HomeMy WebLinkAbout11-09-12 (2)~...~
Social Security Numbe
Decedent's Last Name
FLEISHER
(If Applicable) Enter St
Spouse's Last Name
Spouse's Social
FILL IN APPROPRIATE
OID 'I. Original Return
O 4, Limitetl Estate
OD 6. Decedent Died T
(Attach Copy of l
O 9. Litigation Pmcee~
wrtrtWYVNDENT- THIS
Name
BRYAN S. BREInf
Date of Death MMDDYYYY Date of Birth MMDDYYYY
07/01/2012 09/03/1914
Suffix Decedent's First Name
ARLENE MI
Spouse's Information Below '4
Su~x Spouse's First Name
MI
Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
IVALS
BELOW
O 2. Supplemental Return
O :I. Remainder Return (Dale of Death
O 4a. Future Interest Compromise (tlate of
tl
O prior to 12-13-82)
5
eath after 12-12-82)
Gate . Federal Estate lax Return Required
O)A 7. Decedent Maintained a Living Trust
II)
(Attach Copy of Trust.)
Received O 1 8. Total Number of Safe Deposit Boxes
0. Spousal Poverty Credit (Date of Death
O
Between 12-31-91 and 1-1-95
11. Election to Tax untler S
)
TION MUST BE DOM01 arcn .~ ~ ..,... ec. 9113(q)
(Attach Schedule nt
--~ •~-- ~~~RwrunutNCEAND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephonr?<.NUmber r...
4
77
(717) 520-56
4
('? r:-a _
~~
(REGISTER ~
1 ,~)_9t1SE ONLY Ci j i;-
_~
'
T
..
.
r
_ 1 _i /•: j
~; ~ e C~i
:r)
r,' r.> r~
__
State ZIP Code DATE FILED -~
PA 17033
I BMTC.COM
atUm InCluding accompanying schetlules antl statements, antl 10 the best of my knowledg¢ antl b
hen the p¢rsonal representative is based on all i
li
f
n
e
et,
ormation of which preparer has any knowledge.
D
RN
A
' p 5
ICI( .. /_AT/-
First Line of Address II
BRYN MAWR TRUST( COMPANY
Secontl Line of Address I
1 W. CHOC AVE STE 200
City or Post Office '~
HERSHEY
Correspondent's a-mail
Under panalb- I dt
it is true, Correct antl rnmmie.•
SIGNATl1RE OF PREPARER
1 W. CHOCOLATE AVE STE 200 HERSHEY, Pq 17033
J REPRESFNrnnvv
L Side 1
150561U~,05
~I
RSV 1500 150561Dy05
~ EX(@~a1)(FI)~!
PA Diepartment of Revenue pennsy(vania
Bureau Of Individual Taxes "`" OFFICIAL USE ONLY
PO B x z8o6ot INHERITANCE TqX RETURN County Code Year File Number
Harn bur PA 17t28-o60t RESIDENT DECEDENT n
yr INL ORMATION BELOW :L ~ -" I ~ - I~~ G
GATE
1505610105 J
J 1505610205
REV-1500 EX (FI)
uecedenrs rvem FLEISHE Decedent's Social Securit
R, ARLENE
RECAPITULATION A, y Number
1 ~ Real Estate (Sc hedule q), , . ,
ocks and Bon 1.
ps (Schedule B) ...
3. Closely Held Co rporation, Partnershi
4. Mortgages antl p or Sole-Proprietorship (Schedule C) , . , , 3
., tes Receivable (Schedule D) ..
....
p
5. Cash, Bank De ~
..................... 4.
sits and Miscellaneous Personal Pr
6. Jointly Owned Prr operty (Schedule E). ,
5.
7 Inter-Vivos Transf
S ~
Ps ~ (Schedule F) O Separate Billin 7,580.00
g Requested
Miscellan
(
chedule G) I ....... g,
eous Non-Probate Prope
~.
8. Total Gross As O Separate Billing Requested....... .
7'
se (total Lines 1 through 7)........
960,323.52
9. Funeral Ex
penses ..
~~~~~~"~~~~'~~~~~ 8.
nd Administrative Costs (Schedule H)
967,903.52
10. Gebts of Deced ..
ent, 21,808.17
Mortgage Liabilities and Liens (Schedule I)
i. Tofal Detluctions
(~ .. . . . . . . . ... . 10
otal Lines 9 and 70)........ 9,286.49
~~
12. Net Value of EStat
73. Charitable and G
~ ~~~~~~~~~~~~~~.~"'~~~~ it
31'094'68
m
ov
an election to tax ha rn
72.
enta Bequests/Sec 9173 Trusts for which
not been
made (Schedule J) , . , . 936,$08.$6
14. Net Value Subject t 13
Tax (Line 72 min
TAX CALCULATION - S
15
A us Line 13) , , .
