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HomeMy WebLinkAbout09-30-101505610143 REV-1500 ~`(°'-'°' ~` PA De artment of Revenue y OFFICIAL USE ONLY p peens Ivania County Code Year File Number Bureau of Individual Taxes °~'"ar"E"T°"°"aMeE Po eox.28osot INHERITANCE TAX RETURN 21 09 0801 Harrisburg, PA 77728-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 196 50 8047 07 19 2009 Decedent's Last Name Suffix MOUNTZ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth 12 06 1962 Decedent's First Name MI DONNA M Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return 4. Limited Estate ^ 4a. Futuro Interest Compromise lAn1n M Mnfh nfln. 1 ~-17A~1 g Decedent Died Testate ~ Decade^nt Mainta nec~ a Living Trust (Attach Copy of Nhll) ^ (Altarh [:opy of 1`Cruls ) ^ 9. Litigation Proceeds Received ~ ~ 10. ys~°~"B8~?1~3i X31 a~tt(detge5~f death ^ 3. Remainder Return (date of death prior to 12-13-a2) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes t t,Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytlme Telephone Number AMY M MOYA ~ 717 652.7323 REGISTER OF WILLS USE ONLY First Ilne of address 5011 LocvsT T•nTaF Second line of address 0 0 _~ f..r. ~t~ C`a W ~: ~ O ~-, City or Post Office State ZIP Code ~~ - ~ HARRI SHURG PA 1710 9 ~ H ~ "`_ 4 __ f~'I ~. i.7 ~ ~ -T} correspondents a-mail address: Amy(a~Ledererlaw.com Under penalties of perjury, I declare that I have exarrtined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, mrrec~ and complete. Declaration of preparer other than the personal) representative Is based on all information of which preparer has any knowledge. Smith C~ ~'~ DATE ~ Amy M. Moya 9 oZ7/le7 5011 Locust 1505610143 PA 17109 Side 1 150561!]143 J 1505610243 REV-1500 EX Decedent's Social Security Number oeceael,rerr~e: Mouniz, Donna M. 196 50 8047 RECAPITULATION 1. Real Estate (Schedule A) ...................................................................................... . 1. 2. Stocks and Bonds (Schedule B) ........................................................................... .. 2. 3. Closely Held Corporation, Partnership or Sob-Proprietorship (Schedule C)........ . 3. 4. Mortgages & Notes Receivable (Schedule D) ....................................................... . 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .............. . 5. 384.80 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-V'rvos Transfers 8 Miscellaneous Probate Property ~ Se arate Billin R S h d l t d G 6 437.5 9 p g ( c e eques e ............ u e ) 7, , 8. Total Gross Asssls (total Lines 1-7) .................................................................... . g, 6 , 822.39 9. Funeral Expenses & Administrative Costs (Schedub H) ...................................... . 9. 9,708.89 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedub I) ............................. . 10. 709.82 11. Total Deductions (total Lines 9 & 10) .................................................................. . 1t. 10 , 418.71 12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12. - 3 , 5 9 6.32 13. CharHabb 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. - 3 , $ 9 6.32 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0 00 (a)(1.2) X .00 . . 16. Amount of Line 14 taxable 0 00 i6 O 00 . at lineal rate X .045 . . 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0.0 0 18. 0.0 0 19. Tax Due ................................................................................................................. . 19. O . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 150561D243 J PA Inherit~r~ce Tax R®turn Signature of Additional Fiduciaries ESTATE OF I 1i-09 0801BER Mountz, Donna M. Under penalties of perjury, 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, corcect nd co lete. Declaration of preparer other than the personal representative is based on all information of which preparer has anj~kn edge~~....,~ Signature #2 Name Address1 Address2 City, State, Zip Date Carl Smith 591 Oxford Road laardners, PA 17324 zl '~.`l ~ l~0 REV-1500 EX Page 3 Decedent's Complete Address: File Number 27-09-0801 DECEDENT'S NAME Mountz, Donna M. STREET ADDRESS 3899 Spring Road CITY Shermans Dale STATE PA ZIP 17090 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits (A + 8) (2) 0.00 3. Interest (3) q. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q) Cheek trox on Page 2 Llne 20 to request a refund 5, If Line 1 + Line 3 is groater than Line 2, enter the difference. This is the TAX DUE. (g) 0.00 Check Payable to: REGISTER OF 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 :............................................................................... ^ 0 b. retain the right to dreysignate who shall use the property transferred or its inwme :.................................. ^ X c. retain a reversions interest; or ............................