HomeMy WebLinkAbout10-22-1215D561D143
REV-1500 ~``°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes oEVUerYENT OF REVENUE
Po Box.2sosoi INHERITANCE TAX RETURN 21 12 0455
Harrisburg, PA 17128-OS01 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03 02 2012 06 09 1920
Decedent's Last Name
ELDRIDGE
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix Decedent's First Name MI
MARY J
Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
X^ 1. Original Return ^ 2. Supplemental Return ^ g. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a Future Interest Compromise
(date of death after 12-~ z-82)
^
5. Federal Estate Tax Return Required
6 Decedent Died Testate
(Attach Copy of will)
^ ppe~~de t tvlain ned a Livin Trust
T~ (AtlachGopy ot~rust) 9
8. Total Number of Safe Deposit Boxes
^ g, Litigation Proceeds Received ^ 10. b~tweeri?21~it~J1 ne dit,~dat8espf death ^ 11 Election to tax under Sec. 9113(A)
/ (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
LINDA J OLSEN ESQ 717 540 4332
~~
First line of address
2000 LINGLESTOWN RD
Second line of address
SUITE 202
City or Post Office
HARRISBURG
Correspondent's a-mail address:
State ZIP Code
PA 17110
REGISTER ~IQ~LLS USE'~1VLY
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on ail information of which preparer has any knowledge.
SIGNATURE OF PER/SON RESPONSIBLE FOR FILING RETURN DATE
~G~(~Gr!/I ~~ ~.r~a Robert E- Yauna /lP /~~'f 2 n /~
ADDRESS
15D5610143 15D561D143 J
2000 Linglestown Rd. ,Harrisburg, PA 17110
Side 1
150561D243
REV-1500 EX
oecedenrsName: Eldridge, M1ryJ.
Decedent's Social Security Number
RECAPITULATION
1. Real Estate (Schedule A) ....................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 42 , 2 03.3 9
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 53 , 285.32
7. Inter-Vivos Transfers & Miscellaneous t~oq Probate Property
(Schedule G)
Se
arat
Billi
R
t
d
u
p
e
ng
eques
............
e 7. 72 , 930.00
8. Total Gross Assets (total Lines 1-7) ..................................................................... g. 168 , 418.71
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 3 , 813.51
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 6 , 0 97.62
11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 9 , 911.13
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 158 , 507 .58
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, 158 , $Q 7.58
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 .00 15.
16. Amount of Line 14 taxable
].,r 8 5 ~'~ , 5 8
at lineal rate X .045 r 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0.00 18.
19. Tax Due ................................................................................................................. . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
150561D243 15D561D243
0.00
7,132.84
0.00
0.00
7,132.84
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-12-0455
DECEDENT'S NAME
Eldridge, Mary J.
STREET ADDRESS
815 Crooked Stick Dr.
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
6,000.00
315.79
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.
Make Check Payable to: REGISTER OF WILLS, AGENT.
(1)
7,132.84
6,315.79
817.05
Total Credits (A + B) (2)
(3)
(4)
(5)
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred :.................................................. ^
............................
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
contains a beneficiary designation? ........................................................... ^
. ......................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)j.
