HomeMy WebLinkAbout04-06-11I 1505610105
REV-1500 EX (02-11) (FI)
OFFICIAL USE ONLY
PA Department of Revenue County Code Year t=ile Number
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN ,~~ r ,/'~ ~•~~ ~.
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 1 C.` s
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
191-18-3283 07012010 06171925
Decedent's Last Name Suffix Decedent's First Name M I
SIMMONS L• WHITLEY
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M I
SI~1MONS ~1ARY p
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
17 3- 2 6- 9 3 4 2 REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
^ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death
^ 4
Limited Estate
^ Prior to 12-13-82)
4
F
^
. a.
uture Interest Compromise (date of
5. Federal Estate Tax Return Required
^ 6. Decedent Died Testate
~ death after 12-12-82)
7. Decedent Maintained a Living Trust __ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death ^ 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION`SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
BRYAN S BREIDIGAM 7175205667
First Line of Address
1 W CHOCOLATE AVE
Second Line of Address
SUITE 200
City or Post Office
HERSHEY
State ZIP Code
PA 17033
;~
,- ~,
. "'+"'E
Q
.~,r
Correspondent'se-mail address: BBREIDIGAMBHSYTRUST • COM
REGISTER WILLS USE O~I1l;Y
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T ~"'' ~.~., .ter
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:: I~ I
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E ~ILED ^ ^ ~ ~~
e '+.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of nny knowledge and belief,
it is tr~ecrrect and c~te. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
~I~tJRE OF PN RESPONSIBLE FO~ FILING RETURN _ . DATF_
E O PREPARER OTHER THAN REPRESENTATIVE ~ IDATE
AUUFZ~SS _~
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 OW46472.000 1505610105 _^
J
1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
1,91-1,8-3?83
Decedent's Name: L WHITLEY SIMMONS
RECAPITULATION
1. Real Estate (Schedule A) 1.
2. Stocks and Bonds (Schedule B) . 2. 8 3 4 , 6 4 D • 1, 2
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3.
4. Mortgages and Notes Receivable (Schedule D) 4. 5 D , D D 0 • D 0
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 3 , 817 • 6 4
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested 7. 1, ~ D 31, , 9 5 2. 9 8
8. Total Gross Assets (total Lines 1 through 7) 8 1, , 9 2 0 , 41 D • 7 4
9. Funeral Expenses and Administrative Costs (Schedule H). g. 5 7 , 4 6 8 • 6 4
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) _ 10 4 , 3 3 5. 3 5
1 1. Total Deductions (total Lines 9 and 10) , 11 61 , 8 D 3 • 9 9
12. Net Value of Estate (Line 8 minus Line 11) 12. 1, 8 5 8 , 6 0 6. 7 5
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) , . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) _ _ , 14 1 , 8 5 8 , 6 D 6 • 7 5
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers un~er Sec. 9116
(a)(1.2)x.o- 494,816.69 15. D • DD
16. Amount of Line 14 taxable
at linealratex.o~ 1,363,790.06 1s. 6]„37D•55
17. Amount of Line 14 taxable
at sibling rate X .12
17.
18. Amount of Line 14 taxable
at collateral rate X .15 18
19. TAX DUE 1 g. 61, 3 7 0. 5 5
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505610205 1505610205
OW4648 2.000
REV-1500 EX (FI) Page 3
rlnnnrlnnt~c r`~mnlntn Arlrlrocc•
DECEDENTS NAME
L • WHITLEY SIf1MONS -~
STREET ADDRESS
BETHANY VILLAGE, 325 WESLEY DRIVE _-
CITY
M ANI R STATE ~ ZIP
PA 7 5
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments -
B. Discount
3. Interest
File Number 2],10-079
(3)
Total Credits (A + B) (2)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the 7AX DUE.
(4)
(5)
61,370.5
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred .
b. retain the right to designate who shall use the property transferred or its income
c. retain a reversionary interest
d. receive the promise for life of either payments, benefits or care? Yes
~
~
0
~ No
^~
^~
^~
^~
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death?
^
^ { ~
C~
~~
4. Did decedent own an individual retirement account, annuity, or other non-probate property, which
contains a beneficiary designation?
0 _
^~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before 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. §91 16 (a) (1.1) (i)].
For dates of death on or after Jan. 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 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 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 [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 percent, except as noted in [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(x)(1.3)]. Asibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
(1) __ 6L, 370 • 55
OW4671 2.000
REV-1503 EX + (6-98}
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
OF FILE NUMBER
L. Whitley Simmons 2110-00706
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
owasgs 1.000 (If more space is needed, insert additional sheets of the same size)
REV-1507 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF FILE NUMBER
L. h~hitley~ Simmons 2110-C0 i09
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION _,_ OF DEATH
1 Barbara S. Frey Mortgage dated 2/13/06 50,000.00
OW46AC 1.000
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of same size)
50, 000.00
REV-1508 EX+ (11-10)
pennsylvania ~+t SCHEDULE E
DEPARTMENTOF REVENUE CASH, BANK DEPOSITS, & MISC.
RESIDENT DECEDENTTURN PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
L. Whitley Simmons 2110-00709__
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property iointly owned with right of survivorship must be disclosed on Schedule F.
ITEM ' VALUE AT DATE
NUMBER DESCR1PTlON OF DEATH
1 ~. Senior Health Insurance Co of PA - long term care policy 3,537.80
2 Medicare insurance reimbursement 250.00
3 Conexis Hea-!th Insurance - refund of premium 29.84
TOTAL (Also enter on line 5, Recapitulation) $ ~ 3 , 817.6 4
OW46AD 2.000 If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX + {08-09) SCHEDULE G
pen nsylva n is
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
L. Whitley Simmons 2210-00709
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLI.DETFEDI~+MEOFThETRANSFEREE,TFiEIRRELATIONSF~PTODECEDErJTAND
Tre DATE OF TRANSFER ATTACHA COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
%OF DECD'S
INTEREST
EXCLUSION
IF APPLICABLE'
TAXABLE
VALUE
1. L Whitley Simmons Estate Plan _ 815,279.85
Trust Agreement dtd 10/26/1992
(revoking prior trust agreements )
as amended 3116/2006 by Third
Amendment to Estate Plan
Agreement of Trust
(See Attached List of Assets)
2 L Whitley Simmons Individual 216,673.13
Retirement Account (IRA) Mary P.
Simmons (wife) as beneficiary
(See Attached List of Assets)
TOTAL (Also enter on line 7, Recapitulation} $
1, 031, 952.98
If more space is needed, use additional sheets of paper of the same size.