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^ ^ receiving adequate consideration? .................................................................................................................... x 3. Did decedent own an "intrust for or payable upon death bank account or security at his or her death?....... ^ 0 4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ^x ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTION313 YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 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 ff the surviving spouse is the only beneficiary. For dates of death an or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 percent 172 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 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 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rw-1608 EX• (6-98) SCHEDULE E CASH, BANK DEPOSITS, 8 MISC. PERSONAL PROPERTY cor~toNwEAUNaFrENNSnvnNw INNERITANCE TA%RETURN RE81!)ENr OECEDEM ESTATE OF (FILE NUMBER Mountz, Donna M. 21-09-0801 Include the d liti0etion arW the date the proceeds wars revived by the estate. All property Mlyovmsdwlth pre right of wMvorshlp must be dlsdossdon schedule F. pr more space is rreeded, additlonal pages of Me same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule E (Rev. 6-98) Rw-1670 EX+ (e-%) SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY coetrroHNeurH of reNHSrI.vAntu ItetERrrvrcE rnx RETt1RfY RESIOEHT DECFAENT ESTATE OF Donna M. FILE NUMBER This acheduk must b° completed an0 fibd H the enewar t° arty or questions 7 throu0h 4 on the reverse aide d the REV-1500 COVER SHEET i° yes. ITEM NUMBER DESCRIPTION OF PROPERTY TF~EL~ATEE O TROMISTFER.SATTACH ACOPY OFTTHE DEED FOR RE%ESTATE. DATE OF DEATH VALUE OF ASSET 9i OF DECD'S tt'iTERES7 EXausloH (tF APPLICABLE) TAXABLE VALUE 1 Homesteader Life Company Prepaid Funeral, 6,437.59 100.000°k 6,437.58 Hoffman-Roth Funeral Home and Crematory, Inc., beneflclary TOTAL (Also enter on Line 7, Recapitulation) ~ 6.437.59 (If rare space is needed, additional pages of the earns size) Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule G (Rev. 6-98) REV-1161 Exsl10L8) SCHEDULE H ~a„r~~~~,,r„~ FUNERAL EXPENSES 8r ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Mountz. Donna M. 21-09-0801 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: See continuation schedule(s) attached B. I ADMINISTRATIVE COSTS: t. Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(sl Commission paid 6,740.09 State Zio z. Attomev's Fees Law Offices of Susan E. Lederer 2,500.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 384.80 Claimant Debra Louann Mountz Street Address 3899 Spring Road city Shermans Dale state PA zlo 17090 Relationship of Claimant to Decedent Daughter 4. Probate Fees Cumberland County Register of Wills 54.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 30.00 See colrrtinuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 9,708.89 Copyright (c) 2009 form software only The Lackner Group, Inc. Fonn PA-1600 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF ITEM NUMBER DESCRIPTION 1 Hoffman-Roth Funeral Home 8 Crematory, Inc. H-A 2 Cumberland County Register of Wills - (filing fee for Inheritance Tax Retum and Inventory) H-B7 Donna M. FILE NUMBER AMOUNT 6.740.09 6,740.09 30.00 30.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1600 Schedule H (Rev. 6-98) R•v-1612 EX~ (12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS COAMIONVBALTN OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mountz. Donna M. 21-08-0801 R•port slue Inwmd by th• d•c•d•nt pion m a..m mn remeinM unpatl •ttll• eaa of A•.Ih. Inelulanq unrNmbunsd mwiw •Xpsn•e•. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Alexander Springs ER Physicians - (medical bill) 33.81 2 Blue Mountain Anesthesia Associates - (medical bill) 18.17 3 Carlisle HMA Physician Management - (medical bill) 18.17 4 Kinetic Imaging - (medical bill) 67.37 5 Milton 3. Hershey Medical Center Physicians Group - (medical bill) 90.35 6 NCO Financial Systems, inc. - (collection service for medical bill) 31.97 7 Penn State Milton S. Hershey Medical Center - (medical bill) 13.11 8 Penn State Milton S. Hershey Medical Center - (medical bill for treatment on 3/27/09) 10.39 9 Penn State Milton S. Hershey Medical Center - (medical bill for treatment on 4/03/09) 10.39 10 Penn State Milton S. Hershey Medical Center - (medical bill) 248.34 11 West Shore Emergency Medicine - (medical bill) 82.83 12 West Shore Emergency Medicine - (medical bill) 84.92 TOTAL (Also enter on Line 10, Recapitulation) I 709.82 (It more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1600 Schedule I (Rev. t 2-08) REV•1519 EX+(17-08) SCHEDULE J coM~~~°~~~""'A BENEFICIARIES ESTATE OF FILE NUMBER Mountz, Donna M. 21-09-08 01 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE OUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) (553) I TAXABLE DISTRIBUTIONS [incude outright spousal • distnbubons, and transfers under Sec. 9116 a 1.2 Debra Louann Mountz Daughter 100% of c/o Amanda R. Garland, Guardian residuary estate 226 Birch Lane Carlisle, PA 17015 Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 cover sheet as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI Copyright (c) 2009 form software only The Lackner Group, Ine. Form PA-1500 Schedule J (Rev. 11-08) Jacky M. Mindeck From: RV, Inheritance Tax Extension [RA-InheritanceTaxExt@state.pa.us] Sent: Friday, April 09, 201010:46 AM To: 'JACKY@LEDERERLAW.COM' Cc: 'GFARNER~CCPA.NET' Sub]ect: DONNA M MOUNTZ EST r pennsy~vana L)EPARTM€NT OF R€V€Nt!