HomeMy WebLinkAbout02-23-0915056041125
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Poaox2sasal INHERITANCE TAX RETURN
Hamsburg, PA 17126-0601 RESIDENT DECEDENT 2 1 0 7 0 5 9 8
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 6 0 1 6 2 0 5 8 0 6 1 6 2 0 0 7 0 6 1 1 1 9 1 7
Decedent's Last Name Suffix Decedent's First Name MI
S t e v e n s J R J o h n P
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
S t e v e n s E I i z a b e t h G
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
1 9 6 1 4 7 3 5 2 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Return
4. Limited Estate
QX 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
OX 7. Decedent Maintained a Living Trust 0
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
S c u d d e r G S t e v e n s E s q 6 1 0 4 4 4 9 8 4 0
r.,
Firm Name (If Applicable)
S c u d d e r G S t e v e n s P A
First line of address
1 2 0 N U n i o n S t r e e t
Second line of address
P O B o x 1 1 5 6
City or Post Office State ZIP Code
K e n n e t t S q u a r e P A 1 9 3 4 8
Correspon9lont's a-mail a~f€ss:S~llddert~SCUdderQStevenspa.COm
Under pen ties perjury declare that I h e examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, rrect d co lete. Dec ratio f preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA URE O PE SON RE L OR FILING RE DATE
Scudder G. S~dens, Executor 120 N. Union St. Kennett Square PA 19348
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041125 15056041125 J
15056042126
REV-1500 EX
Decedent's Social Security Num ber
Decedent's Name: John P. Stevens, Jr 1 6 0 1 6 2 0 5 8
RECAPITULATION
1. Real estate Schedule A 1. 0 . 0 0
2. Stocks and Bonds Schedule B 2. 2 4 1 9 6 3 0. 5 5
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0 . 0 0
4. Mortgages & Notes Receivable (Schedule D} ...................... .. 4. 0 0 0
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... .. 5. 1 4 4 5 9 . 8 4
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 2 2 3 2 5 . 1 2
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .....
.. 7. 1 6 6 2 6 2. 4 9
8. Total Gross Assets (total Lines 1-7) ......................... .. 8. 2 6 2 2 6 7 $ 0 0
9. Funeral Expenses & Administrative Costs (Schedule H) .............. .. 9• 2 5 1 5 7 . 8 6
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I} .......... .. 10. 6 2 1 5 . 0 0
11. Total Deductions (total Lines 9& 10) ......................... .. 11. 3 1 3 7 2 8 6
12. Net Value of Estate (Line 8 minus Line 11) ....................... .. 12. 2 5 9 1 3 0 5 . 1 4
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................ .. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ................ .. 14. 2 5 9 1 3 0 5 . 1 4
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a){1.2) X.o - 2 5 9 1 3 0 5 1 4 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .o_ 0 0 0 16. 0. 0 0
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0
17.
0.
0
0
18. Amount of Line 14 taxable
0 0 0
0
0
0
at collateral rate X .15 18. .
19. Tax Due ................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
0. 0 0
15056042126 15056042126
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 07 0598
DECEDENT'S NAME
John P. Stevens, Jr
STREET ADDRESS
868 Oak Oval
CITY
Mechanicsbur STATE
PA ZIP
17055-
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Inlerest
E. Penalty
(1) 0.00
Total Credits (A + B + C) (2)
Total Interest/Penalty (D +E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
0.00
(3) 0.00
(4) 0.00
(5) 0.00
(5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 0.00
Make Check Payable to: REG/STER OF W/LLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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
without receiving adequate consideration? ..................................................................................
3. Did decedent own an "intrust 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? .............................................................................................
Yes No
..... ^
..... ^ 0
..... o a
..... ^
a ^
a ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 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)]. Asibling 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-1502 EX+ (6-98)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
John P. Stevens, Jr 21 07 0598
All real property owned solely or as a tenant in common mull be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real propertv which is ioinUv-owned with right of survivorshia must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCR{PTION OF DEATH
None 0.00
TOTAL (Also enter on line 1, Recapitulation) I $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
John P. Stevens Jr 21 07 0598
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~. Merrill Lynch CMA Account 87251139 2,419,630.55
TOTAL (Also enter on line 2, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1504 EX+(6-98) gCHEDULE C
CLOSELY•HELD CORPORATION,
COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR
INHERITANCE TAX RETURN SOLE•PROPRIETORSHIP
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John P. Stevens Jr 21 07 0598
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
None 0.00
TOTAL (Also enter on line 3, Recapitulation} I $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1507 EX + (6-98)
SCHEDULE D
COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John P. Stevens Jr 21 07 0598
All property jointlyowned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~. None 0.00
TOTAL (Also enter on line 4, Recapitulation)I S 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE I
John P, Stevens Jr 21 07 0598
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~ Fulton Bank Money Market 11,830.14
Account #9902-02317
2 PNC Bank Savings
Account#5004883632
TOTAL (Also enter on line 5, Recapitulation) ~ ~
2,629.70
14.459.84
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
John P. Stevens Jr 21 07 0598
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Elizabeth G. Stevens
ADDRESS
868 Oak Oval
Messiah Village
Mechanicsburg, PA 17055-
RELATIONSHIP TO DECEDENT
Surviving Spouse
c
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET °1° OF
DECD'S
iNTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
~. A. 06/1918 Fulton Bank Joint Checking 32,114.15 50. 16,057.08
Account #1218-15499
2 A. 8/29/06 PNC Bank Joint Checking 12,536.08 50. 6,268.04
Account#5004883237
TOTAL (Also enter on line 6, Recapitulation) I $ 22,325.12
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER•VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
FILE NUMBER
John P. Stevens Jr 21 07 0598
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
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIRRELATIONSHIPTODECEDENTAND
THE DATE OF TRANSFER. ATTACHACDPYOFTHEDEEDFORREALESTATE
DATE OF DEATH
VALUE OF ASSET
%OFDECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
t. Merrill Lynch Trust Account #87247297 87,987.77 100. 87,987.77
John P. Stevens and Scudder G. Stevens, Trustees
2 Merrill Lynch Individual Retirement Account #87270784 78,274.72 100. 78,274.72
FBO John P. Stevens
TOTAL (Also enter on line 7 Recapitulation) ~ $ 166,262.49
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12.99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
John P. Stevens Jr 21 07 0598
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~. Jersey Shore Cemetery 380.00
2. Auer Memorial Home and Cremation Services, Inc. 1,095.00
3. F.B. Welker Monument Company 2,885.00
4. Funeral Reception 250.00
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
p. Attorney Fees Scudder G. Stevens, P.A. 15,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3, 500.00
Claimant Elizabeth G. Stevens
Street Address 868 Oak Oval
city Mechanicsburg State PA Z;p 17055
Relationship of Claimant to Decedent SpOUSe
a. Probate Fees Register Of Wills of Cumberland County 1,410.00
5 Accountants Fees
6. Tax Return Preparer's Fees Scudder G. Stevens, P.A. 500.00
~ I The Sentinel I 62.86
2 Cumberland County Bar Association 75.00
TOTAL (Also enter on line 9, Recapitulation) I $
1
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
John P. Stevens Jr 21 07 0598
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION _ OF DEATH
Department of Treasury
2. ~PA Department of Revenue
5,112.00
1,103.00
TOTAL (Also enter on line 10, Recapitulation) I $ 6,215.00
(If more space is needed, insert additional sheets of the same size)
REV-t 513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
John P. S tevens Jr cl ui u5au
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [nclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Elizabeth G. Stevens Spousal
868 Oak Oval 100%
Mechanicsburg, PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
I, JOHN P. STEVENS, JR., of Mechanicsburg, Cumberland County, Pennsylva-
nia, make, publish and declare this to be my Last Will and Testament and hereby revoke all
prior Wills and Codicils made by me.
ARTICLE 1: Source of Funds for Payment of Taxes etc.:
A. I direct that the costs of administration of my estate, the expenses of my last illness
and funeral, and all estate, inheritance, succession, death or similar taxes (except generation-
skipping transfer taxes) assessed with respect to my estate herein disposed of, or any part
thereof, or on any bequest or devise contained in this my Last Will (which term wherever used
herein shall include any codicil hereto), or on any insurance upon my life or on any property
held jointly by me with another or on any transfer made by me during my lifetime or on any
other property or interests in property included in my estate for such purposes, be paid out of
my residuary estate and shall not be charged to or against any recipient, beneficiary, transferee
or owner of any such property or interests in property included in my estate for such tax
purposes.
B. I specifically direct that any fiduciary having control of United States Treasury Bonds
or notes useable to pay federal death taxes shall so use them if that fiduciary is required to pay
any such tax.
ARTICLE 2: Personal Property:
I give and bequeath all of my personal and household effects of every kind to my wife,
ELIZABETH G. STEVENS, if she shall survive me by thirty (30) days. If she shall not survive
me by thirty (30) days, 1 give all of said property to my children, per stirpes. I request that my
wife, my Co-Executors, and my children abide by any memorandum by me directing the
disposition of this property or any part thereof. If any beneficiary hereunder is a minor, my Co-
Executors may distribute such minor's share to such minor, or for such minor's use, to any
person with whom such minor is residing or who has the care or control of such minor without
further responsibility, and the receipt of the person to whom it is distributed shall be a complete
discharge of my Co-Executors.
Last Will and Testament -JOHN P. STEVENS, JR.
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ARTICLE 3: ResiduarYEstate:
I. Unified Credit Provision
I give, devise and bequeath unto the Trustees of my Intervivos Deed of Trust dated the
30th day of May, 1995, and any amendments thereto, and their successors, such sum as will
exactly equal the amount passing free pursuant to the exemption equivalent of the unified credit
under the Federal Estate and Gift Tax laws then in effect at the time of my death, to dispose of
the net income and principal pursuant to the terms of that trust agreement, as amended.
II. Marital Deduction Provision
A. I give the residue of my estate of every kind and description (including lapsed
legacies and devises), wherever situate, to my wife, ELIZABETH G. STEVENS, if she survives
me (and for purposes of this Will, she shall be deemed to have survived me unless it appears
unmistakably otherwise).
B. If my wife does not survive me, or if she survives me and should exercise her power
to disclaim, in whole or in part, any of my estate by means of a qualified disclaimer described in
Section 2518 of the Internal Revenue Code of 1953, as amended, then I give such disclaimed
portion (or the entire residue of my estate if she does not survive me) to the Trustees of her
Intervivos Deed of Trust dated the 30th day of May, 1995, and any amendments thereto, and
their successors, to dispose of the net income and principal pursuant to the terms of that trust
agreement, as amended.
