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HomeMy WebLinkAbout04-18-12 (2)~" 9 1505611185 '-•: REV-1500 Ex (o2-,,,(FI, OFFICIAL USE ONLY PA Department a Revenue County Code Year File Number suroau alndividualTaxes INHERITANCE TAX RETURN Po sox Zaoso, 21 12 00 41 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDOWYY 201-16-4067 01032012 11051925 Decedent's Last Name Suffix Decedent's First Name MI MILLER JOHN E pf Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Mt Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Retum (Date of Death Prior to 12-13-82) ^ 4. Limited Estate ® 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Retum Required death after 12-12-82) ® 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Wilq (Attach Copy of Trust.) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death ^ 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST t3E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RICHARD C• SNELBAKER First Line of Address SNELBAKER & BRENNEMAN~ P•~• Second Line of Address 44 WEST MAIN STREET City or Post Office MECHANICSBURG 717-697-8528 REGISTER OF WILLS USE ONLY -~,.3 a `~ ns ~ ~ ~ J _ =~ :" ©~ its ~ ~ J ~ ~ ^ r'I FlLED State ZIP Code _ _ PA 17055 ~ `° ~ Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, induding accompanying schedules and statements, and to the best a my knowledge end bdief, it ~ true, correct and complete. Declaration of preperer other than the personal representafnre is based on all information a which preparer has any knowledge. C • EDWARD ROGERS, ~ • , EXECUTOR 200 WESTVIEW DRIVE, MECHANICSBURG OF~2PARER OTHER THAN REPRESENTATIVE DATE PA 17055 RICHARD C• SNELBAKER, ESQ 44 WEST MAIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 1505611185 Side 1 OM4647 3.000 1505611185 ~-~j,~- J 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 201-16-406? Dscedenrs r~ame~ MILLER JOHN E RECAPITULATION 1. Real Estate (Schedule A) . .. .. .. 1. 2. Stocks and Bonds (Sdiedule B) . .. .. .. 2, 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3, 4. Mortgages and Notes Receivable (Schedule D) 4, 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5, s. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g, 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Bitting Requested .... 7. 8. Total Gross Assets (total Lines 1 through 7) 8 0.00 114,144.04 0.00 0.00 596,831.56 0.00 292,655.51 1,003,631.11 9. Funeral Expenses and Administrative Costs (Schedule H).. .. .. .. g, 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 1 p, 11. Total Deductions (total Lines 9 and 10) , 11. 12. Ntt Value Of Estate (Line 8 minus Line 11) 12. 13. CharKable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 13, 14. Net Valua SubJect to Tax (Line 12 minus line 13) , 14, TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers u Sec. 9116 1 x 2 o . . (a)( ) 0.0 0 15. 1s. Amount of Line 14 xaWe t li al te x 0 4 y ra . a ne 6, 3 8 4.5 0 1 s. 17. Amount of Line 14 taxable at alaing rate x .12 4 9 , 5 51.31 17. 18. Amount of Line 14 taxable at collateral rate X .15 7 3 6, 8 8 5.01 1 s. 19. TAX DUE . .. .. .. .. .. 19. 20. FILL IN THE t30X IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OM4648 3.000 9,648.03 2,957.02 12,605.05 991,026.06 198,205.24 792,820.82 0.00 287.30 5,946.16 110,532.75 116,766.21 X^ REV 1500 EX (FI) Pepe 3 Decedent's Complete Address: File Number ? 1. 1. ? M 41. DECEDENTS NAME H STREET ADDRESS LOWER ALLEN TOWNSHIP GTY STATE 2)P Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditalPayments A. Pnor Payments 10 5 , 0 0 0.O U s. oisoount 5 , 2 5 0.0 0 3. Interest (1) 116,766.21 Total Credits (A + B) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. F(II in box on Page 2, Line ZO to request a refund. 110,250.00 (3) ~•~~ (4) ~ • ~ 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 61516.21 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a Vansfer and: Yes No a retain the use or income of the property transferred .......... .... .. ..... ^ : b. retain the right to designate who shall use the property transferred or ks income ... ... .. . ^ c. retain a reversionary interest .................................. . d. receive the promise for life of either payments, benefds or care? ..... .... .. ....... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year Of death without receiving adequate consideration? ..... ....... ....... .... .... .. ^ 3. Did decadent own an "in trust for" or payable-upon-death bank account or security at his or her death? . ^ 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which contains a beneficiary designation? ... ... ........... ....... .. ....... ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE. RETURN. Far dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9118 (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 beneficary. 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. §9118(a)(1.2)j. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefxtiaries is 4.5 percent, except as noted in [72 P.S. §9f18(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. OM4871 2.000 REV-1503 EX ~ (698) SCHEDULE B COMMONWEALTH ~ PENNSYLVANIA STOCKS St BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER John E Miller 21 12 0041 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER ~SCRIPPON OF DEATH t. Harsco Corporation 1,524.58 71.2422 shares of common stock valued at $21.40 per share 2 IPNC Financial ~ 20,583.67 348.049872 shares of common stock valued at $59.14 per 3 PP&L Corporation 92,035.79 3,143.299 shares of common stock valued at $29.28 per share TOTAL (Also enter on line 2, Recapitulation) I $ 114 ,144.04 3W4898 7.000 (If more space is needed, insert additional sheets Of the same size) REV-7509 EX* (17-10) Pennsylvania SCHEDULE E oErnatteNroFRlut:NUE CASH, BANK DEPOSITS, ~ MISC. ,~~" PERSONAL PROPERTY ESTATE OF: FILE NUMBER: John E. Miller 21 12 0041 Indude the proceeds of litigatron and the dale the proceeds were received by the estate. All property jointly owned with right of survivorship must bs dfscbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIP'T10N ~ DEATH ~. Cash 11.50 found in the decedent's possession 2 Donegal Insurance 59.00 premium refund due the decedent 3 Internal Revenue Service 3,324.00 refund due the decedent on 2011 income tax return 4 Jewelry 275.00 consisting of• a. Man's 14K wedding band $75.00 b. Man's. diamond ring $200.00 (see attached appraisal) 5 Patriot News 134.00 subscription refund due the decedent 6 Pennsylvania State Employee Retirement System 0.00 net amount of pension payment due the decedent in the amount of $95.77 which is non-taxable and listed for informational. purposes only 7 PNC Bank, N.A. 9,140.58 savings, account number 5004414166 Interest accrued to 1/3/2012 0.45 8 PNC Bank, N.A. 15,087.77 checking, account number 5004415513 Interest accrued to 1/3/2012 0.05 9 PNC Bank, N.A. 15,010.75 certificate of deposit, account number 31000305562 Interest accrued to 1/3/2012 4.16 10 PNC Bank, N.A. 69,039.98 certificate of deposit, account number 31700307419 Interest accrued to 1/3/2012 43.88 11 PNC Bank, N.A. 10,706.69. certificate of .deposit, account #31100335468 Interest accrued to 1/3/2012 7.94 Total from continuation schedules . owasao z.ooo TOTAL (Also enter on line 5, Recapi Ir more apace is needed, use additanal sheets of paper of the same size. 473,985.81 596,831.56 Estate of: John E. Miller Schedule E (Page 2) 21 12 0041 Item Value at Date No. Description of Death 12 PSECU 5,319.71 certificate of deposit, account number ending in S54 Interest accrued to 1/3/2012 0.35 13 PSECU 10,640.58 certificate of deposit, account number ending in 353 Interest accrued to 1/3/2012 0.70 14 PSECU 9,632.35 certificate of deposit, account number ending in S52 Interest accrued to 1/3/2012 1.10 15 PSECU 7,068.45 certificate of .deposit, account number ending in S51 Interest accrued to 1/3/2012 0.46 16 PSECU 10,565.21 certifiate of deposit, account number ending in S50 Interest accrued to 1/3/2012 0.78 17 PSECU 2,095.93 money-market, account number ending in S7 Interest accrued to 1/3/2012 0.05 18 PSECU 5.10 checking, account number ending in S4 19 PSECU 30.64 savings, account number ending in S1 20 Vanguard 105,936.53 investment, account number 0536-880250 41639 Interest accrued to 1/3/2012 26.06. Total (Carry forward to main schedule) 151,324.00 Estate of: John E. Miller Schedule E (Page 3) Item No. Description 21 Ameriprise investment account coy a. #01010203448 4 002 b. (101010203474 0 002 c. X1010102034?6 5 002 d. X101010203477 3 002 e. #01010203494 8 002 f . X101013455035 8 002 g. #02014178456 9 002 h. XF02014789011 3 002 i. X02014831135 8 002 j. (102014872896 5 002 k. Xk02014589904 1 002 zsisting of following: $78,195.1. $21,618.10 $26,615.88 $20,779.35 $26,670.00 $15,715.77 .