L. Whitley Simmons 2110-00709
PA Inheritance Tax -Schedule G
Item #1
L. Whitley Simmons Estate Pian Trust Agreement dated 10/26/1992 (revoking prior trust agreements)
as amended 3/16/2006 by Third Amendment to Estate Plan Agreement of Trust
Shares /
Asset Face Value per Share Taxable Value
Abbott Laboratories 19 46.1850 877.52
ABM Industries Inc. 75 20.6950 1, 552.13
Adobe Systems inc. 35 26.4450 925.58
Alberto-Culver Co 28 26.9985 755.96
Allergan Inc 14 57.8850 810.39
ALLETE, Inc 28 33.8250 947.10
American Eagle Outfitters Inc 70 11.7300 821.10
Dividend payable 7/9/10 7.70
American Financial Group Inc 35 27.0500 946.75
American Water Works Co lnc 125 20.3250 2,540.63
AmSurg Corp 100 17.6150 1,761.50
Apache Corp 10 83.5250 835.25
Arthur J. Gallagher & Co. 35 24.1900 846.65
Dividend payable 7/15/10 11.20
Avnet Inc. 35 23.7050 829.68
Badger Meter Inc. 35 38.1800 1,336.30
Baker Hughes Inc. 15 41.8450 627.68
Bard, (C.R.) Inc. 14 76.3950 1,069.53
Baxter International Inc. 21 40.7600 855.96
Becton Dickinson & Co. 16 67.1800 1,074.88
Best Buy Co. Inc. 40 34.0850 1,363.40
BJ's Wholesale Club, Inc. 21 40.9250 859.43
BMC Software Inc. 28 34.6750 970.90
Brady Corp. CI. A 24 24.7750 594.60
Bristol-Myers Squibb Co. 45 24.8975 1,120.39
Bunge Ltd. 14 49.3000 690.20
CACI International Inc. 21 42.2900 888.09
Campbell Soup Co. 28 35.7950 1,002.26
CARBO Ceramics fnc. 21 71.7875 1,507.54
Casey's General Stores Inc. 60 35.1950 2,111.70
CenturyLink Inc 35 33.2250 1,162.88
Church & Dwight Co. Inc. 18 62.3750 1,122.75
Clorox Company 12 62.0675 744.81
Coach Inc 31 36.1000 1,119.10
Dividend payable 7/9/10 4.65
ConAgra Foods Inc. 35 23.1800 811.30
ConocoPhillips 17 48.8155 829.86
Cubic Corp. 30 35.9725 1, 079.18
Darden Restaurants Inc 45 38.5450 1,734.53
DENTSPLY International Inc. 28 29.3650 822.22
Dividend payable 7/8/10 1.40
Dionex Corp. 14 73.1750 1,024.45
DST Systems Inc 40 36.1300 1,445.20
Emerson Electric Co. 28 43.2750 1,211.70
Empire District Electric Co. lnc. 50 18.5750 928.75
EQT Corp 24
Family Dollar Stores Inc. 50
Dividend payable 7!15110
Flowserve Corp 25
Dividend payable 7/14/10
Fluor Corporation (New) 30
Dividend payable 7!2/10
Furiex Pharmaceuticals 4
Gardner Denver Inc 28
General Electric Company 800
Dividend payable 7/26/10
Glacier Bancorp, Inc. 85
Global Payments Inc. 21
Graco Inc 30
Hawaiian Electric {ndustries Inc 70
Heinz (H.J.) Company 24
Dividend payable 7/10/10
Helmerich & Payne, Inc. 2g
Henry Schein, Inc. 21
Hershey Company (The) 6,400
Honeywell International {nc. 35
Horace Mann Educators Corporation 49
Hormel Foods Corporation 31
Intel Corp. 100
Johnson & Johnson 14
Johnson Controls Inc. 31
Dividend payable 7/2/10
Kaydon Corp 1 g
Dividend payable 7!6/10
Kellogg Company 14
Kimberly-Clark Corp. 21
Dividend payable 7/2/10
Kraft Foods Inc. 50
Dividend payable 7/14/10
Laboratory Corp of Amer Hldgs 14
Landauer lnc 14
Dividend payable 7/2/10
Lennox International Inc. 19
Dividend payable 7/15/10
Lockheed Martin Corporation 10
Lowe's Companies Inc. 28
Matthews International Corp.-Class A 20
McAfee Inc 21
McCormick & Company Inc. 46
McGraw-Hill Companies Inc. 14
Merck & Co Inc 24
Dividend payable 7/8/10
Microchip Technology Inc. 35
Mosaic Co. 14
Murphy Oil Corporation 17
NextEra Energy Inc 14
Nordson Corp 28
Occidental Petroleum Corp 14
35.3750 849.00
38.1300 1,906.50
7.75
85.3200 2,133.00
7.25
41.8350 1,255.05
3.75
10.0400 40.16
44.1000 1,234.80
14.1500 11, 320.00
80.00
14.5500 1,236.75
36.1250 758.63
27.8150 834.45
22.3150 1, 562.05
43.1175 1, 034.82
10.80
36.3750 1, 018.50
54.7200 1,149.12
47.5550 304,352.00
38.4400 1, 345.40
15.1600 742.84
40.6150 1,259.07
19.3075 1, 930.75
58.9500 825.30
26.6225 825.30
4.03
32.5200 617.8$
3.42
50.2900 704.06
60.3100 1,266.51
13.86
27.8750 1,393.75
14.50
74.6100 1, 044.54
61.1900 856.66
7.53
41.45225 787.59
2.85
74.3700 743.70
20.3900 570.92
28.8800 577.60
30.5900 642.39
37.88375 1, 742.65
28.1200 393.68
34.2700 822.48
9.12
27.6600 968.10
38.5300 539.42
49.0500 833.85
48.7300 682.22
55.2130 1,545.96
76.7500 1, 074.50
Dividend payable 7/12/10 5.32
Omnicom Group Inc. 24 34.0350 816.84
Dividend payable 7/12/10 4.80
Oracle Corporation 42 21.4600 901.32
Otter Tail Corporation 24 19.2150 461.16
Owens & Minor Inc. 25 28.0100 700.25
Park Electrochemical Corp. 60 24.1400 1,448.40
Patterson Companies Inc 35 28.4150 994.53
Paychex Inc. 125 25.8150 3,226.88
PepsiCo Inc. 40 60.9900 2,439.60
Pfizer Inc. 70 14.1650 991.55
Pharmaceutical Product Development Inc 50 24.8375 1,241.88
Piedmont Natural Gas Co. Inc. 28 25.37625 710.54
Dividend payable 7/15/10 7.84
PriceSmart Inc 35 23.1150 809.03
Qlogic Corporation 42 16.5575 695.42
QUALCOMM Inc 17 32.2550 54$.34
Quality Systems Inc. 21 56.6000 1,188.60
Dividend payable 7/6/10 6.30
Raymond James Financial, Inc. 44 24.2300 1,066.12
Dividend payable 7/15/10 4.84
Rofin Sinar Technologies !nc 24 20.6259 495.02
Sensient Technologies Corporation 65 25.9450 1,686.43
Skywest, Inc. 35 12.1500 425.25
Dividend payable 7!6/10 1.40
SM Energy Co 11 39.6900 436.59
Smucker (JM) Company 10 59.6950 596.95
Sonic Corp 100 7.6550 765.50
Southern Copper Corp 28 26.3200 736.96
Southwest Bancorp, inc. 52 13.2300 687.96
Standex International Corp 75 25.9400 1,945.50
STERIS Corp. 100 30.5700 3,057.00
SWS Group, Inc. 100 9.3605 936.05
Syntel Inc 24 33.6850 808.44
Dividend payable 7/14/10 1.44
Sysco Corporation 31 28.7300 890.63
Techne Corporation 14 56.5800 792.12
Thermo Fisher Scientific Inc 21 48.1500 1,011.15
Tidewater Inc. 40 38.5200 1, 540.80
Tiffany & Co. 21 37.4000 785.40
Dividend payable 7/12/10 5.25
TJX Co. 20 42.2500 845.00
Trinity Industries, inc 70 17.4050 1,218.35
United Natural Foods Inc. 55 29.4850 1,621.68
United Parcel Service Inc - Class B 10 57.5050 575.05
Universal Forest Products Inc 2 30.2700 60.54
V. F. Corp 30 71.0100 2,130.30
Valley National Bancorp 30 13.5500 406.50
Wolverine World Wide, Inc. 31 24.9100 772.21
Dividend payable 8/2/10 3.41
World Fuel Services Corp 38 25.2050 957.79
Dividend payable 7/7/10 1.43
Xilinx Inc 50 25.2700 1,263.50
Chase Growth Fund-Sub Inv 6,749.207 14.5900 98,470.93
Alcon Inc. 9 148.3350 1,33.02
Tim Hortons, Inc. 28 31.9250 89.90
EuroPacific Growth Fund 659.645 34.0900 22,48'.30
GMO Foreign Fund IV 1,900.342 10.3900 19,74 .55
Touchstone Intermediate Fixed Income Fund 20,364.086 8.9600 182,46 .21
Vanguard Short-Term Inv Grade Fund 939.850 10.7300 10,08 .59
Temporary Investment Fund 33,898.60 1.0000 33,89 .60
Total 815,27.85
L. Whitley Simmons 2110-00709
PA Inheritance Tax -Schedule G
Item #2
L. Whitley Simmons Individual Retirement Account (IRA)
Shares 1
Asset Face Value per Share Taxable alue
Alliznz NFJ Small Cap Value 1,073.581 24.4000 26,19 .38
Chase Growth Fund 2,484.803 14.5900 36,25.28
GMO Quality Fund 1,945.058 17.2100 33,47 .45
EuroPacific Growth Fund 195.146 34.0900 6,65.53
GMO Foreign Fund IV 643.807 10.3900 6,68.15
Touchstone Intermediate Fixed Income Fd 11,472.841 8.9600 102,79.66
Temporary Investment Fund 4,611.680 1.0000 4,611.68
Total 216,67.13
REV-1511 EX+ (10-09) SCHEDULE H
pennsylvania
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS ,
RESIDE~fT DECEDENT
ESTATE OF
L. Whitley Simmons
FILE NUMBER
2110-00709
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
~. Hoover Funeral Home - professional services
2 Derry Presbyterian Church - cemetery marker and plot
3 Derry Presbyterian Church - memorial reception
4 Harrisburg Cemetery Assn - acct #0117 burial services
B.