€ The following message is being sent from an unmonitored account. Please do not nply. Re: Estate of DONNA M MOUNTZ File Number 2109-0801 Dear Sir or Madam: This is in response to your request for an extension of time to fife the Inheritance Tax Retum for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely retum. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The retum must be filed with the Register of Wills on or before 10/19/2010. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. We now offer you the option to request your extension request via a-mail. Please use the following e- mail address: RA-InheritanceTaxExt~state.pa.us. Please contact me with any questions or concerns at 717-787-8327. Sincerely, Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division Please do not reply to this email. This mailbox is not monitored and you will not receive a rosponse. For assistance, visit us on the web at www.revenue.state.pa.us or call us at 717-787-8327 The information transmitted is intended only for the person or entity to whom tt is addressed and may contain oanfxrential and/or privileged material. Any use of this information other than by the Intended rocfpient is prohibited. H you receive this message in error, please send a reply email to the sender and delete the material from any and all computers. Last Will and Testament ~©n of UU'''' U Donna M. Moiuntz I, Donna M. Mountz, a resident of Cazlisle, Cumberland County, Pennsylvania, revoke any prior wills and codicils made by me and declare this to be my Last Will and Testament. Article One Family Information I have one child, Debra Louann Mountz, born on February 14,1996. All references to my children in my will aze to this child. Article Two Specific and General Gifts Section 2.01 Distribution of Tangible Personal Property I give all my tangible personal property, together any insurance policies covering such property and claims under such policies to my daughter, Debra Louann Mountz. Section 2.02 Distribution of Motor Vehicles I give any motor vehicles that I own at the time of my death to Carolyn Smith. Section 2.03 Definition of Tangible Personal Property For purposes of this Article, my tangible personal property shall include but not be limited to my household furnishings, appliances and fixtures, works of art, motor vehicles, pictures, collectibles, personal wearing apparel and jewelry, books, sporting goods, and hobby paraphernalia. Page 1 of 14 Section 2.04 Incidental Expenses of Tangible Personal Property My Executor shall pay, as an administration expense, the reasonable expenses of storing, packing, insuring, transporting and otherwise caring for my tangible personal property until actual delivery of each article of property to the appropriate beneficiary, Section 2.08 Custodial Accounts Held Under the Pennsylvania Uniform Transfer to Mlnor's Q~t I appoint Amanda Rena Gazland as the altenate custodian for all custodial accounts that I hold for my daughter's benefit at the time of my death. If Amanda Rena Gazland is for any reason unable to serve as alternate custodian, then I appoint Lonnie Gazland, Sr. and Nancy Garland, or the survivor of them, as alternate custodian for all custodial accounts that I hold at the time of my death. Article Three My Residuary Estate Section 3.01 Definition of My Residuary Estate All the remainder of my estate, including property referred to above that is not effectively disposed of, shall be referred to in my will as my "residuary estate." Section 3.02 Disposition of My Residuary Estate My residuary estate shall be distributed to my daughter, Debra Louann Mountz, in accordance with the provisions of Article Six, Section 6.03. Article Four Remote Contingent Distribution If, at any time, there is no person or entity qualified to receive final distribution of my probate or frost estate or any part of it, then the portion of my probate or trust estate with respect to which the failure of qualified recipients has occurred shall be distributed to those persons who would inherit it had I then died intestate owning the property, as determined and in the proportions provided by the laws of the Commonwealth of Pemtsylvania then in effect. Page 2 of 14 Article Five Designation of Fiduciaries Section 5.01 Executor I namc Carolyn and Carl Smith as my Executors. If both of them aze for any reason unable to serve, then I name Amanda Rena Garland as my Executor. Section 5.02 Guardian I name as guardian of each child of mine for whom appointment of guazdian becomes necessary the individual or individuals designated in a separate writing signed by me in the presence of two witnesses. If no separate writing .naming a guardian exists, I name Amanda Rena Garland as guardian. If Amanda Rena Gazland is unable to serve, then I appoint Lonnie Gazland, Sr. and Nancy Garland, or the survivor of them, as guazdian. Article Six General Administrative Provisions The provisions of