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HomeMy WebLinkAbout12-11-09 (2) 15056051058 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN PO BOX 280601 ~~~"~~~~~ ~~ (~ ~ ~ ~ ~ ~~ Hamsb~g, PA n12a-osot RESIDENT DECEDENT _._, ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death _._ _ _ Date of Birth X93-ay-`1~a2 io-2l_- ~ ~~_~ 0~- ~_y- ~aa~ Decedent's Last Name Suffix Decedent's F first Name MI ~__I~IN_~. _ __ _ ___ ~.___ __ _.. _ ~.~~_ j ^ i ~ ~ . _ _ _ ~ 1 ~_.z~.h~.rtt~ ~ ~~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Mi i Spouse's Social Security Number I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _ __ _ __ _ REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ~ 1. Original Retum s~ 2. Supplemental Retum 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ? 4a. Future Interest Compromise (date of t 5. Federal Estate Tax Retum Required death after 12-12-82) C~ 6. Decedent Died Testate t~ 7. Decedent Maintained a Living Trust _,.,~_ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) C~ 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death C? 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONPIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number K~~AN CAu2~c.N '~I 7 - 4 3a-- dsy (c Firm Name llf Aoolicablel - , First Ilne of address F3(o ~N ~ fora©~ LaNC. Second line of address City or Post Office State ZIP Code ~..ewistijert~l ___ ____ '. P~. E _!_733 REGISTER O f^V~IILLS USE CQ '~7 ~ ~- C'~ ~'rn =~ ~ ~ ~~ ~~~ ..~ --- DAT~ I~ED .v i try'1 i C'") I L, A a• ~ C ~::> ~ ~ _ ? ~A ~ _ r-ri o >:, Correspondent's e-mail address: Under penalties of pery'ury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and cgmplete. Declaretan of pre arer other than the personal representative is based on ali information of which preparer has any knowledge. SIGNAT~OF SON R PONSIB F R FILI RETURN /~AT~/~ SIGNATURE OF PREPARER OTHER AN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 r 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~~ zm e~~ ~1 Nt'~ ' ~ ~ _ a~ - ~ 5 as RECAPITULATION 1. Real estate (Schedule A) ............................................. L ! °--'~- 2. Stocks and Bonds (Schedule B) ....................................... 2.' -^~-" 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ; ~----- 4. 5. 6. 7. 8. Mortgages & Notes Receivable (Schedule D) ............................. 4. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. ! Jointly Owned Property (Schedule F) ~t Separate Billing Requested ....... 6. ! Inter-~vos Transfers 8 Miscellaneous Non-Probate Property ~ ~~"~' (Schedule G) CD Separate Billing Requested........ 7. Total Gross Assets (total Lines 1-7) .................................... 8. -~'-' ~©f ~ (p~ . ~ ~~" ~'~'~~~~'~~- ~~~~~~-~ oC©t q to ~ , 1 a 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ~$~ , 9, 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ' l i ~O ~ 1, 12. Net Value of Estate (Line 6 minus Line 11) ........................... ... 12. t ~ ~ ~'l ~ ~ 1 a~ 13. Charitable and Governmental Bequests/Sec 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. ..~. _..~....._t 1~ .,.m._...-,.....-, l l (a--~S ~ ~ a TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ... __ . _... .....__. _.... _. ~. _.. _ .... _ .... 16. Amount of line 14 taxable "mm° ~ __._ . _ M..._, at lineal rate X .0 ~ ~`~ ~ ' ~ a 1 ' 1 ~ 16 ~ .-- _ . ~2~„C6,~ -, ~,.,, ~ ~~ ? " 17. _._._.~..~._~..~.. .. ., Amount of Line 14 taxable W ~ _"~' ~... ._~._...._~~. ._ at sibling rate X .12 ~-' 17. 18. Amount of Line 14 taxable ! ~~I - at collateral rate X .15 --~"~ ' 18. ' "-" - ' ~ ~- 19. TAX DUE ...................................................... ... 19.i fir - ~ ~ p. J~1.3 0 u 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT {~ 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Flb Number i _ ._ __ ; DECEDENTS NAME DECEDENT'S SOCIAL SECURITY NUMBER ~ 1; Zab~~t-L. STREET ADDRESS ,A.~ ~fee'T CITY ~-Mo ~~ STATE f'~ ZIP 1 ~ 04 3 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 5 U'7 . ~?jg 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount . 0524 vj ~~ ~ O Total Credits (A + B + C) (2) a(o~', Q 3. InteresUPenalty if applicable D. Interest .~- E. Penalty Total InterestlPenalty (D + E) (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) l ~d ,~ A. Enter the interest on the tax due. (5q) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ~ ~~ , (o$ Make Check Payable to: REG-STER OF WILLS, AGENT ~ -~y n3 t,;?.. ~ :~~. Z. ~„.,~~' ~G;i aq, wtk~. __~egr.~., ~ ~~" ..u . .,. ~(,.., ee~ 3 ~~.i 'a'id t~vti.S~~"~~~,T; ._, '~ ~.. .. ~'~'....:,~.. ~ .w i"' .., . . 1 .. - . 'P c '.s~y~?44F1-#.`~s ±i~i k~'~,:!%.;. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPR©PRIATE 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 : ............................................ ^ 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? ........................................................................................................................ ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE' IT AS PART OF THE RETURN. ,. r ~ ~ ~ _ ...o'~~~i:..w~.i.sss$-g:`3~ri~.1t~..C~)-.. _~, ......>~. «... iu.~ c~z:.w. ?{u~ rv ~`` ~,~,~,( ~y. ti. F ~~-~~ie.. ~~. +}~ S-,Y t`sk-`,` ~ ...II,2~ ~,.a,e^ u, j:t3« ~~rL~7i~.?,~:~.:l:e.c,'I~LJ~I.~ *Q..~.~x ~, 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-hallf (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 isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDVLE F JOINTLY OWNED PROPERTY ESTATE OF ` FILE NUMBER GttZq~p~ y'"1ilU~ 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 ADDRESS RELATIONSHIP TO DECEDENT a k'1t22/}N C,AJQ1~rr} B. RNA; ~ C , N-~~ C. ~ 3c~ S-I~D1~-~~j,root2 L.qu2 (.,~wis~je~T~~ ~~ ~?33g 3 ~ a .~u`~ ui~ ~(L r J~2._ ~G~lstNl`GS{~V('S f P~ (7055 ~Q~~~ `~a~~l~~ JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR J01 TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SMIILAR IDENTIFYING NUMBER. ATTACH DEED FDR JOINTLWHELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST ,. A~(tj a~S rn~s My\~ nnn2.~e~r ~.~,~- a~~bsl~ ~~1,~0 33~/- ~,~4~{ a, R~Q aco5 Nuaeent S(ZT,t,,co~ 1"l.b~S s1Aa~tle S 1CJ5.Id'-E 33.3°~, 3S, )78' 3, alb ~s P,~-~o~1-,Sl~y~~~ C~~sS ~ ~I~~~SIsi~ ~8,~~.~~ ~.3'/ ~g153a~a~~ `E, ~ a~ So~~a.>zt~,N ~~>L ~1,.~~ a,~$o.83 sod, (,34o~y-S TOTAL (Also enter on line 6, Recapitulation) 13 pt~~ ~ l0`[I (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (Og-09) ~ Pennsylvania SCHEDULE G - DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE INCLUDE THE MAME OF THE TRANSFEREE, THEIR REIATIgVSHIP 10 DECEDENr AND NUMBER ` TH,E DATE Of T/rR~A__NSF~6t. ^ATTACH A COPY ~ THE DEED FDR REAL ESFATE. VALUE OF ASSET INTEREST tF APaucael~l VALUE 1. ~IAdQwI'FI~ L~'k~ J-1.)SJ~NCA ~~c (IbSD•~ I,D30•~ '~ wfpb/O~SI'~. TOTAL (Also enter on Line 7, Recapitulation) $ 0.00 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (12-99) SCNEDI~LE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF ~ ~t Zq, n ~~ FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. M~~en-s - e~ ~=w.r~~sew~ "7, ~t toy{. q~ a ~i~ '~~ ~me~-e.~ y - Dvh~~! sn~ 1,"l a5', ~ B. ADMINISTRATIVE COSTS: 1. Personal Representatve(s Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) _ Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulatian) $' q r 6 g _I . (If more space is needed, insert additional sheets of the same size) REV-1513 EXt (11-OS} ~ Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF y t[_ FILE NUMBER l~ za~e~ t~~ RELATIONSHIP TO DECEDENT AMOUNT OR SNARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Ki tn.cz,J Csty R; c K P~ / 733 ~~ ~wYb«~~ w~, law-~56~~, ~~t ~+1.~'L. -~_'~ a. ~,v~viEE. hh~¢ 3!a- Soc~.~i~%ew L~'z. ~ /Hec~N~c56~ ~ 0~ i7aSS" f ~etu~lil.~ • ~ `- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH I8 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS; A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. 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. __ -- ~, .. N1Y~RS--Ha-R[VFR ~t,`N-ERAt ~®ME, IIVC. ~ i..e ~ ~ ~! `l ~~ 4",~ ` 19D3 M~RKE7' STRi+-Ef 1Ki I~l4T !_pMPHiLt, PF~'NSYLIAtyl.li?Oli '~' r ~- ~'.t~s !~: it^.J3~-4961 ~ ~~~~~s "i ~"~ I.t3C:+~L.i ~' U~'~';RFD A?