C. It is my intention that the funds subject to said trust agreement, as amended, shall
qualify for the Marital Deduction as "qualified terminable interest property", as that term is
defined in the Internal Revenue Code. However, if, in the opinion of my Co-Executors, it is not
advisable to have such property so qualified, they may, in their absolute discretion, make such
election.
ARTICLE 4: Methods of Payment:
My Co-Executors are authorized to make any payments or applications of income or
principal from my gross estate to any beneficiary entitled to the same in any manner as my said
Co-Executors may deem to be to the best interests of such beneficiary, including:
1. To such beneficiary directly;
2. To such beneficiary's guardian of the person or property, or both (whether
formally appointed or not);
Last Will an Testament -JOHN P. STEVENS, JR.
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3. To the person with whom such beneficiary resides;
4. By mailing to such beneficiary's last known address;
5. By depositing to the bank account of such beneficiary;
6. Directly to third persons for the benefit or such beneficiary;
7. To any custodian acting on behalf of such beneficiary under the Pennsylvania
Uniform Gifts to Minors Act, as amended.
ARTICLE 5: Special Distributions:
If the property, principal and/or income of a Trust, or any of my gross estate would be
distributable to any benefiiciary who is under the age of twenty-one (21), or who (in the sole
determination of my Co-Executors) is incapacitated and unable to properly handle his or her
own affairs, then I direct that in lieu of being paid or distributed to such person, such property
and/or income shall be held or retained by my Co-Executors, in Trust, as a separate trust fund
for the benefit of that beneficiary. My Co-Executors, acting as trustee, shall pay or apply so
much of the income and principal of such trust for the health, support, maintenance, and
education of said beneficiary as my Co-Executors deem to be in the best interest of that
beneficiary. The principal and any accumulated income shall be distributed outright and free of
trust to that beneficiary upon attaining the age of twenty-one (21) or upon the regaining of
capacity, or, if that beneficiary dies before such time, to that beneficiary's estate.
ARTICLE 6: Appointment of Executor:
I hereby appoint my wife, ELIZABETH GEORGIA STEVENS, and my son, SCUDDER
G. STEVENS, or the survivor of them, as Co-Executors of this my Last Will and Testament. 1
further direct that no fiduciary of mine shall be required to file a bond, notwithstanding any state
law to the contrary.
ARTICLE 7: Tax Matters:
My Co-Executors shall have absolute discretion, but shall not be required, to make
adjustments in the rights of any beneficiaries, or among the principal and income accounts to
compensate for the consequences of any tax decision or election, or of any investment or
administrative decision, that my Co-Executors believe have had the effect of preferring one
beneficiary or group of beneficiaries over others. In determining the federal estate and income
tax liabilities of my estate, my Co-Executors shall have discretion to select the valuation date
Last Willa d Testament -JOHN P. STEVENS, JR.
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and to determine whether any or aft of the allowable administration expenses in my estate shall
be used as federal estate tax deductions or as federal income tax deductions, and shall have
the discretion to file a joint income tax return with my spouse, and to consent to the splitting of
gifts for gift tax purposes.
ARTICLE 8: Powers of Fiduciary:
In addition to those powers granted by law, my Co-Executors are authorized, without the
leave of any court and with regard to all property at any time held in my estate, and until
distribution of such property is made:
(a) To retain all property in the original form received;
(b) To sell or exchange, to lease or give options for periods of time even longer
than estate administration, or otherwise to dispose of any property, publicly or privately, for
cash or credit or partly for each;
(c) To invest in, or purchase, all forms of property (including, but not limited to,
life insurance based investments such as "single premium annuities", shares of investment
companies, and common funds and the securities and common trust funds of my corporate
fiduciary, if any) without the duty to diversify, irrespective of the laws of investment, and at
premium or discount prices;
(d) To vote directly or by giving proxies (ministerial or discretionary) on any
shares of stock, including shares of stock in its own bank or corporation, if any of the Co-
Executors is a bank or corporation;
(e) To join in any merger, consolidation, reorganization, voting trust plan, or other
concerted action of stockholders, to do any act or thing necessary in connection therewith,
including delegation of discretionary duties with respect thereto;
(f) To litigate, submit to arbitration, compromise or settle any claim;
(g) To hold property in the Co-Executors' own names, in the name of a nominee,
or in bearer form;
(h) To divide or distribute property in cash or in kind, or partly each;
(i) To merge for investment purposes all property held in my estate;
Q) To borrow money from anyone, including the Co-Executors, and to encumber,
mortgage and pledge any property of the estate;
(k) To make loans with adequate security;
Last Will and Testament -JOHN P. STEVENS, JR.
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S:~active_ jectslStevens,John Pand Elizabethlgtip.will.jps.wpd
(I) To make repairs or alterations on any real property;
(m) To continue and operate any business owned by me at my death;
(n) To employ and compensate agents, accountants, investment advisors,
brokers, attorneys-at-law and other advisors deemed by my Co-Executors needful for the
proper administration of my estate; and,
(a) In general, to exercise all powers in the management of my estate which any
individual could exercise in his own right, upon such terms and conditions as he may deem
best, and to do all acts which he may deem necessary or proper to carry out the purposes of
this my Will.