$11,679.60 $37,928.53 $34,859.56 $20,670.58 $27,929.33 21 12 0041 Value at Date of Death 322,661.81 Total (Carry forward to main schedule) 322,661.81 REV-1510 EX + (08-09) Pennsylvania ~~ INFERRANCIc TAX RETURN SCHEDULE G INTER VIVOS TRANSFERS AND MISC. NON~ROBATE PROPERTY ESTATE OF Ft~ NUMt3ER John E. Miller 21 12 0041 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBS N OF PROPS rcLloETrElMIEDPTFETRAABFEREE,nfIRRELATIONSMPTODECEDEMMD iFE OAE OFTRAI~aF6t ATTK7/ACDPY OF Tlf DEEP FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OFDECDS gJTEREST EXCLUSION APPIiCABLE TAXABLE VALUE ~• Ameriprise 292,655.51 100.0000 0.00 292,655.51 IRA accounts as follows: a. #01014011662 4 002 $204,726.44 b. X01014011668 1 002 $13,932.66 c. #01014011670 7 002 $7,564.80 d. #01014011671 5.002 $3,881.52 e. #01014011672 3 002 $26,560.95 f. #01014011687 1 002 $6,436.58 g. #02014608110 2 002 $8,330.84 h. X02014838238 3 002 $21,221.72 Designated beneficiares are: 1. Richard Wolf 10~ 2. Janet Stevenson 5~ 3. Ryan Wolf 5$ 4. Stacey Goss 5~ 5. Sherri Phillips 27.5 6. Pamela Rogers 27.5 7. Brathesda Mission 5~ 8. Pine Street Presbyterian Church. 5$ 9. Downtown Daily Bread 5~ 10. Central. PA Food Bank 5~ TOTAL (Also enter on line 7, Recapitulation) S 292,655.51 If more apace is needed, use additional sheets or paper of the same size. 9W4tiAF 2.000 REV-1511 Ex~ (laoo) SCHEDULE H Pennsylvania oEPKZn~rrroF ~~ FUNERAL EXPENSES AND NNERITMICETAXRETURN ADMINISTRATIVE COSTS RESOENroECEOENr ESTATE OF FILE NUMBER .Tnl,n ti! Ms.ller 21 12 0041 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Malpezzi Funeral Home 94.78 2 Funeral luncheon 260.75 B. ADMINISTRATNE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) C . Edward Rogers , Jr . Street Address 200 Westview Drive City I!sechanicsbura State PA ZIP 17055 Year(s) Commission Paid: 2. AttomeyFees: Snelbaker & Brenneman, P.C. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Ciaim~t Street Address 4. 5. 6. 7. City State ZIP _ Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Retum Preparer Fees: 1 Cumberland Law Journal advertise Executor's Notice 2 Greenawalt & Company, P.C. Total from continuation schedules . 500.00 5,550.00. 713.50 75.00 215.00 2,239.00 TOTAL (Also enter on line 9, Recapitulation) I S 9 , 648.03 ewasnc z.ooo ,, ,,,..,a ~Mo..a .., ..~~..~.., ,.~ a .............. o„..~.~ .,, ,,o,,,,..,....,..,........,,..... Estate of: John E. Miller 21 12 0041 Schedule H Part 7 (Page 2) 3 Register of Wills filing fees for Inheritance Tax Return 15.00 4 The Sentinel advertise Executor's Notice 221.40 5 U.S. Postal Service postage fees for mailing of income tax returns 2.60 6 Reserve for filing fees, accountant fees and other miscellaneous costs associated with the administration of the estate 2,000.00 Total (Carry forward to main schedule) 2,239.00 -V-1512 EX + (12-08) Pennsylvania SCHEDULE oeasat~ENroF'~"~ DEBTS OF DECEDENT, INiERITANCETAXRE7URN MORTGAGE LIABILITIES 8 LIENS RE~rr oECEOENr --- ESTATE OF FILE NUMBER Tohn E . Miller 21 12 0041 -- _- -__ Report debts Incurred by the decedent prior to death that remained unpakil at the date of death, including unreimbunied medical expenses. ITEM VALUE AT DATE !JMBER DESCRIPTION OF DEATH 1• ____ Bonni® K. .Miller. Tax Collector per capita tax 9.80 2 Cardiology Practice medical expense 31.30 3 Internal Revenue Service 4th quarter .2011 estimated income tax payment 1,640.00 4 Continuing Care RX medical expense 226.12 5 PA Department of Revenue tax due on 2011 income tax return 83.00 6 James Norton, DPM medical expense 45.00 7 PA Department of Revenue 4th quarter 2011 estimated income tax payment 144.00 8 Pinnacle Health medica-1 expense 15.80 9 Bethany Village nuring home care 762.00 TOTAL (Also enter on Line 10, Recapitulation) ~i 2 ew+snH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania oa+ARTreMroF REVENUE N~RITANCE TAX RETURN Fi~IDENi'DECEpENT SCHEDULE J BENEFICIARIES FILE NUMBER: RELATIONSHIPTO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not list Trustee(s) OF F~q~ i TAXABLE DISTRIBUTIONS (Indude outdyht spousal dislrlbutions and transfers under Sec. 9116 (a) (1.2).J 1, Janet M. Stevenson 7875 Rabbit Lane Harrisburg, PA 17112 Ameriprise Inventory Value: 14,632.78 2 1. 