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)J. 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-1508 EX+ (8-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Eldridge, Mary J. 21-12-0455
Include the proceeds of IiGgation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1 Refund - Brasstown Manor 2,940.00
2 Refund -Genworth premium 43.34
3 Refund -IRS 2010 personal income tax 190.94
4 Refund -IRS 2011 personal income tax 581.00
5 Refund -Pharmacy/returned medication 6.36
6 Reimbursement -Genworth -Feb. medical expense 1,984.00
7 MidPenn Bank CD #312-000298 12,488.63
8 Navy Mutual Aid - (life insurance death benefit decedent received from death of spouse,
9/15/1986) 23,000.00
9 USAA Federal Savings Bank - Cking.Act. #01011-3059-7 969.12
TOTAL (Also enter on Line 5, Recapitulation) 42,203 39
(H more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev1509 EX+ (6.98)
COMMONW EALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Eldridge, Mary J. 21-12-0455
H an asset was made jofM within one year of the decedent's date of death, it nwst ba reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Dorothy J. Payne
B. Robert E. Young
C
2151 Mountain View Rd. Child
Mc Caysville, GA 30555
815 Crooked Stick Dr. Child
Mechanicsburg, PA 17050
JOINTLY OWNED PROPERTY:
ITEM LETTER
FOR JOINT DATE
MADE DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
DATE OF DEATH % OF
' DATE OF DEATH
VALUE OF
NUMBER
TENANT
JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE. VALUE OF ASSE DECD
S
INTEREST DECEDENT'S INTEREST
1 A8~6 08/09/2009 USAA Federal Savings Bank - CD #5888730 96,413.43 33.333% 32,137.49
2 A 8 B 03/21/1994 USAA Federal Savings Bank - Cking.Act. #01 3,053.01 33.333% 1
017
66
-6925-6 (Jt. w! Robert & Dorothy) ,
.
3 A 8~ B 06/14/2005 USAA Federal Savings Bank -SavingsAct. 59,859.94 33.333°/a 19,953.11
#00276-5024-3 (Jt. w/ Robert & Dorothy)
4 A 8 B 04/07/2008 USAA Federal Savings Bank -SavingsAct. 531.19 33.333°/a 177.06
#505-0859-8 (Jt. w/ Robert & Dorothy)
TOTAL (Also enter on Line 6, Recapitulation) I 53,285.32
(If more space is needed, addRional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98)
Rev-1510 E7(+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Eldrid e, Ma J. 21-12-0455
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY
NUMBER
INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1 USAA Federal Savings Bank - Cking.Act. #018-6925-6 48,000.00 12,000.00 36
000
00
- 512,000 gifted to decedent's 4 children on Jan. 2012; ,
.
Jane Payne, Margie Keller, Robert Young and Trust
for Anne Kerr
2 Savings Bonds -13 Series I, -see attached inventory 36,930.00 100.000% 36
930
00
- POD to Robert Young, decedent's son ,
.
TOTAL (Also enter on Line 7, Recapitulation) I 72,930.00
(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+ (~0-06)
SCHEDULE H
coM w~N grFPF~r~.~~vANIA FUNERAL EXPENSES &
1D~"~D~D~"~ ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Eldrid e, Ma J. 21-12-0455
Debts of decedent must be reported on Schedule I.
ITEM
DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
717.38
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Robert E. Young
Street Address 815 Crooked Stick Dr.
city Mechanicsburg state PA zip 17050
Year(sl Commission paid 12.13
2. Attorney's Fees Hazen Elder Law 2,757.50
3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees
273.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
53.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 3,813.51
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
_ Eldridge, Mary J. 21 12 0455
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Cracker Barrel Restaurant -family funeral dinner 185.76
2 Finch-Cochran Funeral Home 321.75
3 Funeral -hymnal for special music 9 87
4 Pastor for funeral
100.00
5 Pianist for funeral
100.00
H-A 717.38
Other Administrative -ost~
6 Hazen Elder Law
14.25
7 Postage 18.75
8 USAA Federal Savings Bank - Cking.Act. #018-6925-6 20.00
H-B7 53.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-7512 EX+(1T-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eldrid e, Ma J. FILE NUMBER
21-12-0455
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbureed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1 Brasstown Manor -assisted living facility 3,255.00
2 IRS - 2010 - payment,penalty and interest on personal tax return 1,057.00
3 IRS - 2012 estimated quarterly tax payment 1,324.00
4 PA personal income tax for 2011 43.00
5 Riverside Pharmacy -scripts provided for Feb. 326.61
6 USAA master card 50.75
7 Windstream -cable 41.26
TOTAL (Also enter on Line 10, Recapitulation) I 6,097 62
(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
~oM;AQ(JW;ALT~{ QrF a ~N~RN ANIA BENEFICIARIES
ESTATE OF
Eldrid e, Ma J. FILE NUMBER
21-12-0455
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 Marguerite Keller Child One-fourth of the
501 Scott Blvd. residue
Unit 101 .
