HomeMy WebLinkAbout95-0277o21-g5-0277
This is to certify that the certificate hereunto attached is a true and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital
Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L.
304.
AUG 162001
Date
M,06.1p Rp. 4/8'7
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
coMMONwEwrH of rur-nu • ~r~r of HEUrH • wry R
CERTIFICATE OF DEATH
X14.458
TrvE~PRwr
N
sucK
~_
Q
1~
I'
~r
~ MAAEOPDECEDEN,~R~d, Arthur J. Davis Male Bocw.sECURIrrMUMee, n'cEOCOEicM(MwM.D~f:~
+• ,.174 - 20 -6813
.Feb.27, 1995
Ac+ea,.er.~an uMO9,lYEAA uMDel,D,v DwE
C
O
Sr
rrH
BIRnrLACEp,ra nACEOrDE,v„p~rx«+yo~.-«ir~awro~an.,:ep
~1
Q
y
J
~
91+«~Cu.+» ~
(~ MpWr Dq. Moon ~ ...+» ~
`
J 1
~l~
n. ' St.Johns, Mich. tiv+~«+^ Frvawrwk^ ow^ ,~~,,. QI nrn.w.D O1""
sa.d» ^
CgMTY OP DERV CRY,BOIq, IYNOF DERV MAMEMnoIiWdN~DiwMrlydnmko~ DECEDBiTOFMIBRIMC ORgW7 RACE•Amw4an kdr, Bl]ek. 1MYU, Me.
Ctmberland bower Allen Ztap. 'Ihe Woods at Cedar Rim ~(~ wDsy..,7P.c],c,an,
DE~lrs waaPSUenESBlE/ouerm WIBOECEDOREVEREI DEC~ENT'aEDUCRgN ,w,«Wdw~Tlise~ BURVNINDBPOUBE
«ar u.B.ARMEDPORCE87 Mr]o
dd
~k
~
ea''--
. dwm
n mmy
a
ae
... D w L4 i°"~'
Incur sa~esmar- Insu
~'~
rance
~,.«].~
Never
rried
,/ ,L ,
/
,~
oEC~E~r•a.M`~DAOOnESS`sr..,'`x,,b„"'s`'n°c„" s Lower Allen
„~w
0i~°""MO,~ "
,TL91.. PA
~
'
°
824 Lisburn Road RE7cE
a
.rauw
,s, Camp Hill PA 17011 „~ Cumberlard ~'°~' "°•dK'diM"`d
rn.D .r~InmrnsT
gEIEiR's MAME did, kYddo,j,.cD B. DIaViS
J Y
~~ia~r'fotte`~Jyf
s,PDRMAMI SMAMEOyPrPynq^ W. Davis e..°i, tsox'~'e~, Ml 49868
MEn,ooas aco,ePOBRnM
E9 RrwrwunserD
~~ w~cED.DmPOSnaH.wT.aa.,~.r,,,o.~.4,. ~xa~.
«on«Prr
fe ~
o~nD o «
D
],~ March 3, 1995
/ Schaef
own,PA 17088
Con-D`Lite Crematory ],~
oR PEREOMACINq AB BUCN
L M~~re,Irc.,9ll N.21r1 St.
Hag
PA
~~
,
,
2]ke ,dunewYlyYa
Me..earen ~+.so•.e.rnox~.~.erww..er..ndo~.rr.a ucEnsE M~.~eEn
4r, woi01kr1YnoaldrB,b and7Rq OREBgMED
r,yr,ROddrd,. P,ciM, D]'1.1rd
2~2]rwl MoanpNOe b, aF OERN ORE PRDNOIMC®DEADI~.DwtMN NMS CASE REFE/WEDID MEDICAL E%A«INERICOH011EA7
wlopi«iawrsdo]rt. p
'
: ~ s
7 S r
Z - 2 I'- / J ~ D MoD'
O ~L
]s.
>~
E7. PARfk EnIRNkArroP,Yr,,,W«mmpfnlM,rwMM uirdlMarM. Donc,«d«dr moeo «dykiy rMrradr«u,PYrory roM.Mock«Mrl/iua Ap~,ry PARE E: aUw
ogrY]ern oR~dklwr caibwkpndrM, Eu1
LMmiyerrwrooM M. j
YrnNbNrr ~
~Rti4 MIM uWi/ykgawo 4l«nIn PART1.
i
rMarldr.Ul
~OYOEGINE6*+I
d L ~ /
inOwrq-~ ~TrI 57~"7~c•• ~~I ~-! y /~lJ~'1l~ 7 ~C /~7l~Kl ~ ~ .
