Loading...
HomeMy WebLinkAbout12-19-08n 15D56041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county coca Year File Numoer Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 2 1 0 8 0 7 6 5 Harrisburg, PA 17128-0601 ~' RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 198 05 1194 06 16 2008 07 13 1914 Decedent's Last Name Suffix Decedent's First Name MI CULBERTSON RICHARD N (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Ntl Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 'LX ii 1. Original Return `j 2. Supplemental Return a 3. Remainder Return (date of death prior to 12-13-82) I 4. Limited Estate I 4a. Future Interest Compromise ~r~I 5. Federal Estate Tax Return Required lJ ~_. 1 1.1 ale ..f .le.~fA ~f1e. 17.t'J_G ~\ I I ry ,, 6 Decedent Died Testate l ~ ~ Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes ~I,„, (Attach Copy of uvll) l (Attach Copy of Trust) r-^i 9. Litigation Proceeds Received i~ 10. Spousal Poverty Credit (date of death j 11. Election to tax under Sec. 9113(A) L__i between 12-31- 1 and t-1-95j '- (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name ~ Daytime Telephone Number PATRICIA R. BROWN ESQ. 717 249 633, n Firm Name (If Applicable) SALZMANN HUGHES PC REGISTE~ _r~LSU~ONLY' . First line of address ' I? "' ~ ' ' I =~ ~ l~ 354 ALEXANDER•SPRING ROAD, i `-~ r Second line of address r ; j ~ ~ - ~.i --~ N City or Post Office State ZIP Code DATE FILED ~.J CARLISLE PA 17015 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG TU OF PERS N RESPO SIBLE FOR FILING RETURN DATE ".~~~,,(~~ _ Philip J. Hippensteel /L -/ k -O , 52 Ashton Street, Carlisle, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE `y'-' Patricia R. Brown Esq. ADDRESS 354 Alexander Spring Road, Suite 1, Carlisle, PA 17015 __ ~ 15056041147 Side 1 15056041147 15x56042148 REV-1500 EX Deceeent'sName: RlChard N. Culbertson RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable {Schedule D) .......................................................... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) .................................................:..................... 8. Decedent's Social Security Number 198 05 1194 90,214.40 53,573.27 143,787.67 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ..................~.................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .:..............;.....................:.....................: 12 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. 13. ., . .,_a ~,_,.._ c..~.:....a a.. T-... !f ine 17 mimic I inP 1'~1 -------~-~ .................................. 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 0 0 0 15 (x)(1.2) X .00 16. Amount of Line 14 taxable 0 . 0 0 16. at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17. at sibling rate X .12 18. Amount of Line 14 taxable 1 2 9, 6 4 4 7 6 1 a. at collateral rate X .15 19. 19. Tax Due .................................................. .................................................................. . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 12,347.14 1,795.77 14,142.91 129,644.76 129,644.76 0.00 0.00 0.00 19,446.71 19,446.71 Side 2 • 15056t14214b 15fl56fl4214~ REV-1500 EX Page 3 Decedent's Complete Address: File Number 21.08-0765 CECEDENT'S NAME Richard N. Culbertson STREET ADDRESS - - 52 Ash#on Street I,ITY I STATE ZIP Carlisle PA ~ 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 19,446.71 0.00 Total Credits (A + B + C) (2) 0.0'0 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request arefund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1 9, 446.71 A. Enter the interest on the tax due. (5A) g, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ 9; 446.7 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes . No 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 :.................................... ~ ~i c. retain a reversionary interest; or .................................................................................................................. ~ d. receive the promise for life of either payments, benefits or care? .............