ARTICLE 9: Definitions:
A. "Child", "children", or "issue" includes natural and adopted children. Both a legally
adopted person adopted, and a person in the process of being legally adopted, shall be treated
as a natural child of the adopting parent.
B. Whenever the word "Executor" or "Co-Executor", or any modifying pronoun, is used
in this Will, such words shall be taken to include both the singular and the plural, the masculine,
feminine and neuter gender, and shall apply equally to the Co-Executors named herein, and to
any successor or substitute Executor.
C. My spouse is ELIZABETH GEORGIA STEVENS.
D. My sons are John P. Stevens, III, who is married to Reiko Haraguchi Stevens;
Scudder G. Stevens, who is married to Mary Claire Stevens; and, Peter J. Stevens, who is
presently unmarried.
ARTICLE 10: Protective Provisions:
A. Except as otherwise provided herein, all payments of principal and income payable,
or to become payable, to any beneficiary of this my Wiil, and of any trust created hereunder,
shall not be subject to anticipation, assignment, pledge, sale or transfer in any manner, nor
shall any said beneficiary have the power to anticipate or encumber such interest, nor shall
such interest, while in the possession of my Co-Executors, be liable for, or subject to, the debts,
contracts, obligations, liabilities or torts of any beneficiary.
B. Any beneficiary may, by an instrument in writing delivered to the Co-Executors,
disclaim, in whole or in part, any interest that said beneficiary may have hereunder.
Last Will and Testament -JOHN P. STEVENS, JR.
Page -
Initials
S:\active r jests\Stevens,John P and Elizabeth\glip.will.jps.wpd
Ol'
IN WITNESS WHEREOF, 1 have hereunto set my hand and seal this ~ day of April,
2007.
0J
JAN P. STEVENS, JR.
SIGNED, SEALED, PUBLISHED, AND DECLARED by the above Testator as and for
his Last Will, in the presence of us, who thereupon at his request, in his presence and in the
presence of each other, have hereunto subscribed our names as witnesses:
Address: Mechanicsburg, Pennsylvania
E
NS
Last Will and Testament -JOHN P. STEVENS, JR.
Page -6-
Initials
S:lactive,p leas\Stevens,John P and Elizabeth\gtip.will.jps.wpd
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CHESTER
SS.
We, JOHN P. STEVENS, JR., ELIZABETH G. STEVENS, and SCUDDER G.
STEVENS, the Testator and the witnesses, respectively, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that
the Testator signed and executed the instrument as his Last Will, and that he signed willingly,
and that he executed it as his free and voluntary act for the purposes therein expressed, and
that each of the witnesses, in the presence and hearing of the Testator and each other, signed
the Will as witness, and that to the best of each witness's knowledge, the Testator was, at that
time, eighteen years of age, or older, of sound mind and under no constraint or undue influ-
ence.
G _ ~ ~•%
7 r~-t.~t,, -
TH G~: STEVENS, Witness 'J J N P. STEVENS, JR., Testator
SCUDD,f=R~. STEVENS, Witness
Subscribed, sworn to, and acknowledged before me, by John P. Stevens, Jr., the
Testator, and subscribed and sworn to before me by Elizabeth G. Stevens and Scudder G.
Stevens, witnesses, this ~.~ p day of April, 2007.
Not ry Pu is \
COMMONWEALTH OF PENNSYLVANIA
Last Will and Testament -JOHN P. STEVENS, JR.
Page -7
Initials
S:lactive~ ectslSfevens,John Pand Elizabeth\gtip.will.jps.wpd
NOTARtAt. SEAL
KERRY R. BECK, Notary Public
City of l.andenberg, Chester County
My ;ommiss~on Expires Febniary4, ~OtO
AMENDMENT TO DEED OF TRUST
This First Supplemental Agreement, made the ~ day of July, 1995, between
John P. Stevens, Jr., presently of Cumberland County, Pennsylvania, (hereinafter called "Settlor"),
and John P. Stevens, Jr., Elizabeth G. Stevens and Scudder G. Stevens (hereinafter'Trustees"),
WITNESSETH:
WHEREAS, Settlor, by certain Agreement made the 30th day of May, 1995,
created a certain Deed of Trust; and
WHEREAS, Settlor, in Paragraph VII thereof, reserved the right to revoke or amend
said Trust at any time; and
WHEREAS, Settlor now wishes to exercise the said power to amend the same;
NOW, THEREFORE, Settlor, pursuant to the above reserved right, hereby amends
the said Deed of Trust dated the 30th day of May, 1995, as follows:
1. The provisions of paragraph X. are hereby revoked in their entirety, and in lieu thereof,
the following is substituted therefore:
X.
JOHN P. STEVENS, JR. Is hereby appointed Trustee hereunder. Upon the death,
resignation or inability to serve of the said John P. Stevens, Jr. as my said Trustee, I hereby
appoint my spouse, ELIZABETH G. STEVENS, and my son, SCUDDER G. STEVENS, to serve
in his/her stead. I direct that no bond shall be required of my Trustee, or any successor Trustee
for any purpose.
2. In all other respects, Settlor hereby ratifies and confirms the said Deed of Trust dated the
30th day of May, 1995.
