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HomeMy WebLinkAbout06-14-12 (3)J 1505611185 REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Cotle Year File Number Po Box zso6ot INHERITANCE TAX RETURN 27, 11 1 U 41 Hartisburg, PA 17128-06117 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDVI'1'Y 09152011 X9151916 Decedent's Last Name Suffix Decedent's First Namie M I GUSTINA FRANCIS L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I 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 ^ :.. Remainder Return (Date of Death Prior to 12-13-82) ^ 4 Limit d E t t ^ 4 F t I C ^ . e s a e a. u ure nterest ompromise (date of ~~. Federal Estate Tax Return Required ® 6 Decedent Died Testate ® death after 12-12-82) 7 Decedent Maintained Li i T t ~ 8 T t l N . . a v ng rus ~. o a umber of Sate Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ^ 9 Liti i P ^ 10 ^ . gat on roceeds Received . Spousal Poverty Cretlit (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 BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDWARD L• GLASSMAN JR AV P 215-58 3997 ~' REGIS WILLS USE ONLV~ ' )~ C vD , First Line of Address ~~ ,,i ~ F. X1 PNC BANK N-A• ~n~'-., n. `,," Second Line of Address O c-. =~ < ~~ ti ~ 1600 MARKET ST 4TH FL crt ~~ City or Post Office State ZIP Code DATE FILED PHILADELPHIA PA 19103 correspondent'se-mailaddrese: EDWARD-GLASSMANaPNC-COM Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knaMedge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on_all informatk~n aF which preparer has any knowledge. PNC BANK N•A• EXECUTOR BY~ 1600 MARKET STREET, TAX DEPT• 4TH F PHILADELPHIA, PA 19103 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE HUUKtJJ PLEASE USE ORIGINAL FORM ONLY 15U5611185 Side 1 OM464~ 3.0~p 1505611185 REV-1500 EX (FI) 1505611285 Decedents Name: GIJSTINA FRANCIS L RECAPITULATION 1. Real Estate (Schedule A) . . . . 1 2. Stocks antl Bonds (Schedule 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. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) 6 Side 2 9. Funeral Expenses and Administrative Costs (Schedule H). g, 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 11. Total Deductions (total Lines 9 and 10), 11 12. Net Value of Estate (Line 8 minus Line 11) 12 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 13 14. Net Value 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 un~er Sec. 9116 (a)11.2) X .0 - Q . Q Q 15. 16. Amount of Line 14 xable 04 at lineal rate X . Q•QQ 16. 17. Amount of Line 14 taxable at sibling rate X .12 Q . Q Q 17. 18. Amount of Line 14 taxable at collateral rate X .15 52 4 , 561 • 0 9 18. 19. TAX DUE .............. .. 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505611285 1~i05611285 Decedent's Social Security Number i~9s-o7-sso4 199,900.00 Q•QQ Q•QQ Q•QQ 436,857.83 i] . i] Q Q•QQ 636,757.83 90,781.68 16,415.06 107,196.74 529,561.09 s,ooo•oo i)•QQ o•oo o.oo 78,684.16 78,684.16 OMI668 3.000 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number 21 11 1041 DECEDENTS NAME FRANCIS L STREET ADDRESS CITE ME HAN CSBURG STATE PA ZIP 7 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 6 9 ,16 0• D ~ B. Discount 3, 6 4 0. 0 0 3. Interest (1) - 78,684.16 Total Credits(A+g) (2> 72,800.00 (3) x•00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) - 5 , 8 8 4 • 16 Make check payable to: REGISTER OF WILLS, AGE~JT. 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 propedy transferred or its income ... X^ ^ c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ^ d. receive the promise for life of either payments, benefits or care? ............ ^ 2. If tleath occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................... ^ ^X 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ^ 4. Did decedent own an individual retirement account, annuity, or other non-probate 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 tleath 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.t) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the nel 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 tloes 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. Far tlates 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 periznt, except as noted in [72 P.S. §9116(a)(1)]. • The taz 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. o Ma6]1 2.000 REV-tsoz Ex. lot-tq Pennsylvania DEPPRThffMOF REVENUE INHERRANCE TAX RETURN RESIDEM DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: FRANCES L. GUSTINA 21 11 1041 All real property owned solely o~ as a tenant in common must he reported at fair market value. Fair market value is defined as the price a<which properly would be exchanged between a Willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. RNI property that is jointlyowned with right of survivorship must be tliscbsed on Schedule F. swasas 2.000 If more space is needed, use additional sheets of paper of the same size. REV-0 W3 p(t (&98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS Hr BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER E'RANCES L. GUSTINA 21 11 1041 All property jointly-owned with right of survivorship must be disclosed on Schedule F. swasss r.ooo (If more space is needed, insert additional sheets of the same size) REV-150] EX t (698) SCHEDULE D C06TAONWEALTH OF PENNSYLVANIA MORTGAGES 8 NOTES INFERITANCE TAX RETURN RFSIf)FM f1FC.Fr]FlJr RECENABLE ESTATE OF FILE NUMBER FRANCES L. GUSTINA 21 11 1041 AI property jointlyawned with right of survivorship must be tlisclosed on Schetlule I°. 3waenC 1000 (If more space is needed, insert atlditional sheets of same size) REV-1508 EX~ (H-10) Pennsylvania SCHEDULE E OFPARIREM OF REVENUE CASH, BANK DEPOSITS, & MISC. ~a"E"sioEr~oEC ENrNR" PERSONAL PROPERTY FRANCES L. GUSTINA 21 11 1041 Include the proceeds of litigation and the date Ne proceeds ware received by the estate. All property jointly owned with right of survivorship must be tlisclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. REVOCABLE TRUST AGREEMENT DATED MARCH 15, 1990, BETWEEN FRANCIS L. GUSTIIy~A, SETTLOR AND PNC BANK N.A., FORMERLY CCNB BANK N.A. T$USTEE, A COPY OF WHICH IS SUBMITTED HEREWITH. THE ASSETS HELD IN THE TRUST ARE PAYABLE TO THE ESTATE AND AF~E VALUED AS OF 09/15/11, DATE OF DEATH PER THE ATTACHED ''ESTATE TAX SECURITIES VALUATION STATEMENT. 348,100.62 2 PNC BANK N.A. CHECKING ACCOUNT '# 5140025384 VALUE AS OF 09/15/11 PER ATTACHED VALUATION LETTER AS FOLLOWS: BALANCE 09/15/11 76,428.33 ACCRUED INTEREST .16 TOTAL 76,428.49 76,428.49 3 USSA RETURN OF UNUSED '.HOMEOWNERS INSURANCE 70.08 4 PARTHMORE FUNERAli HOME YORK COUNTY VA DE7ATH BENEFIT 100.00 5 USAA BALANCE IN SUBSCI7~IBERS ACCOUNT 2,891.50 6 UNITED STATES TRF~ASURY 2011 FEDERAL INDIIVIDUAL INCOME TAX REFUND 7,998.00 7 YORK COUNTY PA RF7AL ESTATE TAX REFUND 69.00 8 WEST SHORE PA SCF~OOL DISTRICT REA1 ESTATE TAX REF[JND 1,199.84 OW46AD 2.000 TOTAL (Also enter on line 5, Recap If more space is needed, use add'Rionel sheets of paper of the same s¢e. 83 REV-1509IXt (01-10) Pennsylvania DEVARTMENi Of R-'_VENIIE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEF JOINTLY-OWNED PROPERTY ESTATE OF: FILE! NUMBER: E'RANCES L. GUSTINA 2:1111041 tt an asset became jointly owned within one year of the tlecedeM's tlate of tleaN, tt must be reported on Schedule G SURVNNNG JOM TBI4 M(S) N4 hE(S) JOINTLY OWNED PROPERTY: RL~A N.X'/HER IETrER roR Laxr iENANi DATE NUDE JDM OESCRFrON OF FROP92TV w:o<nxAxc AL lxsrirurlox AxD RAxxncccuxr xuaER aR SIMUR xGL IDES I%ING NVI.BER. PTTPGN DEED Kfl IgNTLV XELO REAL ESTPTE. DATE OF DEATI-I VALi.E OF A$$ET %OF DES731ENP5 r`IIStFST DATE OF DEATH VALUE OF DEC®BNr'S M6REST Nqne TOTAL (Also enter on Line 6, Recapitulation) E RELATIONSHIP TO DECEOBNr 0.00 swasAE zooo If more space is needed, use adtlitional sheets of paper of the same size. REV-1510 EX + (OB-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY FRANCES L. GUSTINA 21 11 1041 This schedule must be.completed and filed if the answer to any of questions 1 through 4 on page tlxee of [he REV-1500 is yes. ITEM NUMBE DESCRIPTION OF ROPERTY urxins~rwnE Orramnrsreass,T~iaaEUnorvswa.o oscsosm auo r~onreormasr~A.AnocHACOar oa rrE OSSO VOV nsu esrare. DATE OF DEATH VALUE OF ASSET %OF DECD'S IMEREST EXCLUSION =APPUGABLE TAXABLE VAL U E t. FRANCIS L. GASTINA CREATED A _ _ __ REVOCABLE TRUST, DATED MARCH 15, 1990 WITH PNC BANK N.A., FORMERLY CCNB HAN$ N.A TRUSTEE. AT HIS DEATH THE 7fRUST TERMINATED WITH THE ASSETS DISTRIBUTED TO HIS ESTATE. THE TRUST ASSETS ARE F'{E PORTED ON SCHEDULE E ITEM NUA]BER 1. 