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... ~~ 3. Did decedent own an °in trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................... r , ................................................ I x J IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE 5CHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1508 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Culbertson, Richard N. 21-08-0765 Include the proceeds of litigation and the date :he proceeds were receivetl by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. (If mere space is needed, additional pages of the same sizel Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98} Rev-1510 EX+ (6-98) scHeou~~ c -INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ FILE NUMBER Culbertson, Richard N. 21-08-0765 This schedule must be completed and filed if the ansxer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE] TAXABLE VALUE 1 FS~M Investment $ Trust Services -Revocable 53,573.27 53,573.27 Trust Under Agreement TOTAL (Also enter on Line 7, Recapitulation) I 53,573.27 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (12-99) ~ COMMONWEALTH OF PENNS`(LVANIA INHERITANCE TAX RETURN RESICENT CECECENT SC~1El~ULE H FUNERAL EXPENSES & ADMINISTRATIVE CASTS ESTATE OF FILE NUMBER Culbertson, Richard N. 21-08-0766 Debts of decedent must be reported on Schedule i. ITEM DESCRIPTION AfvIOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 622.56 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Philip J. Hippensteel Social Security Number(s) / EIN Number of Personal Representative(s): . Street Address 52 Ashton Street City Carlisle State PA Zip 17013 Year(s) Commission paid 2008-2009 5;500.00 2. Attorney's Fees SALZMANN HUGHES PC 5,760.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees - 173.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 291.58 See continuation schedules} attached TOTAL (Also enter on line 9, Recapitulation) 12,347.14 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (8-98) ~~ CCMAACN'NEAITH CF ?ENNSYLYANIA INHERITANCE TAX RET'.. RN RESICENT DECECENT SCHEDULE H-A FUNERAL EXPENSES continued ESTATE OF FILE NUMBER Culbertson, Richard N. 21-08-0765 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev1502 EX+ (6.98) a~ ~ SCHEDULE H-~7 ~`~~~" OTN E R ADMfNlSTRATiVE COSTS COMbICNWEAL?H OF PENNS'!LVANIA ti d INHERITANCE'A;( RE'URN con nue .RESICENT CECE~EPIT ESTATE OF IFiLE NUMBER Culbertson, Richard N. ~ 29-08-0765 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev1512 EX+ (6-98) SCHEDULE 1 ,r DEBTS O~ DECEDENT, MORTGAGE LIABlLlT1ES, & LIENS COMMCM,1'_.4LTH Or PENNSYL`/ANIA INHERITANCE T.4;( RETURN RESIC_NT ~ECECENT ESTATE OF FILE NUMBER Culbertson, Richard N. 21-08-0765 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE Or DEATH 1 Borough of Chambersburg EMS 466.00 2 F8M - F8~M Revocable Trust Under Agmt pymt dated 06/20/2008 to Chambersburg 835.86 ALS 3 F&M -Revocable Trust Under Agreement fee for trust services 68.61 4 Midatlantic Cardiology 355.00 5 WSEMS ~ 70.30 TOTAL (Also enter on Line 10, Recapitulation) I 1 795.77 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA;( RETURN RESIDENT DECED6VT SCHEDULS J BENEFICIARIES ESTATE OF FILE NUMBER Culbertson, Richard N. 21-08-0765 NAIb1E AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NU141BER PERSON(S) RECEIVING PROPERTY DECEDENT (~f/ords) ($$$) Do Not _ist Trusteels) ~. TAXABLC DISTRIBUTIONS [include outright spcusal distributions, and transfers under Sec. 9116(a)(1.2)] Carol Jean Beaver Niece 14 404.97 2527 Penbrook Avenue , Harrisburg, PA 17103 Charles A. Culbertson Nephew 14 404.97 205 Park Heights Avenue ' Shippensburg, PA 17257 John Culbertson Nephew 14 404 97 116 South Prince Street , . Shippensburg, PA 17257 Scott A. Culbertson Nephew 14 404 97 320 Northview Road , . Birdsboro, PA 19508 . Darlene K. Englehart Niece 14 404 97 Gwyneed Square Nursing Center , . 