IN WITNESS WHEREOF, John P. Stevens, Jr., Settlor, has hereunto set his hand
and seal, and John P. Stevens, Jr., Elizabeth G. Stevens, and Scudder G. Stevens, Trustees,
Amendment to Deed of Trust
Page -1- . _ ~A
Initialed J
~~~
have hereunto set their respective hands and seals to this said Amendment to Deed of Trust, as
of the day and year first above written.
(l > ~~
JOH(~ P. ~T VENS, J
~Settlo and Trustee J
~ ~ ~~
ELI A$ETH'G~' STEVENS
Trustee
SCU~DER G. STEVENS
Trustee
Amendment to Deed of Trust
Page -2-
Initialed ~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CHESTER
SS
On the ~ day of July, 1995, before me, a Notary Public, the undersigned officer,
personally appeared John P. Stevens, Elizabeth G. Stevens, and Scudder G. Stevens, known to
me (or satisfactorily proven) to be the persons whose names are subscribed to the within
instrument and acknowledged that they executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary Public _____
~, ~,; c Stw~r ~ ;;;,~t~ry pub',ic
P 1a~' ~,c r ~ s..'Roro. Chester G 1997
`My Cor ~~m~~ss~sr; E:xF;;re<..Ir~ne 9,
N9emt;er, Pennsy ~ a~SO`'~a'ion of Plota~ies
Amendment to~eed of Trust
Page -3'
Initialed ~'
DEED OF TRUST
DEED OF TRUST made this 30th day of May, 1995, by and between JOHN P.
STEVENS, JR., (hereinafter called "Settlor") and JOHN P. STEVENS, JR. and SCUDDER G.
STEVENS, or the survivor of them, (hereinafter called 'Trustees"),
WITNESSETH THAT:
Settlor, in consideration of the trust hereby assumed by Trustees, and intending to be
legally bound, hereby designates Trustees as the beneficiaries of the life insurance policies on
Settlor's life listed in Schedule "A" hereto attached and made part hereof, and any securities,
monies or other property which may hereafter be transferred or assigned to Trustees by
Settlor or others by instrument in writing making reference hereto; all such assets to be held
IN TRUST, NEVERTHELESS, unto Trustees, and their successors, who shall invest, reinvest,
manage, collect and distribute the same, and the net income thereof, in the manner
hereinafter set forth.
Trustees shall hold the assets received by them as Trustees to distribute the net
income and principal as follows:
A. My Trustees (other than any Trustee who may be a beneficiary hereunder) may
pay to, or apply fior the benefit of, JOHN P. STEVENS, JR., ELIZABETH GEORGIA
STEVENS, or bath, during their respective lifetimes so much of the principal and accumulated
income as the Trustees deem to be necessary or advisable, in their sole discretion, taking into
consideration any other income or resources of JOHN P. STEVENS, JR., ELIZABETH
GEORGIA STEVENS, individually or collectively, known to my Trustee, for the improvement of
the quality of life of either or both with special consideration for entertainment, recreation,
education, and rehabilitative, medical or psychological care, not otherwise provided.
Specifically, I direct that no funds of this Trust shall be used for payments for care that is
covered by a~C governmental program under which either JOHN P. STEVENS, JR. or
ELIZABETH GEORGIA STEVENS, or both, would otherwise qualify but for this Trust. I further
Deed of Trust
Page -1-
Initials `~ ~_
direct that this Trust shall immediately terminate and all income and principal hereunder vest
to the remainder beneficiaries of this said Trust should any governmental entity attempt to
obtain reimbursement from this Trust for any payments made by said governmental entity on
behalf of either the said JOHN P. STEVENS, JR., ELIZABETH GEORGIA STEVENS, or both.
B. After the death (if not sooner pursuant to I I. A., above) of the survivor of the
said JOHN P. STEVENS, JR. and ELIZABETH GEORGIA STEVENS, the undistributed
balance of principal and accrued interest shall be distributed to my children, per stirpes,
outright and as soon as practicable.
As long as the income or principal to which any beneficiary hereunder may be entitled
is in the possession of the Trustees and not actually distributed by them, such beneficiary
shalt not have the right to anticipate or alienate the same by assignment or by any other
means, and the same shall not be liable for the debts or obligations of such beneficiary or be
subject to be taken, seized, or attached under any process whatsoever.
IV.
If, at the time set for any distribution of income or principal hereunder, any beneficiary
entitled to receive the same shall be a minor or shall have been legally adjudicated an
incompetent, the title to the property to be distributed shall vest in such beneficiary, but during
such minority or incompetency, the income or principal to which such beneficiary is entitled
may be retained by Trustees, who in such case, shall hold, invest and reinvest the same, and
use as much of such principal or income as in their discretion they deem appropriate for the
support, maintenance, education, and welfare of the minor or incompetent, either by payment
of bills therefor or by payment to such person or persons as they may select, without the
intervention of a guardian, committee or other fiduciary. The receipts of such payees shall be
full and complete discharge of Trustees with respect to such payments. Trustees may, but
shall not be obligated to, take into consideration in the exercise of their powers under this
provision, the extent of such beneficiary's estate or income from other sources. Upon
termination of the minority or incompetency, the unexpended income and principal shall be
paid over to the beneficiary or his or her personal representative.
V.
