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
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