773 Summeytown Pike Lansdale, PA 19446 . See continuation schedule attached Continuation Total 129,644.73 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cover sheet jI~ NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J BENEF1CiARIES (Part 1, Taxable Distributions) ESTATE OF: Richard N. Culbertson 06/96/2008 198-05-1194 Item Name and Address of Person(s) Share of Estate Amount of Estate !Number Receiving Property Relationship (Words) {$$$) runup .,, rnppensteei ~ Nephew 14,404.97 52 Ashton Street Carlisle, PA 17013 7 Richard E. Miller Nephew 14 404.97 ' 2438 Holt Street Vienna, VA 22180 8 Dianne Reynolds Niece 14,404.97 827 Fairfield Street Mechanicsburg, PA 17055 9• Frances V. White Niece 14,404.97 644 Luther Road Harrisburg, PA 17111 Total - 57,619.88 1 ~~t t11 ~~ C}. e~t~tm ~ztt I, RICHARD N. CULBERTSON, of Penn Hail, 1425 Philadelphia Avenue, Chambersburg, Franklin County, Pennsylvania, 17201, being of sound mind and memory, do make, publish and declare this my Last Will and Testament, hereby revoking and declaring null and void any and all wills and codicils by me at any time heretofore made. FIRST: I direct my Executors to pay any debts which I may owe which are not barred by the statute of limitations and are considered just by my Executors, the expenses of my last illness, and my funeral expenses. SECOND: I give, devise and bequeath all of my estate, of whatsoever nature and wheresoever situate, to my following named nieces and nephews vvho survive me: Charles A. Culbertson, Philip J. Hippensteel, John Culbertson, Dianne L. Reynolds, Carol Jean Beaver, Scott A. Culbertson, Frances V. White, Richard E. Miller, and Darlene K. Englehart. Should any of my above-named nieces and nephews fail to survive me, his or her share shall be distributed to his or her issue, per stirpes, surviving me, and in default thereof, in equal shares, to my other above-named nieces and nephews who survive me. THIRD: I direct my Executor to pay out of the principal of my estate, a!I federal estate, state inheritance, estate and succession taxes imposed upon or with respect to my estate or any property in which I may have an interest, including any property not forming a part of my testamentary estate, but included Page 1 of a Four-Page Will in my gross estate for tax purposes, in such manner as my Executor, in his sole discretion, shall deem advisable; and no such taxes or any portion thereof so paid shall be collected from or paid by any other person, persons, or corporations by way of reimbursement, proration, apportionment or otherwise. FOURTH: I name and appoint my nephew, Philip J. Hippensteel, Executor of this, my Last Will and Testament. I direct that my Executor shall not be required to post bond for the faithful performance of his duties in this or in any. other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~<-z~:~ __ day of ~;. 2005. WITNESS: ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF FRANKLIN SS. (SEAL) I, RICHARD N. CULBERTSON, the 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 Page 2 of a Four-Page Will and Testament; and that I signed it willingly, and as my free and voluntary act for the purposes therein expressed. WITNESS my hand and official seal, the day and year aforesaid. . ,~ ., Richard N. Culbertson,- Testator _ ~ ~, Notary Public Cfl OIVWEALTH OF PENNS VAMA Notarial Seal Linda W. 4ickinson, Notarryy Public Chambersburg Boro, Fr`anktM County My Commisafon Expires Mar. 22, 2008 Memb4r~ Pu~n~Ma AoMOCiatbh of Notufoa AFFIDAVIT COMMONIJ~IEALTH OF PENNSYLVANIA COUNTY OF FRANKLIN 1A/a f'~~Gh~c~ K. C~'.a~l~~nson and 1 lA,.,o 1~• ~~Ppf~S~~~. the Witnesses whose names are signed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do depose and say to the undersigned authority that we were present and saw the Testator sign and execute the instrument as his Will; that the Testator had signed willingly (or willingly directed another to sign for him) and executed it as his free and voluntary act for the purposes therein expressed; that each of the subscribing