this Article apply to my probate estate. Section 6.01 No Bond No Fiduciary shall be required to furnish any bond for the faithful performance of the Fiduciary's duties. If a bond is required by any law or rule of court, no surety shall be required on such bond. Section 6.02 Fiduciary Compensation An individual serving as my Fiduciary shall be entitled to fair and reasonable compensation for the services rendered as a fiduciary. A corporate fiduciary shall be compensated by agreement with an individual Fiduciary or, in the absence of an individual Fiduciary or in the absence of an agreement, in accordance with the corporate fiduciary's published schedule of fees in effect at the time the services are rendered. In addition to receiving compensation, my Fiduciary may be reimbursed for reasonable costs and expenses incurred in carrying out its duties under my will. Page 3 of 14 Section 6.03 Determination of Principal and Income The Pennsylvania Uniform Principal and Income Act shall govern beneficiaries' rights among themselves in matters concerning principal and income. If the Pennsylvania Uniform Principal and Income Act contains no provision concerning a particular item, my Fiduciary shall determine in a fair, equitable and practical manner what shall be credited, chazged, and apportioned between principal and income. Section 6.04 Spendthrift Trust Provision This will, and all Trusts created hereunder, are intended to qualify as Spendthrift Trusts. In addition, all interests in this will, or in any Trust hereunder, are intended for the personal protection and welfare of Grrantor's named beneficiaries, and no beneficiary shall be allowed to voluntarily or involuntarily assign or anticipate his or her interest in the income or principal of this will or any Trust hereunder, and no beneficiary's creditors, nor a spouse or former spouse of any beneficiary, shall be allowed to attach or otherwise reach any such interest before, actual payment to the beneficiary. If any beneficiary shall become the subject of a judgment or court order, then during the period in which such judgment or court order remains in effect, such beneficiary shall only be permitted to receive distributions from any Trust created for the benefit of such beneficiary at the discretion of the Trustees. This limitation as to the right of a beneficiary to receive a distribution shall apply notwithstanding any provisions within the trust for such beneficiary which authorize distributions for the health, education, support or maintenance of such beneficiary. In addition, if any beneficiary shall become the subject of a judgment or court order, and such beneficiary is only entitled to discretionary distributions from a Trust created for their benefit, it shall not be an abuse of discretion by the Trustees to withhold distributions to such beneficiary while such judgment or court order is in effect. If the Trustees determine that a beneficiary would not benefit as greatly from any outright distribution of Trust income or principal because of the availability of the distribution to the beneficiary's creditors, the Trustees shall instead expend those amounts for the benefit of the beneficiary. This direction is intended to enable the Trustees to give the beneficiary the maximum possible benefit and enjoyment of all of the Trust income and principal to which the beneficiary is entitled. Nothing contained in this Section shall restrict in any way the exercise of any power of appointment granted in this agreement. Section 6.05 Distributions to Incapacitated Persons and Persons Under Twenty-Five Years of Age If my Fiduciary is directed to distribute any share of my probate estate or trust principal to a beneficiary who is in the opinion of my Fiduciary, under any form of incapacity that Page 4 of 14 renders the beneficiary unable to administer distributions properly when the distribution is to be made, and if no other trust is then to be held under my will for the beneficiary's primary benefit, my~Fiduciary may, as Trustee, in my Fiduciary's discretion, continue to hold the beneficiary s share as a separate trust until the beneficiary reaches or overcomes the incapacity. When the beneficiary overcomes the incapacity, my Fiduciary shall distribute the beneficiary's trust to him or her, outright free of trust. While any trust is being held under this Section, the Trustee shall pay to the beneficiary for whom the trust is held such amounts of the net income and principal as the fiduciary determines to be necessary or advisable for the beneficiary's health, education, maintenance and support. Upon the death of the beneficiary before that time, the Trustee shall distribute the trust, including any accrued and undistributed income, to the beneficiary's then living descendants, per stirpes, or, if none, to my then living descendants, per stirpes. If I have no then living descendants the property shall be distributed under the provisions of Article Four entitled "Remote Contingent Distribution" If my Personal Representative is directed to distribute any shaze of my probate estate to my daughter, Debra Louann