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HomeMy WebLinkAbout06-14-12 (2)J 1505610143 REV-1500 Ex(°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county code vear File Number Bureau of Individual Taxes of".a."earar "`"`"'~ PO 80X.280601 INHERITANCE TAX RETURN 21 12 ~~~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~- ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 03 18 2012 02 16 191:3 Decedent's Last Name Suffix Decedent's First Name ~ MI BATHURST HAZEL L (lf Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~~ 1. Original Return ~ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ^ ^ qa Future Interest Compromise ~ ~ 5. Federal Estate Tax Return Required (date or death after l2-12E2) I~ S Decedent Oietl Testate ' ~ 7. (~"~ ~a~opy of T~usua Living Trust _ O 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) 9. Litigation Proceeds Received ^ 10. between i~~ii ~jCra ~if{da95~f seam ~ 11, Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTIION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number KENNETH E LEF7IS ESQ (412) 391 133,,4, First line of address 625 LIBERTY AVENUE 29TH Second line of address State ZIP Code PA 15222 -*, r -n C~ rn City or Post Office PITTSBURGH Correspondent's a-mail Under penalties of perjury, I d it is true, correct and comple6 REGISTER LS USE~HLY '!7 ~ ~=: n ~ ( rl~'~, C7 rii > --p n c7 n ~ ~~a -, ._ v F I DATE FILED v-I schedules and statements, and to the best of my knowledge and is based on all infonnalion of which preparer has any knowledge. SIGN E OF PREPARER OT R T N PRESENTATIVE DATE ,f ,I, ,~ ~- f ~,t Kenneth E. Lewis Esq. ~~, ~~JZ 625 Liberty Avenue,,29th Floor, Pittsburgh, PA 15222 Side 1 15D56710143 150561[1143 J 1505610243 REV-1500 EX Cecedent's Social Security Number Decetlenfs Name. BathU~St,.Hazei L. 186 38 4797 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 8 Miscellaneous Personal Property (Schedule E)__........... 5. 540 • 09 6. Jointly Owned Property (Schedule F) ~_~ Separate Billing Requested............ 6. $$ - 41 7. Inter-Vivos Transfers ~ Miscellaneous t~ -Probate Property (Schedule G) ~! Separate Billing Requested............ 7, 137 , 060.52 g. Total Gross Assets (Dotal Lines 1-7)_............_ ................_..............._..............._. 8. 137 , 656.02 9. ---- - Funeral Expenses & Atlminisirative Costs (Schedule H).._.._.........__ .................. 9. 1$ , 975 • 71 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 17 , 321 • 71 1 i. Total Deductions (total Lines 9 & 10)..._........__....._....__ ................................... 11. 33 , 297.42 12. Net Value of Estate (V_ine 8 minus Line 11)..__......._...._ ................................_... 12. 104 , 358.60 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has hot been made (Schedule J) ............._............._................. 13. 14. Net Value Subject to?ax (Line 12 minus Line 13)......._._ ................................... 14. 104 , 358.60 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 14 taxpble at the spousal tax rate, or transfers under Sec. 9116 15 0.00 (a)(1.2) X .00 16. Amount of Line l4taxpble 104,358.60 1s. 4,696.14 at lineal rate X .045 17. Amount of Line 14 taxpble 0.00 17. 0 • 00 at sibling rate X 12 18. Amount of Line 14 taxlable 0.00 18. 0 - 00 at collateral rate X 15 1s 4,696.14 19. TaxDue........_ . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 REV-1500 EX Page 3 rlocedent's Cemolete AddreSS: File Number 21-12 , DECEDENT'S NAME Bathurst, Hazel L. STREETADDRESS 700 Walnut Bottom Rbad ~~ CITY STATE ZIP Carlisle PA 17013 Tax Payments and Creditsr 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 3. Interest 4. If line 2 is greater than Line 1 +'~Line 3, enter the difference. This is the OVERPAYMENT. 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. Check OF WILLS. AG 0.00 (3) (4) ___ (s> 4,696.14 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and Yes No b. retain the ~se or income of the property transferred :...... .. ........ ... .... ....... r~~~~ ^ ght to designate who shall use the property transferred or ds income;.. .. .... ...... LxJ ^ c. retain a reversionary interest, or __........ ...._.... ....... .. .... ........ _... x d. receive the promise for life of either payments, benefits or care?....._ .. ......_. .. .._... ...._ ~ ^x after December 12 1982, did decedent transfer property within one year of death without I~ 2. redce ving adequa'~te consideration?.. __._. ......__ .... .............._....... ......... ... ............. ..._ ^ L!! 3. Did decedent owh an "in trust for" or payable upon death bank account or security at his or her death?....... ^ 0 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 13 AND FILE IT AS PART OF THE RETURN. For dates of death on or after July tj, 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 sUalute 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 nebvalue 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 stepparenbof the child is 0 percent [772 P.S. §9116 (a) (1.2)I. . The tax rate imposed on the neC~,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) p2 P.S. §91'i16 (a) (1)I. . 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 102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. (1) 4,696.14 Total Credits (A + B) (2) Rev-1508E%e (6-98) .~CiHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTHOF PENNSYLVFNIF INHERI1rNNGE TA%RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bathurst, Hazel L. 21-12 Inclutle the proceeds of litigation and the dale the proceeds were received by the estate. All propertyjointly-owned with the right of survivorehip must be disclosed on schedule f. (If more space is needetl, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1509 E%~I6-98) COMMONWEPLTHOF PENNSYLVRNIA INHERITANCE TA%RETURN RESJDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Bathurst, Hazel L. 21-12 H an asset was made Joint within one year of [ha tlecetlant's oats of tl0a[n, It must oe repene° an acnauHle ~. SURVIVING JOINT TENANY(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Josephine Trybus 410 Pine Villa Gibsonia, PA 15044 Daughter Drive B. C. IfIINTI V r1WNFf] PRrIPFRtV~ ITEM NUMBER LETTER FOR JOINT TENANT DATE' MAD JOIN. DESCRIPTION OF PROPERTY wcLUDE NAME or FIrvANCIAL INSnrurlorv AND SANK AccouNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR ~olNnv-HELD REAL ESTATE. DATE OF DEATH VALUE OF~ ASSE % OF DECD'S INTEREST DATE of DEATH VALUE OF DECEDENT'S INTEREST 1 A over 1 'yr Northwest Savings Bank Account '110.81 50.000% 55.41 #1456000742 TOTAL (Also enter on Line 6, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software o~fly The Lackner Group, Inc. 55.41 Form PA-1500 Schedule F (Rev. 6-98) Rev-1510 E%~ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMON W EhLTH OG PE NNSYLVAN IA INHERITANCE TA%RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bathurst. Hazel L. _ 21-12 This schedule must be wmpletetl and filetl ii the answer io any o<questions 1 through 4 Dn the reverse side of the REV-151p COVER SHEET is yes. ITEM NUMBER DE CRIPTION OF PROPERTY THELDATE OF TRANSFER. ATTACIITA COPVEOF TIOHE DEED ~OR REAL ESTATD DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST ( ExcLUSION IF APPLICABLE) TAXABLE VALUE Hazel L. Bathurst~eed of Trust dated 10111/2002 and consisting of the ollowing assets: 1 Fidelity PA Munic~pal Money Market (cash) 66.320.36 66,320.36 Accrued income ¢n Item 1 through date of death 0.33 0.33 2 134 shares of Ger)eral Motors Co., WTS exp. 2,218.04 2,218.04 7NOI2016 3 2 shares of Generfal Motors Co. common 51.14 51.14 4 134 shares of General Motors Co., WTS exp. 7/1012019 1,467.64 1,467.64 5 190 shares of Hill)Tlan Group Cap Tr Pfd Secs 11.60% 5,808.30 5,808.30 6 638 shares of J.P', Morgan Chase Cap XII Tr Pfd 6.25% 16,267.41 16,267.41 7 1,400 shares of P~pL Corp. 39,525.50 39,525.50 On Item 7 through date of death Accrued dividend 504.00 504.00 8 LL 360 shares of RBp Cap. Rdg Tr V Pfd Secs 5.9% 4,897.80 4,897.80 T©TAL (Also enlter on Line 7, Recapitulation) (If more space is needed, atlditional pages of the same size) Copyright (c) 2002 form software oijly The Lackner Group, Inc. 137,060.52 Form PA•1500 Schedule G (Rev. 6-98) REV-1151 E%+110-061 COM ~N DENT ~ECEO~~~RLVANIF SCHEDULE H FUNERAL EXPENSES & >,I~MINISTRATIVE COSTS ESTATE OF FILE NUMBER Bathurst Hazel L. 21'12 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT MB R A, FUNERAL EXPENSES: See continuation schedule(s) attached 8,808.11 B. ADMINISTRATIVI~ COSTS: 1. Personal Represenlfative's Commissions Name of Personal FRepresentalive(s) Street Address ' City ~F State Zip _ Year(sl Commission paid 2, Attorney's Fees '~. Fox Rothschild LLP 6,000.00 3_ Family Exemption: '~, (If decedent's address is not the same as claimant's, attach explanation) Claimant ~' - Street Addresjs City ' State Zip __ Relationship rbf Claimant to Decedent _ 4. I Probate Fees 5. Accountant's Fees' 650.00 See continuation schedule(s) attached 6. Tax Return Preparer's Fees 7. Gther Administrative Costs 517.60 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 15,975.71 Copyright (c) 2009 form software oily The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Bathurst Hjazel L. 21-12 ITEM DESCRIPTION AMOUNT NUMBER Funeral Ex ep ns~s 1 Allegro Restaurar}t -family dinner 388.89 2 Feller Memorial Hbme -funeral services 8,016.00 3 Jimmy Wans Restaurant -family dinner 278.22 4 Mayes Memorials~li-engraving 125.00 H-A 8,808.11 Accountant 5 Creese Smith R do. -accountant fees 650.00 H-BS 650.00 Other Administkati~sts 6 Josephine Trybu~, Trustee -travel expenses 517.60 H-B7 517.60 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX~ )12A9) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8r LIENS COMMONWEALTH OF PENNSYLVANIA INHERI4ANCE TA%RETORN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bathurst, Hiazel L. _ 21-12 pennm tlnMS Incumetl by the decedent odor tc death that remained unpaid at the date of death, including unreimbursetl medical expenses. (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. 72-08) REV 1513E%* (11-08) SCHEDULE J COMM~'(~~EP~~ED ~ON,({$Y~ANIA `~~ ~T ~N~ BENEFICIARIES ESTATE OF FILE NUMBER Bathurst, Haz I L. 21-12 NAfV1E AND ADDRESS OF RELATIONSHIP TO SHAp,E OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT 0 o us (Words) ($5$) 1 TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Josephine TrybUS Daughter Joint account 55.41 410 Pine Villa Dfive Gibsonia,PA 15044 2 Hazel L. Bathurst Deed of Trust Trust Trustflb/o issue 104,303.19 Go Josephine ~rybus, Trustee Tatal 104,358.60 Enter dollar amoun s for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet, as a ro riate. NON-TAXABLE DI TRIBUTIONS: II. A. SPOUSAL DIST IBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO'fAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -EATER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET[ Copyright (c) 2009 form software o~ly The Lackner Group, Inc. Fonn PA-1500 Schedule J (Rev. 11-08) rv.nru~anuaiinienw~oeinm sonaroi oau miss- im cwmu.wyu FIRST CODICIL -TO- LAST WILL AND TESTAMENT -OF- HAZEL BATHURST I, H~ZEL BATHURST, do make, publish and declare this. to be the First Codicil to my Last Will and Tlestament dated October 11, 2002. ARTICLE ONE I herjeby revoke absolutely ARTICLE SIX of my Last Will and Testament dated October 11, 2002 a~d replace it with the following: "ARTICLE SDI I ap~oint JOSEPHINE B. TRYBUS, Executor of this my Will, giving to my Executor, in additidn to the authority conferred by law, the power to sell any or all of my property, real or personal, at (public or private sale, at such time and for such price and upon such terms and conditions as it mad see fit, or in its discretion to retain the same for distribution in kind, and the power, but not the i~duty, to invest any cash without being limited to legal investments. Should JOSEPHINE B. TRYBUS fail to qualify or cease to act as Executor for any reason, I appoint RAYMOND F. TR3'BUS, as successor Executor. Should RAYMOND F. TRYBUS fail to qualify or cease; to act as Executor for any reason, I appoint REGINA DANIEL, as successor Executor. No bond shall be required of any fiduciary hereunder in any jurisdiction." ARTICLE TWO In all, other respects, I hereby ratify and confirm my Last W ill and Testament dated October 11, 2002. IN VI~ITNESS WHEREOF, I have hereunto set my hand and seal this I ~~ day of ~.iYt ~ ~ w. s'fi (SEAL) HAZEI4, ATHURST Signed, sealed, published and declared by the above-named Testatrix, HAZEL BATHURST, as and for the First (Codicil to her Last Will and Testament dated October 11, 2002 and, at her request the undersigned have hereunto subscribed our names as witnesses hereto. I ~ / rY` Address .