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HomeMy WebLinkAbout06-04-12 (2)'' r 1505610143 REV-1 SOO ex(°'_'°''~,° PA De artment of Revenue OFFICIAL USE ONLY p Pennsylvania County Code Vear File Number Bureau of Individual Taxes °a""aTMQR OfR~'a~ PO 80X.280601 INHERITANCE TAX RETURN 21 12 0143 Harrisburg, PA 17126-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 168 26 4578 O1 25 2012 08 28 1932 Decedent's Last Name Suffix Decedent's First Name MI LUCISANA THERESA (If Applicable) Enter Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffix Spouse's First Name MI O g Decedent Died Teetete (ANarh Copy of Will) ~ T pece~enoPYi~,ined a Living Trust ((AA~ttt C ) g, Total Number of Safe Deposit Boxes g. Litigation Proceeds Received ~ t p, ~c~~Pgv~f!~~e dat ~d~c~SW deem J ~ f f Election to tax under Sec. 9113(A) (Attach Sch. O) Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12.13-g2) q, Limited Estate ~ qa Future Interest Compromise ~ 5. Federal Estate Tax Return Required (date a deem aver tz-t z-az> CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MICHAEL L BANGS 717 730 7310 REGISTER WILLS US~NLY r+,a First line of address ~ ~ 429 SOUTH 18TH STREET ~ x ~ ~' f Second line of address ci>rw? ,F- ~: City or Post Office CAMP HILL State ZIP Code PA 17011 fV ac! correspondents e-mail address: mikebangs~verizon.net Under penalties of perjury, I daGare that 1 have examined this return, including accompanying sehaduka and statements, and to the Ueat of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal repreaentabve is besetl on all information of which preparer has any knowledge. t ~ _ Lac..--e Brenda Tusina ~~1~! ~ ~ 150561[]143 1505610143 J 429 South 18th Street, Camp Hill, PA 17011 Side 1 p'~ 1505610243 REV-1500 EX Decedent's Social Security Number oe~eae^rsName: Lucisana, Theresa 168 26 4578 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule e) ............................................................................ . 2. 95 , 497.99 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. 254 ,103.65 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous f ~q Probate Property (Schedule G) a Separate Billing Requested............ 7, Q02 , l,'] tj . 11 8. Total Gross Assets (total lines 1-7) .................................................................... . 8. 1, 251, 7 7 5. 7 5 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 15 , 42 5 . 2 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 4 , 706.45 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 2 0 , 131.7 4 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 1 , 231 , 644 . O1 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Nat Value SubJect to Tax (Line 12 minus Line 13) ............................................... 14. 1 , 231 , 644. O1 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0 . 0 0 (a)(1.2) X .00 . 16. Amount of Line 14 taxable 0 , 00 16 0.00 at lineal rate X .045 . 17. Amount of Line 14 taxable 0 00 t7 0.00 . at sibling rate X .12 . 18. Amount of Line 14 taxable 1 231 644. O1 18. 184 , 7 4 6.60 , , at collateral rate X .15 19. Tax Due ................................................................................................................. . 19. 184,746.60 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12-0143 DECEDENT'S NAME Lucisana, Theresa STREET ADDRESS 4905 E Trindle Road, Building 3, Suite 82 CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 168,000.00 8,842.11 Total Credits (A + B) (2) 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 Llne 20 to request a refund (1) 184,746.60 176,842.11 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 7 904.49 s 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 :.................................. ^ ^x 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?