Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
06-06-11 (2)
1505610140 REV-1500 EX `°'-'°' PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2~ 1 1 0 0 2 9 0 PO BOX 280601 RESIDENT DECEDENT Harrisbur PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 8 2 2 2 5 6 7 5 0 2 2 0 2 0 1 1 0 6 2 3 1 9 2 6 Suffix Decedent's First Name MI Decedent's Last Name I..i S h a n k J a m e s (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name MI Spouse's Last Name N / A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return ^ 4. Limited Estate ^ X 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received ~ ^ ~ ~ 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) ~ 0 ~ 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIADL yAX le Telepho0ne NumUberBE DIRECTED T0: Name Scot t W. M o r r i son E s q 7 1 7 5 8 2 2 3 0 0 -- First line of address 6 Wes t Second line of address P O. City or Post Office New B I Mai n S t r e e t Box 2 3 2 State ZIP Code 0 o m f i e l d P A 1 7 0 6 8 REGISTE~F WILLS US6'_ONLY ~ ~ ~ 7 7 Lam' ~~., •t'~ c. ~j T.J ~ ~~ f ~_~ li f f y' . , ~~~ ~ r ~. ~ TE FILED ~" _ ~.~~ ~ ~ ; _- ~ ~~ r~ , ` -- -- _-- -cam - ; - 5~.; C: Correspondent's a-mail address: 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 preparerDATEny knowledge. SIGN~TURE O~F PERSON RESPONSIBLE FOR FILING RETURN \~.- ~ ~ - / t W- ADDRESS ~ ?~ D ~/ tL'I FR A /l.' . ~ ~ DAT SIGNAT E OTHER THAN REPRESENTATIVE O ~ Z (~ ~ a r ADD ~ ~~ ~~ .~ ~~W T~~O'b~Tl`~l.G~ ~ / `~~'~ PLEASE USE ORIGINAL FORM ONLY 1505610140 Side 1 1505610140 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME James H. Shank _ STREET ADDRESS 1100 Crandon Way __ - __ CITY Mechanics Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments 40,000.00 A. Prior Payments 2,105.26 B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fitl in oval on Page 2, Line 20 to request a refund. File Number 20 11 00290 __ _ _ _- STATE I ZIP PA j 17050 (1) 55,050.53 Total Credits (A + g) (2) 42,105.26 (3) (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 12,945.27 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; ............................... X c. retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 3. Did decedent own an "in trust for" or payable-upon~leath bank account or security at his or her death? ......... ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 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 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(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT FILE NUMBER ESTATE OF James H. Shank 20 11 00290 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 112.49 ~, West Shore Ambulance Service -refund 628.00 2. Loyalton -refund 3. 100.00 4. Department of the Treasury -income tax refund 4,275.00 5. Citizens Bank Checking Account #6100706672 22,381.59 TOTAL (Also enter on line 5, Recapitulation} I $ 27,497.08 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER•VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER James H. Shank 20 11 00290 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. DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFER. ATTACHACOPYOFTHEDEEDFORREALESTATE. VALUE OF ASSET INTEREST (IFAPPLICABLE) VALUE 1. National Western Life Insurance Company 350,325.10 100.00 3,000.00 347,325.10 Annuity Contract No. 0101249425 TOTAL (Also enter on Line 7, Recapitulation) ~ $ 347, 325.10 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF James H. Shank 20 11 00290 Decedent's debts must be reported on Schedule I. ITEM NUMBER A, FUNERAL EXPENSES: ~, Malpezzi Funeral Home B 2. 3. 4. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: C• State ZIP Attorney Fees: SCOtt W. MOrrISOn Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address ity Relationship of Claimant to Decedent Probate Fees: Glenda Farner Strasbaugh 5 Accountant Fees: g, Tax Return Preparer Fees: ~, I Cumberland Law Journal -estate advertising g. The Sentinel -estate advertising State ZIP DESCRIPTION AMOUNT 744.25 4,000.00 119.50 75.00 230.02 TOTAL (Also enter on Line 9, Recapitulation) I $ 5,168.77 If more space is needed, use additional sheets of paper of the same size. 