HomeMy WebLinkAbout12-12-12Ex (01-10)
--~ REV-1500 ~ 1505610143
I~ OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania councy code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 60X.280601 INHERITANCE TAX RETURN 2 1 12 0 3 8 5
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03 17 2012 09 21 1931
Decedent's Last Name Suffix Decedent's First Name MI
ROTZ WAYNE p,
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return
^ 4. Limited Estate
® g. Decedent Died Testate
(Attach Copy of Will)
^ 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
^ 2. Supplemental Return
^ 4a. Future Interest Compromise
(date of death after 12-12-82)
^ ~, Decedent Maintained a Living Trust
(Attach Copy of Trust)
^ 1 p Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 5. Federal Estate Tax Return Required
0
8. Total Number of Safe Deposit Boxes
^ 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
HAMILTON C DAVIS 717 532 5'~3
~ ~ ~
First line of address
20 EAST BURD STREET
Second line of address
SUITE 6
City or Post Office State ZIP Code
SHIPPENSBURG PA 17257
Correspondent's a-mail address: h d a v i s @Z u l l i n g e r-Davis . c o m
REGIS~EI~F WILL~SE Q,~iL~~j
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Under penal ' f 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 truerc recta complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGN URE OF PF~F(SON RESPONSIBLE FO FILING RETURN DATE
ROXANNE M. COOPER 1~-- L
ADORES
7045 LINCOLN WAY EAST, FAYETTEVILLE, PA 17222
SIGNATURE PREPARER OTHER THAN REPRESENTATIVE DATE
C' . ~ Hamilton CDavis ~z lG ~~ 2
20 East Burd Street, Shippensburg, PA 17257
Side 1
L 1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedents Name: R O T Z, W A Y N E A
RECAPITULATION
1. Real Estate Schedule A
( ) ..........................................................................................
1. 4 6, 0 0 0. 0 0
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 De osits 8~ Miscellaneous Personal Pro e
p p rtY (Schedule E) ................
5. 7 , 8 3 3 5 2
6. Jointly Owned Property (Schedule F
^ Separate Billing Requested .............
6. 2 5, 9 6 5. 1 6
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .............
7, 5 , 7 9 3 . 2 3
8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 8 5, 5 9 1. 9 1
9. Funeral Expenses 8~ Administrative Costs (Schedule H) ......................................... 9.
4,538.00
10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ................................ 10.
4,232.47
11. Total Deductions (total Lines 9 8~ 10) ...................................................................... 11. 8 , 7 7 0 . 4 7
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 7 6 , 8 2 1 . 4 4
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. 7 6 , 8 2 1 . 4 4
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
'] 6 , 8 2 1 . 4 4
at lineal rate X .045
16.
17. Amount of Line 14 taxable
at sibling rate X ,12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due ................................................................................................... .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
3,456.96
3,456.96
Side 2
L 1505610243 1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 12 - 0385
D CE ENT' NA
ROTZ, WAYNE A
STREET ADDRESS
129 WALNUT BOTTOM ROAD
CITY
SHIPPENSBURG STATE
PA ZIP
17257
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 3,456.96
2. Credits/Payments
A. Prior Payments
B. Discount _
Total Credits (A + B) (2) 0.00
3. Interest (3) 0.0 0
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5) 3 , 4 5 6.9 6
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:
f
d
t Yes
^ No
:..................................................................................
erre
rans
a. retain the use or income of the property
r its income
rr
d
f
rt
t
h ^ ^x
:....................................
e
o
rans
e
e prope
y
b. retain the right to designate who shall use t
c. retain a reversionary interest; or ............. ...................................................................................................
?
fit
t
b ^
^ 0
..............................................................
s or care
ene
s,
d. receive the promise for life of either paymen
If death occurred after December 12, 1982, did decedent transfer property within one year of death without
2
.
receiving adequate consideration? ....................................................................................................................... ^ 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ 0
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 O F THE RETURN.
For dates of death on or after Jul 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. §916 {a) (1.1) (i)].
For dates of death on or after Januarryy 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) (u)]. 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 refurn 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 ears 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) (~.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 bloodd or adoption.
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF ROTZ, WAYNE A 21 - 12 - 0385
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 wilting seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned 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 decedent's interest if owned as tenant in common.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 407 NORTH MORRIS STREET, SHIPPENSBURG, PA 17257 (SEE ATTACHED 46,000.00
SETTLEMENT SHEET). SOLD TO AN UNRELATED THIRD PARTY AT ARMS LENGTH
PRICE AND TERMS. SEE SCHEDULE I FOR NECESSA~'AND ORDINARY EXPENSES.
