HomeMy WebLinkAbout04-29-11~ 1505610105
REV-1500 ~` `02-11' `~'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes DEiMTNENTOf11EVENUE County Code Year File Number
Po Box 2806oi INHERITANCE TAX RETURN .~ ( ~ L~.
Harrisbur , PA 1128-0601 RESIDENT DECEDENT ~ ~.\~ ~ ~~'
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
172-26-4029 07/30/2010 11 /09/1931
Decedent's Last Name Suffix Decedent's First Name MI
Barnes Elizabeth R
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH TIRE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
Q~ 1. Original Return O
O 4. Limited Estate O
~ 6. Decedent Died Testate O
(Attach Copy of Will)
O 9. Litigation Proceeds Received O
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82}
7. Decedent Maintained a Living Trust
(Attach Copy of Trust.)
10. Spousal Poverty Credit (Date of Death
Between 12-31-91 and 1-1-95)
O 3. Remainder Return (Date of Death
Prior to 12-13-8~2)
O 5. Federal Estate 'Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
O 11. Election to Tax under Sec. 9113(A)
(Attach Schedule U)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Michael B. Devlin, CPA
First .Line of Address
Boyer & Ritter CPAs
Second Line of Address
141 W. High Street
City or Post Office State ZIP Code
Carlisle PA 17013
REGISTER OF WILLS USE ONLY
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Correspondent's a-mail address: mdevlin@cpabr.COm
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG~~~~o~ ONSIBLE FOR FIt~J,NG RETURN ~ D~~ i i l ~
14 East Harmbr( Drive, Carlisle, PA 17015
SIGNATURE OF P 'yA~RER THER T N REPRESE TATIVE t~/ DATE
A~tSDRESS
Boyer & Ritter CPAs, 141 W. High Street, Carlisle, PA 17013
PLEASE USE OR161NAL FORM ONLY
Side 1
1505610105 150561010.5
J
1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's name: Elizabeth R. Barnes 172-26-4029
RECAPITULATION
1. Real Estate (Schedule A) ............................................. 1. 0.00
2. Stocks and Bonds (Schedule B) ....................................... 2. 179,288.12
3. Closely Heid Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00
4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 31,687.46
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 3,022.76
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
7
670
43
130
(Schedule G) O Separate Billing Requested........ . .
,
8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 344,668.77
9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 10,127.19
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 15,488.94
11. Total Deductions (total Lines 9 and 10) ................................. 11. 25,616.13
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 319,052.64
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. 319,052.64
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 45 319,052.64 16,
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 ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610205 1505610205
14,357.37
14,357.37
O
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REV-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
DECEDENTS NAME
Elizabeth R. Barnes
STREET ADDRESS
5225 V~Ison Lane #1101
CITY
Mechanicsburg STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Total Credits (A + B) (2)
(3}
(4}
(5)
14,357.37
0.00
0.00
0.00
14,357.37
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: Yes No
a. retain the use or income of the property transferred .................................................................................. ........ ^
b. retain the right to designate who shall use the property transferred or its income ............................................ ^
c. retain a reversionary interest ....................................................................................................................... ....... ^
d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^
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? ....... ....... ^ ~
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ................................................................................................................. ....... ~ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT Ay 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 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 far 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(a)(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.
REV 1503 EX+ (6-98}
SCHEDt~LE B
COMMONWEALTH OF PENNSYLVANIA srocKS & BoNOs
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Elizabeth R. Barnes 21•-10-1049
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets of the same size)
REV-iso8 EX+ (ii-io)
F,- ~~nlelv~r~e e
`- ~ ~ - ~ Pennsylvania
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS $c MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Elizabeth R. Barnes 21-10-1049
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with Nght of survivorship must ibe disclosed on Schedule F.
If more space is needed, use additional sheets of paper of the same size.
REV-a,5og EX+ (oi-io)
~ ~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDI~LE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
Elizabeth R. Barnes 21-10-1049
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS ~ REL~ITIONSHIP TO DECEDENT
A• S. Jeffrey Barnes 14 East Harmon Drive son
Carlisle, PA 17015
B.
C.