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 James H. Shank 20 11 00290 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM vAOF DEATHTE NUMBER DESCRIPTION ~. Omnicare Pharmacy Service- medical account 156.92 2. Golden Living Center-West Shore -medical account 991.57 3. Prudential Annuities -account 661.11 4. Fidelity Investments Institutional -account 840.29 TOTAL (Also enter on Line 10, Recapitulation) I $ 2,649.89 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER: ESTATE OF: James H. Shank 20 11 00290 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Ronald K. VV•ilson Collateral 100 Mountain View Road one-half Shermans Dale, PA 17090 2. Mary J. Wilson Collateral 100 Mountain View Road one-half Shermans Dale, PA 17090 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: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. n =-- -r- r- •- _.._ <-1 ~~ '~ _ -. LAST WILL AND TESTAMENT - c,~, ~ __; Y OF ~., .r:; f't = JAMES H. SHANK ?~ < :-~~ ~'~ ~? ,~ I, James H. Shank, a resident of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. ITEM ONE: I direct that all my just debts and funeral expenses shall be paid as soon after my death as may be found convenient. ITEM TWO: All the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wheresoever situate, which I may own or have the right to dispose of at the time of my death, I give, devise and bequeath unto my niece, Mary J. Wilson, and her husband, Ronald K. Wilson, in equal shares, per capita. Should both beneficiaries predecease me, then the rest, residue and remainder shall go to the surviving children of Mary J. Wilson and Ronald K. Wilson. ITEM THREE: I note that there has been no provision made for my daughter, Glenda Blair, and that this is intentional. She should receive no benefit from my Estate. ITEM FOUR: All federal, state and other death taxes payable because of my death with respect to property passing under this Will shall be considered a part of the expense of the administration of the estate and shall be paid out of the residue of the estate, without apportionment or right of reimbursement. I direct that any persons receiving non-probate property that is subject to federal, state or other death taxes shall pay such taxes directly, and such non-probate taxes shall not be paid out of the property passing under this Will. AND LASTLY, I do hereby nominate, constitute and appoint Ronald K. Wilson, to be the Executor of this my Last Will and Testament. In the event that he shall have predeceased me or is unable to serve, then I nominate, constitute and appoint Mary J. Wilson, to be the Executrix hereof. My said Executor or alternate shall have full power to do any and all things necessary for the complete administration of my estate, including the power to sell at public or private sale, without Order of Court and without the necessity of filing a bond, any real or personal property belonging to me, and to compound, compromise or otherwise settle and adjust any and all claims against or in favor of my estate as fully as I could do if living. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, this ~~ day of ,~ 9U s T , 2010. WI ESSES: L7iv-nmo ~ - ax.