Mountz, my Personal Representative may distribute said share to Amanda Rena Garland, acting as custodian, until age 25, under the Pennsylvania Uniform Transfer to Minor's Act. If Amanda Rena Garland is for any reason unable to serve as custodian, I appoint Lonnie Garland, Sr. and Nancy Gazland, or the survivor of them, as successor/alternate custodian(s). Section 6.06 Representative of a Beneficiary The guardian of the person of a beneficiary may act for such beneficiary for all purposes under my will or may receive information on behalf of such beneficiary. Section 6.07 Distributions to Beneficiaries Whenever my will authorizes or directs my Fiduciary to make a distribution of net income or principal to a beneficiary, my Fiduciary may apply for the benefit of the beneficiary any property that otherwise could be distributed directly to the beneficiary. My Fiduciazy shall have no responsibility to inquire into the beneficiary's ultimate disposition of the distributed property unless specifically directed otherwise by my will. My Fiduciary may make distributions in cash or in kind, or partly in each, in proportions and at values determined by my Fiduciary. My Fiduciary may allocate undivided interests in specific assets to a beneficiary or trust in any proportion or manner that my Fiduciary determines, even though the property allocated to one beneficiary may be different from that allocated to another beneficiary. Page 5 of 14 My Fiduciary may make these determinations without regazd to the income tax amibutes of the property and without the consent of any beneficiary. Section 6.08 Ancillary Administration In the event ancillary administration shall be required or desired and my domiciliary Executor is unable or unwilling to act as an ancillary fiduciary, my domiciliary Executor shall have the power to designate, compensate, and remove the ancillary fiduciazy. The ancillary fiduciary may either be a natural person or a corporation. My domiciliary Executor may delegate to such ancillary fiduciary such powers granted to my original Executor as my Executor may deem proper, including the right to serve without bond or surety on bond. The net proceeds of the ancillary estate shall be paid over to the domiciliary Executor. Article Seven Powers of My Fiduciaries Section 7.01 Grant of Powers My Fiduciaries may perform every act reasonably necessary to administer my estate and any trust established under my will. Specifically, my Fiduciaries may exercise the following powers: They may hold, retain, invest, reinvest and manage real or personal property, including interests in any form of business entity including but not limited to, limited partnerships and limited liability companies, and policies of life, health and disability insurance, without diversification as to kind, amount or risk of non-productivity and without limitation by statute or rule of law. They may paztition, sell, exchange, grant, convey, deliver, assign, transfer, lease, option, mortgage, pledge, abandon, borrow, loan, contract, distribute in cash or kind or partly in each at fair mazket value on the date of distribution, without requiring pro rata distribution of specific assets and without requiring pro rata allocation of the tax bases of such assets. They may hold in nominee form, continue businesses, carry out agreements, and deal with themselves, other Fiduciaries and business organizations in which my fiduciaries may have an interest. They may establish reserves, release powers, and abandon, settle or contest claims. Page 6 of 14 They may employ attorneys, accountants, custodians of the trust assets, and other agents or assistants as deemed advisable to act with or without discretionary powers and compensate them and pay their expenses from income or principal or both. Section 7.02 Fiduciaries' Powers Act In addition tv all of the above powers, my fiduciaries may, without prior authority from any court, exercise all powers conferred by my will or by common law or by any fiduciary powers act or other statute of the Commonwealth of Pennsylvania or any other jurisdiction whose law applies to my will. My Executor shall have absolute discretion in exercising these powers. Except as specifically limited by my will, these powers shall extend to all property held by my fiduciaries until the actual distribution of the property. Section 7.03 Alternative Distribution Methods My Fiduciary may make any payment provided for under my will or under the terms of any trust established under my will as follows: Directly to the beneficiary; In any form allowed by applicable state law for gifts or transfers to minors or persons under a disability; To the beneficiary's guardian, conservator, agent under a durable power of attorney or caregiver for the benefit of the beneficiary; or By direct payment of the beneficiary's expenses, made in a manner consistent with the proper exercise of the fiduciary's duties hereunder. A receipt by the recipient for any such distribution shall fully dischazge my Fiduciary. Article Eight Provisions for Payment of Debts, Expenses and Taxes Section 8.01 Payment of Debts and