Witnesses, in the presence and hearing of the Testator, signed the Will as a Page 3 of a Four-Page Will Witness; and that to the best of our knowledge Richard N. Culbertson, the Testator, was at the time 18 years of age or older, of sound mind and under no constraint or undue influence. . - ._ __ WITNESS WITNESS Sworn and subscribed to before me this ~"~ day of '~ o~-r~•sU-/) , 2005. ~~ ` Notary Public COMMONWEALTH OF PENNS VANIA Notarial Seal t.indaN. Dickinson, Notary Public Chambersburg Boro, Ftanklin County My Commission Expires Mar. 22, 2008. ' Member, PennayManla Assooledon of Notaries Page 4 of a Four-Page Will I, ~ IC~ard ~~• CU~.13~1~,T5~>\! of 1 ((,~~~ettlor) ~~ a`ZI ~~'~~~ine.ICC-i(9 AvE RM 139 hereby transfer to FARMERS AND MERCHANTS TRUST COMPANY OF CHAIL•ISERSBL'RG (hereinafter called the Trustee"), a Pennsylvania bank and trust company, such property as may be delivered herewith set forth on Schedule "A" attached hereto, or from time to time hereafter, to be held in Trust as follows: FIRST: Diapositive Provisions For My Benefit -During My Lifetime. A. The Trustee shall collect the income and pay over the net income to me in quarterly or more frequent installments. At my written direction, part or all of such net income may be accumulated and added to principal. B. The Trustee shall pay to me onto others such portion or all of the principal as I may from time to time direct. C. The Trustee shall at least annually give me a detailed statement showing all receipts and disbursements on account of the trust estate and the then balance of trust assets. D. The Trustee is authorized and directed to pay and use such portion or all of the trust assets as it, in its sole discretion, from time to time, shall deem necessary to provide for my maintenance, support, medical, hospital, nursing or nursing home care. SECOND: Diapositive Provisions After My Death. Upon my death during the existence of this trust, the Trustee shall pay the then remaining principal and income to the Executor or Administrator of my estate for disposition as part of my Estate. THIRD: Right to Revoke and Amend. I reserve the right to revoke or amend this trust, in whole or in part, at any time and from time to time by an instrument in writing, delivered to the Trustee and signed by the parties hereto; except that the duties, powers and liabilities of the Trustee shall not be changed without its written consent. The Trustee reserves the right, at any time upon thirty (30) days advance written notice to me, to resign as Trustee and deliver the trust assets to me, after deducting therefrom its fees and any expenses then due and payable. FOURTH: Additions to Trust. Subject to the approval of the Trustee, either I or any other person or entity may add property, real and personal, to the principal of this trust: FIFTH: Trustee's Powers. During the continuance of this trust, in addition to the powers granted by law, my Trustee shall have the following powers, exercisable in all events and without leave of court for my best interests: A. To retain any property or investments which I have herein transferred and conveyed in trust, as long as the Trustee --nay deem it advisable so to do, including securities owned, issued or underwritten by the Trustee or any of the Trustee's affiliates. B. To vary investments, when deemed desirable by the Trustee, and to invest in such bonds, stocks, mutual funds, notes, real estate mortgages or other securities including, without limitation, shares in Franklin Financial Services Corporation, or in such other property, real or personal, including securities owned, issued or underwritten by the Trustee or any of the Trustee's affiliates, as the Trustee shall deem wise, without being restricted to so-called "legal investments", and without being limited by any statute or rule of law regarding investments by fiduciaries. C. To sell either at public or private sale and upon such terms and conditions as the Trustee may deem advantageous, any or all real or