TOTAL (Also enter on Line 1, Recapitulation) I 46,000.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF ROTZ, WAYNE A 21 - 12 - 0385
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 MORGAN STANLEY SMITH BARNEY, ACCOUNT NO. 56K3693A-16 904 5,231.61
2 I ELMCROFT REFUND
3 ~ BNY MELLON PENSION PLAN CHECK, ACCOUNT NO. SKF04MAXOPIP2M5
1,104.00
1,497.91
TOTAL (Also enter on Line 5, Recapitulation) I 7,833.52
SCHEDULEF
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ROTZ, WAYNE A FILE NUMBER
21 - 12 - 0385
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
ROXANNE M. COOPER 7045 LINCOLN WAY EAST Daughter
A FAYETTEVILLE, PA 17222
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT Include name o~~ina vial Inotitu~lon a pd bank account numbe
or similar identifying number. Attach deed for jointly-held real
estate. DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1 A 12/07/2011 F&M TRUST CHECKING ACCOUNT NO. 25,965.16 100% 25,965.16
3472752
TOTAL (Also enter on line 6, Recapitulation) 25,965.16
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF ROTZ, WAYNE A
FILE NUMBER
21 - 12 - 0385
THic Q~tip~~~~p m~,ct hp cemnleted and filed if the answer to anv of questions 1 through 4 on page 2 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
Include the name of the 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
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE VALUE
1 AMERICAN NATIONAL INSURANCE COMPANY, x,793.23 5,793.23
ANNUITY NO. 14515190, PAYABLE TO ESTATE -
SEE ATTACHED VALUATION
TOTAL (Also enter on line 7, Recapitulation) 5,793.23
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
5CI-FDUI.F H
FU ww.°~~ppDww ~ENSES++&~~
~I~ I IW „~ ` ~ I ~
FILE NUMBER
ESTATE OF ROTZ, WAYNE A 21 - 12 - 0385
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A• 1 I PRE-PAID
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees HAMILTON C. DAVIS, ESQUIRE
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
0.00
4,000.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 AUSHERMAN BROTHERS REAL ESTATE -APPRAISAL FEE 350.00
TOTAL (Also enter on line 9, Recapitulation) 4,538.00
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ROTZ, WAYNE A
Schedule H
w,~F~~u~ner~alMExper~es &
/~'1~.~ 1 ~ II~AII~/c
2 ~ THE NEWS CHRONICLE -LEGAL ADVERTISING
3 CUMBERLAND COUNTY LEGAL JOURNAL -LEGAL ADVERTISING
FILE NUMBER
21 - 12 - 0385
Page 2 of Schedule H
113.00
75.00
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS
INHERITANCE TAX RETURN 7
RESIDENT DECEDENT
ESTATE OF ROTZ
WAYN E A FILE NUMBER
, 21 - 12 - 0385
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 PENELEC 148.66
2 TIMMONS OIL 124.93
3 BOROUGH OF SHIPPENSBURG 619.05
4 BAUSERMAN'S LAWN SERVICE 840.05
5 CARE FIRST 80.21
6 DICK'S HOME CARE 140.00
7 2012 COUNTY AND TOWNSHIP TAXES 718.02
8 2012 SCHOOL TAXES 1,101.55
9 REALTY TRANSFER TAX 460.00
TOTAL (Also enter on Line 10, Recapitulation) I 4,232.47
REV-1b13 EX+ (11-08)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA GIENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ROTZ, WAYNE A FILE NUMBER
21 - 12 - 0385 _
T RELATIONSHIP TO ( SHARE OF ESTATE F AMOUNT OF ESTATE
NUMBER ~ NAME AND ADDRESS OF PERSON(S) DECEDENT ~ (Words) ~ ($$$)
RECEIVING PROPERTY I ac Not ust Trustss(s) _ _i_ __ _ _ _ _+___ __ ___
- -- - ---- --- _--------- -- -----r-------- ---
'TAXABLE DISTRIBUTIONS [include outright spousal ~ f
I' distributions, and transfers ! !
under Sec. 9116 (a) (1.2)j I 4
1 ROXANNE M. COOPER !Daughter ; 1/2 OF RESIDUE
7045 LINCOLN WAY EAST
FAYETTEVILLE, PA 17222 ~
2 TIMOTHY W. ROTZ
7045 LINCOLN WAY EAST
FAYETTEVILLE, PA 17222
Son
1/2 OF RESIDUE IN
TRUST
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate.