Expenses I direct that all my legally enforceable debts, secured and unsecured, be paid as soon as practicable after by death. Page 7 of 14 Section 8.02 No Apportionment Except as otherwise provided in this Article or elsewhere in my will, my Executor shall provide for payment of all estate, inheritance and succession taxes payable by reason of my death ("death taxes") taxes from my residuary estate as an administrative expense without apportionment and shall not seek contribution toward or recovery of any death tax payments from any individual. Section 8.03 Tax Elections In exercising any permitted elections regarding taxes, my fiduciaries may make such decisions as they deem to be appropriate in all the circumstances and my fiduciaries shall be under no duty to make any compensatory adjustment as a consequence of any such election. My Executor may also pay such taxes or interest and deal with any tax refunds, interest, or credits as it shall deem necessazy or advisable in the interest of my estate. Article Nine Definitions and General Provisions Section 9.01 Definitions For purposes of my will, the following definitions shall apply: (a) Adopted and Afterborn Persons A legally adopted person in any generation and his or her descendants, including adopted descendants, shall have the same rights and be treated in the same manner under my will as natural children of the adopting parent, provided such person is legally adopted prior to attaining the age of 18 years. A person shall be deemed to be legally adopted if the adoption was legal in the jurisdiction in which it occurred at the time that it occurred. (b) Descendants The term "descendants" shall include a person's lineal descendants of all generations. (c) Education The term "education" is intended to be an ascertainable standard in accordance with Section 2041 and Section 2514 of the Internal Revenue Code and shall include, but not be limited to: Page8of14 Enrollment at private elementary, junior and senior high school including boarding school; Undergraduate and graduate study in any field at a college or university; Specialized, vocational or professional training or instruction at any institution, including private instruction; and Any other curriculum or activity that my Trustee may deem useful for developing the abilities and interests of a beneficiary including, without limitation, athletic training, musical instruction, theatrical training, the arts and travel. The term "education" shall also include distributions made by my Trustee for expenses such as tuition, room and board, fees, books and supplies, tutoring and transportation and a reasonable allowance for living expenses. (d) Fiduciary My "Fiduciary" or "Fiduciaries" shall refer to my Executor and my Trustee, or if they aze different persons, either of them. My "Executor" shall include any executor, ancillary executor, administrator, or ancillary administrator, whether local or foreign and whether of all or part of my estate, multiple Executors, and their successors. (e) Incapacity Except as otherwise provided in my will, a person shall be deemed incapacitated in any one of the following circumstances. (1) The Opinion of Two Licensed Physicians An individual shall be deemed incapacitated whenever, in the opinion of two licensed physicians, the individual is unable to effectively manage his or her property or financial affairs, whether as a result of age, illness, use of prescription medications, drugs or other substances, or any other cause. An individual shall be deemed restored to capacity whenever the individual's personal or attending physician provides a written opinion .that the individual is able to effectively manage his or her property and financial affairs. Page 9 of 14 (2) Court Determination An individual shall be deemed incapacitated if a court of competent jurisdiction has declared the individual to be disabled, incompetent or legally incapacitated. (3) Detention, Disappearance or Absence An individual shall be deemed incapacitated whenever he or she cannot effectively manage his or her property or financial affairs due to the individual's unexplained disappeazance or absence for more than 30 days, or whenever he or she is detained under duress. An individual's disappearance or absence or detention under duress may be established by an affidavit of any fiduciary. The affidavit shall describe the circumstances of an individual's detention under duress, or disappeazance or absence and may always be relied upon by any third party dealing in good faith with my fiduciary in reliance upon the affidavit. An individual's disappearance. or absence or detention under duress may be established by an affidavit of my executor. (fl Internal Revenue Code References to the "Internal Revenue Code" or to its provisions are to the Internal Revenue Code of 1986, as amended from time to time, and the corresponding Treasury Regulations, if any. References to the "Treasury Regulations," are to the Treasury Regulations under the Internal Revenue Code in effect from time to time. If a particular provision of the Internal Revenue Code is