1
City Hershey State PA ZIP 17033
Year(s) Commission Paid:
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s~ e r s h e y Trust C o PWMG
Street Address 1 W Chocolate Ave Ste 200
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. The Patriot News - estate advertising
8 Cumberland County Law Journal - estate advertising
9 John A. Roe, Esq - recording of mortgage satisfaction
10 EstateVal Inc - valuation of trust and estate as:>ets
11 Hershey Trust Company - fiduciary services 7/31/10 - 2/28/11
12 Reserve - miscellaneous filing fees
OW46AG 1.000
TOTAL (Also enter on Line 9, Recapitulation) ~ $
If more space is needed, use additional sheets of paper of the same size.
AMO~JNT
4,093.03
1 300.00
371.20
126.81
29,500.00
14,,750.00
'..728.50
229.55
75.00
42.00
199.14
5 ''„ 6 5 3.41
'.400.00
57, 468.64
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
L. Whitley Simmons 2110-00709_
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM 'JALUE Al' DATE
NUMBER DESCRIPTION ___ OF DE~TH
1. Continuing Care Ry - balance due acct #100043688 47b.36
2 Holy Spirit Hospital - balance due acct #36978419 lOb.00
3 Hampden Townsriip Ambulance - balance due inv #1000711 25.00
4 Verber Family Dentistry - balance due chart #01322 lOb.00
5 Bethany Village - balance due acct #2415 2,33.19
6 Holy Spirit Hospital - balance due acct #36978419 100.00
7 Bethan Village - final balance due acct #2415 48b.00
8 McKesson, Medsurg, Medismart Inc - balance due acct #83571 79.61
9 American Home Medical Equipment - balance due acct #CHBSIMML00 25.42
10 Hershey Trust Company - fiduciary services through 6/30/10 6216.77
TOTAL (Also enter on Line 10, Recapitulation) ~ $ ___ 4 , 3 3 5 . 3 5
owasAH 1.000 If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10) SCHEDULE J
pennsylvania
DEPARTMENTOF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
L. Whitley Simmons -
RELATIONSHIP TO DECEDENT AMOUNT''OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) _ OF TATE
i TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1 Mary P. Simmons Spouse ',
1.
Bethany Village
325 Wesley Drive
Mechanicsburg, PA 17055
Schedule G, Item #2 215,673.13
Life Estate: Non-Marital Trust per Paragraph 278,143.56
4 of the Second Amendment to Estate Plan Tru t
Agreement dated 10/26/92 as later amended
3/16/2006 (See Schedule K attached)
2 L. Whitley Simmons Non-Marital Trust per Issue
Paragraph 4 of the Second Amendment to Estat
Plan Trust Agreement dated 10/26/92 as later
amended 3/16/06 ~'
Remainder value (See Schedule K attached) 1,36,790.06
providing remainder to issue of decedent
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ $
If more space is needed, use additional sheets of paper of the same size.
OW46AI 1.000
REV-1514 EX+ (4-09) SCHEDULE K
pennsylvania LIFE ESTATE, ANNUITY
DEPARTMENT OF REVENUE
& TERM CERTAIN
Bureau of Individual Taxes
Po Box28o6o1 (CHECK BOX 4 ON REV-1500 COVER SHEET)
Harrisburg PA 17128-0601 __
ESTATE OF FILE NUMBER
L. Whitley Simmons 2110-00709 __
This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of death rior to 5-1-89,
actuarial factors for single-life calculations can be obtained from the Department of Revenue. ~,
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to ~t-30-99,
and in Alehh Volume for dates of death from 5-1-99 and thereafter.
Indicate below the type of instrument that created the future interest below and attach a copy of it to the tax return.
~^ Will ^ Intervivos Deed of Trust ^ Other
•
NAME OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT
DATE OF DEATH TERM OF YEARS
LIFE ESTATE IS PAY BLE
Mary P. Simmons 08/02/1927 83 X Life or ~_~Term ofY~ears
Life or ~_~Term of bears
Life or ~^ Term of 'ears
Life or ~^ Term of bears
Life or 1 Term of bears
1. Value of fund from which life estate is payable $ l , ~!~ l , y s .~ • b ~
2. Actuarial factor per appropriate table __ 16.9 4 0 0
Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2) $ 2j7 8 , 14 3 . 5 6
NAME OF LIFE ANNUITANT DATE OF BIRTH NEAREST AGE AT
DATE OF DEATH TERM OF YEAR
ANNUITY IS PAYA LE
Life or _~Term of bears
Life or Term of 1"ears
Life or Term of bears
~^ Life or ~_~~erm of bears
1. Value of fund from which annuity is payable $ __
2. Check appropriate block below and enter corresponding number . _- '
Frequency of payout -^ Weekly (52) Bi-weekly (26) Monthly (12)
^ Quarterly (4) ^^ Semi-annually (2) Annually (1) Other ( )
3. Amount of payout per period $ __
4. Aggregate annual payment, Line 2 multiplied by Line 3 ____ _
5. Annuity Factor (see instructions)
Interest table rate -^ 3.5% ^ 6% ^ 10% ^ Variable Rate % __ '
6. Adjustment Factor (See instructions.) ___
7. Value of annuity - If using 3.5, 6, or 10%, or if variable rate and period
payout is at end of period, calculation is Line 4 x Line 5 x Line 6 $ - _ '
If using variable rate and period payout is at beginning of period, calculation is
(Line 4 x Line 5 x Line 6) + Line 3 . $ __
NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules through G of
the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 1 of the return.
If more space is needed, use additional sheets of the same size.
OW46AJ 1.000
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,:
-=HARRIS'S UR G, RA 1710Fi
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WILL "~'~ '~
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O F ° _ _ t ~:
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L. WHITLEY SIMMONS ';~1=~
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~~
I, L. WHITLEY SIMMONS, presently of Dauphin County,
Pennsylvania, declare this to be my will and hereby revoke all
prior wills and codicils made by me.
1. Tangible Personal Property. I bequeath such items of
my tangible personal property as are specifically itemized on a'.
list, if any, in my handwriting, signed and dated by me at the
end thereof, and attached to this, my Will, to the person(s)
named thereupon to receive such items, and all of my remaining
tangible personal property not used in business or for the
production of income, including, without limitation, furniture,
furnishings, clothing, jewelry, objects of art and decoration,
and the like, and any motor vehicles which I own, together with
the insurance thereon, I bequeath to my wife, Mary P. Simmons, if
she survives me, and if my wife does not survive me, I bequeath
such property equally among my children who are then livAnc~ .
2. residue. I bequeath, devise, and appoint all the rest
of my property, of whatever nature and wherever situated,
including property over which I hold a power of appointment.
.(except that I do not exercise any power of appointment c,iven tq
me by my wife) , to the then Trustee (s ) under an Estate P lar..
Agreement of Trust executed by me as Settlo.r thereof on ~'ebruar~
28, 1978, as thereafter amended, and, in particular, but not
necessarily limited to, an amendment thereto dated October 26,
1992, to be held by said Trustee(s) and added to and adms_nister~d
as part of the trust established by said Agreement. Said trust)
is in existence as of the date of execution of this will, and i~
is my intention, if necessary to validate the foregoing gift to'
the Trustee (s) , to incorposte herein by reference its te7-ras anc~
any amendments thereto.