personal estate or interest . therein owned by the Trust severally or in conjunction with other persons, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all' deeds, assignments, options or other writings whic(~ may be necessary or desirable, in carrying out any of the powers conferred upon the Trustee in this paragraph or elsewhere in this Agreement. D. To vote by person or proxy any and all stock held in the Trust and in the discretion of the Trustee, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of the Trust assets. E. To place and carry any asset of the Trust in the name of a nominee. -2- F. To assign to and hold in the Trust an undivided portion of any asset. G. To make any division of the principal of the Trust assets ar any distribution of the assets partly or wholly in kind. If such division or distribution is made in kind, said assets are required to be divided or distributed at their respective values on the date or dates of their division or distribution. H. To pay all costs, taxes, expenses, compensation and charges in connection with the administration and termination of the Trust. I. To do all other acts in the Trustee`s judgment deemed necessary or desirable for the proper and advantageous management, investment and distribution of the Trust assets. J. To mortgage real estate, and to make leases of real estate, extending beyond the term of the Trust hereunder. K. To borrow money and to assign and pledge assets of the Trust therefor. L. If I shall be unable to act, or shall lack ability, or, in the sole judgment of the Trustee, shall otherwise be unable to apply such payments to my own best interest and advantage, the Trustee may make all or any portion of such payments in any one or more of the following ways: (a) Directly to me. (b) To my Legal Guardian or Conservator. (c) To a relative of mine to be expended by such relative for my benefit. (d) By the Trustee expending the same for my benefit. SIXTH: Compensation. The Trustee shall be compensated in accordance with its standard schedule of fees in effect from time to time during the period of its services, and this compensation shall be paid from principal or income or partly from each in the sole discretion of the Trustee. Settlor hereby acknowledges receipt of Trustee's current fee schedule, which is subject to revision from time to time. -3- Settlor understands that the Trustee, from time to time, may enter into arrangements with sponsors, distributors and other persons associated with various mutual funds pursuant to which the Trustee will perform services for the mutual funds or such persons and for which the Trustee will receive compensation in addition to the fees to be received by the Trustee under this Agreement. If the Trustee invests assets of the Account in such mutual funds, Settlor understands that the Trustee could be viewed as having a conflict of interest_ in doing so. SEVENTH: Protective Provision. No part of the income or principal of the property held under this Trust shall be subject to attachment, levy or seizure by any creditor, spouse, assignee or trustee or receiver in bankruptcy prior to actual receipt thereof. The Trustee shall pay over the net income and the principal to the persons herein designated, as their interests may appear, without regard to any attempted anticipation (except as specifically provided in this agreement), pledge or assignment under the Trust, and without regard to any claim thereto or attempted levy, attachment, seizure or other process against me. EIGHTH: Law Governing Trust. This trust is created and accepted in the Commonwealth of Pennsylvania and shall in all respects be governed by its laws and shall have its situs in Franklin County, Pennsylvania. NINTH: Binding Agreement. It is the intention of the parties to be legally bound by this Agreement. WITNESS: /~~ J The foregoing trust is hereby accepted. Executed on /'d / ~ 19~ ATTEST: FARMERS AND MERCHANTS TRUST COMPANY OF CHAMBERSBURG By: (SEAL) By: -4- INVESTMENT OBJECTIVE