Il. ~ NON-TAXABLE D1STRIBUTIONS:
~A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
36,682.24
36,682.24
TOTAL OF PART fl -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ 0.00
LAST WILL AND TESTAMENT
of
WAYNE A. ROTZ
I, WAYNE A. ROTZ, of the Borough of Shippensburg, Franklin County, Pennsylvania,
declare this to be my Last Will and Testament and revoke any Will or Codicil previously made by
me.
ITEM I: I direct that all my just debts (except as may be barred by a Statute of Limitations)
and my funeral expenses (including my gravemarker and expenses of my last illness) shall be paid
from my residuary estate as soon as practicable after my decease as a part of the administration of
my estate.
ITEM II: I bequeath those articles of my household furniture and furnishings and those
articles of my personal effects and personal property as set forth in a separate memorandum (which
is signed by me, dated and makes specific reference to this Will and memorandum, which I shall
place with my Will or deposit with my attorney), to the persons therein designated.
ITEM III: I devise and bequeath all the residue of my estate of every nature and wherever
situate to my wife, PATRICIA A. ROTZ, providing she shall survive me by thirty (30) days.
ITEM IV: Should my wife, PATRICIA A. ROTZ, predecease me or die on or before the
thirtieth (30~) day following my death, I devise and bequeath all of the Residue of my estate of
every nature and wherever situate, as follows:
A. One-half (1/2) thereof to my daughter, RO~:ANNE M. COOPER. Should my
daughter not be then living, but there be descendants of her who are then living, such
~R
1
descendants shall receive, per stirpes, the share that my daughter would have received.
B. One-half (1/2) thereof shall be distributed to my Trustee hereinafter named, to be
held, IN TRUST, and be administered and distributed for the following uses and purposes
and under the following terms and conditions.
1. During the life of my son, TIMOTHY W. ROTZ, no portion of the
principal of this Trust shall be paid to Tim or expended for his benefit nor distributed
for any other purpose whatsoever except as hereinafter expressly provided.
2. No payments of income shall be made from this Trust until the
Trustee shall have taken into consideration all of my son's (Tim's) available assets
and sources of income including entitlement to benefits and services from any local,
state or federal government or agency (or from any private agency).
3. During the life of my son, Tim, no portion of this Trust either
principal or income, shall be subject to anticipation, pledge, assignment or obligation
of Tim, nor be subject to any reimbursement, execution, attachment, levy or
sequestration or other claims of or interference from the creditors of Tim or of his
estate or of anyone who maybe obligated for his support, including any government
or governmental agency or private agency which has provided benefits or services to
Tim.
4. During the life of my son, Tim, subject to the considerations and
stated in Sub-Paragraph 2 hereof, my Trustee may expend upon Tim, for his health
and medical care, support and maintenance in reasonable comfort, so much of the
income of the Trust as my Trustee shall determine. My Trustee shall have sole and
absolute discretion in determining whether such expenditures for Tim are to be
2
made. It is my desire that the Trustee provide such resources and experiences as will
contribute to and make Tim's life as pleasant, comfortable and happy as is feasible.
My Trustee shall consult regularly with my daughter, Roxanne M. COOPER, to
ascertain Tim's needs and desires and may follow her recommendations in making
payments and expenditures in Tim's behalf. Nothing herein shall preclude the
Trustee from purchasing those services and items which promote Tim's happiness,
welfare and development, including, but not limited to, vacation and recreation trips
away from places of residence, expenses for traveling companions if requested or
necessary, entertainment expenses, supplemental medical and dental expenses,
social services expenses, transportation costs, private room, telephone and television
services, a mechanical bed, an electric wheelchair, personal care services, and the
like. Any income of the Trust not so expended shall be paid in convenient
installments, not less frequently than quarter-annually, in equal shares unto my
hereinafter named remainder beneficiaries as set forth in Sub-Paragraph 8 hereof.
5. During the life of Tim, all payments from this Trust which go to
Tim's direct benefit shall be direct payments to the person or entities supplying
goods or services to at the request of the Trustee.