3. Survival. If my wife and I should die under such
circumstances that it cannot be determined which of us survived,!,
my wife shall be deemed to have survived me for all purposes
hereunder. If any other beneficiary should die within sixty (6a)
days after me, he or she shall be deemed to have predeceased me ',
for all purposes of this will.
4. Spendthrift Clause. No interest (whether in income or
principal, whether or not a remainder interest, and whether
vested or contingent) of any beneficiary hereunder shall be
subject to anticipation, pledge, assignment, sale or transfer i~'
any manner, nor shall any beneficiary have power in any manner t,o
charge or encumber his or her said interest, nor shall the said',
interest of any beneficiary be liable or subject in any manne
while in the possession of my fiduciaries, far any liab=ili_ty o
such beneficiary, whether such liability arises from his or h r
debts, contracts, torts, or other engagements of any type. '~~
5. Facility of Payment for Minors or Incompeten~:a. An
amounts or assets which are payable or distributable to a min r
or incompetent hereunder may, at the discretion of my
fiduciaries, be paid or distributed to the parent or guardian 'of
such minor or incompetent, to the person with whom such minor',or
incompetent resides, or directly to such minor or incompetent, or
may be applied for the use or benefit of such minor or
incompetent. ',
6. Powers. In addition to such other powers and. dutie as
Y i e e herein or which may be ranted. b la~,
may be g~anted e_sewh r g y
my fiduciaries hereunder shall have the following powers and
duties, without the necessity of notice to or consent of any
court:
real _,or...
(a ) To retain a l l or any part _ o f my property, __ __ _ __
personal, in the form in which it may be held at the time of ins
receipt, including any closely held business in which I have a
interest and the s rock of any corporate f iduc i a. y hereunder , a
long as in the exercise of their discretion it may be adv:isabl
so to do, notwithstanding that said property may not be of a
character authorized by law.
(b) To invest and reinvest arly funds held hereunderlin
any property, real or personal, including, but not by way of
limitation, bonds, preferred stocks, commcn stocks and other
securities of domestic or foreign corporations or investment
trusts, mortgages or mortgage participations, mutual funds with
or without sales or redemption charges, and common trust funds''
even though such property would not be considered appropriate ~r
legal for a fiduciary apart from this provision.
(c) To sell, convey, exchange, partition, give opticpns
to buy or lease upon, or otherwise dispose of any property, re~l
or personal, at the time held by them, at public or private sa,e
or otherwise, for cash or other consideration or on credit, anc~
upon such terms and for such price as they may determine, and ~o
convey such property free of all trusts.
(d) To borrow money from any person, including any
fiduciary hereunder, for any purpose in connection with the ',
administration hereof, to execute promissory notes or oth.e:r ',
obligations for amounts so borrowed, to secure the payments of ~~~
- 2 -
--
., _ ..
,,
. :,
- ,. ..
such amounts by mortgages or pledges of any property, real on
personal., which may be held hereunder.
(e) To make loans, secured or unsecured, in such
amounts, upon such terms, at such rates of interest, anal to such
persons, firms, or corporations as they may deem advisable.
(f ) To renew or extend the time f or payment of any ',
obligation, secured or unsecured, payable to or by them as ',
fiduciaries, for as long a period or periods of time and. on su~lch
terms, as they may determine, and to adjust, settle, and. ~'
arbitrate claims or demands in favor of or against them.
(g) In dividing or distributing any property, ~~eal pr
personal, included herein, to divide or distribute in cash, in'~,
kind, or partly in cash and partly in kind.
(h) Without limitation of powers elsew'rnere granted ',
therein, to hold, manage and develop ar.y real estate which may~lbe
held by them at an_y time, to mortgage any such property in such
amounts and on such terms as they may deem advisable, to lease!,
any such property f or such term or terns and upon: such conditions
and rentals as they may deem advisable, whether or not the term
of any such lease shall exceed the period permitted by law or the
probable period of retention under this instrument; to make
repairs, replacements and improvements, structural or otherwise,
in connection with any such property, to abandon an1T such ',
property which they may deem to be worthless or net of sufficient
value to warrant keeping or protecting, and to permit any such,
property to be lost by tax sale or any other proceedings,
(i) To employ such bro}~:ers, banks, custodians,
investment counsel, attorneys, and other agents, and to delega~.e
to them such duties, rights and powers as they may determine, end
for such periods as they think fit. ',
( j ) To register any securities at any t i me ire their ~~~
own names, in their names as fiduciary, or in the names of
nominees, with or without indicating the trust character of the
securities so registered.
(k) With respect to any securities forming a part ofd
the trust, to vote upon any proposition or election at any
meeting cf the corporation issuing such securities, and to grant
proxies, discretionary or otherwise, to vote at any such m~?etir~g;
to join or become a party to any reorganization, readjustment,
merger, voting trust, consolidation or exchange, and to deposit
any such securities with any committee, depository, trustee or
- 3 -
otherwise, and to pay out of the assE
expenses and assessments incurred in
exercise conversion, subscription. or
or hold any new securities issued as
reorganization, readjustment, merger,
consolidation, exchange or exercise c
or other rights and generally to ta}~:E
any such securities as could be to}:er
thereof .
is held hereunder, a:ny fetes,
connection therewith, to ~'~
other rights , and to rece~i ve
a result of any such
voting trust, '~
f conversion, subscriptio
all action with respect o
by the absolute owner '',
(1) Tc engage in sales, leases, loans, and other
transactions with the estate of my wife or any trust established
by either of us , even if they are f i duciaries or beneficiaries!
thereof . '~
(m) To exercise all elections which then may have with
respect to income, gift, estate, inheritance and other taxes,
including without limitation execution. of j of nt income tax
returns; election to deduct expenses in computing one tax or ',
another, election to split gifts, and election to pay o:r to deer
i~ _ i ._ __ _. g ~ _ .-_ -_ -___
payment of any tax, in all events w-~ ~~iou- their begin boul~d to,
require contributeor. from any other person.
n To o orate own or develo~~ anv business o?~ ~~'
( ) p
property held hereunder in ar.y form, including without limitat' or.
sole proprietorship, limited or general partnership, corporate n,
association, tenancy in common, condominium, or any other,
Whetrier cr not they have restr'cted Or nG manayement ryghtS, a~
they in trieir discretion ti~ink best. '~
1
7. Taxes. I direct that all estate, inheritance, and
succession taxes that may be assessed in consequence of my death,
of whatever nature and by whatever jurisdecticn imposed, shall, be
paid out of the principal of my probate estate to the same eff~ct
as if said taxes were expenses of administration, except that ~ny
such taxes (and interest and penalties thereon) imposed. on
account of my interest in or power over any trust estab=l.ished lby
my wife, shall be paid out of the property held in such trust,l,
and all other property includible in my taxable estate for
federal or state tax purposes, whether or not passing under th s
will, shall be free and clear thereof; provided, however, th at, my
executor(s) may in the discretion of my executor(s) request th t
any portion or all of said taxes (to be paid out of the pr~inci al
of my general estate) shall instead be paid out of the pri.ncep~l
of any trust established by me, to the extent expressly !,
authorized under the terms of said trust. ~!
4
r
8. Gender. Unless the context indicates otherwise, anyl
use of either gender herein shall also include the other gender.
9. Fiduciaries. I appoint my wife and Hershey Trust
Company as Executors hereunder. If ever my wife is unable or
unwilling so to serve or to continue so serving, no successor
shall be appointed to serve in her place.
My fiduciary (s) hereunder shall serve as guardian (s) of tl~e
property of any minor beneficiaries hereunder, under any
instrument of trust executed by me, under anv policies of`
insurance on my life, and in any other situation in whirr: the
power to make such appointment e~:ists under the laws of
Pennsylvania.
No individual fiduciary shall be liable for the ac±::~,
omissions or defaults of any agent appointed and retained with'
due care or of any co-fiduciary.
No fiduciary named herein shall be required t o furnish bond
or other security for the proper performance of his or her duties
hereunder .