~a-. JAMES H. SHANK ~~~ NOTARIAL 8EAL JUNE E VACCARO Notary PuMk SPRINGETTSBURY TWP, YORK COUNTY My Commission Expina Mar 30, 2013 ACKNOWLEDGMENT AND AFFIDAVIT I, James H. Shank, the Testator, sign my name to this instrument this ~~day of 2010, and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this instrument as my last Will and that I sign it willingly, that I execute it as my free and voluntary act for the purposes therein expressed, and that I am eighteen years of age or older, of sound mind, and under no constraint or undue influence. We, the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the Testator signs and executes this instrument as his last Will and that he signs it willingly, and that each of us, in the presence of the Testator, hereby signs this Will as a witness to the Testator's signing and that to the best of our knowledge the Testator is eighteen years or olden of sound mind, and under no constraint or undue influence. / ~/ _ /lv[ Witness Witness COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK ss On this the ~ day of cr,~ s r-, 2010 me, undersigned officer, person~ll3La~eared J s H. Shank, Testator, and n ~ ,~C~,4,Q~ ,Witness, and ©D/fl ,Witness, known to me (or satisfactorily proven) to be the persons whose names a subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. .~~ ~_ Notary Public My commission expires: NOTARIAL tEAL .KN~ E YACCARO EPRINGETT88~URI Y 1VMP YORK COUNTY My Commisaion Explns Mu ~0, ZOf~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 March 23, 2011 SCOTT W MORRISON ESQUIRE SCOTT W MORRISON ESQUIRE 6 HEST MAIN STREET PO BOX 232 NE6^I BLOOMFIELD PA 17068 Re: James H Shank SSN: ###-##-5675 Dear Arty Morrison: Pursuant to your letter dated March 04, 2011, the Department of Public Welfare (DPW), Estate Recovery Program, has reviewed the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. I:f you have any questions, please feel free to contact me. Sincerely, ',~/f Y,~u 2~ ~L der Vince A. Porter Recovery Section Manager (717;772--6604 THE SHANK FAMILY IRREVOCABLE GRANTORS TRUST ANSTINE & SPARLER JOHN R. ELLIOTT ESQ. 117 EAST MAR.I~T ST. YOR14 PA 17401 717-846-8811 Jelliott~anstinesparler.com DECLARATION OF TRUST THE SHANK FANIILY IRREVOCABLE GRANTORS TRUST The Trust Agreement is effective the ~ ~Y of UST .2010, by and between JAMES H. SHANK, (the "Grantor"), and RO ALD K. WILSON and MARY J. WILSON, who, jointly or severally, will serve as Initial Trustees, (the "Trustee"), with reference to the following facts: Section 1 Funding the Trust Grantor hereby transfers to the Trustee Ten Dollars ($10.00) to be held and administered according to the terms of the Trust. The Grantor and any other person may transfer additional properly to the Trustee, acceptable to the Trustee, to be held and E ~~ FAMILY IRREVOCABLE GR,ANTO S TR ST.e known as "TH Section 2 Irrevocability The Trust and all interests in it are irrevocable, The Grantor has no power to alter, amend, revoke, or terminate any Trust provision or interest herein, except for the power to name and/or change designated beneficiary(ies), whether under the Trust Agreement or under any statute or other rule of law. Section 3 During the Lifetime of the Grantor During the lifetimes of the Grantor, the Trustee shall hold and administer all funds remaining as follows: a. After paying the expenses and charges of the Trust, the Trustee may, in the Trustee's discretion, pay to or apply for the benefits of the Trust Beneficiaries, as much of the net income and principal of the Trust as the Trustee, in the Trustee's discretion, deems necessary for the reasonable health, support, maintenance, and education of the Beneficiaries. The Trustee may pay more to one Beneficiary than to other and the distributions hereunder shall be counted against the Trust as a whole and not against each Beneficiary's distributive share. Any income not distributed shall be accumulated and added to Trust principal. In exercising the Trustee's discretionary powers hereunder, the Trustee shall be guided by the following statement of the Grantor's purpose and intentions, but the Trustee shall nevertheless be free to make his decisions without direction from the Grantor. Since Trust principal includes annuities, Grantor requests, but does not 2 direct, the Trustee to defer making discretionary income and principal distributions