Castle Rock, CO 80104
2 Dorothy J. Payne Child One-fourth of the
2151 Mountain View Rd. residue
Mc Caysville, GA 30555 .
3 Special Supplemental Care Trust f/b/o Anne E. Trust One-fourth of the
Kerr
Robert E. Young, Trustee residue.
Mechanicsburg, PA 17050
4 Robert E. Young Child One-fourth of the
815 Crooked Stick Dr. residue
Mechanicsburg, PA 17050 .
II.
~ ~ Total
Enter dollar amounts for distributions shown above on lines_ 15 through 18 on Rev 1500 cover sheet as appropl
NON TAXABLE DISTRIBUTIONS.
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
~vrn~ pF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
Copynght (c) 2009 form software only The Lackner Group, Inc. Form P/M1500 Schedule J (Rev. 11-08)
LAST WILL AND TESTAMENT Fi~
OF
MARY JO ELDRIDGE
I, MARY JO ELDRIDGE of Dauphin County, Pennsylvania, declare this to be my Last
Will and Testament hereby revoking all prior Wills and Codicils.
ITEM I. I direct that the expenses of my last illness and funeral be paid from my estate as
soon as practicable after my death.
ITEM II. All inheritance, estate, and succession taxes (including interest and penalties
thereon, but not including any generation skipping tax) payable by reason of my death shall be paid
out of and be charged generally against the principal of my residuary estate without reimbursement
from any person. This provision is not a waiver of any right which my Executor has to claim
reimbursement for any such taxes which become payable as the result of any property over which I
have the power of appointment.
ITEM III. I give, devise and bequeath my tangible personal property to my husband,
THOMAS R. ELDRIDGE. In the event THOMAS R. ELDRIDGE predeceases me or fails to
survive me by thirty (30) days, then I give, devise and bequeath my tangible personal property in
accordance with any memorandum which I have handwritten or signed, located with my will or with
my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons
who survive me or to organizations which exist at my death, and if there is a conflict, the
memorandum having the latest date shall govern. To the extent no such memorandum is found, or
1
~°
..~ a~l of my tangible personal property is not disposed of pursuant thereto, my tangible personal
property shall be added to my residuary estate and pass under Item IV hereof.
ITEM N. All the rest, residue and remainder of my estate, of whatsoever nature and
wheresoever situate, I give, devise and bequeath as follows:
A. ONE-FOURTH (1/4) of my estate to my son, ROBERT E. YOUNG, of
Cumberland County, Pennsylvania. In the event ROBERT E. YOUNG predeceases me or fails to
survive me by thirty (30) days, then his shaze shall be distributed to his wife, NANCY R. YOUNG.
If both ROBERT E. YOUNG and his wife predecease me, their shaze shall be distributed in equal
shares to ROBERT E. YOUNG's issues, per stirpes.
B. ONE-FOURTH (1/4) of my estate to my daughter, MARGUERITE KELLER, of
Colorado. In the event MARGUERITE KELLER predeceases me or fails to survive me by thirty
(30) days, then her shaze shall be distributed to her issue, per stirpes;
C. ONE-FOURTH (1/4) of my estate to my daughter, DOROTHY J. PAYNE, of
Hayesville, North Carolina. In the event DOROTHY J. PAYNE predeceases me or fails to survive
me by thirty (30) days, then her shaze shall be distributed to her spouse, JAMES W. PAYNE, per
stirpes; and
D. ONE-FOURTH (1/4) of my estate to beheld in a Special Supplemental Care Trust for
the benefit of my daughter, ANNE E. KERB, of Old Washington, Ohio, to beheld, managed, and
administered according to Item IX herein. In the event ANNE E. KERB predeceases me or fails to
survive my death by thirty (30) days, then her shaze shall be distributed to her spouse, GARY
KERR. If GARY KE1tR fails to survive my death by thirty (30) days, this share of my estate shall
be distributed to ANNE E. KERR's issue, per stirpes.
