HomeMy WebLinkAbout03-15-12--~ REV-1500 Ex (01-10' ~ 1505610143
PA De artment of Revenue ~ OFFICIAL USE ONLY
p pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 80X.280601 INHERITANCE TAX RETURN 2 1 1 1 0 8 8 6
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW -
Social Security Number Date of Death Date of Birth
175 34 8183 07 28 2011 07 24 1942
Decedent's Last Name
KUHNS
Suffix Decedent's First Name
KAY
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
I
MI
® 1. Original Return ^ 2. Supplemental Return ^ 3_ Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ qa Future Interest Compromise
(date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required
0
® 8 Decedent Died Testate
(Attach Copy of Will) ^ y Decedent Maintained a Living Trust
(Attach Copy of Trust) -.-- - 8. Total Number Of Safe Deposit BOXES
^ 9. Litigation Proceeds Received ^ 1 p, Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
^ 11, Election to tax under Sec. 9113 A
( )
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO
Name :
HAMILTON C DAVIS Daytime Telephone Number
717 532 5713
~, ,
First line of address
20 EAST BURD STREET
Second line of address
SUITE 6
City or Post Office State ZIP Code
SHIPPENSBURG PA 17257
Correspondent'se-mail address: hdavis@Zulliinger-Davis.com
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REGISTER OF11U~S USE 41yLY
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DATE FILED - }
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is rue, rrect and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIG ATU E OF PERSON RESP SIBLE F FILING RETURN DATE
~_ MARY E. EUTZY
AD RE S -
151 GOODHART ROAD, NSBURG, PA 17257
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE -
DATF_
Hamilton C Davis
20 East Burd Street, Shippensburg, PA 17257
Side 1
1505610143 1505610143
ADDITIONAL Personal Representatives
KUHNS, KAY I SS# 175-34-8183 7/28/2011
Under penalties of perjury, the undersigned declare that they have examined this return,
including accompanying schedules and statements, and to the best of their knowledge and
belief, it is true, correct and complete.
2 Signature
Name
Address
City, State, Zip
Date
3 Signature
Name
Address
City, State, Zip
Date
4 Signature
Name
Address:
City, State, Zip
Date
5 Signature
Name
Address:
City, State, Zip
Date
6 Signature
Name
Address:
JILL I. KUHNS
467 OAK FLAT ROAD
NEWVILLE
PA 17241
City, State, Zip
Date
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF KUHNS, KAY ~ FILE NUMBER
21 - 11 - 0886
All real property owned sole)y or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a wilting seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
Attach a copy of the settlement sheet if the property has been sold.
_ -Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION
- - --_-_ __ DEATH
1 304 NEALY ROAD, N. NEWTON TOWNSHIP, CUMBERLAND COUNTY, NEWVILLE, PA 65,000.00
17241 (SEE ATTACHED SETTLEMENT SHEET). SOLD TO AN UNREALTED THIRD PARTY
AT ARMS LENGTH PRICE AND TERMS. SALE NECESSARY TO SETTLE ESTATE. SEE
SCHEDULE I FOR NECESSARY AND ORDINARY EXPENSES.
~ TOTAL (Also enter on Line 1, Recapitulation) I 65,000.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-_ __ -___
ESTATE OF KUHNS, KAY ~ FfLE NUMBER
__ _ -__ 21 - 11 - 0886 ----
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM -- -- --- -- -
NUMBER DESCRIPTION VALUE AT DATE OF
-- -__ __ _ DEATH
1 MEMBERS FIRST FEDERAL CREDIT UNION SAVINGS ACCOUNT NO. 138903-00 13,958.57
2 PNC CHECKING ACCOUNT NO. 5140409695 (SEE ATTACHED VALUATION) 22,468.37
3 PNC SAVINGS ACCOUNT NO. 5130344111 (SEE ATTACHED VALUATION) 9,678.25
4 PNC INVESTMENTS, ACCOUNT NO. 004-745278 (SEE ATTACHED VALUATION) 21,604.13
~ TOTAL (Also enter on Line 5, Recapitulation) I 67,709.32
/+
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF KUHNS, KAY I FILE NUMBER
21 - 11 - 0886
--- -. -_ _
- -
is schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY ~ ~ OF ~ EXCLUSIONS
Include the name of the transferee, their relationship to decedent DATE OF DEATH DECD'S I TAXABLE VALUE:
NUMBER and the date of transfer. Attach a copy of the deed for real estate. VALUE OF ASSET INTEREST (IF APPLICABLE)
1 PACIFIC LIFE ANNUITY CONTRACT NO. ~ 307,531.62 307,531 62
VR11005060, PAYABLE TO HER CHILDREN, MARY
E. EUTZY AND JILL I. KUHNS, AS NAMED
' BENEFICIARIES (SEE ATTACHED VALUATION)
2 ~ JOHN HANCOCK LIFE INSURANCE COMPANY,
~ ANNUITY CONTRACT NO. 2776623, PAYABLE TO
' HER CHILDREND, MARY E. EUTZY AND JILL I.
KUHNS, AS NAMED BENEFICIARIES (SEE
ATTACHED VALUATION)
127,725.60
127,725.60
TOTAL (Also enter on line 7, Recapitulation) 435,257.22
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
/~F~UN~EpR~A~LpEXPENSES &
/w.JlYlllrh7l fV'\I IYG ~~
ESTATE OF KUHNS, KAY I - FILE NUMBER
21 - 11 - 0886 _
Debts of decedent must be reported on Schedule I.
ITEM --- - - -- --
NUMBER DESCRIPTION ~ AMOUNT
__ ~FUNERALEXPENSES:
-----
--- _.-- _
T. - - ----
A. 1 ~I EWING BROTHERS FUNERAL HOME 5,085.09
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
MARY E. EUTZY
Street Address 151 GOODHART ROAD
City SHIPPENSBURG State PA zip 17257
Year(s) Commission paid
2. Attorney's Fees HAMILTON C. DAVIS, ESQUIRE
3. I Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
a. ~ Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 j CUMBERLAND COUNTY LEGAL JOURNAL- LEGAL ADVERTISING
10,019.00
17,500.00
551.50
75.00
- ----
TOTAL (Also enter on line 9, Recapitulation) 33,682.09
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Schedule H
Funeral E~ertlses &
Administrative Cosh cormnued
ESTATE OF KUHNS, KAY I
FILE NUMBER
21 - 11 - 0886
Z i THE NEWS CHRONICLE -LEGAL ADVERTISING
3 .DIVERSIFIED APPRAISALS
101.50
350.00
I
Page 2 of Schedule H
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS i
INHERITANCE TAX RETURN
RESIDENT DECEDENT '. ~,
ESTATE OF KUHNS, KAY ~ 'FILE NUMBER
---__ 21 - 11 - 0886
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM --
NUMBER DESCRIPTION AMOUN7~
1 ADAMS ELECTRIC 332.09
2 DIRECT TV 48.75
3 CENTURY LINK 78 68
4 DARLENE PITTMAN -TAX COLLECTOR - 2011 SCHOOL REAL ESTATE TAX 788.36
5 CARLISLE REGIONAL MEDICAL CENTER 50.00
6 SETTLEMENT EXPENSES (SEE ATTACHED HUD-1) 650.00
TOTAL (Also enter on Line 10, Recapitulation) I 1 947.88
REV-1513 EX+(11-08)
SCHEDULE)
COMMONWEALTH OF PEIJNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-
- _ ___-
_ -
ESTATE OF
- __ _ __ _
- _.
KUHNS, KAY I
--
NAME AND ADDRESS OF PERSONS
NUMBER O
__ -- --
~ RELATIONSHIP TO
DECEDENT
RECEIVING PROPERTY ~
Do Not List Trustee(s)
I, I TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
' under Sec. 9116 (a) (1.2))
1 MARY E. EUTZY Daughter
151 GOODHART ROAD
SHIPPENSBURG, PA 17257
2 ~ JILL I. KUHNS ;Daughter
467 OAK FLAT ROAD
NEWVILLE, PA 17241
3 '' JANET E. KUHNS ~! Daughter
467 OAK FLAT ROAD
NEWVILLE, PA 17241
_
- _ --
FILE NUMBER _ __ --
---
21 - 11 - 0886
- --_ __
SHARE OF ESTATE: _.
AMOUNT OF ESTATE
~ (Words) ! ($$$)
1/3 RESIDUE AND 249,988.39
ANNUITIES i
1/3 RESIDUE AND
ANNUITIES
249, 988.39
1/3 RESIDUE IN
TRUST
;Enter dollar amounts far distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate.
32,359.78
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET! 0.00
- -- - - --
_ - - ---
LAST WILL AND TESTAMENT
I, KAY L KL:rIIhTS, of North Newton Township, Cumberland County, Pennsylvania, declare
this to be my Last Will and Testament and revoke any Will or Codicil previously made by me.
ITEM I: I direct that all my just debts (except as may be barred by a Statute of Limitations) and
my funeral expenses (including my gravemarker and expenses of my last illness) shall be paid from
my residuary estate as soon as practicable after my decease as a part of the administration of my
estate.
ITEM II: I am presently married to JAMES B. KUHNS and I have 3 children: JILL I. KUHNS,
MARY E. EUTZY and JANET E. KUHNS. Janet has special needs and I make this will in this
context.
ITEM III: I devise and bequeath all of my estate of every nature and wherever situate to my
husband, JAMES B. KUHNS.
ITEM IV: If my husband, JAMES B. KUHNS, does not survive, I devise and bequeath all of my
Estate of every natw:e and wherever situate, whether passing under this Will or otherwise, in equal
shares to my children: JILL I. KUHNS,~ MARY E. EUTZY and JANET E. KUHNS, provided
however that the share for my daughter, JANET E. KUHNS, shall be held by my Trustee
hereinafter named, 1N TRIJST, for the benefit of my daughter, JANET E. KUHNS, and for the
following uses and purposes and subject to the terms and conditions hereinafter set forth.
A. I:n providing for the establishment of this Trust for the benefit of m,y daughter,
JANET E. KUHNS, I am aware of the special circumstances and incapacities and
infirmities affecting her which may cause or will cause her t ed special and skilled care
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and/or servic:es and to be eligible for various local, state and federal benefits and
entitlements, as well as possible assistance provided by various private agencies and
organizations. The primary purpose of this Trust is to assure that JANET achieves her
maximum potential and leads as full, independent and normal a life as is possible. To that
end, it is my wish that the Trustees view themselves not only as Trustees in the traditional
sense, but also as protector, guardian and advocate for JANET.
B. T'he Trustees within their complete and unfettered discretion, shall apply the
income and principal of the Trust in furtherance of the purposes of the Trust as set forth in
subparagraph A above and generally to enhance the life of my daughter, JANET, if living,
but only to the extent not provided for by insurance or by Federal, State, local ar any other
assistance programs of any nature whatsoever, including Supplemental Security Income
benefits under the :Federal Income Maintenance Program as then existing. The Trustees
shall provide; Trust payments of such an amount as not to preclude payment of the
maximum amounts of any Federal, State, local or other assistance programs, as noted
above. The income and principal of the Trust may therefore be used as judged necessary
and. appropriate as a supplement to, but not to supplant, such Federal, State, local or other
assistance, and to the extent the income of this Trust is not used, the Tnistees may
accumulate the income and add it to the principal of the Trust. While the Trust for JANET,
remains in existence, the Trustees may also expend such amounts of income and principal
therefrom as they, iri their sole discretion, may deem necessary for the health, maintenance,
education and support of my other children, but only if the Trustees determine that such
beneficiary does not have sufficient funds othe 'se available. Nevertheless, this Trust is
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for. the primacy benefit of JANET, and her present and future needs shall be considered first.
C. The Trustees are empowered to collect and expend on behalf of JANET, all
governmental. financial assistance benefits to which she is otherwise entitled; provided that
such fiords shall not be co-mingled with the other funds of this Trust.
D. In the exercise of the Trustees' discretion to expend income and principal for
JANET, the Trustees are directed that consideration should be given to any Letters of
Instruction which I may, from time to time, direct to the Trustees. Such. Letters of
Instruction, if any, shall be interpreted based upon the express purposes stated herein, and
shall not be interpreted to expand the powers and limitations of the Trustees hereof.
E. Iri the exercise of discretion with respect to income and principal distributions
for JANET, if any, the Trustees shall bear in mind my express desire to preserve, to the
greatest extent possible, this Trust's assets for eventual distribution to my descendants
rather than JANET', whether outright or in Trust. The foregoing sentence is in no way
intended to :limit the sole and absolute discretion of the Trustees with respect to such
distributions or to give any remainderman any right to challenge any distribution made by
the Trustees in the :proper exercise of such discretion. Rather, this sentence is intended to
aid the Trustees and. any Court or administrative agency in properly interpreting my intent in
establishing i:his Tnist, namely, that the needs of JANET, be provided for only to the extent
that governmental benefits and entitlements and other resources are either unavailable,
inadequate, or have been exhausted.
F. If any governmental agency determines that this Trust is an "available resource"
to he utilized and exhausted to pay for services for JANET otherwise provided by public
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funding, then the Trustees may, at their complete discretion, elect to terminate this Trust, in
which case the Trust assets may be distributed to my remainder beneficiaries in accordance
with subparal;raph J below. The other provisions hereof notwithstanding, if my Executor
and/or Trustee at any time determines that it would be in the best interest of :fANET, the
assets going or held for the benefit of JANET may be transferred to a "Payback Trust" or
"Pooled Trust" for JANET's benefit as the same are provided for in the provisions of 42
U.S.C. §1396 p(d)(4)(A) and 42 U.S.C. §1396 p(d)(4)(C) respectively.
G. During the life of JANET, no portion of this Trust either principal or income,
shall be subject to anticipation, pledge, assignment or obligation of JANET nor. be subject
to any reimbursement, execution, attachment, levy or sequestration or other claims of or
interference from the creditors of JANET or of her estate or of anyone who may be
obligated for her support, including any government or governmental agency or private
agency which has provided benefits or services to JANET.
H. During the life of JANET, subject to the considerations as stated above, my
Trustee may expend upon JANET so much of the income or principal of the Trust as
Trustee shall determine. Trustee shall have sole and absolute discretion in determining
whether such expenditure for JANET is to be made. It is my desire that the Trustee provide
such resource's and experiences as will contribute to and make JANET'S life as pleasant,
comfortable and happy as is feasible. Nothing herein shall preclude the Trustee from
purchasing those services and items which promote JANET'S happiness, welfare and
development, including, but not limited to, vacation and recreation trips away from places
of residence, expenses for traveling companions if reque ed or necessary, entertainment
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expenses, supplemental medical and dental expenses, social services expenses,
transportation costs, private room, telephone and television services, a mechanical bed, an
electric wheelchair, personal care services, and the like. It is my intention that this Trust be
a Supplemental Needs Trust (and not a Support Trust) for the supplemental and special
needs of JAI~TET. Irrespective of any other provisions of this Trust, the Trustees are
prohibited from making and shall not have the power to make any distribution which will
cause a reduction or loss of benefits for JANET.
I. Dlu-ing the life of JANET, all payments from this Trust which go to her direct
benefit shall be direct payments to the person or entities supplying goods or services to her
at the request of the Trustee.
J. Upon the death of JANET (or upon my death if JANET shall not survive me),
this Trust shall terminate and all principal and any accumulated and undistributed income
shall be distributed in equal shares unto my daughters, JILL I. KUHNS and MARY E.
EUTZY, provided, however, that should either of them be deceased at the time of the death
of JANET (or upon my death if JANET shall not survive me), her share shall be distributed
to her issue, per stirpes, living on such date, and in default of such then living issue, her
share shall be; added to the shares for my other child or the then living issue of any deceased
child.
K. If' any portion of this Trust shall become distributable to a beneficiary who has
not attained the age of twenty-five (25) years, the Trustee may in its sole absolute discretion
either pay over such Principal and any accrued or undistributed income therefrom at any
time to the guardian(s) of the property of such benef iary, to a custodian for such
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beneficiary under the Pa. Uniform Transfers for Minors Act, which custodian may be my
Executor or be selected by my Executor, retain the same for such beneficiary, IN
SEPARATE TRUST, until he or she attains the age of twenty-five (25) years. In case of
such retention, the Trustee may use or apply so much of the net income and Principal as it
deems necessary or advisable from time to time for support, health and medical care, and
education (including college education, both undergraduate and graduate) of such
beneficiary, or may make payment for these purposes, without further obligation or
responsibility to see to the proper expenditure thereof, directly to such beneficiary or to such
beneficiary's parent or to any person taking care of such beneficiary. Any Principal or
income not so applied shall be distributed to such beneficiary absolutely when he or she
attains the age of twenty-five (25) years. If he or she dies before attaining age twenty-five
(25), such share shall be distributed to his or her personal representative, discharged of trust.
ITEM V: Should m;y daughter, JANET E. KUHNS, predecease me or die on or before the thirtieth
day following my death, I devise and bequeath the residue of my estate of every nature and
wherever situate in equal shares to my daughters, JILL I. KUHNS and MARY E. EUTZY, as shall
survive. Should either of my daughters predecease me but leaving descendants who do survive me,
such descendants shall receive, per stirpes, the share that such daughter would have received had
she so survived me.
ITEM VI: If any property passes outright (either under this Will or otherwise) to a minor (which
shall be defined as anyone under twenty-five (25) years of age) and with respect to which I am
authorized to appoint a guardian and have not otherwise specifically done so, I decline to appoint a
guardian but instead authorize my Executor to distributes h property toga Custodian selected by
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my Executor (and m;y Executor may act as such Custodian) as Custodian for the minor under the
Pennsylvania Uniform Transfers to Minors Act. Provided, however, that this appointment shall not
supersede the right of any fiduciary to distribute a share where possible to the minor or to another
for the minor's benefit.
ITEM VII: I direcl: that all taxes that may be assessed in consequence of my death, of whatever
nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the
expenses of the administration of my estate.
ITEM VIII: I appoint my daughters, JILL I. KUHNS and MARY E. EUTZY , Co-Executors of
this my Last Will.
ITEM IX: I appoirrt my daughters, JILL I. KUHNS and MARY E. EUTZY, Co-Trustees of any
trusts created by this my Last Will.
ITEM X; Any fiduciary under this Will shall have the following powers in addition to those
vested in them by law and by other provisions of my Will applicable to all property whether
principal or income, including properly held for minors, exercisable without Court approval, and
effective until actual distribution of all property:
A. To retain any and all of the assets of my estate, real or personal, without
regard to any principle of diversification of risk.
B. To invest in all forms of property, including stock, common trust funds and
mortgage investment funds without restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any principle of diversification of risk.
C. To sell at public or private sale, to exchange or to lease for any period of time
any real or personal property and to give options for sales, exchanges or leases, for such
7
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prices and upon such terms or conditions as they deem proper.
D. T'o allocate receipts and expenses to principal or income or partly to each as they
from time to time think proper.
E. My Fiduciaries shall have all of the powers contained in Chapter 72 of the
Pennsylvania Probate, Estates and Fiduciaries Code 20 PA. CS § 7201 and following.
F. T~~ compromise any claim or controversy.
G. To distribute in cash or in kind or partly in each.
H. To hold property in their names without designation of any fiduciary capacity or
in the name of a nominee or unregistered.
L If there is no corporate fiduciary acting hereunder, my fiduciary may designate a
corporation (regardless of where organized or headquartered) with fiduciary powers to act
as agent or custodian hereunder, may delegate to it such duties as may be appropriate
(including investment recommendation duties), may pay to it reasonable compensation for
its services, and may discharge it with or without cause.
J. To treat the entire trust estate as a common fund for the purpose of investment,
notwithstanding any provision herein for division thereof into shares or separate trusts.
K. Should the principal of any trust herein provided for be or become so small that,
in the Trustee's discretion, establishment or continuance of trust is inadvisable, my Trustee
or my personal representative may make immediate distribution of the then remaining
principal and. any accumulated or undistributed income outright to the person or persons
there entitled to income and in the proportions they are then entitled to such income. If any
such person is then a minor, distribution may be made to that person's guardian, or to a
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person selected by the trustee to be custodian for such person until the age of twenty-five
(2~) years under the Pennsylvania Uniform Transfers to Minors Act.
L. I:P there are co-fiduciaries serving hereunder, they may delegate any and all
management duties and responsibilities to one of them. My co-fiduciaries may, for
example, designate one of them to maintain a bank account or accounts, and in 1:hat instance
the signature of only that fiduciary shall be required to open and maintain such account, to
deposit funds to such account and to write checks on such account. Other than as specified
herein, the authority of my co-fiduciaries shall be exercisable jointly and severally.
M. The individual fiduciaries shall have jointly and severally all the powers given to
the fiduciaries, except that no individual fiduciary shall participate in the exercise of any
discretion to determine the propriety or amounts of payments of income or principal to
himself or herself or to any person to whom he or she is legally obligated, or possess any of
the incidents of ownership with respect to any policy of insurance on his or her life, and the
remaining fiduciaries alone shall exercise that discretion and possess those incidents of
ownership.
ITEM XI: I direct that my Executor, Trustee or Custodian or their successors shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
ITEM XII: My individual fiduciary shall be entitled to reasonable compensation for his or her
services rendered from time to time and to reimbursement of out of pocket expenses.
ITEM XIII: 'The interests of the beneficiaries hereunder shall not be subject to anticipation or to
voluntary or involuntary alienation.
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IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and
Testament, written on eleven (11) sheets of paper, dated this ~d~ day of
~ "~~ _,2011.
J ~
_ (SEAL)
KAY I. K S, x
The preceding instrument, consisting of this and ten (10} other typewritten pages, each
identified by the si€mature or initials of the Testatrix, was on the day and date thereof signed,
published and declared by the Testatrix therein named, as and for her Last Will, in the presence of
us, who, at her request, ui her presence, and in the presence of each other have subscribed our
names as witnesses hereto.
~~ residing at , ~ f'~
~ ~ ~ y~~~ ~
residing at
10
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND
ss.
I, KAY I. KUHN,;, the Testatrix whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed the
instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the
purposes therein expressed. '
-(SEAL)
Sworn to or aff~rme and ek~on ledg k~~ T ~ ~'{-~ ~ :>
before me by ~I~~ S ,the
Testatrix, this ~_ day oi'
2011.
Notary Public '
COMMONWEALTH OF PENNSYLVANIA
NotaHal Seal
Anc,ef?, ,.q, "rr:daffer, Notary Public
Shippe~es...~r e>i,rr Cumberland County
~ r,,~mmiss,~r rx;;.,•es r1ay i5, 2011
Mem@~F; ehnsyle~nie AssaElatien of Notaries
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
S5.
We, _ ,m~L~n 1S and ~/~~ ,the witness whose names
are signed to the attached or foregoing instrument, being duly q alified according to law, do depose
and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will;
that the Testatrix signed ~~illingly and executed it as her free and voluntary act for the purposes
therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the
Will as a witness; and that to the best of our knowledge the Testatrix was at that time eighteen (18)
or more years of age and of sound mind and under no constraint or undue influence.
I~
Sworn to or aff rmed and su cribed to
before me by C~ U~.S and
I f ,witnesses,
this ~_hday of , 2011.
~4
otary Pry ublic
11
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Angela M. Schaefer, Notary Public
Shippensburg Boro, Cumberland County
My Commission Expires May 15, 2011
Member, Pennsylvania Assoelation of Notaries
r,I1vr<wo• ,_w i •anlNpeflsuwy t<,vau, tvewvnte rr1 f f c4 f
t. NAME OF SELLER: Estate of Kay I. Kuhins
ADDRESS: __ _ _
F. NAME OF LENDER:
ADDRESS: ___
G. PROPERTY ADDRESS: ?.04 Nealy Road, N. Newton Twp., Cumberland Co., Newville, PA 17241
~lorth Newton Township, Cumberland County
H. SETTLEMENT AGENT: South Central Home Settlements, Inc., Telephone: 717.532.7387 Fax: 717.532.6552
PLACE OF SETTLEMENT: 126 East King Street, Shippensburq PA 17257
I. SETTLEMENT DATE: 1212112011
J. SUMMARY OF~ BUYER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM
BUYER 400. GROSS AMOUNT DUE TO SELLER
_
101. Contract sales rice _ 65 000.00 401. Contract sales rice 6
102. Personal ro ert
402. Personal ro ert 5 000.00
103. Settlement char es to BUYS=RLne 1400) 1 137.00 403.
104. ___ 404.
105. 405.
Ad~ustments for items paid by SELLER in advance
107
C
t Ad~ustments for items aid b SELLER in advance
.
oun
taxes 12121111 to 12131111 4.81 407. Count taxes 12121111 to 12131111 4
81
108. School Taxes 12121111 to06130112 415.71 .
408. School Taxes 12121111 to06130112 ~I15
71
109. __ .
409.
110. __ 410.
111. __ 411.
112. 412.
120. GROSS AMOUNT DUE FROM BUYER 66 557.52 420. GROSS AMOUNT DUE TO SELLER 65 420
52
200. AMOUNTS PAID BY OR ON BEHALF OF BUY ER .
500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De osit or earnest mone __
1 000.00 _
501. Excess De osit see instructions
202. Princi al amount of new loans
' 502. Settlement char es to SELLER line 1400 650
00
203. Existin loan s taken sub
ect to _ .
503. Existin loan s taken sub'ect to
204. 504. Pa off of First Mort a e Loan
205. __ 505.
206. _ 506.
207. __ 507.
208. _ 508.
209. 509.
Ad'ustments for items un aid b SELLER Ad'ustments for items un aid b SELLER
213. _ 513.
214. - 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BUYER 1 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 650
00
300. CASH AT SETTLEMENT FROM OR TO BUYER .
600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from BUYER line 120 66 557.52 601. Gross amount due to SELLER line 420 65 420
52
302. Less amounts aid b /for BUYER line 220 1 000.00 .
602. Less reduction amount due SELLER line 520 650.00
303. CASH FROM BUYER 65 557.52 603. CASH TO SELLER 64,770.52
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and is being furnished to the Internal Revenue Service. It you are required to file a return,
a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Sales Price described on
line 407 above constitutes the Gross Proceeds of this hansaction.
You are required bylaw to provide the settlement agent (Fed. Tax ID No: 1 with your correct taxpayer identification number. If you do not provide your correct taxpayer identification
number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number.
TIN: - - i____- - SELLER(S)SIGNATURE(S):
_/
SELLER(S) NEW MAILING ADDRESS:
SELLER(S) PHONE NUMBERS: ____ (H) ,^
~ ODU. IICIYW ~'HIHDLC Iltl VV"IYIYC4.IIVIY VYII fl LVAIY
801. Loan Ori ination Fee ____ _ % _ _
802. Loan Discount ____ _ % _ _
803. A raisal Fee ____ ___
804. Credit Report
- --
805.
--
806.
---
807.
----
808.
---
809.
----
810
.
--
-
811
.
_
900
ITEMS REQUIRED
.
BY LENDER TO BE PAID IN ADVANCE
901. Interest From to $ Ida
902. Mort a e Insurance Premium for 0 mont to
903. Hazard Insurance Premium for 0 mont to
904. __
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. ~ $ !mo
1002. Mort a e Insurance mo. $ Imo
1003. Cit Pro ert Tax _ mo. $ Imo
1004. Count Pro ert Tax __ mo. $ !mo
1005. School Taxes mo. ~ $ Imo
1009. A re ate Anal sis Ad'ustment
1100. TITLE CHARGES
1101. Settlement or Closin Fee to South Central Home Settlements Inc.
1102. _ 425.00
1103. _
1104.
1105.
1106.
1107, Attorne 's fees to Zullinger-Davis PC P.O.C.
includes above items No: _
1108. Title Insurance
includes above items No: __
1109. Lender's Covera e $ _
1110. Owner's Covera e $
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin Fees Deed $ 62.00 ; Mortgaqe $ • Release $
1202. Cit /Count taxlstam s Deed $650.00 • Mort a e $
1203. State Taxlstam s -Deed $650.00 • Mort a e $
1204. Deed $ • Mort a e $ 62.00
650.00
650.00
1205. Deed $ ~ Mortgaqe $ • Release $
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve _
1302.
1303.
1304.
1305.
1306.
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section K 1 137.00 650.00
• •~~ •+~~ ~ ~.i ivn, ivi~ yr oV iClt HIVU JtLLtFi
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me
in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement.
a.
.. .. ,
• ..
°~
MEMBERS 1St ` Issued B Mone y Y No. 000064 l 074
Y~ ygram Pa ment S stems, Inc.
• ®FEDERAL CREDIT iINION P.O. Box 9476, Minneapolis MN 55480
P.O. BoX 40 Drawee: Boston Safe Deposit & Trust Company
r.
Mechanicsburg, Pennsylvania 17055 Boston, MA
5-709/110 ^"
DATE
*** THIRTEEN THOUSAND NINE HUNDRED FIFTY-EIGHT DOLLARS 09~~7~1:1
*** AND 57 CENTS *** ***
----- $13 , 9 5 f3 . 5 7
~Y EXACTLY~'I 3 9 5 8 Dollars `'j 7 Cents
sm Mrte nine fire eigM1t dollars fire serer
cents
OFFICIAL CHECK
r wer: MBERS 1ST FEDERAL.CREDIT UNION
'HE ESTATE OF KAY I KUHNS ~// ) ~~
ER OF ~/y / O // ~/~"~~/Li~~'.. ~~ '
CONTR ER
11-uuuu e ti ~U 7 411' ~:0 L 100 70 9 2~:0 1600 ~ L 30 4 7B 2u'
(~~ ~ ~. I'
~~~ ,~ C„~L CURRENCY
~~ I ~ ~~s
COIN
/ /~ / "' ~ CHECKS
DATE _ /
OEPOS/TS MAY NOT BE A /CABLE FO /MMEO/ATE WITHDRAWAL
DEPQSITTICKET ATTgCHADDINGMACHIN~TAPEORDEPOSTgECAP.
~~
ORRSTOWNBANK
A Trr~dilion r jEsceClence
J3 q~~~7
~: S00 ~~~1 L 3 20~: LO 3 OOBB L 411'
CHEF KS null t T P.. ~., fhl_ qPC RECEIVEC~ fpF. DEPOSIT )L'BI~CT TO THE PI~J\- cl~~.~ OF rHC t.~iF~~F,'r ~. lU ~IFk/_I,~L ~UCr OF a ~J l' ~f PLI~~~hl.E ~ (1LL CC T'U-: T(.FE[A1 C~~~t
__ -
~ pan, 3 i, 2Q' ~ " ~ ; 1 ~ Pad PNC BANK No, 0788 P, 1/2
~~
1_F.~1Dl~lG TIIE lO~dY
January 31, 2012
Hamilton C Davis, Esq
PO Box 40
Shippensburg, PA. 17257
RE: Name: Kay I Kuhns
SSN: 17~-34-8183
DOD: 07-28-2011
Uear Sir/Madam:
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Checking Account
Account # 5140409695 Established: 02-28-1954
KA'Y" I I~UHNS
DOD balance: $ 22,463.37 + 0.03 accrued interest
Sa~vi~ags A,ccouat --
Account # 5130344111 Established: 07-24-199:1
KAY I KUHNS
DOD balance: $ 9,678.25 + 0.02 accrued interest
Investment Account
The' decedent maintained Investment Account # 4745278, 49334672. For further information, you
may call the Brokerage Department at 1-500-762-6111.
Please note that this office provides date of deatJa balances for deposit accounts (IRAs, CDs, Checking and
Savings). We do not process any financial transactions or provide statements, If you need assistance with
any of these items, please call 1-888=PNC-BANK (1-588-762-2265) or stop by your local PNC Sank branch
office.
Sincerely,
National Financial Services Center .
PNC Bank, N.A.
Member FDIC
Page 1 of 2
p~vc
1NV ESTMENTS
February 22, 2012
Hamilton C. Davis
20 East Burd Street, F.O. Box 40
Shippensburg, PA 172.57
RE: 004-745278 /James & Kay Kuhns (Joint With Rights of Survivorship)
Dear Mr. Davis:
The value of the above-referenced account on July 28, 2011 is as follows:
~- - _
-~------_._ -r-,- ,_,_,.~._.,.,.~
u ~ '` ,~h ~ ~~~.~ ~~ ~~ ~~~, ~~,
Amount . Descr- ,tion ~; ,;
._ p _ ~ R, _
~~ ;$' tnbol /.~~
, j;~~
~ Cusip !
~ DOD
n~,~ ~ ~
Race
= . ~---~
r~ ~ ~ ~~ ~~~Accru~d
~ DOD Value Ipter~est
_ _ 1,392.019 Blackrock Asset Allocations Port CIA PCBAX $15.52 $ 21,604.13
---- _ $ 21, 604.13 $ -
___ Grand Total (Market Value + Accrued Interest) $ 21,604.13
If you have any questions, please contact our Estate Resolution Desk at 800-622-7086.
Sincerely,
PNC Investments, LLC.
Estate Resolution Desk
KSJ
The summaries, prices, quotes andlor statistics contained herein have been obtained from sources believed to
be reliable but are not necessarily complete and cannot be guaranteed. They are provided for informational
purposes only. Past pertormance does not guarantee future results.
PNC Investments LLC
Member of The PNC Financial Services Group
1900 East Ninih Street 87-Y873-16-1 Cte~/eland Ohio ii6114-3401,
1NV~,'v/. P n C. C 0 ill
Emportant Investments Information; Brokerage and insurance products are:
No d C Insured_ Not Bank Guaranteed • May Lose Vatue
'~~~ :. crvi~ r ~.rc• i 4 c t y (N; In ~-t n;t t l i( i ,odi t I ~M ~'~ 1' C.
.,.. , ~ J •r3 it n ice rr iuc ~. ,o~ ~ ~~:,o Ly f 11(' II1aJfal e ar i'r i i ., iu ~ i n i „ur : .gene;:
^~ i
January 16, 2012
Hamilton C Davis, Esquire
PO Box 40
Shippensburg, PA 17257
Re: Accumulated Cash Value
Contract: VR11005060
Annuitant: KUHNS, KAY I
Owner: KUHNS, KAY I
Dear Mr. Davis:
We are writing in response to information requested on the above-referenced contract.
The Accumulated Cash Value as of July 28, 2011 is $307,531.62.
If you have any questions, you may contact an Annuity Information Specialist at (800) 722-4448, Monday
through Friday from 6 a.m. to 5 p.m., Pacific Time. You may also contact your registered representative
with questions. Neither Pacific Life nor its representatives give tax or legal advice.
Sincerely,
~~ . C °~~~~~~
Lorene C Gordon
Vice President, Operations
Retirement Solutions Division
Pacific Life Insurance Company
Retirement Solutions Division
P.O. Box 2378, Omaha, NE 68103-2378 www.PacificLife.com
Securities Distributed by Pacific Select Distributors, Inc., Member, FINRA & SIPC
~~(".~ ; ,~ 2012
John Hancock Life Insurance Company{U.S.A.)
John Hancock Annuities Service Center
164 Corporate Drive, Portsmouth, NH 03801-681:5
Mailing Address: PO 13ox 9505, Portsmouth, NH 03802-9505
(877) 543-2363
vvww.j ha nn ui ties. com
January 18, 2012
Law Offices of Zullinger-Davis
Attn: Hamilton C. Davis
20 East Burd St
PO Sox 40
Shippensburg, PA 1725"1
Dear Mt•. Davis:
Re: CONTRACT/CF.R"l'IFICATE # 2776623
a~G7r~i~/ilZf.I
the future is ou~~
y S
This letter is in response to the inquiry recently submitted for the annuity contract referenced above. The date of
death value as of 07-28-201 I was $127,725.60.
If you have any questions or concerns about this letter, please call us at 877-543-2363. Our Claims Service
Representatives are available on weekdays from 9:00 a.m. to 5:00 p.m. EST.
Sincerely,
,Ioly~ Hancock Annuities
Life insurance annuities, including group annuities, are products issued by John Hancock Life Insurance Company {U.S.A,)', Bloomfield Hills, MI "not licensed in New `fork