joinders and approvals of form-'~l or
informal accounts may be filed with the Clerk of the Orphans' coUrt and ~y be
attached to t~his report. , ..~, ~~~_~
Date: ~ 3¢-c'b/
SignatUre
Elyse E. Rogers, Esquire
Name (Please type or print)
415 Fallowfield Road, Suite 301
Address
Camp Hill, PA 17011
(717) 612-5801
Telephone
Capacity: __ Personal Representative X. Counsel for Personal Representative
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 260601
HARRISBURG, PA 17128-0601
ELYSE E ROGERS
KEEPER ETAL
415 FALLOWFIELD
CAMP HILL
ESQ
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
RD 30
PA 17011
REV-1547 IX AFP (01-03)
DATE 09-22-2003
ESTATE OF MOORE WILLIAM
DATE OF DEATH 11-05-2002
FILE NUMBER 21 02-1035
- COUNTY CUMBERLAND
ACN 101
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
T
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS _-~______________________
-------------------------
-------------------------- ----------------------------------
REV-1547 EX AFP CO1-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MOORE WILLIAM T FILE N0. 21 02-1035 ACN 101 DATE 09-22-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
~1) ,00 NOTE: To insure proper
(2) 620 , 982.75_ credit to your account,
(3) ,QO submit the upper portion
0 0 of this form with your
(4) ,
c5) 33,357.49 tax payment.
c6) .00
C7) 549,132.04
203,472.28
1
ca) ,
APPROVED DEDUCTIONS AND EXEMPTIONS: 56,179.46
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10,4 1 5.8 1
C10) -
10. Debts/Mortgage Liabilities/Liens (Schedule I) 66.595.27_
(11)
11. Total Deductions 1 , 136, 877 . O 1
C12)
12. Net Value of Tax Return .00
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C14) 1,1 36,8 77.01
14. Net Value of Estate Subject to Tax
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESS MENT OF TAX: 547,479.55 X 00 = .00
15. C15)
Amount of Line 14 at Spousal rate
589,397.46 X 045 =
2.6,522.89
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 00 X 1 2 _ .0 0
17. C17)
Amount of Line 14 at Sibling rate
, 00 X 15 =
. 00
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
C19)= 26,522.89
19. Principal Tax Due
DATE NUMBER
01-29-2003 CD002109
08-04-2003 CD002869
SCOUNT (+) AMOUNT PAID
ST/PEN PAID (-)
842.11 16,000.00
.00 9,680.79
TOTAL TAX CREDIT 26,522.90
BALANCE OF TAX DUE .O1CR
INTEREST AND PEN. .00
TOTAL DUE .O1CR
~ IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
w orruun_ ~FE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN
ELYSE E ROGERS ESQ
KEEPER ETAL
415 FALLOWFIELD RD 30
CAMP HILL PA 17011
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR FILES '~
----------------------------------------------
-----------------------------
------- ---------------
REV-483 EX AFP (01-03~ ** NOTICE OF DETERMINATION AND ASSESSMEN
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN **
ESTATE OF MOORE WILLIAM T FILE N0.21 02-1035 ACN 201 DATE 09-22-2003
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
2. Pennsylvania Inheritance Tax Assessed
CExcludin9 Discount and/or Interest)
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
4. Total Inheritance Tax Assessed
5. Pennsylvania Estate Tax Due
TAX CREDITS:
PAYMENT I RECEIPT
DATE NUMBER
DISCOUNT C+) AMOUNT PAID
INTEREST/PEN PAID C-)
18,534.2.7
25,680.78
.00
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
CIF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF_TOTALrDUE IccREorvrRCD SIDE DFRTHIS„FORM)FORDINSTRUCTIONS.)
REV-4B3 EX AFP (01-03)
DATE 09-22-2003
ESTATE OF MOORE WILLIAM T
DATE OF DEATH 11-05-2002
•FILE NUMBER 21 02-1035
COUNTY CUMBERLAND
ACN 201
Amount Remitted
25,680.78_
.00
REV-t470 EX (6-88)
~~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
s
Moore, William T.
Daniel Heck
ITEM
SCHEDULE NO.
INHERITANCE TAX
EXPLANATION
OF CHANGES
FILE NUMBEK
2102-1035
201
EXPLANATION OF CHANGES
The maximum "State Death Tax Credit' has been recalculated according to the revisions
to the Pennsylvania Estate Tax as revised by ACT 89 of 2002. This revision is effective
for decedents dying on or after July 1, 2002.
Row Page
COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION NOTICE OF DETERMINATION AND
DEPT. 280601 ASSESSMENT OF PENNSYLVANIA
HARRISBURG, PA 17128-0601
ESTATE CLOSING ELETTER EDERAL REtl-736 EX AFP (01-027
DATE 04-19-2004
''`. ESTATE OF MOORE WILLIAM T
DATE OF DEATH 11-05-2002
FILE NUMBER 21 02-1035
COUNTY CUMBERLAND
'OC rti ;' ,' ~~' __ _ ACN 202
ELYSE E ROGERS ESQ Amount Remitted
KEEPER ETAL
415 FALLOWFIELD RD 3~0
CAMP HILL PA ~~011
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CARLISLENDPAO 17013 HOUSE
NOTE: To insure proper credit to your account, submit the uPPORpYOURnFILES s for=ith-Your-tax-payment~-
CUT ALONG THIS LINE - _ RETAIN_ LOWER PORTION F
------------------------------- ** NOTICE OF DETERMINATION AND ASSESSMENT
REV-736 EX AFP (01-02)
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLO ACN 202TE DATE 04-19-2004
.._,.., WT~LIAM T FILE N0.21 02-1035
naiw~~ ••~ -~ -
EST AX DETERMINATION
1. Credit For State Death Taxes as Verified
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
3, Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
4. Total Inheritance Tax Assessed
5. Pennsylvania Estate Tax Due
25,680.78
.00
6, Amount of ecle~allEstateETaxtReturnPreviously Assessed
Based on F
7. Additional Pennsylvania Estate Tax Due
TAX CREDITS: DISCOUNT (+)
PAYMENT RECEIPT INTEREST/PEN PAID (-)
DATE NUMBER
AMOUNT PAID
.uu
25,680.78
.00
.00
.00
.00
TOTAL TAX CREDIT
.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
^IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. DUETATREFUND.ISEEEREVERSE SIDE OFRTHIS•FORM)FOROINSTRUCTIONS.) ~~-