until after the Grantor's death and receipt of the annuities' proceeds. However, the Grantor understands that circumstances may arise which would make distributions advisable prior to her death and the Trustee may effect such distributions and convert the Trust into cash in order to accomplish the distributions. Section 4 Unon the Death of the Grantor Upon the death of the Grantor, the Trustee shall hold, administer and distribute the Trust Estate as follows: A. Fifty percent (50%) to Ronald K. Wilson; if said beneficiary should predecease the Grantor, then this share shall go to Mary J. Wilson; if she also predeceases Grantor, then the estate shall be divided equally between the children of Mary J. Wilson and Ronald K. Wilson. B. Fifty percent (50%) to Mary J. Wilson; if said beneficiary should predecease the Grantor, then this share shall go to Ronald K. Wilson; if he also predeceases Grantor, then the estate shall be divided equally between the children of Mary J. Wilson and Ronald K. Wilson. 1. Guardians and Conservators. If a guardian or conservator of the person or the Estate, is appointed by a court of competent jurisdiction for any beneficiary hereunder, the Trustee may distribute such monies as would otherwise become distributable to the beneficiary to such guardian or conservator, and the voucher of such guardian or conservator shall be a full acquaintance to the Trustee for any sums so distributed; but the Trustee may in its sole and absolute discretion, require such reports and take such steps that it may deem requisite to insure and enforce the due application of such money to the purposes aforesaid. 2. Certifications of Beneficiaries. In exercising its discretion hereunder, the Trustee shall be entitled to rely upon written certification of the beneficiary, guardian or conservator of the beneficiary as to the nature and extent of the beneficiar~s needs and the inadequacy of the beneficiary's resources apart from the Trust. As to these matters, when relying upon such certifications, the Trustee shall not be required to make further inquiry into the authenticity of the need or to the availability of other resources to satisfy the need. As to these matters, it is the Grantor's desire that the Trustee consider the needs of the beneficiary in keeping with the standard of living that has been previously enjoyed by the beneficiary. 3 Section 5 Spendthrift Clause a, To the fullest extent permissible by law, no interest in the principal or income of any Trust created hereunder shall be anticipated, assigned, or encumbered or subject to any creditor's claim or to legal process, prior to its actual receipt by the Beneficiary. b. Except as herein otherwise expressly provided, all income or principal to be paid to any of the Beneficiaries shall be paid by the Trustee directly and only to the Beneficiary, to the personal representative or guardian of the Beneficiary, or, where, authorized, applied for the benefit of the Beneficiary. If any creditor or other claimant attempts to subject to the satisfaction of the claim of such creditor or claimant the interest of any Beneficiary to receive income or periodic payments from the principal or income, or both, then notwithstanding of any other provisions herein, and in the absolute discretion of the Trustee, the Trustee may suspend such Beneficiar~s payments from the Trust provided, however, that during the time the payments are suspended the Trustee, in his absolute discretion may pay to or expend for the benefit of such Beneficiary as much of the Trust net income, not to exceed the income to which such Beneficiary would otherwise be entitled, as the Trustee deems necessary for the health, support, maintenance and education of such Beneficiary. All income determined by the Trustee to be in excess of the amount necessary shall be accumulated and added to the Trust principal. Section 6 Rule against