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Home My WebLink About04-0500COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003984 HATCH CRAIG A 1013 MUMMA ROAD SUTIE 100 LEMOYNE, PA 17043 ........ fold ESTATE INFORMATION: SSN: 173-09-9489 FILE NUMBER: 2104-0500 DECEDENT NAME: FLEXER BERNETTA H DATE OF PAYMENT: 05/27/2004 POSTMARK DATE: 05/27/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/01/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $12,026.50 REMARKS: TOTAL AMOUNT PAID: $12,026.50 'SEAL CHECK# 654 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 100355gl No. ~ Date 0 · Local Registra/ ' NAR 02 2o0 . COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT AGE (Last B~lhaay) [ UNDER 1 YEAR I 100 Y'" : COUNTY OF DEATH DECEDENT'S USUAL OCCUF~'ION R~0SMETOIOGIST STATE FILE NUMBER SEX SOCIAL SECURITY NUMBER :2:£~ DATE OF DEATH iMon[h, Oa¥. Yea~} BERNEITA H. FLEXER E.FEMALE '. 173- 09 --948~."]' ,. MARCH 1, 2004 FEB. 1, WILLI~°~,PA ..... [] E- ,., [] ~. [] N.ar.~..~..~ ~ c.... ~ i o. 190/-, ,. %." ...... ~ """"~' ~ ~s~,,)u I T~H~I~' *". BETHANY LUTHERAN VIIIAGE w* DECEDE"? OF.,S.^N,C OR,G,.? .^CE- ~.....~,........ W~..~.~ ~" ,, ,,..o~,~ c~.. '~'~' ...... ~ g~m le .... ,--oR. ..... ,0. ~ ~ICSB~G, PA 17055 i I WIDOWED ,B. FCEDENT'S PMXINSYLVANIA - ,,~.,~,~,~.~. LOWER AL~E~ TOWNSHIP FANDLEY MOI}.TRER'$NAME{Fi,$' M~le.M,,~,~ .... ) LYDIA TAYLOR ~,~114 ~ S~E~, ~ICSB~G, PA ~7055 ~LD~D C~Y & WI~S~RT, PA 17701 DUE TO (OR AS A COf4SEQUE NCE O~): IDESCRIBE HOW INJURY OCCURRED. DATE OF INJURY TIME OF INJURY iNJURY AT ~ORK? Y. [] 13°'' 3m,. u. ~.~.~ ...... ~,,~, ~0~ REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER L - 2oo 0 COUNTY CODE YF-J~ NUMBER D~'C~'uEN'PS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER zl- Flexer, Bernett& H. 173-09-94'89 ~111 DATE OF DEATH (MM-DO-YEAR) I DATE OF BIRTH (MM-DO-YEAR) ~ REI'UF&I MU~T BE FILED IN DUPLICATE WITH THE UJ 03/01/200~ 102/01/1904' REGISTER OF WILLS ~ r (,F APPL'CABLE) suRv'v'NG SPOUSE'S NAME (LAST, F'RST, AND M'DDLE 'N'T'AL) SOCIAL SECURITY NUMBER v~UJ 'lXlr__.l 1. OdginalRetum I I 2. SupplementalRetum [----] 3. Remainder Return (date of death prtor to12-13-82) C.3 n'v I I I 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) I-----I 5. Federal Estate Tax Retum Required ~ ~:~ ~[~] 6. Decedent Died Testate (Attach copy of Will)I'~"1 7. Decedent Maintained a Living Trust (Attach copy of Tmst) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 1 0. Spousal Poverty Credit (date ot Death between 12-31-91 and 1-1-~6} r~ 11. Election to tax under Sec. 91 1 3(A) (Attach Sch O) Z O THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX !NFORMATION SHouLD ~ DIRECTED TOt: NAME Craig A. Hatch, Esquire FIRM NAME (If Applicable) Gates, Halbruner & ~atch, P.C. TELEPHONE NUMBER 717-731-9600 COMPLETE MAILING ADDRESS 1013 Mumma Road, Suite 100 Lemoyne, PA 1704'3 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. J~ Owned Property (Schedule F) (6) L._J Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 3. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) o.oo 0.00 0.00 0.00 0.00 6,512.4'8 278,985.51 (8) OFFICIAL USE ONLY 285,4'97.99 3,376.06 800.29 (11) 4',176.35 281,321.65 0.00 281,321.65 (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE IN~FRUC'rlON~ ON REVERSE SIDE FOR APPUCABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0.00 x.00 (15) 0.00 16. Amount of Line 14 taxable at lineal rate 281,321.65 x.045 (16) 12,659.4,7 17. Amount of Line 14 taxable at sibling rate 0o00 x.12 (17) 0o00 18. Amount of Line 14 taxable at collateral rate 0,0 0 x .15 (18) 0.0 0 19. Tax Due (19) 12,659.4,7 · · BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 2W4645 1.000 D~ceden~'s Complete Address: ADDRESS Bethany Lutheran Village 325 Wesley Drive C~Y M~chanicsbur~ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B, Prior Payments C. Discount 0.00 0.00 632.97 0.00 0.00 Interest/Penalty if applicable D. Interest E. Penalty ISTATE 17055 (1) 12,659.&7 Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) 632.97 0.00 12,026.50 4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 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) A. Enter the interest on the tax due, (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 12~ 036.50 ~ .... ~ke ~eck Payable to: OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ....................... [~ [---] b. retain the right to designate who shall use the property transferred or its income; ......... r'~ c. retain a reversionary interest; or ................................ r-~ 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? ............................ [---] r-~7] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? [--'] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ r-'] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it rs true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESSIZZ4~ c~larle~ st~ Mechanicsburg, PA 170~3 SIGNATURE OF_ PREPARER O'I~R TH~I~I REPRE. S~-NTATIVE ADORESS ~,.9'13 ~'~ Rb~ad, Ste. 100 zLemoyne, PA 170~3 DATE 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 3% [72 P.S. § 9916 (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 0% [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 0% [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 4.5%, 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 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 2W4646 1.000 , REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY E$¥ATE OF FILE NUMBER Flexer, Bernetta H. -2004- If an asset was made joint within one year of the decedent'a date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Fries, Evelyn M. Daughter 1114 Charles Street Mechanicsburg, PA 17055 JOINTLY-OWNED PROPERTY: tm'nm DATE DESCRIFq]ON OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT similar identify/lng number, Attach deed for jointl~/-held real estate. VALUE OF ASSET INTEREST DECEDEN'PS INTEREST 1. A 04/35/1995 Way~oint Bank 13,034.97 50.00 6,512.48 Checking Account Acct. No. 90848618 TOTAL (Also enter on line 6, Recapitulation) ' $ 6,512.48 2W46AE 2.000 (If more space is needed, insert additional sheets of same size) REV-1510 ~ + (1-97) COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Flexer, Beraetta H. -2004- 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. DESCRiPTiON OF PROPEH ~ Y %OF ITEM INCLUOE'nE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DATE OF DEATH DECD'$ EXCLUSION DE(:]H:)ENTAND THE DAli OF TRANSFER. ATFACH A COPY OF THE TAXABLE VALUE NUMBEF DEED FOR RE,N. ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1. Way~oint Bank 267,828.20 100.00 0.00 267,828.20 Brokerage Account Acct. No. 285-25387-15 Account Title= The Flexer {Family Irrevocable Trust ~ated Aug~zst 14, 1998 2 Way~oint Bank 11,157.31 100.00 0.00 11,157.31 Certificate of Deposit Acct. No. 8000054736 Account Title: The Flexer F~m;ly Irrevocable Trust dated August 14, 1998 TOTAL (Also enter on line 7, Recapitulation) $ 278,985.51 (If more space is needed, insert additional sheets of same size.) 2W46AF 2.000 REy-1511 EX + (1-97) COMMOI~NEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS c,~iATE OF FILE NUMBER Flexer, Bernetta H. -2004- Debts of decedent must be reported on Schedule I. n'EM NUMBER DESCRIPTION AMOUNT A. 50.00 5. 6. 7. FUNERAL EXPENSES: Rev. Jill Seagle memorial service Hayhuret Memorials gravesite marker Charles M. Noll Funeral Home funeral goods & services 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: AttorneyFeesNaune.' C.-,~tes, Halbrtt~er & Hatch, P.C. 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 Probate Fees Accountant's Fees Tax Return Preparer's Fees Ritter* s Hardware fax service 672.80 TOTAL (Also enter on line 9, Recapitulation) $ 3, 37 6.0 6 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) 0.00 2,000.00 0.00 25.00 0.00 0.00 2.99 625.27 .RE~-151?.EX + (;-97) COMMOhINEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILITIES, & LIENS P..~ATE OF FILE NUMBER Flexer. Be~'~3ett& H. -2004- Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION C~tes, H&lbruner & Hatch, P.C. £ee £or prep&r&tion o£ decedent's 2003 income tax returns Bethany Village nursing home bill Alert Pharmacy pharmacy bill federal and Pennsylvania TOTAL (Also enter on line 10, Recapitulation) AMOUNT 420.00 251.55 128.74 800.29 2W46AH 2.000 (If more space is needed, insert additional sheets of the same size) REV-1513 EX-~ (9-00) COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ,-~ATE OF Flavex NUMBER k 4 I1. · ~erne~ta ~, NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLEDISTRIBUTIONS[include~trightspous~distributi~s, andtransfem underSec. 9116(a)(1.2)] Fries, Robert S. c/o Charles & Evelyn Fries 1114 Charles Street Mechanicsburg, PA 17055 Wadlinger, Jean F. 149 Mainsville Road Shi~ensburg, PA 17257 Fries, Bernetta J. 200 South 16th Street Camt~ Hill, PA 17011 FILE NUMBER -2004,- RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Grandson Granddaughter Granddaughter Fries, Evelyn M. 1114 C~narles Street Mechanics~urg, PA 17055 Daughter AMOUNT OR SHARE OFESTATE 91,603.06 91,603.06 91,603.05 6,512.48 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 2W46AI 1.000 (If more space is needed, insert additional sheets of the same size) DEATH CERTIFICATE 5.; 4,3 Rev. 2/67 NAME OF DECEDENT (F,rm Middle. La.~) COMMONWEALTH OF PENNSYLVANIA ,, DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH BERNEITA H. FLEXER '.FMVLALE '. 173- 09 --9489 '. MARCH 1, 2004 FEB. 1, WILL~[~, PA I. 1904 t- I',. I AGE (Lasl 8i¢l~clay) I UNDER 1 YEAR 100 ~' : CIJMBERLARD DECEDENT'S USUAL OCCUPATION I KIND OF BUSINESS/INDUSTRY ~0. S~,uL~ !ST I,,BEAUTY SALON 1114 CHARLES STREET IRES'DE"CE MECHANICSBURG, PA 17055 onobhers~e) FATHER'S NAME (Fks% M ~tdle. Las~) ,~.. MRS. EVELYN FRIES WAB DECEDENT EVER INDECEDENT'$ EDUC~3'ION I U S. ARMED FORCES? I(S~mfy only h.:3hesl q;a~e c~n~lefecl] I ~TAL ST~US - Mam~ SURVIVI~ S~ ,,. ,,. ,,. WI~ ,,. ,,..~,.. P~S~V~IA ~ ,,~..~, ~ ALL~ ~SHIP L~ TA~R <-~.m,.~,~ .~114~,,~I~ S~,~R~ICSB~G, PA ~7055 Q ~,.~ 3, 2004 I~LDW~D C~Y & I,,,WI~S~RT, PA 17701 LICENSE NUMBER INAME AND ADORE,SS OF I~IUTY . ,SUPERVISOR ,bF.S.# 011452 - LI~Q-M.NOLL F.H. ,1 E.C~NTRAL AVE. ,S.WMSPT. ,PA 17702 ~ I ~ I~. 3.. u. . . I I '"~" ..... ' ....~ ..................... ~'> ..................................................................... ~ .... l/~ 'MEDICALEXAMINERICORONER (Item 27) Type ~ Prinl J~/ ~, ~ ~. manneraastat~ .................... .. ~.. ' ~ '~ ~ ~[~ ~c ~ /~ THE FLEXER FAMILY IRREVOCABLE TRUST dated August 14, 1998 THE FLEXER FAMILY IRREVOCABLE TRUST THIS TRUST AGREEMENT is executed in triplicate on this 14th day of August, 1998, by and between BERNETTA H. FLEXER, by and through her attorney-in-fact, CHARLES S. FRIES, now of 1114 Charles Street, Mechanicsburg, Cumberland County, Pennsylvania 17055 (hereinafter called "Settlor") and CHARLES S. FRIES and EVELYN M. FRIES, now of 1114 Charles Street, Mechanicsburg, Cumberland County, Pennsylvania 17055 (hereinafter called "Trustee" or "Trustee(s)"). ARTICLE I. TRUST ESTATE 1.01. Initial Principal. Settlor, desiring to establish an irrevocable trust, does hereby irrevocably transfer, assign and deliver to the Trustees and their successors, and assigns the assets listed on Schedule A, attached hereto and made a part hereof. As further evidence of such assignment, the Settlor has executed or will execute or cause to be executed such other instruments as may be required for the purposes of completing the assignment or transfer of title to such property to the Trustees. The Trustees accePt such transfer and assignment to themselves as Trustees, and undertake to hold, manage, invest and reinvest the assets of this Trust, and to distribute the income and principal of the Trust in accordance with the provisions of this Agreement. 