1 5~ of Residue: $34,918.53 Sister Josephine M. Wolf C/0 C. Edward Rogers, Jr., Trustee 200 Westview Drive Mechanicsburg, PA 17055, Life.Estate Trust is created under Mother-in-law Decedent's Will in which 207 of residue is bequeathed to said beneficiary with the remainder beneficiaries receiving the trust upon termination of the trust or her death. Value. of life estate calculated as follows: 20~ of residue $139,674.10 X .04571 (actuarial factor) _ $6,384.50 for Life Est to Value taxable at ENTFR OOLIAR AMOUNf$ FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 78 OF REV•1500 COVER SHEET, AS API NONTAXABLE DISTRIBUTIONS. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: See Attached TOTAL OF PART II - 8 W ~8A12.000 $49,551.31 $139,674.10 ' .5~ 'ROPRIATE. TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ S 1913 more space Is needed, use add~lonal sheets of paper of the same size. Estate of: John E. Miller ' - Schedule J Part 1 (Page 2) Item No. Description Relation 3 Richard A. Wolf 2477 Riverview Avenue Reading, PA 19605 Ameriprise Inventory Value: 29,265.55 10~ of Residue: .$69,837.05 Brother-in-law 4 Sherri L. Phillips 7875 Rabbit Lane Harrisburg, PA 17112 Ameriprise Inventory Value: 80,480.27 22.5 of Residue: $157,133.36 Niece Remainder Beneficiary on Trust 5 Pamela L. Rogers 200 Westview Drive Melchanicsburg, PA 17055 Ameriprise Inventory Value: 80,480.27 22.5 of Residue: $157,133.35 Niece Remainder Beneficiary on Trust 6 Ryan Wolf C/O Richard Wolf 2477 Riverview Avenue ' Reading, PA 19605 Ameriprise Inventory Value: 14,632.78 Nephew Remainder Beneficiary on Trust 7 Stacey Goss 2203 Cullum Drive Reading, PA 19601 Ameriprise Inventory Value: 14,632.78 Niece Remainder Beneficiary on Trust 21 12 0041 Amount $99,102.60 $237,613.63 $237,613.62 14,632.78 14,632.78 Estate of: John E. Miller 21 12 0041 Schedule J Part 2B (Page 1) Item No. Description Amount 1 Pine Street Presbyterian Church 310 North Third Street Harrisburg, PA 17101 Ameriprise Inventory Value: 14,632.78 5$ of Residu®: $34,918.53 $49,551.31 2 Central. Pennsylvania Food Bank 3908 Corey Road Harrisburg, PA 17109 Ameriprise Inventory Value: 14,632.78 5~ of Residue: $34,918.53 $49,551.31 3 Downtown Daily Bread 310 North Third Street Harrisburg, PA 17101 Ameriprise Inventory Value: 14,632.78 5~ of Residue: $34,918.53 $49,551.31 4 Bethesda Mission 2101 Norrth Front Street Harrisburg, PA 17110 Ameriprise Inventory Value: 14,632:78 5~ of Residue: $34,918.53 $49,551.31 REV-1514 EX+(1-09) ~-Ivania auroau d IndMdu~ Taxn Po ew~28o801 Harisburp PA 17128.0601 SCHEDULE K LIFE ESTATE, ANNUITY ~ TERM CERTAIN (CHECK BOX 4 ON REV-1500 COVER SHEET) ESTATE OF FILE NUMBER John E. Miller _ 2132 0041 This schedule should be used for all single-life, joint or successive life estate and term-certain caculations. For dates of death prior to 5-1-89, actuarial factors for single-irfe calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 430-99, and in Alpph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest below and attach a copy of it to the tax return. X^ Will ^ Intervivos Deed of Trust ^ Other #1 NAME OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEAF`tS LIFE ESTATE 13 PAYABLE Josephine M. Wolf 06/16/1918 X Life or Term of Years Lffe or Term of Years Life or Term of Years Life or Term of Years Life or Term of Years value of fund from which life estate is payable „ , , , , , , , , , , , , , , , , , , , , , , $ 139, 674.10 Actuarial factor per ap ro mate table .. ... ............. ...... 0.04571 interest table rate - ~ 3.5% ^ 6°k ^ 10% ^ Variable Rate 0.00000% Value. of life:estate (Lips 1 multiplied by Line 2) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , $ 6, 384.50 t~1.R81~ at~i _ : ~ • NAME OF LIFE ANNUITANT DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE Life or .Terre of Years Life or Tenn of Years Life or Term of Years n Life or n Term of Years ~ . value or rung rrom wrncrt annuity is payable ............................... $ y . vo 2. Check appropriate bkx~c below and enter corresponding number ... , . , , ............. 