renumbered, or the Internal Revenue Code is superseded by a subsequent federal tax law, any reference shall be deemed to be made to the renumbered provision or to the corresponding provision of the subsequent law, unless to do so would cleazly be contrary to my intent as expressed in my will. The same rule shall apply to references to the Treasury Regulations. (g) Legal Representative As used in my will, the term "legal representative" means a person's guardian, conservator, personal representative, executor, administrator, Trustee, or any other person or entity personally representing a person or the person's estate. Page 10 of 14 (h) Per Stirpes Whenever a distribution is to be made to a person's descendants per stirpes, the distribution shall be divided into as many shares as there are then living children of such person and deceased children of such person who left then living descendants. Each then living child shall receive one share and the share of each deceased child shall be divided among such child's then living descendants in the same manner. (i) Shall and May Unless otherwise specifically provided in my will or by the context in which used, I use the word "shall" in my will to command, direct or require, and the word "may" to allow or permit, but not require. In the context of my Trustee, when I use the word "may" I intend that my Trustee may act in its sole and absolute discretion unless otherwise stated by in my will. (j) Other Definitions Except as otherwise provided in my will, terms shall be as defined in the Pennsylvania Probate, Estates and Fiduciaries Code as amended after the date of my will and after my death. Section 9.02 Survivorship Presumption If any beneficiary shall be living at my death, but die within 30 days thereafter, then such beneficiary shall be deemed to have predeceased me for all purposes of my will. Section 9.03 General Provisions The following general provisions and rules of construction shall apply to my will: (a) Singular and Plural; Gender Unless the context requires otherwise, words denoting the singular may be construed as plural and words of the plural may be construed as denoting the singular. Words of one gender may be construed as denoting another gender as is appropriate within the context. The word "or" when used in a list of more than two items may function as both a conjunction and a disjunction as the context requires or permits. Page 11 of 14 (b) Headings of Articles, Sections, and Subsections The headings of Articles, Sections, and subsections used within my will aze included solely for the convenience and reference of the reader. They shall have no significance in the interpretation or construction of my will. (c) Governing State Law My will shall be governed, construed and administered according to the laws of the Commonwealth of Pennsylvania as from time to time amended. Questions of administration of any trust established under my will shall be determined by the laws of the situs of administration of such trust. (d) Notices Unless otherwise stated, whenever my will calls for notice, the notice shall be in writing and shall be personally delivered with proof of delivery, or mailed postage prepaid by certified mail, return receipt requested, to the last known address of the party requiring notice. Notice shall be effective on the date personally delivered or on the date of the return receipt. If a party giving notice does not receive the return receipt but has proof that he or she mailed the notice, notice shall be effective on the date it would normally have been received via certified mail. If notice is required to be given to a minor or incapacitated individual, notice shall be given to the pazent or legal representative of the minor or incapacitated individual. (e) Severability The invalidity or unenforceability of any provision of my will shall not affect the validity or enforceability of any other provision of my will. If a court of competent jurisdiction detemunes that any provision is invalid, the remaining provisions of my will shall be interpreted and construed as if any invalid provision had never been included in my will. Donna Mountz, having signed this Will in the presence of ____~ ~ ~ ~ ~ and ica'is r~p(,~,(+s,,~,~ who attested it at my request on this day, a-~ 2007 at Harrisburg, Pennsylvania, declare this to be my Last Will and Testament. Donna M. Mountz, Testa ' Page 12 of 14 The above and foregoing Will of Donna M. Mount2 was declared by Donna M. Mountz in our view and presence to be her Will and was signed and subscribed by the said Donna M. Mountz in our view and presence and at her request and in the view and presence of Donna M. Mountz and in the view and presence of each other, we, the undersigned, witnessed and attested the due execution of the Will of Donna M. Mountz on this day, ___~~~.er ~W , 2007. ` ~ residing at ~~,~, Lct,~ r~ y~--1~~- ALt,7~~~~..- residing at _ ~ CnL~C? MT_ ~ ~cz~a.