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Home My WebLink About08-30-11„~ Exro,_~a~ Z5L1563,Q14 PA Department of Revenue .~ Bureau of tndividuai Taxes op~,~n~y~va~,f~` OFFICIAL USE ONLY PO 64X.280601 Gounly Code Year Harrisburg, PA 17128_0601 INHERITANCE TAJC RETURN Ede Ncrmcer ENTER DECEDENT fIVFORMA?'!ON BELOW RESIDENT DECEDENT 21 ~- 0 ~ Z 2 2 0 Social Security Number Date of Death 0 5 4 14 1714 Date of Birth ~~ lg aolo og ag Decedent's Last Marne 1 91`7 C H OMYN Suffix Decedents First Name PETER nn! (If Applicable) Entet-Surviving Spou3e=S information Beiow 'T Spouse's Last Name CHOMyN Suffix Spouse's First Name BERTHA MI Spouse's Social Security Number M THIS RETURN MUST BE Fll~ED IN DUPLfCATE ~yTH THE i=1LL iN APPROPRIATE pyALS BELOW R~GISTE~, QF WILLS ~ 1. Original Return d 2. Supplemen#al Return [] 4. Limited Estate ~ 3. Remainder Return {date of death (] qa, Future Interest Compromise {date or death after f2-12$2 pr+ar to 12-~ 3-82) (~ 5 F i~ ~. O~ent Died'reslate (Attach Cagy of WiU) ® 7, Decedent AAaints+nad a Livin 7 . ederal Es#ate Tax Return Required O Q 8. Litigation Proceeds Received g rusl {Attacks Copy of Trust} __ 8. Total Number of Safe t7eposi# Boxes ~~ ~~ CO [~ 1 p, Spouses! Poverty Credit (date of death between 'f2.31-91 and 1-~-95) D 11. Election to tax und FtRESPONp6~T - TyfS SECTIpN MUST BE COMPLETED. ALL COFtR~Sp01~Dt~tCE Name er Sec. 9113(q) (Attach Sch. O} ROBERT W KING gFlD C QNFIDENTtAL T/V( lNFpRMATION $ypULp BE DIR>;CTEp Tp; Dayteme Telephone Numt~Cer; 724 8~~ 150g::: ~ ~-, ti, ~ :.mot,. ~ ~„-,..,~ First line of address REGISTE~LS U~` tafVL~* 114 NORTH MAPLE AVENUE .~._ .~ ~~~ ~ . Second line of adt#ress , ~ ~ =n - T- rty or Post Office { ~' GRE E N S g UR G State ZIP Code DATE FILED PA 15601 Correspondent's a-mast address; _ Under penalties of perjury. I declares it,~r r r....._ ---- it is 1r.... -~ --' '"'"" "'` °jQ cofrtptete. Declaration of preparer other than the personal representative is based on aII information of which r t re um, inc}uding accompanying schedules and statements, and to the best of my know+ladge and belief SIGNATURE OF PERSON RESPONSBLE FOR F1UNG RETURN ,~ p eparer has any knowtedge ' 1DDRES Peter J. Chomyn iii DArE /~~. 2535 Iburne Drive exf d, PA 15090 IGN OF P PARER O7FiEi2 REPR _ .. . ENTA7IVE Rob®rt W King 114 North Mapie Avenue, G sburg, Pq 15601 DATE ~Z Z .- L 15056bpyy3 Side 1 15o5~1a14~ J (~ J ]~5056Z0243 REV-1500 EX ~ecedenYs Name: _ _ CHOMYN, PETER J. Decedent's Social Security Number RECAPITULATION --- --- --- ------ _---~ 5 4 14 1 71 4 1. Real Estate (Schedule A) ................ ......................................................... 1. 2. Stocks and Bonds (Schedule B) ......................... .............. ........................................ 2. 3. Closely Held Corporation Part , nership or Sole-Proprietorship (Schedule C).......... 3 4. Mortgages & Notes Receivable (Schedule D) ......... ....................................... .......... 4. 5• Cash, Bank Deposits ~ Mi scellaneous Personal Property (Schedule E) ................ 5. 6. Jointly Owned Property (Schedule ~ ^ Separate Billing Re 7 I 33,475.65 . quested ............. 6, nter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. ~~ 8. Total Gross Assets (total Lines 1-7) .................. ....... 487,264.42 ......................................... _ ..... 8. 9. Funeral Expenses & Administrati 520, 740.07 ve Costs (Schedule H) .......... ........ ....................... 9. 10. Debts of Decedent Mort 12 , 714.2 7 , gage Liabilities, 8~ Liens (Schedule I) ..... ........................... 10. 11. Total Deductions (total Lines 9 & 10) ............................ 4 63.64 .......................................... 11. 12. Net Value of Estate Line 8 i 13, 177.91 m nus Line 11) ................... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12' an election to tax has t b S 0 7 ~ 5 6 2.16 no een made (Schedule J) ............. ............•.•..•.••.••.••....,.... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . ................................................ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 14 15. Amount of Line 14 taxabl 5 ~ 7 ~ 5 6 2 16 --- e at the spousal tax rate or ------. , transfers under Sec. 9116 (a)(1.2)X.oo 235, 000.00 15. 16. Amount of Line 14 taxable at lineal rate X .045 2 7 2 X 5 6 2 1 6 16. 17. Amount of Line 14 taxabl 0 . 0 0 e at sibling rate X .12 12,265.30 18. Amount of Line 14 taxable 1 ~• at collateral rate X .15 18. 19. Tax Due ............................... ...................................................................................... 19. 12,265.30 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L 1505610243 Side 2 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: Cho_m_yn, Peter J. STREET ADDRESS File Number 21 - 1 p _ 01220 y _rceswick Drive CITY Mechanicsburg STATE I ZIP PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. Check box on Page 2 Line 20 to request a ~~ tlPAYMENT. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE (1) 12,265.30 Total Credits (A + B) (2) 0.00 (3) _ 13.07 (4) (5) 12,278.37 Make Check Payable to: REGISTER OF WILL S, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PI,,,A CING 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 roe Yes No .............................................................. ^ ^ c. retain a reversionary interest; or ....................... P p ~ transferred or its income;............... II~~ x d. receive the promise for life of either a u 2. If death occurred after December 12, 1982, dedecedentftransferre~..••.••....•.••.,•.•••,...••~••~••~•~~~•~•~~••~•~~•~••~••~••~ .............................. x receiving adequate consideration? ............. property within one year of death without ^ .. .. 3. Did decedent own an "in trust for" or payable upon death bank account or sec 4. Did decedent own an Individual Retirement Accoun ^ ^ urity at Fiis or her death?......... contains a beneficia desi nation? ............. t. annuity, or other non-probate property which x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YE S, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. For dates of death on or after Julyy 1, 1994 and before Jan. 1, 1995, the tax rate im o spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. p sed on the net value of transfers to or for th For dates of death on or after Januarryy 1, 1995, the tax rate imposed o e use of the surviving [72 P.S. §9116 (a) (1.1) (ii)]. The stafute does not exempt a transfer to a sunrivin sous assets and filing a tax return are still a licable even if the survivin n the net value of transfers to or for the use of the survivin pp 9 p e from tax, and the statutory requirementsfor d sGosu erofnt For dates of death on or after July 1, 2000: g ~°use is the only beneficiary. • The tax rate imposed on the net value of transfers from a deceased child 21 years of a adoptive parent, or a stepparent of the child is 0 percent [72 P.S. 9116 § (a) (1.2)j. ge