0.000 Frequency of payout -^ Weekly (52) Bi-weekly (26 Monthly (12) ^ Quarterly(4) ^ Semi-annualy (2) ^ Annually (1) X~Other ( ) 0 3. Amount of payout per period ....................................... $ 0.00 4. Aggregate annual payment, Line 2 multiplied by Line 3 ,, , , , , , , , , , , , , , , , , , , , , 0.00 5. Annuity Factor (see instructors) Interest table rate -^ 3 1/2°~ ^ 6% ^ 10% ^ Variable Rate 0.00000 % 0.00000 6. Adjustment Factor (See instructions.) ,,, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 0.00000 7. Value of annuity - If using 3.5%, 6%, or 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 , , , , , , , , , , , , , $ 0.00 If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line S x Line 6) + Line 3 ..................................... $ 0.00 NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 th rough 18 of the return. If more space is needed, use additional sheets of the same site. ewasA.~ 1.010 ~~~~/ ~ /®~ M V M MSS ~~~e~~ Jto~E 34 WEST MAIN STREET MECHANICSBURG, PA 17055 Phone: 766-9422 .~~~ ~ `7~?cc~cai ~ . ~~%~~-' R ~~ ~ ~~~-~ ~- ~~. ~ ~~~~ ~1 LAST WILL AND TESTAMENT 1, JOHN E. MILLER, of the Township of Lower Allen, County of Cumberland and Conunomvealt.h of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. 1~ IRST. I order and direct that all my just debts acid funeral expenses be paid by my .Executor. Executrices or Executrix, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. Sl_COND. I order and direct that al.l income, inheritance, estate and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. Tlus provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. THIRD. I order and direct that all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, be distributed and disposed of as tollo~a s: A. I give, devise and bequeath twenty per centum (20%) of my net residuary estate auto my Trustee or Trustees, as the case may be, IN TRUST, NEVERTHELESS, as a Special Supplemental Care Trust for the benefit of my mother-in-law, namely, .1OSEP.HINE A4. WOLF, if she survives me, on the following terms: (1) INTENT It is my intention by this trust to create a purely discretionary supplemental care fund for the benefit of JOSEPHINE M. WOLF and not to displace financial assistance that may otherwise be available to her. Illustrative of the kinds of supplemental, non-support disbursements that would be appropriate for my Tnistee to make from this trust for JOSEPHINE M. WOLF include: ww o~cESs $NEIBAKER 8C BRENNEMAN. F.C. sophisticated medical or dental or diagnostic work or treatment for which there are not funds otherwise available, including plastic surgery or other non-necessary medical procedtues; private rehabilitative training; dental raze; recreation and transportation; differentials in cost between housing and shelter for shared and private rooms in institutional settings; supplemental nursing care and similar care that assistance programs may not otherwise provide; telephone and television service, compatuons for travel, reading, driving and cultural experiences and payments to bring her siblurgs or others for visitation in the event my Trustee deen-rs that appropr7ate and reasonable. uw o~css SNELBAKER & BRENNEMAN, P.C. it is important that JOSEPHINE M. WOLF maintain a high level of human dignity and that her care be humane. If this trust were to be eroded by creditors, subjected to liens or encumbrances, ox cause assistance benefits to be unavailable or terniinated; it is likely that the trust corpus would be deleted prior to her death, especially if the cost of care for her would be high. In such event there would be no coverage for emergencies or supplementation to basis needs. The trust provisions contained ui this instrument should be interpreted.by my Trustee in light of these concenis a-rd this intent. (2) OPERATION OF TRUST My Tntstee shall pay or apply for the benefit. of my mother- in-law for her lifetime such. amotutts from the principal or income, or both, of this mist up to the whole thereof, as the Trustee, in the trustee's sole and absolute discretion, may from time to tune deem necessary or advisable for the satisfaction of JOSEPHINE M. WOLF'S special non-support needs, if any. Any income not distributed shall be added annually to principal. As used in this instrument, "special non-support needs" refers to the requisites for maintaining my mother-in- laws good health, safety and welfare when, in the discretion of the Trustee, such requisites are not being provided by any public agency, office or department of state where shelives or of the