0.00 100.0000 0.00 0.00 2 FOR INFORMATIONAL '.PURPOSES ONLY: THE DECEDENT WAS I{ECEIVING A MONTHY ANNUITY FRC~1 THE OFFICE OF PERSONNEL MANAC{EMENT. ALL BENEFITS TERMINATF~D AT THE DEATH OF FRANCIS L. GUSTINA WITH NO FURTHER B~NEFITS DUE HIS HEIRS OR THE fISTATE 0.00 100.0000 0.00 0.00 TOTAL (Also enter on line 7, Recapitulation) $ ~ ~~ ' 1f more space is nestled, use atltlilional sheets of paper of the same s¢e. 9 W 16AF 2.000 Rev-isii ex. nooel Pennsylvania DEPARTMEM'OF REVENDE MHERITANCE TAX RENRN SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER FRANCES L. GUSTINA :!1111041 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES. t, PARTHMORE F[7NE~2AL HOME FUNERAL SERVICES 1,025.12 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of PersonallRepresentative(s) pNC BANK N.A. Street Address 4212 CARLISLE PIKE Ciry CAMP HILL State PA ZIP 17011 Year(s) Commission jPaid: 2012/2013 2. Attorney Fees: STONE, LAFAVER, & SHEKLETSKI 3. Family Exemption: (If decedent's address is not the same as Uaimant's, attach explanation.) Claimant Street Address Ciry State ZIP Relationship of Claimant to Decedent 4. I Probate Fees: 5. ~ Accountant Fees: 6. Tax Return Preparer Feqs: 7. 1 REIMBURSEMENT '~O STONE, LAFAVER, b SHEKLETSKI FOR: PROBATE FEE 577.50 LEGAL ADVERTISING 75.00 TOTAL 652.50 Total £rom continuation schedules . TOTAI swosAC z.ooo ~. It more space is neetleq use adtlitional sheets of paper of the same size. 25,470.00 25,470.00 652.50 38,164.06 90.781.66 Estate o£: FRANCES L. GUSTINA 21 11 1041 Schedule H Part 7 (Page 2) 2 SES INSURANCE AROKERAGE SERVICES INC. REAL ESTATE LIABILITY INSURANCE 264. 00 3 THE SENTINEL LEGAL ADVERTISING 200. 16 4 YORK COUNTY ~~ EXEMPLIFIED COMES OF LETTERS TESTAMENTARY FILING FEE '~~ 50. 00 5 REGISTER OF WI~LS PA INHERITANCEI TAX RETURN AND INVENTORY FILING FEE I 30. 00 6 EXPENSES RE MA NTENANCE AND UPKEEP OF 22 F RMEIOUSE LANE, CAMP HILL, PA 17011 TO DATE OF SALE A FOLLOWS: REAL ESTATE REPAIRS 11,466.00 WATER SERVICE '~, 53.92 ELECTRIC SERVI~E 163.78 LAWN MAINTENANCE 127.20 TOTAL ' 14,610.90 14,610. 90 7 BROKER COMMZSS~CON 11,466.00 STATE TAX STAM~S 1,999.00 SELLERS ASSIST'. 8,600.00 ~ MISC. EXPENSES I 744.00 TOTAL 23,009.00 23,009. 00 Total (Carry Forward tJo main schedule) 35,164.06 REV-1512IX* (1b W) Pennsylvania SCHEDULE I DEPARrr~ENr of=REVENUE DEBTS OF DECEDENT, iNRERnANCErAZREruRN MORTGAGE LIABILITIES 8 LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER FRANCES L. GUSTINA 21 11 1041 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 PPL ELECTRIC UTILITY SERVICE 82.95 2 ~ i7SAA P6C INSURANCE 77.00 3 PAWC WATER SERVICE 13.54 4 MESSIAH VILLAGE H~ME CARE LLC TRANSPORTATION SE]~tVICES 47.15 5 MESSIAH VILLAGE FINAL ROOM, BOARDS AND NURSING CARE 12,695.55 6 ALERT PHARMACY SE~2VICES FINAL PHARMACY CH~RGES 15.66 7 CORDON'S LANDSCAP$NG LLC LAWN MOWING '. 84.80 8 HOSPICE OF CENTRA$. PA RESIDENTIAL CARE ~ 1,080.00 9 FAIRVIEW TOWNSHIP'.. SEWER SERVICE '. 147.00 10 PA DEPARTMENT OF )~EVENUE 2011 PA STATE IND VIDUAL INCOME TAX RETURN nnT.nxCE DUE 112.00 11 PNC BANK N.A. '. ACCRUED TRUSTEE F'~ES 309.41 12 STONE LAFAVER, & HEKLETSKI ~ LEGAL SERVICES RE ERED TO 09/15/11 1,750.00 ~I TOTAL (Also enter on Line 10 Recapitulation) E 16, 415.06 swasnR zoDO ~ If more space is needed, insert atltlitional sheets of the same size. -_ I REV-1513 EX+(Ot-10) SCHEDULE J Pennsylvania DFPARTAENr DF REVENUE BENEFICIARIES INHERRANCEE TAX RETURN RESIDENT DECEDEM ca i r r c ur: FILE NUMBER: FRANCES L. GUSTINA of ~~ tnni NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TG DECEDENT Do Not Llst Trustee(s) AMOUNT OR SHARE OF ESTATE TAXABLE DISTRIBUTIONS IlnUude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. DONNA E. GUSTINA 3817 O'NEILL RbAD LIMA, NY 14485 25$ OF RESIDUAI, ESTATE PER ATTACHED STATEMENT '. INVENTORY VALUE: 131,140.27 Niece 131,140.28 2 FRANCES A. KRA LE 3629 WORSLEY DIVE FORT WORTH, TX', 76133 25$ OF RESIDUA. ESTATE PER ATTACHED STATEMENT y, INVENTORY VALUp: 131,140.27 Niece 131,140.27 ENTER