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse 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. Rsv-7607 F7(a (6-96) SCHEDULE B STOCKS 8 BONDS COMMONWEALTH OF PENN6VLVANIA INHERITANCE TA%RETURN RE610ENr DECEDENT ESTATE OF FILE NUMBER Luclsana. Theresa 21-12-0143 All property IolnNyovmsd wIM ngM of survivorship must tw di~clossd on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 5,013.018 shares of Merrill Lynch - Blackrock Global 19.0500000 95,497.99 Allocation FD Inc A TOTAL (Also enter on Line 2, Recapitulation) 95,497.99 (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 B (Rev. 6-98) Rev,150s EX+ (8.98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RETURN RE81DENr I~CEDENT ESTATE OF FILE NUMBER Lucisana, Theresa 21-12-0143 InrJude the proCeade of litigation and Me dale the proceeds were received by the estate . All Property Jolmly-ovmed with tlts right of wrvivonhip must bs disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Citizens Bank 36,529.81 2 Merrill Lynch -miscellaneous cash 0.42 3 Merrill Lynch - 2012 Distribution from Merrill Lynch IRA 20,605.75 4 60,955 Merrill Lynch Bank Deposit -Account #990286916 60,955.00 5 370 Merrill Lynch CD - (CD Banco Popular DE P R) 36,905.98 6 380 Merrill Lynch CD - (CD Bank of China) 37,971.69 7 Nationwide Bank -Checking Account 31,434.53 8 Nationwide Bank -Money Market Account 28,441.81 9 Refund from The Homeland Center 1,133.02 10 Refund from Pinnacle Health 50.00 11 Refund from Prescription Solutions 29.97 12 Refund from United Health Care Services 45.67 TOTAL (Also enter on Line 5, Recapitulation) I 254,103.85 (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) Rav-7570 EXs (8.98) ESTATE OF (FILE NUMBER Lucisana. Theresa 21-12-0143 This schedule must be wmpleted and fled rf the answer to eny of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTpY THE DATE OF RANSFE~RSA77ACIiTA COPY OF TIHE DEIED FOR REAEES~ E. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Merrill Lynch -This IRA was in process of rollover 455,646.72 455,648.72 from Schwab to Merrill Lynch at date of death. Closed at Schwab on 1/23/2012 (see attached check) two days prior to date of death. Received at Merrill Lynch on 1/30/2012 so check amount represents date of death value. 2 Merrill Lynch -IRA Account 872-70365 (the 387,226.82 387,226.82 beneficiaries of this annuity are the decedent's nieces and nephew) 3 Security Benefit -Annuity Contract 7003108275. 59,300.57 59,300.57 Decedent's nieces and nephews are the beneficiaries of this annuity. TOTAL (Also enter on Line 7, Recapitulation/ (If more space is needed, additional pages oT the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. SCHEDULE G INTER-VIVOS TRANSFERS 8 MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 902,174.11 Forth PA-1500 Schedule G (Rev. 6-98) Rrv-~~a~ ex+I~o~oal cornr~~~~~~nnw SCHEDULE H FUNERAL EXPENSES 8r ADMINISTRATIVE COST; ESTATE OF FILE NUMBER Lucisana, Theresa 21-12-0143 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: See continuation schedule(s) attached ~ 5,829.73 B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Streat Address City State Year(sl Commission paid 2, Attomev's Fees Michael L. Bangs 8,000.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 323.50 5. Accountant's Fees 475.00 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 797.06 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 15,425.29 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-08) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Lucisana, Theresa 21-12-0143 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex en nses 1 Gingrich Memorials -headstone engraving 2 Neill Funeral Home, Inc. Other AdministrativA Costs 3 Brenda Tusing -reimbursement for travel expenses of executrix 4 Brenda Tusing -reimbursement for after service (funeral) 5 Cumberland Law Journal -estate advertising 6 The Sentinel -estate advertising 640.00 5,189.73 H-A 5,829.73 175.00 400.00 75.00 147.06 H-B7 797.06 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) .. Rw-1672 EX+112-09) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMON W EALTH OF PENN9V LVAN IA INHERITANCE TA%RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Luciaana, Theresa 21-12-0143 RepoA debt Ineurtad by Ma decedent prior to death that remalrrod unpaid at the data of