~i~ L3PEitAT~'iY ~. October 30, 2009 Mrs.Kieran M. Cavri:ch 836 Stonybrook-L~.ne _. _ .Lewisberry -, PA 1.7339..._... Services for Elizabeth Hine October 23, 2009 ROBFRTH Hai'+isR ~UPER~ISUn LH5I1.W $..~$+1h}.R ~6`!VERAL Qt~~-~L+i: Charges for Services•Selected $ 4,590.00 Professional Services Use of Facilities Automotive Equipment $ 4,590.00 Charges for Merchandlae Selected Casket - $ 2,075.00 Gown _. - 150..00 $ 2,225.00 Cash :Advanced _ Newspaper Noaice/Local $ 408.00 Mass Offering 125.00 Certified Copies- 36.00 Flowers 185.00 -- =-=~rgan2-s~ :=-- _:,._ _:= -- -= _- .._. _- =-------100:00- ---_:- :- __ . __ -_ _ - == _.__.-. _ _ .. Soloist 75.00 Altar Servers 20.00 Bagpiper 200.00 Total: $ 1,~+~.~ ~. Prudential The Prudential Insurance Company of America Customer Service D11ice PO Bo:c 13902 Philadelphia, PA 19176 www.prudential.com D 1201582957 KIERAN M CAVRICH 836 STONYBROOK LN LEWISBERRY PA 17339 w sH o 000000890 ACCOUNT NO D40250666 BATCH NO. HTD28 Reason far Check: DEATH CLAIM Check Number: D 1201582957 Check Arrtount: $4,655.50 Date of Check: OCT 29 2009 Contract Number: D40 250 666 Insured/Annuitant: ALBERT L HINE YOUR CHECK STATEMENT Page 1 of 1 We hope we have been of help to you during this difficult time. This check for $4,655.50 represents the proceeds from the death claim orl contract D40 250 666.. SOURCE OF FUNDS $1,026.00 3, 64.80 33.86 27.06 53.78 54,655.50 FACE AMOUNT OF INSURANCE PAID-UP ADDITIONAL INSURANCE TERMINATION DIVIDENDS POSTMORTEM DIVIDEND INTEREST FROM THE DATE OF DEATH AMOUNT OF CHECK - If the deceased was named as a beneficiary on any other insurance contracts, we suggest that a new beneficiary be named as soon as possible. Social Security benefits may also be available. for more information, get in touch with the appropriate government office in your area. If you have any questions or would like more information, please call our Claims Area toll free at 800-496-1035. We are available Monday through 8:00 a.m. and 8:00 p.m. Eastern Time .One of our customer service representatives will be glad to help you. (FP996TD28) 544 ""433 Detach before cashing or depositing check. Please retain this check sta ement for tut re reference. vin Yruclential Customer Service Otfice PO Box 13069 Philadelphia, PA 79176-3069 www.pruden[ial.com 11680423314 KIERAN M CAVRICH 836 STONYBROOK LN LEWISBERRY, PA 17339 ~~~ ~~~ Reason for Check: Death Claim Check Number: 11880423314 Check Arnount: $525.12 Date of Check: OCT 27 2009 Policy Type: Life Insurance Insured: E HINE Claim Number: 074414 Policy: MP0106512 YOUR CHECK STATEMENT Page 1 of 1 If you have any questions, please call our Customer Service Office at 800-496-1035, Monday through Friday, 8:00 a.m. to 6:00 p.m. Eastern Time or write ta: Customer Service Office PO Box 13069 Philadelphia, PA 19176-3069 P67400 potash hotpre ~~ghinp or depositing check. Ptoasa •etai^ •tij~ ~tio^~ ~•arnmo^r 'nr t~~+~~•~ •ote.o^.;e. 516 0000 Page: 1 Document Name: untitled DDHIST Acct 2331029474 Alpha key HINE.E..01 Demand Deposit Display History _ Request ALLTRANS Last stmt 10/21/09 6017 11/13/09 S --Date-- ----Description----- -Serial Nbr- -Reference- ------Amount------ * 10/13/09 DAILY BALANCE 9,089.97 * 10/15/09 #CHECK 653 07262603050 (6,209.16) * 10/15/09 DAILY BALANCE 2,880.81 * 10/19/09 #CHECK 654 06351504000 (100.00) * 10/19/09 DAILY BALANCE 2,780.81 * 10/21/09 INTEREST CREDIT 00000000000 0.02 * 10/21/09 DAILY BALANCE 2,780.83 10/26/09 #CHECK 655 07272105630 (1,345.00) 10/26/09 DAILY BALANCE 1,435.83 10/29/09 #CHECK 657 06364709840 (80.00) 10/29/09 DAILY BALANCE 1,355.83 10/30/09 #CHECK 656 06285808510 (25.00) 10/30/09 DAILY BALANCE 1,330.83 DDDHISTREQ _ DDDHISTBAL _ DDDMAIN _ DDDACCT _ DDDINT Last page _ of information. GN20000I02 CONIlKAND =__> F2=Retrieve F3=Exit F4=CRFwindow F7=Backward Date: 11/16/2009 Time: 10:27:22 AM COMBINED REPORT Elizabeth Hine Printed On: 11/20/2009 Page 1 Reported Values Asset Account quantity Price Market As Of Elizabeth Hine MFS Multimarket Income JAV-181544 2.776 6.16 $17.10 10/21/2009 Nuveen SR Income JAV-181544 17.695 5.97 $105.64 10/21/2009 Pimco High Yield Class A Sub Total Joint Owner w/ROS JAV-181544 7,386.864 ~'3$J ~~~~ 