Perpetuities If it is determined that any provision of the Trust violates any applicable rule against perpetuities or remoteness of vesting, the Trustee will administer the affected portion for the maximum period allowed by law and then pay that portion of the Trust funds outright and free of Trust to the then Beneficiary of the Trust income. Section 7 Trustee Powers a. The Trustee is exclusively empowered to do the following; each designated trustee may act independently as needed: 1. Hold and retain all or any property received from any source, without regard to diversification, risk, productivity, or the Trustee's personal interest in such property in any other capacity, and to keep all or part of the Trust property at any place within the United States or abroad. 2, Invest and reinvest the Trust funds (or leave them temporarily un-invested), in any type of property and every kind of investment, including, but 4 not limited to, corporate obligations of every kind, preferred or common stocks, securities of any regulated investment Trust, and partnership interest. 3. Participate in the operation of any business or other enterprise and to incorporate, dissolve, or otherwise change the form of such business. 4. Deposit Trust funds in any commercial savings or savings and loan account. 5. Borrow money for any reasonable Trust purpose and upon such terms, including, but not limited to, reasonable interest rates, adequate security, and such loan duration as the Trustee deems advisable. g. Lend Trust funds to such persons (including the estate of the Grantor or a trust created by the Grantor) and on such terms, including but not limited to, reasonable interest rates, adequate security, as such loan duration as the trustee deems advisable. 7. Sell or otherwise dispose of Trust assets, including, but not limited to, Trust real property, for cash or credit, at public or private sale, and with such warranties or indemnifications as the Trustee deems advisable. 8. Buy assets of any type from any person (including the estate of the Grantor or a trust created by the Grantor) and on such terms, including but not limited to, cash or credit, reasonable interest rates, and adequate security, as the Trustee deems advisable. 9. Improve, develop, manage, lease or abandon any Trust assets, as the Trustee deems advisable. 10. Hold property in the name of any trustee or any custodian or nominee, without disclosing the Trust, but the Trustee is responsible for the acts of any custodian or nominee Trustee so uses. 11. Pay and advance money for the Trust's protection and for all expenses, losses and liabilities sustained in its administration. 12. Prosecute or defend any action for the protection of the Trust, the Trustee in the performance of Trustee's duties, or both and to pay, contest, or settle any claim by or against the Trust or the Trustee in the performance of Trustee's duties. 13. Employ persons, even if they are associated with the Trustee, to advise or assist the Trustee in the performance of Trustee's duties. 5 14. Pay any and all income tax liabilities on Trust income from Trust funds. 15. Distribute Trust assets in kind or in cash. 16. Execute and deliver any instruments necessary or useful in the exercise of any of these powers. 17. Trust income or principal may not be used wholly or partly discharge any legal obligation of the Grantor. This restriction supersedes any contrary Trust language. When determining the legal obligation to support any beneficiary, the Trust's existence shall not be taken into consideration. 