~` 3 C~°~ Address~~u M i l `f-o ~~ v~ 2 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF ~ L. ~~ ~ ~ ) I, HAZEL BATHURST, the Testatrix, whose name is signed to the attached or foregoing instrumept, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as the First Codicil to my LAST WILL AND TESTAMENT dated October 11, 2m02 and that I signed it willingly as my free and voluntary act for the purposes therein expressed. HAZEL THURST Swo~n to or affirmed and acknowledged before me this _ C ~ `~ day of ~~! , 20D~, by HAZEL BATHURST, the Testatrix. attorney) Notarial Seal Robert L. Patton Notary Public Tyrone eoro, flair County MY Commission F_xplrsa Nov. 2 , 2003 ~' oteu9ee officer or state of admission of AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF ~ G, i4 ~ ~ ) ~Sy .'9'- ~G4 ~'~"Ov~ the witness(es) whose dame(s) are(is) signed to the attached or foregoing instrument, being duly qualiFied according Ito law, do depose and say that we were (I was) present and saw the Testatrix, HAZEL BATHUR~T, sign and execute the instrument as the First Codicil to her Last Will and Testament dated Oc~ober 11, 2002; that the Testatrix signed willingly and executed it as her Free and voluntary act for tht` purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Codicil as a witness; and that to the best o1'our (my) knowledge the Testatrix was at tha>)' time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence.'' ~~ Sworn to or affirm~d and subscribed to before me this ~_ day of n,~~'er,n kJ?,r , 20~ _.---"'~ {~T and o€' officer or state of attorney) Notarial Seal Ro~erone Borno~§Ialr~Counryi~ My Cbmmiaslon Expires Nov. 20, 2003 Member, PennSylvFnla nssociatbn of Notaries 4 N:\!POtentialClienls\Bathurst\Hazel L. Bathurst - pourover will.wpd LAST WILL AND TESTAMENT I, H~ZEL L. BATHURST, do make this my W ill, hereby revoking any and all Wills and Codicils at anyl time heretofore made by me. ARTICLE ONE I diiject that my tangible personal property be distributed at the discretion of my Executor. Any items not disposed of by my Executor shall be sold and the proceeds added to my residuary estate an~ distributed as part thereof. ARTICLE TWO All ~he residue of my estate I give to the Trustee of my Deed of Trust dated as amended at any time prior to my death, to hold IN TRUST as part of the Trust Estate thereunder; or, if said Deed of Trust is no longer in effect, to hold IN TRUST on the ~erms and conditions specified in said Deed of Trust on the date of this Will or of the last Codicil hereto, with like effect as if they were set forth herein verbatim. ARTICLE THREE Except as otherwise provided in the Deed of Trust referred to above, I direct that all transfer, estate, inheritance, succession and other death taxes which shall become payable by reason of my death, together with any interest and penalties thereon, shall be paid out of my estate as an administration exp~nse, without apportionment or right of reimbursement. I direct that all shares of the residue, inclr~ding any share passing to a charity, be calculated after provision for any taxes chargeable as an administration expense. ARTICLE FOUR my Executor to claim any expenses of administration of my estate as income tax deductions upon an income tax retum or returns or estate tax deductions on an estate tax return in the sole discretion of my Executor. No compensating adjustments between income and principal shall be rr~ade as a result of such action. ARTICLE FIVE I he~eby authorize my Executor, in her sole discretion, to disclaim, on behalf of me ' or my estate, any p}operty or interest in property passing, or which would otherwise pass to me or my estate, without ~ourt authorization