1 8.59 $63,453.16 $63,575.90 x63,575.90 10/21/2009 Elizabeth H/ne '$63,575.90 Combined Totals For Elizabeth Hine '$63,575.90 ~I I11~~ 5~,~~~go o~ ` l ~ !f'ta,+~+~ T SKd K ~ d n~ OCCcJ~p O u~ ~ tti,~ lr~ ~v ~~ ~C~ , 1~(~ea~c See q`H'ccc~ (e'~S ~ ~,~ar~ ZG~~~-J ASBSTGW 2 Securities products and services are offered through MML Investors Services, Inc., 100 Corporate Center Dr, Suite 201 Camp Hill, PA 17011 Telephone:(717) 763-7365 This report has been prepared from information obtained from outside sources deemed reliable. However no guarantee is made as to the accuracy, reliability or completeness of the information. - You should rely on the statements from the product sponsors as the official record of your account. ~~`.~ October 14, 2009 NFS/1VIlVII,ISI 1295 State Street Springfield, MA 01111 RE: JAV-177660 &JAV-181544 To Whom It May Concern: ~a~ ,~^n (~ ~~~ V~ _ . ~Y"' I . ~ ~~ ~~ ~~ a~ I give authorization to transfer 563 shares of Pimco High Yield-A {PHDA~ from our joint brokerage account #JAV-181544 into the joint brokerage account #JAV-177660 held by Annie Hine & Marie Bernard. Please contact my agent of record, Justin Dunwoody, at 717-760-5370 if you have any questions or concerns. Sincerely, ~~ Elizabeth Hine Annie Hine Ki Cavrich _r July 30, 2009 NFS/NIlVILISI 1295 State Street Springfield, MA 01111 RE: JAV-177660 &JAV-181544 To Whom It May Concern: V J\ `p~ ~~ rd S I give authorization to transfer $64,000 from our joint brokerage account #JAV-181544 into the joint brokerage account #JAV-177660 held by Annie Hine & Marie Bernard. Please transfer the below amounts accordingly: MMT-$296.68(50 Shares) NSL-$3207.56(621 Shares) POM-$1473.25(102 Shares) PEG$3397.03(101 Shares) FPRXX-$4796.63 DHOBX-$46684.50 DHOAX-$2369.76 PHDAX-$1774.59 Please contact my agent of record, Justin Dunwoody, at 717-760-5370 if you have any questions or concerns. Sincerely, Elizabeth Hine Annie Hine Kieran Cavrich n ~ O H „ N W ~ ~x°~ ~ ~ ~ ~ ~ x v ~ w ~ •, o n x ~I~ ~ ~ O O "~ '-' p~ H -A. ~ ~ '~' ~ CrJ rn p ,..~ ~' ~ ~~ ~ ~ ~ O n n ~~ ~~ .~~ ~~ .~ ~}c r \F~ ~~~ F=-t ]L1~S`Y' ~L ANY) ~S7['ANT>EiN'~' ®JF' ~~~~~ I"I-~ HII~17E I, ELIZABETH HIKE, of the Borough of Lemoyne, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any will or codicil previously made by rne. ITEM 1: Upon my demise, I direct that my body be laid to rest mext to my late husband, W z x x H N W W Albert Lincoln Hine, in a plot which I own in the Rolling Green Memorial Cemetery, Lower Allen Township, Cumberland County, Pennsylvania. ITEM 2: I direct that all my just debts and funeral expenses be paid as soon as practical after my death. ITEM 3: I direct that all taxes and interest and penalties thereon that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my Estate. ITEM 4: I give, devise and bequeath all the rest, residue and remainder of my estate of every nature and wheresoever situate, together with insurance thereon in equal shares to my daughters, KIERAN MARIE CAVRICH 836 Stonybrook Lane, Lewisberry, Pennsylvania 17339 and ANNIE ELIZABETH HIKE 312 Southview Drive, Mechanicsburg, Cumberland County, Pennsylvania 17055, per stirpes. Should my daughter, ANNIE ELIZABETH HIKE, predecease me without having any surviving natural born or adopted children, I bequeath the share of such deceased daughter to my surviving daughter, KIERAN MARIE CAVRICH, per stirpes. 1 ITEM 5: I specifically direct and intend that my son, ALBERT HIKE, shall not receive any portion of my estate and specifically disinherit him. ITEM 6: Should any beneficiary entitled to a share of my estate not have attained the age ~~ of twenty-five (25) years at the time of distribution to him or her, I devise and bequeath the share of such beneficiary to my son-in-law, THOMAS J. CAVRICH OF 836 Stonybrook Lane, Lewisberry, Pennsylvania 17339 (I appoint ANNIE ELIZABETH NINE, of 312 Southview Drive, Mechanicsburg, Pemisylvania ] 7055, as alternate Trustee), to be held in separate trusts, to hold, manage, invest and reinvest the shaze so received, in accumulation of income thereon, and to use and apply the income and principal, or so much