74
E INSTRUCTIONS
.
mount of Line 14 to FOR APPLICABLE RATES
able 936,808,88
at the spousal tax rat
transfers under S
116
ea
(a)(L2)X.0_
16. Amount of Line 14 tax
at lineal rate X .0 ble
15.
_
17. Amount of Line 14 tax
at sibling rate X .12 ble
- 76.
78. Amount of Line 14 taxa le
of collateral rate X 15 77.
936,808.86
79. TAX DUE ..........
~~ 78. 140,521.33
_......
...
....
... _.......... 79.
140,521.33
20. FILL IN 7HE OVAL IF y PU ARE REQUESTING
q REFUND OF AN OVERPgyMENT
it
I O
II
L 1505610201
Side 2
j 1505610205
II
REV-1500 Ex (Fq Page 3
Decedent's Complete Address:
DECEDENT'S NAME
ARLENE A. FLEISHER
MESSIAH VILLAGE
100 MT. ALLEN DRIVp
MECHANICSBURG
Tax Payments and
t. Tax Due (Page 2, Line 19)
2. Credds/Paymenfs
A. Prior Payments _
8. Discount
FII• Number
PA ~~~ 17055
(1) 140,521.33
3. Interest j
Total Credits (A+pl) (2)
4. If Line 2 is greater than Line 1~ Line 3, enter the difference. This is the OVERPAYMENT. 139,999.79
fill in oval on Page 2, Line 2 fo request a refund. (3)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (4)
(5) 521.54
j Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER HE FOLLOWING
t. Did decedent m ke a transfer and: QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
a. retain the u or income of the property transferred .........................................................
b. retain the righ to designate who shall use the property transfened or its income ............................................ ^ No
c. retain a reve ionary interest ....................................... ~~~~~~~~~~~~~~~~~~~~~~~
d. receivetheprmiseforlifeofeitherpayments,benefitsorcare?,,,,,,,.,,~~~~~~~~~~~~~~~~~~~"'~"~"""""""'~"~~~~~~~~~~~~~~~~ ^
Z. If death occurred fter Dec. 12, 1982, did decedent transfer property within one year of death ^ ^
without receiving dequate consideration? .............................................................................................................. ^
3. Did decedent own an "in trust for" orpayable-upon-death bank account or security of his or her death'? ..............
4. Did decedent own n individual retirement account, annuity or other non-probate property, which ^
contains a benefici ry designation? ...........
IF THE ANSWER TO ANY OF THE BOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF~THE RETURN.
is 3 percent [72 P.S. §9116 (a) (i 1) p)),
For dates of death on or after July 1 19 4, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of th
e survivng spouse
For dates of death on or after Jan. i, j 1995, the tax rate imposed on the net value of transfers to or for the usr. of the surviving spouse is
[72 P.S. §9116 (a) (1,1) (ii)]. The statute oes 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 eve if the surviving spouse is the only beneficiary,
For dates of death on or after July i, 20 0; 0 Percent
• The tax rate imposed on the net val a 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 fh child is 0 percent [72 P.S. §9116(a)(1.2)j.
• The tax rate imposed on the net value f transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)].
• underaSection 9p02, as anhndiv dual v~yho has at least one parent necomtmon w'th the decedent' whether by blood or ado do
Percent [72 P.a. §9116(a)(1.3)J. Asibling is defined,
P n.
COMMONWEgIiH OF PENNSYLVANIA
DEPAgTMENT OP REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 ]128-p601
RECEIVED FROM;
ACN
ASSESSMENT
', CONTROL AMOUNT
NUMBER
NO. CD 016524
THE BRYN MAWR ?TRUST COMPANY
1 WEST CHOCOLAfTE AVE
SUITE 200
HERSHEY, PA 170y33
~oIJ
ESTATE INFORMATION
FILE NUMBER:
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
REMARKS
CHECK#15331
SEAL
'~ SSN: 176-32-4947
~~~,
2112-1026
FL ISHER ARLENE A
09 20/2012
09/19/2012
CU BERLAND
07/ 1/2012
REV-1162 EX(11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
TOTAL AMOUNT PAID:
S 133,000.00
I INITIALS: DMB
', RECEIVED BY: GLENDA EARNER STR_ q=GH
REGISTER OF WILLS
', TAXPAYER
REV-~SDB EX+ (~-u)
~ `pennsylvania
DEPARTMENT OF REVENUE
INHERRANCE TAx RETUNN
RESIDENT DECEDENT
FLEISHER, ARLENE A.