1.02. Additional -Principal. The Settlor and any other person or persons, with the consent of the Trustees, shall have the right at any time to make additions to the corpus of this Trust or any share thereof hereby established. Ail such additions shall be held, governed, and distributed by the Trustees in accordance with the terms and conditions of this Agreement. The Trustees, in their sole discretion, may require, as a prerequisite to accepting property, that the transferring party provide evidence satisfactory to the Trustees that (i) the property is not contaminated by any hazardous or toxic materials or substances; and (ii) the property is not being used and has never been used for any activities directly or indirectly involving the generation, use, treatment, storage, disposal, release or discharge of any hazardous or toxic materials or substances. 1.03 Disclaimer. The Trustees shall have the right to disclaim, in whole or in part, prior to its acceptance by the Trustees, any interests in property for any reason, including but not limited to a concern that such property could cause potential liability under any federal, state, or local environmental law. ARTICLE II. IRREVOCABILITY OF TRUST 2.01. Irrevocability. Settlor has been advised of the consequences of an irrevocable trust and hereby declares that this Trust shall be irrevocable and shall not be altered~ amended, revoked, or terminated by Settlor or any other person or persons. ARTICLE III. LIFE INSURANCE POLICIES [THIS PORTION IS INTENTIONALLY LEFT BLANK.] ARTICLE IV. TRUST DISTRIBUTIONS 4.01. Trust Principal. The entire corpus of this Trust, including the assets initially transferred to this Trust, subsequent additions to this Trust, and the proceeds of any sale, exchange or investment of such Trust assets, shall be used for the purposes herein contained. 4.02. Income Distribution. During the Settlor's lifetime, the Trustees shall distribute all of the net income of the trust to, or for the benefit of, BERNETTA H. FLEXER. The Trustee shall make no distributions of principal to BERNETTA H. FLEXER. 4.03. Principal Distributions. Upon the death of the Settlor, the Trust shall terminate. Upon termination, the remaining trust estate shall be divided into separate and equal shares with one share for each of the Settlor's grandchildren, ROBERT SCOTT FRIES, BERNETTA J. FRIES, and JEAN F. WADLINGER. The Trustees shall distribute one share to each of the Settlor's grandchildren, ROBERT SCOTT FRIES, BERNETTA J. FRIES, and JEAN F. WADLINGER, per stirpes. If any of the Settlor's grandchildren predecease the termination of this Trust, then his share shall be distributed .equally to his issue, per stirpes. If any of the Settlor's grandchildren predecease the termination of this Trust without leaving issue, then his share shall be distributed equally to the Settlor's surviving grandchildren, per stirpes. 4.04. General Power of Appointment. Settlor's daughter, EVELYN M. FRIES, and Settlor's son-in-law, CHARLES S. FRIES, are hereby granted the general power to appoint some or all of the principal of this Trust to themselves, their estates, their creditors, the creditors of their estates, in such proportions and upon such terms (in trust, outright gifts, or in any other manner) as each deems advisable. This power shall not be exercisable under their Wills. If Settlor's daughter or son-in-law fail, either in whole or in part, to exercise this general power of appointment herein granted, the unappointed principal shall continue in trust and shall be administered according to the terms of this Trust. 4.05. Broad Special Power of Appointment. BERNETTA H. FLEXER is hereby granted the special power to appoint, at any time 2 and from time to time, the principal of this Trust, in whole or in part, and in any manner and in such proportions as she deems advisable to whomever she desires. This power shall not be exercisable by her Will. This special power of appointment does not grant to BERNETTA H. FLEXER the power to appoint the principal of this trust to herself, her estate, her creditors, or the creditors of her estate. If BERNETTA H. FLEXER fails, either in whole or in part, to exercise this special power of appointment herein granted, the unappointed principal shall continue in trust and shall be administered according to the terms of this trust. ARTICLE V. POWERS OF TRUSTEE 5.01. General Powers. In addition to such other powers and duties as may have been granted elsewhere in this Trust, but subject to any limitations contained elsewhere in this Trust, the Trustees shall have the following powers and duties: A. In the management, care and disposition of this Trust, each Trustee shall have the power to do all things and to execute such deeds, instruments, and other documents as may be deemed necessary and proper, including the following powers, all of'which may be exercised without order of or report to any court: (1) To sell, exchange, or otherwise dispose of any property, real, personal or mixed, wheresoever located, at any time held or acquired hereunder, at public or private sale, for cash or on terms as may be determined by the Trustee, without advertisement, including the right to lease for any term notwithstanding the period of the Trust, and to grant options, including an option for a period beyond the duration of the Trust. (2) To invest all monies in such stocks, bonds, securities, investment companies or trust shares, mortgages, notes, choses in action, real estate, improvements thereon, and other property as the Trustee may deem best, without regard to any law now or hereafter in force limiting investments of fiduciaries; except that the Trustee may not invest in any stock or securities issued by the corporate Trustee or issued by a parent or affiliate company of such Trustee. (3) To retain for investment any property deposited with the Trustee hereunder; except that the Trustee may not retain for investment any stock or securities in the corporate Trustee or in a parent or affiliate company of such