DOLLAR AMOUNTS F~R DISTRIBUTIONS SHOWN ABOVE ON LINES 151HROUGH 1 a OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIO 5 A. SPOUSAL DISTRIBUTIONSIUNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARRABLE AND GOVERt{IMENTAL DISTRIBUTIONS: 1. See Attached 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER_ swasAi z ooo ~~ If more space is needed, use additional sheets of paper of the same size. L_ Estate o£: FRANCES L. GUSTINA Schedule J Part 1 (Page 2) Item No. Description 3 AMY J. RYAN 424 KINGS COURT WEST BABYLON, NY 11704 25$ OF RESIDUA, ESTATE PER ATTACHED STATEMENT INVENTORY VALU~: 131.140.27 4 MICHAEL B. GUS INA 10405 HUDSON R~AD HEAVER DAM, NY' 14814 25$ OF RESIDUAL ESTATE PER ATTACHED STATEMENT I, INVENTORY VALU~: 131,140.27 Niece Nephew RelatcLon 21 11 1041 Amount 131.140.27 131,140.27 Estate of: FRANCES L. GUSTINA Schedule J Part 2B (Page 1) Item No. Description 1 ST THERESA ROMAN CATHLOLIC CHURCH 1300 BRIDGE ST~2EET NEW CUMBERLAND, PA 17070 CASH BEQUEST INVENTORY VALU~: 5,000.00 21 11 1041 Amount 5,000.00 ESTATE OF FRANCIS L. GUSTINA FILE # 21 11 1041 ATTACHMENT TO SCHEDULE J, BENEFICIARIES CALCULATION OF RESIDUARY ESTATE SCHEDULE A-REAL ESTATE 199,900.00 SCHEDULE E- CASH,',BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY 436,857.83 TOTAL GROSS ASSETS 636,757.83 LESS: SCHEDULE H-FUNERAL AND ADMINISTRATION EXPENSES 90,781.68 SCHEDUL~ I- DEBTS OF DECEDENT 16,415.06 SCHEDULE J-CHARITABLE BEQUESTS 5,000.00 TOTAL 112,196.74 112,196.74 RESIDUARY ESTATE. 524,561.09 THE RESIDUARY ESI~ATE IS PAYABLE TO NIECES AND A NEPHEW EQUALLY AS DETAILED BELOW: NAME OF HEIR INTEREST ALLOCATED AMOUNT DONNA E. GUSTINA '. 25% 131,140.28 FRANCES A. KRAGLEi` 25% 131,140.27 AMY J. RYAN 25% 131,140.27 MICHAEL B. GUSTINA 25% 131,140.27 TOTAL 524,561.09 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1)126-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT PNC BANK NATIONAL_ASSOCIATION PO BOX 308 CAMP HILL, PA 17001-0308 mla ESTATE INFORMATION: ssN: oss-o~-5504 FILE NUMBER: 211 1 -1041 DECEDENT NAME: iGUSTINA FRANCIS L DATE OF PAYMENT: "12/06/2011 POSTMARK DATE: ;12/06/2011 COUNTY: (CUMBERLAND DATE OF DEATH: ~b9/15/2011 REMARKS: CHECK# 51501 SEAL ACN ASSESSMENT CONTROL NUMBER REV~11 fit EX(11-961 N0. CD 015292 AMOUNT 101 ~ 569,160.00 TOTAL AMOUNT PAID: INITIALS: HEA RECEIVED BY: 569,160.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER LAST WILL AND TESTAMENT OF FRANCIS LOUIS GUSTINA. I. FRANCIS LOUIS GUSTINA, of Fairview Township, York County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Executrix hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: All the rest, residue and remainder of my estate, whether real, personal or mixed, and wherever situate, I hereby give, devise and bequeath to my wife, NARY GLADYS G'~USTINA, if she survives me by thirty (30) days. ITEM III: Should my wife, MARY GLADYS C;USTINA, fail to survive me by thirty (30) days, then I hereby give acid bequeath the sum of ]?ive Thousand ($5,000.00) Dollars unto ST. THERESA'S ROMAN CATHOLIC CHURCH, New Cumberland, Pennsylvania. Page 1 of 6 ITEM IV!: Should my wife, MARY GLADYS GUSTINA, fail to survive me by thirty (3''0) days, then I hereby give and bequeath my tangible personal prq'perty unto ,my hereinafter named Executor for sale or distributiory, as he has been otherwise instructed. ITEM V:I Should my wife, MARY GLADYS GUSTINA, fail to survive me by thirty (~'0) days, then I hereby give, rest, reside and remainder of my estate, devise and bequeath all the wheth~=_r real, personal or mixed, and v~heresoever situate, unto such of the following named persons as hall survive me, in equal shares to my nieces and nephews: DONNA ELIZAI}sETH GUSTINA, FRANCES ANN GUSTINA KRAGLE, AMY JOSEPH GUSTINA RYAI~T, and MICHAEL BERRY GUSTINA. Should any person entitled to a share of my estate not have attain~d the age of twenty-one (21) years at the. time of distri- bution to h~m or her, I devise and bequeath the share of each such person to m~ trustee hereinafter named IN SEPAF'ATE TRUST to hold, I manage, invest and reinvest this share so recei.