or younger at death to or for the use of a natural parent, an • The tax rate imposed on the net value of transfers to or for the use of the decedent's lin 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)). • The tax rate imposed on the net value of transfers to eal beneficiaries is 4.5 percent, except as noted in sibling is defined under Section 9102, as an individual who has at least one parent in com or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3) . q mon with the decedent, wfiether by bloo~ or adoption. SCHEDULE E CASH, BANK DEPOSIT ~1 COM1~pNyyEALTH OF PENNSYLVANIA S, & MISC^ INHERffANCE TAX RETURN PERSONAL P RESIDENT DECEDENT ~\ • `OPEI~TY __ -------- ESTATE OF y ~ ----- _' Chom n Peter J. -- --- i- ---- ---_____ ! F LI E NUMBER ~- Include the proceeds of litigation and the date the -------_ _ 21 - 10 - 01220 survivorship must Ise disclosed on schedule F. proceeds were received by the estate. All property •ointl ~ Y-owned with the right of ITEM -- NUMBER - ____ ---- _ DESCRIPTION VALUE AT DATE OF 1 Wachovia Bank Certificate of Deposit Account by Peter J. Chomyn Sr. _ Number 247402053868356 with legal title held DEATH 7, 935.93 2 Wachovia Bank Checking Account Number 1010185375 Sr. 115 in the name of Peter J. Chomyn 25, 539.72 TOTAL (Also enter on Line 5, Recapitul tt noa 33,475.65 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G ---RESIDENT DECEDENT- MIS TER-VIVOS TRANSFERS & __ ------ _- ___ --- - 'I C. NON- ---___ PROBATE PROPERTY ESTATE OF Chomyn, Peter J. ____ __ "_ ---- ____-_-_-- .This schedule must fie completed and filed if the --_ answe --_ ___ I FILE NUMBER ------__ _21 - 10 - 01220 r to __ ___ any of questions 1 through 4 on -- ITEM DESCRIPTION OF PROPERTY Page 2 IS NUMBER Include the name of the transferee -- ----- --------,_ --_--- - -- y@S. their l I , re ationship to decedent ----_________, - and the date of transfer. Attach a ---------- COPY of the de ed for real estate. 1 WaChOVla Bank Certlfl DATE OF DEATH % OF i ----- I VALUE OF ASSET ~I DECD'S EXCLUSION i INTEREST I (IF APPLICABLE TABLE VALUE Cate Qf pep0$It ACC Number XXXXXX ount xJ~JCX)C9557 opened on 7/7/2009 Legal Titl ) -' __-_ 27,481.70 ~ -o --L_----------------__- I 100 /o ~ , e: Peter J. Chomyn Family Trust 27'481.70 2 ~ Wachovia Bank Certificate of Deposit Ac Number)UCXx;~~( count x~'UCX955 9 I 42,798.95 o I~ ~ opened on 7/7/2009 Legal Title: Peter J. Chom n y Family Trust 100 /o 42, 798.95 3 'Wachovia Bank Ch eckmg Account Number 1149 opened on 8/25/2 ~ ~ I 37,55s.1s I o 100 / 010, Le al ~ Peter J. Tltl ~ i Cho 9 e. m yn Family Trust ~ o I ~ 37,559.16 ;' Morgan Stanley Smith B I~ ~ arne Management Account he ~ y -Decedent Financial I Id In the name f P i Ch ~ o eter J. oman Fa ~ mlly Trust U/A/D 11-03-1997, Acc I Number xxx-xxxxx-11 255 ~ i I . For holdings see tem ~~ 4-41 s I ~ i ,' 4 ~ 892 shares of AT&T Inc. at 28 I $ .325 per share I I 5 1400 shares of American Electric Power C 25,2s5.9o ° 100 /o I i ~ 25,265.90 I o. $35.895 per share Inc. at 14,358.00 o I 100 /o ' 217 shares of Co ~ 14, 358.00 i mcast C orp at $20.60 per share ~ 4,470.20 ~ 100° 7 ! 75 shares of Commonwe afth Real Estate Investment ~ Trust at $24 895 e /n ~ i 4,470.20 1 8s7 . p r share , 12 ° I 100 /~ I 8 ' 320 shares of Eric 1,867.12 ,~ sson LM Tele h one er P Co. at P share $10.41 I 3 331 20 I ~ , . o 100 /o I 9 ~ 200 shares of Firs t E j ~ 3, 331.20 ner 9Y Corp. at 3 $ 5.933 per share i i 7,18s.so i 100% 10 ; 6 shares of Five Star Quality Care, Inc. ~ share at $6.10 per ~ ~ ~ 7,186.60 I 3s.so o I 100 /o ~ 36.60 I I TOTAL (Also enter on line ~ Qe..,..:+._ • - ----r•~y~auvn) ~ 487 264.42 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF INTER- SCHEDULE G ' MISC. NON~VOS TRANSFERS & PROBATE PROPERTY ' -continued Chom ------__ _----_- __ yn, Peter J. ---_ -- ----- I FILE NUMBER - This schedule must be completed and filed if the answer to - -- ___ 21 - 10 - 01220 ITEM -_ --- __ ---- ---- ------- an of u __-__ __ Y q estions 1 through 4 on page 2 is yes. _-__-_~ NUMBER Include the name ofshe trans~eNree theirOrelationship to decedent -- ---?--- --- ____-___ __ - and the date of transfer. Attach a c DATE OF DEATH I % OF --- --` - opy of the deed for real estate. VALUE OF ASSET j EXCLUSION ~ 11.600 shares _- DECD's T of _ _ ~ axq General ---.__-___ INTEREST (IFAPPLICABL ~ BLE VALUE Electric C --- E~ share o. at $16.10 per ! 9 sso.o -- o ~ ~ 100 /o I ~ 9, 660.00 12 ; 100 shares of Hospitality Properties ~ ~ ~ Trust at $22.00 ~ per share 5 ~ ~ i 2,200.50 ~ 100% I ~ I ~ 2,200.50 13 192 shares of Medco Health Solutions I per share ' nC. at $60.26 ~ 11,569.92 100% ~ '~ 11 i , 569.92 14 ,' 800 shares of Merck &C o. Inc. at $35.095 er ~ p share 2 s,o7s.oo 100% i 15 400 shares of N ~ 28,076.00 extera Energy Inc. at $52.356 peg ~ 20,942.4p share 100% I 20, 942.40 I ~ ~ ~ 16 888 shares of PPL Cor ~ ~ pat $25.89 per share ~ ~ ~ I 22, 990.32 100 % ~ 17 ~ 420 shares of Pfizer Inc. at $16.72 per share I ~ 22, 990.32 I I 7, 022.40 100 % 18 i 400 shares of Piedmon I I 7,022.40 share t Natural Gas at $28.812 per 11,524.80 ~ 100G/o I 19 ' ! ~ 11, 524.80 200 shares of Progress Energy Inc. at $44.01 per ;share s,8o2.00 0, ~ 100 ~o 8, 802.00 20 ~ 30 shares of Senior Housing Properties Tr I $22.88 per share ust at s8s.4o o I 100 /~ I 686.40 21 j 10 shares of TravelCenters of ~ i America LLC at $3.34 I per share I 33.4o I 100% ~ I I i I i 33.40 22 ~ 333 shares of Eaton Vance Munic' i $12.065 per share ipal Bond Fund at ~ 4,o17.sa o 100 /o I I 4,017.64 23 ; 389 shares of Nuveen Prem~ Fund at $13.47 per share ium Income Municipal 5,239.83 o I I 100 /o ~ I ~ 5,239.83 I Page 2 of Schedule G i COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chomyn, Peter J. INTER-VICHEDULE G MISC. NON PROBq ~NSFERS & ------ _- continued PROPERTY I FILE NUMBER ________ ,This schedul st be completed and filed if the an -----,---- 21 - 10 - 01220 STEM _ _ ewer to any of questions 1 through 4 on page 2 is yes. NUMBER Include the name ofshe transfere0e theirOrelationship to decedent T ~-_-__- -- _ _.__-____ and the date of transfer Attach a I DATE OF DEATH ~ % OF ~ ----- --------~_ copy of the deed for real estate. VALUE OF ASSET DECD'S EXCLUSION 24300 shares of RBS Capital Fundin T ~ INTEREST i (IFAPPLICABLE) I TABLE VALUE $15.51 per share 9 rust VII at ~ -----~---------__;________ 4,653.00 100% --___ I' _ 25 4,620.765 shares of Inv esco Tax-Exempt Securities Fund Class Y at $10 55 ~I 48 748 91 j . per share , . o ~ 100 /o 26 ! 896.057 shares of Columbia Hi h Yiel ~ Fund at $9.609 per share g d Municipal ~ i s sll oo ! ~~ ~ , . o ~ 100 /o 27 i 856.898 shares of Franklin F e deral Ta I x Free Income ~ ,Fund Class A at $11 53 er h I i s,sso o3 i o . p s are . 100 /o I 28 ~ 991.251 shares of Oppenheimer Roch I ver National ;Municipal ALS Fund C ~ I 6 7s ~ ~ lass A at $6,84 e p share , o.o2 o I 100 /o ~ i 29.511.412 shar i es of Templeton Global O pP°rtunities Fund Class A at $17 58 s 9so 5s I . per share i , . 