of such disclaimer. ARTICLE SIX I appoint JOSEPHINE B. TRYBUS, Executor of this my Will, giving to my Executor, in additidn to the authority conferred by law, the power to sell any or all of my property, -2- real or personal, at public or private sale, at such time and for such price and upon such terms and conditions as it may see fit, or in its discretion to retain the same for distribution in kind, and the power, but not the duty, to invest any cash without being limited to legal investments. Should JOSEPHINE B. TIRYBUS fail to qualify or cease to act as Executor for any reason, I appoint REGINA DANIELy as successor Executor. No bond shall be required of any fiduciary hereunder irnany jurisdiction. ARTICLE SEVEN Unl$ss a contrary intention is clearly specified, as used herein the singular form may include the plural, tie plural form may include the singular, and any gender may include any other gender. I,NO~JITN/ESS WHEREOF, I have hereunto set my hand and seal this day of ~ ~~~iH.4~.[ J , 20~ L._ ~~ a.-~ ~ 5 fi (SEAL) HAZ L.BATHURST Sig~ed, sealed, published and declared by HAZEL L. BATHURST, the Testatrix above named, as a d for her Will and, at her request the undersigned have hereunto subscribed our names as witnesse hereto. Address 'sPSvl /Jl~ 'Tf~ ~~ , ~~ ~~~ / Address~~i~~~28jttu~ ,~c( f~.~RPLStJTi/~ /c70~S~ -3- ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) ~ / ) ss: COUNTY OF `'~-~, ~~~~ ) I, Hg1ZEL L. BATHURST, the Testatrix, whose name is signed to the attached or foregoing instrume~4t, having been duly qualified according to law, do he;reby acknowledge that I signed and executed the instrument as my Last Will; voluntary act for th~ purposes therein expressed. and that I signed it willingly as my free and z ~3 ~~~ w, ~ -f- HAZ L.BATHURST Sw>drn to or affirmed and acknowledged before me this _ ~ day of j~~~L , 20 ~ by HAZEL L. BATHURST, the Testatrix. (Seal and official capacity of officer or state of admission of attorney) Notadal Seal Donna C. Wilt, Notary Publ~ Richland Twp., Allegherry Co~N~r M Commission Expires Nov. 25, ~opq Memt;q~- ~e~nnsylvsnl?i Assxietlon of Notaries -4- AFFIDAVIT COMMONWEAL'VH OF PENNSYLVANIA ) ss: COUNTY OF l ~!-~ ~'~'~~ ) the witne: qualified HAZEL I willingly subscribi: to the bes of sound Sworn to or and subscribed to before me this ~ day of _ ~~, 2~~- (Seal and official capacity of officer or state of admission of attorney) ~~ ~ °y~p~ Np~sry Pubilc ~. Rk;hland TwP•~ AIRY MY Commisswn Expires Nov. 25, 004 Member, PBnnSylvanla pggpClaaon Of NOlanea -$- N:\!POtentialClients\Bathurst\Hazel L Bathurst - Deea of 7rust.wptl COPY DEED OF TRUST F MADE this ~ day of ~ , 2[I%J.~; by and between HAZEL L. BATHURST Ohereinafter called the "Settlor"), and HAZEL L. BATHURST and JOSEPHINE B. TRYBUS (her~irafter collectively called the "Trustee"). Thy Settlor desires to create a revocable trust of her interest in certain property, as listed in Schedule ~"A" attached hereto, together with all the Settlor's right, title and interest in and to the same. I Th~ Trustee is willing to accept the trust and to hold the said property, together with any additions ther~to and changes therein (hereinafter called the "Trust Estate"), in trust for the uses and purposes and ~rpon the terms and conditions hereinafter set forth. In consideration of the premises, the parties hereto have agreed and do agree as follows: ', ARTICLE ONE Thd• Trustee shalt hold, manage, invest and reinvest I:he Trust Estate and shall distribute the incobne and principal as follows: A. ' During the lifetime of the Settlor, unless the trust is sooner revoked, the Trustee shall pay''the net income quarter-annually, or more frequently if the Trustee deems it advisable, to or fot the benefit of the Settlor. In addition, the Trustee shall distribute to the Settlor such sums from 1rincipal as she may request. In the event of the Settlor's physical or mental incapacity, the Trustee is authorized to expend the net income and the principal to such extent and in such manner as it deems advisable for the comfortable maintenance and support of the Settlor