JOINTLY OWNED PROPERTY:
TTEM
NUMBER LETTER
FOR IOINT
TENANT DATE
MADE
IOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET ;/a OF
DECIEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A. 01/22/02 Dollar Bank Passbook Saving Account # 10665637599 6,045.52 50% 3,022.76
TOTAL (Also enter on Line 6, Recapitulation) I $ 3,022.76
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX~+ ;08-Q9
~b pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Elizabeth R. Barnes 21-10-1049
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
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(]:F APPLICABLE} TAXABLE
VALUE
1. CB&T Cust IRA/Rollover American Funds Money Market Acct. #82285259
130,670.43 100 130,670.4;
Beneficiaries: S. Jeffrey Barnes, Cynthia 6. Vriens, and Gretchen L. Bames
TOTAL (Also enter on Line 7, Recapitulation) $ I 130,670.43
If more space is needed, use additional sheets of paper of the same size.
REV-1.51.1. EX+ ,IO-(19)
'-- ~ ~~ pennsylvan~a
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Elizabeth R. Barnes 21-10-1049
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: _
1' Hoffman-Roth Funeral Home 2,902.07
2. Chaplain gratuity (Carlisle $200) and Honorarium gift to Episcopal Relief (Pittsburgh Service $250) 450.00
s. Sewickley Cemetery burial fee 490.00
a. Rome Monument Works -headstone engraving 140.00
s. Memorial Service expenses -reimbursements to Cindy Vriens and Gretchen Barnes 255.88
s. Memorial Service Luncheon -Carlisle PA service 440.34
~. Funeral Service Luncheon -Pittsburgh, PA 438.18
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 0.00
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
Z• Attorney Fees:
0.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
0.00
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 477.50
5• Accountant Fees:
6• Tax Return Preparer Fees: 1,200.00
~• Cumberland Law Journal ($75.00) & The Patriot News ($190.73)- estate advertisements 265.73
s. Estimated closing fees and costs 100.00
s. Zeigler's Moving & Storage -moving personal property from Bethany Apt to storage Unit 477.66
~o. U-Haul Storage Unit rent (July to March) 1,769.35
~ ~ . U-Haul Truck Rental and movers to empty storage unit 320.48
~ 2. Lawrence Knapp - 2010 Individual income tax prep for decedent 400.00
TOTAL (Also enter on Line 9, Recapitulation) ,~ 10,127.19
If more space is needed, use additional sheets of paper of the same size.
REV-151.7.. EX+ ;12-0~3)
~~: ~~ ~,` pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
.............
INHERITANCE TAX RETURN
MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Elizabeth R. Barnes 21-10-1049
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• Verizon -phone bill July 65.29
2. Bank of America -VISA 226.32
3. Continuing Care RX -prescriptions 576.99
4. Anglican Diocese of Pittsburgh -dental insurance final bill 59.42
5. Capital Anesthesia -medical copay 3,gg
6. West Shore Endoscopy Center -medical copay 106.76
7. Hampden Physician Associates -medical copay 39.97
8. Continuing Care RX -prescriptions 313.38
9. Bethany Skilled Nursing 6,589.50
10. Bethnay Village -Monthly Fee 1,912.75
11. Associated Cardiologists, PC -medical copay 14.84
12. Verizon -final bills 74.39
13. Capital Anesthesia -medical copay 5.97
14. Central PA Pulmonary Associates, LLC -medical copay 12.80
15. Lower Allen Township EMS -ambulance transport 14.98
16. Camp Hill Emergency Physicans -medical copay 8.80
17. Bethany Skilled Nursing -final bill 2,696.66
18. Bethany Village -final monthly fee (net of $268.86 reimbursement) 1,583.14
19. Pinnacle Health Medical Services -medical copay 15.80
20. West Shore EMS-BLS -ambulance Transport 196.20
21. Pinnacle Health Medical Services -medical copay 38.39
22. Jackson Siegelbaum Gastroenterology -medical copay 16.60
23. Bonnie K. Miller -West Shore School District Local 2010 tax 11.00
24. PA Income Taxes - 2010 balance due on decedent's final return 905.00
TOTAL (Also enter on Line 10, Recapitulation) ~ 15,488.94
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
~, ~ ~ ~ ~~ Pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Elizabeth R. Barnes 21-10-1049
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under _
Sec. 9116 (a) (1.2).]