100% 30 ~ 5 Florida Housing Finance Cor . IVlul ~_ ds j with a maturity date of 12/1/23 l y d I I I 4,923.65 I ~ I 1 a 4.75°0 an eld 00E/o 31 10 Florida State Board of Education Ca Outlay ;bonds with a mat i 10 ur ty date of 6/1/24 and a 5 I ,243.90 0, 100 r° o yle d 32 10 Florida State Board of Educa bonds with a maturity date of 6/1/26 and a 5o0utlay i I yield 33 5 JEA Florida Water and Sewer S stem maturity date of 10/1/28 and a 4.625% yield ds with a 34 ~ 5 Miami-Dade Coun Flori I with a maturity date of 10/1 37 and Obligations bonds a 5% yield I 35 ' 10 Miami-Dade County Florida Aviation I bonds with a maturity date of 10/1/28 a Revenue nd a 5% yield I i 10, 344.40 I 100 %~ 4,913.25 I 100% 4,664.25 I 100% 9,611.10 I 100% 4,653.00 48;748.91 8,611.00 9, 880.03 6, 780.02 8,990.56 4, 923.65 10,243.90 10, 344.40 4, 913.25 4,664.25 9,611.10 Page 3 of Schedule G COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS T RESIDENT DECEDENT MISC. NON-PRO RANSFERS & -- --_----_ ---- _ BATE PROPERTY ESTATE OF ---- - ---__ continued - - -- - Chomyn, Peter J. - ---- -- _-_ =-___--- - __ __ This schedule must be c - I FILE NUMBER ------- 21 - 10 - 01220 ------ ---------- -- -- °m --- __ - P eted and filed if the answer to an f ITEM DESCRIPTION OF PROPERTY -~ i NUMBER Include the name of the transferee their l I y o questions 1 thr_uo h 4 0 g n Pale 2 Is ~----------- yeS. , re ationship to decedent -- _ and the date of transfer. Attach a co 36 PY of the deed for real estate. I 5 Nllami-~ade COUnty FlOrlda AVIatIOn R -+-- DATE OF DEATH I % OF I~ - VALUE OF ASSET I DECD'S ~ EXCLUSION _ INTEREST ! (IF APPLICABLE) ;I T~°-XABLE VALUE _ evenue bonds with a maturity date of 10/1/33 and a ~ 5% yield i __ 4,65s.2o I 100% --~ -- I ~ ~ 4, 2856 20 37 10 Miami-Dade County Florida He ~ alth Fa i ili ! i ~~ I c w th a maturity date of 8/15/26 and a 5 125%y bonds ; ~o,4a5.~o ~ 100% . yield i 38 120 Montgomery Cou t I I 10,445.70 I n y Pennsylvania Hi gher ! ;Education & Health Authorit b ~ 19'976•so ~ 1 y onds with a maturi date of 4/1/27 and a 5% yield ~ I 00% ~ ~ ~ 19,976.60 ~ 39 10 Philadelphia Pennsylvania I Gas Works Revenue bonds with a mat i i I I s o ur ty date of 10/1/32 and a 5% iel I y d , 84.30 10p% I ~ 40 5 Tampa Florida Rev I 9, 084.30 enue bonds with a maturi of 11/15/28 an o ty date d a 4.75 /° yield I 4,8~s.oo 100% 41 10 General Motors A I ~ 4,876.00 ~ cce tan P ce Corp. bonds with a I maturity date of 1/15/25 and a 7.15% yield 8'738'51 100% I I I I ,I ;' i i I ~ it I 8, 738.51 I I I i I i I Page 4 of Schedule G COMNONWE,q~TH OF pENNSY~VANIq INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Chomyn, Peter J SCI-E~UL.E H RISES & •,-` - Debts of decedent mu_ st be re ITEM -----------------__ ported on Sched__u__le I. NUMBER ~ ------ ------ ______ FUNERAL E)(pENSES: DESCRIPTION ~ 1 Malpezzi Funeral Home - Funer ------------- al services B. 4 5. s. 7. 1 TOTAL --- (Also enter on line 9, Recapitulation) 2, 000.00 20.00 70.00 430.00 400.00 32.00 FILE NUMBER -----? 1 - 10 - 01220 -- AMOUNT 2,447.47 ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions ' Name of Personal Representative(s) Street Address ~_ City State Zip ______~-, ! Year(s) Commission paid 2. ~ Attorneys Fees King & Guiddy 3. Family Exemption: (If decedent's a ddress is not the same as Gaimant's, attache Ian Claimant xp anon) Street Address ~ City --~'-~ ----- ~ ~ Relationship of Clai State Zip mant to Decedent • ; Probate Fees Grant of Letters I I Balance Due on Letters ! Account Accountant's Fees ~ ! ~ Tax Return Preparer's Fees Mason Fin ~ ancial Services ! Other Administrative Costs Register of Wills -Short Certifica tes I i ~ I ~ ~ ~, i 7 4.17 COMMONWEALTH OF PENNSYLV I H INHERITANCE TAX RETURN ANIA F(,,'~ ___ ___ RESIDENT DECEDENT ----- ----_- = i- _ ESTATE OF Chomyn, Peter J. ----____ 2 Register of Wills -JCS Fee ---- -- ------------___ 3 Register of Wills -Fee to file Will 4 Register of Wills -Automation fee 5 i Cumberland Law Journal -Estate ad vertisement 6 I The Sentinel -Estate Advertis ement 7 Register of Wills -Fee to file Invento ry 8 !Register of Wills -Fee to file Inheritan ce Tax Return 9 ~ King & Guiddy -Attorney Fee Inci dent to the Administration of the Trust i it FILE NUM EB R 21-10-01220 it Page 2 of Schedule H 23.50 15.00 5.00 75.00 166.30 15.00 15.00 7,000.00 COMNONyyE,gLTH ~ PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT M LIABILITIES, & LIE RTGAGE NS ESTATE OF --~- - --- Chomyn, Peter J. -- -- - ~ =- ------------_- I FILE N MBU ER -------_ -- _ ________ ~ 21 - 10 - 01220 Report debts incurred by the decedent prior to death that remain ----- ed unpaid at the date of death, including unreimbursed medical ex penses. ITEM - _ NUMBER ------ - -- ___ DESCRIPTION - 1 Cumberland Law Journal -Fee Advertise Trust AMOUNT --- -- ------ 2 Wachovia Checking Account XXXXXXXX5115 - p 75.00 outstanding checks issued prior to death and presented fors checking account total of Payment after death. 388.64 TOTAL (,also enter on Line 10, Recapitul t na oiof 463.64 REV-1513 EX+ (11-05) 1 . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETUR SCHEDULE J ___ RESIDENT DECEDENT N BENEFICIARIES ESTATE OF -- ---~ --_ --_ _ -__-- Chomyn, Peter J. -. ---- ----------- NUMBER NAME AND ADDRESS OF PERSON(S) - - -------__--__ RECEIVING PROPERT RELATIONSHIP TO ~ D Y I !TAXABLE DISTRIBUTIONS in ----- [ clude outright s o ECEDENT ~ --~_--Do Not Llst Trustee(s) _ p usal distributions, and transf ers under Sec. 9116 (a) (1.2)] 1 Peter J. Chomyn III, Trustee of the Peter J. Chomyn Family Trust 2536 Shellburne Dr j Trust . Wexford, PA 15090 ~. i I I I TOTAL OF PAitT ~I _ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON L -------_ INE 13 OF REV-1500 COVER SHF~ FILE NUMBER --_-- _ __ 21 - 10 - 01220 SHARE OF ESTATE AMOUNT O EF STATE (Words) ($$$) i 100% Residue Estate ,I Enter dollar amounts for distributions I shown above on lines 15 throu h 18 o I NON-T g n Rev 1500 cover sheet, as appropriate. IA. SPOUSAB DISTRIBUTIONSNUNDER S ECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN i I i B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS i I 0.00 --- ~.t~~r~t 3~f1I ~n~r C?P~~~zmPn~ o~ . PEER -~. ~~-iOiViYN I, PETER J. CHOMYN, of Lee County, Florida, bein of mind anr! memor 9 sound and disposing y, and fully aware of the uncertainties of this life, do hereb this instrument to be m Y declare y Last Will & Testament, and hereby revoke all prior wil codicils. fs and ARTICLE I. I direct that my legally enforceable debts, funeral ex ens expenses be paid as soon as practicable after m p es, and administration y death. ARTICLE II. I devise the rest, residue, and remainder of my estate, of e description, which I now own very kind, nature, and or hereafter acquire, or have the right to dispose of at the time of my death, to the then acfing Trustees of th PETER J. CHOMYN TRUST, dated at inter vivos trust named the _ ,~. that all of the above assets pour ov ~ ~ 997, that it is my wish er into that Trust; by this devise and bequest I do not incorporate by reference the provisions of said Trust . created by said TRUST AGREEMENT ~ but enlarge the living Trust (which living Trust has independent significances) so that the property so devised and bequeathed to the sal after being received by said Trustees be blen P d Trustees shalt immediately d.,d with and thereafter be administered and accounted for in a!I respects as an integral part of said and, accordi i livin9 Trust as so enlarged n9~Y, the receipt of said Trustees for the property passin to Will shall ba r complete ciischar a of ~ 9 there by this g ~Y Personal Representative: Last Will & Testament Of PETER J. CHOMYN Page 1 - _ ir/~.