HomeMy WebLinkAbout09-12-12J 1505610143
REV-1500 Ex(°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania county code Year File Number
Bureau of Individual Taxes DEPAR7AENT OF REVENUE
Po Box.28oso1 INHERITANCE TAX RETURN 21 12 OQ~Q
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
12 13 2011 09 11 1931
Decedent's Last Name Suffix Decedent's First Name MI
LENT JOHN
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
LENT ROXIE D
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 1l 3. Remainder Return (date of death
J ~J prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise r ~ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
C g Decedent Died Testate ~ ; ~ p~c~d~~lt Maint ned a Living Trust ~ 8. Total Number of Safe De Slt Boxes
(Attach Copy of vulq 11'. ! (Attach Gopy of~rust) --- P°
9. Litigation Proceeds Received 1 °. Spousal Povert Creditl(date of death r t ~. Election to tax under Sec. 9113(A)
- ~ between 12-31 ~Jt and -1-95) ---- (Attach SCh. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
AMY M MOYA 717 652 7323
First line of address
5011 LOCUST LANE
Second line of address
City or Post Office
HARRISBURG
State ZIP Code
PA 17109
REGISTER tLS USEeZBVLY
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DA~E FILED
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Correspondent's a-mail address: Amy@LedererlaW.COm
Under penalties of perjury, I deGare that I have examined this return, inGudin9 accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. DeGaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
ciruen iov
- - - --~-•~--• D TE
L .~ 'L c ~l Roxie D Lent R -7~1L
North
\TURE OF
THAN REPRESENTATIVE
DATE
~/~/,
1701
Amy M. Moya
5011 Locust Lane, Harrisburg, PA 17109
Side 1
1505610143 1505610143 J
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Lent, John
RECAPITULATION
1. Real Estate (Schedule A) ....................................................................................... 1. 84 , 550.00
2. Stocks and Bonds (Schedule B) ............................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3.
4.
5•
6.
7.
8. Mortgages & Notes Receivable (Schedule D) ........................................................
Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...............
Jointly Owned Property (Schedule F) ] Separate Billing Requested............
Inter-Vivos Transfers & Miscellaneous -Probate Property
(Schedule G) ~ Separate Billing Requested............
Total Gross Assets (total Lines 1-7) ..................................................................... 4.
5.
6.
7.
g.
1 , 000.00
15 6 ,14 5.4 9
2 41 , 6 95 .4 9
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 15 , 715.82
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 6 , 187.2 6
11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 21 , 90 3 . 0 8
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 219 , 7 92.41
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. 219 , 7 92.41
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .o0 48 , 3 94.60
15.
O. 00
16. Amount of Line 14 taxable 171 3 97.81
at lineal rate X .045 ~ 16. 7 712.90
~
17. Amount of Line 14 taxable
at sibling rate X .12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18. 0. 0 0
1 s. Tax Due .................................................................................................................. 1 s. 7 , 712.90
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
150561D243 150561D243 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-12
DECEDENT'S NAME
Lent, John
STREET ADDRESS
11 North Old Stonehouse Road
CITY -- S TAT E %ZIP
Carlisle ! PA ~ 17015
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
7,300.00
384.21
(1) 7,712.90
Total Credits (A + B) (2) 7,684.21
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.
(3)
(4)
(5> 28.69
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Y_es No
a. retain the use or income of the property transferred :............................................................................... ', x~ !J
b. retain the right to designate who shall use the property transferred or its income :.................................. __ '~
c. retain a reversionary interest; or ............................................................................................................... '~~
d. receive the promise for life of either payments, benefits or care? ............................................................ '~
2. If 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 "in trust for' or payable upon death bank account or security at his or her death?....... ~ [x ~,
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which z
contains a beneficia desi nation .....................
rY 9
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of
assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1502 EX+(~1-08)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lent, John 21-12
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property 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 fads.
Real property which is jointlyownad with right of survivorship must be disclosed on schedule F.
Attach a copy of the settlement sheet if the property has been sold
Include a copy of the deed showing decedents Interest if owned as tenant In common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 1/2 interest in real estate located at 11 North Old Stonehouse Road, Carlisle, Silver Spring 84,550.00
Township, Cumberland County, Pennsylvania, titled to John R. Lent and Roxie D. Lent as
tenants in common (x169,100.00 full assessed value x 1.00 common level ratio)
TOTAL (Also enter on Line 1, Recapitulation) I 84,550.00
(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 A (Rev. 11-08)
Rev-1508 EX+16-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Lent, John 21-12
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
pr more space Is needed, aaditlonal pages of the same size)
Copyright (c) 2002 fomt software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-7510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS ~
MISC. NON-PROBATE PROPERTY
ESTATE OF (FILE NUMBER
Lent, John 21-12
~ nis su~eauie musr oe compietea ana mea ° the answer to any or questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
THE DATE OF TRANSFER.SATTACFi ACOPY OF THE DEED FOOREREEADL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 32,256.93 shares of VP Conservative CI 2, RVS 34,231.95 100.000% 34,231.95
Retirement Advisor Advantage Plus Var Ann, held in
Ameriprise Annuity Account No. 93007512223 2 004,
John R. Lent, owner, Roxie D. Lent, beneficiary
($1.06/NAY)
2 Cash held in Ameriprise Account No. 00021935606 0 428.30 100.000% 428.30
021, titled to John R. Lent, Trustee of the John R. Lent
Living Trust dated 2!15/95
3 4,255.75 shares of JP Morgan Income Builder CI A, 37,280.38 100.000% 37,280.38
held in Ameriprise Account No. 00021935606 0 021,
titled to John R. Lent, Trustee of the John R. Lent
Living Trust dated 2/15/95 ($8.76/NAY), CUSIP
#4812A3288
4 1,755.59 shares of Permanent Portfolio Fd Inc, held in 81,283.86 100.000% 81,283.86
Ameriprise Account No. 00021935606 0 021, titled to
John R. Lent, Trustee of the John R. Lent Living Trust
dated 2/15/95 ($46.30/NAY), CUSIP #714199106
5 Prepaid Funeral Contract with Hoffman-Roth Funeral 2,921.00 100.000% 2,921.00
Home & Crematory, Inc., beneficiary
TOTAL (Also enter on Line 7, Recapitulation) I 156,145.49
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+(10-06)
COMM~I NT DECED~RNVANIA
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Lent, John 21-12
~........ .................. ......~. .... .a.Mv. vv~~~.wu~c ~.
ITEM DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
3,266.32
B.
1. ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Roxie D Lent
Street Address 11 North Old Stonehouse Road
city Carlisle State PA zio 17015
Year(s) Commission paid 2012 4,852.00
2. Attorney's Fees Law Offices of Susan E. Lederer (estimated) 3,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00
Claimant Roxie D Lent
Street address 11 North Old Stonehouse Road
city Carlisle state PA zio 17015
Relationship of Claimant to Decedent SpOUSe
4. Probate Fees Cumberland County Register of Wills (estimated) 257.50
5. Accountant's Fees Parks 8 Company 310.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs 30.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 15,715.82
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Lent, John 21-12
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Hoffman Roth Funeral Home & Crematory, Inc. 3,266.32
H-A
Other Administrative Costs
2 Cumberland County Register of Wills (filing fee - PA Inheritance Tax Return and Inventory)
H-B7
3,266.32
30.00
30.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+(72-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
COMMONNIEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lent, John 21-12
Report debts incurred by the decadent prior to death that romained unpaid at the date of death, Including unrolmburaed medical ezpenaes.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Sarah A. Todd Memorial Home (patient services) 3,789.75
2 Sarah A. Todd Memorial Home (prescriptions) 206.34
3 PSERS (reimbursement of prorated pension payment) 1,564.49
4 Tuckey Mechanical Services (1/2 share of electrical repairs) 45.00
5 Penn Waste, Inc. (1/2 share of trash collection) 22.18
6 PPL (1/2 share of electric bill) 53.50
7 Pennsylvania Department of Revenue (personal income tax owed) 506.00
TOTAL (Also enter on Line 10, Recapitulation) I 6,187.26
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+ (11-08)
SCHEDULE J
COM IN~~CE°1F~~rR"ANIA BENEFICIARIES
ESTATE OF FILE NUMBER
Lent, John 21-12
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 a 1.2
1 Roxie D. Lent Spouse Life estate in real 48
394.60
11 North Old Stonehouse Road estate; annuity ,
Carlisle, PA 17015 on Schedule G
2 Stephanie L. Brechbiel Daughter 113 of residuary 45
818
05
4510 Fish Hawk Court trust estate; ,
.
Chesapeake Beach, MD 20732 remainder
interest in real
3 Amy J. Lent Daughter 113 of residuary 45
818
05
17614 North 58th Street trust estate; ,
.
Glendale, AZ 85308 remainder
interest in real
4 Elizabeth L. Anderson Daughter 113 of residuary 45
818
05
8901 Creek Road trust estate; ,
.
Newport, PA 17074 remainder
interest in real
5 Michael Gray
528 Enola Road
Apt
B Stepchild Remainder 11,314.55
,
.
Enola
PA 17025 interest in real
, estate
See continuation schedule attached Continuation 22,629.11
Enter dollar amounts for distributions shown above on lines 1
5 throw h 18 on Rev 150 Total
0 cover sheet as a r 219,792.41
o riate.
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
i y iAL yF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
John Lent 12/13/2011 189-26-0141
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
o m~cnene group Stepchild Remainder interest in 11,314.55
119 3rd Street real estate
Boiling Springs, PA 17007
7 Melinda J. Gray Stepchild Remainder interest in 11,314.56
12 South Oak Ct. real estate
Madison, NJ 07940
Total 22 629 11
1
REV-1514 EX+ (4-09)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
~ TERM CERTAIN
(Check Box 4 on Rev-1500 Cover Shee
ESTATE OF FILE NUMBER
Lent, John 21-12
This schedule should be used for all single life, joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
C
^ Will
NAME OF LIFE TENANT ^ Intervivos
DATE OF BIRTH Deed of Trust
NEAREST AGE AT
DATE OF DEATH ^ Other
TERM OF YEARS
LIFE ESTATE IS PAYABLE
Roxie D. Lent 11/12/1938 73 ®Life or ^ Term of Years
^ Life or ^ Tenn of Years
^ Life or ^ Tenn of Years
^ Life or ^ Tenn of Years
1. Value of fund from which life estate is payable
$ 82,050.00
2. Actuarial factor per appropriate table .17261
Interest table rate - ^ 3 112% ^ 6% ^ 10% ®Variable Rate 3%
3. Value of life estate (Line 1 multiplied by Line 2) $ 14,162.65
NAME OF ANNUITANT
DATE OF BIRTH NEARESTAGE AT
DATE OF DEATH TERM OF YEARS
ANNUITY IS PAYABLE
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
1. Value of fund from which annuity is payable
2. Check appropriate block below and enter corresponding number
Frequency of payouts Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4)
^ Semi-annually (2) ^ Annually (1) ^ Other
3. Amount of payout per period $
4. Aggregate annual payment. Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^Variable Rate
6. Adjustment Factor (see instructions) $
7. Value of annuity - If using 3 1/2%, 6%, 10% or if variable rate and period payout is at end of period,
calculation is: Line 4 x Line 5 x Line 6 $
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of the
tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return.
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule K (Rev. 4-09)
REV-1647 EX+ (9-00)
SCHEDULE M
COMMONWEALTH OF PENNSYLVANIA FUTURE INTEREST COMPROMISE
INHERITANCE TAX RETURN
RESIDENT DECEDENT (Check Box 4a on Rev-1500 Cover Sheet)
ESTATE OF FILE NUMBER
Lent, John 21-12
This schetlule is appropriate only for Estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the tvoe of instrument which created the future interest and attach a coov to the tax return
® Will ^ Trust ^ Other
I. ~ Beneficiaries
NAME OF BENEFICIARY
1, Roxie D. Lent
2. Stephanie L. Brechbiel
3, Amy J. Lent
4. Elizabeth L. Anderson
5. Michael J. Gray
RELATIONSHIP DATE OF BIRTH AGE TO
NEAREST BIRTHDAY
spouse 11/12/1938 73
daughter 04110N961 51
daughter 04/10/1964 48
daughter 02103!1968 44
stepchild 08/18/1959 52
II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9
months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse
exercises such withdrawal r'~qt.