DUE W (diA]A CON]EIX1EN(:E OFy.
~.wr+Yyrmnalinr
e i
(
DUE 70108 ASA CONSEg1ENCEOF} I
aw. ~IBt76lYE10
~
CMIB[~bw «iQuy
i
iNYYp~kI W/~Aif DUE70(OR AS ACQiSEOUENCE OF}
I
ANAURJPBY
PERPDRMEq WEIEAUWPBY PE,OIN08
PRKMI W
~ OPOEAH ORE OFINJURY THE OF M6AIRY MWURYRWORKT DEBCPoBE,101AI BilURY OCCUNED.
piwM. Coy, TMD
OF DER119 Nlk~~l ~' 1lemidd~ ^
A0.1dry ^ P«,dnokN++grw, ^ _. - ,.. D No -.
lYO !b~ ry
Ns ^ ND 1__1
9ukMO ^ Ca1lM notWdr]nWnd ^ Y.
PIACEOF d.IUNY-Alkmw
Wr Mr44a
aMb LOCRION
,
%
l9baa6 GY/k,w„•],w)
]OO. ]Of
~~Y~
'AC6TI1f7E1D PNM]ICIAN (PnYMEkr. caWYk4 crwM Osn wlNn ]rwllw PM~Iw War/r,17 deM aMOnnpe,W kem ~
w lww'!.r
arWaoe
dd
b
r .
SgNRURE AND TIR~jE OFnCERTIFlER
,wnt
w.
r
,
rr~j r~w~wrrM]Yi .................................................... ^ ]i ~i.C 1~~.
•PROMOIIMI4NDANDCEITTIP7'MD PMYBICWI~nydnygkPr~+OOSMlirtl carByopbuuoo cl0®N)
TsMkMMw, rorwB.,rr,err~W YEMM.rM.WPOOO.WdrbrMbr~)«tlwYwlr]MYA ........................... L1CEN]E/N~U~MBER _ DRE ]KiNEDIMnr,. OOY. ~)•~'~
]1 ~^•'~~•}~77 *'^ ~ ]76 ~-Zg ~v
•k~,c~LOCArIMEwooRaRm NAME ANDADORESBOF PEABON,M,OCDYPLETEDCAUSE OF DERM
ttlemz>)r,q.«PdM (A . E'N 4 /F-n~n~ ~,2~ l~ 'c~ .
OwY,e BBWMrsoY,]tlon«Wlar lno~rlEOEon. i•BO'opkdon,drM oltlxd«o, doM. and PMr. and 6Nbtl» s onA
BMYYI«M.Db. ...................
],. 6 L ~7,a.n
~7L P ~ .~ ~~- q-,
.
REOISTRAR'B agNRT1i,E AND ~. G P H r c.<, Ps4 ?o r T
~~ ~. ~~
reaulla
R
]..
G
c- '• ~
OF
A.J. Davis
I, A.J. Davis, of 3405 Walnut Street, Camp Hill, Pennsylvania,
17011, being of sound and disposing mind and memory, do make,
publish and declare this my Last Will and Testament, hereby
revoking and annulling any and all Wills by me heretofore made.
ITEM I - I direct that all my just debts and funeral expen-
ses be paid out of my personal estate as soon after my decease as
may be found convenient.
ITEM II - I direct that my body be cremated and not buried or
otherwise disposed of and that Richard J. Reese, or his successor,
be retained for the conduct of my funeral.
