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1N RE: ESTATE OF
C. ROBERT TODD,
DECEASED
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
N0.21-09-00423
DISCLAIMER
I, OZELLA D. TODD, by her Agent, William S. Todd, pursuant to Power of Attorney
executed October 7, 2004, hereby exercise the rights granted to me in Chapter 62 of the Probate,
Estates and Fiduciaries Code (the "PEF Code"), and I hereby disclaim and renounce any interest to
which I may be entitled under ITEMS THREE and FOUR of the Last Will and Testament of C.
ROBERT TODD dated October 7, 2004, and probated at the above number, and under applicable
law including, but not limited to the following assets:
Date of Death Value
Cash and securities in CitiSmithBarney Account No. 724-12995 $ 1,746,730.98
American Home Bank Certificate of Deposit No. 0290004572 250,566.09
M&T Bank, Certificate of Deposit No. 31003919231769 100,210.57
Highmark Blue Shield, premium refund 331.60
Total
$ 2,097,839.24
IN WITNESS WHEREOF, intending to be legally bound hereby and intending that this
Disclaimer and Renunciation shall be filed of record in the Office of the Clerk of the Orphans' Court
Division of the Court of Common Pleas of Cumberland County, Pennsylvania, as provided in Section
6204 of the PEF Code, I have hereunto set my hand and seal this ~`~, day of June, 2009.
Ozella D. Todd, by her gent,
William S. Todd
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[copy of Power of Attorney, referred to above, attached] ~ ~ ~;
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
On this, the ~~ day of June, 2009, before me, a Notary Public, the undersigned officer,
personally appeared William S. Todd, known to me to be the person whose name is subscribed as
Agent for Ozella D. Todd, and acknowledged that he executed the same as the free act of his principal
for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal.
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Notary Public
COMMONWEALTH OF PENNSYLVANIA
NOTAWAL SEALpublic
Corrine L. Myers, Notary
Carlisle Borough, Cumberland County
Ivly commission expires May 27, 2~l l
F~.\FILES\DATAFILE\Estate Planning\4264.2.w.poa
60p~1
POWER OF ATTORNEY
OZELLA D. TODD
to
C. ROBERT TODD, CHARLES R TODD, III,
WILLIAM S. TODD and/or LISA T. WEBBER
NOTICE
THE PURPOSE OF THIS POWER OFATTORNEYIS TO GIVE THE PERSON YOU
DESIGNATE (YOUR "AGENT') BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH
MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR
PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOUOR APPROVAL BY YOU.
THIS POWER OFATTORNEYDOES NOT IMPOSE A DUTY ON YOUR AGENT TO
EXERCISE GRANTED POWERS, BUT WHENPOWERS ARE EXERCISED, YOUR AGENT
MUST USE DUE CARE TOACT FOR YOUR BENEFITAND INACCORDANCE WITH THIS
POWER OFATTORNEY.
YOUR AGENTMAYEXERCISE THEPOWERS GIVENHERE THROUGHOUT YOUR
LIFETIME, EVENAFTER YOUBECOME INCAPACITATED, UNLESS YOUEXPRESSLY
LIMIT THE D URATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A
COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY.
YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S
FUNDS.
A COURT CAN TAKEAWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR
AGENT IS NOT ACTING PROPERLY.
THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY
ARE EXPLAINED MORE FULLY IN THE PENNSYLVANIA PROBATE, ESTATES AND
FIDUCIARIES CODE, 20 PA. C.S. CHAPTER 56.
IF THEREISANYTHINGABOUT THIS FORM THAT YOUDO NOT UNDERSTAND,
YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU.
I HA VE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND
ITS CONTENTS.