United States, or are not otherwise being provided by other sources of income available to her. Special non-support needs shall include but shall not be 1united to the list of suggested non-support items set out in tlus article. In the event that she is unable to maintain and support herself independently, the Trustee may, in the exercise of the Trustee's best judgment and -2- fiduciary duty, seek support and maintenance for her from ail available public an~ private sources. The Trustee shall take into consideration the applicable resource. and lnnitations of any public assistance program for which she is eligible. >n carrying out the provisions of this trust, my Trustee shall be mindful of the uw o~cEs SNELBAKER Sf BRENNEMAN, P.C. probable firtttte needs of my mother-in-law, but not of the trust remainder beneficiaries. No part of the corpus of the trust created hereby shall be used to supplant or replace public assistance benefits of any county, state, federal or other goveriunentaI agency that has a legal responsibility to serve persons with disabilities t]tat are the same or similar to those which JOSEPHINE M. WOLF uia}' be experiencing. For purposes of determining my mother-in-law's public assistance eligibility, no part of the principal or undistributed income of the trust shall be considered available to her. In the event that the Trustee is required to release principal or uicome of the trust to or ou behalf of JOSEPHINE M. WOLF to pay for benefits or services which such public assistance is otherwise authorized to provide were it not for the existence of this trust, or in the event the 'T'rustee is requested to petition the court or any other administrative agency for the release of trust principal or income for this purpose, the Trustee is authorized to deny such request. My Trustee is authorized, in the Trustee's discretion, to take whatever administrative or judicial steps may be necessary to continue the public assistance program eligibility of JOSEPHINE M. WOLF, including obtaining inshuctions fiom a court of competent jurisdiction ruling that the trust corpus is not available to the beneficiary for such eligibility purposes. Further, my Trustee should cooperate with the beneficiary's conservator, guazdian or legal representative to seek support and niauitenance for the beneficiary from all available resources, including but not limited to, the Supplemental Social Security Income Program (SSI); the Medicaid Program; and any other similaz or successor programs; and from any private support sources,. Any expense of the Trustee, including reasonable attorney fees, shall be a proper charge to the tn~st. -3- (3) SPENDTHRIFT PROVISIONS No interest in the principal or,income of this trust shall be anticipated; assigned or encutmbered or shall be subject to any creditor or to any legal process prior to the actual receipt by the beneficiary. Furthermore, because this tnist is to be conserved and maintained for the special non-support needs of JOSEPHINE IVI. WOLF tluoughout her life, no part of the corpus hereof, neither principal nor tmdistributed income, shall be construed as part of JOSEPHINE M. «'OLF'S estate or be subject to the claims of voluntary or invohuitary creditors liar the provision of care and sen~ices, including residential care by any public entity, office, department, or agency of any state or the United States or any goveinmentai agency. Under no circumstances can the beneficiary compel a distribution. (4) TRUSTEE AUTHORITY' TO TERMINATE TRUST Nohvithstanding anything to the contrary contained in this trust, in the event that the trust has the effect of rendering JOSEPHINE M: WOLF ineligible for any progrant of public benefit, the Trustee is authorized, but not required, to terminate this mist. In determining whether the existence .of the trust leas the e#ect of renderutg JOSEPHINE M. WOLF ineligible for any program of public benefit, my Tn~stee is gtattted full and complete discretion to initiate either administrative or judicial proceedings, or, both, for the purpose of determining eligibility. All costs relating thereto, including reasonable attorney fees, shall be a proper charge to the trust. In the event of voluntary termination, the undistributed balance of the-trust shall be distributed to the beneficiaries named in paragraph 8. hereinbelow. (5) VOLUNTARY CARE It is my wish that subsequent to the termination of the trust for the uw oFr~cEs SNEIBAKER FL 3RENNEMAN. P.C. benefit of JOSEPHINE M. WOLF, if the remainder beneficiazies are living and distribution has been made outright to them, if JOSEPHINE M. WOLF is still living because there has been a voluntary termination of the trust in accordance -4- with the pl•ovisions of this article, drat such contingent benefit' manage and distribute the tarter will conserve, proceeds of the former trust for the benefit of JOSEpg.