SCHEDULE E
CASH, BANK DEPOSITS & MISC.
PERSONAL PROPERTY
Jj^ ~ ` Pennsylvania
DEPARTM
1 ENT OF REVENpE
INHERRANCE iAy RETURN
RESIDENT DECEDENT
[S7A7E Of
FLEISHER. ARl Frig e
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC.NON-PROBATE PROPERTY
FLEISHER, ARLENE A,
2112-1026
PA Inheritance Tax
Schedule G -Item #,1 ARLENE A. FLEISHER REVOCABLE TRUST AGREEMENT DATED 8/17/2000
1 ABM INDUSTRIES INC COM
2 ABBOTT LABORA7C/RIES
3 ALLERGAN INC
4 ALLETE INC '.,
5 AMERICAN FINANC~AI CROUP INC
6 AMSURG CORP '.
7 ANALOG DEVICES '~
8 APACHE CORP '.
S AVNET INC '~
10 BMC SOFTWARE INq
11 BADGER METER INC!
12 BgRD, C R INC '
13 BAXTER INTERNATIONAL INC
DIVIDEND PgyqBLE i /yi2
14 BECTON DICKINSON 8 CO
15 BRADV CORPORATION
16 BRISTOL MYERS Spt~IBB CO
17 OBOE HOLDINGS INCA
18 CACI INTERNATIONA INC
19 CAMDEN NATIONAL C RP
20 CASEY'S GENERALS ORES INC
21 CHURCH 8 DWIGHT C~ INC
22 CLOROX CO
23 COACH INC
DIVIDEND PgyqBLE 7/~ry2
24 CONOCOPHILLIPS ~.
25 CORNING INC
26 CUBIC CORPORATION '
27 DST SYSTEMS INC
28 DARDEN RESTAURANT INC
29 DIAMOND OFFSHORE D~2ILLING INC
30 Epi CORPORATION
91 EMERSON ELECTRIC CChMPANY
32 EpUIFAX INC
33 FAMILY DOLLARS STOR S INC
DIVIDEND PAYABLE 7/13~j12
34 GARDNER DENVER INC ~'.
35 GENERAL DYNAMICS INCj
36 GLOBAL PAYMENTS INC
37 GRACO INC
38 GUESS7INC
39 HELMERICH 8 PgyNE INC i
40 HONEYWELL INTERNA710fJAL INC
41 HORMEL FOODS CORP ~'
42 INTEL CORPORA710N
43 J 8 J SNACK FOODS CORPi
DIVIDEND PgyqBLE 7/OS/1~
44 JOHNSGNB JOHNSON
45 JOHNSON CONTROLS INC '
DIVIDEND PgyqBLE 7/03/12 ~i
46 KIMBERLY CLARK CORP
DIVIDEND PgyggLE 7/03/12 i
47 KOHLS CORP
Shares
000957100 89.0000
002824100 40.000p
018490102 17.000p
0'16522300 33.0000
025932104 80.0000
03232P405 41.0000
032654105 BO.000p
037411105 12.0000
053807103 q1 0000
055921100 33.0000
056525108 200000
067383109 200000
071813109 24,0000
075887109 50.0000
104674106 28.0000
110122106 53.0000
12503M708 70.0000
127190304 40.0000
133034108 5.0000
147528103 41.0000
171340102 42.0000
189054109 14.0000
189754104 37.0000
208250104 40,0000
219350105 120.0000
229669106 16.0000
233326107 20.0000
237194105 20.0000
252710102 20.0000
26884L109 28.0000
291011104 33.0000
294429105 44.0000
307000109 33.0000
365558105
369550108
37940X102
384109104
401617105
423452101
438516106
440452100
458140100
466032109
33.0000
20.0000
30.0000
35.0000
70.0000
50.0000
41.0000
74.0000
130.0000
40.0000
19.6498
64.0600
92.7325
41.9375
39.3025
29.8650
37.3325
87.3025
30.8950
42.6375
37.6075
107.0500
53.0900
74.5150
27.4950
35.8250
27.7525
55.2013
36.5825
58.9500
55.2100
72.0713
58.3425
55.6050
12.8425
47.7981
54.5200
50.4650
59.1400
53.8100
45.8575
46.8088
67.2025
52.4825
65.6000
43.0525
45.4203
29.9350
42.9600
55.1750
30.2900
26.4850
58.8375
478160104 16.0000
478366107 37 0pt)D 67.5638
27.3363
494368103 24.0000
83.2775
500255104 50.0000
45.2713
Taxable
1.748.83
2,562.40
1,576.45
1,383.94
3,744.20
1,224.47
2,986.60
1,047.63
1,266.70
1,407.04
752.15
2,141.00
1,274.16
8.04
3,725.75
769.86
1,898.73
1.942.68
2.208.05
182.91
2,416.95
2,318.82
1,009.00
2,158.67
11.70
2,224.20
1,541.10
764.77
1,090.40
1,009.30
1,182.80
1,506.68
1,513.30
2,059.59
2,217.68
6.93
1,731.92
1,312.00
1,291.58
1,589.71
2,095.45
2,148.00
2,262.18
2,241.46
3,444.35
2,353.50
5.20
1,087.02
1,011.44
6.66
1,998.66
17.76
2,263.56
48 KRAFT FOODS INC CL A
DIVIDEND PAYABLE 7/16/12
49 50075N104 28
0000
LABORATORY CORP Of AMERICA . 38.4250
50 LANCASTER COLONY CORP
51 505408409
20
0000
LANDAUER INC .