Trustee. (4) To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, 3 consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security held by this Trust. (5) To use lawyers, real estate brokers, accountants and any other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. (6) To compromise, settle or adjust any claim or demand by or against the Trust and to agree to any rescission or modification of any contact or agreement affecting the Trust. (7) To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging, pledging or conveying any property of the Trust, including the power to borrow from the Trustee (in the Trustee's individual capacity) at a reasonable rate of interest. (8) To retain any business interest transferred to the trustee, as shareholder, security holder, creditor, partner or otherwise, for any period of time whatsoever, even though the interest may constitute all or a large portion of the trust principal; to comply with the provisions of any agreement restricting transfer of the interest; to participate in the conduct of the related business or rely upon others to do so, and to take or delegate to others discretionary power to take any action with respect to its management and affairs which an individual could take as outright owner of the business or the business interest, including the voting of stock (by separate trust or otherwise regardless of whether that separate trust will extend for a term within or beyond the term of the trust) and the determination of all questions of policy; to execute and amend partnership agreements; to participate in any incorporation, reorganization, merger, consolidation, sale of assets, recapitalization, liquidation or dissolution of the business, or any change in its nature, or in any buy- sell, stock restriction, or stock redemption agreements; to invest in additional stock or securities of, or make secured, unsecured, or subordinated loans to, the business with trust funds; to take all appropriate actions to prevent, identify, or respond to actual or threatened violations of any environmental law or regulation thereunder; to elect or employ with compensation, as directors, officers, employees, or agents of the business, any persons, including a trustee of any trust held under this instrument, or any director, officer, employee, or agent of a corporate trustee of any trust held under this instrument, without adversely 4 affecting the compensation to which that trustee would otherwise be entitled; to rely upon reports of certified public accountants as to the operations and financial condition of the business, without independent investigation; to deal with and act for the business in any capacity (including in the case of a corporate trustee any banking or trust capacity and the loaning of money out of the trustee's own funds) and to be compensated therefor; and to sell or liquidate the business or any interest in the business. (9) To register any stock, bond or other security in the name of a nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that the stock, bond or other security is a trust asset and the Trustee shall be responsible for the acts of the nominee. (10) To set aside as a separate trust, to be held and administered upon the same terms as those governing the remaining trust property, any interests in property, for any reason, including but not limited to a concern that such property could cause potential liability under any federal, state, or local environmental law. B. Whenever the Trustee is directed to distribute any trust principal in fee simple to a person who is then under twenty-one (21) years of age, the Trustee shall be authorized to hold such property in trust for such person until he becomes twenty-one (21) years of age, and in the meantime shall use such part of the income and the principal of the trust as the Trustee may deem necessary to provide for the proper support and education of such person. If such person should die before becoming twenty-one (21) years of age, the property then remaining in trust shall be distributed to the personal representative of such person's estate. C. In making distributions from the Trust to or for the benefit of any minor or other person under a legal disability, the Trustee need not require the appointment of a guardian, but shall be authorized to pay or deliver the distribution to the custodian of such person, to pay or deliver the distribution to such person without the intervention of a quardian, to pay or deliver the distribution to the legal guardian of such person if a guardian has already been appointed, or to use the distribution for the benefit of such person. D. In the distribution of the Trust and any division into separate trusts and shares, the Trustee shall be authorized to make the distribution and division in money or in kind or in both, regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Trustee shall be binding and conclusive on all persons taking hereunder. The Trustee may in making such distribution or division allot undivided interests in the same property to several trusts or shares. E. If at any time after Settlor's death the total fair market value of the assets of any trust established or to be established hereunder is so small that the corporate Trustee's annual fee for administering the trust would be equal to or less that the minimum annual fee set forth in the Trustee's regularly published fee schedule, then the Trustee in its discretion shall be authorized to terminate such trust or to decide not to establish such trust, and in such event the property then held in or to be distributed to such trust shall be distributed to the persons who are then or would be entitled to the income of such trust. If the amount of income to be received by such persons is to be determined in the discretion of the Trustee, then the Trustee shall distribute the property among such of the persons to whom the Trustee is authorized to distribute