2
ITEM V. If a beneficiary under this Will has not attained the age of thirty (30) years, the
share of the beneficiary shall be placed in a separate trust, for the benefit of that beneficiary
according to the terms in Article VI.
ITEM VI. In the event that a Trust is created by or as a result of any part of this Will for
beneficiaries under the age of thirty (30), the terms and conditions of the Trust shall be as follows:
A. To expend and apply so much of the net income and so much of the principal of the
Trust as the Trustee shall consider advisable for the support, health, care and education (including
college, trade school, or other similar training or education) of the child until the child attains the age
of thirty (30) years.
B• Upon attaining the age of twenty-two (22), one-third (1/3) of the principal and
accumulated income of the child's share shall be distributed outright to the child.
C. Upon attaining the age oftwenty--five (25), one-half (1 /2) of the remaining principal
and accumulated income of the child's remaining share shall be distributed outright to the child.
D• Upon attaining the age of thirty (30), the remaining principal and accumulated income
of the child's share shall be distributed outright to the child.
E. No beneficiary or remainderman of this Trust shall have any right to alienate,
encumber, or hypothecate his or her interest in the principal or income of the Trust in any manner,
nor shall any interest be subject to claims of his or her creditors or liable to attachment, execution, or
other processes of law.
ITEM VII. In order to carry out the purposes of the Trust for beneficiaries under the age of
thirty (30), outlined in ITEMS V and VI of this Will, the Trustee, in addition to all other powers
3
granted by this Will or bylaw, shall have the following powers over the Trust estate, subject to any
limitations specified elsewhere in this Will:
(a) to retain in the form received and/or to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regazd to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(fl to file fiduciary/income tax returns and pay the tax due for any year for which such a
return is required,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; to pay from my estate reasonable compensation for all their services,
(i) to receive required minimum dishibutions from any individual retirement account of
which the trust beneficiary is the beneficiary; to make elections with regazd to individual retirement
accounts; and to distribute the required minimum distribution to the trust beneficiary(ies). Payments
made hereunder to or for the trust beneficiary's benefit from any qualified plan or individual retirement
account payable to the trust by reason of my death shall equal at least the amount of the mandatory
minimum distributions from such plans or accounts and shallcomplywiththe requu-ements of Revenue
4
Ruling 89-89, I.R.S. 1989-27. No qualified assets shall be used to pay administrative expenses or
taxes of my estate,
(j) to conduct along with or with others, any business in which I am engaged in or have
an interest in at the time of my death, and
(k) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services aze performed.
ITEM VIII. I hereby appoint my son, ROBERT E. YOUNG, as Trustee of the Trust(s)
created in this Will outlined in ITEMS V through VII for any beneficiary(ies) under the age of thirty
(30). If ROBERT E. YOUNG is unable or unwilling to act as Trustee hereunder, I appoint my
daughter, DOROTHY J. PAYNE, as successor Trustee.
ITEM IX. Special Supplemental Care Trust for ANNE E I~RR. a disabled adult. I hereby
nominate and appoint my son ROBERT E. YOUNG, as Trustee of the Special Supplemental Care
Trust under this my Last Will and Testament. If ROBERT E. YOUNG is unable or unwilling to
serve, I appoint my daughter, DOROTHY J. PAYNE, as successor Trustee. If both ROBERT E.