~red and the a.ccumul.a- tion of inepme therefrom and to use and apply the income or principal or so much Thereof as in trustee's discretion may be necessary or appropriate~lfor the education of the beneficiary or for medical emergenciesi of the beneficiary after taking intro account the sources Page 2 of 6 of income end assets of the beneficiary including government entitlemen$s. Any principal or income not so applied shall be dis- tributed t© such beneficiary absolutely when he or she attains the age of twenty-~ne (21) years. If the said beneficiary dies before attain- ing the ag~ of twenty-one (21) years, the trust shall terminate and such share~~lshall be distributed to the other named legatees in Item VI of my lastwill as are then living. ITEM II: The interests of the beneficiaries hereunder shall not be subject!ito anticipation or voluntary or involuntary alienation. I appoint PNC BANK, N.A., Trustee of any trusts created under this my Last Will and Testament. I appoint my wife, MARY GLADYS GUSTINA, Executrix of this my la~t will. Should my wife, MARY GLADYS GUSTINA, fail to qualify or~cease to act as Executrix, I appoint PNC BANK, N.A., Executor o~ this my last will. the serv legal mat I direct that any fiduciary named herein shall retain of the law firm of Stone LaFaver & Stone in handling all in connection with my estate. Page 3 of 6 ITEM XI': No fiduciary acting hereunder shall be required to post bond or entelr security for the faithful performance of his/her duties in any juriskliction. IN WITNESS WHEREOF, I, FRANCIS LOUIS GU~ST~IiDrA,C_have hereunto set my hand and (seal this ~~ day of .?~'M~n 2001. <e, p '~ ;~,f!//Z!i{,`~y ~ pub /.Gl FRANCIS LOUIS GUSTINA SIGNEDr~ SEALED, PUBLISHED and DECLARED by ]?RANCIS LOUIS GUSTINA, the Testato~ above named, as and for his Last Will and Testament, and in the pres~nce of us, who at his request, in h:is presence and in the presence of 'leach other, have subscribed our names as witnesses. ~ __ a ~2h~e,Q.~t.,, ~~" ~ r Address Witness Addre-~. ~~ Page 4 of 6 ~II~~ ~~_ COMMONWEALTH OF PENNSYLVANIA: CO~INTY OF CUMBERLAND SS: I, FRF~NCIS LOUIS GUSTINA, the Testator whose name is signed to the attach~d or foregoing instrument, having been duly qualified according t~o law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed i~ as my free and voluntary act for the purposes therein contained.', FRANCIS LOUIS GUSTINA Sworn to or affirmed to and acknowledged before me by FRANCIS LOUIS GUS']j'INA, the Testator, this ~ day of ,,~~•Q.z.i 2001. xyyr r Ve t/'Sryf{TryiHylr~r~7G{Lp,~`1 ~RI F_ .IUCP~Y, i\~ ~YN~ri `__~~-~~L..d~T-I' ~t Curh eland BOr0. Cumberland Co. No t ~[r Pub 1 ' c Crafr1R1E Sn~ Fminoa tuerrJr ~ rnv>S Y OF PENNSYLVANIA COUNTY OFiCUMBERLAND SS: we, I~l,,~~ic:> (+1 _ «ne and ~ ,~ ~~`~~ , 1.he witnesses whose names are signed to the attached or foregoing I, Page 5 of 6 instrument, being duly qualified according to law, depose and say that we were pres'~ent and saw Testator sign and execute-the instrument as his last will; that Testator signed willingly and that he executed it as his free ,and voluntary act for the purposes therein expressed; that each of us i~n the hearing and sight of the Testator signed the will as witnesse~; that to the best of our knowledge, the Testator was at that time e}ghteen or more years of age, of sound mind and under no II constraint ~r undue influence. I'i ~\ r W' neS I ~` `\ i Wi_tness S\\wornto or affirmed to and acknowledged before me by JRvr~.,~ h` _ -f `15~..P and ~ ~~~~~ , witnesses, I'this /~ day of __~^~e'i'~ -~ 2001. r~/~ ~i Notary Pub is Public xland Co. in.~ Page 6 of 6 ~~~~Q FUNDED REVOCABLE TRUST AGREEMENT jj THIS AGREEMENT OF TRUST executed in duplicate-this 15th day of March 1990 , betWeeri Francis L. Gustina and Glad~}s A. Gustina (A/K(A Mary Gladys Gustina) (hereinafter called Settlors), and CCNB BANK., N.A. of New Cumberland', Cumberland County, Pennsylvania, (hereinafter called Trustee),'' WITNESSETH FIRST: Settlors grant, assign and set over to Trustee and its successors all of the property described in Schedule "IAA", annexed hereto and said property, together with all other propierty, real or personal, that may be added to the Trust (such property and additions being hereinafter .called