ITEM III - I give and bequeath to the following legatees the
following sums of money:
ta) Mrs. Mildred Wilson Davis, my cousin - $1,000.00;
(b) Mrs. Marian Davis Clement, my cousin - $1,000.00;
~.e~ Mrs. Ann Finkle, my former secretary - $1,000.00;
~~ Honor United Congretional Church, Honor,
Michigan - $5,000.00; ~
~~ Starr Commonwealth For Boys, Albion, Michigan -
JD
I
Arthur S. Amick, if living at the time of my death,
otherwise to his heirs, Lewisburg, Pennsylvania - $1,000.00
~'
Clarence J. Yon, if living at the time of my
death, otherwise to his heirs Altoona Penns lvania ~
,~' ~ Y - $1,000.00;
John A. Daugherty, if living at the time of my death,
otherwise to his hers, Fayetteville, Pennsylvania - $1,000.00
First Church of Christ, Scientist, Harrisburg,
Pennsylvania - $5,000.00;
Shrine Crippled Childrens Hospital, Philadelphia,
Pennsylvania - $10,000.00
S-~) York Lodge X410, F & AM, Grand Rapids, Michigan -
~,,~,<~°~~"New Castle Pennsylvania Consistor ~
Y - $5,000.00;
YMCA, Grand Rapids, Michigan - $5,000.00
~~ Lawrence Phillips, c/o Paul Revere Life Insurance
Company, Harrisburg, Pennsylvania - $1,000.00
ITEM IV - I give and bequeath the residue of my estate, of
every nature and wherever situate, to my Trustee, hereinafter
named, In Trust, for the following uses and purposes:
ta) To pay the net income therefrom, one-half
tom) to my sister, Mrs. Bess Marie Davis Cermanske and
one-half t]~) to my brother Rex Ivan Davis (also known as
Leroy W. Davis) for so long as each shall live.
D
-2-
(b) In the event either my brother or sister pre-
deceases me or dies during the term of this Trust, the
net income therefrom shall be paid to the survivor of them,
for so long as he or she shall live.
(c) In the event the net income therefrom, shall not
be sufficient to pay to my brother
sum of Three Hundred ($300.00) per
Trustee shall invade the principal
extent necessary to make up the di
income and Three Hundred ($300.00)
brother and my sister.
and to my sister, the
month, for each, my
of this Trust to the
fference between the
per month for each of my
(d) My brother and my sister, shall each have the
power of electing to take the sum of Ten Thousand ($10,000.00)
Dollars, either before Trust administration is commenced, or
during the course of Trust administration, and if so elected,
all benefits under the Trust shall terminate as to the party
so electing as of the date of election, and the remaining
party shall after such date, receive all of the income
therefrom.
(e) In the event my brother and sister predecease
me, or in the event one predeceases me and the other dies
during the term of the Trust, or in the event both die
during the term of the Trust, the then - remaining principal
and any accumulated or undistributed income, shall be
-3-
i
paid in equal shares to the following, at which time
this Trust shall terminate:
Shrine Crippled Childrens Hos ital,
Philadelphia, PA - one-half (~)
National YMCA - one-quarter tl/4)
Boy Scouts of America - one-quarter t1/q)
ITEM V - All federal, state, and other death taxes payable
because of my death, with respect to the property forming my gross
estate for tax purposes, whether or not passing under this Will,
including any interest or penalty imposed in connection with such
tax, shall be considered part of the expense of the administration
of my estate and shall be paid from the estate without apportionment
or right of reimbursement. All such taxes on present or future
interests shall be paid at such time or times as my Co-Executors may
think proper, regardless of whether such taxes are then due.
ITEM VI - M~ ('n_~..e,.,,a...-.. __ ~ ...____ _ . _ _
following powers for the administration of my estate except as
limited hereinabove, in addition to those vested in them by law and
by other provisions of my Will:
A. To retain any or all assets of my estate,
real or personal, without regard to any principle of
diversification, risk, or productivity. ,
-4-
r
B. To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds,
without restriction to investments authorized for Penn-
sylvania fiduciaries as they deem proper, without regard
to any principle or diversification, risk, or productivity.
C. To cause to be registered in their own. names,
without qualification or description, or in their names,
as fiduciaries hereunder in the names of their nominee
or nominees, without qualification or description, any
securities at any time held in my estate.
D. To sell at public or private sale, to exchange
or to lease for any period of time, any real or personal
property and to give options for sales, exchanges or
leases, for such prices and upon such terms and conditions
as they deem proper.
E. To allocate receipts and expenses to
principal or income or partly to each as they from time
to time think proper.
ITEM VII - I nominate,
Harrisburg, Pennsylvania, and
Co-Executors of this, my Last
ITEM VIII - I nominate,
Harrisburg, Pennsylvania, to
and Testament.
constitute and appoint HAMILTON BANK,
HERBERT G. RUPP, ESQUIRE, to be the
Will and Testament.
constitute and appoint HAMILTON BANR,
~e the Trustee under this, my Last Will
-5-
~~
1
ITEM IX - I direct my Co-Executors to retain the services
of Rupp and Meikle, for the settlement of my estate, if such ser-
vices are available, because of its familiarity with my affairs.