YOUNG and DOROTHY J. PAYNE are unable or unwilling to serve, I appoint The Family Trust, of
Allegheny County, or its successors, as successor Trustee. The shaze of my estate that is set aside
for ANNE E. KERR shall be held by my Trustee, ROBERT E. YOUNG or his successor(s), in
trust for ANNE E, KERR's benefit in a Special Supplemental Care Trust in accordance with the
following provisions:
A. INTENT
It is my intention by this trust to create a purely discretionary supplemental Gaze fund for the
benefit ofANNE E. KERR and not to displace financial assistance that may otherwise be available
s
instructions from a court of competent jurisdiction ruling that the trust corpus is not available to the
beneficiary for such eligibility purposes. Further, my Trustee should cooperate with the beneficiary's
conservator, guardian, or legal representative to seek support and maintenance for the beneficiary
from all available resources, including but not limited to, the Supplemental Social Security Income
Program (SSI); the Medicaid Program; and any additional, similar or successor programs; and from
any pnvate support sources. Any expense of the Trustee, including reasonable attorney fees, shall be
a proper charge to the trust.
F. SPENDTHRIFT PROVISIONS
No interest in the principal or income of this trust shall be anticipated, assigned or
encumbered or shall be subject to any creditor or to any legal process prior to the actual receipt by
the beneficiary. Furthermore, because this trust is to be conserved and maintained for the special
non-support needs of ANNE E. KER.R throughout her life, no part of the corpus hereof, neither
principal nor undistributed income, shall be construed as part of ANNE E. KERR'S estate or be
subject to the claims of voluntary or involuntary creditors for the provision of care and services,
including residential care by any public entity, office, department, or agency of any state or the
United States or any governmental agency. Under no circumstances can the beneficiary compel a
distribution.
G. TRUSTEE AUTHORITY TO TERMINATE TRUST
Notwithstanding anything to the contrary contained in this trust, in the event that the trust has
the effect of rendering ANNE E. KERB ineligible for any program of public benefit, the Trustee is
authorized, but not required, to terminate this trust. In determining whether the existence of the trust
has the effect of rendering ANNE E. KERB ineligible for any program of public benefit, my Trustee
8
is granted full and complete discretion to initiate either administrative or judicial proceedings, or
both, for the purpose of determining eligibility. All costs relating thereto, including reasonable
attorney fees, shall be a proper charge to the trust.
In the event of voluntary termination, the undistributed balance of the trust shall be
distributed to ANNE E. KERR's spouse, GARY KERB. If GARY KERB is not surviving then the
undistributed balance of the trust shall be distributed to ANNE E. KERR's issue, per stirpes.
H. VOLUNTARY CARE
It is my wish that subsequent to the termination of the trust for the benefit of ANNE E.
KERB, if my contingent beneficiaries are living and distribution has been made outright to them, if
ANNE E. KERR is still living because there has been a voluntary termination of the trust in
accordance with the provisions of this article, that such contingent beneficiaries will conserve,
manage and distribute the proceeds of the former trust for the benefit of ANNE E. KERB to insure
that she receives sufficient funds for her basic living and supplemental needs when public assistance
benefits are unavailable or insufficient. This request pertaining to the use and management of the
trust proceeds after the termination of the trust is not mandatory, but is an expression of my wishes
only.
I. BENEFICIARIES OF TRUST RESIDUE UPON DEATH OF DISABLED
BENEFICIARY
Unless sooner terminated, the trust created for ANNE E. KERB shall terminate upon her
death. At that time all remaining trust assets shall be distributed to ANNE E. KERR's spouse,
GARY KERR. If GARY KERB is not surviving, then all remaining trust assets shall be distributed
to ANNE E. KERR's issue, per stirpes.
9
J. TRUSTEE'S POWERS
Subject to the requirement that my Trustee be prudent, my Trustee shall have full power and
authority to manage and control the trust estate and to sell, exchange, lease, rent, assign, transfer and
otherwise dispose of any or part thereof upon such terms and conditions as my Trustee may, in my
Trustee's discretion, deem proper. My Trustee may invest or reinvest all or any part of the trust
estate in such common or preferred stocks, bonds, debentures, mortgages, deeds, deeds of trust, notes
and other securities, investments of property, including common trust funds, which my Trustee, in
my Trustee's absolute discretion, may select or determine. It is my express intention that the Trustee
shall have full power to invest and reinvest the trust funds as I might do if living, without being
restricted to forms of investments which Trustees may be otherwise permitted bylaw to make, and
without any requirements as to diversification of investments. My Trustee may continue to hold in
the form in which received, any securities or any property which I might own at the time of my death
or which my Trustee may at anytime acquire hereunder; and may invest any part of the trust funds in
property located within or outside of the Commonwealth of Pennsylvania.