~ ARTICLE 111. 1 appoint my son, PETER J. CHOMYN, JR., as the personal re rese estate. If my son, PETER J. CHOMYN, JR. is unwilling or un p ntative of m~~ able to act as my personal representative, then I appoint my grandson, PETER J. CHOMYN, III, as th representa~ve of m e personal Y -estate. i dire:, c;,~,; no bo~,d be required of the personal representatives named herein. In additior, to, and without in any wa li powers conferred upon m P p y Y meting the Y p .rsenal re resentatives b law, I vest my personal representatives with full povuer and authority to sell, transfer, or conve an real or personal, which I own at the time of my death, at s y Y pfOperty, terms fiepluding credit), as m uch time, and upon such y personal representatives may determine, and to do every other act and thing necessary or appropriate for the complete admi ' nistration of my estate. On .~~L'~.9yd,,~,,~•~;,~ L~, 1997 in the presence of the undersigned witn PETER J. GHOMYN 1 - 1997, in our presence, PETER J. CHOMYN signed this instrument and declared it to be his Last Will & Testament. !n his presence and in the presence of each other, we hereunto sign our names as attestin wi 9 tnesses, in Lee County, Florida. `~ ~ /i ~7 , -- ,f 1 ~,~/~, 1 ~ ~} ' .... .. Witness ~ ~--~"cZ~.c~ c:~,_ ~~ Last 'Jl/ill & Testament Of PETER J. CHOMYN Page 2 -, ~.' -;~ SELF PROOF OF WILL State Of Florida County Of Lee We, PETER J. CN~MyN, thr rpc*ztCr, and the witnesses, wh«.sP Harr. :_~~6 ~. ~9 e„ are: and whr/~; names are signed to the afi~ached or foregoing instrument having been sworn, declared to the undersigned officer that PETER J. CHOMYN, in the of the witnesses, signed the instrument and declare Presence d rt to be his Last Will & Testament, and that each of the witnesses, in the presence of PET ER J. CHOMYN, and in the presence of each other, signed the will as witnesses. ,..._, j ;.L ', r r Witness l f~~ • -' Ic ~~.i .~ Witness .~ ~.._,~ i~ , The foregoing instrument was acknowledged before me this ~~~ of • .j ;~ ~ ---- day "~ t- 1997, by PETER J. CHOMYN, the testa _ tor, who ( is personally known to me, ( )has produced ______`_ --_. as identification, and ! ~~~~ ~. ~~~ and ~# +~ ~'~ ----- ~~~!JEhe witnesses ~vho are personalty known to me. ~ ~'' ~ ,~~ ,~ -~-z/ , Not f .~ ~-~--~^=~~~~c~ ary Public ~...Go, ~ - r .. ,~P,tiY P~ OFFICIAL N ARY SEAL ate: -.. -~ _ ~' U _ ~~ RALPH A RICHAROSON -rc ~~-~!4j~2 /~ COMMISSION NUMBER ,~'`~• s~`~ Eli ,~, ; ~ :~':_a~ Fi~yCi~ MV GOMMI9SION EXPIRES `~ ~ '^ Last Will & Testament Of PETER J. '~ ~~ ~~~' ~ ~ W xF 0. W ~ F- ~ -'- O ~ O ~ Q U~zQ ,~ F. Q W O N G'"~~~M ~`'~ M ~ ~ ~ Q U ~Z~Q ~ N i..7 O E F,UQU Cry W ~¢ i U ~ n U~ [ -~ . ti c ~ ~a~~W ~ -O ~ ° rlj ~ Wa~~~'' a Q N ~ J 'ti ~ C1 E-' W L'" > ~ av spa ~U'" a c "' A~~~'"v ' z w~ ~ W ~ ~ ~ y a ~ ~ ~ ~'I r-y ~ ~ W PET R t C_MYN ~~-n11 v ~... This Trust Agreement made this~~~ - day of between ~ ~ 997, by and PETER J. CHOMYN of Bonita S rin s P 9 ,Lee County, Florida, hereinafter called the Settlor, and PETER J. CHOMYN, or his successors, hereinaf ter called the Trustee. WHEREAS, the Settlor hereby revokes all Amendments to such Trust Agreements; prior Trust Agreements anti (Whenever the words "Trustee" and "Settlor" ar singular and a found, they shall include the plural and all genders.) TI NAME F TRII T This trust shall, for convenience, be known as PETER J. CHOMYN Fq/yj~ y TRUST the . dated 7997, and it shall be sufficient that it be referred to as such or devi e. many deed, assignment, bequest TI CR F P A The Settlor has paid over, assigned, grants delivered d, conveyed, transferred and and by this Agreement does hereby pay over, assi n 9 ,grant, convey, transfer PETER J, CHOMYN FAMILY TRUST Page T ~-- and deliver unto the Trustee the property described in Sched made a part hereof, and an ule A, annexed hereto and y other property that may be received or which has been received by the Trustee hereunder, as invested and reinveste ._ as the "trust estate" d (hereinafter referred to ), which shall be held, administered and distribut as hereinafter set forth. ed by the Trustee r !C S T N RING I IFE OF ETT nR . (A) ~P~SlT10N OF INCOMc onto ~ PU The Trustee shall hold, manage, invest and rein vest the trust estate (if any requires such management and investment) and shall collect therefrom and shall dispose of the net income a the income, if any, , nd principal as follows; 11) During the lifetime of the Settlor, the Trustee shall pa to benefit of the Settlor, or to such person or y or apply for the: persons and in such proportions as he may, from time to time direct, all the net income from this trust. (2) During the -ifetime of the Settlor, the Trustee ma ' benefit of the Settlor such sums from the princi y pay to or apply for the pal of this trust (even to the point of completely exhausting the same) as in his sole discretion shall advisable frorn time to time for the health, su o be necessary or pp rt, and maintenance of the Settlor, taking into consideration to the extent the Trustee deems advisabl or resources of the Settlor known to the Trustee, e, any other income f B) I ,yT Tp AD Tp ORPU~ Either the Settlor or any other person may, at any time and fro m time to time add property, acceptable to the Trustee, to the trust estate limitation, the proceeds of fife insurance made ~ Including without payable to the Trustee. fC) RIGi~T TO REVOKE AR~_E„D The Settlor reserves the right during his lifetime, except durin an 9 y period when PETER J. CHOMYN FAMILY TRUST Page 2 ~: he is certified incapacitated by two doctors as s et forth in ARTICLE IV, at any tirriE; and from time to time and intended to take effect in his lifetime, by an ' writing, signed and acknowledged b instrument in Y Settlor and delivered to the Trustee: ~ ~) To revoke this instrument entirely and to rec ' slue from the Trustee all t-•ust property remaining after makin g payment or provision for payment of all e connected with the administration of this trust; (2 Xpenses ) From time to time to alter or amend this instrument in any and every particular; (3) From time to time to change the identity or number, or both, of the Trustee• withdraw from the o ~ and (41 From time to time ~~to Aeration of this trust any or all of the trust property, fD) ~N IB E p~RSONAt PRnoz.. , ~v~ rcTt Settlor's household and personal effects, furnitur