1 • Cynthia B. Vriens daughter 1 /3
2. S. Jeffrey Bames,14 East Harmon Drive, Carlisle, PA 17015 son 1/3 and joint account
3. Gretchen L. Games daughter 1 /3
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. I ~ 0.00
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
OF
ELIZABETH R. BARNES
I, ELIZABETH R. BARNES, of the Township of Upper St. Clair,
Allegheny County, Pennsylvania, do make, publish and declare this
my Last Will and Testament, hereby revoking any and all Wills and
Codicils heretofore previously made by me.
FIRST: I direct my Executor to pay my just debts, the
expenses of my last illness and my funeral expense: as soon as
may be convenient after my death.
SECOND : Except as I may have provided in a m~?rtorandum signed
by me and kept with the original of this Wi~_l or with my copy j
thereof, I give my personal effects, household effects and other
C
tangible personal property to my husband, RICHARD N[. BARNES, if j
he survives me, and if he does not so survive me t~ my then
I
living children ire as nearly equal shares as poss:ibl_e .
THIRD: I give the residue of my estate to my husband,
RICHARD M. BARNES, and NATIONAL CITY BANK, Pittsburgh,
Pennsylvania, to hold IN TRUST, to invest and reinvest and to
distribute the net income (hereinafter-called "Income") and
principal in the manner set forth below.
The Trustees shall distribute the Income and principal as
follows:
(A) During the lifetime of my husband, F:ICHARD M.
BARNES, if he survives me, the Trustee shall pay t:he Income
quarter-annually to him or for his benefit and may expend in
addition such sums from principal as the Corporates Trustee
considers advisable, in view of other readily available funds of
which the Trustee has knowledge, to provide for his welfare and
comfortable support.
(B) The Trustees shall also pay to my husband such
portions of the principal as my husband requests in writing, not
to exceed in any one calendar year on a noncumulative basis (i)
if he dies before December 1, FIVE THOUSAND ($5, 000) DOLLARS, or
2
(ii) if he is living on December 1, the greater of FIVE THOUSAND
($ 5, 000 ) DOLLARS or five ( 5 0 ) per cent of the aggregate value of
the principal as of December 1.
(C) Upon the death of my husband, the trust shall
terminate and be distributed, or if he has not survived me, my
estate shalll be distributed, in equal shares to :my children,
CYNTHIA B. VRIENS, S. JEFFREY BARNES and GRETCHEN I~. BARNES. In
the event that a child has not survived my husband and me, but is
survived by a spouse who has not remarried, the share of such
child shall be distributed to his or her surviving spouse. If a
spouse of any child who predeceases my husband and me has
remarried, his or her share shall be distributed Ito my deceased
child's then living issue, per stirpes, subject to the minority
provisions hereinafter set forth. If any child of mine should not
be living at the time of such termination without a spouse or
issue surviving, his or her share shall be distributed to my then
living issue, per stirpes, subject to the minority provisions
hereinafter set forth. In the distribution of my estate adopted
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issue shall be treated as_the natural children of their adoptive
parent.
(D) If, on the termination of any foregoing trust, a
share of principal is directed to be paid to any person who is
then under the age of twenty-one (21) years, such share shall not
be paid out, but shall be retained by the corporai~e Trustee in a
separate trust. Until he or she attains such age,, the Trustee
shall pay to said person or expend for his or her benefit so much
of the Income and principal as the Trustee considers advisable
and shall add the rest of the Income to principal and invest it.
When said person attains such age, the principal :hall be paid to
him or her. If he or she dies before such time, t:he principal
shall be distributed, outright or in trust, as he or she directs
i
by specific reference to this paragraph in his or her Will, and
any unappointed portion shall be paid to the persons entitled to !
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his or her estate.
(E) Income allocated to a minor may be expended
for his or her benefit or may be paid to his or her natural
guardian, to the guardian of his or her person or estate or to a
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Custodian for him or her under an appropriate Uniform Gifts or
Transfers to Minors Act, without liability on the part of the
Trustee to see to the application thereof. The T:ru.stee may also
deposit amounts in an interest-bearing account in the minor's
name in its own banking department or elsewhere acid may pay a
reasonable allowance to the minor.