death, Inelutling unnNmbunsd medleal expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Brockie Pharrnatech 144.95 2 Community Life Team EMS 92.00 3 Gift 6 Associates -decedent's 2011 income tax return preparation 475.00 4 Goodwill Fire Rescue EMS 25.00 5 Holy Spirit Hospital 212.50 6 Keystone Hearing Institute 25.00 7 Pinnacle Health Hospitals - (bill of 1/27112) 50.00 8 Pinnacle Health Hospitals - (bill of 2/13/12) 250.00 9 Pinnacle Health Hospitals -Invoice 2/24/12 50.00 10 Quest Diagnostics 75.00 11 South Central EMS, Inc. 120.00 12 United States Treasury -Income tax due on decedent's 2011 income tax return 3,187.00 TOTAL (Also enter on Line 10, Recapitulation) I 4,706.45 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-161] EX* (11-08) SCHEDULE J °°""'rl' ,Fi~'t~p~~""'" BENEFICIARIES ESTATE OF FILE NUMBER Lucisana, Theresa 21-12-01 43 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 Gail T. Gillis Niece one-quarter of 1114 Cocklln Street estate Mechanicsburg, PA 17055 Gabriael Lucisano Nephew one-quarter of 1085 Lafayette Street #503 estate Denver, CO 80218 Sharon R. Lucisano Niece one-quarter of 429 Sample Bridge Road estate Enola, PA 17025 Brenda Tusing Niece one-quarter of 2233 Powhatan Avenue estate Vlrginla Beach, VA 23455 Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 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. 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F ~_ ~ F 71 ` ~~ C~ v ~ Q ~.< 0. ~ 7 •$ ~ - ~$~~V N ~ 7 3 P.. = N ^ N x ° O 4 a ~•( fat ° ~ ~" ~ c z ppgg U ~ O N . ~ x M C ~ ~ $ ° y _ _ 9 N ~ ^ °' ~ $ ~ a' ~ r y p } v M ~N O V ~O N ~ N ~ N ~~ a m r N v ~ N uo '0 g ~(1 a ~ E7 ~+ ~ ~ ~ WN ~~zoan~ ~ r ~> ~ ~~a~~ ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ a~ ~ E A o ~ ~ rs ~w~az n ~ aai~az ao~+H ~ ~ a ~ ~ ~U~~Q d ~' ~ EN> ~ N ~~ ~~ M a N ~+1 O r Meg i TIRE!ffiTf BSNBFIT 01/23/2012 C~~{ 0000321646 Cross: 455646.72 X3243 NATIONilIDB SAVIt76S PLAN !Mail: Mail Code: 00001 Net: 455646.72 .Q-26-4578 MLPF4S IRA DDA: 87655-16854 SCFIWAB +~~ C X104 F~EA~IZF18L1tk): ~17N. TX 78yli9 (7° ~~i J/ ~ ~ 0 BIiNK ~Afi~tICA ~ 1 t.35 - ~ " rV, / t&56 QF1At~R ST. GbNG3RD,G s~szo t21a D/l~E: ~011231i07'i, PgkY F+olu frunahBd frttr rive ttwusand six hurMred roar six snd 72/1 U0 Dorms na t~ MJRDER of . ~ .,r<. .~ . M6PP~eS IRA ~/~~e•~/L- C Ffl0 TtiERi`SA LUGISANA 2:1'1A'TAN AVENUE Vii ACM, WA 2455 ~. ~,. ~~ ~ ~ 1i ~~~~ I ~~ g~ ~ ~~ ~ ~ a ~ ~ ~ ~ R N ^M O"i ~ ~ ~ N ~N N ~ N 0 Ca N 1 ~ ~ ~ ea w a a ~ ~ ~.. a = ~ ~~ ~ ~ ~+ ~ ~ f j• o ~ a ~ ~ ~~~ ~ ~ a' t:. N ~ o. r~ ~ ~ ~ i £ M . i . ~ N M 3! i Q ~~ ~ C -~ ~ } ~ ~ ~ ~ 8 O yN N ~N ~ LS {" NM M •~N ' ~ 3 P ~e ~:n ~~ g o ~ $4 C E s ~ ~ g ~ $ p F~~ 8 ~ ~ - $ ~~ - 3 ~ g y ~~a~ I,N ~ ~ ~ ~ 4 ~~~g Y. N 8 ~ ~~ ~ ' °~ ~ ~ ~ 88 ~,, ~ oa , ~ ~ ~" ~ is 5 ~ ~ e a~ v ,~ ~e~~ ffi e ^~ HENHST PAYMENT, LUF<P SUM 01/20!2012 703243 NATIONWIDE SAVII~iGS PLAN ~•1 Q Q ~a 0 a ~ u ~- Cx/: 0000321237 Mail Mvl Code: 00000 -^^^^~~• ~~'.«. .^no~a~a]IIL~• A7CCC.a1CR~Lpe cross as~3s.ao NEf 20.605.75 ~E cnea~- April 2, 2012 Bangs Law Office LLC Attu Michael L Bangs 429 South 18th St Camp Hill PA 17011 Estate of Theresa Lucisana Date of Death: Tan 25, 2012 SSN: 168-26-4578 Dear SirlMadam: One Citizars Drive ROP112 Riverside, RI02915 ha accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. As pea your request, there were no accoums opened within one year prior to date of death. The decedent did have a bmkeragc account with our institution. A copy of your request has been forwarded to our Investmcnts Department; please contact them at 800-942-8300 option 4. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667. L)ocedent Acct REF#: 536322 !Af c~.~s.