e, furnishin k articles of personal 9 and equipment, domestic or household use or ornament, Jewelr equipment, and items of a like or similar nature vvhic y' sporting and owned by Trustee shall remain in the h may have been transferred to care, custody and control of Settlor so long as he shall live and is not disabled; and Trustee shall ' r with respect to such have no responsibility or Liability property during that time. (E) G T T---O 1N_~URAI~rF P~,i I I The Settlor retains during his lifetime all rights un to the Trustee, includin der insurance policies payable g the right to change the beneficiaries, and to assi policies to any lender as security for an 9n any y loan. The rights of the assignee of any policy shall be superior to the rights of the Trustee. If an be revoked with respect to it. D Y policy is changed, this trust shall wring the lifetime of the Settlor, the Trustee shall have no responsibility with respect to any policies fort _- otherwise, he payment of premiums or IF) ~ SPO ITI OV SD R In addition, for my lifetime, I shall be entitled to fu II use and possession of any PETER J. CHOIVIYN FgMILY TRUST Page 3 ~~ non-income producing real estate owned by the Trust, s residence. pacifically including my ~BIICL~ ~A-?ARTY ANn Rcu ^ o~~ ~.r - - ~r, i N ,~ ff the Settlor, Trustee or his successors, is u . . nder a legal disability or by reason of illness, or mental or physical disability is, in the writte . n opinion of two doctors currently practicing medicine, unable to properly manage his affairs, he shall be ~ deemed incapacitated for the - purposes of this Trust Agreement. The Settlor, Trustee or his successors, deemed incapacitated under this Ar rehabilitated when he is no longer under a t~cle, shall be deemed legal disability or when, in the written opinion of any two doctors currently practicing medicine manage his affairs. U -he is able to properly pon rehabilitation, that individual shall resume the duties and powers he had prior to incapacity and his successors shall relin uis be relieved of all duties. q hall powers and All physician s statements should be in writing, notarized anti attached to this original trust instrument. Third parties are rote such statements without any further act or noti p cted m relying upon ce; and no further act an the part of the parties hereto or of any court shall be necessary to vest in a successor Trustee the fiduciary powers and duties in the administration of this tru st. ARTI _~ ~ v ADMI iicTO ^ TION AFTFR BATH n~ crTT. „ Upon the death of the Settlor, the trust shall termin ~ ate and the Trustee shall distribute the trust estate, including any property received under Settlor's Will or otherwise, as follows: A• From time to time the Settlor may attach to this trust a signed and dated document which will indicate the distribution of certain tan ible 9 personal PETER J. CHOMYN FAMILY TRUST Page 4 ~..'- Pro ert P Y and said document is incor orated g P herein by reference thereto. At the time of the execution of this the PE7 TRUST I ER J• CHOMYN FAPVIILY am married to BERTHA MAY STUCKEY CHOMYN. marriage we entered into that certain Antenu tia Prior to our our respective p I Agreement concerning prope~1eS, In connection with said Agreement the h residence therein referred to ome • was sold and its replacements is the home we are residing in on the execution of this Will. ., Additional) ~ ~ " Y, I ratify and confirm other portions of the A ree whereby we have g meet purchased properties in our joint names with rights t~ survivorship and that all other provisions of said Ant f h shall continue unabated and enuptial Agreement unchanged unless hereafter amended by agreement between ourselves, and not withstandin an f thereof, I, in addition tv the terms of said g Y °ther provisions cash sum of TEN THOUSAND Agreement' hereby devise the AND NO/100 DOLLARS n-Y wife gE ($10,000.00) to RTHq MAy STUCKEY CHOMy C N, if she survives me. AN of the rest, residue and remainder of the , Trust assets shall be distributed in equal shares, share and share alike in ONE THIRD the fol-owing manner; 1. (1/3) to my son, PETER J. CHOMYN, JR., and his wife, PAMELA CHOMYN, or the survivor thereof. 2 • ONE THIRD (1 /3) to my granddaughter ' HOLLY CHOMYN, if surviving, and if not surviving, then this share shall la distributed in a pSe and be qua) shares, share and share alike among the remaining residual heirs. 3. ONE THIRD (1/3) to my grandson, PETE ---- R J. CHOMYN, III, if surviving, and if not surviving, then this share shall la distributed in a pSe and be qua) shares, share and share alike among the remaining residual heirs. PETER J. CHOMYN 1=gIVI~Ly TRUST Page 5 E: ..... _ _ ~.'` a• No beneficiar ` " - ` y shall have the power voluntarily or involunta ' alienate, conve r~lY to sell, y, assign, transfer, mortgage, pledge or otherwise dispose of or encumber any interest in his or her share until ph sica Y !distribution or payment is made to his or her creditors or to ' execution, sequestration Judgment, levy, k ,garnishment, attachment, bankruptcy or other insolvency proceedings, or any other legal or equitable roc p ess. OS T D Prior to the distribution of property under ARTICLE IV of this Tr the Trustee may, in his sole and absolute discretion, a ust Agreement:, from the principal of the trust estate, such p Y to the estate of the Settlor amounts as may be needed to pay all or any part of the Settlor's legally enforceable debts, funeral expenses expenses of the Settlor's estate, together with all es administration tate or other death taxes, including any penalties thereof. f_ LE I (A) S C ESSOR TRt i Tyr If PETER J. CHOMYN dies, resigns, refuses or is at any time un Settlor's son, PETER J, CHOMYN, JR. shall be s able to act, then uccessor Trustee and shall have all the powers and discretion of the Trustee. If Settlor's son, PET dies, resigns, refuses, or is at any time unable ER J' CHOMYN, JR., to act, then Settlor's grandson, PETER J CHOMYN, 1I1 shall be the alternate successor Trustee and shat and discretion of the Trustee. No successor I have all the powers Trustee shall be responsible for acts or omissions of prior Trustees and shall be under no obligation to in u' q ire into the acts or PETER J. CHOMYN FgMILY TRUST Page 6 ~'~ k:.- ~. _ to examine the accounts of an Yone who w _ as a Trustee prior to the qualification of such successor Trustee. (13) .