6. If my residential real estate is an asset of this Trust, the Trustee
may retain it and pay the cost to maintain it for the use of Tim, so long as it maybe
practical for him to reside there. If at anytime during the existence of this Trust, Tim
is no longer able to reside in that residence, and it appears unlikely that he will be
able to return to the residence, then my Trustee, in Trustee's discretion, shall have
/,~/~ _r 3
1%~
the power to sell such residential real estate and add the proceeds the principal of
this Trust.
7. Should the existence of this Trust disqualify Tim, from eligibility
for any substantial governmental or private aid or benefits or services, then this Trust
may, in Trustee's discretion, be terminated and the then remaining principal and any
accumulated and undistributed income be distributed to my remainder beneficiaries
under Sub-Paragraph 8 hereof. It is my intention in creating this Trust to provide for
the comfort and happiness of Tim, without interfering with, reducing or
disqualifying him from aid, benefits or services he would otherwise be entitled to
and to maximize the ultimate distributive shares for my remainder beneficiaries. I
do hereby specially waive, renounce and disclaim any rights which I, my heirs and
assigns, and any other person or entity may otherwise have to seek invasion of the
assets of this Trust pursuant to any statute or rule of law of any jurisdiction.
8. Upon the death of Tim, or upon my death if Tim shall predecease
me, this Trust shall terminate and all principal and any accumulated and
undistributed income shall be distributed, per stirpes, to my then living issue.
9. If any portion of this trust shall become distributable to a
beneficiary who has not attained the age of twenty-one (21) years, the Trustee may,
in Trustee's absolute discretion, either: pay over such Principal and any accrued or
undistributed income therefrom at any time to the guardian(s) of the property of such
beneficiary; or pay over the same to a custodian for such beneficiary under the Pa.
Uniform Transfers for Minors Act, which custodian may be my Executor or Trustee
or be selected by my Executor or Trustee; or, retain the same for such beneficiary,
G~/z, 4
IN SEPARATE TRUST, until he or she attains the age of twenty-one (21) years. In
case of such retention, the Trustee may use or apply so much of the net income and
Principal as it deems necessary or advisable from time to time for support, health
and medical care, and education (including college education, both undergraduate
and graduate) of such beneficiary, or may make payment for these purposes, without
further obligation or responsibility to see to the proper expenditure thereof, directly
to such beneficiary or to such beneficiary's parent or to any person taking care of
such beneficiary. Any Principal or income not so applied shall be distributed to such
beneficiary absolutely when he or she attains the age oftwenty-one (21) years. If he
or she dies before attaining age twenty-one (21), such share shall be distributed to
his or her personal representative, discharged of trust.
ITEM V: If any property passes outright (either under this Will or otherwise) to a minor
(which shall be defined as anyone under twenty-one (21) years of age) and with respect to which I
am authorized to appoint a guardian and have not otherwise specifically done so, I decline to
appoint a guardian but instead authorize my Executor to distribute. such property to a Custodian
selected by my Executor (and my Executor may act as such Custodian) as Custodian for the minor
under the Pennsylvania Uniform Transfers to Minors Act. Provided, however, that this appointment
shall not supersede the right of any fiduciary to distribute a share where possible to the minor or to
another for the minor's benefit.
ITEM VI: All death taxes (and interest and penalties thereon) imposed upon any property
passing under my Will but not otherwise, shall be paid out of my residuary estate. I authorize my
Executor, in my Executor's sole discretion, to make an election, in whole or in part, to cause a
Pennsylvania Inheritance Tax to be payable by my estate on property passing to or for the benefit of
~,,~.
5
my spouse to defer the Pennsylvania Inheritance Tax on such property. My Executor shall be
without liability to anyone for making or failing to make such election.
ITEM VII: I appoint my wife, PATRICIA A. ROTZ, Executrix of this my Last Will.
Should she fail to qualify or cease to act as Executrix, I appoint my daughter, RO~;ANNE M.
COOPER, Executrix of this my Last Will.
ITEM VIII: I appoint my daughter ROXANNE M. COOPER and ORRSTOWN BANK,
Trustees of any trusts created by this my Last Will.
ITEM IX: I direct that my Executrix, Trustees, Custodian or their successors shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
ITEM X: My corporate fiduciary shall be entitled to compensation based upon its regular
schedule of fees for such services in effect from time to time during the period over which its
services are performed.