513847103 93.1700
DIVIDEND PgyAgLE 7/03/12
5 30.0000
51476K103
16
0000
712375
2 LOWES COS INC ' ' 57.5475
53 MASTERCARD IN 548661107
54 MATTHEWS INTERNATIONAL CORP 330000
57636010q 28.0825
55 MAXIMUS INC 5.0000
577128101
431'4875
56 MCCORMICK & COIINC 230000
577933104 32.4150
57 MCGRAW HILL CO$ INC 90.0000
579780206
512200
58 MERCK & CO INC 33'0000
580645109 60.4050
DIVIDEND PgyggL 7/09/12 18 0000
58933Y105
50
0000
447575
59 MICROCHIP TECHN~LOCV INC . 41.4300
60 MURPHY OIL CORP 5 9 5 01 71 04
41
0000
61 NATIONWIDE FUNC~CL-D '
626717102 32.9025
62 NEXTERA ENERGY I~JC q0 0000
638678621
496825
63 NORDSON CORP 5,140.6750
65339F101 14.1500
64 OCCIDENTAL PETR LEUM CORP 16.0000
655663102
66'0000
68.6978
DIVIDEND PgyggL 7/15/12
65
674599105 30
0000 50.8625
OWENS & MINOR IN . 84.8925
66 PARK ELECTROCHE ICAL CORP 690732102
30
0000
67 PATTERSON COS IN '
700416209 30.5225
68 PAYCHEX INC ! 49.0000
)03395103
25.8325
69 PEPSICO INC ~' 41'0000
704326107 34.5450
70 PFIZER INC 41 0000
713448108
31.3700
71 PHILLIPS 66 42'0000
717081103 70.3150
72 OLOGIC CORP ' 81.0000
718546104
22'8125
73 QUAKER CHEMICAL CARP 20.0000
747277101 33.4290
74 OUALCOMM INC 120.0000
747316107
13.6700
75 RAYMOND JAMES FINbNCIAL INC 400000
747525103 46.0075
76 RENT-q-CENTER INC 40.0000
754730109
55.2882
77 ROYAL DUTCH SHELL I~lt SPONS ADR 51.0000
76009N100 342675
78 SCHEIN HENRY INC ! 24.0000
780259107
33.9475
,
79 SENSIENT TECHNOLOdIES CORP 40.0000
806407102 70.1850
80 SIGMA gLDRICH CORP !; 49.0000
817257100
78.8882
81 J M SMUCKER CO NEW 60.0000
826552101 36.7438
82 SNYDERS-LANCE INC ' 50.0000
832696405
73.5513
83 SOUTHERN COPPER COP 12'0000
83355110q 75.5625
84 STANDEX IN7ERNATIOf~gL CORP 45 0000
84265V705
25.1300
85 STERIS CORP
; 50'0000
854231107 31.4838
.
86 SYN7EL INC 90.0000
959152100
42.0575
DIVIDEND PgyqBLE 7/1/12 60.0000
97162H103 50
0000 31.3275
87 SYSCO CORP '. . 60.3025
88 TJX COS INC 871929107
3]0000
89 7ECHNE CORP
;
872540109 29.5875
90 TELEFLEX INC 30.0000
878377100
42.8425
91 TEMPLETON INSTRUTIO AL FD -FOREIGN 16.0000
879369106 30
0000 74.6625
92 THERMO FISHER SCIENTIFIC INC .
880210505 750 6060 61.0875
DIVIDEND PgyqgLE 7/169999111112
93 883556102
30
0000 17.1800
TIDEWATER INC ' 51.6200
94 TIM HORTON'S INC ''
95 TOUCHSTONE INTER 886423102
250000
46
2545
MEDI{~7E FIXED INCOME FD
96 UNITED NATURAL FOODS hNC 88706M103 33 9000
89155H652 .