thereof as, in Trustee discretion, may be necessary or appropriate for such beneficiary's maintenance, support, and education (including college educatian, both graduate and undergraduate) without regard to his or her parents' ability to provide for such maintenance, support or education, or to make payment for these purposes, without further responsibility, to such beneficiary's parents or to any person taking care of such beneficiary. Any principal or income not so applied shall be distributed to such beneficiary absolutely when he or she attains the age of twenty-five (25) years. If he or she dies before attaining the age twenty-five (25), the Trust shall terminate and such share shall be distributed to his or her personal representative. ITEM 7: My Executrix, trustee or their successors shall have the following powers in addition to those given by law to be exercised by them in their absolute discretion, which powers shall be applicable to all property held by them, effective without the order of any court and until the actual distribution of all such property: 2 a. To retain any investments at discretion including stock of any corporate fiduciary hereunder or of a holding company controlling it; b. To invest and reinvest in the executrix's or trustee's discretion as permitted under Act 28 of ] 999, as amended, the "Prudent Investor Act," with the specific right to invest in stocks, bonds and real estate, including non-income producing residential real estate for the occupancy of any present income beneficiary or beneficiaries, and in such diversified,. proprietary money market and mutual funds, including such mutual funds of any corporate fiduciary hereunder or those of any successor or affiliated corporation or a holding company controlling it, as my executrix and trustee deem appropriate; c. To sell, to grant options for the sale of, or otherwise convert any real or personal property or interest therein, at public or private sale, for such prices, at such time, in such manner and upon such terms as they may think proper, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof without liability of any purchaser to see to the application of the purchase money; d. To borrow money and to secure the repayment thereof by mortgage of real or personal W property, pledge of investments or otherwise, without liability on the part of the lenders to see to the ~ application thereof; e. To compromise claims by or against my estate or any trust created ..hereunder; f To allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries or trusts, in cash or in kind, or partly in each; g. To register investments in the name of a nominee or to hold the same unregistered in such form that they will pass by delivery; 3 r h. To join in any recapitalization, merger, reorganization or voting trust plan affecting investments; to deposit securities under agreement; to subscribe for stock and bond privileges; and generally to exercise all rights of security holders; To 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 period as my executrix and trustee deem advisable even for more than five (5) years and beyond the duration of any trust; j. To deduct administration expenses upon either the federal estate tax return or fiduciary W z x x bw income tax return with or without adjustment as between principal and income, as my corporate or disinterested executrix shall determine; k. To associate with them in the absence of a corporate fiduciary, an accountant, custodian and investment advisor, and other agents and to compensate them from principal or income or both, as my executrix or trustee shall determine, such compensation to be a reduction of the compensation of my executrix or trustee; To associate with them at any time, in their absolute discretion and of their choice, a corporate fiduciary which shall have the same powers as my executrix or trustee, such designation by my executrix or trustee and acceptance by a corporate fiduciary to be in writing; m. To combine, without prior court approval, any trust herein with any other trust with substantially similar provisions, although