Date: ~C ~ ~- ~ ~~ y ~ ~ ~l ~~
Ozella .Todd
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I, OZELLA D. TODD, of 129 Strayer Drive, Carlisle, Cumberland County, PA 17013,
hereby revoke any general power of attorney that I have heretofore given to any person and do hereby
appoint my husband, C. ROBERT TODD, of 129 Strayer Drive, Carlisle, PA 17013, my sons,
CHARLES R. TODD, III, of Hawaii, and WILLIAM S. TODD, of 1 Hill Street, Mount Holly
Springs, PA 17065, and my granddaughter, LISA T. WEBBER, of 108 Stonehedge Drive, Carlisle,
PA 17013, acting jointly or severally, as my agent(s) ("my agent") with full power of substitution,
for me and in my name, to transact all my business and to manage all my property and affairs as I
might do if personally present, including but not limited to exercising the following powers.
Durable Power of Attorney
This power of attorney shall not be affected by my subsequent disability or incapacity. All
acts done by my agent pursuant to this power during any period of my disability or incapacity shall
have the same effect and enure to my benefit and bind me and my successors in interest as if I were
competent and not disabled.
Powers of Agent
I hereby empower my agent to do any or all of the following, each of which is fully defined
and explained in Section 5603 of the Pennsylvania Probate, Estates and Fiduciaries Code, 20 Pa.
C.S. § 5603, to include, without limitation, all amplification of such powers as specified therein:
To make gifts on my behalf which are limited to the class of persons consisting solely
of my spouse, my issue, the spouse(s) of my issue, and my agent if he/she is a
member of such class, or any of them. During each calendar year, the gifts made to
any permissible donee, pursuant to such power, shall have an aggregate value not in
excess of, and shall be made in such manner as to qualify, in their entirety, for the
annual exclusion from the federal gift tax permitted for myself, and if applicable, my
spouse.
In addition to the gifts authorized above, a gift made pursuant to such power maybe
for the tuition or medical care of any permissible donee to the extent that the gift is
excluded from the federal gift tax as a qualified transfer. My agent may consent,
pursuant to the Internal Revenue Code, to the splitting of gifts made by my spouse
to my issue or a spouse of my issue in any amount and to the splitting of gifts made
by my spouse to any other person in amounts not exceeding the aggregate annual gift
tax exclusion for both myself and my spouse under the Internal Revenue Code.
2. To create a trust for my benefit.
3. To make additions to an existing trust for my benefit.
4. To claim an elective share of the estate of my deceased spouse.
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5. To disclaim any interest in property.
6. To renounce fiduciary positions.
7. To withdraw and receive the income or corpus of a trust.
8. To authorize my admission to a medical, nursing, residential or similar facility and
to enter into agreements for my care. [See Exhibit "A" attached hereto.]
9. To authorize medical and surgical procedures. [See Exhibit "A" attached hereto.]
10. To engage in real property transactions.
11. To engage in tangible personal property transactions.
12. To engage in stock, bond and other securities transactions.
13. To engage in commodity and option transactions.
14. To engage in banking and financial transactions.
15. To borrow money.
16. To enter safe deposit boxes.
17. To engage in insurance transactions.
18. To engage in retirement plan transactions, including to designate one or more
beneficiaries or contingent beneficiaries for any benefits under such plan on account
of my death and to change any such prior designation of beneficiary made by me or
by my agent; provided, however, my agent shall have no power to designate
himself/herself as a beneficiary or contingent beneficiary to receive a greater share
of any such benefits than he/she would have otherwise received unless such change
is consented to by all other beneficiaries who would have received the benefits but
for the proposed change.
19. To handle interests in estates and trusts.
20. To pursue claims and litigation.
21. To receive government benefits.
22. To pursue tax matters.
23. To make an anatomical gift of all or part of my body.
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24. To do all other things which my agent shall deem necessary and proper in order to
carry out the foregoing powers which shall be construed as broadly as possible.
Reliance on Power
This power maybe accepted and relied upon by anyone to whom it is presented until such
person either receives written notice of revocation by me or a guardian or similar fiduciary of my
estate or has actual knowledge of my death.