ITEM XI: My individual fiduciary shall be entitled to reasonable compensation for his or
her services rendered from time to time andlor to reimbursement of out of pocket expenses. I
understand that the total compensation for my corporate and non-corporate fiduciaries may be
greater than what would be payable if multiple fiduciaries were not named.
ITEM XII: I specifically give unto my Attorney, HAMILTON C. DAMS, ESQUIRE, or
should he be unable or unwilling to act, JOEL R. ZULLINGER, ESQUIRE, as the case may be, in
his sole discretion, the right and authority to revoke the appointment of any corporate fiduciary
designated in my Will or in any Codicil thereto, provided that he simultaneously appoint a substitute
corporate fiduciary.
ITEM XIII: Any fiduciary under this Will shall have the following powers in addition to
those vested in them by law and by other provisions of my Will applicable to all property whether
w~. s
principal or income, including property held for minors, exercisable without Court approval, and
effective until actual distribution of all property:
A. General Management and Investment Powers. The Executor and Trustee shall
have full power and authority to manage and control the estate and trust estate, to borrow
money from any source (including the power to borrow from a Trustee or any affiliate of a
Trustee) and to sell, exchange, lease, grant options, rent, mortgage, pledge, assign, transfer
or otherwise dispose of or encumber (including sales to a Trustee) all or any part of the trust
estate (for terms extending beyond the termination of the estate or trust estate or otherwise),
upon such terms and conditions as the Executor or Trustee may see fit. The Executor or
Trustee may invest and reinvest all or any part of the trust estate in such stocks, common
and preferred (including the corporate stock of any corporate Trustee, or any of its
affiliates), debentures, shares or participations in any common or mutual fund, interests in
any general, limited, or limited liability partnership or in any limited liability company,
bonds, notes, repurchase agreements and deposit accounts of any kind from or in any bank
(including any corporate Trustee, or any of its affiliates), savings and loan association or
other financial institution or brokerage firm, stock options and warrants, securities or other
property, real or personal, within or without the State of Pennsylvania, domestic or foreign,
whether or not of the class or kind now or hereafter ordinarily approved or held to be lawful
for the investment of estate or trust funds, as the Executor or Trustee may, in the Executor's
or Trustee's discretion, select. The Trustee may make and change such investments from
time to time according to the Trustee's discretion, and the Trustee may continue to hold any
stocks, securities or other property received by the Trustee hereunder without any duty of
diversification. The Executor or Trustee may determine whether any money or other
7
property coming into the Executor's or Trustee's hands, concerning which there may be
reasonable doubt, shall be considered as a part of the principal or income of the trust estate,
and may apportion between such principal and income any loss or expenditure in connection
with the trust estate as to the Trustee may seem equitable, taking account of all present and
future interests in the trust estate. The Trustee shall not be obligated to amortize premiums
for trust securities out of income nor make additions to income because of the purchase of
securities at a discount. The Trustee may exercise all options and all conversion,
subscription, voting and other rights of whatsoever nature held by or pertaining to any
property, including securities of the corporate Trustee or any affiliate thereof, held by the
trust estate. Any corporate Trustee shall not disclose the name, address, or share position of
the beneficial owner(s) of registered securities held by the corporate Trustee or its nominees
unless the beneficial owner(s) request otherwise in writing. It is the intention of the Testator
that the Trustee shall have the authority to invest in such ways as shall give due
consideration for the theories of total return investing, modern portfolio theory, and the
theory of risk and return. Accordingly, the Trustee is authorized to invest in any type of
investment which plays an appropriate role in achieving the investment goals of the Trust,
which investment shall be considered as part of the total portfolio. It is my specific direction
that no category or type of investment shall be prohibited. I specifically do not wish to limit
the universe of Trust investments in any way other than is dictated by the Trustee's exercise
of reasonable care, skill, and caution. In connection with the Trustee's investment and
management decisions with respect to this Trust, the Trustee is specifically entitled to take
in account general economic conditions, the possible effect of inflation or deflation, the
expected tax consequences of investment decisions or strategies, the role which each
Gds. a
investment or course of action may play within the overall trust portfolio which may include
financial assets, interests in closely held enterprises, tangible and intangible personal
property, and real property; the expected total return from income and the appreciation of
capital; other resources of the beneficiaries; the needs for liquidity; regularity of income and
preservation or appreciation of capital; and the asset's special relationship or special value, if
any, to the purposes . of the Trust or to one or more of the beneficiaries. Nor shall my
Trustee be limited to any one investment strategy or theory, including modern portfolio
theory, the efficient markets theory or otherwise, but shall be free to consider any
appropriate investment strategy or theory under all the circumstances. The Trustee may
delegate investment and management functions which a prudent person of comparable skills
would properly delegate under the circumstances. Should the Trustee delegate such
function, the Trustee shall exercise reasonable care, skill and caution in selecting an agent,
establishing the scope and terms of the delegation consistent with the purposes and terms of
the Trust, and periodically reviewing the agent's actions in order to monitor performance
and compliance with the terms of the delegation. Should such delegation occur as set forth
above, the Trustee who complies with the requirements for delegation shall not be liable to
the beneficiaries or to the Trusts for the decisions and actions of the agent to which the
function was delegated, but by accepting the delegation of a Trust function by the Trustee of
this Trust, the agent submits to the jurisdiction of the courts of this state.