Trustees shall have the following powers in addition to those vested in them by law
Deed of Trust
Page -2-
Initials ,~~
~_
and granted to them elsewhere in this Indenture:
1. To retain all or any part of the real or personal property of the trust as long as
they deem advisable, and to invest, reinvest and keep invested any real or personal property
of the trust, without confining it to that class of investments which are defined as "legal
investments" under the laws of the Commonwealth of Pennsylvania, or of any other
jurisdiction, and without regard to diversification, and with the right to retain, acquire or
dispose of any stock or other investment in which they may be interested, and to hold the
same or any part thereof uninvested as long as they deem advisable, all of the foregoing to
be without liability or accountability on their part to any person or persons for depreciation or
loss for doing so.
2. To sell, pledge, mortgage, lease without limit of time, exchange, grant options
for purchase, lease or exchange of any asset of the trust, to execute bonds and collateral
bonds and to grant mortgage extensions and renewals. Any such transaction may be made
for such considerations and on such terms, either for cash or credit, or partly to each, and
either secured or unsecured, as they may see fit.
3. To continue any business in which the trust shall have an interest, and to
change or join in the change of the organization thereof, from time to time, by incorporation,
partnership agreement, or otherwise; to contribute any property of the trust to such business
enterprise so that their freedom of action and decision with respect to the conduct of any such
business may not in any manner be restricted, and they shall be absolved of any liability with
respect thereto; to accumulate income of any such business for periods permitted by law if
they consider it advisable so to do in order to strengthen the capital structure, or to add the
same to principal temporarily or permanently.
4. To appoint proxies to vote at any election or meeting of any corporation in
which the trust is a stockholder, and to make subscriptions for stocks, bonds, privileges or any
other rights to which the trust may become entitled by reason of holding interests in such
enterprise.
5. To purchase investments and securities at a premium or discount, and to
charge the said premium to principal or income, or partly to each, and to credit the discount
when received to principal or income, or partly to each, as to them, in their uncontrolled
discretion, shall deem best.
Deed of Trust
Page -3- .
Initials
6. To hold, manage, operate, repair, alter or improve real estate or other property
and to lease real estate and other property upon such terms and for such periods as Trustees
may deem advisable. In connection with said real estate, or any personal property, Trustees
shall also have the full power to sign, execute and deliver any unrestricted bonds and
mortgages, collateral bonds and extensions and renewals of mortgages, in their capacity as
Trustees binding the trust therefor, and to sign, execute and deliver any lease or leases with
or without options to purchase, for any length of time less than or beyond five years and to
reserve in said leases either fixed rentals, rentals based on the amount of business or profits
of the lessees, or rentals based upon any other conditions, and to grant separate options for
the purchase of real or personal property, all upon such terms and conditions as Trustees
may deem advisable.
7. To borrow money from themselves as well as from others for the purpose of
paying any taxes, local, state or federal, and debts of the trust, for the protection of corpus or
the improvement of any assets of the trust, and to pledge assets of the trust to secure the
repayment thereof.
8. To own and deal in and with policies of insurance on the life of any person,
including the life of Settlor, provided, however, that Trustees shall be under no duty to pay any
premiums thereon and provided further that in the event of a default in the payment of any
premium Trustees are empowered to elect any option available under the terms of said
policies which they deem advisable.
9. To hold or register assets in their name or in the names of their nominees, or in
bearer form, without disclosing any fiduciary relationship.
10. To delegate administrative functions among themselves and to appoint agents
and attorneys-in-fact for such functions.
11. To distribute the assets or any part thereof in kind, in such manner and at such
valuations as they shall determine.
12. To retain and pay counsel (including investment counsel) for advice and other
professional services.
13. To be absolved of any liability whatsoever if they shall obtain the approval for
any past or future action from a majority of beneficiaries who are then sui juris, without the
necessity for the appointment of guardians or trustees ad litem.
Qeed of Trust
Page -4-
Initials
14. To litigate, submit to arbitration, settle or compromise any claim by or against
the trust.
15. In general, to exercise all powers in the management of the Trust, to include
the making of gifts, whether for estate planning purposes or otherwise, which any individual
could exercise in his own right, upon such terms and conditions as Trustees may deem best,
and to do all acts which Trustees may deem necessary or proper to carry out the purpose of
this Trust.
Vt.
Trustees shall also receive and hold under the terms hereof any additional property or
properties (including, without limitation, life insurance policies or the proceeds thereof) which
Settlor or any other person may at any time or times place in trust hereunder by letter or
instruments in writing making appropriate reference to this Indenture, and Trustees may
accept the same or any part thereof subject to such modifying terms, provisions and
conditions as may be specified in the instrument of transfer or designation.
VII.
This Trust is hereby declared to be revocable and Settlor does not relinquish any rights
to revoke, alter or amend this Trust in any way. Further, if a durable power of attorney, signed
by me, is in effect at any time relevant to the provisions of this section VII, I direct my
Trustees to abide by the wishes of said attorney-in-fact concerning the right to revoke, alter or
amend this Trust.
VIII.
The insurance companies issuing policies, if any, which are, by the terms hereof, or
otherwise, made payable to the Trustees hereunder, are hereby relieved from liability to see to
the fulfillment of this Trust Indenture or application of the proceeds of said policies.
IX.