IN WITNESS WHEREOF, I A. J. DAVIS, hereby set my hand to this,
my Last Will and Testament, each page of which has been initialed by
me, on this ~ ~,Z'~ day of •~ , 1983, in
n
Pennsylvania.
~~ ~
/ . ~'J . DAVIS , ~ SEAL )
Witnesses:
~o ~
~~
~.7D
-6-
i.
COMMONWEALTH OF PENNSYLVANIA :
SS.
COUNTY OF C u ~+bo~.t~,~ :
I, A.J. DAVIS, testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law,
do hereby acknowledge that I signed and executed the 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.
Sworn or affirmed to and acknowledged before me by A. J. DAVIS,
testator, this 'LS"ti-. day of ft Q ~ ~ 1 , 1983 .
NOTARY PUBLIC
My Commission Expires:
RUY11 ~ ~~~~ IpipQY PUBLIC
CAILP INLI 000D. CYl9E1E11tAfl0 CWMn
,~ COiltltSitt>!1 UlP1RES JEC. !S, lgRR ( SEAL )
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF cuMsea. c.q~rD
We, ~1A~uc ~ ~^KtJ' and R~~ti1~ ~, avAA
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say
that we were present and saw the testator, A. J. DAVIS, sign and
execute the instrument as his Last Will; that he signed willingly
and that he executed it as his free and voluntary act for that pur-
pose therein expressed; that each of us in the hearing and sight of
the testator, A. J. DAVIS, signed the Will as witnesses; and that to
the best of our knowledge the testator, A.J. DAVIS, was at the time
18 or more years of age, of sound mind and under no constraint or
undue influence.
Sworn to and subscribed
before me this ?_gT4 day
of ~ n~ , 1 1983 .
Notary Public
My Commission Expires;~d,~~gW~~~~~
( SEAL ) CAwP INII r301i13, CfI~OERtai10 COUNiIi
' ar CQGIAISSIDH fJIPIRES DEC. IS. 1986
`_, .
....: .y-:...
/ FOR DATER OF DEATH AFTER t2/3ipi ~~ FIERI:
~ ~ INHERITANCE TAX RETURN '~ABPDUBAL
~coM THOFPE!'wsTLVANIA RESIDENT DECEDENT PO~~CRED1T18a"'MEO
FlLE NUMBER
°~A`HiOf~~'~ (TO BE FILED IN DUPLICATE 21-95-0277
........ Da~r.?eoeot-- -- ....T.. ~..~ ---•---- -
I-
V
~~Gi
WO
ViLm
_, , ... ,..i..,
IS, ARTHUR J.
NUMBER
/ 174-20-6813
WRVMNO aPOUBE'e NAME (IAeT,
1.Oriplnal Return
4. limited Estate
0. Decedent died Testate
DATEDEATH I DATE OF BIRTN
PIDDLE WITIAL) I sOC1AL SECURITY NUMBER
2. Supplemental Return
Q 4a. Future Interest Compromise
(for dates of death aRer t 2-12-a~
[~ 7. Decederrt Maintained a Uvinp Trust
ie..~_~ ---'- -.. ..
824 LISBURN ROAD ~~ ~ ~ t,~`\
CAMP HILL, PA ~, ' ~" ~
1_/ ~_.
AYpUNT RECEIVED (BEE WiTRUCTgN~
I
c
O
g
NUMBER
CoreStates Bank N.A
F.C. 1-3-9-20
P.O. Box 7558
1. Real Estate (Schedule /~ (1) 0
00
2. Stocks and Bonds (Schedule B) _
.
224,656.28
~. Closely Held 3tocWPartnership interest (Schedule C) (~) 0
00
4. Mortpapes and Notes Receivable (Schedule D) (4) .
0.00
F. Cash, Bank DeposRs ~ Misceganeous Personal Property
(Schedule E) 5 101.21
e. Jointy Owned Property (Schedule F) (tf) 0.00
7. Transfers (Schedule t3) (Schedule U (77 0.00
a. Total Bross Assets (total Roes i -7)
0. Funeral Expenses, AdmiMstratNe Costs, Miscsganeous (y)/
_ 16.248
ra6
Expanses (Schedule ~ / .