(F) The interest of any beneficiary, ir.~cluding a
remainderman, in Income or principal shall not be subject to
assignment, alienation, pledge, attachment or claims of creditors
while the funds are in the hands of the Trustee, but this
sentence shall not restrict the exercise of any power of
withdrawal or appointment hereinbefore granted.
(G) Except as may be otherwise specifically
hereinbefore provided, on the death of a beneficiary, any Income
accrued or received after the last regular Income payment date
shall be treated as accruing after the beneficiary"s death. All
stock dividends in shares of the distributing corporation are
principal .
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__._.r~-_ - - - -- -__.___....- ---____ ___,.__. - _--
FOURTH: (A) The Trustees shall have the following powers, in
addition to those granted by law: to accept assets in kind in
distribution from my estate or elsewhere; to coll~ec:t proceeds of
insurance on my life and to use such proceeds to purchase assets
from my estate or to make loans to my estate; to :retain assets in
kind or to sell the same; to invest in any kind o:f property
without regard to any statutory limitations; to retain policies
of life insurance, to pay premiums thereon from income or
principal and to exercise all rights of ownership thereover; to
pledge, exchange or mortgage real or personal property and to
lease the same for terms exceeding the term of the trust; to give
or exercise options for sales, leases and exchanges; to borrow
money; to compromise claims; to vote shares of corporate stock,
In person or by proxy, in favor of or against management
proposals; to carry securities in the name of a nc>minee,
including that of a clearing corporation or depository, or in
book entry form or unregistered or in such other f~o:rm as will
pass by delivery; to allocate realized capital gains. to income or
principal; and to make division or distribution either in cash or
6
in kind, allocating to each share identical or different kinds of
or interests in property and property having different bases for
Federal income tax purposes.
(B) While observing its primary responsibility to act
in the best interests of the beneficiaries, the corporate Trustee
is aut~~c;rized to deal with its entire banking institution and its
affiliates on the same basis as with unrelated in:~titutions. By
way of illustration and not limitation, the TrustE~e may invest in
interest-bearing accounts in or certificates of deposit issued by
its banking department, in shares of registered investment
companies for which the Trustee or an affiliate performs services
for a fee, whether as custodian, transfer agent, investment
advisor or otherwise, or in securities underwritten by syndicates
of which the Trustee is a member, but not if purch~a~sed from the
Trustee; may borrow money from its banking department; may retain
shares of its corporate stock or that of any company having
!~
control over it, but the Trustee shall not review said stock for
Investment purposes and shall sell, purchase or vot:e said stock
only as directed by an adult Income beneficiary of t:he trust in
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which it is held; and may execute purchases and sales through its
affiliated brokerage service at the affiliate's rc=gular
institutional rates so long as that service provides competitive
execution. Any broker or dealer executing transactions on behalf
of the trust may receive commissions that are reasonable in
relation to the value of the brokerage and/or research services
provided. The term "affiliate" shall include a subsidiary of the
Trustee or of an affiliate.
~ (C) The corporate Trustee may resign at: any time,
without stating cause, by petitioning a court of c:o:mpetent
jurisdiction to designate and appoint a successor corporate
Trustee. In the case of the merger or consolidation of the
Trustee, the resultant company shall become successor Trustee
hereunder without notice to any party.
(D) The Trustee shall be entitled to receive
compensation for its services hereunder in accordance with its
schedule in effect when the services are performed.
8
FIFTH: I appoint RICHARD M. BARNES as my Executor and give
to him as Executor the same powers as are given to the Trustees
under Article Fourth above and also the power to file any
qualified disclaimer I could have filed if living. In the event
that he is unable or unwilling to serve, I appoini~ S. JEFFREY
BARNES as Executor, and in the event that he is unable or
unwilling to serve, I appoint LAWRENCE M. KNAPP a~> Executor.
No bond or other security shall be required of any
fiduciary hereunder in any jurisdiction.