income, and in such proportions, as the Trustee in its discretion shall determine. F. The Trustee shall be authorized to lend or borrow, including the right to lend to or borrow from the Settlor's estate, at an adequate rate of interest and with adequate security and upon such terms and conditions as the Trustee shall deem fair and equitable. G. The Trustee shall be authorized to sell or purchase, at the fair market value as determined by the Trustee, any property to or from Settlor's estate, the estate of Settlor's spouse, or any trust created by Settlor or Settlor's spouse during life or by will, even though the same person or corporation may be acting as executor of Settlor's estate or the estate of Settlor's spouse or as trustee of any other such trusts and as the Trustee of this Trust. H. The Trustee shall have discretion to determine whether items should be charged or credited to income or principal or allocated between income and principal as the Trustee may deem equitable and fair under all the circumstances, including the power to amortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal, to treat any dividend or other distribution on any investment as income or principal or to apportion the same between income or principal, to charge any expense against income or principal or apportion the same, and to provide or fail to provide a reasonable reserve against depreciation or obsolescence on any asset subject to depreciation or obsolescence, all as the Trustee may reasonably deem equitable and just under all of the circumstances. I. The Trustee is hereby authorized and empowered to purchase such insurance policies as it deems appropriate. 5.02. Voting by Trustee. When the authority and power under this Trust is vested in two (2) or more Trustees or Co- Trustees, the authority and powers are to be held jointly or individually by the Trustees or Co-Trustees. 5.03 Trustees Power to Deal with ~nvironmental Hazards. The Trustee shall have the power to use and expend the trust income and principal to (i) conduct environmental assessments, audits, and site monitoring to determine compliance with any environmental law or regulation thereunder; (ii) take all appropriate remedial action to contain, clean up or remove any environmental hazard including a spill, release, discharge or contamination, either on its own accord or in response to an actual or threatened violation of any environmental law or regulation thereunder; (iii) institute legal proceedings concerning environmental hazards or contest or settle legal proceedings brought by any local, state, or federal agency concerned with environmental compliance, or by a private litigant; (iv) comply with any local, state or federal agency order or court order directing an assessment, abatement or cleanup of any environmental hazards; and (v) employ agents, consultants and legal counsel to assist or perform the above undertakings or actions. Any expenses incurred by the trustee under this paragraph may be ~charged against income or principal as the trustee shall determine. ARTICLE VI. SPENDTHRIFT pROVISION 6.01. General Provision. No beneficiary shall have the power to anticipate, encumber or transfer his interest in the Trust Estate in any manner other than by the valid exercise of a Power of Appointment. No part of the Trust Estate shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. ARTICLE VII. CONSTRUCTION OF TRUST 7.01. Choice of Law. This Trust shall be administered and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. 7.02. Code. Unless otherwise stated, all references in this Trust to section and chapter numbers are to those of the Internal Revenue Code of 1986, as amended, or corresponding provisions of any subsequent federal tax laws applicable to this Trust. 7.03 . Other Terms. Unless the context otherwise requires, the use of one or more genders in the text includes all other genders, and the use of either the singular or the plural in the text includes both the singular and the plural. 7.04. Captions. The captions set forth in this Agreement at the beginning of the various divisions hereof are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their construction and application. 7.05. Situs of Trust. The Trust shall have its legal situs in Cumberland County, Pennsylvania. ARTICLE VIII. COMPENSATION OF TRUSTEE AND APPOINTMENT OF SUCCESSOR TRUSTEE 8.01. Compensation. The Trustees shall receive as their compensation for the services performed hereunder that sum of money, based on an hourly charge or percentage rate, which the Trustees normally and customarily charges for performing similar services during the time which they perform these services. 8.02. Removal of Trustee. Settlor may remove the Trustees, at any time or times, with or without cause, upon thirty (30) days written notice given to the current Trustees. Upon the death of the Settlor, a majority of the current beneficiaries may remove the Trustees, at any time or times, with or without cause, upon thirty (30) days written notice given to the Trustees. Upon the removal of the Trustee, a successor Trustee shall be appointed in accordance with the terms set forth'in Paragraph 8.03. 8.03. Appointment of Successor Truste~. The Trustees may resign at any time upon thirty (30) days written notice given to the Settlor if Settlor is living, or in the event of Settlor's death, upon thirty (30) days written notice given to the current beneficiary or beneficiaries (including a beneficiary's natural or legal guardian or legal representative), hereunder. Upon the death, resignation, removal or incapacity of both Trustees, JEAN M. WADLINGER shall serve as successor trustee. Any other Trustee may be appointed by the Settlor during Settlor's lifetime, or, after Settlor's death, by a majority of the current income beneficiaries. Any successor trustee thus appointed, or, if the Trustee shall merge with or be consolidated with another corporate fiduciary, then such corporate fiduciary, shall succeed to all the duties and to all the powers, including discretionary powers, herein granted to the Trustee. 