~t~ t~cS, '? Page 13 of 14 PENNSYLVANIA SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF DAUPHIN ) ss: We, DONN_ A M. MOUNTZ, ~m~ {~, IMpy~, N and ~ s ~ ~~~ ,the testatrix and the witnesses, respectively, whose names are subscribed to the foregoing instrument, being first duly sworn, do hereby declaze to the undersigned authority that the testatrix signed and executed the instrument as her Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the tcstatrix, signed the Will as witness and that to the best of each such witness's knowledge the testatrix was at that time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. ~A "'"""" y"1 u~w DONNA M. MOUNTZ;. Witne s Witness Subscribed, sworn to and acknowledged before me by ONNA M. MOUNTZ, the testatrix, and subscribed and sworn to before me by ~ , r1a and `bd'is ~ p(~~.~ ~( ,witnesses, this P, ay of -~3.i , 2007. Public COt~IMpAtWi•:'pL ~ Ia pF PENN5YLVAN{A Nntarial Seel Jeoqueiine ivt. h6indeu~:, Netery Pu6f~ Lowe. Pexter~ 7wp., C>euphin Camay PAyr Cn:YVnieyx Ex~irzs Uct 25, 2070 Member, Penneywarns Assodsllon o} M1otadea Page 14 of 14 ©M~TBa.~~ _ ~~~~~ Bolling Springs Office If you have any questions, please call our Telephone Banking Center at 1-80U-tc, ~'~r 110%02/2009te~ Business Date; 11/02/2009 Ti~ae: 02:03 PM **~~~ Deposit $78.85 Totai Balance: 5107.80 Available Balance: x28.95 4303 /02 108 Thanks for visiting us today. Me are happy to assist you! ©~~Ilk 499 Mitchell Road, Millsboro, DE 19966 Mail Code DB-MB-12 Susan E Lederer Law Offices 5011 Locust Lane Harrisburg, PA 17109 Re: Estate of: Donna M Mountz Social Securit :196-50-8047 Date of Death: July 19, 2009 Dear Sir or Madam: Phone (888)502-4349 Fax (302)934-2955 April 5, 2010 Per your inquiry, please be advised that at the time of death, the above-named deoedeM had on deposit with this bank the following. 1. Type of Account Account Number Ownership (Names o, fl Opening Date Balance on Date of Death Accrued /merest Tonal Checking Account 9846062645 Donna M MoumZ 0//C16~09 $ 305.95 $ 0.00 $ 305.95 Please be advised, there was no safe deposit boz found for the above decedent '~ If upon reviewing the information above, you believe tLete are additlonsl accounts not referenced, please provide us with an account number and/or name of any possible joint account hoiden For at><y additional information on the above accounts, including ownership sod aqy changes, closures and/or reimbursement of our Cartlsk West Road btandt, 812 t2 Waal Fegh Straat, CsrMb, PA 17013 Call #717-240.8717. ~~ ~~ pkASe contact Sincerely, wa:r~a ~~~ N rissa Sears, < ) Adjustment Services J~ ~, ~' ~~ FUNERAL HOME 6t CREMATORY, INC.' Carolyn Smith 591 Oxford Road Gaftiners, PA 17324 ~7 219 North Hanover Street Car~~e, Pennsylvania 17013 717.243.4511 toll free 1.866.451.4511 fax 717.243.3723 wwwhoffrnarvoth.com info~hoffrrriariroih.com July 24, 2009 Statement of Funeral Expenses for. Donna M. MountZ Date of Death: July 19, 2009 ~ Account Id: 15678-162 PACKAC,E: Traditional Funeral Service TRADITIONAL FUNERAL SERVICE PACKAGE $ 4,350.00 MERCHANDISE: Sub Total: ; 4,350.00 Casket Kinsey ~ $ 990.00 Outer Container: Cave Proof•[3ox $ 975.00 Sub Total: ; 1,965.00 TOTAL FUNERAI. HOME CHARQES: ; 6,315.00 CASH ADVANCES: North Middleton Church Of God Cemetery $ 550 00 3 Certified Death Certificates at $ 6.00 each $ . 18.00 Newspaper Notice -Sentinel $ 89.00 Flowers $ 159.00 Sub Total: S 816.00 Total Funsral Expense: ; 7,131.00 Payments made: Homesteaders Ufs Company -6,437.59 Discount: Contract vs PreArrangement - 380.81 Total Balance Due: Please return this portion with your Remittance Amount Enclosed Donna M. Mountz Service ID #: 15878-162 SERVING OUR COMMUNITY SINCE 1 9.0~ ,L+ ~~/W/~ WWI (pSq W ~- a{ ~ f y~~ ~SO$ .`T .#~ m N N N m a IJ7 m 0 0 0 0 ti ti 0 0 r ~_ N N V `\, O r. '••,~~ ~ ~ r. „a r, ~.. , i ~e~ d i . 0 H a M 0 ~ o ~ ~ o `~ 'c c ~ ~ h p ~ T U ~ c °moa m r ti u~ .n ~ ~ E o :~ oC~UUU ~ :. ;, F.. <.:_' September 29, 2010 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, Pennsylvania 17013 ~~.. ~ t f~~ ~l 'L K y t/ t/r ~E~~~it~ ~~: ~~~~~~~~ ~ 'J ?U-p SFP 3p PM 12: 24 ~~ e~.vvo~'c°a~ . pq RE: ESTATE OF DONNA M. MOUNTZ SOCIAL SECURITY NO.: 196-50-8047 DATE OF DEATH: 07-19-2009 FILE NO.: 2009-00801 Ladies and Gentlemen: Enclosed for filing with your office please find two (2) completed Form REV-1500 with the following attachments: • Date of death valuations; and • Copy of the Last Will and Testament of Donna M. Mountz. Also enclosed for filing with your office is one (1) original Inventory for the above- referenced Estate, along with a check made payable to Register of Wills in the amount of $30.00 for filing fees. Please advise if any additional fees or expenses are due with regard to this matter. One (1) additional photocopy of the front-page of the completed REV-1500 form and one (1) additional photocopy of the front-page of the completed Inventory for the Estate have been provided. Please time/date stamp these copies as received and return them to me in the envelope provided. If there are any questions or further requirements regarding this return, please do not hesitate to contact me. Very truly yours, .~ Amy M. M a Enclosures 5011 Locust Lane • Harrisburg, PA 17109 • Phone 717.652.7323 Fax 717.652.7340 • susan@ledererlaw.com www.ledererlaw.com