~k~ Account Number 6215490818 Account Title Theresa Lucisana Date ed 8/18/2006 Account T Ch Balance as of DOD $36529.01 Intecrat from Last F to DOD S .80 Account Balance as of DOD X36529.81 YTD Interest to DOD ~ 1.06 6144356786 Natianwkle Bank YQ~ A~ a 4n Your Side' March 22, 2012 Bangs Law Office, LLC 429 South 18s` Street Camp Hill, PA. 17011 Re: Estate of Theresa Lucisana Dear Mr. Bangs, Nationwide Bank 03:22:16 p.m. OS-09-2812 2 /2 This letoer it in regards to information on Theresa`s acxlount. We respectfulty submit the following. ACCOUNT DATE OWNERSHIP' BALANCE Checking 01/2512 Theresa Lucisana w! 531,43453 #100000602019 Brenda Kay Tusissg, POA Money Market Oi/25/2012 Theresa Lueisatla w! #100002985119 Brenda Kay Turing, POA (DOD balance includes acxn>,,od interest) If you have any glustians, please oamacx me at 614-435-6788. Sincerely, C~`y"` Tara Leonard Nationwide Bank 528,441.81 P.O. Box 182794 • Caklmtxl6 Eli 43218-2794.614.249-BY16 -800-336-7219 -FAX 81424.45386 • wrwv.rratiorrwidetccrorp On Yar Silo is a service mark d NaNarNride MtAUai k Ganpaey. Membee FDIC securirybenefit com • d0u BA62a6? ~~~ SECURITY BENEF /l~~ Felxuary22, 2012 MCFYs~LBN~GS, E9QUFtE 4299011tH 18'F' S7}~f C./N~P FHl PA 17011 Slibje[,t Cdihact IVurrber: 7003108275 Non{~lified, Theresa Lt~sarra DearWorrSpotaal Beneficiary. tllfe halve been nolifled that Theresa Lr-cisarr3 has passed away. Please accept our oortdolenoes and e~derd than b the famly. The 25, 2012 aocarnt value was $59,300.57. Ora records ixSCaUe the prrrrary buries for iftis oattrac~ are Brenda Tusig, Gabriel l~ano, Gad Geis and Sharon Ludsara. This teller is tp nd7Y You d the optiars You rrrayeuaerrtise with the Seaxily Benefit arrx~y. As with any decisan that may Rpact your finances, we reoormrerd eorilacting a fnar~cial pharr>er a tax advisor for guirianoe. Please review the aptiens belay, oorriplete and return the ernbsed Proof d Oeath Faun along with an origirgl certified Dopy d the Death Certificate. 1. Lirrv Su?n Payrrient lhider this setllerrient rrietftod, a tax Y may be irtctrred on the eidre ds>rbutiori. Ple~e Hole this drstrixfiori would not be efigbie fior tollouer th an ~iA or otl~er oluaNfied retirerrieri plan. To receive a dislrbu6on, seiec~ option "A"under section 3 d the Proof d Death Fam. 2. Establish BenefidaryAooa~ Under tl~is option, the aooourit will) be registered as `,lane Doe ben~ary for ,lade 9nAh, deceased', where you wdl rerriairi as beneficiary. As a norrspcxsal beneficiary, you are required b begs taking dstribu6ors using one d the foflowix~ two optior>s: a Payout wittiiri 5 sears d dale d death - WiUdrawals may be deferred for a full 5 years iolbwiig the date d dealFi. D+strrtxfions may be taken syslerriz~ally or in a krrp sum A tax liability is rat iiciured ur>bl you begs reoeivirig payment. To cFioose this option, select option "C' under sedan 3 d the Proof d Death Form, and, if you're ready b berg takng distribufiors, select option "C" or'U" order section 5 d the Proof d Death Form b. tJfe F.xaecfancv -This ~n allows you >p spread your tax liabilig over you life expe~,y. You mat receive your fist d'sirbr~on within one year the dale d death. Select option "C" order section 3 rf.you wsh tD use this option ff you're ready tD begn talvig dr~utioris, select option °A" order section 5 d the Prod d Death Form th the event the dece~ed drent was receiving Scheduled S~~sOerrtatic W~Fdt'awals (S9dV), any payments made after the dale of death mat be returned b Seaxily Benefit before a cr~irrlxAi'ori due to death can be processed. We teoogrime th's can be a diffiait brie for n~ig frtaricial decisias. ff you have questions, please call our Natior>al Service Center at 1 ~800~88-2461. Qu represer~tatiues ate available Malay through Friday from 7:00 am. fo 6:00 pm. Cenhal Tme. tine Secun~ 3enef;t Place • Topeka Ka~cas 66636-^v0~~' securirybenefli.crom • 800 088.2461 k (~tService Spew Service Seari~Y 1 i i` i, ~I BENEF~T' ,~ SECURITY ~ ~~~ Cne Securm HeneM °lace ' ~~'~"` Karsas65taF Uis-' e(.