SIXTH: I realize that fiduciaries are given discretion by
law to make various elections which affect the income and
transfer taxes payable by estates, trusts and beneficiaries, as
well as the relative shares of beneficiaries, such as taking
administration expenses as deductions for either estate or income
Ii tax purposes, selecting options for the payment of employee death
benefits, electing to take qualified terminable int:
erests as part
of the marital deduction, selectin alternate v
g alu~~tion dates,
post onin the
p g payment of taxes, filin ~
g joint income tax or gift {
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tax returns, allocating any exemption from P ~ :;`~
generation-ski ping
transfer tax, filing estimated income tax returns and making
payment thereon and effecting a redemption of corporate stock.
The decisions made by my fiduciaries in any of thE~se matters
shall be binding upon, and not subject to questior.~ :by, any
affected persons. I rely upon my fiduciaries to take into
consideration the total income and transfer taxes p<~yable by
reason of their decisions, including those payable by my
survivors, and they are authorized in their discretion, but not
required, to make adjustments between income and principal as a
result thereof. They are specifically authorized to file a joint
income tax return with my husband for any period during which
such a return is permitted, without requiring him -to sign an
indemnification agreement.
SEVENTH: I appoint NATIONAL CITY BANK, Pittsburgh,
Pennsylvania, guardian of the estate of any minor receiving any
sums of money, real property or other intangible pE~rsonal
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property free of trust by reason of my death, if such property is
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in excess of the amount which may be paid to the natural
guardian; and I authorize said guardian, in his sole discretion
and without order of court, to retain such property in kind or to
sell the same, giving good title to any real estate, to invest
and reinvest without being limited to "legal" investments and to
use both income and principal for the minor's welfare,
comfortable support and education, including col]_ege expenses.
EIGHTH: I direct that all estate, inheritance and other
taxes in the nature thereof, together with any interest and
penalties thereon, becoming payable because of my death with
respect to the property constituting my gross estate for death
tax purposes, whether or not such property passes under this
Will, shall be paid from the principal of my residuary estate,
and no person receiving or having a beneficial interest in any
such property, whether under this Will or otherwise, shall at any
time be required to contribute to or refund any part thereof; ~
PROVIDED, however, that this direction
shall not apply to the ~
taxes on any property included in my estate solely because of a
11
power of appointment thereover which I possess but have not
exercised or on any qualified terminable interest.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
~: ~
~'
t h i s ..~ ~' ""day o f ~~r. .~ ~ .G~.~_~ 19 9 ~~ .
~~~.,G-.~ ~~'~- t~)~ '~.~«~~.~'~- (SEAL)
Signed, sealed, published and declared by ELI~~ABETH R.
BARNES, the Testatrix above named, as and for her Will, in the
presence of us, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our :names as
witnesses hereto.
.~, ,_,
`~ ; ,
^~~
./
~ ~- _ ~'
12
_:~„~-
u~`. .
`;
_ +~
•! ; T
',:Y
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF ALLEGHENY )
We, ELIZABETH R . BARNES, the Testatrix, and -~'zt.-1 ~~ lr
- .~ ~ and ~Srt-~-~r--~, ,C~_ ,~~ ~~~
the witnesses `whose names are subscribed to the foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the testatrix signed a:nd executed the
instrument as her Last Will and Testament and that she 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 testatrix, signed
the Will as witnesses and that to the best of the_ir~ knowledge the
testatrix was at that time 18 or more years of agE~, of sound mind
and under no constraint or undue influence.
~e~tatrix
~ '~
i ~~
ti r
Witness ~~
;`;
Witness -~
Subscribed, sworn to and acknowledged before me by
ELIZABETH R. BARNS, the testatrix, and subscribed and sworn to
before me by _ fry jrt ~~~
~-.~- ~~ .• ~'- ~'~~ and
!~ ~i __
.__. - ~~> Gt S r~ ~~~ ~~ ~2- /~~ - ~`c~vi c,~~ ~ i t ne s s e s , this
day o f ~' ~ ~~~~ ~,-~-z. ~ 19 9 8 .
I. l ~'.
Notary Public ~-~.~
13 Notai7al Seal
Lawrence M fCnapp, Notary Public
Pittsburgh, Allegheny County
My Commission Expires Jan. 14, 2002
Member, Pennsylvania assOCia:ion of NotariHs
_.- _ _ _
Y .. - . - . ..>.'