B. To allocate receipts and expenses to principal or income or partly to each as they
from time to time think proper.
C. To compromise any claim or controversy.
D. To distribute in cash or in kind or partly in each.
9
E. To hold property in their names without designation of any fiduciary capacity or
in the name of a nominee or unregistered.
F. If there is no corporate fiduciary acting hereunder, my fiduciary may designate a
corporation (regardless of where organized or headquartered) with fiduciary powers to act as
agent or custodian hereunder, may delegate to it such duties as may be appropriate
(including investment recommendation duties), may pay to it reasonable compensation for
its services, and may discharge it with or without cause.
G. To treat the entire trust estate as a common fund for the purpose of investment,
notwithstanding any provision herein for division thereof into shares or separate trusts.
H. Should the principal of any trust herein provided for be or become so small that,
in the Trustee's discretion, establishment or continuance of trust is inadvisable, my Trustee
or my personal representative may make immediate distribution of the then remaining
principal and any accumulated or undistributed income outright to the person or persons
then entitled to income and in the proportions they are then entitled to such income. If any
such person is then a minor, distribution may be made to that person's guardian, or to a
person selected by the trustee to be custodian for such person until the age of twenty-one
(21) years under the Pennsylvania Uniform Transfers to Minors Act.
I. To continue the operation of any business in which I may be interested or
engaged at the time of my death (regardless of the form or organization of any such
business), which business or an interest in which shall be received by my fiduciary. This
authorization shall include the right to change the form of any such business by the
reorganization or incorporation thereof, or the formation of a general or limited partnership
with respect thereto, and shall also include the right to invest in any such business including
~v
the right to invest in any business the property of any trust hereunder for such periods of
time and upon such terms and conditions as my fiduciary shall deem advisable. No
fiduciary shall be liable for any loss resulting from continuing any such business, but my
fiduciary may, in my fiduciary's discretion, sell, liquidate or otherwise discontinue any such
business at such time or upon such terms and conditions as my fiduciary shall deem
advisable.
K. If there are co-fiduciaries serving hereunder, they may delegate any and all
management duties and responsibilities to one of them. My co-fiduciaries may, for
example, designate one of them to maintain a bank account or accounts, and in that instance
the signature of only that fiduciary shall be required to open and maintain such account, to
deposit funds to such account and to write checks on such account. Other than as specified
herein, the authority of my co-fiduciaries shall be exercisable jointly.
ITEM XIV: The interests of the beneficiaries hereunder shall not be subject to anticipation
or to voluntary or involuntary alienation.
ITEM XV: In the event that at the time for distribution hereunder, either from my estate or
from any trust created by this Will, there shall not be any person then living who is a linial
descendant (issue) of myself (or my spouse or my children) then and in such event, the amount
distributable shall be distributed as follows:
A. One-third (1 /3) thereof to the CUMBERLAND VALLEY ANIMAL
SHELTER, for its general purposes.
B. One-third (1/3) thereof to the DEPARTMENT OF CHILDREN AND
YOUTH SERVICES O:F FRANKLIN COUNTY, PENNSYLVANIA, for the benefit of
abused children.