U Unlimited right of withdrawal n Limited right of withdrawal
Explanation of Compromise Offer:
6. Michelle Group stepchild 01!0311964 48
7. Melinda J. Gray stepchild 08/12/1966 46
See Article Two, Section 2.01 of the Last Will and Testament of John R. Lent.
IV.
Copyright
The life tenant, Roxie D. Lent, intends to remain in the house and has no plans to vacate the residence. Mrs. Lent
has adequate funds to be able to maintain the residence during her lifetime.
Since there are no extraordinary facts or circumstances involved in this matter, an actuarial approach should be
used.
Summary of Compromise Offer:
1. Amount of Future Interest:
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet)
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One ^ 6% ^ 3% ^ 0%
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
^ 6% ®4.5%
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet)
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet)
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1)
;) 2002 form software only The Lackner Group, Inc
67,887.35
67,887.35
67,887.35
Form PA-1500 Schedule M (Rev. 6-98)
Last Will and Testament ~~ ,C~ ,~
of
John R. Lent
I, John R. Lent, a resident of Carlisle, Cumberland County, Pennsylvania, revoke
any prior wills and codicils made by me and declare this to be my Last Will and
Testament.
Article One
Family Information
I am married to Roxie D. Lent. Any reference in my Will to my wife is to Roxie D. Lent.
I have three children. Their names and dates of birth are:
Stephanie L. Brechbiel, born on April 10, 1961;
Amy J. Lent, born on April 10, 1964; and
Elizabeth L. Anderson, born on February 3, 1968.
All references in my Will to "my children" are references to these children.
Article Two
Distribution of My Property
Section 2.01 Specific Distribution of Interest in Real Estate
If my wife has predeceased me, then as soon as practicable after my death, I direct that
my Executor sell my residence located at 1 ± Old Stone House Road, Carlisle,
Cumberland County, Pennsylvania and distribute the net proceeds, in equal shares, to
Stephanie L. Brechbiel, Amy J. Lent, Elizabeth L. Anderson, Melinda J. Gray, Michael J.
Gray and Michelle Group. If any of the above beneficiaries predeceases me, that
beneficiary's share is to be distributed to his or hi:r issue, per stirpes, or, if none, to the
surviving beneficiaries, pro rata.
If my wife, Roxie D. Lent, survives me, then I giv:; my wife a life estate in said property.
During the term of said life estate my wife shall be: responsible for the payment of all real
estate taxes, utilities, sewer or water rents and similar charges on the property. She shall,
at all times, maintain adequate insurance on the property and shall maintain the property
in a reasonably good state of repair.
If my wife chooses to vacate the residence, or upon my wife's death, then as soon as
practicable, I direct that my Executor sell my residence located at 11 Old Stone House
Page 1
Road, Carlisle, Cumberland County, Pennsylvania and distribute the net proceeds, in
equal shares, to Stephanie L. Brechbiel, Amy J. Lent, Elizabeth L. Anderson, Melinda J.
Gray, Michael J. Gray and Michelle Group. If any of the above beneficiaries predeceases
me, that beneficiary's share is to be distributed to his or her issue, per stirpes, or, if none,
to the surviving beneficiaries, pro rata.
Property passing under this Section shall pass free of any administrative expenses or
death taxes.
Section 2.02 Disposition of Tangible Personal Property
I direct that my Executor distribute my tangible personal possessions according to a
separate "Personal Property Memorandum" or other similar writing signed by me and
kept with my personal records. It is my intent that the writin
tangible personal possessions under applicable state law. If the writingeis notfound at the
time of my death, or is ruled an improper disposition, this bequest will lapse and my
tangible personal possessions will become part of my living trust. If any items of tangible
personal property I happen to own are not mentioned in the writing, those items will
become part of my living trust. If any gift of tangible personal property lapses, then the
items comprising the lapsed gift will become part of my living trust.
Section 2.03 Pour-Over to My Living Trust
I give all of my probate estate, excluding any property over which I have a power of
appointment, after payment of expenses and taxes that aze paid under this Will, to the
then-acting Trustee of the John R. Lent Living Trust dated February 15, 1995 and
executed before this Will, to be added to the property of that trust. I direct that the
Trustee administer the property as provided in the trust agreement and any amendments
prior to my death.
Section 2.04 Alternate Disposition
If the trust referred to in Section 2.03 is not in effect at my death, or if for any other
reason the pour-over cannot be accomplished, I specifically and completely incorporate
the terms of the trust into this Will by reference. I' direct my Executor to then establish a
trust in accordance with the provisions of that trust and distribute the remainder of my
estate, excluding any property over which I have a power of appointment, to the Trustee
of that trust to be administered as provided in the trust agreement.
Article Three
Designation and Succession of Fiduciaries
Section 3.01 Executor
I nominate Roxie D. Lent as my Executor. If Roxie D. Lent fails or ceases to act as my
Executor, I nominate the following as my successor Executor, to act in the order named:
Elizabeth L. Anderson; then
Page 2
Stephanie L. Brechbiel; then
Amy J. Lent.
Article Four
Powers of Fiduciaries
Section 4.01 Grant
My Executor may perform every act reasonably necessary to administer my estate and
any trust established under my Will. In addition to this general grant of powers, my
Executor is specifically authorized to:
Hold, retain, invest, reinvest, sell, and manage any real or personal
property, including interests in any form of business entity including, but
not limited to, limited partnerships and limited liability companies, and
policies of life, health and disability insurance, without diversification as
to kind, amount or risk of non-productivity and without limitation by
statute or rule of law;
Partition, sell, exchange, grant, convey, deliver, assign, transfer, lease,
option, mortgage, pledge, abandon, borrow, Loan, and contract;
Distribute assets of my estate in cash or in kind, or partly in each at fair
market value on the date of distribution, without requiring pro rata
distribution of specific assets and without requiring pro rata allocation of
the tax bases of such assets;
Hold any interest in nominee form, continue businesses, carry out
agreements, and deal with itself, other fiduciaries, and business
organizations in which my Executor may have an interest;
Establish reserves, release powers, and abandon, settle or contest claims;
and
Employ attorneys, accountants, custodians for trust assets, and other
agents or assistants as my Executor deems advisable to act with or without
discretionary powers and compensate them and pay their expenses from
income or principal.
Section 4.02 Powers Granted by State Law
In addition to all of the above powers, my Executor may, without prior authority from
any court, exercise all powers conferred by my Will, by common law, or by the
Pennsylvania Probate, Estate & Fiduciaries Code or other statute of the Commonwealth
of Pennsylvania or any other jurisdiction whose law applies to my Will. My Executor has
absolute discretion in exercising these powers. Except as specifically limited by my Will,
these powers extend to all property held by my fiduciaries until the actual distribution of
the property.
Page 3
Section 4.03 Distribution Alternatives
My Executor may make any payments under my Will:
Directly to a beneficiary;
In any form allowed by applicable state law for gifts or transfers to minors
or persons under disability;
To a beneficiary's guardian, conservator, or caregiver for the benefit of the
beneficiary; or
By direct payment of the beneficiary's expenses.
A receipt by the recipient for any distribution will fully discharge my Executor, if the
distribution is made in a manner consistent with the proper exercise of my Executor's
duties under my Will.
Article Five
Administrative Provisions
Section 5.01 Court Proceedings
If any trust is established under my Will, that trust will be administered in a timely and
efficient manner consistent with its terms, free of active judicial intervention and without
order, approval, or other action by any court. It will be subject only to the jurisdiction of a
court being invoked by the Trustees or by other interested parties, or as otherwise
provided by law.
Section 5.02 No Bond
I direct that no Executor be required to give any bond in any jurisdiction.
Notwithstanding this direction, if a bond is required by law or by court determination, no
sureties will be required on the bond.
Section 5.03 Compensation and Reimbursement
Any fiduciary serving under my Will is entitled to reasonable compensation
commensurate with services actually performed. In addition, any fiduciary serving under
my Will is entitled to reimbursement for expenses properly incurred.
Section 5.04 Ancillary Fiduciary
If any ancillary administration is required or desired and my domiciliary Executor is
unable or unwilling to act as an ancillary fiduciary, my domiciliary Executor may have
power to designate, compensate, direct, and remove an ancillary fiduciary. The ancillary
fiduciary may either be a natural person or a corporation. My domiciliary Executor may
delegate to the ancillary fiduciary any powers granted to my domiciliary Executor as my
domiciliary Executor deems to be proper, including the right to serve without bond or
Page 4
without surety on bond. The net proceeds of the ancillary estate will be paid over to the
domiciliary Executor.
Article Six
Taxes, Claims and Expenses
Section 6.01 Payment of Death Taxes, Claims and Expenses
The Trustee of the trust referred to in this Will is authorized to pay expenses incurred for
my funeral and for the disposition of my remains, claims against my estate, and expenses
of estate administration. Accordingly, I direct my Executor to consult with the Trustee to
determine which expenses and claims should be paid by my executor from property
passing under my Will, and which expenses and claims should be paid by the Trustee
from the trust.
I direct my Executor to follow any instructions contained in the John R. Lent Living
Trust in making any tax elections, including, but not limited to, the allocation of my GST
Exemption. Any taxes imposed by reason of my death on property passing under and
outside my Will are to be apportioned and paid in the manner provided in the John R.
Lent Living Trust, and I incorporate the tax apportionment provisions of the John R. Lent
Living Trust as part of my Will.
In no event may any death taxes be allocated to or paid from property that is not included
in my gross estate for federal estate tax purposes or which qualifies for the federal estate
tax marital or charitable deductions.
Section 6.02 Tax and Administrative Elections
My Executor may exercise any available elections under any applicable income,
inheritance, estate, succession, or gift tax law. Thin authority includes the power to select
any alternate valuation date for death tax purposes and the power to determine whether
any administration expenses of my estate are to be used as estate tax deductions or as
income tax deductions. No compensating adjustments are required between income and
principal as a result of those determinations unless my Executor determines otherwise, or
unless required by law.
My Executor, in its sole and absolute discretion, may elect to have all, none, or part of the
property comprising my estate for federal estate tax purposes qualify for the federal estate
tax marital deduction as qualified terminable interest property under Section 2056(b)(7)
of the Internal Revenue Code (the "QTIP Election").
My Executor is not liable to any beneficiary of my estate for tax consequences that arise
as a result of the exercise or nonexercise of any tax elections or for decisions made
concerning the allocation and distribution of property in kind in full or partial satisfaction
of any beneficiary's interest in my estate.
My Executor, in his or her sole and absolute discretion, may make any adjustments to the
basis of my assets authorized by law, including but not limited to increasing the basis of
Page 5
any property included in my gross estate, whether or not passing under my Will, by
allocating any amount by which the basis of my assets may be increased. My Executor is
not required to allocate basis increase exclusively, primarily or at all to assets passing
under my Will as opposed to other property included in my gross estate. My Executor
may elect, in his or her sole and absolute discretion, to allocate basis increase to one or
more assets that my Executor receives or in which 'my Executor has a personal interest, to
the partial or total exclusion of other assets with respect to which such allocation could be
made. My Executor may not be held liable to any person for the exercise of his or her
discretion under this Section.
Article Seven
General Provisions
Section 7.01 Applicable Law
The validity and construction of my Will shall be determined by the laws of the
Commonwealth of Pennsylvania.
Section 7.02 Contest Provision
If any person, directly or indirectly attempts to contest or oppose the validity of my Will
or my living trust, including any amendments to my trust, or commences, continues, or
prosecutes any legal proceedings to set my Will or living trust aside, then that person will
forfeit his or her share, cease to have any right or interest in my property, and will, for the
purposes of my Will, be deemed to have predeceased me.
Section 7,03 Construction
Unless the context requires otherwise, words denoting the singular may be construed as
denoting the plural, and words indicating the plurral may be construed as denoting the
singular. Words of one gender may be construed as denoting another gender, as context
requires.