Hold Harmless
All actions of my agent shall bind me and my heirs, distributees, legal representatives,
successors and assigns, and for the purpose of inducing anyone to act in accordance with the powers
I have granted herein, I hereby represent, warrant and agree that if this power of attorney is
terminated or amended for any reason, I and my heirs, distributees, legal representatives, successors
and assigns will hold such party or parties harmless from any loss suffered or liability incurred by
such party or parties while acting in accordance with this power prior to that party's receipt of
written notice of any such termination or amendment.
Pennsylvania Law Governs
Questions pertaining to the validity, construction and powers created under this instrument
shall be determined in accordance with the lawslof the Commonwealth of Pennsylvania.
Signed this ~~~ day of (~C ~h2ti , ~.~ `~.
WITN S:
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Ozella .Todd
Social SecurityNo.: ~ ~9 ~d ~ ,.. ~~~1
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
On this, the 7 ~~ day of ~~ ~`/,,~ -L ,~~ `-~, before, me, the
undersigned officer, personally appeared Ozella D. Todd, Principal, the person whose name is
subscribed to the within instrument, and acknowledged that she executed the same for the purposes
therein contained.
IN WITNESS WHEREOF, I hereunto set my hand o facial seal.
/~~,^~~ d-' (SEAL)
Notary Public
NOTARIAL SEAL
-4- VICTORIA L. OTTO NOTARY PUBLIC
ICY COMM SSI01~ E PM ES DECD2 2006
EXHIBIT "A"
I authorize and direct any physician, health care professional, health care provider, and
medical care facility to provide to my agent information relating to my physical and mental condition
and the diagnosis, prognosis, care, and treatment thereof upon the request of my agent. It is my
intent that this authorization for my agent to be considered a personal representative under privacy
regulations related to protected health information and for my agent to be entitled to all health
information in the same manner as if I personally were making the request. This authorization and
direction shall also be considered a consent to the release of such information under current and
future regulations, laws and rules, including but not limited to, the express grant of authority to
personal representatives as provided by Regulation Section 164.502(g) of Title 45 of the Code of
Federal Regulations and the medical information privacy law and regulations generally referred to
as HIPAA.
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ACKNOWLEDGMENT BY AGENT
I, WILLIAM S. TODD, HAVE READ THE ATTACHED POWER OF ATTORNEY
AND AM THE PERSON IDENTIFIED AS THE AGENT FOR THE PRINCIPAL. I HEREBY
ACKNOWLEDGE THAT IN THE ABSENCE OF A SPECIFIC PROVISION TO THE
CONTRARY IN THE POWER OF ATTORNEY OR IN THE PENNSYLVANIA PROBATE,
ESTATES AND FIDUCIARIES CODE, 20 PA. C.S.101, ET SEQ., WHEN I ACT AS AGENT:
1. I SHALL EXERCISE THE POWERS FOR THE BENEFIT OF THE
PRINCIPAL.
2. I SHALL KEEP THE ASSETS OF THE PRINCIPAL SEPARATE FROM MY
ASSETS.
3. I SHALL EXERCISE REASONABLE CAUTION AND PRUDENCE.
4. I SHALL KEEP A FULL AND ACCURATE RECORD OF ALL ACTIONS,
RECEIPTS AND DISBURSEMEI~TS,ON BE~IALF OF THE PRINCIPAL.
Dated: ~ ~ 7 ~D
William S. Todd, Agent
COMMONWEALTH OF PENNSYLVANIA )
. SS.
COUNTY OF CUMBERLAND
On this, the 7 ~ day of , ~(jD~' , before me, the undersigned
officer, personally appeared William S. Tod ,Agent, and in due form of law acknowledged the
foregoing Acknowledgment to be his act and deed and desired that the same might be recorded as such.
WITNESS my hand and notarial seal.
Notary Public
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
Corrine L. Myers, Notary Public
Carlisle Borough, Cumberland County
My commission expires May 27, 2011
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