My Trustee is further authorized to invest in life, annuity, accident, sickness, including
disability, and medical insurance on behalf of and for the benefit of the trust beneficiaries.
My Trustee shall not be obligated to undertake litigation for collection of any benefits or
assets payable by reason of my death including, but not limited to, such benefits under life insurance
policies, employee benefit plans or other contracts, plans or arrangements providing for payment or
transfer at death which are payable to my Trustee unless my Trustee is indemnified to my Trustee's
satisfaction against any liability and the expense of such litigation. Payment to my Trustee and the
io
receipt of or release by my Trustee shall fully discharge any payor, and no payor need inquire into or
take notice of my Will to see to the application of such payment.
My Trustee shall, in addition to the powers granted above, have all powers otherwise granted
under the Pennsylvania Fiduciaries' Powers Act as amended after the date of my Will and after my
death.
My Trustee shall specifically have the powers to invest in non-income producing assets.
K. UNSUPERVISED ADMINISTRATION
The trust created by this Will may be administered by my Trustee free from the control of any
court that may otherwise have jurisdiction over my estate.
ITEM X. Over the years I have loaned money to my children. Documentation of those loans
will be kept with the Will. These loans are not to be forgiven in the event of my death. If there is a
discrepancy between my records and my child's records regarding payments made by him or her on
any loan, my records shall prevail unless adequate proof of such payment is provided to my
Executor.
ITEM XI. I nominate and appoint my son, ROBERT E. YOUNG, as Executor of my Will.
If ROBERT E. YOUNG is unable or unwilling to act as Executor, I appoint my daughter,
DOROTHY J. PAYNE, as Executrix of my Will. I direct that my Executor or Successor Executrix
be permitted to serve without bond. In addition to those powers granted by law, I grant them power
to sell both real and personal property, at private or public sale, to invest cash without being limited
to statutory investments, to distribute in cash or in kind in like or in unlike shares and to file any
qualified disclaimer I could have filed if living.
11
IN WITNESS WHEREOF, I, MARY JO ELDRIDGE, hereby set my hand to this my Last
Will and Testament, on __~y~ ~ ~ ~~ 2007, at Harrisburg, Pennsylvania.
~ r - ~~
MA J RIDGE
~~
In our presence, the above-named MARY JO ELDRIDGE signed this and declared this to
be her Last Will and now at her request, in her presence, and in the presence of each other, we sign
as witnesses.
Name Address
2000 Linglestown Rd Suite 202 Harrisburg PA 17110
2000 Lin~lestown Rd Suite 202 Harrisburg PA 17110
12
I, MARY JO ELDRIDGE, Testatrix, who signed the foregoing instrument, having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my Will,
and that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
MARY~O ELDRIDGE, the Testatrix,
this / day of_
2007. '
C(
Notary Public
1
J E RIDGE
~~ONWEAI-TFi OF PENNSYLVAN~q
Me~ssa M (Cain, Notary Public
~gtret~arMta Tkrp., Dauphin C~ly
~ G~nxnission E~hies Aul~,11, 2p10
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
and ~~~ z
miGG~...
witnesses, this - / 9~
day of , 2007.
~~
Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Melia M. Kain, Notary PubNc
~ Twp., Dauphin County
Mylon E~q~kee qup.11,2010
13
_.
Calculated Value of Your Pa er Savin s Bond s
P g ~~ Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 03/2012
Total Price Total Vaiue Total Interest YTD Interest
$25,000.00 $36 930 00 $11.930.00 ~r~n nn
Bonds: 1-13 of 13
Serial # Series Denom Issue
Date Next
Accrual Final
Maturity
Issue Price
Interest Interest
Value Note
004030598
004030594 I
I $1000'
$1
000 02/2003.