Section 7.04 Headings and Titles
The headings and paragraph titles are for reference only.
Section 7.05 Internal Revenue Code, IRC or Code
References to the Internal Revenue Code, the IRC or the "Code" refer to the Internal
Revenue Code of the United States. References to specific sections of the Code apply to
any sections of like or similar import that replace the specific sections as a result of
changes to the Internal Revenue Code made after the date of my WiII.
Page 6
Section 7.06 Other Definitions
Except as otherwise provided in my WiII, terms will be interpreted as defined in the
Pennsylvania Probate, Estate & Fiduciaries Code, ~ as amended after the date of my Will
and after my death. .
Section 7.07 Survivorship
For purposes of this Will, if my wife actually survives me by any period of time or if the
order of our deaths is not known, then my wife will be deemed to have survived me. Any
other beneficiary will be deemed to have predeceased me if the beneficiary dies within 30
days after the date of my death.
Section 7.08 Severability
If any part of this instrument is determined to be void or invalid, the remaining provisions
will remain in full force and effect.
I, John ~ R. -Lent, having signed this Will in the presence of
~ ~ 1 ~ ~ 17 G a _ and `-°
it at my request on this day, July 8, 2011 at Carl lsi e, Pennsylvani~a,_ Clare this~o besmd
Last Will and Testament. Y
F~
John ~~ L, t, Testator
The above and foregoing Will of John R. Lent was declared by John R. Lent in our view
and presence to be his Will and was signed and subscribed by the said John R. Lent in
our view and presence and at his request and in the view and presence of John R. Lent
and in the view and presence of each other, we, the undersigned, witnessed and attested
the due execution of the Will of John R. Lent on this day, July 8, 2011.
,,{ _~~
~' ` residing at 3 ~ ~'Lt.,~n-~ (,i„ y,~
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Page 7
PENNSYLVANIA SELF PROVING AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
,)
I, JOHN R. LENT, the 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; and that I signed it willingly and as
my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and acknowledged before me by John R. Lent, the testator, this day,
July 8, 2011.
C
JOHN R. NT, es~ator
1, {~^
Il(
AV
Not ijblic %~ --
'~,J
GOMMONWEALTfi OF PENNSYLVANIA
NoCaMal Sabl
Jacqueline M. Mlndeck, NCtary Public
lower Paxton Twp., Dauphin County
My commission n~ ost zs aot~
Member. Pennsvlvanla Association of Nolorloe
Page 8
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, ~ ~ ~ ~ ~~ a and J ~~ J . I~r~,.-ter
namcs are si ned tot a attached or foregoing instrument, being dulytqualified accord~ng
to law, do depose and say that we were present and saw the testator sign and execute the
instrument as his Last Will; that the testator signed willingly and executed it as his free
and voluntary act for the purposes therein expressed; that each subscribing witness in the
hearing and sight of the testator signed the will as a witness; and that to the best of our
knowledge the testator was at that time 18 or more years of age, of sound mind, and
under no constraint or undue influence.
,A
~~ ~~~ ~~
r
Witn s
- ~ ~ ~ -~~
Witness
~ 11
~1
~~,'~ '
Notar~~Pt~blic `
.~
COMMONWEALTH OF PENNSYLVANIA
I NOtarlal5eal
Jacqueline M. Mlndedc, Notary Public
Lower Paxton 1Wp,, Dauphin County
My COmrtu~on €itW1i/ OCt 2S, 2014
Mpffi~l4 ~In~W.Vania 118~Gdetlon of Notaries
Page 9
The
• JOHN R. LENT
LIVING TRUST
prepared for
JOHN R. LENT
JAMES, SMITH & DURKIN
Attorneys-at-Law
20 Valley Road
Hershey, Pennsylvania 17033
(717) 533-3280 FAX (717) 533-2795
O James, Smith & Durkin
All Rights Reserved
JOHN R. LENT LIVING TRUST
Table of Contents
Article One Trust Creation .... .
.................................
1-1
Article Two The Trust Estate .
.................................... 2-1
Article Three Appointment of Trustees
...... .
.........................
3-1
Article Four
. Trustor's Lifetime Rights. .. _ .. ,
........................
~-1
Article Five Trust Administration Upon My Death -
.........
............. ~-1
Article SiY Specific Distributions of Trust Property
...... .
..............
6-1
Article Seven Division into Survivor's Trust and Famil
Trust
y
................ 7-1
Article Eight The Survivor's Trust
. ................................. 8-1
Article Nine The Family Trust ....
................................ 9-1
Article Ten Common Pot Trust
.................................. 10-1
Article Eleven Division and Distribution of Trust Property . ................. 11-1
Article Twelve Distribution If No Designated Beneficiaries
. ................. 1?-1
Article Thirteen Trustee Administration
............................... 13-1
Article Fourteen Trustee Investment Powers
................. .
...........
14-1
Article Fifteen General Provisions.. -
........
......................... l~-1
i
JOHN R. LENT LIVING TRUST
Article One
Trust Creation
Section 1. Parties to My Trust
This trust agreement dated ~~~ ~ ~ - j ~ is made between JOHN R. LENT, the Trustor,
also known as JOHN R. LENT, and the following initial Trustee:
JOHN R. LENT
Section 2. Name of My Trust
This trust may be referred to as the:
JOHN R. LENT LIVING TRUST, dated _ .~.~ (~- ~~
The formal name of my trust and the designation to be used for the transfer of title to the name
of my trust is:
JOHN R. LENT, Trustee, or his successors in trust, under the JOHN R. LENT LIVING
TRUST dated ; ?, - ~ ;~ - ~ r ~ and any amendments thereto
Section 3. Revocable Living Trust
My trust is a revocable living trust.
Section 4. Trustor as Trustee
Notwithstanding any other provisions in this trust agreement, when I am serving as Trustee under
this trust, I may conduct business and act on behalf of the trust without the consent of any other
Trustee.
1-1
~~ Section 5. My Family
a• Marital Status
I am currently marred and my spouse's name is ROXIE D. LENT. All references
to my spouse in this trust agreement are to her.
b. The name(s) and birth date(s) of the children of .TORN R. LENT are:
Name Birth date
STEPHANIE L. BRECHBILL April 10, 1961
AMY J. LENT April 10, 1964
ELIZABETH L. ANDERSON February 3, 1968
All references to the children of JOHN R. LENT in this instrument are to these
children and any children subsequently born to or adopted by him.
1-2
Article Two
The Trust Estate
Section 1. Initial Transfer of Property
I hereby assign, convey, transfer and deliver to my Trustee all trust property set forth on
Schedule "A" attached hereto and made part of this trust agreement. My Trustee acknowledges
receipt without consideration of all assets listed on Schedule "A".
All assets titled in the name of my trust or in the name of my Trustee, but not listed on Schedule
"A" shall be considered a part of my trust estate to the same e:ctent as if set forth on Schedule
..A..
Section 2. Additional Transfer of Property
iV1v Trustee is authorized to accept additional transfers of property interests of all kinds, at any
time in any manner by me or any other person or entity.
All property interests received by transfer, assignment, gift, bequest, devise or beneficiary
designation shall not become a part of my trust estate unless disclaimed by my Trustee.
Section 3. Composition of Trust Property
In addition to the property described in the previous Sections, my trust estate shall include the
following:
a• All insurance policies transferred to my trust or policies in which m_v
trust is named as beneficiary plus the proceeds of those policies;
b• Any interest in any pension, retirement or death benefit, bonus,
profit-sharing or employee's savings plan or any similar contract
created or entered into by an employer for the benefit of some or all
employees which is transferred to my trust or in which my trust is
named as beneficiary and all proceeds of any such benefit, bonus, plan
or contract; and
c• Any other property or interest in property which becomes subject to
my trust.
2-1
Section 4. Acceptance of Trust Property
All property transferred to my trust and not disclaimed by my Trustee shall be held, administered
and distributed according to the terms of this agreement.
c. Notice to Removed Trustee
Written notice of removal under this agreement shall be effective immediately
when signed by the person or persons authorized to make the removal and
delivered to the Trustee personally or deposit by United States certified mail,
return receipt requested. The written nonce removing a Trustee shall designate
a successor Trustee.
d• Transfer of Trust Property
The Trustee so removed shall promptly transfer and deliver to the successor
Trustee all property of the trust under its possession and control.
Section 4. Designated Successor Trustees
Whenever a Trustee is removed, dies, resigns, becomes legally incapacitated or is otherwise
unable or unwilling to serve, that Trustee shall be replaced as follows:
a. The Death or Disability of a Trustee While Y am Serving as
Trustee
.. I may serve as the only Trustee or I may name any number of Trustees to serve
with me. If any of these other Trustees subsequently die, resign, become legally
incapacitated or aze otherwise unable or unwilling to serve as a Trustee, I may
or may not fill the vacancy.
b- Disability Trustees of JOHN R. LENT
Upon the disability of JOHN R. LENT, if he is then serving as an initial Trustee
he shall be replaced by the following Disability Trustee(s):
ROXIE D. LENT
If, for any reason, the Disability Trustee(s) named above are unable or unwilling
to serve, the following successor Disability Trustee(s) shall serve until the
successor Disability Trustee(s) on the list have been exhausted. Unless otherwise
specified, if Co-Disability Trustees are serving, the next following named
successor Disability Trustee shall serve only after all of the Co-Disability
Trustees cease to act as Trustees.
(I) AMY J. LENT
(2) ELIZABETH L. ANDERSON
3-2
c. Death Trustees of ,TORN R. LENT
Upon the death of JOHN R. LENT, if he is then serving as an initial Trustee he
shall be replaced by the following Death Trustee(s):
ROXIE DL LENT
If, for any reason, the Death Trustee(s) named above aze unable or unwilling to
serve the following successor Death Trustee(s) shall serve until the successor
Death Trustee(s) on the list have been exhausted. Unless otherwise specified,
if Co-Death Trustees are serving the next following named successor Death
Trustee shall serve only after all of the Co-Death Trustees cease to act as
Trustees.
(1) AMY 7. LENT; 'THEN
(2) ELIZABETH L. ANDERSON; THEN
(3) STEPHANIE L. BRECHBILL
Section 5. No Designated Successor Trustees
If at any time there is no Trustee acting under this agreement and there is no person or institution
• designated and qualified as a successor Trustee, a majority of the beneficiaries then eligible to
receive distributions of income or principal under this agreement or their personal representatives
shall appoint a successor Trustee. If any trust existing under this agreement lacks a Trustee and
no successor is appointed pursuant to this Section, the vacancy shall be filled by a court of
competent jurisdiction.
Section 6. Responsibility of Successor Trustees
A successor Trustee shall have the same rights, powers, duties, discretions and immunities as if
it had been named as initial Trustee under this agreement. No successor Trustee shall be
personally liable for any act or failure to act of any predecessor Trustee or shall have any duty
to examine the records of any earlier Trustee. A successor Trustee may accept the account
rendered and the property delivered by or on behalf of a predecessor Trustee as a full and
complete discharge of the duties of the predecessor Trustee without incurring any responsibility
or liability for so doing.
•
3-3
Article Four
Trustor's Lifetime Rights
Section 1. Rights While I am Alive and Legally Competent
During my lifetime while I am legally competent I shall have the following powers over the trust
property and my Trustee:
a• Right to Trust Income
My Trustee shall pay to me or apply for my benefit all the net income from this
trust monthly or in other convenient installments as I may direct.
b• Right to Trust Principal
My Trustee shall pay to me or apply for my benefit such sums from the
principal of this trust as I may direct. I may not, however, direct my Trustee to
make Qifts from trust property to third parties. If my Trustee inadvertently
makes a distribution I intended as a gift directly from the trust to a third party,
that distribution shall be construed as a distribution to me first, then a gift to the
third party from me.
c• Right to Add and Remove Property
By written direction delivered to my Trustee, I may add other property to my
trust or withdraw property in any amount and at any time.
d• Right to Amend or Revoke iVly Trust
I shall have the right to amend, modify, alter, revoke or terminate my trust or
any separate trusts created under this agreement at any time in whole or in part.