52.8350
97 UNITED PARCEL SVCS INC ~. 72'926'5400
911163103 9.1500
98 VALUECLICK INC '' 33.0000
911312106
54.8675
99 WESTWOOD HOLDINGS CRbUP INC 120000
92046N102 78.1075
DIVIDEND PgyqBLE 7/02/19 120.0000
961765104
50
0000
191475
100 WILLIAMS - SONOMA INC ! . 37.3950
101 WOLVERINE WORLD WIDE I~IC 969904101
102 WORLD FUEL SERVICES COP 32.0000
978097103 34.7225
DIVIDEND PgyqgLE 7/06/72
1 50.0000
981475106 qq 0000
38.4050
03 XILINX INC ; 37.8625
983919101 700.0000
33.2950
1,075.90
8.12
1,863.40
2,137.13
920.76
8.80
926.72
2,157.44
745.55
2,048.80
1,993.37
805.64
2,071.50
21.00
1,349.00
1,987.30
72,740.55
1,099.16
3,356.93
2,546.78
16.20
915.68
1,265.79
1,416.35
1,286.17
2,953.23
1,855.91
668.58
1,640.40
1,840.30
2.211.53
1,747.64
814.74
2,807.40
3,865.52
2,204.63
3,677.56
906.75
1,130.85
1,574.19
3,785.18
1,879.65
3,618.15
3.60
1,094.74
1,285.28
1,194.60
1,832.63
12,895.41
1,548.60
3.90
1,156.36
1,743.56
667,277.84
1,810.63
937.29
1,937.70
1,869.75
18.50
1,111.12
1,920.25
7,665.95
1.65
3,329.50
104 GUNGE LIMITED
105 BLACKROCK LIOWIDITY FUNDS TEMPFUND PORTFOLIO 016962105
DNIDEND PAYABLE 09248U619
TOTAL
20.0000 62.5144
27, 346.8400 1.0000 1.250.29
27,346.84
3.95
~~
960,323.52
~I:_v~: x ,:n.l;,,
~ pennsytvania
DEggqTM
ENT (IF q[VENUE
INHEk ITgNCE TAX RETURN
RESIDENT DFCEDEM1'T
FLEISHER, ARLENE A.
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
FILE NUMBE
Decedent's debts must be reported on Schedule I, 2--~-----
A. FUNERAL EXPANSES: DESCRIPTI01
1 MYERS FUNERAL HOME -PROFESSIONAL SERVICES
13,293.52
B. ADMINISTRATIVE COSTS:
i• Personal Representative Commissions:
Name(s) rdf Personal Representative(s)
Street Adrjress _
City
Year(s) Commission Paid: State _ Zip _
Z' Attorney Fees:
3' family Fxemption:~, (If decedent's address is not the same as claimant's, attach explanation
)
.
Claimant
Street Address _ .,. __
city.
Relationship Of Claimant to Decedent State _ Zip
4' Probate Fees; '. - -
5• Accountant fees:
6' Tax Return Preparer Dees:
~ BRYN MAWR TRU T CO -
FIDUCIARY FEES 8/15/12 - 4/15/13 (ESTIMATE)
s 1,500.00
CUMBERLANDLAlryJOURNAI-ADVERTISEMENT FEE 6,700.00
s THE PATRIOT NEW
~S -ADVERTISEMENT FEE 75.00
11
70 MINI-STORAGE - MwNTHLY STORAGE 130
3
FEE
~ ~ CUMBERLAND COUNTY REGIST .
1
ER OF WILLS - PA INH TAX RETURN FILING FEE 94.34
15.00
tf more space is needed, use additional shOTAoL Paper of the 0 mei s ie / Re[apltulation) ~
21,808.17
.LV ,.i.~ _., ii...
`pennsylvania SCHEDULE I
pEPpgTMENT pf gEVENUE
rNnEq~rnncE rar gE-rugN DEBTS OF DECEDENT,
gesioENr oecEOENT MORTGAGE LIABILITIES ~ LIENS
STATE OF
LEISHER, ARLENE
FILE NUMBER
ITEM 2112-1026
Report debts incur, by the decedent prior to death that remained unpaid at the date of death, including unrelmbursed medical expenses.