principal) shall be Meld by Trustee, IN TRUST, upon the following terms. SECOND: Trustee shall manage all property comprising the principal of this Trust and shall collect the income therefrom end accretions thereto and shall pay the net income and hold and djistribute the principal of said Trust as follows: (A) Trustee shall pay the net income therefrom to Settlors aped the survivor of them for and during their lives and the lifetiMe of the survivor of them, subject to the provisions of Item FI~~'TH, in such periodic installments as Trustee shall find convej~ient but at least as often as quarter-annually. (B) Upon the death of the' survivor of Settlors, 'Trustee shall distribute the then remaining principal and any accumulaiCed or undistributed income to the executor or administrator of the estate of the survivor of Settlors for distribu$ion as a part of his or her estate. be free Settlors or to vol THIRD: The principal and income of this Trust shall from anticipation, assignment, pledge or obligation to and shall not be subject to any execution or attachment untary or involuntary alienation. ` FOURTH_ Trustee shall have the following powers in addition Ito those vested in it by law and by other provisions of this Trusl~t, applicable to all property, whether principal or income, exercisable without court approval, and effective until actual distribution of all property. ', (A) To retain any or all of the assets of this Trust, re~l or personal, including stock of Trustee, or of its parent h~lding company, without regard to any principal of diversification or risk. (B) To invest in all forms of property including stock,. cogtmon trust funds and mortgage investment funds whether operated }~y Trustee or its parent holding company, without re~stricticjn to investments authorized for Pennsylvania 2 Fiduciaries as it deems proper, without regard to any principal oi° diversification or risk. (C) To exchange, or to lease personal ',property and leases, fc~r such prices deems pro~er. I, (D) To principal liior income or sell at for any to give and upon allocate partly to public car private sale, to period of time, any real or options far sales, exchanges or such terms or conditions as it receipts and expenses ~ to each as Trustee from time to time thinl~s proper in its sole discretion. i (E) To hold property in the name of Settlors or either of ,them, or in its name without designation of any fiduciary ~apacity, or in the name of a nominee or unregistered. ~IFTH: Trustee may apply the net income of this Trust for ~he support of Settlors and the survivor of them, should he,l she or they by reason of age, illness or any other cause in t~e opinion of Trustee be incapab:Le of disbursing it; and Truste~ is further authorized to expend or apply from the principal ~f this Trust such sums as it, in i'_ts sole discretion, may from 1~ime to time think advisable for the support of them in the station of life to which they are accustomed at the creation of this Tr~st, or during illness or emergency. 3 SIXTH:_ Subject to. the approval of Trustee, anyone may add property, real or personal to the principal of this Trust by deed, will or otherwise. ',SEVENTH: Trustee shall receive compensation for the performancte of its function hereunder in accordance with its standard ~chedule .of~fees in effect from time to time. during the period over which its services are performed.. (EIGHTH: Settlors reserve to themselves, and to the survivor o~f them, the right by an instrument in writing intended to take effect during their lifetime or during the lifetime of the survivor signed by them or by the survivor and delivered to Trustee toy revoke or amend this Agreement in whole or in part provided that the duties, powers and liabilities of Trustee shall not be subistantially changed without its written consent. Both Settlors m~st execute any such amendment or :revocation if both of them are ll~ving. The situs of this Trust for administration and accounting purposes shall be in the County of Cumberland and Commonwealth of Pennsylvania, and all questions pertaining to the construction or validity of the provisions of this instrument shall be g~verned by the laws of that Commonwealth. 