Any amendment or revocation of this trust agreement must be delivered to my
Trustee in writing. The power to amend, revoke or terminate this trust is
personal to me and may not be exercised by any other person or entity.
After my death this trust or any trust created by this agreement shall be
irrevocable and not subject to amendment.
4-1
~.
e• Delivery of Property After Revocation
After any revocation or termination of any trust created by this agreement, my
Trustee shall promptly deliver the designated trust property to me.
f. Trustee's Retention of Assets Upon Revocation
In the event of any revocation of all or part of my trust, my Trustee shall be
entitled to retain sufficient assets to reasonably secure the payment of liabilities
my Trustee has lawfully incurred in administering the trust and any fees that
have been earned by my Trustee until such time as those liabilities have been
discharged and fees paid, unless I indemnify my Trustee against loss or e:cpense.
Section 2. Power to Direct Investments
I shall have the right to direct investments of trust property as follows:
a• Invest trust funds in specified securities, properties or other forms of
investment:
b• Retain as part of the trust estate for specified periods of time,
securities, properties or other forms of investment held in trust under
this instrument; and
c• Sell, encumber, lease, abandon or dispose of any trust property
ivly Trustee shall not be liable for any losses sustained as a direct or indirect
result of any action taken in accordance with the terms of the written direction.
All directions shall be in a writing signed by me specifying, if applicable, the
period of time during which the instructions shall remain in effect and describing
any other conditions affecting the directions.
Section 3. Trustor's Rights During Disability
a• Disability Defined
I shall be considered disabled in the event a court of competent jurisdiction
determines that I am legally incompetent or in the event that I am not
adjudicated incompetent, but by reason of illness or mental disability I am, in
the opinion of two licensed physicians unable to properly handle my own affairs.
4-2
b• Income and Principal Distributions
My Trustee during the period of my disability shall pay to me or apply for my
benefit as much of the principal and net income of this trust as my Trustee in
its sole discretion shall deem necessary or advisable.
c• Payment of Obligations
My Trustee during the period of my disability shall from time to time pay my
valid obligations, my medical expenses and provide for my comfortable
maintenance and welfare, taking into consideration my other income or
resources.
d• Trustee Guidelines
In making distributions under this Section, my Trustee shall give primary
consideration to my needs and secondary consideration to the needs of anv
dependent children.
e• Tax Planning
During my life, should I become disabled. my Trustee may exercise the
follow-ina powers as attorney in fact on my behalf, either alone or in conjunction
with any other attorney in fact under a durable power of attorney, but the
primary concern of my Trustee shall be for my welfare and secondarily for the
welfare of my lineal descendants for tax planning:
1. My Trustee may make additional distributions to my
lineal descendants equally by class for the purpose
of continuing any gift program initiated by me
which my Trustee reasonably determines will
achieve beneficial results for estate and/or income
tax planning purposes.
?. My Trustee may initiate a gift program on my
behalf which my Trustee reasonably determines will
achieve beneficial results for estate and/or income
tax planning purposes by making distributions to my
lineal descendants equally by class so long as such
distributions are made in the form which qualify for
and are limited to the annual exclusion for federal
gift tax purposes.
4-3
3. During any period when I am disabled my Trustee
shall be under no obligation to initiate, recommend
or consider any tax planning objective or program
for me and any exercise of its discretion in this
regazd when conducted in good faith shall not
subject it to liability to any person affected thereby.
Section 4. Exercise of Trustor's Rights and Powers by Others
Any right or power that I could exercise personally under the terms of this agreement except the
power to amend, revoke or terminate any trust created by this agreement may be exercised for
and on behalf of me by any attorney in fact who, at the time of the exercise, is duly appointed
and acting for me under a valid and enforceable durable power of attorney executed by me or,
if there is no such attorney in fact, by my duly appointed and acting conservator after petition
to a court of competent jurisdiction.
The power to amend, revoke or terminate any trust created by this agreement is personal to me
and may not be exercised by any other person or entity.
Section ~. Rights Concerning Standby Property
It is contemplated that certain assets may be added to the trust estate from time to time with the
possession and control thereof retained by or redelivered to me. If I execute and deliver to my
Trustee an instrument effectively transferring such assets to my Trustee together with any further
documentation necessary to effect the record transfer thereof, in the event of my death or
incapacity the assets shall be deemed to be assets of the trust estate and held by me as the
nominee of my Trustee. During the period such assets are in my possession, they shall be subject
to the following terms and conditions:
a. I may receive directly and devote to my own use and benefit
any dividends, interest, income or distributions from or upon
such assets and neither I nor my Trustee shall have any duty
of accounting to the other or to any other person with regard
thereto.
b• Any sale, exchange or other transfer of such assets by me
shall constitute a withdrawal of such assets from the trust
estate and my Trustee shall have no further interest therein
or duties with regard thereto. Though not a condition
precedent to any such withdrawal, I agree to notify my
Trustee of all such withdrawals.
4-4
c• I shall be responsible for the reporting of the income from
such assets to the appropriate taxing authorities and my
Trustee shall have no responsibility for including such
income on any fiduciary returns prepared by it or for the
preparation of any other income tax return with respect
thereto unless I duly notify my Trustee of such income items
and a full and adequate accounting thereof is made and
presented to my Trustee.
d. I shall protect and indemnify my Trustee against all losses,
liabilities and expenses which may result directly or
indirectly from my use, possession, management or control
of such assets.
e- Upon my death or incapacity, my Trustee shall be entitled to
the possession thereof and thereafter shall have all the rights,
powers and duties with respect to such assets which are
otherwise granted to my Trustee herein. It is understood that
my Trustee shall be responsible only for the assets which
actually come into its possession and control. However, it
is also understood that my Trustee shall use any reasonable
and prudent means to secure possession of any trust assets of
which it has knowledge. My Trustee shall have no duty,
accountability or responsibility to me or to any other person
with respect to any assets of which it has no knowledge or
of which it is unable to obtain possession and control.
Section 6. TrustorPl'rustee Bank Accounts
It is contemplated that I may establish a joint bank account or accounts with my Trustee and
create powers of attorney in respect thereof in other persons. Deposits from time to time made
by me or other authorized persons into such an account shall constitute transfers to the trust estate
and withdrawals therefrom which may be made without the co-signature of my Trustee shall
constitute withdrawals from the trust estate. However, my capacity and other authorized persons
with respect to any such account shall be that of nominee of my Trustee not co-owner. At anv
given time the trust estate shall include the then balance of any such account.
4-5
Section 7. Life Insurance Premiums and Retirement Plans
During my lifetime I shall have all powers over life insurance policies and retirement benefits
owned by or made payable to my trust, including the following:
a• Payment of Premiums
I shall be responsible for the payment of premiums and other charges on each
policy or insurance owned by or made payable to my trust. My Trustee shall
have no duty to make any payment or be responsible to determine whether such
payments have been made.
b• Custody of Policies
My Trustee shall not be responsible for the custody or safekeeping of any life
insurance policy before its actual delivery to my Trustee nor after its withdrawal
by its owner.
~• Change Beneficiaries
I shall have the right to change the beneficiary and to receive any dividends or
other earnings of such policies or plans without accountability therefor to my
Trustee or any beneficiary in this agreement.
d• Assignment
I may assign any policy or plan benefits to any lender to the extent allowed by
law including my Trustee as security for any loan to me or any other person.
e• Surrendered Policies
If any life insurance policy is surrendered or if the beneficiary of any policy is
changed, this trust agreement shall be revoked with respect to such policy.
However, no revocation of the trust with respect to any policy, whether pursuant
to the provisions of the preceding sentence or otherwise, shall be effective unless
the surrender or change in beneficiary of the policy is accepted by the insurance
company.
Section 8. Undistributed Net Income
Any net income not distributed under the provisions of this Article shall be added to the trust
principal.
4-6
Article Five
Trust Administration Upon My Death
Section 1. Trustees Discretion to Pay My Debts and Taxes
After my death my Trustee in its sole discretion may pay all or any part of my following
expenses, debts, claims and taxes becoming due or payable by reason of my death:
a. My final medical expenses and all funeral costs;
b. Legally enforceable claims against me or my estate;
c. Reasonable expenses of administration of this trust and my probate
estate, if any;
d. Any allowances mandated by a court of competent jurisdiction to those
dependent upon me;
e- Any estate, inheritance, succession, death or similar taxes payable by
reason of my death; and
f. Any penalties or interest on any of the above claims, debts or taxes
owed by me or my estate.
Section 2. Payment by My Trustee or by My Personal Representative
ivly Trustee in its sole discretion may make distributions authorized under this Article either
directly to the person or entities to whom payment is owed or to the personal representative of
my probate estate. Written statements by my personal representative that such sums aze due and
payable by my estate shall be sufficient evidence of their amount and propriety for the protection
of my Trustee. My Trustee shall be under no duty to see to the application of any such payments
made to my personal representative.
Section 3. Tax Elections
With regard to the payment of any income tax, gift tax, estate tax, inheritance tax or any other
tax required because of my death, my Trustee shall have the right to make any available elections
allowed under the law. My Trustee is authorized to sign and file any tax return required because
of my death.
Section 4. Payment of Death Taxes, Claims and Expenses
a• Payment out of Trust Property
All death taxes, claims and expenses payable under the provisions of this Article
shall be paid by my Trustee out of the trust estate except as specifically provided
for elsewhere in this agreement.
b• Exception for Property Passing Outside of Trust
Notwithstanding any other provision in my trust all death taxes, claims and
expenses incurred by reason of assets passing outside of my trust or probate
estate shall be assessed against those persons receiving such property.
c• No Payment from Survivor's Share
Notwithstanding any other provision in my trust unless all other assets available
to my Trustee have been exhausted, all death taxes, claims and expenses payable
under the provisions of this Article shall not be paid from the Survivor's Trust
as defined in Article Eight or from any property passing to my surviving spouse
that qualifies for the federal estate tax marital deduction.
5-2
Article Six
Specific Distributions of Trust Property
Section 1. No Specific Distributions
My Trustee shall make no specific distributions of trust property to any beneficiaries under this
trust agreement upon my death. All distributions of trust property shall be made in the Articles
that follow.
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Article Seven
Division into Survivor's Trust and Family Trust
Upon my death I do not wish my Trustee to allocate and distribute the remaining trust estate
including any property that becomes distributable or payable to my Trustee at my death into two
separate shares to be identified as the Survivor's Share and the Family Share.
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Article Eight
Survivor's Trust
In accordance with Article Seven, I do not wish my Trustee to create a Survivor's Trust.
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Article Nine
Family Trust
In accordance with Article Seven, I do not wish my Trustee to create a Family Trust.
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Article Ten
Common Pot Trust
After the death of the Trustor my Trustee shall not create a Common Pot Trust. All trust
property that has not been distributed under prior Articles of this trust agreement shall be held,
administered, divided and distributed according to the provisions of the Articles that follow.
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Article Eleven
Division and Distribution of Trust Property
Section 1. Division of Trust Property Into Shares
My Trustee shall divide all trust property not previously distributed into sepazate shares of equal
market value as follows:
a• One Share for Each Living Child
My Trustee shall create one share for each of my then living children.
b• One Share for Each Deceased Child
My Trustee shall create one share for each of my deceased children who has
then living descendants.
Section 2. Distribution of Trust Shares for My Living Children
The trust share of each of my children who survive me shall be held, administered and distributed
as follows:
a• Distribution of Net Income and Principal
My Trustee shall promptly distribute, free of the trust, all accumulated net
income and principal of the trust share to each of my living children who
survive me.
b• Distribution Upon Death of a Child Who Survives Me
If any child who survives me, dies before the complete distribution of his or her
trust shaze, that child's trust share shall terminate and my Trustee shall distribute
the balance of the trust property to such child's then living descendants, per
stirpes.
If such deceased child has no then living descendants, my Trustee shall distribute
the balance of the trust property equally to the other beneficiaries named in this
Article, pro rata.
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Section 3. Distribution of Trust Share for Descendant of Deceased Child
My Trustee shall promptly distribute, free of the trust, alI accumulated net income and principal
of the trust shaze set aside for each of my deceased children to their descendants, per stirpes.