TN WITNESS WHEREGF, I, L. WI~ITLEY SI?~~OI1S, herewith set my
hand to this, my vast Will, typewritter: on s_x (5) sheets of
paper including the self-proving attestation cla~.~se and
signatures of wimesses, this ~ ~ ;day of G ~-~~~~~ r-- 192.
~~
L. WHITLEY SIMM~NS
~'~
residing at .~~...~.~
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r e s i d i n g a t ;;! t .n rL~, ~ __-
'~,~~ ~' ~~"~.,_e! i~ , ~ r e s i d i n a t ~~~ ,~ , ~ ; ~~ti '~~~ .~ ,~
J
_ 5 _
Witnessed:
COMMONWEALTH OF PENNSYLVANIA
~; . S S .
COUNTY OF ~~~~,~~.
L . titi~HITLEY SIMMONS (the testator) , ~Cc,1,~~~~ ~' %~ ,~,,~'~,
~~-.~,, ,.~-~ N~~, /~,,/,i ~ and (~. ~ic~ ~1 ~-,~,~,~ /~~.w ( h e
witnesses) wi~rose names are signed to the forgoing instrument',
being first duly sworn, each hereby declares to the undersigned
authority that the testator signed and executed the instrumentlas
his last will in the presence of the witnesses and that he had'
signed willingly, and that he e~:ecuted it as his free and
voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the testator,
signed the will as witness and that to the best of his or her
knowledge the testator was at that time eighteen years of age cbr
older, of sound mind and under no constraint or undue influence.
WITNESS
j ,/
S ~ ~~
l
T E S`?'ATOPa
~• - ~~ -
.t'
L. W:~ITLEY SIi~L~ONS
~~~ ~
~ %~ ~, ~ ~~, 1, '`,i
~~
WI'I'NES S
.,
Subscribed, sworn to and acknowledged before me by L. WHITLEY
SINLMONS , the testator , and subs cr ~ bed and Sworn before me by
'~' ~ ~' ;L=.~-~ ~:; .-~-~ ~ ~~-r~~.~ ,/% %~,~~,~~- and ''
n ~
` ~ ~~,- ~L ` ,/, .~ ~ ~, the witnesses, this ~~ ` ~ day
of~~~ _~~ 1G92 . _~
-~
-. ~ ~,
~ ~~~ __
/~ Notary Public
..®..~
~~
- 6 -
10-13-92
SECOND AMENDMENT
to
ESTATE PLAN TRUST AGREEMENT
BY THIS AGREEMENT, executed on October 26, 1992, L. WHITLF
SIMMONS, presently of Dauphin County, Pennsylvania, as Settlor
thereof, hereby amends in its entirety the Estate Plan Trust
Agreement entered into by him as Settlor thereof on February 28
1978, as heretofore amended by a First Amendment thereto dated
December 1, 1981, the said trust now containing the assets
itemized on Schedule A hereto, and the same L. WHITLEY SIMMONS,
hereby agrees to perform as the sole Initial Trustee of said
Trust, and of such additional property as may be placed in trus
hereunder, by the Settlor, the Settlor's wife, Mary P. Simmons,
or with the consent of the Trustee(s) any other person, a1:1 in
trust subject to the terms and conditions set forth herein. If
L. WHITLEY SIMMONS ever is unable or unwilling to serve, or_ to
continue so serving, as the Trustee hereunder, he shall be
succeeded as Trustee by his wife and Hershey Trust Company, and
if ever his wife is unable or unwilling so to serve, or t~o
continue so serving, no successor shall be appointed to serve is
her place. The foregoing provisions notwithstanding, on each
fifth anniversary date of the Settlor's death during the
surviving lifetime of the Settlor's wife, or on the first
business day thereafter, if such anniversary date is not a
business day, the Settlor's wife for reasonable cause shall. havE
the right to name a replacement corporate fiduciary for they
corporate fiduciary then serving hereunder, which right shall bE
exercised by the Settlor's wife delivering a notice in writing k
certified mail, postmarked the aforesaid date(s) to the then
acting corporate fiduciary. No individual fiduciary hereunder
shall be required to furnish bond or other security for the
proper performance of his or her duties hereunder. The
Trustee (s ) hereunder shat l serve as guardian (s ) of the praperty
of any minor beneficiary hereunder. No individual fiduciary
shall be liable for the acts, omissions or dE,faults of any agent
appointed and retained with due care, or of any co-fiduciary.
1. During Settlor's Lifetime. During the lifetime o:f the
Settlor--
(a) The Trust may be revoked by the Settlor by w~ritte
notice to the Trustee(s), and in case of such revocation, a:11
property then held in the Trust shall be given over to him. The
Trust may be altered or amended by agreement. between the Settlor
and the Trustee (s) .
(b) The net income of the Trust, if any shall be paid
to or for the benefit of the Settlor no less often than quarter-
annually, and the principal of the Trust, or any portion t~hE~reof
shall be paid as the Settlor, or someone acting legally orl his
behalf, may demand and without qualification. Even though the
Settlor is not adjudicated incompetent, if he is under a lE=_gal
disability, or because of mental or physical disability he is,
in the opinion of the Trustee(s) unable to make reasonable dema d
for amounts from the principal, the Trustee(s) shall pay for hi
benefit, or for the benefit of his wife, such amounts from the
principal of the Trust as may be necessary to maintain for eith r
of them a standard of living approximately equal to that
maintained by either of them during the lifetime of the Settlor
and to meet their expenses arising from ill health or inval_idis .
2. Allocation of Assets. The primary purpose for tree
establishment of this Trust is to provide for the Settlor'; wif
and family after his death. The Settlor anticipates that a. maj r
portion of his estate may be administered hereunder as a r_e~sult
of bequests to the Trustee(s) contained in his will. Upon the
Settlor's death:
(a) If the Settlor's wife survives him, then the
Trustee(s) shall establish a Marital Trust hereunder, governed
Section 3 below, by allocation thereto, from the property held
hereunder, including property received from the Settlor's estate,
an amount, if any, equal to (i} the minimum amount, after taking
into account all deductions other than the marital deduction and
applying all credits available, which is necessary as the m~arita'1
deduction to reduce to the lowest possible amount the federal
estate tax payable by reason of the Settlor's death, less (.ii)
the value of all other assets in the Settlor's gross estate whic
qualify for the marital deduction and which pass or have parsed
to his said wife under other provisions of this instrument or
otherwise. In determining such amount, all assets involved in
the calculation shall be valued at final federal estate tax
values, but in funding the Marital Trust, date of distribution
values shall be used and only assets that qualify for the marita~.
deduction shall be used. The interest of the Settlor's waif e in '~,
the Marital Trust shall qualify for the marital deduction, and '~
any provisions herein which may appear to conflict with or i_n and
way defeat the Settlor's intention to obtain the marital
deduction for the Marital Trust shall be construed or applied to!~
accomplish that intention. i
(b) The remainder of the property passing hereunder
(or, if the Settlor's wif e does not survive him, all the property
passing hereunder) shall be held as a Non-Marital Trust governed
by Section 4 below.
- 2 -
3. Marital Trust. The income and principal of the Marit l
Trust (if established hereunder) shall be distributed as f ollow~:
(a) Income. The Trustee(s) shall pay the net income
from the Marital Trust to or for the benefit of the Sett:lor's
wife, for her lifetime, in such installments, but not less
frequently than quarterly, as the Trustee(s) may determine., ~I
(b) Principal. The Trustee(s) shall pay from time t
time from the principal of the Marital Trust to or f or the bene it
of the Settlor' s wife
(i) such sums as shall in the discretion ofd the
Trustee(s) seem proper for her support, maintenance, and health
care or necessary to permit her to maintain a standard of l.ivin
approximately equal to that maintained by her during the Settlo 's
lifetime, taking into account such other sources of income,
support and estate that may be available to her, and ~I
(ii) such sums, including any or all the princip 1,
that the Settlor's wife, or someone acting duly on her behalf, ay
request in writing. ',
(iii) if any unproductive property is held in thel~~
Marital Trust at any time, the Settlor's wife shall have the po er
to require the fiduciary(s) hereunder either to make the proper y
productive or to dispose of it and reinvest the proceeds i.n
productive property within a reasonable time.