This Trust has been executed and accepted in the Commonwealth of Pennsylvania,
which is hereby designated as the situs of this Trust, and all questions pertaining to its
validity, construction and administration shall be determined in accordance with the laws of
said Commonwealth.
X.
JOHN P. STEVENS, JR., SCUDDER G. STEVENS, or the survivor of them, are hereby
Deed of Trust
Page -5-
Initials
appointed Trustees hereunder. Upon the death, resignation, or inability to serve of any
Trustee, I hereby appoint my spouse, ELIZABETH GEORGIA STEVENS, to serve in his
stead. I direct that no bond shall be required of my Trustees or any successor Trustee for any
purpose.
IN WITNESS WHEREOF, Settlor and Trustees (who hereby accept their trusts
hereunder} have hereunto set their hands and seals the day and year first above written.
1 ,~
~ ~tiL ~ t Q~ E'~~`
JOHN ~ STEVENS, JR., Settlor
i 1
'La;i. - C''G~~~)
~JOHf~ P. STEVENS, JR., Trustee
1 _
~ L1ZA6~TH GEORGIA STEVENS, Trustee
i
~ i ;
'`` ~ ~~~ ~~~SEAt~'
SCU DEf!t G. STEVENS, Trustee
Deed of Trust
Page -b"- /j
initials / ~
~~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CHESTER
SS.
On the 30th day of May, 1995, before me, the subscriber, a Notary Public in
and for the Commonwealth and County aforesaid, personally appeared the above-named,
JOHN P. STEVENS, JR., and in due form of law acknowledged the foregoing Deed of Trust to
be his act and deed and desired that the same might be recorded as such.
WITNESS my hand and seal the day and year aforesaid.
Notary Pub1i
Nc~taria+ Seal
hSary Claire Stevens. Notary Public
Kennett Square t3aro, Chester Coun~
h1y t'.nmmission ExF.dres Jung 9,199
M¢mtaer, r'ennsyMania ~sodation pf Nataries
Deed of Trust
Page -7- ~~
initials 1
~/
F1~1ta~Bank
LISTENING.
July 30, 2007
Scudder G. Stevens, P.A.
120 North Union Street
P.O. BOX 1156
Kennett Square, Pennsylvania 19348
Dear 1 ir. Stevens:
RE: John P. Stevens, deceased June 16, 2007
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
Visa # 4756 2100 0900 0830, open October 1984, credit limit $8,600.00,
date of death balance owing $-0-, in his name only.
Checking # 1218-15499, open 6/19/1980, date of death balance $32,114.15
(any accrued interest ($75.66) would not have been payable had the account
been closed on the date of death) joint with Elizabeth G. Stevens with
Scudder G. Stevens as Power of Attorney.
Money Market # 9902-02317, open 3/14/1986, date of death balance
$11,820.17 plus accrued interest $8.48. Scudder G. Stevens as Power of
Attorney.
If you should have any further questions, please do not hesitate to contact me at (717)
291-2437.
Very truly yours,
o~~t~~~
Karen D. Hillegas
This information is furrnshed as a ~'~~' of business coLrtesy Credit Inquiry Processor
in 4nswer tc your inquiry, ?~~ is for your canf'rdantial use on~y.
i`Io responsibilit', is assumed ~~ iris ha~~k o! any at its u!Ji..ers•
my opinion y2rein exp~sSe~J i-~ sc~a;vct tc change wiihout rs~iice.
P O Box 4887 ~ Lancaster, PA 17604
fultonbank.com ~ 1-800-FULTON-4
JIA.-09-2007 0035 PNCI3ANK 412 768 3458 P.01i01
!~ P~iCBATJC
Thq Thinking 9~hind Y1+t Monry
July 9, 2007
Scudder G Stevens
PQ 13ox 1156
Kennett Square, PA 19348
1Z.E: Jo1m P Stevens (Deceased)
SSN: 160-16-205$
D4D: 06-16-2007
Dear 1vlr. Stevens:
Izt response to your request for Date of Deetla balances for the customer noted above, our
records show the following:
Checking Account
,A,ceount # 5004883237 Established 08-29-2006
JOHN P STEVENS
ELIZABETH G STEVENS
1]C!D balance: 512,536.08 ~- 5.19 accrued interest
$avi~ggs Account
Accottttt # 50048$3532 Established 10-25-2005
JOl-iN P STEV~tS
DOD balance: $2,629.70 + 2.11 accrued interest
Pleasc note that this office only provides date of death balances for deposit accounts
(~tAs, CDs, Checking and Savings accounts). We do not process any nnancial
transactions or provide statements. if you need assistance with any of these items,
please call 1-888-PNC-HANK (1-888-762-2255) or stop by your local PNC Bank branch
office.
Sincerely,
Col Cent rowder ~~~ ~ C-l
1-800-762-1775
P7~PFSG04-F
S00 p'irst Ave
Pittsburgh, PA 15219
Member FDIC
Page 1 of 1
TOTAL P.01
5e1. 18 2BB7 16:14:15 17172878288 ->
Merrill Lynch Page BB1
Mer~lfLynr.~
FACSIMILE COYER SHEET
TO Scudder Stevens or Carrie Black
AT 610-444-9840
FAX 16104449841
FROM Merrill Lynch
SENDER Chrystal Meier
DATE Mon Sep 1016:13:11 EDT 2007
If the transmission is incomplete or illegible, please contact the sender.