Section 4. Distributions to Underage or Disabled Beneficiaries
Notwithstanding any other provision in this trust agreement, if any person otherwise entitled to
receive a distribution of trust property is under 25 years of age or is mentally disabled or legally
incompetent as defined in Article Twelve, my Trustee shall retain and administer that person's
trust property for his or her benefit as follows:
a• My Trustee's Discretion
My Trustee may pay to or apply for the benefit of such beneficiary so much of
the net income and principal of the trust as my Trustee, in its discretion, deems
proper considering all other sources of income and resources available to such
beneficiary and known to my Trustee.
b• Payments Made to Beneficiary or Personal Representative
My Trustee is authorized to make payments under this Section either directly to
the beneficiary, to the beneficiary's personal representative or to any other
person my Trustee may deem proper to be used for the benefit of the
beneficiary.
c• Trustee's Decisions are Final
All decisions by my Trustee as to those it makes payment to, the purposes for
which these payments are made, and the amounts to be paid out of the trust are
within my Trustee's sole and absolute discretion.
d• Undistributed Net Income
All undistributed net income shall be accumulated and added to the principal of
the trust.
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e• Termination and Distribution
My Trustee shall distribute the trust property to a beneficiary under this Section
as follows: one-half when such beneficiary reaches age 21 and the balance when
such beneficiary reaches age 25, or when he or she is no longer disabled as
determined by a court of competent jurisdiction, or upon certification by two
licensed physicians that such beneficiary is able to properly care for his or her
property and person, or at a later date if other trust provisions in this Article
direct.
f. Death of Disabled or Underage Beneficiary
Upon the death of a beneficiazy under this Section, my Trustee shall distribute
all of such beneficiary's remaining trust share, including the trust principal and
accrued and undistributed income, to any person or entity, and upon any trust,
terms, and conditions, or to or in favor of the estate of such deceased
beneficiary, as he or she may direct by his or her last will or living trust
agreement. No exercise of this general power of appointment shall be effective
unless it refers to this trust agreement and expressly indicates an intention to
exercise this general power of appointment.
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Article Twelve
Distribution if No Designated Beneficiaries
NONE
12-1
Article Thirteen
Trustee Administration
Section 1. Co-Trustees to Act by Majority Vote
At any time that there are two or more Trustees serving under this agreement they shall act by
majority vote and any exercise of a power or discretion by a majority of the Trustees shall have
the same effect as an exercise by all of them.
If the Trustees are not able to reach agreement on any decision as set forth in this Section they
shall petition a court of competent jurisdiction for instructions and shall take no action on the
disputed matter until a court order deciding the issue has been rendered.
Section 2. Power to Delegate
Notwithstanding any other provision of this agreement, any one or more of the Co-Trustees
serving under this agreement may from time to time delegate to another Co-Trustee or Co-
Trustees routine acts of trust administration.
Section 3. No Bond Required
No Trustee under this agreement shall be required to post any bond for the faithful performance
of its responsibilities.
Section 4. Trustee Compensation
My Trustee shall be entitled to reasonable compensation for services rendered payable without
the need for a court order. In calculating the amount of compensation customary chazges for
similar services in the same geographic azea for the same time period shall be used as guidelines.
My Trustee shall also be entitled to reimbursement for reasonable costs and expenses incurred
during the e:ercise of its duties under this agreement.
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Section 5. Change in Corporate Trustee
Any corporate successor to the trust business of any corporate Trustee named under this
agreement or acting hereunder shall succeed to the capacity of its predecessor without re-
conveyance or transfer of trust property.
Section 6. Power to Divide or Combine Trusts
My Trustee shall have the power to divide a single trust into separate shares each to be
administered in accordance with the terms and conditions of the single trust from which they
were created when my Trustee in its discretion determines that division is desirable or advisable
in view of tax considerations, including considerations related to the income tax, the gift tax, the
estate tax or the generation-skipping transfer tax or other objectives of the trusts and their
beneficiaries.
My Trustee shall not be required to make a physical segregation or division of the various trust
shares created under this trust agreement except as segregation or division may be required by
reason of the termination and distribution of any of the trusts, but my Trustee shall keep separate
accounts and records for different undivided interests.
My Trustee in its discretion shall have the further power to combine two or more trusts having
substantially the same terms into a single trust for purposes of administration when tax or other
factors indicate that such combination would be desirable or advisable.
In deciding whether to combine trusts, my Trustee should consider the generation-skipping
"inclusion ratio" of the trusts to be combined. Trusts having the same inclusion ratios may be
combined. Trusts having different inclusion ratios should generally not be combined unless their
inclusion ratios are maintained unchanged through substantially separate and independent shares
of different beneficiaries within the meaning of I.R.C. Section 2654(b), and the applicable
regulations thereunder.
Section 7. Termination of Small Trust
My Trustee shall have the power in its discretion to terminate any trust created under this trust
agreement whenever it becomes so small in relation to the costs of administration as to make
continuing administration uneconomical. Upon termination my Trustee shall distribute the
principal and any accrued or undistributed net income to the income beneficiaries in proportion
to their shares of the income. If no fixed amount of income is payable to specific beneficiaries,
my Trustee shall distribute the principal and any accrued or undistributed net income in equal
shares to those beneficiaries who would then be entitled to income payments from the trust.
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Section 8. Limit on Trustee's Discretion
Notwithstanding any language purporting to confer absolute, sole or unrestricted discretion on my
Trustee in exercising any discretionary power with respect to this trust, my Trustee shall at all
times act in accordance with fiduciary principles and shall not act in bad faith or in disregard of
the purposes of my trust.
Section 9. Written Notice to Trustee
Until my Trustee receives written notice of any death or other event which triggers the right to
payments from any trust created under this agreement it shall incur no liability for distributions
made in good faith to persons whose interests may have been affected by such event.
Section 10. Duty to Account
My Trustee shall render accounts to the income beneficiaries under this trust agreement at least
annually, at the termination of a trust created hereunder and upon a change in the Trustees in the
manner required by la~v. `
Section 11. No Court Supervision
No trust created under this agreement shall require the active supervision of any state or federal
court.
13-3
Article Fourteen
Trustee Investment Powers
Section 1. Trustee's Powers
To carry out the purposes of the trusts created under this agreement and subject to any limitations
stated elsewhere in this instrument my Trustee shall have all of the following powers, in addition
to all of the powers now or hereafter conferred on Trustees by law:
a• Retention of Property
My Trustee shall have the power to retain any property received into the trust
at its inception or later added to the trust without regard to whether the trust
investments are diversified as long as my Trustee considers that retention is in
the best interests of the trust or in furtherance of my goals in creating the trust.
b• Additions
My Trustee shall have the power to receive additions to the assets of the various
trusts created under this agreement from anv source.
c• Business Participation
My Trustee shall have the power to terminate, to continue or to participate in the
operation of any business enterprise including a corporation a sole proprietorship
or a general or Iimited partnership and to effect any form of incorporation,
dissolution, liquidation, reorganization including but not limited to
recapitalization and reallocation of classes of shares or other change in the form
of the business enterprise or to lend money or make a capital contribution to any
such business enterprise.
d. Permissible Investments
My Trustee shall have the power to invest and reinvest the assets of the trust as
my Trustee may determine to be in the best interests of the trust without
limitation by any law applicable to investments by fiduciaries. The permitted
investments and reinvestments may include securities such as common or
preferred stock, mortgages, notes, subordinated debentures and warrants of any
corporation and any common trust fund administered by a corporate fiduciary
or other property, real or personal, including savings accounts and deposits and
interests in mutual or money market funds or investment trusts, annuities and
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~.
insurance whether or not such investments are unsecured or of a wasting nature.
e• Dealing with Property
My Trustee shall have the power to acquire, grant or dispose of property,
including puts, calls and options (including options on stock owned by the
estate), for cash or on credit including maintaining margin accounts with brokers
at public or private sale upon such terms and conditions as the fiduciary may
deem advisable and to manage, develop, improve, exchange, partition, change
the character of, abandon property or any interest therein or otherwise deal with
property.
f. Borrowing Authority
My Trustee shall have the power to borrow funds from any person including my
Trustee guarantee indebtedness or indemnify others in the name of the trust and
to secure any such obligation by mortgage, pledge, security interest or other
encumbrance and to renew, extend or modify any such obligation for a term
within or extending beyond the administration of the term of the trust. No
lender shall be bound to see to or be liable for the application of the proceeds
of any obligation and my Trustee shall not be personally liable for any
obligation.
g• Leasing Authority
My Trustee shall have the power to make, renew or amend for any purpose a
lease as lessor or lessee for a term within or beyond the term of the trust with
or without option to purchase.
h• Natural Resources
My Trustee shall have the power to enter into any arrangement or agreement
including a lease, pooling or unitization agreement, for exploration, development,
operation, conservation and removal of minerals or other natural resources.
I• Voting Rights
My Trustee shall have the power to vote a security in person or by general or
limited proxy, to participate in or consent to any voting trust, reorganization,
dissolution, liquidation or other action affecting any securities and to deposit
securities with and transfer title to a protective or other committee.
J• Title to Assets
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My Trustee shall have the power to hold securities and other property in
negotiable form or in the name of a nominee (including "street name" of a
broker) or by deposit to a clearing corporation with or without disclosure of the
Trustee relationship, but my Trustee shall be responsible for the acts of any
nominee or clearing corporation in connection with the property.
k• Insurance
My Trustee shall have the power to insure the assets of the trust against any risk
and my Trustee against liability with respect to third persons.
~• Settlement of Disputes
My Trustee shall have the power to pay or contest any debt or claim and to
compromise, release and adjust any debt or claim and to submit any matter to
arbitration.
m• Payment of Expenses
My Trustee shall have the power to pay any taxes, assessments, reasonable
compensation of my Trustee and other expenses incurred in the collection,
management, care, protection and conservation of the trust property.
n• Principal and Income
My Trustee shall have the power to allocate items of income or expenditure to
either income or principal and to create reserves out of the income all as
provided by law and to the extent not so provided to allocate or create reserves
as my Trustee in its discretion deems appropriate and my Trustee's decision
made in good faith with respect thereto shall be binding and conclusive on all
persons.
o• Division of Trust
My Trustee shall have the power to make any distribution or payment in kind
or in cash or partly in kind and partly in cash and to cause any share to be
composed of cash, property or undivided interests in property different in kind
from any other share either pro rata or non pro rata without regard to differences
in the tax basis of such property and without the requirement of making any
adjustment of the shares by reason of any action taken pursuant hereto.
Any division, allocation, apportionment or valuation of the property to distribute
the assets to or among any of the trusts or beneficiaries shall be made by my
Trustee and the good faith determination of my Trustee shall be binding and
14-3
conclusive on all parties.
p• Litigation
My Trustee shall have the power to prosecute or defend actions, suits, claims or
proceedings for the protection or benefit of the trust and my Trustee in the
performance of my Trustee's duties.
9• Employment of Agents
My Trustee shall have the power to employ agents including attorneys,
accountants. investment advisors, custodians, appraisers or others to advise or
assist my Trustee and to delegate to them fiduciary powers and to indemnify
them against liability for positions taken in good faith and with reasonable basis.
r• Corporate Fiduciary
If any stock of a corporate Trustee or of any affiliate or successor of a corporate
Trustee shall be included in the assets of the trust, the Trustee shall have full
authorit<~ in the Trustee's sole discretion and notwithstanding any regulation or
rule of la~v to the contrary to retain the stock and any increases resulting from
stock dividends and stock splits and from the exercise of purchase rights and the
purchase of fractional shares needed to round out fractional share holdings that
may arise concerning the stock. The Trustee shall vote the stock either directly
or by proxy except to the extent the Trustee is prohibited by law from voting the
stock in accordance with the written instructions of a majority of the living
beneficiaries then entitled to current distributions of income or their personal
representatives. In the event there are no eligible beneficiaries to give
instructions, the Trustee is authorized to vote the stock in the best interests of
the beneficiaries in view of the purposes for which the trust was created.
s• Investment Transactions
With regard to record keeping for investment transactions, my Trustee need not
provide copies of confirmations or similar notifications each time a trade or
investment transaction occurs, but investment transactions shall be set forth in
my Trustee's periodic accounting. ,
t• Repairs and Improvements
My Trustee shall have the power to make ordinary or extraordinary repairs or
alterations in buildings or other structures, to demolish any improvements, to
raze existing or erect new party walls or buildings.