_v v _
{ ~T~
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-fir •'~
..
.:.
ST}}~EN~T L'EKY'CIb .,:
:.
:P~,,GE.. .
JUL.21-AUG.20,2010 1 OF 2
ELIZABETH R BARNES
14 EAST HARMON DR
CARLISLE PA 17015
INTEREST PAID YEAR TO DATE 1.25
T rrnrn~Tm f~TrnrtnRT T V
STONEHEDGE
~~,.y~y,,•~~~~TTTT##~~
~:.~ :.-:. •. ~' ~ ::::::::: .:::• ... .. ..... .
:::~:~::-:4)TfFER':AT3171TI4~:;•:•::~::~
--~~~.~~. .~ vv...
:~:•::::::_:::~CHEC~.~:i~Fif17~::~:::':~::=
ar .a ~.a
:'•:::c:SgBT£iA~`1;UI~S:~<:`::;'~:>':=:~
:•3N3'A,RE;9•T::1?I%
::'-::::'~~::'B~•:; ~:::
NO. AMOUNT NO. AMOUNT NO. AMOUNT
7,866.86 4 17,675.28 2 630.00 13 11,299.37 O.OEi 13,612.83
T !~!'~/1TlATT T r"Im TTlr mew
" `DACE::>::.:.: :_ ;::?:::` ::-~ >':':>:=`': =:>:~'R1~1I~~CTTOI~`~DL~TP~'~ .
.ZON':::~;: ; =: ;:: >':` '::-':<:
•:&~OTHII~~: ADDI'.',~.1: ~
:::~:? S~B.TRA4°~TONE:~: ? ~:~
::: :=:::` ~::>B~: ":~:::<::
07-21-10 BEGINNING BALANCE $7,866.86
07-30-10 BENEFIT PAYMENTS PENSIONS 2,472.3 10,339.21
OB-03-10 US TREASURY 303 SOC SEC 1,193.00 11,532.21
OB-OS-10 WEB PMT Continuing Care RX 576.99
08-05-10 WEB PMT BANK OF AMERICA 226.32 •
08-OS-10 WEB PMT VERIZON 65.29
08-05-10 WEB PMT Anglican Diocese of Pitt 59.42 10,604.19
08-06-10 WEB PMT Continuing Care RX 313.38
OB-06-10 WEB PMT West Shore Endosco
Cen
py 106.76
08-06-10 WEB PMT Hampden Physician Associ
39 97
08-06-10 WEB PMT Capital Anesthesia
3.99 10,140.09
OB-10-10 REVERSE DIRECT DEPOSIT
1,193.0 8,947.09
OS-11-10 WEB PMT Bethany Skilled Nursing 6,589.50
08-11-10 WEB PMT Bethany West Apartments
1,912.75
08-11-10 CHECK NUMBER 0256
490.00 45.16-
08-16-10 DEPOSIT 1,009.93
08-16-10 CHECK NUMBER 0257
140.00 824.77
08-18-10 JANNEYMONTGOMERY CREDIT 13,000.00 13,824.77
08-19-10 WEB PMT WSEMS
196.20
08-19-10 WEB PMT pinnacle Health Med Svcs
15.80 13,612.77
08-20-10 INTEREST PAYMENT 0
06
. 13,612.83
ENDING BALANCE
$13,612.83
gA
113 • ~~•~••~~
M14R•i~
. ........................................
256 08-11-10 490.00 257 OS-16-10 140.00~~~
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 EX AFP C98-OB)
INFORMATION NOTICE
AND FILE N0. 21 10 - 1049
TAXPAYER RESPONSE ACw 10170020
~DA1rE 12-13-2010
S J BARNES
-~~w S ~ e i~ i~ ~ w~
~ ^ T 7 7 ~ +
j4 ~~+~T ~},4Rrv~u ~~2c~E
~~2u~~~ ~~ ~7ar~'
EST. OF ELIZABETH J BARNES
SSN 172-26-4029
DATE OF DEATH 07-30-20110
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
a SAVINGS
CHECKING
TRUST
CERTIF.