NUMBER
DESCRIPTION VALUE Ai DATE
1' ALERT PHARMACY INC -BALANCE DUE ON ACCOUNT
OF DEATH
2 MESSIAH VILUAGE -NURSING HOME BALANCE DUE 40.56
3 MINI-S70RAG~ - ggLANCE DUE ON ACCOUNT 9,042.25
4 VERIZON - BALANCE DUE ON ACCOUNT 188.68
5 MESSIAH LIFEI~/gYS -BALANCE DUE ON ACCOUNT 10.80
4.20
I
TOTAL (Also enter on Line 30, Recapitulation) ~
IF more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (O1-70)
~', pennsy!lvania
OEPq RTMENT OP gEVENUE
INHERITANCE Tq% RETURN
RESIDENT DECEDENT
SCHEDULE?
BENEFICIARIES
NqM(= AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 2172-~
1 TAXABLE DISTRI UiIONS [Include outright spousal distributions and transfers under RELATfONSHIp T(1 DECEDENT
Do Not Uat Trustee(s) AMOUN
Sec, 9116 (a) (1.2).] OF
1 SEE ATTACHED LIST OF BENEFICIARIES
ENTER DOLLAR AMOU ~~TS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
NON-TAXABLE DISiRIB ONS
A. SPOUSAL DISiRIB ONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOi TAKEN: IT
1. I
B. CHARRABLE AND GOI~ERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - E TER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
I If more space is needed, use additional sheets of paper Df the same size.
i
FLEISHER, ARLENE A.
2112-1026
PA Inheritance Tax
Schedule J _ Beneficiaries
Dumber Name and address
of Persons Receivin pro a Relationship
t
Amount or Shar
1 HARVEY O. FLEI~
HER o Decedent e
Of Estate
26 CHAMPIONS B
HOUSTON, 7X 77 END CIRCLE
89-
18
NEPHEW
00 187,361.77
2 DgVID C. ELFISH R
2135 KENEBUNK NE
MFR, TX 75703 ~ NEPHEW'
, 187,361.77
3 .STEVEN M. FLEIS ER
'1302 EVERGREEN
LONGVIEW
TX 7 TREET
NEPHEW
, 8 187,361.77
4 k'AREN F. WILKENS~'
3439 KILRUSH DRI`•,~ E
~
ARLINGTON, TX 76Q'
14-3218 NIECE
187,36'1,77
5 SHERYL F. HAMILT0 ~1
2992 FM 1377 i
PRINCE70N, TX 75gd 7 NIECE
187,361.78
936,808 86
LAST WILL AND TESTAMENT
OF
ARLENE A. FLEISHEF.
I. ARLENE A, FLEISHER of the Borough of Camp Hill, Cumberland
County, Pennsylvania, declare this to
hereb be mY Last Will and Testament,
y revoking any will previously made by me.
I I direct the payment of all my just debts and funeral
expenses out of my estate as soon as may be practical after my death.
II - I bequeath my automobile, together with any insurance
thereon, to my brother, Lester W, Fleisher,.
IIL - I bequeath my furniture and household goods to Iny
sister-, Eva P, Fleisher, and my brother, Lester W. Fleisher..
IV - S direct that my dwelling house known as 2102 Parkside
Road, Camp Hi11, Pennsylvania
may be occupied for the rest of their
respective lives by any of my living sisters and brother who choose to
occupy the house, without payment of rent, except that they shall be
responsible for the payment of heat, utilities, taxes and insurance.
v - I devise and bequeath all the rest, residue and remainder
of my estate of whatever nature and
wherever situate unto my sisters,
Eva P, Fleisher and Helen M. Fleisher, and my brother, Lester W.
Fleisher, in equal shares, the .share of a deceased sister or brother to
be paid to the survivor or survivors.
~1 nQe ~
Page 1
. ARNOLD & SLIKE, ATTOANHYS-AT-LAW, 4104 MAAAHT STA88T, OAMP NILL, PA 1]011
VI - Should both of my sisters and my brother be deceased at
the time of my death, then all of my estate of whatever nature and
wherever situate shall be paid to my nieces and :nephews living at the
time of my 'death.
V$I - I appoint my sister, Eva P. Fleisher, Executrix of
this, my La$t Wi11 and Testament. Should my said sister fail to
qualify or pease to act as such,
then 2 appoint my brother, Lester W.
Fleisher, to, act in this ca
pacity. Neither of my personal representa-
tives shall }~e required to post bond in this or any jurisdiction..