02/2003 04/2012 02/2033 $1,000.00 $477.20;, Rate
4.68% $1(477.20
---
004030596
I ,
r$1~000r
2/2003 04/2012
-"
04/2012 02/2033
02 $.1,000.00_
0 $477.20 4.68% ,$1(477.205
004030595;
004030594
I
I _
:$1,000
^
02/2003 _
--~
04/2012:
~ /2033
02/2033( $1,000.
0:
$1,000.00 $477.20+
$477.20. 4.68%
4.68% ~1,477.20b
$1(477.20
.
004030593 ~
" I $1000:
$1 000 02/2003
02
/2003 04/2012
~_"~_
0 02/2033'
-~~
~ $1,000.00 ~ .$477 20 * 4.68% ~1r477.20
004030592 -
004030591*
_ I
I
$1 000'
__.~ .o- _
02 _
" ./2003, 4/2012.
04/20.12 ~ 02/2033
02/2033 $1,000.00'
.,
__1,000,00 ~ $477.20
$477 20 4 68%
_.
4 68%: $1 477.20
{
~1
477 20
004030590
_
I
$1,000"r
$1
000
022003
02/2003
04f2012~
0
.02%2033(
$1,000.00,
$477,201
468%r r
r
#1(477.20:
"--+
004030589 ;
------------ --r.
--
I
._ t
~
A_
- ' - "
__r~1~000F 02f2003: 4/2012
" .
04/2012 02/2033
-
02f2033~ _$1,000.00+
1
000.00 $477 ZO'
~
$47720 4 68%
---._.... ,.
4
68% 1 477 20 _
_~. r _ .. _
1477
20
001487639:
' ""'"-"" - " """"" "
001487638? I
~
I ,x$5,000
S 000 ~ O2/2003µ
02/2003 04/2012
04
//2012 ~ _
02/2033( __
,
$5,000.00 1
$2,386 00 : .
.
"---~°..r
4 68 /o X
,.
`-- - __
$7,386.00'
001487637;
I
,$5,000;
02/2003 .
04/2012 _02!20331 _
02/2033' $5,000.00(
$5
000
00 $2,386.00*
2
38 4 "68%
~
8 $7(386 OOw __
_
- ..
- -
Totals for 13 Bonds ~ _
,
.
«
26 000.00 , $ $
,
6 00;
11,930.00 ' 4._6
_%.
° $7x386 00' _
o : --'
536.930.0 ~ ~~ _
Notes
NI :Not Issued
__. _--,-
-t--- ----------
NE :Not eligible for payment
.-
P5 :Includes 3 month interest penalty
. .. .. _ .
MA Matured and not earnin interest
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Mary ,-. Eldridge. Estate
CIO Robert E. Young
81 > Crooked Stick Dr
Mechanicsburg, PA 1705()
Dear Mr. Young:
May ~; ?0I2
28518832.9001
This will acknowledge settlement of the Navy Mutual Aid benefit payable upon. the. death of
Mary J. Eldridge.
A check in payment of the benefit, including interest accrued is enclosed. The. interest accrued
is taxable. Next. January you will receive a .Form 1099 to report the interest. The amount of
interest accrued on the benefit appears on the enclosed check stub, and will be reported on the
Form 1099.
The death: certificate is being returned, we have retained a copy for our records.
The Navy Mutual betielit is now paid in full. Please do not hesitate to contact us if we can
provide you with any additional ini-ormation or assistance.
Specific Account Information:
1 • Date C)pened - 15 September 1986
2. Ownership - ?~'Iary 3 Eldridge
3. Value as of 2 Mar ZOI 2 - 52:3,000.(}(}
=7•• -~.~:c~~~:rt - Ftind~ ~,~cre frc;rt, a lift ins~2rz;t~ce d~:,rztlz Y;e.nefit that. w ere left iin deposit ~l~ia~}:
Mutual ~~~as paying interest quarterly).