(c) After Wife's Lifetime. Upon the death of the
Settlor's wife, all the principal then held in the Marital Trustj
shall be distributed as she may by her will appoint, making
specific reference to this Marital Trust under this Agreement ofl'~,
Trust. Except as expressly stated in the preceding sentencE=_, ',
there shall be no restriction, condition or qualification on, or~'~,
to the power to make such appointment and the permissible
beneficiaries. The power of appointment shall be exercisable by',
the Settlor's wife alone and in all events, and there shall be nj
power in any person other than said wife to appoint to any person
any part of the property passing under the Marital Trust. To th
extent that said wife shall fail to exercise effectively her pow
of appointment over any part of the property in the Marital Trus
the Trustee(s) shall (except to the extent that the Settlor's wi
expressly directs to the contrary in her last will or in a writi~{
delivered to the Trustee(s) during her lifetime) pay from the ~~~,
unapportioned portion of the principal of the marital trust: '~
'r
~e
ig
- 3 -
(i) the amount of any additional estate, j
inheritance or other death taxes imposed on account of the Beat
of the Settlor's wife by reason of her power of appointment ove
and other rights in the unappointed portion of the principal of
the Marital Trust (the amount of each such additional tax to be
equal to the excess if any of the tax, including any interE~st
thereon, payable by reason of her death over the amount of such
tax which would have been payable if no such tax was payab]_e by
reason of her death with respect to the unappointed principal o
the Marital Trust), and i,
(ii) any expenses incurred in the administration of
her estate attributed to the determination of such taxes (and t e
Trustee(s) may accept the written statement of her personal.
representatives as to the amount of taxes and expenses payable
hereunder),
and the remaining balance of the principal held in the Marital
Trust at her death shall be added to and considered part of the
Non-Marital Trust and shall be administered and distributed and r
the provisions herein governing the Non-Marital Trust.
4. Non-Marital Trust. The income and principal of the ~,
Non-Marital Trust shall be distributed as follows:
(a) Income. The net income from the Non-Marital Trust
shall be paid at least annually to or for the benefit of the
Settlor's wife in such amounts as in the discretion of the
Trustee(s) seems proper to provide for her support, maintenance,'
and health care, and for the maintenance by the Settlor's waif e of
the standard of living maintained by her during the Settlor's
lifetime, taking into account such other sources of income, ',
support and estate that may be available to her. No beneficiary
of the Non-Marital Trust shall participate as a Co-Trustee .in an
decision under this Subsection (a) for his or her own benefit.
(b) Principal. The Trustee(s) shall from time to tim
pay such sums from the principal of the Non-Marital Trust to or
for the benefit of the Settlor's wife and issue as may in the
discretion of the Trustee(s) seem necessary for their support, ~~
maintenance and health care, for the maintenance by the Settlor'~
wife of the standard of living maintained by her during the ~
Settlor's lifetime, and for the education of the Settlor's issue
taking into account such other sources of income, support and
estate that may be available to the beneficiary and the needs an
resources of all the beneficiaries. Any of the foregoing
distributions to or for the benefit of the Settlor's issue shall
be based on their needs, rather than on a desire to maintain
- 4 -
absolute equality of payments among them. The Settlor's first
priority for the income and principal of the Non-Marital Trust
taken together is the support, maintenance and health care of t e
Settlor's wife for life, and the support, maintenance, hea:Lth c re
and undergraduate education of each of the Settlor's grandchild en
until completion of his or her undergraduate education. In
determining whether an invasion shall be made for the benefit o
the Settlor's wife from the principal of the Marital Trust,, or
from the principal of the Non-Marital Trust, such invasion shal
be made from the Marital Trust as f ar as practical. No
beneficiary of the Non-Marital Trust shall participate as a Co-
Trustee in any decision under this Subsection (b) f or his or he
own benefit .
(c) Additional Principal Distributions. The Trustee s)
may also pay from the principal of the Non-Marital Trust su~.ch s ms
as in the discretion of the Trustee(s) seems proper f or the:
establishment of a child of the Settlor in a business or
profession or towards the acquisition or furnishing of a home f r
a child of the Settlor, taking into account the other re°,ources of
the child, the desirability of the transaction, and the reasona ly
anticipated needs and resources of all the beneficiaries
hereunder, provided, however, that the total distributions to 0
for the benefit of a child of the Settlor under this sentence
shall not exceed the reasonably anticipated amount that would b
distributable to him or her pursuant to Subsection (f) bel.o~w if no
distributions were made under this Subsection (c); and each
payment to him or her under this Subsection (c) shall be deemed !an
advancement to such child (or to his of her issue if he or ;she i s
not then living) in making the division of the property held in
the Non-Marital Trust pursuant to Subsection (f) below, and shal l
be charged against his, her, or their share. No beneficiary of
the Non-Marital Trust shall participate as a Co-Trustee in any
decision under this Subsection (c) for his or her benefit.
(d) Leaal Support Obligation. No payment shall be ma e
under Subsections (a), (b) and (c) above which would discharge t
any extent the legal obligation of any person for the support of
the recipient of such payment.
(e) Wife's Rights of Withdrawal. In addition to the
foregoing, during any calendar year the Settlor's wife shall. have
the unqualified right in her sole discretion to demand in or,~e or
more writings delivered by her to the Trustee(s) that she be: paic
up to Five Thousand Dollars ($5,000.00) from the principal. of the
Non-Marital Trust, and in addition, on December 31 of any such
calendar year she shall have the unqualified right in her sole
discretion to demand in a writing delivered by her to the
- 5 -
Trustee (s) that she be paid from the principal of the Non-~'Iarit
Trust, an amount equal to five percent (5%) of the aggregate
market value of the assets held in the Non-Marital Trust as of
such date, minus all amounts distributed to her under this
Subsection 4(c) during such calendar year. The right permitted
the Settlor's wife under this Subsection 4('c) may be exercised
her only as herein provided before the end of any given ca:lenda
year to which applicable and any amount as to which such right
not exercised for any such calendar year shall lapse and sYiall
accumulate or carry over to any future calendar year.
al
of
(f) After Wife's Lifetime; Limited Power of Appoint-
ment by Wife. Upon the death of the survivor of the Settlor an
his wife, if she survives the Settlor, the Trustee (s) shall. pay
the balance held in the Trust, outright or in trust, in such
amounts or proportions to or for the benefit of any or all of t
Settlor's issue as his wife may direct in her will making s,peci
reference to the Trust hereunder. To the extent that the
Settlor's wife should fail to exercise effectively her limited
power of appointment over the Trust, or if she should predeceas
the Settlor, then from and after the death of the survivor of t
Settlor and his wife, the Trustee(s) shall distribute the
principal remaining in the Trust per stirpes to the Settlor's
issue, adjusted for any advancements pursuant to Subsection 4(c)
above, provided, however, that (i) if the Settlor's grandson,
James Simmons, or the Settlor's granddaughter, Lisa Simmons, is
beneficiary hereunder, the foregoing notwithstanding, the share
allocable to James, and the share allocable to Lisa, shall not
exceed Twenty Thousand Dollars ($20,000.00) each, and any amount
in excess thereof which ,lames or Lisa would otherwise have
received except for such limitation, shall be distributed to the
Settlor's granddaughter, Lana, if she is then living (subject to
the limitations of Subsection (ii) appearing immediately
hereafter), and if she is not then living, shall be distributed
per stirpes to the issue of the Settlor, not counting either Jam
or Lisa, or any issue of James or Lisa, as issue of the Settlor
for such purposes; and (ii) no grandchild of the Settlor (ot:her
than James or Lisa, for whom separate terms are heretof ore ~~tate
in the immediately preceding Subsection (i}) shall, pursuant: to
such per stirpital distribution, receive more than one-ha]_f of t:
amount that is allocable under such per stirpital distribution t
any then living child of the Settlor, and any excess over such
one-half which any such grandchild would otherwise have received
except for this limitation, shall be distributed per stirpes to
the issue of the Settlor, but for such purposes maintaining the
limitations stated hereunder, respectively, for James Simmons any
Lisa Simmons, and any other grandchild of the Settlor, provided,
however, further, that if any one of the issue who is a
e
is
e
a
s
e
- 6 -
beneficiary under this Subsection is then under the age of thi ty
(30) years, his or her share shall be held for him or her in a
separate trust hereunder under the terms of Section 5 below.