such other trust may have been created by separate instruments and by different persons, and, if necessary to protect different future interests, to value the assets at the time of such combination and to record the proportionate interest of each separate trust in the combined fund; provided however, that no such combination shall be permitted if the effect of such combination 4 r would be (1) to violate the applicable rule against perpetuities; (2) to disqualify any interest in one or more of such trusts for a deduction for federal estate tax purposes which would otherwise be allowable; or (3) to cause the loss of the exempt status of one or more of such trusts from the imposition of the generation-skipping tax; n. To exercise any stock options which they may receive; t:o borrow such funds from any source as my executrix or trustee may deem necessary for the exercise of such options; and to pledge assets as my executrix or trustee deems appropriate for this purpose; o. No trustee shall be required to qualify before, be appointed by, or, in the absence of a breach of trust, account to any court (and failure to account alone shall not be considered such a breach); nor shall trustee be required to obtain the order or approval of any court :in the exercise of any power or decision granted hereunder; p. To allocate any generation-skipping transfer tax exemption from the federal generation- skipping transfer tax to any property to which I am deemed the transferor under the provisions of Section 2652(a) of the Internal Revenue Code of 1986 and its successors, including any property transferred W under my will and any property not in my probate estate and any property transferred by me during life as H to which no allocation was made prior to my death, to the extent necessary to cause the inclusion ratios W W N applicable to such transfers to be zero; q. To disclaim any interest in property without court approval; and r. To do all other acts and things necessary or appropriate in the management, administration and distribution of my estate or trust. 5 i_ ~ ITEM 8: In the event any legatee or devisee named in this will dies under such ~ circumstances that there is not sufficient evidence to determine absolutely whether such legatee or devisee survived me, I direct such legatee or devisee shall be presumed to have predeceased me and devise and bequeath the gift in favor of that legatee or devisee to such persons and in such manner and in such proportions as set forth in this will for distribution if the legatee or devisee predeceased me. ITEM 9: Until distributed, no gift or beneficial interest shall be subject to anticipation or ~ voluntary or involuntary alienation. ITEM 10: I appoint my daughter, KIERAN MARIE CAVRICH, Executrix of this my Last Will. Should my daughter, KIERAN MARIE CAVRICH fail to qualify or ceases to act for any reason as my Executrix, I appoint my daughter, ANNIE ELIZABETH HIKE, alternate Executrix of this my Last Will. ITEM 11: I direct that my personal representative, trustee or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~~ day of ~.A,~ c:~ , 2008. L HINE Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ;~ t ~.Z;~'wr~._ '~`1 ~ ~~-vr.~l,~ residing at residing at '~~,~ , I v j ~: . f6+ew_ C~sb~~~~ 1~~, ~ -~ Jar 6 COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF CUMBERLAND ) We, ELIZABETH HIKE, ~ /- ~ e h'J, (jE'~ t'l t~.. , and a! ! S ~ .~I2 ~ ~ ~ ~ „ ~ ,the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as witness and that to the best of his or her knowledge, the Testatrix was at the time eighteen (18) years or older, of sound mind and under no constraint or undue influence. 9~,,,~ Subscribed, sworn and acknowledged before me t,~ ,~ (~ ~'~~ : i; ~ by ELIZABETH HIKE, the Testatrix, and subscribed and sworn to before me by ~,.,,~ f ~. _/~ ~~ e Nlc !'~ and t' I S;+ Ivl ~9~ ~~. ~W y,,,~ ,the witnesses, this d ~ day of ~7;.a.2 d~. ZooB. Notary Public (S ~) COMMONWEALTH OF PENNSYlNA1M NOTARIAL SEAL NENRY F. COYNE, NOTAR'~ PUBLIC NAMPDEN TWP., CUMBERLAND COUNTr '7 MY COMMISSION EXPIRES / NE 17 200E ~_ /~ Wi ess