ACCOUNT NAME: ~ ~~~' ~ ~i /'C~ l~ C u I e r~S ~ l~ The client hereby selects (by initials) the following Investment Objective and directs the Trustee/ Manager or Advisor to invest the assets in individual securities, mutual fund(s) or the Asset Allocation Model designed for that objective: Note: If the account is an Asset Allocation Model complete side one and side two. If it is not an Asset Allocation Model complete only side one. INVESTMENT OBJECTIVE Capita Preservation -Focuses on protecting the assets within the portfolio from loss of value. Investments include money market accounts, certificates of deposit, short-term Treasuries. Taxable Tax-exempt X Cur: 2nt Income -Provides an immediate income. Investments include a mixture of Treasuries/Treasury Bond funds featuring laddered maturities. Portfolio may contain a small percentage of equities. (Municipal/Municipal Bond funds for tax-exempt accounts) ~ Taxable Tax-exempt Growth & Income -Features both current income and growth assets with emphasis determined at the individual account level. Investments include equities/equity funds and fixed income securities/funds (government, corporate, municipal). Taxable Tax-exempt Capital Growth -Stresses the growth of the assets within the portfolio. Investments focus primarily on equities to reach the objective. Taxable Tax-exempt Aggressive Growth -Emphasizes aggressive growth by almost exclusive utilization of equity securities/funds. While these securities may be more volatile, they offer good poten~,ial for future growth. Taxable Tax-exempt ~~ ~~ DATED: /o ~ ~ ~ - t ~ SIGNED SIGNED ACCEPTED BY: FARMERS & MERCI-iANTS TRU/,ST COMPANY DATED: / o -/ ~ - 9 ~ BY ~~-~~/~ ~'~ ~~ ~v 5/20/98 SCHEDULE "A" ACCOUNT NAME: ~l.e ~ a r'~ /~l , C u l6 e~ ~`soni T CASH in the amount o£ Check PANY RECEIVED THE FOLLOWING: $ a9, 3~g- o.~ -- - vta.~~/ti ~~ ~ 33-I~S~~ Withdrawal Authorization Currency from Account # ~~ ~ SPECIAL NOTICE Investments through the FPM Trust Department are not bank deposits; are not obligations of, or guaranteed bS•, any bank; not insured or guaranteed by the Federal Deposit Insurance Corporation (FDIC? or any other government agency, and involve investment risk, including the possible loss of principal or your original investment. 1 DATE SETTLOR DATE SETTLOR Trustee hereby aclaiowtedges receiving the above Assets on this date. /o -/8-~f° By , ~ l~~ U DATE Farmers ~ Chambersburg Company N C O 7 (U L (U N O m z .. v 10 N = C U ~ ~ N . . rn m ? O a~ ~ o o a~ N f0 U ~ m N W C O O O c a c a m N N ~ ~ ~ N ~ N y _~ C d C C 7 ~ 7 N 3 U U U Z = Z c ~-~ ~-~ 7 o m a ~ a r . U r U a ~a ~a U C ~ f0 L(7 V N V CD ~ ~ ~ c0 N 0 0 0 0 0 0 0 0 0 0 0 ~ ~j ^ 0 0 0 0 0 0 0 0 0 0 0 ~ l0 ch 0 0 0 0 0 0 0 0 0 0 0 EA Ef3 EA fA fA EA E~ EA ffl b9 EA 69 fA C a N ~ ~ U O) ~ O Q N N (A fA (D I~ ~ a0 N U C •-- m M ~p CO N ~p N I~ m In Efl M EA N U1 N O U ~ ~ m o ~ m o N C I~ ti y O O O O Ul ~ m 7 Z ~ v c o_ r~ Q 7 rj O U M t~ Q N f- C Y V C Y U L U Q t U U T _ _ a -~ T O C ~ ~. fD 7 j ~ V D~O f ~ ~• 3' 07 ~ f ~o ~ W '. to ~ (D (D rn ~ ;~ mDm c~ m.~ ~ ~ m~ z ~ cn ~ ~~ v-i ~ m '' ; m ; ate, O m~ ° zm ' ~' ~ ~ 3 ~ ~ ~ v ~ ~, ~ r n ~. D o m Z c~ o D ~- ~ ~ N O - o 'p -+, ~ ~ ~ ~ N (D n C ~' ~ ~ O ~p f O= .-. ~ ~ n CD ° i N. C ~ ~ I ~ ~. I O t0 -k ;D N= ~ ~ Tr Z . ~ z m G- Dtnz ~ ~ °mm cn ~ r i C7 O O ~- ~° ~ ~~ ~ ~g o ~ ~~ ~° ~~ ~ ~ ~~ o ~~ ~ ~ ~ ~ ~ o 1 n o N C ~ o ~ ~ ~ ~ c o ~ c 'n `~ `~ o ~ a ~ m ~ o ~ ~o i _J n S d ^Z l J C D ~ m D ~ ~ ~ ~ ~ ~, o ~ c C ~ o .--r W N O Q' 1 O w ~ O O ~ 07 rN-r Ca C O ~ O ~ °O D co m cD (D c z m Z Z D -~ C -~ n .,, ~~ 0 3 ai N. m ,~ m a ~~ x °~ N_ O p N ~~ .~ c m ~ ~ n ~~ ~~ o a ~ c r m 'n C 2 c o y ~ n c r, ~y o ~c c - m a~ ~ < ~ v N ~ .-. (D ~ y C ~ -• (D n 7 n ~~ `.J.y ~. V ~' X`~ ~T ~~ • n :~ J ~- U a' c 7c y ~, N O O m ~ ~ m m ~ m = W n Q m ~ N (D ~ n i c p (0 l'f ~Q ~ ~. ~ ~ X O ~ ~ ~ ~ _ j v co a ~ ~ m N ~ m ~- y ~ nXi a ~ D ~ p ~ Q ~ ~ ~ n ~ cn in ~ N < C r r N ~ .