5. Separate Trusts. The income and principal of a :separate
trust in which a share in the Trust is held f or a beneficiary
pursuant to the terms of Subsection 4(f) above shall be
distributed as follows:
(a) Income. The income shall be distributed at leas
quarterly to or for the benefit of the beneficiary. No payment
shall be made under this Subsection 5(a) which would discharge o
any extent the legal obligation of any person for the suppc>rt o
the beneficiary .
(b) Principal . The Trustee (s) shall pay from th.e
principal such sums to or for the benefit of any or all of the
beneficiary and his or her issue as in the discretion of the
Trustee(s) seems proper for their support, maintenance, health
care, and education, and such sums to or for the benefit of the
beneficiary as in the discretion of the Trustee(s) seems proper to
help establish him or her in a business or profession or acquir
or furnish a home for him or her, taking into account the other
sources of income, support and estate that are available to the
distributee, the reasonably anticipated needs and resources of he
beneficiary and his or her issue, their income and estate tax
brackets, and the desirability of the transaction (if any). No
payment shall be made under this Subsection 5(b) which would
discharge to any extent the legal obligation of any person for t e
support of the distributee.
(c) Distribution of Separate Trust.
(i) When such beneficiary shall have attained th
age of twenty-five (25) years, the Trustee(s) shall distribute t
him or her at his or her written request one half (1/2) of the
remaining principal balance then held in his or her separate
trust; and when such beneficiary shall have attained the age of
thirty ( 3 0 ) years , the Trustee (s ) shat l distribute to him or' her
at his ar her written request the entire balance then held in hi
or her separate trust.
(ii) If such beneficiary should die before making
proper request for the entire balance in his or her separate
trust, then the entire balance in his or her separate trust shal
at his or her death be distributed, outright or in trust, in suc.
sums or proportions as such beneficiary may direct in his or her
last will, expressly referring to his or her separate trust
- 7 -
hereunder, but only among the Settlor's issue; and to the exte t
that such beneficiary shall fail to exercise effectively his o
her limited power of appointment hereunder, the aforementioned
balance in his or her separate trust shall then be distributed per
stirpes to his or her issue, or, if no such issue survive :him r
her, per stirpes to~the issue of his or her parent who was a child
or more remote descendant of the Settlor, or, if no such issue
survive him or her, per stirpes to the issue of his or her
grandparent who was a child or more remote descendant of the
Settlor or, if no such issue survive him or her, per stirpes to
the Settlor's issue, with the share of any of such issue for wh m
property is then held in or payable to a separate trust under t is
Section 5 being added to such separate trust. ~~
(d) Disposition Upon Application of Rule Against:
Perpetuities. Notwithstanding Subsection 5(c) above, if during
the lifetime of a person for whom a separate trust under this
Section 5 was established the interest of such person therein
becomes void under the applicable rule against perpetuities, the
the balance in such separate trust shall then be distributed
outright to such person.
n
6. Failure of Issue. If ever there is no beneficiary in
existence for any amount held hereunder, as hereinbef ore provid d,
such amount shall be distributed equally among Cornell Universi y,
Harvard Business School, Derry Presbyterian Church, Goodwill
Industries of Dauphin County, Delta Gamma Foundation of Columbus,
Ohio, and the Pennell Endowment of the Gettysburg College L.ibrar .
7. Disclaimer. If the Settlor's wife should disclaim any
interest to which she is entitled in the Marital Trust, such
interest which has been disclaimed by her shall be allocated to
and shall be held, administered and distributed as part of the
Non-Marital Trust.
8. Survival Clauses. If the Settlor and his wife should
die under such circumstances that it cannot be determined which c
them survived, the Settlor's wife shall be deemed to have su.rvivE
hirn for all purposes hereunder. If any other beneficiary
hereunder should die within sixty (60) days after the Settlor, 01
within sixty (60) days after any other person the survival of whc
determines his or her rights hereunder, then such beneficiary
shall be deemed to have predeceased the Sett:lor or such other
person for all purposes hereunder.
9. Powers. In addition to such other powers and duties a~
may be granted elsewhere herein or which may be granted by law,
the fiduciaries hereunder shall have the f oll_owing powers and
~f
:d
pm
- g -
~i
duties, without the necessity of notice to or consent by any
Court:
i
(a) To retain all or any part of the property of th~~
Settlor, real or personal, in the form in which it may be held at
the time of its receipt, including any closely held business i
which the Settlor has an interest and any stock of any corpora e
fiduciary hereunder, as long as in the exercise of their
discretion it may be advisable so to do, notwithstanding that aid
property may not be of a character authorized by law.
(b) To invest and reinvest any funds held hereunder in
any property, real or personal, including, but not by way of
limitation, bonds, preferred stocks, common stocks, and other '~,
securities of domestic or foreign corporations or investment ~I
trusts, mortgages or mortgage participations, and common trust !,
funds, even though such property would not be considered
appropriate or legal for a fiduciary apart from this provision.
i
(c) To sell, convey, exchange, partition, give options
to buy or lease upon, or otherwise dispose of any property, real
or personal, at any time held by them, with or without order of
court at their option, at public or private sale or otherwise, or
cash or other consideration or for such credit terms as they th'nk
proper, and upon such terms and for such prices as they may
determine, and to convey such property free of all trusts.
(d) To borrow money from any person, including any
fiduciary hereunder, for any purpose in connection with the '~
administration hereof, to execute promissory notes or othez•
obligations for amounts so borrowed, and to secure the payments~lof
such amounts by mortgages or pledges of any property, real or
personal, which may be held hereunder. ',
(e) To make loans, secured or unsecured, in such.
amounts, upon such terms, at such rates of interest, and to suc
persons, firms or corporations as they may deem advisable.
(f) To renew or extend the time for payment of any
obligation, secured or unsecured, payable to or by them, for as
long a period of time and on such terms, as they may determine,
and to adjust, settle and arbitrate claims or demands in favor f
or against them.
(g) In dividing or distributing any property, real o
personal, included herein, to divide or distribute in cash, in
kind, or partly in cash and partly in kind.
- 9 -
(h) To hold, manage, and develop any real estate wh ch
may be held by them at any time, to mortgage any such property in
such amounts and on such terms as they may deem advisable, to
lease any such property for such term or terms, and upon such
conditions and rentals as they may deem advisable, whether or of
the term of any such lease shall exceed the period permitted b
law or the probable period of retention under this instrument; to
make repairs, replacements and improvements, structural and
otherwise, in connection with any such property, to abandon an
such property which they may deem to be worthless or not of
sufficient value to warrant keeping or protecting, and to permit
any such property to be lost by tax sale or any other proceedings.
(i) To employ such brokers, banks, custodians,
investment counsel, attorneys, and other agents, and to delegat
to them such duties, rights and powers as they may determine, a d
for such periods as they think fit.
(j) To register any securities at any time in their
names as fiduciary, or in the names of nominees, with or withou
indicating the trust character of the securities so registered.
(k) With respect to any securities held hereunder, t
vote upon any proposition or election at any meeting of the per on
or entity issuing such securities, and to grant proxies,
discretionary or otherwise, to vote at any such meeting; to joi
or become a party to any reorganization, readjustment, merger,
voting trust, consolidation or exchange, and to deposit any suc
securities with any committee, depository, trustee or otherwise,
and to pay out of the trust created herein, any fees, expenses,
and assessments incurred in connection therewith; to exercise
conversion, subscription or other rights, and to receive or hol
any new securities issued as a result of any such reorganiz~atio ,
readjustment, merger, voting trust, consolidation, exchange or
exercise of conversion, subscription or other rights and generally
to take all action with respect to any such securities as could e
taken by the absolute owner thereof.