~E hl «rOLF to insure that she receives sut$c' living and su lent funds for her basic PPlemental needs when public assistance benefits are unavailable or insufficient. (~) TRUSTEE'S POWERS Subject to the requirement that my Trustee be prudent, ruy Tt'ustee shall have full power altd autliority to manage and control the trust estat sell, exchange, lease rent, e and to ' asstg~l, transfer and otherwise dispose of any or part tltereolupon such temis and conditions as m Y Trustee mays in my 7-rustee's discretion, deem Pz~oPer. My Tn~stee may investor reinvest all or any part of the trust estate in such conuuon or preferred stocks, bonds,. debentures, mort a deeds, deeds of trust, notes and other sectu-ities, investments ofpro ert g ges, including conunon trust fluids which nn Trustee, in m P Y, `~ ~ Y Trustee's absolute discretion, nzay selector determine. It is my express intention that the T shall have fitll power to invest and re' tustee mvest the trust funds as I mi without being restricted to forms of investments which Trustees n aht be tf ltvtng, Pet7nitted by law to Y o~e1'wise m~e, and without an - 3 requirements as to diversification of investments. l~fy Trustee ma3' continue to hold in the forth in which r securities or any pro ert which I might otim at the time oftn eceived, any P y Tnistee may at airy time ac Y death or which my quite heretmder; and may invest any part of the trust fiui~Is lit Property located within or outside of the Commonwealth of Pemasylvania. My Trustee is futthex authorized to invest in life, annuity, accident, sic.(cness, including disability, and medics! insurance on behalf benefit of the trust beneficiaries. of and for the h'lY Trustee shall not be obligated to undertake litigation for uw°~"~ collection of an SNELBAKER $ y benefits or assets payable by reason ofm BRENNEMAN, P,C• not limited to, such benefits Y death including, but under life insttrattce policies, employee benefits plans or other contracts. plans or arrangements providing for payment or transfe r at -S- death which are payable to my Trustee ur-less mY Thee is rode . Trustee's satisfaction against any liabili I1lIIlf ed t0 Illy tY and the e~Pense of such litigation. Payment to 1ny Trustee and the receipt of or release by my T~stee sh discharge ally payor, and no payor need ' all fully inquire into or take notice of my Will to see to t.be application of such payment. M3' liustee shall, in addition to the powers granted above, have all powers otherwise granted under the Perris lv amended a#ler the date of my Will and Y ama Fiduciaries' powers qct as after my death. ~'IY Trustee shall specifically have the powers to invest in non_ income producing assets. (7) UNSUPERVISED ADM~ISTRATION The trust created by this Will may be administered b t Y ray Trustee tiee from the control of any court that may otherwise have jurisdiction ove estate. r my ~~) REMAINDER BENEFIC TERMINATION OF TRUST WHETHER By A TPOF TRU3~ OR DEATH OF JOSEPHINE 1b1. WOLF UPON If JOSEPHINE M. WOLF should predecease me, or at such time as the foregoing tz-ust is terminated, whetl~er by act of the Trustee pursuant to 1»'agraph (4) above or upon the death ofJOSEPHIIVE M WOLF I i and bequeath the remai ~ g ve, devise Wing net balance of the gust fund in equal shares unto PAMELA L. ROGERS, SHERRI I;. PHILLIPS, RYAN Wp GOSS, share and share alike, absolutely. j'F' and STACEY (9) APPOINTMENT OF TRUSTEE S I nominate, constitute and appoint C. EDWA~ ROGERS, JR., to be the Trustee of the foregoing Special Supplemental Caze Trust, but if for reason he should fail to qualify as such Trustee or cease so to serve any that event, I nominate, constitute and a 'than and in LA`" °~~ ppoint PAMELA L. ROGERS and BRENNEMAN, P,C• .SNELBgKER & SHERRI L. PHILLIPS, to be the Trustees of said should