/~ ~~ 11
L%l/ ~
C. One-third (1/3) thereof to MESSIAH UNITED METHODIST CHURCH, 30
South Penn Street, Shippensburg, PA 17257, for its general purposes.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and
Testament, written on thirteen (13) sheets of paper, dated this ~ day of ~--- , 2006.
l~ ~ ~sE.~u.>
WAYNE A. ROTZ
The preceding instrument, consisting of this and twelve (12) other typewritten pages, each
identified by the signature or initials of the Testator, was on the day and date thereof signed,
published and declared by the Testator therein named, as and for his Last Will, in the presence of us,
who, at his request, in his presence, and in the presence of each other have subscribed our names as
witnesses hereto.
I
residing at
^,
~`~
r residing at t' ~~
12
COMMONWEALTH OF PENNSYLVANIA:
ss.
COUNTY OF CUMBERLAND
I, WAYNE A. ROTZ, 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.
WAYNE A. ROTZ
Sworn to or affirmed and acknowledged
before me by WAYNE A. ROTZ, the
Testator, this ~ day of
2006.
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Teresa J. Burkholder, Notary Public
Shippensbur~ Boro, Cumberland County
My Commission Expires Aug, b, 2008
Member, Pennsylvania As:,~ciatian of Notaries
Nota'~ PubY~c
COMMONWEALTH OF PENNSYLVANIA:
ss.
COUNTY OF CUMBERLAND
We, ~ - ~,~lCl~ ~ ~<<~ ,the
witnesses w ose names are signed to the attached instrument, being duly qualified according 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 Last Will as a
witness; and that to the best of our knowledge the Testator was at he time eighteen (18) or more years of age
and of sound mind and under no constraint or undue influ,~nce.
a~ ~)cGi
Sworn to or ned and subscribed to
before me by r cN ~ ~.~/ ~ rand
~.~c~,f, ,witnesses, this
~ day of _ ~, 2000.
Notarial Seal
Teresa J. Burkh+~d~er. Notary Public
5hi pensbur~ Boro: '~~~~rnberland County
Gommtsston Expires Aug. 6, 2008
Member, Pennsylvania A+s:.~eietian cf Ngt~rive
13
A. Settlement Statement U.S. Department of Housing and
Urban Development
OMB Approval No. 2502-0265
B. Type of Loan
1. ^ FHA 2. ^ FmHA 3. ^ ConV. Unins. s. Fts Number. 7. Loan Number; 8. Mortgage Inaurarws Caae Number,
4. ^VA 5. ^Conv. Ins. MS49862
C. Note: This form k rumished b gNe you a datament d actusl aettlemant coda. Amounts paid to end by the ptlbment agent are shown. Items marksd'(p.o.c.)' were paid outride the dosing; they ero
shown hers to intormstionel purposes and aro not irw;ludad In fhe toWa.
D. Name 6 Addrea of Borrower. E. Name 6 Addraas of Seller. F. Norma 6 Address of Lender.
RONALD L. SAILHAMER AND JANET E. SAILHAMER ESTATE OF WAYNE A. ROTZ
494 E. KING STREET 407 NORTH MORRIS STREET
SHIPPENSBURG, PA 17257 SHIPPENSBURG, PA 17257
G. Property Location:
407 NORTH MORRIS STREET
SHIPPENSBURG, PA 17257 (FRANKLIN)
(21-6A16-019A)
J. Summary of
H. Settlement Agent
MADISON SETTLEMENT SERVICES-CARLISLE, LLC
59 S. PITT STREET, CARLISLE, PA 17013 (717) 243-2121
Plea Of Settlement I. Settlement Date ! Disburasmerd D
59 S. PITT STREET, CARLISLE, PA 17013 10/12/2012 I 10/12/2012
101. Contract sales price 546,000.00 ntract a 546,000.00
102. Personal Property 402. Personal Property
103. Settlement Charges to Borrower (Una 1400) 51,118.00 403.
104. 404.
105. 405.
Adjusments for keme paid by seller in advance Adjustments for keme paid by seller in advance
106. Cityltown fazes 406. City/town taxes
107. County taxes 10/12/2012 to 12/3112012 ~ S718.02/Year 5156.94 407. County faxes 10!1212012 to 12/31/2012 ~ 5718.02Near 5156.94
108. Scholl Tax 1011212012 to 613012013 ~1101.55/Year 5789.85 408. School Tax 10/12/2012 to 6/30/2013 (~1101.55/Year 5789.85
109. 409.
110. 410.
111. 411.
112. 412.