(1) To engage in sales, leases, loans, and other
transactions with the estate of the Settlor, the estate of his
wife, or any trust established by either of them, even if they a e
also fiduciaries or beneficiaries thereof.
(m) To make all necessary proofs of death under the
insurance policies of which they are the beneficiary, to execute
any receipts for the proceeds and to institute any action tc,
collect said proceeds and to make adjustments of any claim
thereunder, provided, however, that they need not institute any
- 10 -
action unless they shall have been indemnified against all.
expenses and liabilities to which they may become subject as a
result thereof. If, however, they desire to institute such ac ion
without indemnification, they are hereby authorized to be
reimbursed for all expenses and liabilities incurred as a resu t
thereof from any amounts which may be held in trust hereunder hen
or thereafter.
(n) To operate, own, or develop any business or
property held hereunder in any form, including without limitat'on
sole proprietorship, limited or general partnership, corpo.rati n,
association, tenancy in common, condominium, or any other, whether
or not they have restricted or no management rights, as the=_y in
their discretion think best.
10. Spendthrift Clause. No interest (whether in income o
principal, whether or not a remainder interest, and whether ves ed
or contingent) of any beneficiary hereunder shall be subject to
anticipation, pledge, assignment, sale or transfer in any manne ,
nor shall any beneficiary have power in any manner to charge or
encumber his or her said interest, nor shall the said interest f
any beneficiary be liable or subject in any manner while :ir.~ the
possession of the fiduciaries for any liability of such
beneficiary, whether such liability arises from his debts,
contracts, torts, or other engagements of any type.
11. Facility of Payments for Minors or Incompetents. any
amounts which are payable or distributable hereunder to a minor or
incompetent may, at the discretion of the fiduciaries, be paid r
distributed to the parent or guardian of such minor or
incompetent, to the person with whom such minor or incompetent
resides, or directly to such minor or incompetent, or may be
applied for the use or benefit of such minor. or incompetent.
12. Taxes. Estate, inheritance and succession taxes that
may have been assessed in consequence of the Settlor's death, of
whatever nature and by whatever jurisdiction imposed, whether or
not on account of property passing hereunder, may on request of
the Settlor's personal representatives and consent of the
Trustee (s) be paid out of the principal of the Non-Marital Trust
hereunder, as if said taxes were expenses of administration
thereof, and all property passing to the Marital Share hereunder
shall be free and clear thereof, provided, however, that rzo such
taxes shall be paid out of assets that are not includible ir.~ the
federal gross estate of the Settlor.
13. Gender. Unless the context indicates otherwise, any u e
of either gender herein shall also include the other gender.
- 11 -
14. Law Governing. This Trust shall be administered. and
interpreted in accordance with the laws of the Commonwealth of
Pennsylvania.
IN WITNESS WHEREOF, the Settlor and the Trustee(s) have
hereunto set their hands and seals on the date first mentioned
above.
WITNESS:
r
.,
WITNESS:
I
~~,~~
~~~ ~ ,
SETTLOR:
/r~
~/ ~~
~''~~ i~-~-~~~--- ( SEA )
L. WHITLEY SIMMONS
TRUSTEE:
~;
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~L-~' ~---,.
-'`"'"r`~~`~- ( SEA j
L. WHITLEY SIMMONS
- 12 -
T_
SCHEDULE A
One Dollar ($1.00) - Attached below
~- _ t i
li ~ ` 3
1 r _
~. -~ ~ ~- 7NI5 HO7L15 LEGA4IENUER -
-~ s i ia~~<- FOkALLLEL'7'3:PU8LICANgPMVATE '`~ yn,4~~~ -~ ~~1~ ~~
I-
-se++-.' 1. ~~ ~ : ,
. `l f ~,~i~ Aza<
~-~~_. ~ ~ :5.9.3 ~05~5 51 ~F . ~~ ~~ ~'~
-. ~ @`s2~' ~ - - ~ ~ r v '~:~ ~-:~~ .S<ra/ it'n!r/.rim;rgr. l 1
a - / mn<mrtJflr ~iml </.TJrtfis ' - ~YYf.•~ <
I, the undersigned L. WHITLEY SIMMONS, this 26th day of
October 1992, do hereby acknowledge that in my capacity s
Settlor of the accompanying Estate Plan Agreement of Trust I ha e
paid to myself as Trustee thereof One Dollar ($1.00) in cash, s ch
payment representing the initial funding of such Trust.
L. WHITLEY SIMMONS
- 13 -
COMMONWEALTH OF PENNSYLVANIA
;~ ~/ SS:
COUNTY OF ,~/~=~i%~~"~
On this , the ~-~ f ~ day of ~~' ~ U-~ _, 19 9 2 , before me ,
Notary Public, the undersigned officer, personally appeared
L. WHITLEY SIMMONS, known to me (or satisfactorily proven) to b
the person whose name is subscribed to the within Agreement of
Trust, who acknowledged to me that he executed the same for the
purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official sell.
r~~)
Notary Public
(SEAL)
)"«."(}G~`;.'i~! vii!..... ~~:fi:a
E•~h~,' r jjj};"i::~~iui, ~ ;Ji•`~.c, vci?. ! L . ~ i~z3ti l
- 14 -
THIRD AMENDMENT
to
ESTATE PLAN AGREEMENT OF TRUST
of
L. WHITLEY SIMMONS
BY THIS AMENDMENT, executed on ~Lt~~~'~- ~ ~ , 2006, L. WHITLEY
SIMMONS, presently of Dauphin County, Pennsylvania, as Settlor, hereby amends the Second
Amendment to Estate Plan Agreement of Trust entered into initially by him on October 26, l 99?,
and the same L. WHITLEY SIMMONS, hereby agrees to continue performing as the Initial
Trustee of the said Trust.
1. Subsection 4(f) of the said Second Amendment to Estate Plan Agreement of Tru
(beginning on page 6 thereof j is hereby deleted therefrom and replaced by the following, same-
numbered Subsection:
(fj After Wife's Lifetime' Limited Power of Appointment b~jife.
Upon the death of the survivor of the Settlor and his wife, if she survives the Settlor, the
Trustee(s) shall pay the balance held in the Trust, outright or in trust, in such amounts or
proportions to or for the benefit of any or all of the Settlor's issue as his wife may direct in. her
will making specific reference to the Trust hereunder. To the extent that the Settlor's wife
should fail to exercise effectively her limited power of appointment over the Trust, or if she
should predecease the Settlor, then from and after the death of the survivor of the Settlor and his
wife, the Trustee(s) shall distribute the principal remaining in the Trust per stirpes to the Settlor's
issue, adjusted for any advancement pursuant to Subsection 4(c) above.
2. Further, said Third Amendment shall contain a new paragraph numbered 15 as
follows:
15. Adoption. The terms issue, children and grandchildren do not inclucie
those who are adopted.
3. In all other respects, the said Second Amendment to Estate Plan Agreement of
Trust of the Settlor, as amended by the within Amendment thereto and all prior amendments
thereto, shall remain in full force and effect.
IN V~~ITNESS WHEREOF, the Settlor and the Trustee(s) have hereunto set their hands
and seals on the date first mentioned above.
Witness:
--~
,~ -,
_. .
~. ..
SETTLOR:
~~ ~r"7 Seai)
L. WHITLEY SIMM NS
Witness:
--~
i
~~ " -~,
~___., .
,'
r~.--.
COMMONWEALTH OF PENNSYLVANIA
TRUSTEE:
L. WHITLEY SIMMONS
SS:
COUNTY OF DAUPHIN
On this ~` day of ~ , 2006, before me, a Notary PubJ'~.ic, the
undersigned officer, personally appeared L. WHITLEY SIMMONS known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within Third Amendment
to Estate Plan Trust Agreement, who acknowledged to me that he executed the same for the
purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal
NOTARY P LIC
(Seal)
f ` -~_~.~~.~..- - -
Natarial Seal
'.-i';%+ i_. ~~I!jtC~~IGIII, Notary °ublic
~~'d:,, Day ~~~hin County
„ ~-~~ires iUay 5 '~7
.-_._ iZt~~;~i O~ i, .~~~~e8