8.04 Exoneration of Truste~. No Trustee shall be liable for any loss or depreciation in value sustained by the Trust as a result of the Trustee retaining any property upon which there is later discovered to by hazardous materials or substances requiring 8 remedial action pursuant to any federal, state, or local environmental law, unless the Trustee contributed to the loss or depreciation in value through willful default, willful misconduct, or gross negligence. 8.05 Indemnification of Trustee Upon Distribution. Notwithstanding any contrary provision in this Trust Agreement, the Trustees may withhold a distribution to a beneficiary until receiving from the beneficiary an indemnification or an agreement in which the beneficiary agrees to indemnify the Trustee against any claims filed against the Trustee as an "owner" or "operator" under the Comprehensive Environmental Response, Compensation and Liability Act of 1980, as from time to time amended, or any regulation thereunder. ARTICLE IX. PERPETUITIES CLAUSE 9.01. General Provision. Notwithstanding anything to the contrary in this Trust, each disposition I have made here, legal or equitable, to the extent it can be referred in its postponement of becoming a vested interest to a duration measured by some life or lives in being at the time of my death is definitely to vest in interest, although not necessarily in possession, not later that twenty-one (21) years after such lives (and any period of gestation involved); or, to the extent it cannot be referred in any such postponement to such lives, is to so vest not later than twenty-one (21) years from the time of my death. ARTICLE X. ACQUISITION OF UNITED STATES TREASURY BONDS ELIGIBLE FOR TAX PAYMENT; PAYMENT OF TAXES, FUNERAL EXPENSES, AND EXPENSES OF ADMINISTRATION 10.01. Acquisition of Bonds. The Trustees may, at any time, without the prior approval or direction of the Settlor and whether or not the Settlor is able to manage Settlor's own affairs, acquire United States Treasury Bonds selling at a discount, which bonds are redeemable at their par value plus accrued interest thereon for the purposes of applying the proceeds to the payment of the United States estate tax on the Settlor's estate; and the Trustees may borrow from any lender, including itself, with or without security, to so acquire these bonds. 10.02. Payment of United States Estate Tax by Bond Redemption. The Settlor directs that any United States Treasury Bonds which may be redeemed at their par value plus accrued interest thereon for the purpose of applying the proceeds to the payment of the United States estate tax imposed on the Settlor's estate, and which are held by the Trustee, shall, to the extent of the amount determined to be required for payment of the estate tax, be distributed to the legal representative of the Settlor's estate to be used by the legal representative ahead of any other assets 9 and to the fullest extent possible to pay the estate tax. 10.03. Payment of Death Taxes and Other Estate Settlement Costs. After the Trustees have complied with paragraph 10.02, above, and ascertained from the legal representative that all such bonds have been redeemed in payment of the United States estate tax, the Trustees shall also ascertain from the legal representative whether the legal representative has sufficient assets to pay the remaining legacy, succession, inheritance, transfer, estate and other death taxes or duties (except the additional estate tax imposed by Section 2032(c), or corresponding provisions of the Internal Revenue Code of 1986 applicable to the Settlor's estate and imposing the tax) levied or assessed against the Settlor's estate (including all interest and penalties thereon), all of which taxes, interest and penalties are hereafter referred to as the death taxes, interest and penalties. If the legal representative advises the Trustees that insufficient funds exist to pay all the death taxes, interest and penalties, the Trustees shall then pay to the legal representative from the trust property, an amount equal to all the death taxes, interest and penalties in excess of the funds available to the legal representative for this purposes, which payments are to be made without apportionment. In making the payments, the Trustees shall use only those assets or their proceeds which are includable in the Settlor's gross estate for purposes of the United States estate tax and shall not impair the marital portion without first exhausting the entire non-marital portion. If the Executor of the Settlor"s estate, in such Executor's sole discretion, shall determine that appropriate assets of Settlor's estate are not available in sufficient amount to pay (1) the Settlor's funeral expenses, and (2) expenses of administering the Settlor's estate, the Trustees shall, upon the request of the Executor of the Settlor's estate, contribute from the principal of the trust estate the amount of such deficiency; and in connection with any such action the Trustees shall rely upon the written statement of the Executor of the Settlor's estate as to the validity and correctness of the amounts of any such expenses, and shall furnish funds to such Executor so as to enable such Executor to discharge the same, or to discharge any part of all thereof itself by making payment directly to the person entitled or claiming to be entitled to receive payment thereof. No consideration need be required by the Trustees from the Executor of Settlor's estate for any disbursement made by the Trustees pursuant hereto, nor shall there be any obligation upon such Executor to repay to the Trustees any of the funds disbursed by it hereunder, and all amounts disbursed by the Trustees pursuant to the authority hereby conferred upon it shall be disbursed without any right in or