10. Debts Mortysye Uabgities, Usns (Schedule ~ (1 2,896.96
11. Total Deductions (total Roes 0 JR 10)
12. Net Value of Estate (qne a minus qne 11)
1S. Charkable and Oovernmentat Bequests (Schedule .~
14. Net Value Sub)ect to Tax (qne 12 minus qne t3)
-7
(a) 229 757.49
(11) 19145.52
h2)
- 210,611.97
(1 195 611.97
(14) 15000.00
o. apwsa~ I ransms (TOr Gates of death after 0-00-~
See Instructions for Appgcable Percentage on Reverse (1ti) 0.00 X .08 =
81de. (Include values from Schedule K or Schedule M) 0.00
1 tf. Amount of qne /4 taxable a Q% rate (1 tf) 0.00
(Include wlues from Schedule K or gchedule M)
17. AmourN of qne 14 taxable at 1 tf % rate (1 ~ 15000.00
(Include values from Schedule K or Schedule M)
18. Principal tax due (Add tax *om qne 1 tf,16 and 17)
1si. Cradles Spousal Poverty Credk Prior Paymerds Discount Interest
0.00 + 0.00 + 0.00 0.00
20. N qne 1~ ~sater than qne 1 ti, enter the dtlhrsnce on qne 20. This b the OVERPAYMENT
21. H Iine 1 s is greater than qne 10, enter the diRerence on qne 21. This is the TAX DUE
A. Enter the interest on the balance due on qne 21A
B. Enter the foal of qne 2/ and 21 A on qne 21 B. This is the BALANCE DUE
x .oe = 0.00
.is 2 250.00
(1 °) 2 250.00
(19) 0.00
(20)
(21) 2 250.00
(21 OA) 0.00
(z16) 2 250.00
k b true, correct and oompleb. I declare that aq real ~isUlte has been reported atat trw~market Ovalue~Deciaration of preparer other than personal represen~Uv~ dk e '
based on aq IMormation of whk:h r sr has a knowled e.
SIaNA OF PE SON S NSI tF OR FILJNO RETURN ADDRE S
CoreStetes Bank N.A. BY: -~~ P.O. Box 7558/F.C. 1-3-9-20 eta
Veronica R Murphy, Tax Officer Philadelphia PA 19101-7558 ~~ o'~ 9,f"
SI NA O PR O AN R PR NTATIV
S ate
~, r
Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
• 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 296 (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 196 (.01) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98
• Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (~ IN THE APPROPRIATE BLOCKS.
1. Did decedent make a transfer and:
YE8 ~ 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. H death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate consideration? tf death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving
adequate consideration ? ...............................................................
............................................... X
3. Did decedent own an 'intrust for' bank account at his or her death? .......................
.................. X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THIS RETURN.
• oc~wor~xn~orrsManvua~
i M(P(fANCf T/Uf IE7L/~1
ESTATE OF
ARTHUR J. DAVIS
ITEM --- _~ ..•va vn
NUMBER DESCRIPTION
1 • 12,887 shares CoreStates Bond Trust @ 8.064
Accrued Income' to death
2• 119,964.56 shares Corefund Fiduciary Reserve @ 1.00
Axrued Income to death
3• Accrued income from Florence Mackenzie Trust
SCHEDULE B
STOCKS AND BONDS
FILE NUMBER
21-95-0277
VALUE AT DATE
OF DEATH
103,820.77
601.28
118,964.56
30.63
139.04
Total (also ~~t~r on Tina 2. Racapkulatioa)
(If mon space is nNd~d, insert additional shoats of same atza)
cwMOr+wt~-tH os raManv~
~ , NfRRANCE TNf IEftRr1
IE&OEM CECEDFM ~ '
ESTATE OF
ARTHUR J. DAVIS
SCHEDULE E
CASH BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please PrMt or T
FILE NUMBER
21-95-0277
ITEM - -- -- v~+ vn ~cneawe F
DESCRIPTION
NU<riBER VALUE AT
DATE OF DEATH
1 • Cash from Room at Wood at Cedar Run
27.0(
2. Medical Reimbursement from drugs
285.8(
3. Accrued interest earned on Security Deposit at Wood at Cedar Run
74.2'.
4. Insurance Premium Refund
114.1(
5. Security Deposit from Woods at Cedar Run
2,295.0(
6. Trust under Agreement by Arthur J. Davis with Cores Bank N.A
Income balance as of date of death r~ 2,305.0E
~~ ~~~ ~w ~~
~f r~'~
'/
Total (also enter on Rn• 4, ReoapRulation)
(If more space is needed, Insert additional sheets of same size) 5, 1.21
r , oarra±wsKmoF-cnsnvua~
..ai.nwa rNC rsuw,
a4scsnraaawr
ESTATE OF
I7'E Y
NUMBI
a
1.