IN WITNESS WHEREOF, I have hereunto set m
the °~ ~ , 1 day of Y hand and seal on this,
'~-+ ~-`]'~",'1~:°;v 1985.. I
Arlene A,~. SEAL)
Fleisher
Signed, sealed', published and declared b
therein named,'on this and one (1) otherysheetNofA
her Last Will FLEISHER, Testatrix
her re nd Testament in our presence paper as and for
our namesst an~ in the presence of each otherwho, in her presence, at
as a$testing witnesses. ~ have hereunto subscribed
~'
Na e Cam Hill; PA
Address
~. a
Nane Landisbur pA
Address
ARN Qj,p $[ $LIIC$~ A•R,OANIS'S.AT-I,AW, RI09 MARKBT STREET, CAMP MILL, PA 1]OII
i page 2
COtM40NWEALTH OF PENNSYLVANIA)
COUNTY pF CUMBERLAND), SS.
WE, the undersigned, the testatrix and. the. witnesses
whose names are signed to the foregoing instrument
sworn, do h~'reby declare to the r`respectively,
signed and undersi ned authoritbeing first duly
e ecuted the instrument as her Last.Wi11
that she si Y that the testatrix
her) g ed willingly (or willingly directed anotherTtot~ent and
and th t she executed it as her free will and voluntar
the purposes therein expressed gn for
presence and heari:n r and that each of the witnessesact for
that-to-the est ofg of the testatrix signed the will as witnesses and
eighteen yea s of a their knowledge the 'testatrix was-at
or undue inf uence.ge or older, of souhd mind that time
and under no constraint
l~~n tQl~n n f
/J
VTitnes
I Witnes s ----_
Subscribed, sworn to and acknowled ed
and sub ibed'land Sworn to before me bg before me b
day o f ~y-~~c. 0 198= y both witnesses, tthisea?a '1~~
-----_
~'
/^
~-. ~ ~ ~ ~
Notary .Public
THELMA S. MICAUSLI ;
MY Commlasfon N NOTARY PUBLIC
Cam ~Oire9 July 3, 1988
0 VIII, Pq Cumberland County
ARNOLD & $LiKE, AT}O0.NEY3•AT-I,AW, yleg MARKET 57AEET, CAMP HILL, pA V011
i
REVOCABLE TRUST AGREEMENT
THIS AGREEMENT made this /7 ~K I
2000 by and between ~Y of ~
ARLENE A. FLEISHER of the Borough of Cam j
County, pennsylvania, here' P Hi11 Cumberland
wafter called `senior" and HERSHEY TRUST CO. , of 100
Mansimn Road ~
East, Hershey, Dauphin County, Pennsylvania, hereinafter called ` ~ '
`trustee,' ~
WITN~SSETH:
WHEREAS, settior desires to create a revocable '
trust of certain assets for the Purposes j
hereinafter contained;
N7O W T I
$EREFORE, in consideration of the mutual convenants contained herein, I
senior intends to assign, convey, transfer, set over and deliver to
to have trustee certain assets ofsettlor
atpd to hold the same and any other assets which the trustee may hereafter at any time
hold or ackluire hereunder, all of which assets being hereinafter ri:feaed to collectively as the
trust estate, iN TRUST, nevertheless, for the followin I
terms and Qonditions hereinafter set forth, g uses and purposes and subject to the
I
Ttvsltee shall hold, maintain, invest and reinvest the trust estate for the benefit ofsettlor.
It shall collept the income therefrom
and first pay any expenses of the pest, including tr'ustee's
reasonable e~Cpenses incurred in performance of its duties and reasonable compensation to the
trustee for itsl services. Trustee shall pay such
SAIDIS, Pat't of the income and principal as the trustee, in
S H UFF g~ its discretion, ibelieves is necessary and proper for the support and maintenance ofsettlor, and
MASLAND i
eaasc~s.-?~ may disperse $uch amounts in an Y j
2109 Markn Sfrcet Y one of the following wg s: j
~P wu, rn
A• To that person or co ,
_'tllor*__------_
rporation who is taking care of or has custody j
-----~_
B• Directly to the settlor; ~
C• To any creditor of settlor for his benefit.
Upon the death of settlor, this trust shall continue for the benefit of settlor's sister and
brothek Eva P. Fleisher and Lester W,
Fleisher so long as either of them is living, the setae
Power9 and duties as were the case whi]e settlor was living and as aze set forth in Paragraph I,
hereinbefore stated. Ill addition therefore trustee shall have the discretion to accumulate
income if it is not neces the
sarY for the support of settlor's brother or sister, or to allocate the net
income ~qually among the reatainder beneficiaries hereinafter stated.
D~hen settlor and her brother and sister. are deC~ed, this trust shall terminate and
balance t~ren remainin the
g, including any accumulated and undistributed income, shall be paid to
the following named nieces and ne hews
P ,the share of deceased niece or nephew to be paid to his
or her issue per stirpes.