~-• ~ C (D G N ~ y v (~ ~ ~ C " ~ .N. N C . .. ( /I ~- N y (D ~; W ~ ~ ~ . ffl f19 N N I ~ ~ ~ o ca w d o w w ° w v ~ o. i W d N ~ W ~ 0~0 ~ O N W ~ N ~ - W W ~ f~ N E~ N ~ O O ~ ~ O N ~ CO m m n X ~ N (D C, N a ,< ~' iU n n n~ m .n c <~ tU (D y VJ Q1 7 d 0 N e» cfl~cfl o O N O' ~I ~ d v N O = OD N Oo O V 00 W, (~ ~ ~ i ~ ~ ~ ~: ~~ O U~ N ~ O W V' CO O CJ1 ~ O o o 0 0 0 U1 CT1 C 01 N N p1 W O O C o O1 fA ff3~ O 5i w o a ao = c 00 0 0 00 0 0 O O O O 3 00 O O O O O~ O O O O O O O 0 0 0 0 0 .-r W 0 i W O 0 n 0 c ;. ,.~.. 'S Q ':..~ 0 ~: 0 N O O ;_ rF d> t ~... I W'` o' -N O Ia r o0 N \/ ^~ 1// "S ^Z N Q N C Z o < m ~ 3 _ ~ z -~ ~ ~ ~ D Z 0 rh ~ C ~ a c~ ~, m ~ ~ cQ n N rh N :J Q x .~ 0 n y rD s c D v N n~ cn A A ~ N N p ' N N y N N ~p °o °o p- 0o ao n ~ -o -n m ~m m m x 3 m ~ m m o.m =~°• m m n d o m N 3 - 3 QN (~"~v (D O' d Q A =0 3 m a O N O' N n N O' (D Q d ~ C ~ C d O QQ C oDco~ ~~ o ~ ~ ~ n~ O N N y 3 ~ ~ m ~ ~0 0 ~ ~ ~~ c (D O =O O N O (D N ~_ (D Q O7 ~ v C ~ 7 (O ~ n~ i ~ N ~ n0 ~O (D = ~k O n O N W 7r W po W 1 0 ~ ~ N O O N V W N O ~, j ~ O Q 3 3 n O 3 N O O y O O S v -o d V CT (7 (n W W m N y A W S n fl1 v C -, N ~D ~D rF 0 0 0 0 0 0 0 m O CJ1 A ~ Ul A ~ p O O O ~ p O O O ~ p m y N y C~J N W y N ~p N N N ~ N N N ~p °o °- °o °o °o °' °o °o o° °~ 0 0 00 0 0 o ro m c a C7 N N S .'i7 O N V 0 m 7 A O 3 _A lD "'' O d c0 O S v V CJ1 ~ W O ~ N (O ~ W OD y W W S 00m °'m °Dm 0 0 0 m m ~ > > cn cn m ~ s ~ g ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 0 0 0 N 0 N N 41 n ni 0 0 0 c ~ ~ ~ M n (~ C7 ~ W W W C C C <D O O O ~ O O C d `G ~ `G d d 7 p" ~ ~ (n to cn d n~ n~ ~ ~ # ~ C7 7 CD (D (p d (D fD c0 O 3 (D m m ~ y ~ o 0 o a: ~p x x x ~ ~ ~?+ ~ O m m m x 1~~ .. o' m m m m x v in in co ~ ~ -gy ~ ~ D D D p.-. 3 o ~ O O O O ~ ~ v ~ . -: T Tl T1 O O ~ ~ ~ fl' ~ O_ O_ d fD C ~ ~ ~ -'~ . N x (R C N C UI C O X `z `~ `~ ~ 6 - 0- _ O' N d N 7 ~ 0 Q' ~ ~ O ~ > > a d m 7 3 ~ 3 3 ~ W ~, C71 N N O (D N OD d O O O O y : N S Oi Ut ~ ~ O O O 5 v I v ~> ~, N ~ °~ w V V V °~ n. A OD Oo W ~ O O O O d ~` '~ 61 ° ° ° ° 3 ° ° ° ° i o o o 0 ' o O o o 0 0 0 0 0 0 N O) O Ol Ul A A ~ O O O O O O p W N N s N y N N N N N N ~ T 0 0 0 0 0 0 C ~/~ 0 0 0 0 0 0 m m w m m w ~ ~D v v v v v v o ~ <" <' <' <~ <' <" < t/1 a a a a a a a m m m m m m~ a o_ o_ o_ a o_ a Q ~ 0 0 0 0 o. n a a n a Q ~ ~' 1 O O O O O O ~ (D v N N (D N o. ~ n. ~ a ~ m co m co m cn ~ C ~ C ~ C d 61 d a n a n Q n o Z o Z o Z ~ m ~ n~ ~ ~ D ~ D ~ D C C C C O C O C O 7 D- 7 d 7 d W ~ W ~ W ~ O_ m J O_ Q N 0 v n O W N O N W A V A Oo n O W W O W d A W W W V O O) N A O 01 V U7 CJ7 3' v A -o G/ O 0 0 0 0 0 0 m O 0 0 0 0 0 0 S s.. , 3 rr ~}: W O d> W 0 O ~' 3 N Q _ r N~' ~r tQ d", ~. ••. O N, _O O Oo r+ O o, 1 W O N G, O n ^~ ii/ i.i Z ~ - Z O n ~_ ~D Z ~ D Z l~1~ ~ Cc ~ N ~ ~ ~ rn ~ < m ~ C/) c~ ~D ~-r W u O A ~ s w N ~ o n, 0 a ~ ~ c c A ~ ? C1 61 T N ~ (D ~ d ~ m N w V N (D ^^N 1G fA V m O O 0 0 co v Q lD T C a 7 n O 3 N o n d O N O S A o v ~ ~ m y O N O S 0 in ~ n o O o -+ m ~_ o ~ O N O N 0 3 O r O N O N W 0 0 o O 0 0 0 0 0 0 0 0 0 0 O ~ (` A A .9 m ~ Ut C`7 A A ~ O Cn A ~ ~ 1 N O O A N N CJ1 -~ N N V 1 ~ N W -~ A O N N O N V N ~ O N N ~ O N N N N N ~ N N N N N N ~ N N N tD N o ~ _ 0 0 0 0 0 0 0 0 0„ o 0 0 0 0 0 0 0 0 0 o 0 p, o 0 0 0 o 0 Q, 0 a lD w w m w w oo m w w o0 0o ao w w N ~ 'O '~ Z 'U ~~ r D D D D D D ~ T ~ ~ T Z~ m ~ m m m m m ~ c c c c c c ~ m m m m ~°1~ a Q ~ ~ n~ N~ ~ O O O O O O O 'O 'O ~ ,O N (D N A U~ ~~ m N d 01 d d 41 W d O O ~ 07 y • n n n ('1 C7 n ~ ' _ . - ~ ~ N ~ S ~ ~ (D J (D 7 ~ (D O (p ~ O a O n C7 C) C) C7 C) to O Q O O Q fl1 (G > 0 > 0 O > > 0 > C~ o > v ~ N v v+ w m d v, m m ~ N Q (n Q N n ~3„ rn ~ ~ Q m = ~ = N ~ m J S S ? S S v, ~, A S N n. n i v .n v ~ n i -1 ~ ~ -1 ~ -1 ~ ~ ~ c "' o~i y m m ~ m o m ~ > > > > > > w m o- fO ~ ~~ 7 O () 7 ~ 3 ~ Q N (D (n (D N N N (D f/l (D fn (D C) C (7 ~ N ~ O (a ~ D (D 7 (D 3 Xk (D N 7 N p 7 n ~_' ~ ~ (D O f 3 7 W ~ 7 ~ ~ .. N N 7 ~ ~ N 61 OD 41 41 J - (D (D ~ Z1 ~ Z1 0 ~ ~ ~ . . c . 7 V1 (~ S S ~ `G Yk ~ O O O O f0 O W 2 ( Q d O Q ~ Ui ~ Z Z ~ ~Z A w ~ ~ •m ~ ~ _ ~ r C C O o C W 40 N ~~ m m ~ ~ ni ~ ~' n "' x > rn ~ ~ n n = x -p 0 ~ N pl O S C'1 S C7 ~ Z7 N ~ O U ~ r ~ ~ n GD ` - : ~ O_ ~ fn tD d C N Oo N O~ N ~ O ~ p N ~ ~. 