~ ~efe<rilu` 1, THERESA LLCISANA, of Hampden Township, Cumberland County, Pennsylvania; declare this to be my lass will and revoke any will previously made by me. ITEM I. 1 direct that all my~ust debts and funeral expenses, including my gravemarker and all expenses of my last illness, shat! be paid from my residuary estate as soon as practicable ai~er my death as a pan of the expense of the administration of my estate. ITEM IL .411 estate, inheritance and other death taxes (including interest and penalties2 payable by resson of my death shall be apportioned among, charged to, and paid by the recipients acrd beneticieries of the property or interest included in the measure of the tax in the proportion that the net amount of such properly or interest bears to the amount of my net estate. In detetm~ning the ahocation of the tax. frc properly or interest included in the measure of a particular tax shall be reduced by ae~f deductions specifically attributable to that property or interest with respect ti) the ta?:. The term "nei estate" shall mean my gross estate as detine3 for purpose of a particular ta:~. less anv deductions (other than the unified credit) allowable for the propose of that tax. ITEM IlI. I gimme .~rrd heyueat!+-~ al! of r:ry I-,ousehoid goods, auiomobiles, jewelry, and all other article, of household and personal use, equipment and ornament, together with all insurance ther:,on and relating thereto, in equal shares to my nieces and nephews, BRE\'DA TtiSING, GAIL 1'. L:_~C'lANO. SHARJI~ R. LUCIAN(.: ar..d (iAI3R1A1=L LUCIAN(i, or to the survivor of theta who survrve my death b ~ thirty (34) day ,. ITEM IV. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate in equal shares to my nieces and nephews, BRENDA TUBING, GAIL T. LUCIANO, SHARON R. LUCIANO and GABRIAEL LUCIANO, or to the survivor of them who survive my death by thirty (30) days. ITEM V. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. ITEM VI. I appoint my niece BRENDA TUBING executrix of this my last will. Should my niece Brenda Tusing predecease me or otherwise fail to qualify or cease to serve as executrix of this my last will, I appoint my niece GAIL T. GILLIS executrix of this my last will. ITEM VIL. In addition to the other powers and authorities granted to my personal representatives b}' Pennsylvania iaw and by the other terms and provisions of this will, I hereby give to my personal representatives the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper. without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale. to exchange, or to lease for any period of time, any real or persona! property and to give options for sales, exchanges, or laases, for such prices . and upon such terms or conditions as my personal rtatives deem proper, and to allocate receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM VIII. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this ~ day of 2010 n ~~~ TI~RESA LUCISANA 7~e p~eoed"mg i~tnm4em, consisting of this and THREE other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by THERESA LUCISANA. the testatrix therein named, as and for her last will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. 4 GU[7Nt'Y OF QJIr®lE3tIJUyD 3 i ~= The undersigned., being the tesfstriu whose name is signed to the attached or foregoing iostinnoent having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. T RESA C ANA Sworn or affirmed to and acknowledged before p-e by the t~statrix natrted above day a Notary dale COMMONWEALTH OF PENNSYLVANIA COUNTY' OF CUMBERLAND coMMONw>:atni fl~ ~l~risr,.v ~. Nobrlal sod Vt4ild~r K Stab, tJrt3ry Pattlc la~-xAtaiTw,~., Qrr~land t;ou+ly My Camim~ E May to, tot t PermsylvaNa Aisot~ldion of Notarlea ( SS: 1 WE, ~~~ c I L (J~~~ -~ _ and ~ A ~ 1 T ~ , ~ ~ ~ s ,the witnesses whose names are signed to to attached or foregoing instrument, being duly qualified according to law, do depose and say that we were preseni and saw Lhe testatrix sign and execute the instrument as her iast will; that she signed it willingly and that she executed it as her tree and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix. signed the will as witnesses; and that to the best of our knowledge, the testatrix was at that time l~,pr more years of age, of sound mind, and under no constraint or undue influence. -~..~^..~~.~,o Sw~~sn r a:Iirmed to d acknowledged . heforrr 's ~_ day of (//~ 4. _.~.~f ~ ~'1 coMMOr+vvEn~rH of ~rtwsnvnr~aA t+aa~aai seal - WerdyK Stratb, Nofaryt~~Ic My t`.anxNsslon E~ptres MayMay 10 f'a~nsylvaNa AsaocAatlat a Notaltos