duty upon the Trustees to seek or obtain contribution or reimbursement from any person or property on account of such payment. The Trustees shall not be responsible for the application of any funds delivered by it to the Executor of the Settlor's 10 estate pursuant to the authority herein granted, nor shall the Trustees be subject to liability to any beneficiary hereunder on account of any payment made by it pursuant to the provisions hereof. IN WITNESS WHEREOF, the Settlor and Trustees have hereunto set their hands and seals as of the day and year first above written. WITNESS: ( SEAL ) BERNETTA H. FLEXER, by and through her attorney-in-fact, CHARLES S. FRIES, SETTLOR COMMONWEALTH OF PENNSYLVANIA : : COIINTY OF CUMBERLAND : SS: On this, the 14th day of August, 1998, before me, a Notary Public, the undersigned officer, personally appeared BERNETTA H. FLEXER, by and through her attorney-in-fact, CHARLES S. FRIES, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Trust Agreement, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official Seal.. y ' ' xpires: 11 The foregoing Trust Agreement was delivered, and is hereby accepted, at Lemoyne, Pennsylvania, on August 14, 1998. WITNESS CHARLES S. FRIES EVELYN M. FRIES (SEAL) (SEAL) 12 SCHEDULE "A" SCHEDULE REFERRED TO IN THE ANNEXED TRUST AGREEMENT DATED: AUGUST 14, 1998 FROM BERNETTA H. FLEXER, SETTLOR TO CHARLES S. FRIES and EVELYN M. FRIES, TRUSTEE Property Description: 13 PA REV-1500 SCHEDULE F JOINTLY OWNED PROPERTY LOOK FOR US. WE'LL GET YOU THERE. 5/14/2004 GATES HALBRUNER & HATCH 1013 MUMMA RD STE 100 LEMOYNE PA 17043 The information which you requested on the account(s) of BERNETTA H FLEXER (Social Security Number 173-09-9489) is/are as follows: Account Number 8000054736 90848618 Class of Account CERTIFICATE CHECKING Date Opened 110499 042595 Principal Balance 11157.31 13024.44 Accrued Interest 0.00 .53 Balance at Date of 11157.31 13024.97 Death Account Ownership IRREVOC TRU JTO Name of Joint Owner, if any Date Ownership 110499 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established EVELYN M FRIES 042595 Additional Information Requested Sincerel~~;~~i ERIN E WATTS SENIOR SERVICES REP. RO. Box 171 I. HARRISBURG. PENNSYLVANIA 17105-1711 Toll FrE~ 1-866-WAYPOINT (I-866-9;=9-7646) · IN YORK AREA 717/815-4500 · www.wagpointbank.com PA REV-1500 SCHEDULE G INTER-VIVOS TRANSFERS and MISCELLANEOUS NON-PROBATE PROPERTY SERVICES May ll, 2004 Gates, Halbruner and Hatch, P.C. 1013 Mumma Road Suite 100 Lemoyne, PA 17043 Atto: Traci L Sepkovic Per your request. 1. Noted on st~ements(a~ached) 2. N/A 3. 09/09/1998 4. N/A 5. N/A 6. $267,828.20(det~ls a~ached) 7. $1,945.96 8. N/A Please feel free to contact us with any questions you may have. Kenneth Fetrow Waypoint Brokerage Services, Inc. ;~450 ~ASTI~RN BOULL:VARD. YORIC PENNSYLVANIA 1740;~ 717/755-1066 · I-BOO-;~55-E1526 · 717/755-1175 fAX · www. wagpointbrokerage.com LOOK FOR US. WE'LL GGT YOU TH(~RE 5/14/2004 GATES HALBRUNER & HATCH 1013 MUMMA RD STE 100 LEMOYNE PA 17043 The information which you requested on the account(s) of BERNETTA H FLEXER (Social Security Number 173-09-9489) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established 8000054736 90848618 CERTIFICATE CHECKING 110499 042595 11157.31 13024.44 0.00 .53 11157.31 13024.97 IRREVOC TRU JTO EVELYN M FRIES 110499 042595 Additional Information Requested ERIN E WATTS SENIOR SERVICES REP. P.O. Box 171 I, HARRISBURG, PENNSYLVANIA 1710S-1711 Toll Free I-SGG-WAYPOINT (I-86(~-9;~9-7~;4(;) · IN YORK AREA 717/81S-4S00 · vvvvvv, wagpointbank.com PA REV-1500 SCHEDULE H FUNERAL EXPENSES and ADMINISTRATIVE COSTS PAY TO TH[ ORDER OF CHARLES S. FRIES EVELYN M. FRIES 1114 CHARLES STREET MECHANICSBURG, PA 17055 America DATE DOLLARS m:O3&3O~81~Em: 51, :~2271, O ,B,' 0 q ~ 8r 938 60-1841313 ,"000000 SO00," EVELYN M. FRIES CHARLES S. FRIES 1114 CttARLE5 STREET MECHANICSBURG, PA 17055 ~'ma18 2313 0O9O648618 652 ¢'9///ou WAYPOINT FOCUS 5O Account: Name: Address: 90848618 BERNETTA H FLEXER OR EVELYN M FRIES 1114 CHARLES ST MECHANICSBURG PA 17055-3946 170553946 Page 1 of 1 05/15/04 The image shown below represents an official copy of the original document as processed by our institution BERNETgA H. FLEXER 5O? 507 05/12/04 6082600 672.80 http ://10.15.1.108/dsi-bin/dsigtwy.dll/print?20040512---6082600.htm 5/15/2004 CHARLES M. NOLL FUNERAL HOME ~ONN H.A. OHNMEISS, SUPERVISOR I EAST CENTRAL AVENUE ~OUTH WILLIAMSPORT, PA 17702 Date March 1, 2004 in AccountWith Mrs. Evelyn M. Fries & Estate of Mrs. Bernetta Flexer Funeralof Mrs. Bernetta H. Flexer (A) SERVICES SELECTED 1. Professional services of funeral director & staff ..................................................... Embalming .............................................................................................................. $ Other (Dressing & Casketing, Hairstyling, Cosmetic Application) .......................... $ 2. Facilities and equipment Visitation, funeral services, administration areas, preparation room, and other facilities ..................................................................... $ 3, Automobile equipment: Local removal, hearse, family cars, clergy car, Mechanicsburg, Pa pallbearer car, flower car, limousine(s)...~r~O$.~o~.[&tiQn...fr~ .................. $ __. TOTAL OF PROFESSIONAL SERVICES, FACILITIES & AUTOMOBILES ................. $ 450.00 290.00 140.00 880.00 (B) MERCHANDISE SELECTED Casket,. ~ ~ ~r~ t iv.e...~mhu s .L i h I e., .Cr.e~a t ior~..Con ta ine r ............ $ Outer Receptacle .................................................................................................... $ Acknowledgement cards, register book(s), memory folders, temporary grave marker, burial clothing, other clothing, cremation urn, other ............................................................................................ ..~ __ TOTAL MERCHANDISE SELECTED ........................................................... ' ....... SPECIAL CHARGES (c) · · · .......................... ..