4 IN WITNESS WHEREOF, Settlors hav~a hereunto set their hands the day and year first above written and Trustee has executed this instru,acnt and caused its corporate seal to be affixed hereto. ~~~i[2.~/.L tF~rapncis ~L. Gusti//n~~a ~,e R~?". I~CL ~ ICJ !, Gladys A. Gustina ATTEST: i CCNB BANK, N.A. ~~^~ , BY ~ ~07.t-/.~ By~ v~ ?~c- ~~ °~~'~~~~~~ A. Smiley (SEAL) ~~ COMMONWEALTH OF PENNSYLVANIA ) )SS: COUNTY OFCUMBERLAND ) On this the _~ day of ~!_(J_! Ll~~ _, q ~, before met', a Notary Public, the undersigned officer, personally appeared 'Franr•iC T.. ~~j,A~ and Gladys A. Gustina . known to m~e (or satisfactorily proven) to be the persons whose names are! subscribed to within this instrument and acknowledged that theyexecute the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereto set my hand and official steal. n 1 % x.11..._ _ ---- !`-'~--- Notary Public My Commission xpires: i ~ Dianna L. Payna, tic3ry Public 5 I Camp Hill 2oro, Cumbarlan~ County My Ceraniss~on E:xp'ves Sopt.15, 1930 Me-ber, Penrsylvania s~datian o1 f`ctaries COMMONWEALTH OF PENNSYLVANIA ) )SS: COUNTY OF CUMBERLAND ) On this the 15th day of March 1990 before me a Notary Public, the undersigned officer, personally. appeared J. A. Smiley _____ who acknowledged himself to be the dice President and Trust Officer of CCNB Banks N.A., a corporation and that he as such Vice -President eland Trust Officer being aut.horized to do So, executed !the foregoing instrument for the purposes therein containedlby signing the name of the corporation by himself as Vice President and Trust Officer i,IN WITNESS WHEREOF, I have hereunto set my hand and official s~leal. `,'~''~° 7( /j ~ j~'/,I Notary µblic~ My Commission Expires: I, Dianna L. Payne, Ncfzry PuS;ic _ Camp Hill Boro, Cumbadarxi County My Coaaaission Expires Sept. 15,1~rJ Membar, pnnnsyhlanm <aaectgtion of Nutnric~ 6 SCHEDULE "A" CCNB Bak, N.A. Certificates of Deposit: #108269 $10,000.00 #11204 3 10,000.00 #112078 7,000.00 #112113 10,000.00 #112466 10,000.00 #117507 10,000.00 #117528 10,000.00 #117568 10,000.00 #119129 10,000.00 #119172 10,000.00 #121068 10,000.00 #1235791 10.000.00 I TOTAL OF CERTIFICATES $117,000.00 i CA~H $53,000.00 it I li ill A. Settlement Statement (HUD-1) i.^X FHA 2.^RH:i 3.^COM1V. UNns 4,^VA 5.^Gonv. Ins. G Note: Thk form e: famished b 9Nn lmv a ncrd a 'tp.o.c)'vrsre paM OUlabe Ne olos7M: ~Y me D. Name 3 Address of Borrower: Paul A. PWrowka, Hedha' J. Pvkrorks 0060 CeissonsCourl, Enoka PA 17025 G. Property Location: 22 Farmhouse Lane Camp Hill, PA 77011 i, 105. 216. 220. OM8 Approval No. 250&0265 FINAL slrorm here for k+formetloiW purposes eM are not ~nWWed In the totak E. Nam e a Address of Seller: F. Name 8. Address of Lender The EsiekdFmmcbL GusBna MNEf Mat9e9e Cory. 22 Farmhouse Lane, Camp HAt PA 17011 i ISAOA. ATI4A. ~0 Roseeood Drive Demers, MA 01927 H. Settlement Agent I. Settlement Date: 72/OBL!D71 GuvdmnTmmierCmporra8on ~ DieWrsement Date: 12/082011 9075 Market SL, Cemp Hi9, PA 170N i 717-B1N099 Place of Settlement 1075 Meld SL, Cemp HB, PA 77017 i TitleFxpress Printed 12/0920N at 1 t15 am by SLC 404. 577. b 301, IXoss emowA duce from bIXrarmr Qire l~'D) 270.903.24 801. grass amoumcue sees N~•~°r ._. 302. Legs emouMa paid byrta banaaer (One 208.67280 802 Less reduclbna in v2mrd due seler pine 520) 23,009.00 383. Gsh QX Flam ^ ToBomo r 2,271.241 803. bah ^% 70 ~ ^ From SNlar __ ___ _ _ i~-,159.7t4~ 'Paid outside d elos6q by (~onaxn, (Sk&r, )enter, (I)iwestor, Sro(K~r. "Creddby let~da shmvn on Pepe 7, "'Credit a/ sells shovm on page t. _...... __. _. _. _.. i __.. _..... ._......._... unn.t ara 8194,07200 30. Years a.tzso% ^x rr9woal .F ro''$ ^X ldareA ' ~. p Mortgage Ilrswarrce ~Y+ as~ Ya ^X No. ^Yes,OCendse toemaxi~md %. Thefest change n k i'~"~;-~ ~~ w7H pe on I / end can changea~n wmy Yeas alter 1 I .I:vay che~ge $$ 7t x.. ~ ~ k' „'s. ' dY %. OVer On l'dedlhe ben Your r:y~^a .~'~«.'~tx1k ~^F s 4%u ',dale,Y~Ydaesl rate can exxeese ar geese by ~x .~ ~~=Ew1 t'Y 4ax,5~~,.'