18. Except as otherwise specifically provided in the Grantor's Will (or other dispositive instrument executed by the Grantor), the Trustee shall pay any federal estate tax payable by reason of the inclusion of any portion of the Trust in the taxable estate of the Grantor. The Trustee shall also pay all state inheritance or succession taxes attributable to Trust property and payable by reason of the Grantor's death. The Trustee shall charge to or recover the payments from the persons entitled to Trust benefits, as and to the extent provided by any applicable tax law or proration statute. Section 8. Definitions For all purposes, the term "issue", "descendant", "child", "children", "grandchild" or "grandchildren" includes those who are legally adopted. The term "child of the Grantor" or "issue of the Grantor" means a child, step-child or issue of JAMES K. SHANK. Section 9. The Trustee a. During the Grantor's lifetime, RONALD K. WILSON AND MARY J. WILSON shall serve as Trustees. In the event that a Trustee is unavailable to serve, then the survivor shall serve as sole Trustee. b. Any Trustee may resign by giving written notice, specifying the Resignation's effective date, to the person or institution designated a successor Trustee, if there is one, or otherwise to the current income Beneficiary or Beneficiaries (including any Beneficiary entitled to Trust payments for health, maintenance, support and education) or the custodial parent of any such minor Beneficiary. 6 c. No Trustee shall be required: 1. To obtain the order of any court to exercise any power or discretion under the Trust, or 2. To file any accounting with any public official, although the Trustee shall maintain accurate records concerning the Trust and shall furnish each current income Beneficiary (including any Beneficiary entitled to Trust payments for health, maintenance, support and education) or the custodial parent of any such minor Beneficiary an annual accounting of the condition of the Trust, including receipts and disbursements, which may be satisfied by a copy of the Trust's federal income tax return, if one is required. d. Each individual Trustee is entitled to a reasonable compensation for services in administering the Trust and to reimbursement for expenses, and each corporate Trustee is entitled to compensation based on its published fee schedule in effect at the time services are rendered. e. Any successor Trustee may, without liability, accept without examination or review, the accounts rendered and the property delivered by any predecessor Trustee. Each Successor Trustee or Co-Trustee has the same title, powers and duties as the Trustee succeeded, without any additional conveyance. f. No Trustee shall be liable for mistakes or errors in judgment unless resulting from the Trustee's bad faith or gross negligence. g, Any individual Trustee shall be deemed to have automatically resigned, without fixrther act on the Trustee's part, immediately upon receipt by the next successor Trustee of an acknowledged, written instrument executed by two licensed physicians. The physicians must state in writing that they are certified by a recognized Medical Specialty Board. In addition, the writing must indicate that they have examined the Trustee and concluded that by reason of accident, physical or mental illness, progressive or intermittent physical or mental deterioration, or other similar cause, the Trustee has become unable to prudently exercise Trustee powers in the beneficiaries' best interest. Examination expenses shall be paid by the Trust. h. Until the Trustee receives written notice of any birth, marriage, death or other event upon which payment rights may depend, they shall incur no liability to the persons whose interest may have been affected by that event for good faith disbursements. i. The Trustee may, but need not, use the insurance proceeds received, due to the Grantor death, to make loans to, and purchase assets from, Grantor's 7 estate or any Trust created by the Grantor. The Trustee shall also, if they deem it to be in the best interest of all beneficiaries, consider not making distributions of insurance proceeds to any beneficiary until at least two (2) years after the date of each Grantor's death. j, At