14-4
u• Business Personnel
My Trustee shall have the power to elect or employ directors, officers,
employees, partners or agents of any business and to compensate such persons
whether or not any such person is a Trustee, director, officer, partner or agent
of a Trustee or a beneficiary of the trust.
v Farm or Ranch Property
With respect to farm or ranch property, my Trustee shall have the power to
participate in and operate any farming (including tree farming) or ranch
operation personally or with hired labor, tenants or sharecroppers to lease any
farm for cash or a share of crops under a lease which permits or precludes the
material participation of my Trustee, to fertilize and improve the soil, to employ
conservation practices, and to participate in government programs and to perform
any other acts deemed necessary or desirable to operate the property. In making
a decision whether to materially participate in farming or ranch operations, my
Trustee shall consider whether an election should be made or has been made
under IRC § 2032A to qualify for special farm-use valuation.
~~• AncilIary Trustees
If for any reason my Trustee deems it advantageous to act through an ancillary
Trustee, my Trustee may designate an ancillary personal representative or
Trustee qualified to serve in the jurisdiction where such ancillary Trustee is to
act and may delegate to such ancillary Trustee such of the powers granted under
this agreement as my Trustee deems advisable without being chargeable with
loss if any arising out of such designation or delegation. My Trustee may
specify whether any corporate Trustee or any person or persons acting in an
ancillary capacity hereunder shall serve with or without bond. Except as may
be otherwise specifically provided, no ancillary Trustee need comply with the
provisions of any Uniform Trustee's Accounting Act, the Uniform Trust Act or
similar acts in force in any state where the Trustee may be acting.
x• Retention of Closely Held Interest
My Trustee shall have the power to retain any real estate interests, closely held
securities or affiliated companies or business interests and to sell or dispose of
such interests only after careful consideration and after determining that sale or
disposition is in the existing circumstances in the best interests of the trust or its
beneficiaries.
Y• Exercise of Authority
14-5
Except as otherwise provided in this agreement, my Trustee shall have the power
to do all acts that might legally be done by an individual in absolute ownership
and control of property.
Z• Powers of an Interested Trustee
Any Trustee who has an interest as a beneficiary in this trust agreement or any
trust created by it shall be an interested Trustee. In all instances where an
interested Trustee distributes or participates in the distribution of trust income
or principal to or for the benefit of such Trustee which is limited by any
standard other than the standazds of education, health, maintenance and support,
the distribution shall be limited by the ascertainable standards of education,
health, maintenance and support. "
No individual Trustee shall exercise or participate in the exercise of any
discretionary power regarding distributions to any person or persons such Trustee
is legally obligated to support as to that support obligation.
Article Fifteen
General Provisions
Section 1. Spendthrift Protection
Neither the principal nor the income of any trust created or contained under this agreement shall
be liable for the debts of a beneficiary nor shall the same be subject to seizure by any creditor
of any beneficiary under any lien or proceeding at law or equity. Except to the extent otherwise
expressly provided in this agreement, no beneficiary shall have authority or power to sell, assign,
transfer, encumber or in any manner to anticipate or dispose of a beneficial interest whether
income or principal. The limitations herein shall not restrict the exercise of any power of
appointment or the right to disclaim by any beneficiary.
Section 2. The Rule Against Perpetuities
Unless sooner terminated or vested in accordance with other provisions of this agreement, all
interests not otherwise vested including but not limited to all trusts and powers of appointment
created hereunder shall terminate twenty-one (21) years after the death of the last survivor of the
group composed of me and my lineal descendants living on the date of my death. At that time
distribution of all principal and all accrued, accumulated and undistributed income shall be made
to the persons then entitled to distributions of income and in the manner and proportions herein
stated or if not stated equally irrespective of their then attained ages.
Section 3. Incompetency and Disability
For all purposes under this agreement a person shall be deemed disabled, incompetent or legally
incapacitated if and so long as a guardian or conservator of his or her person or estate duly
appointed by a court of competent jurisdiction continues to serve, or upon certification by two
licensed physicians that such person is unable properly to Gaze for his or her person or property.
Section 4. Income and Principal Payments
All payments of income or principal shall be made in such of the following ways as my Trustee
determines appropriate:
15-1
Article Fifteen
General Provisions
Section 1. Spendthrift Protection
Neither the principal nor the income of any trust created or contained under this agreement shall
be liable for the debts of a beneficiary nor shall the same be subject to seizure by any creditor
of any beneficiary under any lien or proceeding at law or equity. Except to the extent otherwise
expressly provided in this agreement, no beneficiary shall have authority or power to sell, assign,
transfer, encumber or in any manner to anticipate or dispose of a beneficial interest whether
income or principal. The limitations herein shall not restrict the exercise of any power of
appointment or the right to disclaim by any beneficiary.
Section 2. The Rule Against Perpetuities
Unless sooner terminated or vested in accordance with other provisions of this agreement, all
interests not otherwise vested including but not limited to all trusts and powers of appointment
created hereunder shall terminate twenty-one {21) years after the death of the last survivor of the
group composed of me and my lineal descendants living on the date of my death. At that time
distribution of all principal and all accrued, accumulated and undistributed income shall be made
to the persons then entitled to distributions of income and in the manner and proportions herein
stated or if not stated equally irrespective of their then attained ages.
Section 3. Incompetency and Disability
For all purposes under this agreement a person shall be deemed disabled, incompetent or legally
incapacitated if and so long as a guardian or conservator of his or her person or estate duly
appointed by a court of competent jurisdiction continues to serve, or upon certification by two
licensed physicians that such person is unable properly to care for his or her person or property.
Section 4. Income and Principal Payments
All payments of income or principal shall be made in such of the following ways as my Trustee
determines appropriate:
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a• To each respective beneficiary in person upon his or her personal
receipt;
b• Deposited in any bank to the credit of such beneficiary in any
account carried in his or her name or jointly with another or others;
c• To the parent or legal representative of the beneficiary;
d• To a Custodian under a Uniform Transfers to Minors Act selected by
my Trustee for such period of time under applicable law as our
Trustee determines appropriate;
e• To some neaz relative, friend or institution having primary
responsibility for the care and custody of the beneficiary;
f• By my Trustee using such payment directly for the benefit of such
beneficiary; or
j• To my Trustee of any revocable trust of which the beneficiazy is the
Trustor.
Section ~. Education
For all purposes under this agreement the term "education" shall be given broad interpretation and
may include but not be limited to:
a• High School
Education at public or private elementary or high schools including boarding
schools.
b• College
Undergraduate and graduate study in any and alI fields whatsoever whether of
a professional character in colleges or other institutions of higher learning.
c• Specialized Training
Specialized formal or informal training in music, the stage, the handicrafts, the
arts or vocational or trade schools whether by private instruction or otherwise.
15-2
Section 10. Definition of Death Tazes
The term "death taxes" as used in this agreement shall mean all inheritance, estate, succession and
other similaz taxes that are payable by any person on account of that person's interest in the estate
of the decedent or by reason of the decedent's death including penalties and interest but excluding
the following:
a• Any addition to the federal estate tax for any "excess retirement
accumulation" under Internal Revenue Code Section 4980A.
b• Any additional tax that may be assessed under Internal Revenue Code
Section 2032A.
c. Any federal or state tax imposed on ageneration-skipping transfer as
that term is defined in the federal tax laws unless that generation-
skipping transfer tax is payable directly out of the assets of a trust
created by this instrument.
Section 11. Words Relating to the Internal Revenue Code
As used in this agreement the words "gross estate," "adjusted gross estate," "taxable estate,"
unified credit." "state death tax credit," "maximum marital deduction," "marital deduction,"
"pass" and any other word or words which from the context in which it or they are used refer
to the Internal Revenue Code shall have the same meaning as such words have for the purposes
of applying the Internal Revenue Code to my estate.
For purposes of this agreement my "available generation-skipping transfer exemption" means the
generation-skipping transfer tax exemption provided in section 2631 of the Internal Revenue Code
of 1986 as amended in effect at the time of my death reduced by the aggregate of (1) the amount
if any of my exemption allocated to my lifetime transfers by me or by operation of law, and (2)
the amount, if any, I have specifically allocated to other property of my gross estate for federal
estate tax purposes.
For purposes of this trust agreement if at the time of my death I have made gifts with an
inclusion ratio of greater than zero for which the gift tax return due date has not expired
including extensions and I have not ye't filed a return, it shall be deemed that my generation-
skipping transfer exemption has been allocated to these transfers to the extent necessary and
possible to exempt the transfers from generation-skipping transfer tax.
Reference to Sections of the Internal Revenue Code and to the Internal Revenue Code shall refer
to the Internal Revenue Code amended to the date of my death.
15-4
Section 12. Personal Representative
For purposes of this agreement the term "personal representative" shall mean Trustee, executor,
executrix, administrator, administratrix, conservator, guardian, custodian or any other type of
personal representation.
Section 13. Gender and Number
In this agreement where appropriate except where the context otherwise requires, the singular
includes the plural and words of any gender shall not be limited to that gender.
Section 14. Definition of Per Stirpes
As used in this agreement when a distribution to beneficiaries is "per stirpes" it shall mean that
the distributions are to be divided into as many equal shares as there are then-living children of
such beneficiaries and deceased children of such beneficiaries who left then-living descendants.
Each then-living child of the beneficiary shall receive one share and the share that is allocated
to each deceased child of the beneficiary shall be divided equally among such deceased child's
then-living descendants.
Section 15. Captions
The captions of Articles, Sections and Paragraphs used in this agreement are for convenience of
reference only and shall have no significance in the construction or interpretation of this
agreement.
Section 16. Severability
Should any of the provisions of this agreement be for any reason declared invalid, such invalidity
shall not affect any of the other provisions of this agreement and all invalid provisions shall be
wholly disregarded in interpreting this agreement.
15-5
STATE OF PENNSYLVANIA
COUNTY OF DAUPHIN SS
//,~ )
On this the ~' ~fday of ~~ 1 IT•!~t % ~
. ~ before me, '~~-C~ • S~~
the undersigned officer, personally appeazed ROXIE D. LENT, Trustor, 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 purposes therein contained.
In wi~ess~whereof I hereurt my hand and official seal.
Notary Public .- - ----- .
~' ,':'i'-J SEAL
CG~!~~i -~~';E Plotary Public
=~~ v +'~ ~ . ~. ~ i?uphin County
Title of Officer My COf1niSS~Of~ ~icpires Feb. 20,1995
STATE OF PENNSYLVANIA )
COUNTY OF DAUPH SS
i )
On this the ~ day of - 19 %J ,before me, ~~~ ~'~--
the undersigned officer, personally appeazed JOHN R LENT, and ,Trustees, known to me (or
satisfactorily proven) to be the persons whose names aze subscribed to the within instrument and
acknowledged that they executed the same for the purposes therein contained.
In witnes whereof I hereunto y hand and official seal.
Notary Public
NOTARfAL SEAL
Title of Officer ' E, Notary Public
Gerry Twp.. Dauphin County
My Commiss~an ~;pires Feb. 20,1995
~_
15-7
COO pl`T
FIRST AMENDMENT TO
THE JOHN R. LENT LIVING TRUST
On February 15, 1995, I, JOHN R. LENT signed the JOHN R. LENT
LIVING TRUST, as Trustor, more formally known as
JOHN R. LENT, Trustee, or lus successors in trust, under the JOHN R.