during; such period of incapacity. B. Upon the death of the Settlor, the Trustee shall pay from the Trust Esta[e such amounts as the pe~isonal representative of the Settlor's estate shall certify as being required for the payment of debts, lexpenses of administration and estate and inheritance; taxes and being in excess of the amount of funds available to the personal representative for such purposes, such payments to be made either do the personal representative of the Settlor's estate or directly to discharge such obligations in thel Trustee's discretion; provided, however, that if the Trust Estate contains any United States government bonds which are redeemable at par in payment of Federal estate taxes, the Trustee shall a~ply such bonds to the payment of the Federal estate tax of the Settlor's estate to the extent of the ~'ar value of the bonds plus accrued interest or to the extent of the Federal estate tax, whichever is ~ess. C. The Trustee shall distribute the following sums to the beneficiaries indicated: 1. ', One-half (1/2) of the balance of the trust estate shall be distributed to JOSEiPHINE B. '~'RYBUS, outright and free of trust, if she survives :iettlor. If JOSEPHINE B. TRYBUS does nit survive Settlor, her share shall be distributed in equal shares to her issue, per stirpes, subject, however, to the provision for minor beneficiaries as hereinafter set forth. 2. One-quarter (1/4) of the balance of the trust estate shall be distributed to REGINA DANIE~., outright and free of trust, if she survives Settlor. If REGINA DANIEL does not survive Settlor, her share shall be distributed in equal shares to her issue, per stirpes, subject, however, to the provision for minor beneficiaries as hereinafter set forth. -2- One-quarter (1 /4) of the balance of the trust estate: shall continue intrust for the benefit of Settlbr's grandchild, AUTUMN RHODES, and shall be administered and distributed as provided below. (a) During the lifetime of said grandchild, the Trustee shall pay the Income from her trust, inn its discretion until Settlor's said grandchild attains age twenty-one (21) and automatically thereafter, at least quarter-annually to or for the benefit of Settlor's said grandchild] If the Trustee considers the Income to be insufficient, in view of other income of which ithas knowledge, to provide for the health, support, maintenance and education of said grandchild and her children, the Trustee is authorized in its discretion to use so much of the prin~ipal as it deems advisable therefor even to the complete exhaustion of the trust estate. ~! (b) Upon the death of Settlor's said grandchild, if her trust has not already terminated] any remaining portion of said grandchild's trust shall be distributed in equal shares to tl~e issue of AUTUMN RHODES, per stirpes, subject, however, to the provision for minor beneficiaries as hereinafter set forth. (c) JJ~, Settlor appoints REGINA DANIEL to serve as Trustee of the trust created herein for tpe benefit of AUTUMN RHODES. Should REGINA DANIEL fail to qualify or cease to ac~ as Trustee for any reason, JOSEPHINE B. TRYBUS shall serve as successor Trustee. Either Trustee appointed herein shall have the authority, while serving as Trustee, to designate a successor Trustee in the event that all of the Trustees named herein choose not to serve or to continue to serve. -3- ARTICLE TWO If, render the provisions of this trust agreement, any property would otherwise be distributed free of trust to any minor, the Trustee shall receive or continue to hold such properly in trust, invest and re~nvest the same and collect the income thereof, and shall pay to the guardian of the estate of such nAinor during his or her minority or, in the Trustee's discretion, shall apply directly all of the net incor{ne and, if the net income shall be insufficient, so much of the principal of the property held in trr~st for such minor as the Trustee may deem necessary or advisable for the support and complete eduction of such minor. The Trustee shall distribute to such minor the property held in trust for him orher when he or