~.. Direct"remation w' c"~w-~'~"[~"~ ........................................ t.JW%..~.;~.~ ~V .,:~ ................................ TOTAL OF SPECIAL CHARGES (D) CASH ADVANCES Grave Opening. Sai~t..,~ol~g~s...L~l~ar~n(~e.l,a~ar~..R~dn.)...C~u.r~.h....$ Newspaper notices (local and out-of- town), ads~UD .-.~ Z.~ ~, .~.~...O.b~ LUSTy..... $ ~~~. ~..,.Har. risb. urg Patr~{'ot News .......................... $- Airfare ................................................................ $ Clergy and Mass offering..~RV..... ~l ]~..V,.....S~aglm ........................................ $ Certified Copies of the death certificate lO...Transcrip.ts...@..$...Z.OQ..Eac~,, Flowers ......................... w~n.tz,.Elo, ris ts. ......................................................... ..................................... Tr, adi tioua L.Cr. ema tio~z,.S~rv±c~.. S.pray ....... $ Vault service charge ............................................................................................... $ ~Cp.~.r.Qp.~.e.~r~Q~f.~.m.~.ber~.a.~d~t~y.~.P.A...-.~Fae~(~.for..C~se~ t.$ .a.D..d_ ..A...u..t., .h.Q.T,~ ~.~ .~iQP... f.o.r...Cr.a,ma~ i.o.u...Lo...Occur ................................ S Cemetery Memorial/Marker - Final Dating Fee ...................................................... $ TOTAL CASH ADVANCES .................................................................. $ 90.00 2,023.00 2 023 O0 75:00 56.62 81,06 5ILO0 2D.,O0 53.00 25.00 ._~ ,'~ 360.68 '?:~ TOTAL (A) (B) (C) (D) ............................................................................................ $ 3,353.68 ~'¢:r CREDITS ............... VA FED ............ VA CO. ............ OTHER CEF..~..~e -2,72~., 41 * TOTAL ..................................................................................................................... $ 625.27 Additional Items of goods and services .................................................. TOTAL ......... $ 625.27 PA REV-1500 SCHEDULE I DEBTS OF DECEDENT 9 MORTGAGE LIABILITIES and LIENS BUREAU OF ZNDZVZDUAL TAXES INHERITANCE TAX DIVISTON DEPT. 280601 HARRISBURG, PA 17128-060! COMHONNEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSMENT OF TAX REV-IS47 EX AFP CRAZG A HATCH ESQ GATES ETAL 1013 MUHMA RD STE 100 LEMOYNE PA 170q3 DATE 07-26-200q ESTATE OF FLEXER DATE OF DEATH 03-01-200~ FZLE NUMBER 21 0~-0500 COUNTY CUMBERLAND ACM 101 Aeoun~ Ree'i ttod BERNETTA H MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGZSTER OF NTLLS CUMBERLAND CO COURT HOUSE CARL/SLE, PA 17013 CUT ALONG THZS LZNE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF FLEXER BERNETTA H FZLE NO. 21 Oq-0500 ACN 101 DATE 07-Z6-200q TAX RETURN HAS: (X) ACCEPTED AS F~LLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIG/NAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 5. Closely Held S~ock/Partnership Zn~erost (Schodula C) ($) q. Mortgages/Notes Receivable (Schodule D) (q) E. Cash/Bank Deposits~Misc. Personal Property (Schedule E) ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assets .00 NOTE: To insure proper .00 credit to your account, .00 submi~ the upper portion .00 of ~his form wi~h your .00 ~ax payment. 285,q97.99 6~512.q8 278~985.51 APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expenses/Ada. Costs/Misc. Expanses (Schedule H) (9) 10. D. ts,,ortG. . 11. To,al Deductions Ne~ Value of T,x Return '* ~ ~ ~:::~.' .0 0 13. ChaPi{~ble/OovePnmen{al Bequ~s{s~ Non-~leo{~d 9113 TPus{s (Schedule J) 1~. Ne{ V~lue of Es{a{e Sub~ec{ {o T~x ("L (1~) ~ ~1~ 21.65 NOTE: Z~ an assessment ~as lssued pPevlously, lines 16, 15 and/~ "16, 1~ 18 ~': 19 ~111 Pe~lect ~iguPes that include the total o~ ALL PetuPns ass~E~'d to.ate. ASSESSMENT OF TAX: 15. Amoun~ of Line lq a~ Spousal ra~e (1E) ·"~ O0 ~ · O0 16. Amoun~ of L/ne lq ~axable a~ Lineal/Class A ra~e (16). 281,~21.65 x Oq5 = 12,659.q7 17. Amoun~ of Line lq a~ Sibling ra~e (17) .00 X 12 = .00 18. Amoun~ of L/ne lq ~axable a~ Collateral/Class B ra~e (18) . O0 X 15 = . O0 19. Princi=al Tax Due (19)= 1Z,659.~7 TAX CREDITS: PAYMENT RECEZPT DZSCOUNT DATE NUMBER /NTEREST/PEN PAZD (-) AMOUNT PAZD 05-ZT-ZOOq CDOO~98q 6~Z.97 12,026.50 TOTAL TAX CREDZT 12,659.q7 BALANCE OF TAX DUEI .00 , ~NTEREST AND PEN. . O0 TOTAL DUE .00 ~ ZF PA/D AFTER DATE ZNDZCATED~ SEE REVERSE ( ZF TOTAL DUE 1S LESS THAN $1~ NO PAYMENT IS RE~U~RED. FOR CALCULATZON OF ADDZTZONAL ZHTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CRED/T" (CR)~ YOU HAY BE DUE A REFUND. SEE REVERSE S~DE OF THZS FORM FOR INSTRUCT/ONS. RESERVATION: Estates of decadents dying on or before December 12, 198Z -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral} benef[ciarims of the decedent after the expiration of any estate for life or for years, tho ComeoneeaIth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYNEHT: REFUND (CR): OBJECT[OHS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Section 9140]. Detach the top portion of this Not[ce and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-56Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-BOO-447-50ZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBlOZl, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501] for an explanat[on of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (SZ) discount of the tax paid is allowed. The 1SZ tax amnesty non-participation penalty is computed on tho total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six (SI) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at e rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Tho applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 lOX .000548 ~'~-1991 llX .OOOSOX ~ 9Z .000247 1985 162 .000438 199Z 9Z .000Z47 ZOOZ 6Z .000164 1984 llZ .000301 1993-1994 72 .00019Z 2005 5Z .000137 1985 152 .000356 1995-1998 92 .000247 2004 4Z .000110 1986 lOZ .000274 1999 7Z .00019Z 1987 lex .000Z74 ZOO0 7X .OOO19Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Hot[ce, additional interest must be calculated.