LENT LIVING TRUST dated February 15, 1995, and any amendments
thereto
Pursuant to the right reserved to me under Article Four of the original trust
agreement referred to above which allows me to amend my Living Trust in writing
at any time, I hereby amend that trust agreement in the following respects:
1. Article Three, Section 4 of my original Living Trust Agreement is hereby
revoked and amended as follows:
Section 4. Designated Successor Trustees
Whenever a Trustee is removed, dies, resigns, becomes legally incapacitated or is
otherwise unable or unwilling to serve, that Trustee shall be replaced as follows:
a• The Death or Disability of a Trustee While I am Serving as
Trustee
I may serve as the only Trustee or I may name any number of Trustees to
serve with me. If any of these other Trustees subsequently die, resign,
become legally incapacitated or are otherwise unable or unwilling to serve
as a Trustee, I may or may not fill the vacancy.
b• Disability Trustees of JOHN R LENT
Upon the disability of JOHN R. LENT, if he is then serving as an initial
Trustee he shall be replaced by the following Disability Trustee(s):
ROXIE D. LENT; THEN
ELIZABETH L. ANDERSON; THEN
STEPHANIE L. BRECHBILL; THEN
AMY J. LENT
If, for any reason, the Disability Trustee(s) named above are unable or
unwilling to serve, the following successor Disability Trustee(s) shall
serve until the successor Disability Trustee(s) on the list have been
exhausted. Unless otherwise specified, if Co-Disability Trustees are
serving, the next following named successor Disability Trustee shall serve
only after all of the Co-Disability Trustees cease to act as Trustees.
c• Death Trustees of JOHN R. LENT
Upon the death of JOHN R. LENT, if he is then serving as an initial
Trustee he shall be replaced by the following Death Trustees}:
ROXIE D. LENT; THEN
ELIZABETH L. ANDERSON; THEN
STEPHANIE L. BRECHBILL: THEN
AMY J. LENT
If, for any reason, the Death Trustee(s) named above are unable or
unwilling to serve the following successor Death Trustee(s) shall serve
until the successor Death Trustee(s) on the list have been exhausted.
Unless otherwise specified, if Co-Death Trustees are serving the next
following named successor Death Trustee shall serve only after all of the
Co-Death Trustees cease to act as Trustees.
I confirm and readopt the remaining provisions of my original trust
agreement, reserving to myself the right to amend further that trust agreement and
this amendment thereto.
Dated: , 2001.
C
J R. LENT, Trustor and Trustee
2
COMMONy~rgALTH OF PENNSYLVANIA)
COUNTY OF DAUPHIN )
We, ~_ ~ j.,~. ~ ~T ~r~p~~ and ~ ~
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
trustor sign and execute the instrument as the Fust Amendment to his Revocable
Trust; that the trustor signed willingly and executed it as his free and voluntary act
for the purposes therein expressed; that each subscribing witness in the hearing and
sight of the trustor signed the instrument as a witness; and that to the best of our
knowledge the trustor was at that time eighteen or more years of age, of sound mind
and under no constraint or undue influence.
F`,
~~,- ~,
I, JOHN R. LENT, trustor, 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 the First Amendment to
my Revocable Trust; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
JO .LENT `Y
Subscribed and sworn to and acknowledged before me by 7pI~ R.
LENT, the trustor, and subscribed and sworn to before me by
el~~~ T ~xeQd ,and ~ ~ ~ witnesses, on
2001.
n ~ D ~ ~ ~
Notary Public
Notarial Seal
Susan E. Lederer, Notary Public
Harrisburg, Dauphin County
My Commission Expires May 3, 2004
~ ~~ aIpIIII~V~IINU~ ~~~~ ~ `~
Prepared by/Mail to: 00~3QS , ~~~
Susan E. Lederer, Esquire TAX PARCEL: 38-23-0581-014
5011 Locust Lane
Harrisburg, PA 17109
Deed
This indenture, made the 8th da of
of our Lord two thousand and eleven (2011)y July' in the year
Between
JOHN R. LENT and ROXIE D. LENT,
in-Fact pursuant to a Power of AttorneyedatedAFebruar
6, 2007 and recorded simultaneously herewith in the y
Recorder of Deeds Office of Cumberland County,
Pennsylvania, Grantors
and
JOHN R. LENT and ROXIE D. LENT as tenants in common,
Grantees
Witnesseth , That the Grantors , for and in
consideration of the sum of One and No/100 ($1.00) Dollars,
lawful money of the United States of America, unto them well and
truly paid by the Grantee at or before the sealing and delivery
hereof, the receipt whereof is hereb~• acknowledged, have
granted, bargained and sold, released. and confirmed, and by
these presents do grant, bargain and sell, release and confirm
unto the Grantee, her successors and assigns.
ALL THOSE CERTAIN lot or parcel of ground situate in Silver
Spring Township, Cumberland County, Pennsylvania, more
particularly bounded and described as follows, to wit:
BEGINNING at a point on the line of Old Stone House Road, L.R.
21028, which said point is on the line dividing Lots 13 and 14
on the hereinafter mentioned plan and which said point is 140.00
feet south from Fireside Lane; thence along the line of said Old
Stone House Road, South 04 degrees 16 minutes West, a distance
of 100.00 feet to a point on the dividing line between Lots 14
and 15 on the hereinafter mentioned plan; thence, continuing
along said dividing line, North 85 degrees 44 minutes West, a
distance of 175.00 feet to a point at lands now or late of
Hooke, Lebo and Hooke; thence, continuing along said lands,
North 04 degrees 16 minutes East a distance of 100.00 feet to a
stake on the dividing line of Lots 13 and 14 in the hereinafter
mentioned plan; thence along said dividing line, South 85
degrees 44 minutes East, a distance of 175.00 feet to the point
or place of BEGINNING.
BEING all of Lot No. 14, Section C, of Trindle Acres, as such
plan is recorded in the Office of the Recorder of Deeds in and
for Cumberland County, Pennsylvania, in Deed Book 21 and Page
61. .
BEING THE SAME PREMISES which PERRY R. LAUDIG AND BETTINA K.
LAUDIG, his wife, by their deed dated March 30, 2001, and
recorded in the office of the Recorder of Deeds Office of
Cumberland County, Pennsylvania in Book 242, Page 44, granted
and conveyed unto JOHN R. LENT and ROXIE D. LENT, his wife,
Grantors herein. A Power of Attorney, dated February 6, 2007,
authorizing ROXIE D. LENT to act as Attorney-in-Fact for JOHN R.
LENT is being recorded simultaneously with this instrum~n~ in
the Office of the Recorder of Deeds in and for Cumberland
County, Pennsylvania.
THIS TRANSFER IS EXEMPT FROM REALTY TRANSFER TAX AS A
TRANSFER BETWEEN HUSBAND AND WIFE.
UNDER AND SUBJECT to all restrictions, easements,
covenants, conditions and agreements of record
TOGETHER with all and singular the building, improvements,
ways, streets, alleys, passages, waters, water-courses, rights,
liberties, privileges, hereditaments and appurtenances
whatsoever thereunto belonging, or in any wise appertaining, and
the reversions and remainders, rents, issues and profits
thereof, and all the estate, right, title, interest, property,
claim and demand whatsoever of the said Grantor, in law, equity,
or otherwise howsoever, of, in, and to the same and every part
thereof .
TO HAVE AND TO HOLD the said lot~or
described, with the messua e or teneme piece of ground above
hereditaments and remisesghereb nt thereon erected,
intended so to be pwith the a y granted, or mentioned and
ppurtenances, unto the Grantee, her
successors and assigns, to and for the only proper use and
behoof of the Grantee, her successors and assigns, forever_
AND the Grantors, for themselves, their heirs, personal
representatives and assigns, do covenant, promise and agree, to
and with the Grantee, her successors and assigns, by these
presents, that the Grantors, theirs heirs, personal
representatives and assigns, all and singular the hereditaments
and premises hereby granted or mentioned and intended. so 'to be,
with the appurtenances, unto the Grantee, her successors and
assigns, against them, the Grantors, their heirs, personal
representatives and assigns, and against all and every person
and persons whomsoever lawfully claiming or to claim the same or
any part thereof, by, from or under him, her, them or any of
them, shall and will, Subject as aforesaid, WARRANT and forever
DEFEND.
In witness whereof, the Grantors have her
their hand and seal. Dated the da and eunto set
written. ~' year first above
Sealed and Delivered
~in the Pressence of
`~ 7
~~ r
_ ~' i
~' EAL )
JOHN R. LENT by his
Attorney-in-Fact, ROXIE D. LENT
~;~~ ~~.
(SEAL)
ROXIE D. LENT
Ce~ti~cate of Residence
I hereby certify that the precise residence of the Grantees
herein is as follows:
John R. & Roxie D. Lint
11 Old Stone House Road
Carlisle, PA 17013
Attorney for Grantee
Acknowledgement
COI~IONWEALTH OF PENNSYLVANIA ,
COUNTY OF CUMBERLAND ~ = ss
On this, the ~,,~~' day of v,1
' 2011, before
me, a Notary Public in and for the Commonwealth Pennsylvania,
the undersigned officer, personally appeared ROXIE D. LENT,
Attorney in Fact for JOHN R. LENT, and ROXIE D. LENT, known to
me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument. and acknowledge that she
executed the same for the purposes therein contained.
TN WITNESS WHEREOF, I hereunto set my hand and official
seal.
,,~--~~`"y Nod ary Publ i c
~• t'
1
.:~'
~.
iA
COMMONWE4LTN QF PENNSYLVANIA
NOtarlal Seal
Jacque-lne M. Mindeck, Notary public
rower Pextnn Trop., L~iuphln County
Cammlplon Cx Irec Cat. 15 3Gaa
Member. Penn anlp p On n@3
ROBERT P. ZIEGLER
RECORDER OF DEEDS
CUMBERLAND COUNTY
1 COURTHOUSE SQUARE
CARLISLE, PA 17013
717-240-6370
Instrument Number - 201119944
Recorded On 7/19/2011 At 10:44
06
* Instrument Type -DEED :
AM
Invoice Number - 90147
* Grantor -LENT, JOHN R User ID - ES
* Grantee -LENT, JOHN R
* Customer - LEDERER
* FEES
STATE WRIT TAX $0.50
STATE JCS/ACCESS TO $23.50
JUSTICE
RECORDING FEES - $11.50
RECORDER OF DEEDS
PARCEL CERTIFICATION $10.00
FEES
AFFORDABLE HOUSING $11.50
COUNTY ARCHIVES FEE $2.00
ROD ARCHIVES FEE $3.00
CUMBERLAND VALLEY SCHOOL $0.00
DISTRICT
SILVER SPRING TOWNSHIP $0.00
TOTAL PAID $62.00
* Total Pages - 5
Certification Page
DO NOT DETACH
This page is now part
of this legal document.
I Certify this to be recorded
in Cumberland County PA,
:~~ of cvyee9
o ~ ~~`~-~-/°
RECORDER O D EDS
t7so
* -Information denoted by an asterisk may change during
the verification process and may not be reflected on this page.
NIVIIIIV~Nlllil~
Payable To: DEBRA BASEHORE VVIEST
269 WOODS DRIVE
MECHANICSBURG, PA 17050.2635
Phone: (717)697-1294
MAP NO: 38-23-0581-014
Desc: 11 N OLD STONE HOUSE ROAD
Acres .400 Deed: 00242-00044
IuL0714 IISEIC' !C PB 21 PG 61
IIIIIIIIIIIIVIIIIIIBVIIIVIIIIIBIII~IIIIIIIIIIO Acres)
$1.00 FEE FOR ADDITIONAL RECEIPTS
Tax Payer:
LENT, JOHN R & ROXIE D
11 N OLD STONEHOUSE RD
CARLISLE, PA 17015-9773
Office Houns: MONDAY 9-12; TUESDAY 9-11 AM
ALSO 4120 & 4/27,47PM
CALL FOR HOURS AFTER JUNE 28
PHONE (717) 697-1294
I Value: Land: 46,000 Improvement: 123,100 Tota
Bill No: 3218
BIII Date: 3!1/11
Control No:38004695
COUNTY R/E Discount
.1.90200 $315
20 Face Penalty
COUNTY LIB .