5. into interest earned in 20I ? for ':'Mary J Eldridge
Sincerely,
~ ;~! ,~
Anthony P. Classford
Director of Beneficiary Sei-~~ices ~4r: Educatican
Enclosures
1:2sui'i~:~ I fr~yY 1;r~ f!~r~ ~~er~;c,
UIaAA 5/c:l/~.U11. 4:lU:bU YM YAC:rI; ~/UG:.1-- 1'A31--GCZ'VGI'
USAA FEDERAL SAVINGS BANK
May 14, 2012
Hazen Elder Law
2000 Linglestown Road, Ste. 202
Harrisburg, PA 17110
Re: Estate of Mary Jo Eldridge
To Whom It May Concern:
This letter is in response to your request for account information in the name of Mary Jo
Eldridge.
Checking account 50508598 was opened on April 7, 2008 and was registered in the
names of Mary Jo Eldridge, Robert Young, and Dorothy Young, as joint with rights of
survivorship. The account balance on March 2, 2012 was $531.19.
Checking account 1869256 was opened on March 21, 1994 and was registered in the
names of Mary Jo Eldridge, Robert Young, and Dorothy Young, as joint with rights of
survivorship. The account balance on March 2, 2012 was $3,053.01.
Checking account 101130597 was opened on December 14, 2009 and was registered
in the name of Mary Jo Eldridge, with Robert Young as Representative Payee. The
account balance on March 2, 2012 was $969.12.
Savings account 27650243 was opened on June 14, 2005 and was registered in the
names of Mary Jo Eldridge, Robert Young, and Dorothy Young, as joint with rights of
survivorship. The account balance on March 2, 2012 was $59,859.94.
Certificate of Deposit account 5888730 was opened on August 9, 2009 and was
registered in the names of Mary Jo Eldridge, Robert Young, and Dorothy Young, as joint
with rights of survivorship. The account balance on March 2, 2012 was $96,413.43.
USAA Federal Savings Bank USAA Savings Bank
10750 McDermott Freeway 3773 Howard Hu P
San Antonio. TX 78288-0544 8~ kwy Ste 190N
(800) 531-2265 (210) 456000 ~ V~~' NV 89109
FDIC 1NSURID (800) 922-9092
FDIC INSURID
USAA Relocation Services, Inc.
10750 McDermott Freeway
Sao Amonio, TX 78288-0553
(800) 531-7741
~"!'~' x/21/201£ 4.10. ;~Q PM FA(}~ 3/003 Pdx Uarvcr
If you need additional information, please call 1-800-531-1045, ext. 7-3355 Monday
through Friday, 7:30 a.m. to 6:00 p.m., C.S.T.
Sincerely,
71lo~rcca ~ .$a~jGQOss
Monica J. Sampson
Bank Survivor Relations
USAA Federal Savings Bank
MID PENN B/WK
Apri124, 2012
Hazen Elder Law
2000 Linglestown Rd. Ste 202
Harrisburg PA 17110
Re: Estate of Mary Jo Eldridge
Date of Death: 3/2/12
SSN: XXX-XX-8329
Dear Ms. Woodhouse:
In response to your recent letter requesting information on the accounts of Mary Jo Eldridge,
I have accumulated the necessary data below:
Account Name: Mary Jo Eldridge
Account #: 312000298 -Certificate of Deposit
Date Opened: 2/2/2005
Balance DOD: $12,467.03
Balance Accrued Interest DOD: $21.60
Total DOD Balance: $12,488.63
Date Joint Ownership Established: N/A
If you have any questions, please contact me at (717) 896-5381.
Sincerely,
Je ica Kerwin
Deposit Processing Specialist
349 Union Street, Millersburg, PA 17061 1-866-6HAPPEN • 1-877-9HAPPEN • www.midpennbank.com
Member FDIC