~STIT T rQ~ - T As often as the Trustee shall deem such action to be or to an advantageous to the trusts y beneficiary, the Trustee may, by written instrumen substitute Trustee with res t, resrgn and appoint ~~s pect to all or any part of the trust principal, includin property as to which the Trustee cannot act, an g Y person, or any bank or tru~;t company, within or outside the State of Florida, The subs ' of the trtie, polders and same under the su er t~tute Trustee shall have all p vrsron of the resigning Trustee, who shalt act as adviser to the substitute Trustee. The adviser m substitute Trustee b aY at any time remove the Y written instrument delivered to the substitute Trustee. removal or resignation of the substitute Trustee, the advise upon the r may resume the office of Trustee or may continue to act as adviser and ap oint P another substitute Trustee. qny adviser may receive reasonable com pensation for services as an adviser. (C) 1 NT -I- CES ~R ~ That should all of the named Trustees resign, die ° should a Trustee be dissolved or in some m r become incapacitated, or anner cease to legally exist, a new Trustee sha11 immediately be appointed by a majority of the beneficiaries (in interest not in number), or beneficiary, or guardian of same; should a m ' alorrty of the beneficiaries not agree to the appO1ntment of any successor Trustee, an Circuit Court of an Y beneficiary may apply to the y county in the State of Florida wherein the Jud e case is assigned, shall a ~ g ~ tO whom this ppoint a successor Trustee to this trust for as man is necessary; any Trustee, to resin Y times as 9 ,shall give any remaining Trustee thirty (30) days notice, in writing, of his or her intention; rf there are no r shall be given to at least one beneficiary, emaining Trustees, this notice (D) ~~ATI ~ roc T rsl ~ T r - r As compensation for services hereunder, the Trustee may, at his option, receive PETER J. CHOMYN FAMILY TRUST t Page 7 i,, t' { _ I„`'. reasonable fees for his services; in the case of a cor o according to the schedule of fees it then ha prate Trustee, it may charges fees s rn existence for trusts of comparable size. Such commissions may be charged currently or d eferred in the discretion oi` the Trustee. r. The Trustee shall have the right to make a re asonable charge each year for his ,,,; services in preparing income and other tax retur may be made to the corpus of the trust a ns for the trust estate. Such charge state or to the income thereof or partly to one and partly to the other in the discretion of the Tru stee. (E) ~BND Q ~~LIFICA7 ~nni No bond shall be required of m ~' y Trustee or any successor Trustee hereunder. The Trustee and successor Trustee shall not be r squired to qualify in any court and are ,~ relieved of the filing of any document and accountin to a g ny court. ARTIC VIII .LBUST S' POh~c^ f ', The Trustee shall have the continuing, absolute, discre ' with an tionary po~yef to deal y property, real or ersonal as free) as I p y might in the handlin of affairs, including the g mY own general power to sell any trust assets, whether real or erso for such price and upon such terms as the Trustee sees p nal, frt, without any court order. The Trustee's powers may be exercised independent) y and without the prior or subsequent approval of any court of judicial authority and n Trustee shall be required to inquire into the pro ri ° person dealing with the ~ p sty of the Trustee's actions. The Trustee and his successors and parties serving in thei power and authority conferred by Florida Statutes Sect' r stead, shall have the ion 737.402 as amended from time to time. In addition and not in limitation of an authority, and without application to an y Common law or statutory y court, he and his successors and parties PETER J. CHOMYN Fgl1/ll~Y TRUST Page 8 :~ -~ ..~,. ~.~~ _ _ ~, _ r~ - _. servin _ _ ~. gin his stead shall have the ._. ~ exercised in their sole discr powers and responsibilities described below, etron. ~ to be ~' To retain an diversification, risky property transferred to the Trustee ~`. ,non-productivity, or under-producti • ~ f egardless o f any lac. (B) vity, k of C ~t ~ A To hold, convey, exchan persona- or mixed, and an ge, or acquire an estate Y reinvestment thereof y interest in the trust ro stocks, bonds, notes ~ and to invest and reinvestpnran~ real, investment trusts or co other securities its affiliates. mmon trust funds ~ including shares Y real The Trustee shall have as 'shares of stock of an °f interests in any investments as one holdin Y corporate trustee or •~ wide a latitude in the selection and ma ' ' to the investments for Trustees as fixed b free of an or of an Y trust and shall not be restricged Y other jurisdiction. Y the statutes or laws of the State of Florida (C) ~ly~-~.€ To carry any insurance including public liabilit deemed advisable with an insured. Y. and to use insurance Y insurer against an proceeds to re Y hazards;, pair or replace the asset (~~ OW To borrow mone fro Trustee, and to y many (ender, includin pledge any property in the Trust, g the Trustee or an affiliate of the (E) N r; both, and to allocate d~vis~on or distribution at fair interests in d-fferent kinds or dis ro market value in cash or in prope~y anion P Portionate shares of ro kind or g the beneficiaries. P party or undivided (F) I.~~MINATION OF -rQ, To terminate the trust at any time the Trust continue the trust b ee shall consider it impracti intentions for creatin reason of costs, or other reasonable cause in Ii g this trust, cable to ght of Settlor's (G) ~ CIA INSTITUTIO ~ To sign checks financial institution, 'orders to withdraw or to owned b Also, to place sto make deposits on accounts at any y this trust, And included is the fight tonobtain ~ °n checks or on market, other accounts or investments and any assets deposit re ertificates of deposit, money gardless of any penalty involved or he right to withdraw or other accounts. early certificates of to borrow against certificates of deposit PETER .1. CHOMyN Fgl{/ll~y TRUST Page g ._ r~ - _ . ~;;;. ARTI IX THIRD PARTI~c n n~__ -I-R~~STF~~ S Slrye_ ,.-,-~,R~ (A} Banking institutions, savings and loan associations, insurance co brokerage firms as well as stock transfer agents and alf meanies, stock other third parties are authorized to rely on the provisions of this trust instrument and are exonera ted from any loss, claim or liability in relying on said instrument and its provisions. P• ' dealing with the Trustee and successor Trustees named hereunder are no `~rties t required to investigate or to see to the proper exercise of powers or to follow the dis osi ' p tion of money and/or property delivered to the Trustee hereunder. !B) The Trustee shall have the power and authority to designate the authorized signature on accounts with banks and brokerage houses and any other institution whether such signatories be Trustees or not, and all institutions relying on such authorized signatures are exonerated from any loss, claim or liabilit Accordingly, one of two or more Trustees, as well as non-fiduciar y y parties may be authorized signatories. (C) The certificate of the Trustee that he is acting according to the terms oft ' his instrument shall fully protect all persons dealing with the Trustee. ~-T1CLE X No income or principal beneficiary of any trust created hereunder shall have an right or power to anticipate, pledge, assign, sell, transfer, alienate ore y ncumber his or her interest in the trust, in any way; nor shall any such interest in any manner be fiabl . E for or subject to the debts, liabilities or obligations of such beneficiary or claims of a ny sort against such beneficiary. PETER J, CHOMYN FAMILY TRUST Page 10 f. ~;~ .!