2.
3.
B.
1.
2.
3.
4.
C.
1.
2.
3.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES Plsas• T • or Print
FILE NUMBER
__ 21-95-4277
Funeral Expenses
Reese Funeral Home, Inc. -burial services
Boyer Funeral Home, Inc. -contract amount on acct #230-OS
R. J. Bomberger Memorial - dep on memorial marker
Administrative Costs :
Personal Representative Commissions
8ocW Security Number of Personal Representative: 23-0972337
r..r commission: psid Year of Termination
Attorney Fees Rupp & Mikle
Family Exemption
CWmant Relationship
Address of CWmant at decedent's death
Street Address
~ state
Probate Fees
Miscellaneous Expenses:
Register of Wilis, Cumberland County -probate letters -testamentary
Cumberland Law -estate notice
Patriot News #1 -estate notice
Total (slso eater on line ~. Recapitulation)
(If more space is needed, insert additional sheets of same size)
2,018.00
175.00
275.00
10,098.10
3,200.00
0.00
288.00
77.23
117.23
16,?,~.56
odaua~KnroF-¢w+sn~~
• MEWTM/CE TNlIETlI1W
/~.~~T~~oE~T
ESTATE OF
vVVVIIIr IIVq
NUMBER
i • Woods at Cedar Run -haircut on 2/9/95
2• Nurses House Call -services rendered
3• Wasserott's -balance due on order #791061
4• Wasserott's -balance due on order #791060
5• Health Force of Harrisburg -balance due on Account #040124000
6• Fairview Professional Pham~acy -pharmacy services
7• Susquehanna Internal Medicine Associations -2/9/95 office visit
8• Nurses House Call -nurse aid services up to death
9• Wasserott's -services 2/22/95
SCHEDULEI
DEBTS OF DECEDENT
MORTGAGE LIABILITIES AND LIENS
Picnen D.:..~ ..~ T. _ _
FILE NUMBER
71-o~_ner.
8.00
60.00
11.55
25.00
599.79
291.37
23.71
1,801.25
76.29
Total (also eMsr on line 10 RscapRula>3on)
(M mo-e space b needed, Insert addkionsi sheets of same size)
` ~Ma+rcKn~ oFrcuerivNw
wE?(TANC( TALC IETUgC
IE61pEM OECE CE/R
ESTATE OF
ARTHUR J. DAVIS
A. Taxable Bequests:
Ann Finkle
,~ Arthur S. Amick
Clarence J. Yon
John A Daugherty
Lawrence Phillips
Rex Ivan Davis (a.k.a. Leroy W. Davis)
ITEM I NAME AND ADDRE33 OF BENEFICIARY
NUMBER
B. Charitable and Governmental Bequests:
Honor United Congretional Church -Honor
Michi
an
~ ,
g
Starr Commonwealth for Boys -Albion, Michigan
First Church of Ch
i
t
r
s
-Scientist, Harrisburg
Shrine Crippled Children Hospital - Phila
PA
,
York Lodge #410, F & M, Grand Rapids, Michigan
New Castle Pennsylvania Consist
.~ ory
YMCA, Grand Rapids, Michigan
8•
9 Shrine Crippled Childrens Hospital Philadelphia, PA
• National YMCA
10. Boy Scouts of America
SCHEDULE J
BENEFICIARIES
TOTAL CHARRABLE AND GOVERNMENTAL BEQUESTS (Also enter on ins 13, RecapRulal
(If more space is needed, insert additionN sheets os same size)
FILE
21-95-0277
Friend
Friend
Friend
Friend
Friend
Brother
8
AMOUNT OR
8HARE OF ESTATE
OR
y
1000
1000
1000
1000
i 000
10000
5,000.00 5
5,000.00
5,000.00 '
10,000.00
5,000.00
5,000.00
5,000.00 ;
79,405.99
39,702.99
39,702.99
198,811.97
n'ORNEY-ATI_,gW ~.:~,,`~`''"~„""' ~w g--*. .. ~' ~
,~ ~.,.