D 0 LL AR BAN K provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/benErficiary of this account.
If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
Pnnsylvania. Please call :717) 787-827 w.ith..auestions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 10665637599 Date 01-22-2002 To ensure proper credit: to the account, two
Established copies of this notice must accompany
$ 6 , 045.52 payment to the Register of Wills. Make check
Account Balance payable to Register of Wills, Agent".
Percent Taxable X 50.000
$ 3 ~ 0 2 2 . 7 ( NOTE: If tax payments are made within three
Amount Subject to Tax months of the decedent s date of death,
Tax Rate ~( lfj deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 453.41 nine months after the date of death.
PART TAXPAYER RESPONSE
1
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of
0 N E Wills and an official assessment will be issued by the PA Department of Revenue.
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 +~
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate 7 X
8. Tax Due 8 $
PART DEBTS AND DEDUCTIONS CLAIMED
a
DATE PAID PAYEE DESCRIPTION eMnilNr Darn
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief. HOME C~7l7 ) ~.~+'~
~' ~E~~e WORK curl ~ zz~--b~~ Cc~c> tZ ~v--to
TAXP S NATURE TELEPHONE NUMBER ~ DATE
iv~ML ~u~~er vn Llne 5 Or IaX computation) $
The right choice for the long term®
American Funds®
PO Box 2560
Norfolk VA 23501-2560
AT 01 250826 16621H931 A**3DGT
'11111111111111"IIIIIIIIIIII'I'II~II~I~I1111'II'III'II'lll"'ll'
CB8tT CUST IRA/ROLLOVER
ELIZABETH R BARNES/DEC'D
5225 WILSON LN APT 1101
MECHANICSBURG PA 17055-6664
Best wishes for the New Year
This statement shows your complete account activity for 2010.
We recommend you keep it for your tax records. See our online
Tax Center for tax forms, interactive worksheets, average cost
information, and more. You can also go online to make your
IRA contributions. Visit us at americanfunds.com/taxes.
Guide to market recoveries
Year`-End Statemer~.t Page 1 of 4
December 31, 2010
Your 8nandal adviser
MCANDREWS/PASTIN
(412) 562-7936
JANNEY MONTGOMERY SCOTT LLC
600 GRANT ST STE 3100
PITTSBURGH PA 15219-2709
For more account information
^ Call your financial adviser
^ Automated inionnation and services;
Website - americanfunds.com
American FundsLine ®- 800/325-35510
^ Personal assistance - 8 a.m. to '~B p.m. Esatem time M-F
Shareholder Services - 800/421-0180
A look back at several significant market declines -and their
subsequent recoveries -can offer useful perspective for today.
Visit americanfunds.com/recoveries to access our tools and
resources.
Year-end
.................................................................................................
....
....
........................
........
Reinvested Change in........ ..................... ....................
Value on dividends and account Value on Ending =
17/31/09 + Additions + capital gains - Withdrawals +/- value = 17/31/10 share balance
CB&T CUST IRA/ROLLOVER
ELIZABETH R BARNES/DEC'D
American Funds Money, Market Fund-A
Account ~ ; :~}4 $130,670.43 $0.00 $0.00 -$130,670.43 $0.00 $0.00 0.000
American Funds Money Market Fund-A
,
~ 1;;::
Account # ~ -~ ~~ ~_ $0.00 $43, 556.81
._:.>..._,..fi_____z
$0.00
-$43, 556.81
$0.00
$0.00
0.000
American Funds Money Market Fund-A
.. ~
y
: T.e::..:
Account # _ .~~.` $0.00 $43,556.81
.. _~~~:'_U
$0.00
-$43,556.81
$0.00
$0.00
0.000
American Funds Money
Market Fund-A
.
~~ :}2~:
Account ~ '~~:'.,~ $0.00 $43,556.81
_,..-..,~'<-.~~;i, $0.00 -$+133,556.81
$O.OO
$0.00
0.000
Totals
$130.670.43 513@.67@.43 50.oe -5ZS1,340.s6 50.00 50.0@
1 250626/000OOi
AF5..R41 t20w.0457864004.43287.432H7.C~6AF502.INVMpL..._...AFL......017t 1579~J5flE100
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