~ F ...~ .. TI .-,~.~ 1 FLORIDA ~ Al~~ This Agreement shall be construed and regulated in al the State of Florida, I respects by the laws of II SURV VOR ;,;; This Agreement shall be bindin g upon the heirs, personal representatives, successors and assigns of the parties hereto. ~. AR.~L+~E )CIII V y ,... In the event this Trust Agreement is found not to be a v ' and the Settlor cannot or chooses no alid Inter Vivos Trust t to amend in order to revalidate same, then this instrument shall be deemed to be a part of Settlor's Las sole WIII should the Settlor not have a Will i t Will and Testament (or the n existence) and incorporated therein by reference and enforced and carried out despite technical m d attars. IN WITNESS WHEREOF, PETER J, CHOMYN, has si Settlor, and PETER J, geed this instrument as CHOMYN, has signed this instrument as Trustee, to evi his acceptance of the Trust Agreement. dance - Signed, sealed and delivered in the presence ot: Witness ETER ' HOMYN Se for ~~~ , Witness PETER J. CHOMYN FAMILY TRUST Page ~ 1 C~~~~ The undersigned hereby accepts the trust imposed by the fo instru nt an agrees~to serve as Trustee upon the terms and regoing 1~rust conditions set forth. fitness - ~ ~~ PETER J. OMYN, Tr tee Witness ~~~ STATE OF FLORIDA COUNTY OF LEE We, PETER J. CHOMYN, .opt s. StUIiT~ L ~NWAY and are the Settior and the witnesses, respectively, whose names are signed to the attached or fore oin ~ sworn, do hereby declare to the unders' g g instrument, being first duly igned officer that the Settior individually and as Trustee signed the instrument as his Revocable Trust Agreement same as Trustee, that he signed, and that each of the N,i 'and accepted the Settior, at his request, and in the rese tnesses, in the presence of p nce of each other, srgned the trust as ~~ witness. PETER . CH YN '~ ~ 1 Witness f Witness ~-c~ The foregoing instrument was acknowledged before me thisc~~~ of __ day 1997 by PETER J. CHOMYN, the Settior, who ( is personally known to me, )has produced ~ as identification, and ?.t9R1 S. SRA9~~9 and U,v1~{"~ CQ SAY ,the witnesses, who are personally known to me and who did not take an oath. ~~~~~ Notary Public --'-'-- My commission expires: PETER J. CHOMYN FAMILY TRUST RY P OFFICIAL NOTARY SEAL p~P ~Bf RALPH A RICHARDSON * ~~ 13 /* COMAAISSION NUMSER Page 12 ~ ~ ~ CC56664! ~rF ` ~~~ MY CONIMI3SIOM EXPIRES ~F FAO JULY 1 2000 EA This Schedule is to be attached to the PETER J. CHO MYN FgM~LY TRUST dated ~ 997 by and between PETER J CHOMYN 1 PETER J. CHON-YN , as Settla~r and as Trustee. ~'~ The followin g property was delivered to the Trustee by the Settlor: ~~ ~ 7 . 2. 3. -~ A ~i „~ PETER J. CHOMYN FAMILY TRUST Page 7 3 ..-- Cl/.~ ~~ rIRST AM.~NDMENT TQ TI3E T'ETER ~. CHpMYN rAMILY 'T'RUST' PETER J. CHpMYN, as Settlor, made, exec uted and delivered a certain Trust Agreement dated November 3, 1997, in favor of PETER J. CHOMYN, Trustee; anal WHEREAS, the Settlor reserved the ri ht g at any time to amend or revoke the Trust Agreement in whole or in part; and WHEREAS, PETER J. CHOMYN now deli res to amend said. Trust Agreement as set forth herein and to retain in trust all of the as sets held therein; and WHEREAS, PETER J. CHOMYN, JR, has di ed and Settlor wisl~~,es to amend the Trust to reflect alternate distribution. NOW, THEREFORE, KNOW ALL MEN B Y THESE PRESENTS, that for and in consideration of the premises and intendin to g be legally bound, the Settlor hereby amend PETER J, CHOMyN FAMILY TRUST there s the to, as follows: 1• The Settlor hereby deletes that ort' P ion of Article V, Section {B) ~~, . • hereb devise the cash sum oT' TEN THOUSAND y AND NO/100 DOLLARS ($10,000,00 .., inserts in lieu thereof ONE HUNDRE ) ~~ and D TEN THOUSAND AND :~10/100 DO $1.10 000,0 , LLARS 2• The Settlor hereby modifies Article '~, Section (C) (1) to add, "If PAME~,A ~HOMyN should not survive then her share shall Ia se and be distributed in en„a~ hares, share arm n~..~___ ,.. ~~ 3. following: The Settlor hereby modifies Article VII Sect><on (A,), and inserts the -- ~--~~ ~ ~~l ~~~ reruses or is at an time unable to act then Settlor's randdau titer I30LLY CI30MY N shall be the alternate successor Trustee and shall have all the owers and discretion of the Trustee. In all other respects, the Settlor republishes and reconfirms THE PETER J. CHOIVIYN FAMILY TRUST dated November 3, 1.997. IN WITNESS WHEREOF, PETER J. CHOM YN has signed this Amendment this day of ~l~t, 5 200. ~~- ETER J. CI Iviyp ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. I, PETER J, CHOMyN, Settlor, whose name is si instrument, having been dui gned to the attached or fore oin Y qualified according to law, do hereby acknowled e that g g executed the instrument as my FIRST TRUST; that I signed it as my free and voluA~-~n NDMENT TO THE PETER J. CHOMyN ~ed and tary act for the purposes therein expressed. AMILY Z~ P J• OMYN Sworn or affirmed to and acknowledged before me b pe 2009, Y ter J. Chomyn, Settlor•, this 1 ~'~- day of otary t~~l~~....,., NQTARIgL SEAL DIANE M SMITH Notary Pubtlc MECHANICSBURG BORO, CUMBI:RLANDO~ ~~v C.:ammission Expires Jun 22, 2012 arrz~aavrT COMMpNWEALTH OF PENNSYLVANIA, . COUNTY OF CUMBEIZI.AND ss. We, the witnesses whose names are signed to the attac and according to law, do depose and say that we were d or foregoing instrument, bein dul instr~urient as his AMEN,~MENT TO THE PET present and saw Settlor sign and Xe calif ed CHOh~'N signed willingly and that he executedR J~ CHOMYIV FAMILY TRUST, that PET e the therein expressed; that each of us in the heaxin ~t ~ his free and volunt ER J. TO THE PETER M. CHO g and sight of the Settlor signed the A r the purposes knowledge, the Settlor was a~ FAMILY TRUST as witnesses; and tha MEIVDIVIENT he time 18 years of age or more, of soundtrno the best of our constraint or undue influence. nd d ~er no Sworn or affirmed to and acknowledged b re --__ day o f me this 2009. Notary public SECOND AMENDMENT TO THE PETER J. CHOMYN FAIylILy-1,RUS T PETER J, CHOMyN~ as Settlor ma de, executed and delivered a certain Tr dated November 3, 1997, in favoi• of PE ust Agreement TER J. CHOMyN, Trustee; and W~~AS, the Settlor reserved the r' fight at any time to arxiend or revoke Agreement in whole or in part; and the Trust WHEREAS, PETER J. CHOMYJV no w desires to amend said Trust Agreeme forth herein and to retain in trust all oft nt as set he assets held therein; and WHEREAS, PETER J. CHOMyN, JR. has died and Settlor wishes to amend t reflect alternate distribution, he Trust to WHEREAS a First Amendment to the Trust was executed on August 1 g 2 Settlor desires to modify P~'agraph #1 0 009 and f that First Amendment and confirmed Paragra h # Paragraph #3 , p 2 and NOW, THEREFORE, KNOW ALL MEN BY THESE PRESEr1TS, that consideration of the premises and intendin for and in g to be legally bound, the Settlor hereb PETER J. CHOMyN FAMILY TRUST Y amends the thereto, as follows: 1• The Settlor hereby deletes that , devise the cash sumo Portion of Article V, Section (B) ~~• her f TEN THOUSAND AND NO/100 D eby inserts in lieu thereof TAO OELARS ($'10,004,00)..." and H~DRED THIRTY-FIVE DOLLARS 5235 000.00. THOUSAND AND NO/100 2• The Settlor hereby modifies Arti cle V, Section (C) (f) to add, "If pAM ~HOMyN should not survive then he EI'A' r share .ahan ~,.__ _ e dictN;t,,.~..~ 3. The Settlor hereby modifies Article VII, Section (A), and inserts the following: If PETER J. CHOMYN, III dies, resigns, refuses or is at any time unable to act, then Settlor's granddaughter, HOLLY CHOMYN, shall be the alternate successor Trustee and shall have all the powers and discretion of the Trustee. In all other respects, the Settlor republishes and reconfirms 7,HE PETER J. CHOMYN FAMILY TRUST dated November 3, 1997. IN WITNESS WHEREOF, PETER J. CHOMYN has signed this Second Amendment this 23rd day of December, 2009. ~~y~~ ~_ PETER J. CHOM~' ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. I, PETER J. CHOMYN, Settlor, whose llama is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby aclaiowledge that I signed and executed the instrument as my SECOND AMENDMENT TO THE PETI~R J. CHOMYN FAMILY TRUST; that I signed it as my free and voluntary act for the purposes therein expressed. ~- n r ; PETER J. CHOMIN ~'~ '~ Sworn or affirmed to and acknowledged before me by Peter J. Chomyii, Settlor, this 23rd day of December, 2009. ~'~ Notary Public >`JOTARIAL SEAL DIANE M SMITH Notary Public MECF{ANICSBUk~ 9Gk0, C~Ih,'19ERlAiJD CNTY My Commission Expires Jun 22, 20) 2 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA, ; COUNTY OF CUMBERLAND ss. We, /"~v~(c'~~ ;~. ~J~ ~ c"~ J„ `~ and o the witnesses S~ ~'~ ~°2 ` ~~ ~ ~- ~-t ~ whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saws Settlor sign and execute the instrument as his SECOND AMENDMENT TO THE PETER J. CHOMYN FAMILY TRUST t PETER J. CHOMYN signed willingly and that he executed it as his free and volunt act for hat purposes therein expressed; that each of us in the hearing and sight of the Settlor. signed the SECOND A11~ENDMENT TO THE PETER M. CHOMYN FAMILY TRUST as ;iv'itnesses: an that to the best of our knowledge, the Settlor was at the time 18 ea o d and under no constraint or undue influence. ~ y ~ ~~g~or mo e;l of sound mind ~^~ _ ;' Sworn or affirmed to and acknowledged before me this ~:~~~~;,( day of ^~~ c'.~.-Y~~.,,.-c;~ 2009. _f. 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[ W Q ; , -,-. ~ ~ r ~ ~ , c ~ b I 2 F ~ ~ 4 ~ ~ C ~, °' N 4 S N ~ .? ,C C ~ ~!~ ~/~ ~ S ~ G LY LY, 9 ', E r L ~` ~ ~ v ~ ~ _ ~ a+ dd~ ~Z ~ ~ N ~ N ~ ~~. r ~ Ln 1~ ~ m -~ v ~,`,,... r., r ! i ~ t '`- • ~~; .~ ~: ~, ~, ti ' e. ~ LL ' N -- b'~~. ti ~O m ~ m I~ I i r KING &GUIDDY ATTORNEYS AT LAW 114 NORTH MAPLE AVENUE GREENSBURG, PENNSYLVANIA 15601 TELEPHONE (724) 836-1500 FAX (724) 83G-1G68 ROBERT W. KING MELISSA A. GUIDDY August 29, 2011 Register of Wills Cumberland County Court House 1 Court House Square # 102 Carlisle, PA 17013-3322 ~: Estate of: Peter J. Chomyn File Number: 21-10-01220 Dear Register of Wills: JONES MILLS OFFICE (724)593-2700 ~7 :~~~, 1 .. J.. ~°~7 F dry 1""~a` 1...,. _ ~;,~ ,~; .-._ _. ~ ~ . `r> ~~ -~ r.~ `~ . Please find enclosed herewith an Inventory and an Inheritance Tax Return, in du licate which I kindly ask be filed in regard to the above-referenced Estate. An extra copy of the Inpentor~ signature page of the Inheritance Tax Return are enclosed for time-stamping as well as a self ad y and a envelope for your convenience in returning the same to my office. dressed Enclosed are the following checks: 1 • Check number 1004 in the amount of $70.00 represents payment of the balance due on the grant of letters. 2. Check number 1005 in the amount of $15.00 represents payment of the fee to file the Inventory. 3. Check number 1006 in the amount of $15.00 represents payment of the fee to file the Inheritance Tax Return. 4 . Check number 107 in the amount of $12,278.3 7 represents payment of the inheritance tax. If you have any questions with regard to this matter, please do not hesitate to contact m office Y . i -2- _... .._.. ,. , k. Yours very truly;.- . i. 'i Robe: RWK:dm Enclosures: Inventory Inheritance Tax Return (in duplicate) four (4) Checks Time stamp pages Return Envelope August 29, 2011 INVENTpRY REGISTER OF WILLS QF CUMBERL.AND -------------------_..........----................................----._..._......................_...-----. COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYt_VANIA COUNTY OF Cumberland SS } Fite Numr,er 21 -10 - 01220 Peter J. Chomyn III ......................................-................--------...___....................-._.--------------------............ Personal Representatives} of the Estate of Chomyn, Peter J. deceased; depose(s) and says} that the items appearing in the -fallowing inventory include ail of the personal-asset---_------~----------~-~-~~---~-------~~~~~-~- and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed o osite inventory represents its fair value as of the date of the decedent's death, and that Decedent own s wherever situate Commonwealth of Pennsylvania except that which appears in a mernarandum at the end of this inv pp each item of said ed no real estate outside of the entory. I verify that the statements made in this Inven- '~ tort' are true and correct. f understand that false state_ ~-~~ --~~- _ _ _ _ ___ rnents herein are made subject to the enalties ~ - p of Peter J. ~om n I °~--~----..------.-...- .. .....................-------.._.._._._.........--~--------.._._.._....---------....._...-_. 38 Pa.C.S. § 4904 relating to unsworn falsification to y authorities. Attorney -- (Name) (Firm) (Address} (Telephone} DATE OF DEAT}i 7'{11812010 Robert W King King & Guiddy 114 North Maple Avenue Greensburg, PA 95fi01 724183fi-'[ 500 _.........------------------__........ -- - ... ------- !Supreme Court I.D. No.} 25820 BAST RESIDENCE g Keswick Drive Mechanicsburg, PA 17050 FIGURES MUST BE TOTALED DECEDENT'S SOC. SCC. NO, 054-14-1714 Personas Property Wachovia Bank Certificate of Deposit Account Number 247402053868358 with legal title held by Peter J. Chomyn Sr. 1Nachovia Bank Checking Account Number 1010185375115 in the name of Peter J. Chomyn Sr. Total Personal Property 7,935.93 25,539.72 33~~,475.65 C 7 Q _..... .~.~ -~_ ~, .-,-, `~ ~~ c~ t,, r _ ~ ~ ~' .~,° -., . -~-' , - ..o ~- ' - ~...... , ~ ~ ~ r,, , . p ~,: (Attach additional sheets if necessary) Total Personal Pro e p rty and Reai Estate $33,475.65 ~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 014913 CHOMYN PETER J III 2536 SHELLBURNE DRIVE WEXFORD, PA 15090 -'°---- fold REMARKS: RECEIPT TO ATTY CHECK#1007 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER REV-1162 EX(11-96) TOTAL AMOUNT PAID: INITIALS: WZ RECEIVED BY: REGISTER OF WILLS $12,278.37 GLENDA EARNER STRASBAUGH REGISTER OF WILLS