any time after the creation of a property interest which ma ghat does, benefit a person, or of the grant to a person of a power affecting property, person may disclaim all or a portion of the interest or power. However, the disclaimer must be in writing, and in accordance with applicable state laws and Internal Revenue Code of 1986, Section 2518, as amended from time to time. A disclaimant shall be deemed to have predeceased the event which caused the disclaimant's rights to mature. k. The Trust, and all Trusts created under it, shall meet the requirements of the Internal Revenue Code of 1986, Section 2033 through 2045, as amended from time to time. This is so that no part of the Trust shall be included in the Grantor's gross estate for estate or similar tax purpose. Therefore, the Trust provisions shall be construed, and each trust created under it, shall be administered, so as to meet those requirements. Section 10. Miscellaneous a. The Trust shall be governed by and construed according to the laws of the Commonwealth of Pennsylvania. b. The Headings in the Trust are inserted for convenience only and are not a part of the Trust. c. Whenever the context or the Trust requires, the masculine gender, includes the feminine or neutral, and vice versa, and the singular number, includes the plural, and vice versa. If the Trust refers to the death of the Grantor and there are two Grantors, then the clause shall be interpreted as the death of the last living Grantor. d. Except as otherwise specifically provided in the Trust Agreement, the determination of all matters with respect to what is principal and income of the Trust Estate and the apportionment and allocation of receipts and expenses, shall be controlled and construed by the Pennsylvania Uniform Trust Act (20 Pa.C.S. 7701 et. Sea.) as from time to time amended. Any such matter not provided for either in the Trust Agreement or in the Pennsylvania Uniform Trust Act shall be determined by the Trustee, in the Trustee's discretion. 8 IN WITNESS WHEREOF, the Grantor and the Trustee have hereunto set their hands as of the date first above written. J S H. SHANK, Grantor ~~~~~ ~ RONALD K. WILSON, Trustee ~j ~ J. LSON, Trustee COMMONWEALTH OF PENNSYLVANIA NOTARAL tEAt. /uONe ss. SPIINNEI'fII~IY T1MI 110RIf COIMIIY My Con~~ton a wr 30, 1013 COUNTY OF Notary Public My Co 'Sion Expires On this the ~ day of , 2010, before me, a Notary Public, the undersigned officer, personally appeare JAMES H. SHANK, GRANTOR, and RONALD K. WILSON AND MARY J. WILSON, TRUSTEES, known to be (or satisfactorily proven to be) the persons named herein and who executed the foregoing, and acknowledged that they executed the same for the purposes therein contained. NOTARIAL iEAI E VACCARO SPRINGE?TEe~ 1Vyp.1roRK COtlNflr Mp Commbsion ExptrK Mu ~. 2013 9 ~~ citizens Bank March 15, 2011 Scott W. Morrison, Esquire Center Square P.O. Box 232 New Bloomfield, PA 17068 Estate of James H. Shank Date of Death: Feb 20, 2011 SSN: 182-22-5675 Dear Sir/Madam: One Citizens Drive ROP112 Riverside, RI 02915 In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667. Sincerely, ~~~~ Heather Medeiros Decedent Account Processing REF#: 485671 ~~ Citiz~r~s ~ar~k. Account Number 6100706672 Account Title James H Shank Date Opened 6/6/1966 Account Type Checking Principal Balance as of DOD $22,380.71 Interest from Last Posting to DOD $ .88 Account Balance as of DOD $22,381.59 YTD Interest to DOD $1.18 "' ° NATIONAL ASTERN ~~~~, ~ ::Y .:,~~- ~~ ...~- ~ LIFE .INSURANCE COMPANY sso >rASTA TEMENT OFSACCOUNT-l~oz STA CURRENT ANNLiITY CONTRACT NUMBER USE THIS NiJMBER WHEN YOU NEED SERVICE o t o t 248425 DATE 12/3 t / t ~ ( OR MAKING ADDITIONAL PAYMENTS) ANNOUNCEMENT TO OBTAIN AUTOMATED FINANCIAL INFORMATION ABOUT YOUR POLICY OR REQUEST A STATEMENT OF ACCOUNT YOU MAY CONTACT US ONLINE AT www.nationalwesternlile.com OR THROUGH OUR AUTOMATED SHANK F AM I RR TRT 8/ t 7/ t O VOICE RESPONSE SYSTEM AT 1-SSSfi95-5001. -p-,.