.14300 $23
70 $321.63
$353.79
MUNIC. R/E ,
.80450
$133
32 $24.18 $~,~
TAX AMOUNT DUE . $136.04 $149.64
If Date 0f P
ayment Is On $472.22
3/1/11 thru 4/30/11 $481.85 $530.03
5/1/11 thru 6/30/11 7/1/11 or Later
TAXPAYER'S COPY -KEEP THIS PORTION FOR YOUR RECORDS
DEBRA BASEHORE WIEST
269 WOODS DRIVE
MECHANICSBURG, PA ],7050-2635
TEMP -RETURN SERVICE REQUESTED
ADDR;.S; CH.vNGI S CF.i~ BF_ ^.~1ADE ON BACK OF BIu_~
OFFICIAL COUNTY MUNICIPAL TAX BILL
IIII~~~~~~11~111111~1~,1~~,+,II11~~~11'~'~~f~~~ll~~llllll~,l~l~~~ 87110-21 036
LENT, JOHN R & ROXIE D
~~ 11 N OLD STONEHOUSE RD
CARLISLE, PA 17015-9773
87110.R-21036
Rug 21 12 02:28
P Rmeri.prise Financial 717-566-1073
p.4
RiverSource L'~fe Insurance Company
Ameriprise Financial Company
70100 AmeHprise Financial Center
Minneapolis, MN 55474
August 18, 2012
ALAN RTCHARD MALKOFF
STE A
15 N ROSANNA ST
HUMMELSTOWN, PA 17036-1520
Dear ALAN RICHARD MALKOFF:
Thank you for your recent inc{uiry regarding JOHN RLENTs accounts, These are the values of the
accounts as of 1 2/1 3120 1 1.
Account Information
Annuities -Post 1985
Account Number Owt~ership
93007512223 2 004 Individual
Life Insurance
Account Number Ownership
90902477910 2 004 Individual
SPS Advantage
Account Number Ownership
00021935606 0 021 Trust
Annuities -Post 1985
Account Number Total Value
93007512223 2 004 $34,231.95
Life Insurance
Account Number
909024?791 Total Value ~ +
0 2 004 $2,000.00 /
SPS Advantage
Account Number Total Value
00021935606 0 021 $118,992.54
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nug zl 12 02:29p Rmeriprise Financial 717-566-1073
p. 10
--- - Personal Financial Services Report Package_
Mr John R Lent MR ALAN R MALKOFF CFP®, John Lent Account # 0930 0751
Ameripxise 11 Oid Stonehause Rd N MBA 2223 2 004
Financial ~ Carlisle, PA 17015 Financial Advisor Period: 0410212006-12/13/2011
Created: D8J21J2012
Comparative Holdings by Investor
John R Lent
Acct Name: RVS Retirement Advisor Advantage Plus Var Ann, JOHN R LENT
Acct No:XXXXXXX2223 004
Asset Name Acct Type; Non-Qualified
Quantity Price(S) Value(S) Quantity Prtca(S) Value(S) °~ Return
AIIBem VPS Intl Val ~~ Date: ~~~~ End Date:12J13J2011
3,113.84 2.11 6,557.89 N/q
NIA
NJA
COL Shrt Dur USG CI3 2,411.40 1.20 2,899.07 NIA
COL VP Div Eq In C13
8,263.16
1.63
13,436.18
NJA NIA N!A
COL VP Global 8d CI3
1,368.98
1.34
1
830
78 N/A N!A
Fid VIP MidCap CI 2
1,283.88
1.99 ,
,
2
558
24 N/A N/A NIA
FT VIP Small Cap Val
1,055
90
2
35 ,
. NJA N!A NJA
VP Conservative C12 . . 2,485.96
N1A
N1A
NJA
NJA NIA 32,256.93 1.06 34,231.95 NJA
Account Total: $29
768
12
,
. $34,231.95 2.13%
IrnrestorTotal: 529
768,12 -~- ~~~-~
, E34,231.95 2.13%
Portfolio Total: ~ $29,768.12 _ -
}
534,231.95 2.13%
Please see the end of this report for important disdosure information.
Ameriprise Finandal Services, Inc. -Page 3 of 6
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Rug 21 12 02:28p Rmeriprise Financial
717-566-1073
Aeot NamrSLatepic f'ortft+tio Sevvfo~ Adrr magc JOHN R LENT A$ 7TEE OF THE JO
ACCL No:YJ(%X7Utxg8Dy D21 HN R LENT LN TR U/A OTp 2-f 5~6F
/ltstt Nafne
Ticker Aect type; Na+rOuaYfiea
CASH CASH EOUM1tALEMS ~ Itbffe Quafftity pript. (t7 Wlue (SJ
JA1.1(,`RG,yN lNCOLtE BUDDER CL A JN
9AX
BALMICED 128.30 1,00 128.30
J.P. WORGM!
N x.'35.75
8-70 37280.38
pp~~
~OLID FD 8JC PRPFX
PERM~PO
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LANCEC
1,755.SC
16.30 81,283.88
aocafM Totar. Sf 18.962.54
The date of death values provided are for estate tax purposes and are not a value to be paid.
Accounts may be subject to mazket fluctuation as governed by each product. Please note that the
values indicated for any Life Insurance product(s) with the insured deceased reflect the gross death
benefit at date of death and not the cash value. Values indicated for Life Insurance Products with
only the owner deceased reflect the cash value as of the date of death. Values for any proprietary
mutual funds include accrued dividends as applicable. Values provided for brokerage products are
manuatly calculated, and should be used as estimates only. The prices used to provide values are
estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides
these values as a service to its clients. Actual values used in preparation of tax returns or for
planning purposes should be verified by your legal and accounting advisors.
We appreciate the opportunity to be of service to you. Please contact us if you have any questions.
sincerely,
Death Settlements Processing Team
70100 Ameriprise Financial Center
Minneapolis, MN 55474
1-800-862-7919, Option 2, ask for Estate Settlements
p. S
PREPAID FL,T~dEF. __ _,_ _ ._ _ . ,.
STATEMENT OF FUNERALRACT ~~~cG~c{,,,~ ~, ~ ~
GOODS AND SERVICES SELECTEDpA ~
Funeral Service Arrangements For: ~PrintNanei ih
{ 1 ~
Our Service:
Arrangement and
Professional Staff Services
Embalming $
:Other Preparation of the Body $
Other $
If you have selected a funeral that may require embalming, such as a
.funeral with viewing, you may have to pay for embalming, you do not
have to pay for embalming you did not approve if you selected az-
rangements such as direct cremation or immediate burial. If'we charge
for embalming, we will explain why as below:
. Use of Facilities/Staff/Equipmentfnr:
Visitation Days @ $
Funeral/Memorial Service /day . $
- Graveside Service $
Transfer of Deceased ( $
Family Car(s) # _` @ $ ~ ~~) ' $
Funeral Coach each :. $
Funeral Sedans/Limousines $
_ Utility/Service Vehicles $
Forwarding/Receiving Remains $
. Other Services/Facilities/Equipment $
(Specify) ~ $
r-
Total Services
Acknowledgement Cards $
Obituary Notices $
Certified Copies of Death Certificates ~ "~ ~a g ~
Flowers $
Clergy Honorarium
OrganistlPianist $ - ''~ ~= --
Vocalist ~
Police Escort $
Grave Opening and Closing $
Estimated Sales Tax
Luncheon
Ot~Sher (Specify): ~^
t f. ; ~... r .. 1-f r
Total Cash Advance Items
$ .:~ ''~
$~ ,,"r"
TOTAL FUNERAL PRICE $ ~~~ ,r ~---~-
_ . IRREVOCABLE ASSIGNMENT- By initialing here .~/'; . ~ ~ , ,~
funding this contract to a trustee as owner. See terms of Assigmm~t and prepaid FuneralAgre me tton reversee insurance policy or annuity
This Statement of Funeral Goods and Services Selected and the above Irrevocable Assignment together with the terms
side shall constitute the entire prepaid funeral contract. on the reverse
FOR HOME SALES ONLY
You, the buyer, may cancel this transaction at any time prior to midnight oa-the third business dayafter the date of this transaction. See the '
"Notice of Cancellation" form for an explanation of this right. AG.I2EEMEN~i``IND'ICCEPTANCE BY:
included
AGREEMENT AND ASSIGNMENT BY: .%~ ~ +
_ ~.-.y" .- - "-ti - , ~..:'~.~`-ice.. -' ~ ~{ .
• :.-r.. „ ,,t lam, ,jC _r ~'~~ (Funeral Provt~er s Authorized Representative)
Signature of Pr6posed Insured)Anauttant or purchaser, ~ ~
D te)
if other than Proposed Insured/Annuitant (Soctal Secunty Number) t-f~~r~ t , ~. ~ 7 ; ~-~" 1, ~ ( a
_ /~ , ~., l~ ~ (Funeral Provtder'sName) z.cs-l pit !I" }
(Address) ~ 1 `=' 1~+'>~t !` t._t-" (~ -~ 7/ ~~~ Q~E~ ,,,. ~ r~1. Y f ~~.
(Phone) ~ / ,i ~~,t f }~ ,`._.i ~ r_4c _, ! ~ I, /.-
t .,, ( €-~~~ ~ _ (Funeral Provider s Address) ~ ~ ~,:;
~ ~ ~ (Phone)
(City/State, Zip) ~' '~~ t`~ ~.
(Date) ( ,`, ~ ~;%`~.. f _ ^ ,~ ~
. ~? - '
r' (City/State) r ! ~' r`
~ (Zip)
(Contract Beneficiary's Name) ~ fL. ~~` !t'/ '
(Social Security Number) (Contract Beneficiary's Address)
DME--11/2004PA Item #6014 ~,,,,. ~...__ . _ _ (Phone)
Disposition ^ Burial
Casket O None
Manufacturer
Model # and Name
Exterior Material & Color _
Interior Material & Color
Outer Burial Container
Manufacturer
Model # and Name
Material `
Other Merchandise (specify)
Register Book
Service Folders
Required Purchases
Chazges aze only for those items that you selected or that are re-
quired. If we are required by law or by a cemetery or crematory to
use any items, we will explain the reasons in writing below. Any
legal, cemetery or crematory requirement that we represented to you
as compelling the purchase of any goods and services called for by
this Agreement is identified and described below:
Total Cost of Selected Items $
This Cost is: ^ Guaranteed ^
Not Guaranteed
Non-Guaranteed Cash Advance Items
-'-°"°'~~ cVPY1:SELLER
- COPY 2: Pi1R['I
----~ r= ~, ~~ ~:
_ 4 rL?~TERAL ~ OIv1~. ~ ~RE~~i1~4TJ~.~`. ~ i~ C
~~ I ; i'~G~th t-iCi 0•!8. ji(c^^~?
Cc~rlisl°, °erlnSylvor is i 7 0?
7.243.~c
toll free 1.866.451.46;
fc~x ? 17.2x3.3,'• ~.'.:
'•v;rAN.il:;ttm^hrGtt1.CG!"i i
infaa:hofbrrr~cih.co~ ~;
Mrs. Roxie D. Lent ,~anuary 5, 2012
11 North Old Stonehouse Road
Carlisle. PA 17015
Statement of Funeral Expenses for: John Robert Lent
Date of Death: December 13, 2011
Account id: 1 641 1-269
PACKAGE:
Immediate Cremation, Memorial Service at Another Facility
OPTION 4 -Cremation $ 2,190.00
Sub Total: $ 2,190.00
TOTAL FUNERAL H
OME CHARGES:
CASH ADVANCES: $ 2,190.00
8 Certified Death Certificates at $ 6
00 each
.
Newspaper Notice -Sentinel $ 48.00
Newspaper Notice -Patriot - $ 204.10
Clergy- 2 @ 100.00 $ 329.32
Flowers $ 200.00
Trees $ 63.60
Coroner's Fee $ 106.30
Organist ~ 25.00
$ 100.00
Sub Total: $ 1,076.32
Total Funeral Expense: $ 3,266.32
Payments Made:
Total Payments Made:
$
3,266.32
FDLIC
Roxie Lent
Check 179461
Check 6102
----------------------------------
Please return this portion with your Remittance.
$ Amount Enclosed
John Robert Lent
Service ID#: 16411-269
~~
Dec 30, 2011 2,921.00
Jan 5, 2012 345.32
Balance: $ 0 00
SEP,VING OUR COMMUNITY SINCE 1 9Oi