she shall reach the age of majority. If any such minor shall die before reaching th~ age of majority, the property held in trust for him or her shall be distributed to such person or pe~{sons as by the laws of the state of his or her domicile; would have been entitled to the same if suchll minor at the time of his or her death had been legally seized and possessed of the said property in h~s or her own right. i ARTICLE THREE Al~ shares of principal and income shall, until actual distribution to the respective beneficiaries, be free from the debts, contracts, alienations and anticipations of any beneficiary or beneficiaries, andthe same shall not be liable to any levy, attachment, execution or sequestration. j ARTICLE FOUR Thle Trustee in addition to and without limiting the usual rights and powers in trustees, shall havle the following rights and powers: -4- (a) To invest in, accept and retain any real or personal property, without restriction to legal investments; (b) To sell, exchange, partition or lease for any period of time any real or personal property and to give options therefor for cash or credit, with or without security; (c) To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; (d)' To compromise, arbitrate or abandon claims; (e) To make distribution in cash or in kind or partly iin each; (f) To make elections, decisions, concessions and settlements in connection with all income6 estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person thereby aft~ected; (g), To administer a separate trust for each beneficiary hereunder, but for convenient administration such separate trusts may be combined in one common trust fund, each separate trust having an undivided interest therein. ARTICLE FIVE Upbn the death, resignation or inability to continue to serve of HAZEL L. BATHURST as a f frustee, JOSEPHINE B. TRYBUS shall continue to serve as Trustee. Upon the death, resignation', or inability to continue to serve of JOSEPHINE I3. TRYBUS as a Trustee, REGINA DANIE$, shall serve as successor Co-Trustee or successor Trustee, as the case may be. ARTICLE SIX A. The Settlor reserves the right to increase the principal of the Trust Estate by adding thereto additional securities and other property. B. The Settlor reserves the right to revoke this Deed of Trust at any time, in whole or in part, by written notice delivered to the Trustee. -5- C. The Settlor further reserves the right to alter or amend this trust at any time by a proper instrument in writing, executed by the Settlor, delivered to and accepted by the Trustee. ARTICLE SEVEN Thus Deed of Trust has been delivered to and accepted by the Trustee in the Comrnonwealth of Pennsylvania and shall be governed in all respects by the laws of the said Comrnonwealth. WITNESS the due execution hereof the day and year first above written. WITNESS: SETTLOR: i/\e¢tl~t'~ ~/X -~,ct?~/R.~~.~r~ ~ ~ ~. I3cLf~ tin S ~ (SEAL) HA7f L. BATHURST WITNESS: TRUSTEES: ~. ~ ~~ S t _(SEAL) H EL L. BATHURST Q _ . _. ~ ~ , _ _ . ~ ~i . ~tc~,L~w~---' (SEAL) S HINE B. TRYBUS -6- COMMONWEALTH OF PENNSYLVANIA ) ss: COUtVTY OF ~-~~~~~ ) On this, the ~L~day of ~ ~/ , 20G~`ttefore me, a notary public, personally appeared HAZEL L. BATHURST, known to me (or satisfactorily proven) to be the person whose namle is subscribed to the within instrument and acknowledged that she executed the same for the purpgses therein contained. IN NVITNESS WHEREOF, I have hereunto set my hand and official seal. Notary Public Lonna CN W~jl~ta'NOtary Public Wichland Twp., Nlegheny County - Uv Commleslon Expires Nov. 25, 2004 AArm~.^ar, *kinnnYNanla AsBOCIatfOn of tJOter108 -~- COMMONWEALTH OF PENNSYLVANIA ~ ss: COUNTY OF ~~~~~ ) On this, the _--L[--- day of r ' , 2~efore me, a notary public, personally appeared JOSEPHINE B. TRYBUS, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purpdses therein contained. IN !WITNESS WHEREOF, I have hereunto set my hand and official seal. Notary Public Notarial Seal Donna C. Wilt, Notary Public Richland Twp., Allegheny County My Commission Expires Nov. 25, 2004 Mamber. ~'ennsyNanle Association of Notaries -g-