120. Gross Amount Due From Borrower =48,064.78 420. Gross Amount Due To Seller 546,946.78
201. Deposit or Earnest Money 501. Excess deposit (sea instructlons}
202. Prindpel amotatt of new loan 502. Settlement Charges to Sallar (line 1400} 5523.91
203. Existing loan taken subject to 503. Existlng loan(s) taken subject to
204. 504. Payoff of first mortgage loan
205. 505. PayoA of second mortgage loan
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for keme unpaid by seller Adjuatmentb for Items unpaid by seller
210. Cily/town taxes 510. Cilyrtown texas
211. County taxes 511. County taxes
212. Assessments 512. Assessments
Z13. 513.
214 514
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid By1For Borrower 520. Total Reduction Amount Due SNler 5523.91
aw. wart ~ aaaemm~ rrortu r o oorrower svu. wen wr seaaemerrr< r o-rrom senor
301. Gross Amount Due From Borrower (Una 120) 548,064.79 601. Gross Amount Due To Seller (line 420) 546,946.79
302. Less Amounts Paid BylFor Borrower (Una 220) 602. Less' Deductlon in Amt. Due To SsUer (Una 520) 5523.91
303. Ca:h From ^To Borrower 548,064.79 603. Cash OTo ^From Seller 546,422.88
Loan Number. File Number: MS49862 Page t of 2
L. Semement chugs:
700. ToW SdeafBroker s Commissbn
Division of Commission (line 700) as follows: Paid From Paid Fran
Borrowers Funds Seller's Ftxtds
701' at Settlement at Settlement
702.
703. Commission paid at Settlement
704.
600. Rams Payable In Connection With Loan
801. Loan Orlainatlon Fee
900. Remo Required 8 Lender To Ba Paid In Advance
901. Interest
903. Hazed Insurance Prai
1000.Resenra DeposRac
1001. Hazard insurance
1002. Mortgage insurance
1003. City property taxes
1004. County property taxe
1100. TRIe Charyesl
1101. Setlement or
1102. Abstract or till
1103. Titre examinal
1104. Title insuaanet
1105. Document pre
1108. Notary fees
1107. Attorneys fee
(includes about
1108. Title Insurana
(includes about
1109. Lenders cove
i 110.Ownet+s coves
1200. Govsmment
1201. Recording fee
1202. County taxlsl8
1301. Sunray
1302. Pestlnspectlon
1304. Final Water/Sewer/Trash to Borough of Shlppensburg x63.91
1400. Total Settiemtutt Charges (enter on Tine 103, Section J and 502, Section K) 51,116.00 5523.91
I have earrfully reviewed the HUD-1 Settlement Statement end to the beet of my knowledge and belief it is We end ecareta statement of ati receipts end diabrrsemenla made on my account a by me in this Vanasctlan.
1 further oerltty the I Mars receNed a copy of the HUD-1 Settlement StstemenL
BORROWERS SELLERS
RONALD L. SAiLHAMER Roxenna M. Cooper, ExaaMx
JANET E. SAILHAMER
The HUD-1 Settlement Statement which I hers prepared is a true and soarete account d this transaction. I have cased or I will cause the funds to bs diaburasd in acoordancs with this statement.
Settlement Agent Date
WARNING: It is a aims to knowingly make fates statements to the United States on this a any other eimisr loan. Penaltioa upon conviction can include a fins and'arpriacmm~nt For detdls see; Title 18 U.S. Code
Section 1001 end Section 1010
Loan Number: File Number: MS49862 Page 2 of 2
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N~TI NAN
AMERICAN NATIONAL INSURANCE COMPANY _ ___
LIFE INSURANCE AND ANNUITY CLAIMS DEPARTMENT
P. O. BOX 69G840 SAN ANTONIO TX, 78269-6840 BUS: 1-800-615-7372 FAX: 210-853-1406
November 19, 2012
HAMILTON llAVIS
ATTUItNEY AT LAW
I' O I30X 40
SHIPPENSI3UI2G PA 17257
RI+;: CLAIM: C77b443
INSURED: WAYN ROTZ
POLICY: 14515190
Thank you for your letter.
The information you requested is as follows.
The elate of death value (03/17/2012) for the above Policy was $5793.23, which included interest up
until that date. Please note aclclitional interest may have been Paid up until the day we l•eccivccl tl><e
required claim documents.
If you have any further questions please feel free to give us a call Ott 1-800-C15-7372.
Sincerely,
c/ 2LGL~ / G P~G(A~ ~'L
Tricia Nelon ACS
Senior Claims Specialist
TN/AG