fail to qualify or cease so to serve trust (or either of them if one each and all to serve without bond or -6- otizer security as a condition of 9t~alification hereunder. All references to "Trustee" ~ the forego~g trust Provision shat construed to include the plural "Trustees" in l be Fiduciaries of the trust. the event that co-trustees serve as the B• I give, devise a<id bequeath ten per centum (10%) ofm RICHARD A WOLF. o Y net residuary estate unto C• I gwe, devise and bequeath five •/ANET STEV Per centum (5 /) of my net residuar ENSON. y estate unto D• I give, devise and bequeaflz hventy-two and one-half per cen ~ o residuar}~ estate unto S tum (22/ /o) ofm 1.,. I give, devise and bequeath tcveut~~ L PHILLIPS. Y net residuary estate unto P y two and °ne-halfper centum 2 ~ o AMELA L. ROGERS. (2~ ~) of my net 1'• I give, devise and bequeath five per centum (5%) ofm net to PINE STREET PRESBYTERIAN CH URCH iuz szduary estate unto G• I gi ve, devise and bequeath f ve per centum 5 / Hatxisbtzrg, pA CENTRAL pE~SYLVANIA FOOD ofmy net residu BANK ' ~' estate unto H. I give, devise and be zn Harrisburg, PA. queath five per centum (5%) of zny net residu DOtiV1VTOWIV DAILY BRE AD in H ~7' estate unto I• I gi ve, arrisburg, PA. devise azzd bequeath five per centu S°; BETHESDA MISSION in H un (" , °) of mY arrisbur net residuary estate unto I~OUR1'H g, PA. ----__• II any zndivldual beneficiary named hereinabove should predece ase me, I order and direct that the issue of such deceased benefieia beneli°iaz•}', said issue to receive the rY shall be substituted for said per stizpes by z•epresentation and not per ca zitaf zny estate attributable to the deceased beneficiary P . constitute and a Etecutor o/'this, nz~ PPoint C. EDWARD ROGERS, JR., to be the Last Wil! and Testament, such .Executor or cease so to serve but if for any reason he should fail to ,then and i qualify. ~ uw s .SNELBAKER & BRENNEMAN. P, C, n that event, I nominate, constitute and a Pgn1ELA L. ROGERS azzd SHERRI L. PHILLIPS PPoint (or either of them if one should fail to or cease so to serve) to be the Executrices hereof, each qualify security as a condition of qualification heretmder, to be d1e E 1 to serve without bond or other serve without bond or other seciuit xecutrix hereof each Y as a condition of and bO~ to representative. qualification as mypersonal I:N ~~~ITNESS WHEREOF, I, JOIIN E. ~,IILLER, have he reuinto set mY hand and seal -7- 10 IIllS• Illy Las Lvllic(1 ~ have of ixe 111 and Testament t~'hicll coils' d Il>.v sl lsts of eight gllatpre Ous 24u~ ~g~ ~ da}~ ° f e~~en Pages to each o f JallualY, Ttivo Tho~andEight X2008). Jpl~ E. MILLER the SEAL) Illecedillg instl-~llent, identiGe collsisrin d h~; the ~' g oftlus old slgllatur declared e ofthe sev h'' ~O.I-i Testator en ~~) othe NE' ~'lIL j~'as on file date r t~e~tten t ~estanlellt therep f Page, each 111 the ~R, die Testator therein presence slgled~ sealed, Published other, need, o us, tv as Ilan and e subscribed oul. nal ho, at his request, tll lus arld fox his Last Wlll and hes ~ Witnesses hereto presence and in the presence of each fP -~_ uw°~ ~~ELBAKEq & NNEMgN, p C. 'S. UOn-1~iONFt~, AL TH OF .pENNS ~ VANIA) COUNTY Ol; CUILIBERLANll SS. ~i'e, JOHN E- Testator aztd The ~~,-• ~IILLE inslrumeztt ztnesses, re pe~ eHARD C. SNEL$A~R being first duly s~~.orn, do ltereb pse n and JANE J. GOONEY, the Test<•ztor signed and executed the insh• antes are signed to stgited willingly, y declare to the undersi ttte attached or fore and that he e, uznent as his Last Wil! geed audtori going etpressed- auc( that each of theYeeuted it as lzis F-ee ty that the Will as ~. and Testament and that he had ~ ~~-itztess and that to the best of s, zn d'e and volunt~, act for the eighteen rears of as Pl'eseuce and he Purposes therein ~e oz' older, of sound his or her knowledge ~e~"'g of the Testator, sigzted the miztd and under no Testator was constraint or at that time undue influence. Testator , ~'iktess '\~ CI-~~ Wztztess Sttbsc. abed, sworn to anti subscribed and sw and ackno witztesses m °zYt to before me b ledged before zne by JO this 24 day °f'.January, 2003. y RICgA~ C• SNELg~R~LLE.R, the Testator, and JANE J. GOONEY, O Notary public [~u~w o~S R~ "'E~BAKEq & -"ENNEMAN, P,C. coML ~ ~v~ ~~ gp,,~,,_YPublb~er,,,,~,,~~ Member, Penns ~~_ _.~ ~'MI nts Assogau~ of M~rrea