0 O 3 ., p 7 ~ o CO a , '~ ~ N ~ ~ ~ N fD 41 ~ W n S ~ - ~ 7 ~ ~ ~ ~ p N 7 O7 `..) I Q Q O Ut Do A ~ N ~ CIt N... . A N ~ ..: N m N m ~ N J V °V ~ ; W 0 O) v W N n + 01 V Oo (~ _ W O W O N ~ 00 W O W O O y (O 00 O O y ~ A 00 O O CO :.41. N O: N O A A O N (D O) (O A N (p I W (T W O O S" ~1 O ~ O O) S ^1 O O S I ~ ~ '~ O) cD cD ~ ~. aD A N _ 'O 'O N ~1 V D1 - ~ ~ _. O) ~ DI 01 N W W (7 ~ D1 m v N W N (O N O O N O y ~ O. W O OD O O y O O O O y ~1 O O ~1 O 41 V O N (O A A O N O O O O N ~1 W O O W O _S ~1 O m O) S O O O O 3 I ~ 3 ~ n O 3 N 0 o n Gl O O ~' A ti Gl A U1 ~ d W o ~ pt y _v, a N ~D rt y n .-r ~,'`~.. W W O _N ^• \~, Q. Z '=`I \J ~i 0 N 7~ ~D Z N ~ ~ .ter ~ -: C c ~ 3 ~ Q. ~" ~ m ~ ~ p ~ n 3 ~ C/') to ~D ~D r y ~D ,~',~ ~ tQ ~"~' Q ~_ O N >C O 0~ 0 W, "~. Q Q ~. Q X O • n :~ CD N 1'~ D V N N iD Ul v - _ A co n ( ( 1 ~ C71 A U1 ~ ~ ` ` -~ • OO~o A N ~ C`7 [n C` A i` O y N N ~ C rt N N N N N N ~ fl' OD 00 ~D 00 OD 00 00 O7 00 N .-~ ~ ~ ~ ~~ '~ ~ ~' o 0 0 0 0 o m _ w N c ~ io m. N~ io m, 5 a Sv a a a a a a ~ S V G O G A ~S c0 -+ m ~ (Il ~ A ~ (y' tN N W N O. y A (T N m N O N W p (D iD S~ S O ~ O V (O ~ W V ~ O p W (n ~ ~ ~ ~ < ~ N _a N j N N y n y a ry- ~ N S N ? N N ~ i ~ i v Vii ~ y ~ N N (~ r0 r0 ~ N D 3= ~n ~ (e ~ ~ ~ ~ ~ ~z ~~ o ~ ~ ~ , ~ ~' ~- O N O V A G ~G n `S n O V O ~''~ 0 0 N ~p G N fD < O O ~ O O O ~ O 0 O 0 O ~ d ~ d T ~ ~- ~ !- ~ N ~ y V m n r < O Z7 _ tD ~ W (D O O 7 ~, ~ fC U1... (D tD i11 ~ ~p (D y O n ~ G~ m ' ~ °~ m ~ v < n `~ ~ ;. v fD 1G1 fD O O `G N ~ N N nVf ny C N (D Z _ ~ o~ O~ N ~ < G D ~ < ~ ~ ~ < d'~ d~ ^ 7 C 7 N N C N ~ ill C ~ d OD o O : A o ao ~ ~ 7 n ~ m n V 4 ~ o 7 C W O ~ ~ i U 7 d ~ D ~ CD ~ ~ ~ v TI ~ a Q. ~D N - ~ : W N cn N n (D W cn d t A ~ fD W W ~ 0 O p O O ~ 7 n N N '.. .N !. N N n o l '~ o 0 _ I I A .p ~ A A p ~ '-. y' ~ O O O O y O O O O O O O O y p p) (n y O O O O y O O 0 0 0 0 0 0 t0 O cp c0 Z O O O O 5..: O O 0 0 0 0 0 0 S ~ ~ ~ 7 n j. p ~ ~ 'O p ~ W A CO _ p _ O m _ O ~ . d y O~ W iD ~ V ~ p O j y (O V O ~ (O O O O 07 W N cp O O W W ~ (7i y W O O O y O) O) W O) c0 Oo O c0 fB A V ~ S A O O O ? Oo 07 O Oo V N O S W A A V 00 N ~- W m W V A ~ O _. m .~a O ~ (D (T ~ ~ (O ~ Ul .~ N W V ~ oo (D 00 C7 Vt Cit O V O O (O ~ O W V ~ O) Ut Ut fD OD 0o C~ A N U1 m O A O W 00 O Q W A 00 m N O M I Ut V ~ CD O) O (n i0 » V O V p O O j O O W p O O (li m M ~ ~ ~ ~ m m , , rn ~ rn rn rn 3 0 0 o r p ~ o 0 0 o r p cn o cn o ~ ao rn m o 0 o r p 0 O 0 O o O y tl1 o O I 0 O 0 O o O rn y o O o O V O J cD io V 0 0 0 0 o 0 y y ~ c I i (r e ~ N e y ~ d ~ m 7 W ~ , r W ~ W j qt p N N N -~ W 7 ~= O O O ~ O O O O O N O m p W O O O O O O O y tl1 I~ A O O O O O O y y ~ A ~ A O O Ui ~ 0 O 0 V 0 O m Cn y y ... p c~ n n ~ 0 rT N rr ._~ . . ~ W ~ O Q C ~~ W ^ Q O ~/ _N ~• /~/~ ii Z ~~ 0 m a ~ c~ z Z ~ ~ '~ C/l Q ~ ~ ~ m ~ ~ ~; v < n ~ ~ N ~D ~, 7 rF a ~- 1 a_ N 0 O 00 ~, O Q W Q N x S ~_ • v n J b T N tf] (D cn -' n ~ I I ~ ~ m d 0 o a v ~ ~ m I ~ i N y y ~; N I N 7 7 ~ r 'I T i O O) O). O)' Q) OD QD OD O W O II aD~ O W O ~ N ''~ O O I 0 0 N C ~ ~ O CI S ~ -1 ~ ~ o_ O ~ m 3 ~ ~ t m ~. N T ~I ~ 7 a a N y m m m m m m o a ~ m x ~ ~ ~ `~ d N X N ~ ~ ~ ~ ~ 9 .-. Q Q' 4 p1 C1 N ~ `7 ~ C1 7 ~ ~ ~ a ~ o ~ v , . m ~' m ~. o ~ ° 0 0 0 c o ^ ~ O to v~ w D ~ -~ `i er 3 0 0 o o ' ° o' °o °o co o v 0 0 N m ~ N N.. N w . y ~ ry W OD O OD J a au aD -:OO O ~co O. O: O O T =. O N o °1 ~ ~ Q ~ ~ °i m m ~ _a ~ o x ~ IN N N ~ ~ ~ ~ ~ a OD W OOO O m ~ o m ou m au 0 o 0 0 0 J c c N ao ~ J d" a ~ V V J I y 00 W O O~ n ~ o .~ J o m ~ o _ O ~ G ~- N n ~ ~ ~ ~ p U~ Ul Ul O O 0 0 0 0 j ~-^ C 01 -' d i 3_ ~ J N .N-. (~) ~ _. N N N O ~ j N N N O O O O O) N S d W N n d N ~ S C1 x m 1 o ~~ ~ ~ ~ m w m N ~ S -"~ O N n 61 S 0 0 -° 0 0 0 0 0 0 0 O O O o'0 0 O ' O O 0 0 0 °o °0 0 C 7 v m n 0 3 d .~i m c m D ~ 3 dm C _~ ~ ~ 3 ;" ~ O d N °- D Z 0 ~ . m n cn ~ ~ ~_ Z .~ D Z rh ---~ C~ C ^~^ ~ inf. c./"~ ~ m ~~ ~ m ~ ~ D O' C "~ G1 0' A ~ ' O. W ~``~,, Av n ,~ C d n , n' W 0 W O O \I