• A Harvey Fleisher, 26 Champions Bend Circle, :Houston, TX 77069
B• David Fleisher, 513 Carriage Drive, Tyler, TX 75703
C• Steven Fleisher, P.O. Box SI 12, Longview, Tx 78608
', D• Mrs• Karen Wilkins, 3439 Kiirush Drive, Arlington, TX 76014
E• Mrs. Sheryl Hamilton, 2992 FM 1377, Princeton, TX 75407-2128
SAIDIS, No in~erest in income or principal shall be assignable by, or available to anyone having a
SHUFF &
MAC claim against,a beneficiary. before actual payment to the beneficiary,
2109 Market street
~P alll, PA
IV
as, in iu discrem''on, it may consider desirable in order to facilitate the settlement of the estate of
settlor. In exercising such power, trustee ma '~
Y P$Y in whole or is part any of the following items:
the expenses of last illness and burial including post of gravemarker; debts; income taxes; death
taxes on any and all property included in the
gross estate for tax, purposes; and all other items in
conne¢tioa with the settlement of the estate. Any such items may be paid directly by trustee or
the farads for their payment may be transferred b
Y tee W the executor or the administrator of
the said estate, and neither such executor or
administrator nor any beneficiary of such estate shall
be regtt~red to reimbutge trustee for any funds so paid or transferred.
_V
Settlor hereby reserves, exercisable whenever and as often as senior may wish while
settlor is 'diving, the power to withdraw all or
part of the principal, to add to the trust upon
approval hnd acceptance by the trustee
, and to revoke or alter this trust in whole or in part by
writings other than a Wil] delivered to the trustee, but not to increase the responsibilities ofthe
tntstee without its written consent.
VI
Any corporation resulting from any merger, conversion or consolidation to which
Hershey Tt1Mst Co. may be a party or an co
Y rporation otherwise succeeding generally to all or the
greater part pf the assets and business of Hershe T
Y rust Co. shall be the successor to it as trustee
hereunder without the execution nor filing of any paper or any further action on the part of an
Paz'ty hereto qr beneficiary thereunder. Y
SAID SI
SHUFF & i
Nta- viz
:los nwwc saK~ Thts ittMtrument shall be construed and a
cynv x+u, ee dministered in accordance with the laws of the
Conmtonwealt't of Pennsylvania. The v
alidity of the trust hereby created s
accordance witfn the laws of ~ be determined in
the Commonwealth of Penns
ylvarria.
V____III
MY trustee hereinafter named shall have
the following powers and duties, in addition to
those vested in it by law and other provisions of this Will:
including its own stock
A• T~retain rey or all of the assets of this trust, real or
gard to any principle of diversification or ask,
B- To invest in all forms ofproperty, includin
jfimds and mortgage investment funds whether operated by it or others
co investments authorized for Pe g sm~' °O~OII trust
to any principle of diversification oar lv~a fiduciaries, as it de ' ~~0m re~~on
risk. ems Proper, without regazd
C• To sell at public or private sale, to exchan e
pleriod of time, any real or personal property and to give o
ldases, for such n g , or to lease for any
p 'ces and upon suoh terms or conditions prions for sales, exchanges or
as it deems proper.
toi each as it from To allocate receipts and expenses to principal or income or partly
torte to time thinks proper in its sole discretion.
E' TO make Payment to the parents or guazdians of an
indompetent beneficiary.
Y minor or
norarinee or ante • To hold property in my name or in its name, or in the name of a
gistered.
also'ibe such executor.
G• To lend to, or purchase from, my executor even thou
~ trustee may
Trustlee shall receive compensation for the performance of its functions hereunder in
accordance til'ith its standard schedule of fees in effect
fiom time to time during the period over
which its servpces aze performed; provided
SAIDIS, that trustee agrees to calculate its fees based on the
S H UFF g~ combined assets of this trust and identical trusts for Lester Fleisher and Eva Fleisher and to
MASLAND
:ro, chazge the prolportionate part of the Fee to each
carp xw. re ~t• Consideration will be given to a reduction
of trustee's fee$ depending on the type of investments authorized by Settlor.
IN WITNESS WIiERFOF, the parties hereto have set their hands and seals ffie day and
Year ,first above written.
SAIDIS,
SHUFF &
MA°
2109 M+rket Street
~v am, rn
A"ITE$T:
Q, a-~R,~'°'F^~t"~ (SEAL)
Arlene A Fleisher
1•IERSHEY TRUST CO.
BY:
O cer