¢~ s :`~ y4'; Hrlerest r~te6 grecadeed to never be Iowa tlun %ahlgher Nan %. I f' ~. ^X No. ^Yes, Bcen dsabamezi~umd8 +' 4r O No. ^ Yea, tha teal 9mreese can be on I / end the monthly ' >} ~4 =~ amount awed cenrise log ~i~ ~" „~,,.gr~ ~ The mmmnumBcen wa dsebie8 II 0 ` . ~ a '~ y> P~,e'r ^X Na. ^ Yes, yov rimximum preprymeN Den*b ~ 8 ~~ ~ca dre m I~x. ~ ~ e ~i" ~' 7"s~~}r _bc ^X No, ^Yec, you have aba0oonp~medd8 «~. z~.F, .~£ ~.x~s w+t,: *a"^E+ ° a`.@ Ymson / / „r..; ~ '. ^You do nd haveemodht/esapw~medfa 4ems, such as properly lezas a ,~ erd hwneovma's incrrnnce. Ya muslpeyNese Bans directly yourseM. ~ F~s~ ~-©YOU have en eddi0onal manNly es~pwpaymedd8329.19 ~~.^n'~ ,~ ~,' Ortresu9s inatold irifiel momNy am01r ov~d91,406,06. This irFtudes pdncipsl lderesl a. k „y, ° r-, ~`q, T,~'9''y ~„~Y °, mwigage ineuawe and enY ilemc chacl~belovr. .~~~ `~y ,~~^ - 'Y ryi r4~ ~ 7.s d x^ proPedYta%es ^X Homwvmers imwarca ,,qq ~u.v"3' sx? v~, ^Fbed'msuronce 08choolTaxes z z=1 SJ~ d'~u,~~~ 3Y la~ .. d i,F. ` ~' :~ Aq x _ T ° ^ ^ Note: If you have arty ouesdons alwul the dlemeM Ctarges and Loan Termslisled on Nis fohn, pleasr wnlad yourlendar. i I _.... _..._.... I .._.... ~ ___ _._ _.. _...... ._... _.. __._ „-.,. a,.an ~1 HVD-1 I have carelWp leviraed the HUD-1 Selllament $tataznanE and W Iha besl U tay klu'Metlpa erN beliN, tl Is a irile and eceulc~ c161ameM W all rccelf~is end rllcbasemenfs lntle on my wwuN m by me in hhk InnwNoh 1 tlalher wNfy lyf I have mcekad a copy of the HUPt SelUemvd StafaneM. 41~L ~~ The HU0./ Seelswrd SlNemeM Mad1 I have pn:pa<ed is a Wa aM aaauate secant M thk 4amaclbrt I hi ve wusatl m x111 wuae dicMased'n ecmrtlanw vdlh Ih'n slalenleM DATE WARNIN6IT IS A CRM9E TO KNOWINGLY `rylP+,.'~^.KE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANV SIMILAR FORM. PENALTIES UPON CONVICTION CAN INC W DE q FINE AND IMPRISONMENT FOR DETAILS SEE TITIE 18 V.S CODE S~CTION 1001 AND SECTION 1010. ~ct. 1. 2011 11:59AM PNC BANK L~I:AD1~6TkEWAY October 7, 201 ~ Carol Koscien~ki PNC Bank Wealth Management R]'s: Francis L Gustina SSN: 0~5-07-6504 DOD: 9-15-2011 Deaz Ms. No. 4621 P. 2/3 In response to~our request for Date of Death (DOD) balances for the customer noted above, our records show e following: Checking Ac ount Account # 51 0025384 Established: 10-O1-1968 I FRANCIS L GUSTINA DOD balanced $ 76,428.33 + 0.16 accrued interest Savings Acco nt Account # 51 0160048 Established: 03-14-1989 FRANCIS L GUSTINA DOD balance: $ 0.00 + 0.00 accrued interest **This acco t had a Zero balance at the time of death. Please note tha this office provides date of death balances for deposit accounts (1RAs, CDs, Checking and Savings). We o not process any financial transactions or provide statements. If you need assistance with any of these ite s, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Fin ctal Services Center F'NC Bank, N.A. Member FDI ICI Page 1 of 2 2sTia Tu ruvass s~ ~TIq Ii6E Do. 1 Iccwc rc'cOoC. by .amzil4... nme ve cct+ks: TPl1TC1a S 6tnTm imoma': slssnt-Dnl-n-zr n31i oe nv1'a: ThurWY. SePtmbcc a5 1D11 Y9IC8 H 36N/i3A S.OII/DSD IYAN 6Em92SS A6JD1ID OSNWSB PSH CDSLP ND. a1GW3/.. OFSCAISTIDX GTC YPSLL CPSQ PD2CS VMAL PD8 VEItIL __ ______ ~- oalss 15.7]00 ss. nooo OB9. D4 1, MDT [VlID y) 043141[ioY 69'.0690 FRPLd11Y LDE ITC 6td. RY OALVL 09/16 23.2800 2E.28UDD 1,218.59 MDT 4Vm $) 06t2T9lOt 5.2450 32DGR ITBT tOL IX 626US qP 2- OH/i6 31.]A00 I1.161pD BrT11.6H 907 i@0 3) 09it29'l60 S9q.]330 Si.6iOGL SIZE II tie DP ap mHT 4) g21a32660 5,99* .136D 3LtrCaHDR MR![1 iT lD1Q 9DR ~' Da/16 Ln.aaov 1o.aaioe fis,n6 s4 emz rven 31 YW LD ITBT I 61D 417D t39QRPm 3gO1TY LD2 Ot/SS 1].66OD iT.6Wq 11,179. a1 1lOT TY® 5) Sy4L72701 II . CHD uetQG i. D9/y6 63.6100 53.61000 10,064.4] 9DR H® 6) 41161]306 la .]390 ~ ID IHJ"a. p9(15 (0.4900 19.8000 40, 1,:5D0 2,568.64 PDf9IC C% ]) 169287234 6 P IaDD8i1 ~ MSCI IIm1D M2 Of/15 21.5900 21.SIIODO ,1,234.20 ,CDT PDem B) 652 9 8 36 9 4 92 0.6H4D IS6 QJl TL I y,l,y yy CL S H 6600 Y91CL T tOTL 680876 998 EO INC O9/35 6 SL BOq S1.9n D00 13.291.45 YL,T HDM 9j 74i~4]9109 . . LY9f J@168Mf 20/zo POw o9/16 VDOITT3I SG. ]l0D 16.3]D00 lY,k16.62 3D,T 6Vtm 10> ]44aoD4D4 7 r v.72oo PI 6 L - IA H{ 969D B[IIDi T PALCL HIOffiT MT 29IH 16, 09/16 D 11.56DD ]1.660D0 171,561.60 MTP 7060 DR09 il) ]]96 . . 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