CONFIDENTIALITY NOTE: THE INFORMATION CONTAINED IN THIS FACSIMILE TRANSMISSION IS CONFIDENTIAL AND IS
INTENDED ONLY FOR THE USE OF THE ADDRESSEE NAMED ABOVE. ADDITIONAL RESTRICTIONS ANDIOR LIMITATIONS MAY APPLY
TO THE USE ANDlOR CONTENT OF THIS FASCIMILE. SUCH RESTRICTIONS ANDIOR LIMITATIONS, IF APPLICABLE, ARE DESCRIBED IN
THE ATTACHED DOCUMENT. IF THE RECIPIENT OF THIS FASCIMILE IS MOT THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED
THAT ANY RETENT{ON, DISSEMINATION, DISTRIBUTION OR COPYING OF THIS FASCIMILE IS STRICTLY PROHIBITED. IF YOU HAVE
RECEIVED THIS FACSIMILE IN ERROR, PLEASE IMMEDIATELY NOTIFY US BY TELEPHONE AND DESTROY THE ORIGINAL
TRANSMISSION.
Ma of Paga(s) (including this pagaJ 3
Subject Dato of death va{ua-IRA
Dear Carrie or Scudder,
Per your request, I have attached the date of death value for 872-70784
n/o John P. Stevens deceased.
If you need additional assistance, please contact me by phone or a-mail.
Thank you,
Chrystal
Ghrystal L. Meier
Client Associate
Merrill Lynch
214 Senate Ave, Suite 501
Gamp Hill, PA 17011
717-975-4619 Direct
717-207-8280 Fax
chrystal meier@ml.com
---------------------------------------------
5e~ 18 2867 16:14:41 17172678288 -> Merrill Lynch Page 882
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PHOENIX
August 27, 2007
Statement of Benefits
John P Stevens, Jr., Trust dated 5/30/95
Scudder G Stevens, Trustee
120 N Union St
P O Box 1156
Kennett Square PA 19348
Re: Insured: John Stevens
Claim No: 070719BP0605
Charles W Clark
29 Brentwood Rd
Camp Hill PA 17011-2504
Policy Number 1,054,647 1,149,456
Basic Face Amount $3,390.00 $3,385.00
O tionterm
Paid-U Additions
Accumulated Dividends $1,653.75 $1,251.24
Accumulated Dividend Interest $26.88 $19.91
5Th Dividend One Year Term Insurance
Post Mortem Dividend/Cash Dividend $56.63 $55.76
Termination Dividend
Loan Interest Refund
Loan Interest Char e
Loan Balance
Premium Refund $32.84 $36.16
Premium Char e
Interest Amount $31.38 $28.88
Interest Rate Paid On Proceeds 3.00%
Interest Start Date June 16, 2007 Payment has been mailed under separate cover
Interest End Date Au ust 29, 2007
Proceeds Before huerest $5,160.10 $4, 748.07
Net Proceeds $5,191.48 $4,776.95
Total Proceeds $9,968.43
Payee(s): John P Stevens, Jr., Trust dated 5/30/95
Prepared By: Allyson Clapp
Benefits
Payable Amount $9,968.43
Extension: x8883
1-800-814-3692
P.O. Box 22012 518 479 8000 Phorze
Albany, NY 12201-2012 www.phoenixwm.com
-Group Life Claims Division
P.O. BOX 3016
UTICA, NEW YORK 13504-3016
STATEMENT OF CLAIM
Met~ife
INSURED: STEVENS, JOHN P
PAYEE: JOHN P STEVENS TRUST
ADDRESS: SCUDDER G STEVENS- TRUSTEE
PO BOX 1156
KENNETH SQUARE PA 19348
CLAIM NUMBER:
GROUP/SUB/PAY POINT
FACE VALUE:
INTEREST AMOUNT:
AMOUNT PAID:
20706010233
0092161 0074 8170
$ 22500.00
$ .00
$ 22500.00
The interest portion of this payment is taxable income and should be included on your federal and state income tax returns. If
the interest paid is $200 or more, it will be reported to the IRS, and you will receive Form 1099-INT at year end. Therefore,
please notify the claims office listed above of any address changes.
METROPOLI~pI LIEE 11~. SEQ..
p~Q, BOX 3016 sssoi
UTICA" jyE~Q[ YORK 1 3504-30 1 6
iMetLife
UNITED STATES STEEL CORP
5 ~ " 50-937/213
METROPOLITAN LIFE INS. CO.
ssso~
~~ NFW vn~~ '~SO4-~°'~ CheckQ~Qa1663954
Claim No. Group No. Sub. Pay P[. Name of Insured NOT VALID BEFORE
20706010233 0092161 0074 8170 STEVENS, JOHN P JUL 31 2007
Amount
Pay to the Order of: Gullets Cents
JOHN P STEVENS TRUST ~-',-',2250000
SCUDDER G STEVENS- TRUSTEE
JPMorgan Chase Bank N.A. PO BOX 1156
6040 Tarbell Road KENNETH SQUARE PA 19348
Syracuse, NY 13206 AUTHORIZED SIGNATURE
n'OOL66395411' ~:02L309379~:3 3 2 300 5 2811'