~ FOR- JAMES H SHANK YOU MAY ALSO REACH OUR CLIENT SERVICE DEPARTMENT OLL FREE 1-800-922-9422. THE BEST TIME TO CONTACT US 1 OO MOUNTAIN VIEW RD AT T IS BETWEEN9:00-11:OOA.M. CENTRALSTANDARDTIME. SHERMANS DALE, PA t7ogO PLEASE NOTIFY US IMMEDIATELY OF ANY ADDRESS CHANGE ACTIVITY DETAIL FOR THE YEAR DEPOSITS DATE RECEIVED DEPOSIT ~ DATE RECEIVED DEPOSIT DATE RECEIVED DEPOSIT o8/t9/to 90,000.00 o8/t9/to 90,000.00 o8/t9/to 90,000.00 o8/t9/to 75,500.00 NOTE: THE STATEMENT MAY NOT REFLECT THE MOST RECENT PAYMENT DUE TO RECEIPT AFTER STATEMENT DATE. TOTAL DEPOSITS 345,500.00 TOTAL WITHDRAWALS .00 ACCOUNT SUMMARY NOTE: INTEREST IS EARNED DAILY AND IS COMPOUNDED ANNUALLY ON THE POLICY 2g2 .59 s` 3 t 5 7 7 ANNIVERSARY. IF THE VALUE WN AS A , NET SURRENDER VALUE AT STATEMENT DATE SHOWN IS WITHDRA LUMP SUM. IT MAYBE oo SUBJECT TO AN EARLY BALANCE AT START OF YEAR FROM PRIOR YEAR END STATEMENT............ WITHDRAWAL PENALTY. PLEASE REFER TO YOUR 5©0 ' ~o RING 345 CONTRACT FOR EXACT , PLUS DEPOSITS RECEIVED DU TEMENT PREIOD (SEE DETAIL ABO VIA,) ............................. CHARGES. ANY WITHDRAWALS SHOWN HERE STA . • ... • • . 4 , 025 . t 0 PLUS INTEREST EARNED (INTEREST IS COMPOUNDED WILL INCLUDE APPLICABLE SURRENDER CHARGES. • • • • .... ANNUALLY ON POLICY ANNIVERSARY).......... . .00 LESS ADViINISTRATION CHARGES AND PREMIiJNI TAXES ................... . 00 LOAN BALAANCE .............................................. . .~~ LESS WITHDRAWALS ............................................ 350,325.to BALANCE AT STATEMENT DATE ................................. . -~- /,.,~, G~~, -,:~rf~~~~V~r~~- l/L' UGC-.L- .~,~ v~(~ 6~~,/~ NEW DEPOSITS ARE EARNING 2.000 .~.-~!/~l ~iyt 'r - . ~~ IN THE EVENT OF A SURREVEERESULTS AND/OR PENABTIESBONCPREVIOUSAPARTIALLWETHDRAWALS~~A6oa WITH A POSITIVE OR NEGATI anaaoi 3n3aOj SS ~~ a+ 'filrx - ~ - ~ W t t~- 4 tr y dl?1Si11. 5~ ~ .-3H i 'Y ~ ~t A v 1: ~ "'IS t ~~~ ~ ~ ~ L. .~~.¢M ~ ~ -mod" ! ~ ''~.~ v ~ ~' } ~ - ; ~° ,. - rr _ ~ ~ ~ ~-ate t 1, _ g ~ c "'f t ~ _ ~'.1 ~ _ ..~ Y ! - ~ vE,tT y~ , ?,, ~ ~~:, r ~4~~ ~ ~ ~ ' -t <'t {X t ~ ~ •~ • a ' tii L_ try ~, ~Z-'' a .~' & t~^' !c~y'~~ ~ '~£ as C~ K F~ ~~ .Tyti•~~`. H " w ~~ ~ fi ,~,. .~ ~ Cdr ~ ~_ + d Xi" ~ ~ ~~.~ r e T... p,~ °~`.: ~~ ~`' ,~yz t ~ ~ _ ~ Q +~ r ~ tip: ~. .F~"~ t p ~ cn .1 x'y y ~. ~ ~ ~ i / L p~ , ~1~~ I ~ yQ ~~ C ~ ~ II i, ~ ! if .. __ i ~ ~~:- ~ ~, ~ ." ti .4tP . _ ~, `s~- ~r ~ ~k'' i Ili ~I II ~I l~ i a ~ x i t ~. ;'~„ 5 3X.. f t?'~ ~' .~. a X41;' ~'s su. r,x, ~. t ' w `r, r ~.. ~,, ~' +. ~ ,r .. - i ~ - f*,. r ~. a.,~ fir. ,~ ,r..x ,i, _w° - L r ~ ~? r=- III' a. ~i" ~~ t r ~ is I ,. i 't' •4 ._ '~i o ~ ' _. n° ~' . _.. - ` c5~. - _ ~,__ - k 7 - - - i -r... ~r._-. r - n. x, ~. t 7f~ F-d '~ .:~r .c•~r '~ - - 4 ~l~ ~ _ r ~ '~ ~ nJ_~G J =y )~~ L~ 1~L'f i~?-`~ r. 4 ` { 4~; - .".'6' k ~ a i ?-.. ~ _~ w ~ ~ ~~~T".~ h ~~N' '~ 1-+. ~ ~ 5{Z -~f R ~~,. i '~15~a4 • t' 't °"'t~ y YaS r ~, '"r ea '~ S u .,~1 ~ ~ ~ { ~~` Y ~Y~ ~~ r ~~ ~7 t~ ~ ~~, j~~, iP,~, ~+/v~,~u 1~;~=~ .. '~' .y y4~ } f ' - 4. ~ 4 5 '.~ "~` 7. +` +} v ? ` r ' f' ,~ " . 44 4 y r "1 ; 1"RY;`r t T :~ ~ ~ ~ ti_ 7 .~ .. ~" ~ ~,,' 7o- '~ • ~ ~ ~' ~~ r '.+c ,~n A' ~ '~+f F- {r .~~ ~v ^ „L i~ _ k ,fit, 4 .~eKw~ a i 1. y~ A r~,yy ~ ~t,~ ~~ L ~ +y':. .Y,..w,~.f ~ ".~} ~..n ..Y ,,.,~K..-.~r1 e,a H y~~'k ~a 1..~ _~.Y..fi_YY~ f -e.w. ~ ~'" 4"~ ~. +, ~. '`.:z~ a 3K~ ~<n ~ ~` 6 ~ ~ YZ' ~^' x 'F'+ 'r ', J" a ~'~ ~ 5~e ~,Y ~-. ~ 4, . < ~~, rt,i ~ ~ rats ~s "~4a s. ~ ~ ~~ ui~r c ~, t Z t ~~ ~'' ,.y ~ Y"y i ~~ ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: REV-1162 EX111-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 014543 WILSON RONALD K 100 MOUNTAIN VIEW ROAD SHERMANSDALE, PA 17090 told ACN ASSESSMENT AMOUNT CONTROL NUMBER TOTAL AMOUNT PAID: 512,945.27 REMARKS: RECEIPT TO ATTY CHECK#112 INITIALS: CJ SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS