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HomeMy WebLinkAbout03-23-12 (3) 1505610143 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue pennsylvania county code Year File Number Bureau of Individual Taxes OEPnrsTMENT OF REVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 12 180 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Decedent's Last Name COMENSKY Suffix Decedent's First Name ANNA (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name COMENSKY FRANK Spouse's Sociai Security Number FILL IN APPROPRIATE OVALS BELOW a 1. Original Retum 4. Limited Estate g Decedent Died Testate (Attach Copy of Will) MI B MI J THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82} 4a. Future Interest Compromise ~ 5. Federal Estate Tax Retum Required (date of death after 12-12-82) ~. Decedent Maintafi~ned a Living Trust 1' 8. Total Number of Safe Deposit Boxes (Attach Copy of l rust) 9. Litigation Proceeds Received 1 p. spousal PoveA Credit ((date of death 11, Election to tax under Sec. 9113(A) between 1231 ~1 and 7-1-95) (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA;IC INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES D BOGAR ('717) 737 8761 First line of address ONE WEST MAIN STREET Second line of address City or Post Office SHIREMANSTOWN State ZIP Code PA 17011 REGISTER OF WILLS USE ONLY ~ na e_~ ~ p r~.,y ~J --s'- ~~„~ '' C17 na r ~ ~ ~~~~~ _ ~ -. ~ ~~ C . T,.t `'? ,, ~.7 C~7 C,~ ) i..l _.r._. C7 ~~.~ .. . r-r-r u Fps ~'j~ t_, --;, Correspondent's a-mail address: JbOgar@bogarlaW.COm Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and comple~2. Declaration of prepa ntative is based on all information of which preparer has any knowledge. Jane V. Serres "24 White Oak Boulevard. Mechanicsburg. PA 17050 S!G U E OF PR~R OTHER THAN REPRESENTATNE DATE James D. Boger o1 ADD SS One West Main Street. Shiremanstown. PA 17011 Side 1 1505610143 1505610143 1505610243 REV-1500 EX Decedents Name: C01711enSiCy, Anna B. Dec:edent's Social Security Number 179 32 4178 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 31 , 108.54 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 10 , 502.50 7. Inter-Vivos Transfers & Miscellaneous coq Probate Property Se arate Billin Re uested S h d l G p g ............ q ) u ( c e u e 7. 8. Total Gross Assets (total Lines 1-7) ..................................................................... g. 41 , 611.04 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ....................................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 41 , 611 , 04 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to fax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 41 , 611.04 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec, 9116 31 108 .54 15 (a)(1.z) x .o0 , . 16. Amount of Line 14 taxable 10 502.50 16. at lineal rate X .045 , 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ................................................... .............................................................. . 19. 20. FILL iN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 0.00 472.61 0.00 0.00 472.61 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12-180 DECEDENT'S NAME Comensky, Anna B. STREET ADDRESS 4106 Seneca Avenue CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (i} 472.61 2. Credits/Payments A. Prior Payments B. Discount 23.63 Total Credits (A + g) (2} 23.63 3. Interest (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4} Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 448.98 Make Check Pa able to: REGISTER OF WILLS AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. z c. retain a reversionary interest; or ............................................................................................................... x d. receive the promise for life of either payments, benefits or care? ............................................................ x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate propert/ which contains a beneficiary designation? .................................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent (72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~-- 48S00047,Q46 REV-485 EX (05-04} SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date of Death County Code Year File Number 179-32-4178 ~ 01/02/2012 =__21 _' 12 ~ ! 0180_ - -- - - - - : __ _._ ._---J Decedent's Last Name Suffix First Name MI -- ------ - --- ------- - - ----- - - t ,..- , Comensky ! ~ Anna 3 °.D ~. ~_.___.~• ~_ ____._ a,.,w,.... __ _ ADDRESS OF DECEDENT STREET.• 4106 Seneca Street CITY: STATE: Camp Hill PA ZIP CODE: 17011 NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX NAME: Jane V. Serres STREETADDRESS: 24 white Oak Boulevard CITY: STATE: Mechanicsburg PA ZIP CODE: 17050 NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING J I a. NAME: Jane V. Seises RELATIONSHIP: Daughter/Executrix STREETADDRESS: j 24 white Oak .Boulevard CITY: STATE: Mechanicsburg PA ZIP CODE: 17050- 1 b. NAME: Al h ~ ~' CO rM .GG1 S RELATIONSHIP: J~ V ~~ Ll S ~ ~C /~ t~ STREiEL `DOD~SS: ~ "[ .~_~~ .~. C q GJL V~ CITY: (, ~ ~kE: ZIP CODE: ~Q M. ~ ~'C ~ L ~" c. NAME: RELATIONSHIP: t 7V ~ t STREETADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: ~ wells Fargo Bank j STREETADDRESS: 6416 Carlisle Pike Suite 2100 CITY: STATE: M c n' b ,g PA ZIP CODE: 1 NAME O~F PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY DATE OF CONTRACT TO RENT BOX ' NUMBER OF 80X ft f ~ t'I~- 2~ 0 o f E103 1 TITLE UNDER WHICH BC1X IS REQUESTED L° 7~ E? ~. ,.~ ..(-,~-; NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX i a. NAME: r b. NAME: 1 STREETADDRESS: i .STREET ADDRESS: CITY: STATE: ZIP CODE: CITY: STATE: 21P CODE: E NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY rt 1/ U 1/) ~ WAS A WILL IN THE BOX? ^ YES NO If yes, a. Date of will: b. Name and address of personal representative, if named In the will NAME: I ~ STREETADDRESS: ' CITY: STATE: ZIP CODE: i , c. Name and address of attorney, if any NAME: I i STREETADDRESS: CITY: STATE: ZIP CODE: ~ 48500041,Q46 4B500041046 c n CG n~vtnc~T R[~X INVENTORY Page of KCV-40:J C/~ v/ ~^ - - - - INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in bo:c. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date: appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. {7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness:-List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17728-0601 ITEM NO. ITEM DESCRIPTION `` ~+ f -y f I / ~i~ ~..C J~ t e J ~- ~ ~. © r O !!ll T S ..errs " s ~ -~ ~ v- ~~' 1 ~' I e~~ - v S .1: o - ~ ~ ~. 8' ~~~ ~ a ,~, ~t .~ T - 8 ~ ~ .~ .,. _ ~ 73 .6 ,-r _ _ ~ ~ .-~- ti c!l r'a. v~ 1~.. P o l.,i g ~- fan Iz C I CERTIFY UNDER P ALTY PERJURY THAT THE ABOVE RECORD IS C CT AND C P ETE T THE BE5T OF MY KNOWLEDGE AND BELIEF... PERSON RECEIVING COPY OF SAFE DEPOSIT BOX INVENTORY: (GNAT SIGNATURE PRI N ME Jane. V. Serres PRINT NAME AND CHECKAPPRDPRIf~TEBOXBELOW: PRINT TITLE Executrix DATE ~l o~ /~ ~ (~ CHECKAPPROPRIATEBGX: Executor(tdx) ~ Adm(nislrator(trix) ~ Estate Representative ~ Joint owner of safe deposit box NOTE: Attach additional 8'/z" x 11" sheets} if necessary or use duplicates of this page of form. The Department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(), to require disdosure of Social Security numbers in connection with radministering state tax laws. The Department uses the Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements with Federal and local ta>ong authorities. The. state law prohibits the CommoTwvealth's personnel from disclosing confidential tax information except for official purposes. i f Rev-1508 EX+ (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Comensky, Anna B. 21-12-180 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 schedules F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH _ 1 Wells Fargo -Certificate of Deposit No. xxxxx5214. Principal balance at date of death 5,117.28 $5,117.07; accrued interest $0:21. 2 Wells Fargo -Certificate of Deposit No. xxxx9655. Principal balance at date of death 21,320.17 $21,303.82; accrued interest $16.35 3 Wells Fargo -Individual Retirement Account No. xxxxx8791. Principal balance .at date of 4,671.09 death $4,670.43; accrued interest $0.66. ***Note: The following assets were jointly owned by Anna B. Comensky and Frank J. Comensky, surviving spouse, and are, therefore, non-probate assets which are not reported on this Pennsylvania Inheritance Tax Return: *Wells Fargo Checking Account No. ~~XX~~X7343, *Wells Fargo Savings Account No. X~~X~~1366, *Wells Fargo Certificate of Deposit No. XX~~~1577, * 11 - Series I - $1,000.00 U.S. Savings Bonds (as referred to in the Safe Deposit Box Inventory, a copy of which is attached to this Pennsylvania Inheritance Tax Return) TOTAL (Also enter on Line 5, Recapitulation) ( 31,108.54 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) m o, o ~ O ~ ~ O d` d C "~ ~ ¢ CT Cy ~ d. M N v M Q ~ O N fA ~ N ~ O ^~ ~ ~- EPr ~ O ~~ ~ N A N ~ ~ C ~ O ~ .o ~ O ~ ~ ~ ~ N ~ O ffl ~ ~ O to Cd y ~ d N QQ„ ~ y b d ~ ~9 ~ N ~ M ~ o ° " o~ q ~ r~ E7 '~ A h Ef3 d ~ O N ~ M ~ .n ~ d- ~o ~ A ~ ~ O ~ ,~ ~ .$ cMi ~ W ~ ~ w ~ d `~ ~ ~ `~ A A ~ ~ O v y ~ ° U ~ ~ ~ w A A ~ w W ~ L GR {s7 U ~' W G w O d" ~' ~ ~ ~ cad ~ A ~ ~ O N `c -n ~. ~ ~ O N ~ ~ O A u ~ ~c ~ ~ ~ O N R, N N ~ ° a, O U ~ ~ o o ~ r- ~q o ~aa • 0 M N ¢Y . ~ M ` c~ ;Z. rn ~ ~ ,~ ~ 0 ~ °~' ~ ~ o u ~ ~ -' ~ d, ~ p ,~ ~ U ~ ~ G ~ ~ ~ :~ ~ U ~ ~ S ~ ~ T G ~ ~ ~ ~ z a ... m ro) U ~~°~ T 0~3d ~ how ~ ~ ~ F, O "' ~ ~ O ~~ o `~ ~ ~ ~ co o ~ ~ o ~ U ~ ~ ~ ~ ~ ~~~°o w ~ upp ~ 3 °' O 3 O O ~ ~ p0 O "' ~ O ~ N ~ ~ ,~' rf~ p ~ ~ O ~ N U o ~ ~ ~ U ~ ~ ~~~o ~~o w N w W O O O o o ~ ~' ~ ~ Q N ~ ~~ ~ O N d ~ ro M o ~ o p ~ U '~ H v ~ ~ G ~ ?~ w~~~o ~ o ~ ~ N N M Q~ ~f'J C? ~ ~ ~ N ~ U~ f+ `Y' ~ p ~ ~ y GO U5 c"7 ~ O ~tf> ~ ~ ~ N O ~ `'`A O ~ ~ ~ ~ ~ N `p ~O ~ ~ ~ ~ ~ ~ ~ ~ i d" N ~ ~ O ~ ~ ~ ~p ~ ~ t" ear. ~ ~ ~ ~ o~, ~ f r,~;,, ~ G+ ~ ~ ~ p LUs~ +~+ a Gti+ tO`~- ~ N ~ ~ G U ~ •~ ~ C~7 EfY ~ } ~ ~ ~. ~ ~ u1 cJC '_'~/ .~ N p ~ N M O ~ O ~ O to ~ ~ ~ ~ O O cad ~ N Q` N ~ ,~ ~ ~ N <t if7 ^ ~ cd w o +°~ ~ N ° o ~ ~ ~ °~ ~ p ~ s-~ .o ~ O 0 ~ '4 4., ~O N O` •.p 4~ ,,, d'~d. N d" ~ ~ ~' U a0 c~ O ~ ~' N ~ ~ ~ y ~ i ~ O y ~, ~ q ~ d U .~ N ~ N F„ Y'n Nv o LG d ~~ d ~ ~ ~ ~ ~ T t~i ~ ~+ p U °~ cd ~+ d ~-+ p CJ cNe ~ ~., 67 ~ ~ ~ ~p ~ ~ a ~a p p ~,~ U U s,, ~ C p Q ~, ~ O ~ 0 p ~~ o o t., ~ o 0 O . ~ ~ cc~ a~i ~ ~ a`"i ~ . Y cUd ~ NU cU 4'' `' t0 N ~ , tN- N ~ ~' U1 O ~y, i4+ ~, ~ O ~ <C r°n w o .~' ~ a ~ zn tr ~, ~ ~ ~ ~ ~ ~ o ~ °~' a ~ ,~ ~ ~ o y •o O~ o° d~ h~~~ c o f a f a '~"' ~-, ~ ti U r d Uca y p N ~S ~~ ~ ~ U 0~ d Rev-1509 Ex+(6-98) gCHEDULE F COMMONWEALTH OFPENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT __ __-. _ - ESTATE OF FILE NUMBER Comensky, Anna B. 21-12-180 If an asset was made joint within one year of the decedents date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Frank J. Comensky 4106 Seneca Avenue Husband Camp Hill, PA 17011 B, Jane V. Serres 24 White Oak Boulevard Daughter Mechanicsburg, PA 17050 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOIN TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELDRFAL ESTATE. DATE OF DEATH ALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A,B 06/16/2010 Wells Fargo -Checking Account No. 4,074.78 33.333°/a 1,338.26 xxxxxx4230. Principal balance at date of death $4014.76, accrued interest $0.02. 2 A, B 07/20/2010 Wells Fargo -Certificate of Deposit No. 13,795.25 33.333% 4,598.42 xxxxx2527. Principal balance at date of death $13,794.69; accrued interest $0.56. This account was jointly owned with Frank J. Comensky, surviving spouse. 3 A, B 07/20/2010 Wells Fargo -Certificate of Deposit No. 13,697.45 33.333% 4,565.82 x~ol:x2523. Principal balance at date of death $13,697.07; accrued interest $0.38. TOTAL (Also enter on Line 6, Recapitulation) ~ 10,502.50 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) o~ °. ~ o ~ ~ `~ N ~' ~ o N U M 'i O N to ~ ~ ~ N o '~ ~ ~ G ''' P7 cp ca N , p p. N ~ O ~ O yy, ~` i.+ C d ~ ,~, ,.~ a.+ ~ O O O tt3 ~ ~ A ~ ~ ~ ~ O ° ~ U ~ ~~ ~ ~~ N ~ ~ ~ ~ ~' ~ ~ h .D M O F O ~ o ~ ~ ~ ~ ~ -~- a+ O ~ ~ ~ M ~ ,~ ~ ~ ~n ~ c0 O ~ ~ A C: ~ ~ N ~ cn N ~ ~ ~ ~ ~~ ¢ Z ~ A °~' ~ .a~ ~ QM '~ ° ~ z .~ a. c~ ~ y ~ W `~ A Q ~ w W U m ~ T o ~' p ~ ~ ~ ~ N ~ ~ N ~ ~ ~ ~ ~ O A ~ ~ U ~ ~ ~ G ~ ~ N ~, N C~- ~ ~ o ~ ~ v ~ `~ o ~ o ~ -`-d ~O ° U W qa • 0 y i N d. C~ Z, a d d ~ ~ ~ [^ ~ ~ :~ U d ~ ~+ G aid ~ °~'' z .~ ~A w ~ ~ ~ 3 0 ~ b U ~ O ~ d ~ ~' O 4.. ~ ~ O ~ `"~ O ~ O ~ ~ O Q~ o ~ w ~ ` . o y `n `n N ~ ~ d o ~ ~ o ,.-, U ~ ~ x ~ ~ ~ ~ p, `° ~ `° O w `' ~ ~' r - rn ~ m ~ ..+ O ~ y ~ ~ ' in c+ ~ U ~ ~ f . ~ .~ U ~ ~ Q ~ ~' U c. ~ O ~~ ~ O O O ~ ~ `~ ~ O O c~ O ' ti ~ 0 ~' ~ ~~` ' ~ ~,' h ~ N N N ~ ~ ~' yin 0 ~ '` ~ a~ ~a y ~~ ~ ~ ~ O ~ o O U o ~ .b ~ `' C7 ~ p ^c] ~ ~ cu ~ ~ O w w ~. x, "'' G O Q ~ a°- ,.0~ G ~ GO i O ~ O "'~ ~ O c-+ N ?, a~i ~ Rs ch o °' 0 0 ~ v f ~~ N ~ G G O ~. ~~~~0 N '~. K3 N O ER ~D tin ~r ~ o ~ N o .O N M ' W '~- ~n O+ > ~ c ,-~ ~} ' m O ~ ~ N ~ ~ Q ~ m ~cd M if'S M ~ ~ c? o `n ~ 0 ~ ~ 00 M N ~ ~ ~ rS M Q` d" O N ~ ~ `r O h ~ U7 ~O r+ M C"' ~ ~ ~ ~ O d ~sW.~ O ~ ~' ~ GL+ '"" a ~ a s w v a ~ ~ ~ ~ o ~ ~ ~ ~ ,M+ tfr ~ v (~'7 d ~ ~ ~ y }' ~ .r. N p ~ d Y '> M u~ O ~ ~ p p ~ O ~ ~ ~ 0 t'~ u ~ N 4 '~ O ~ ~ N ~ N ti17 o O ... O O u F, ~ ~ ~ '0 O O O ~ 4. s0 N Q` '~cl d', ,,~ d' ate.. N cd ~ d" U ' M' d' ~ - ~ d ~ ~ O ~ N4. .D ~ n ~ d' y q _ D c o O O t; d' O p `O O O +~ v ~ ' ~O 17 ~ GO U O G w y O +~ ~ O .~ cd ~ m ~ ~ ,-i ~ a F.(~ ~ ~ Y N ~ ~ ~ ~ s-. O G> ~ ~_~( O F.C. a~ '~ Q d y +~ `~ P~ ~ a ~ Q p ~ F ~, ~ ~' a `n ~ P ~ ~°? ~ ~, a ~ Ga C~ ~ ~ , °' ~ ~ ~ ~ ~ d p ~ ~ ~ a.~ O ~ ti a t.+ ~ `~ c d ~ ~ 4-• ~ y ~ tJ ~ ~ ~ O ~ p 0 '' ~ ti U c-+ a? O ~ ~ ~ ~ ~ ~ O 3 ~ O ~ O ~ ..-~ ~ a ~ ~-. ~ O O ~., Q ~ W O v, r, , c. O `~ ,~~ ' r1~ O N ~ ~~. ~ ~ O ~ 6 d N ~ ~ ~ h ~"' O °> ~ V1 ~ ~ v~ a7 G .cam N '~ O ~ ~ O ca `~r O OU O ~ ~ ~ N U ~ ~ ~ U1 p N y~ N N~ O U p o ~ '~ ~ Q N ~ d r Od + cd n p , - ~ ~ U ~ ~ O O ~ ~, O *~ U ~ d aS a7 d y G ~ ~ ~ p ~ ~ ~ Q ~ ~ ~, ~ ~ cd ~ . 0 l1) REV-1513 EX+ (11-08) COM IN~ ERITANCE~ ~X RETURN ANIA RESIDENT DE EDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Comensk ,Anna B. ~ 21-12-18 0 NAME AND ADDRESS OF RELATIONSHIP 70 SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (1Nords) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal . distributions, and transfers under Sec. 9116 a 1.2 1 Frank J. Comensky Spouse One hundred 4106 Seneca Avenue percent of rest, Camp Hitt, PA 17011 residue and remainder Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. 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 SHEETL Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) LAST WILL AND TESTAMENT OF ANNA COMENSRY I, ANNA COMENSKY, of Camp Hill,. Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, unto my husband, FRANK J. COMENSKY, provided he survives me by sixty (60) days. SECOND: Should my husband, FRANK J. COMENSKY, prede- cease me or die on or before the sixty-first (61st) day following my death, I devise and bequeath all the rest, residue and remain- ~er of my estate of whatever nature and wherever situate, includ- ing any property over which I hold power of appointment and together with any insurance policies thereon as follows: (A) One-Third (1/3) thereof to my daughter, ANN MARIE E. COMENSKY, provided, however, that should she predecease me, then to her issue per stirpes by representation; (B) One-Third (1/3) thereof to my daughter, JANE V. SERRES, provided, however, that should she predecease me, then to her issue per stirpes by representation. (C) One-Third (1/3) thereof, in equal shares, to the children of my deceased son, FRANK COMENSKY, said children being ELIZABETH A. COMENSKY, DOMINIC COMENSKY and EMILY COMENSKY, provided, however, that should any of these specifically named grandchildren predecease me, I direct that said deceased grandchild's share be divided evenly between the surviving grandchildren as specifically set forth in this Clause SECOND (C) . THIRD: Should any of my grandchildren riot have attained the age of twenty-two (22) years at the tame for distri- bution to him or her, I give, devise and bequeath the share of. each such grandchild to my hereinafter named Trustee or Trustees, IN SEPARATE TRUSTS, to hold, manage, invest and reinvest the shares so received, and to use and apply from time to time such portion of income and principal for the said grandchild's post- high school education (including college, trade school or other similar training or education),. as my Trustee or 'Prustees, in their sole discretion, deem advisable. The Trust~ae or Trustees, in exercising their discretionary authority with :respect to the payment of income or principal of the within Trust to my grandchildren, shall take into consideration any income or other resources available to my grandchildren from sources outside this ~ust . Any income or principal not so applied shall be dis- tributed to each grandchild when he or she attains the age of twenty-two (22) years. In the event any of my grandchildren die prior to the termination of the Trust established. herein for their benefit, the interest of my grandchild in staid Trust shall cease with any income and principal being divided evenly between or among that deceased grandchild's brothers and sisters or the separate trusts established hereunder for their k~enefit and, in the absence of any brothers and sisters, to my other grandchil- dren in equal shares. FOURTH:. In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicablEa to all proper- ty, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale,, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or 2 conditions as are deemed proper. This includes tree power to give legally sufficient instruments for transfer of thES property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partii~ion, subdivi- sion, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of versification, risk or productivity, (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F} To exercise any election or privilege given by the Federal and other tax laws, including, but not nE:cessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. ~Il To select a mode of payment under. any rn~a1 ified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. FIFTH: I nominate and appoint JANE V. SERRES, as Trustee of the hereinabove described trusts. In the event of the 3 death, resignation or inability to serve for any reason whatso- ever of the said JANE V. SERRES, I nominate and a~>point, ANN MARIE E. COMENSKY, as Trustee of the hereinabove ciescribed trusts. I direct that my Trustee or Trustees shall serve without bond and shall receive fair and reasonable compen:~ation. SIXTH: I direct that all inheritance, ~=_state, transfer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. SEVENTH: All interests hereunder, whether principal or income, which are undistributed and in the posse~;sion of the fiduciaries acting hereunder, even though vested or distribut- able, shall not be subject to attachment, execution or sequestra- tion for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subjects to pledge, assignment, conveyance or anticipation. EIGHTH: I nominate and appoint my huslband, FRANK J, COMENSKY, Executor of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of the sand FRANK J. COMENSKY, I nominate and appoint my daughters, ANN MARIE E. COMENSKY and JANE V. SERRES, Co-Executrixes of this, my Last Will and Testament. T direct that my Executor or Executrix, Trustee or Trustees, as the case may be, and their successors, shal_1 not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto sE.t my hand and seal to this, my Last Will and Testament, this /~ day of 2001. ~~ (SEAL) ANNA COMENSKY ~, 4 r Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address Address 5