AGREEMENT R-:
OF TRUST ~ Y
THIS AGREEMENT made this ~~Y/
between Arthur J. Davis day °~'i'~
'of Came Hill ~A'D• 1984,
party of the first ~ Cumberland Count
part and hereinafter y' Pennsylvania,
referred to as the "Settlor",
AND
The Hamilton Bank, a corporation
Harrisburg, Dau hin with an office
P County, Penns in the City of
hereinafter called „ Ylvania, party of the second
the Trustee", part,
WITNESSETH:
~E~S, Settlor desires to
of the Trustee avail himself of the skill and
in the management and control of certain knowledge
hands of the Trustee;
Property in the
NOW, THEREFORE, in consideration of the
ments herein contained mutual convenants and
• the parties hereto agree-
agree as follows:
THE RES: The Settlor hereb
the assets listed Y transfers and conveys to the
in Schedule "A" attached Trustee
fer and convey additional hereto, with the ri
property from ti ght to trans-
me to time.
TRUST POWERS:
hereby established
The Trustee agrees to hold and p'anage the Trust Res
together with an
terms and conditions of the Y Property hereafter added, u on the
` ,~~ ~~'~utias trust and for the uses and P
+~~- i
r,~ ~.- ~9P9wers of trust as follows: '., ..,.,Purposes and with `
cf the._f~s or'assets Pais7r'~ ialMat apd~ ,:
tan83ble aad is said trusts in such propertt~st ~ ~ ~' Fart
intangible, includ T, real and pa=b~1,
stocks, bonds in8;,(but not. limited to
and securities of whatever kind ~~ ~ ) e°emon and
ments, mutual ' real estate °` :.Preferred
and common funds (includin °°OrtBagea
by a subsidiar - 8 funds o ~ ~°d8-
3' or affiliated Perated by the Trustee or
restricted to entity) and money market funds
investments technicall , without being
may hold, retain the fog Y referred to as le al
received g investments, and
manage, control (including stock of Hamilton Bank),
alter, assign, improve, encumber
Cate, lease Possess,
, transfer, sell outri ht f mortgage,. pled e
installment a g or cash or other consideration hYPothe-
greements, grant options and
Propert conve °r-on
Y, without order of ;, Y real estate and
curt, without bond Personal
or Private sale or sales or ' without
transac bids' at public
as my Trustee tions, and upon such
may deem reasonable and term,; and sonditioc,a
advisable.
,. _,.~~:
The Trustee may pay bills and discharge obligations and may
exercise the voting rights, options, elections, privileges, and
any other tights pertaining to or inhering in any property .in ,the.
Trust Fund. ..,
INCOME DISTRIBUTION: The Trustee shall distribute income to the
Settlor semi-annually, or more frequently upon the request of the Settlor.
The Trustee may disburse and apply directly income and/or principal for
the maintenance, care, treatment and support of the Settlor, if, in the
opinion of the Trustee, Settlor may be incapable of handling or disbursing
the same.
TERMINATION: Either party may terminate this trust and agreement
by giving 50 days written notice to the other party.
If this agreement is in full force and validity at my
death, the Trustee shall account to my Executor and shall pay the Trust
Res unto my Executor.
COMP~ON; The Trustee shall receive compensation for the per-
formance of its duties and functions hereunder in accordance with its
schedule of fees in effect from time to time during the period over which
its services are performed.
IIrTERPRETATION: This Trust shall be construed according to the laws
of Pennsylvania and its situs shall be Dauphin County.
Ill itZTNBSS 1t1igA3p!'*.~ Settlor h
---: ~.,
1 .~ a:: I _ lay- , ~, ` 9~.. " as hereunto-set his`haad ahd seal:-
I I' ~ ~ ~ _ R
~ __
.,
Arthur ~ ~av
~;,, 1 / •
THE HAMIL ' N AIQI:
By .may ~
ATTEST:
.. ..a,.._ . _. ~ ::rr
SCHEDULE "A°
Cash
U.S. Government Securities:
25,000 U.S, Treas. Notes Dtd 12/2/82
10.12570 due 2/15/88
25,000 U.S. Treas. Notes Dtd 2/1/83
9.875% due 2/15/86
25,000 U.S. Treas. Notes Dtd.2/28/g3
9.625% due 2/28/85
25,000 U.S. Treas Nts. 9.8757, due
5/15/88 dtd 3/1/83
25,000 U.S, Treas Nts. 9,6257, due
3/31/85 dtd 3/31/83
45,000 U.S. Treas Nts. 11.00% due
11/15/86
24,930.00
23,845.00
24,897.50
45---- 1~ DO
179,109.87