HomeMy WebLinkAbout05-29-13 � 1505610143
REV-1500 Ex`°z,,, "�"
OFFICIAL USE ONLY
PA Depadment of Revenue pennsylvania co��y coae rea� F�ie Numbe�
Bureau of Individual Taxes �^^^*•E�*�A�E��E
Po eox.zaosoi INHERITANCE TAX RETURN 21 13
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
04 28 2013 11 18 1929
DecedenYs Last Name Suffix DecedenPs First Name M�
KRUSE MARJORIE J
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffx Spouse's First Name M�
RRUSE ERNEST J
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Retum � 2. Supplemental Retum � 3. Remainder ReNm(Date of Death
Prio�to 1243-62)
� 4. Limdetl Estate � 4a.Fuwre Interest Compromise � 5. Fetlerel Esfate Tax Retum Required
(tla[e ot death afler 12-02A2)
� s Decetlent Died Tes�a�e � � oeceaer��n�taimained a�iving rrust _ e. Total Number of Safe De osit Boxes
(Attach Copy of Will) (Atlach opy of Trust) P
� 9. LitlgationProceedsReceived � 10.eerwaeni2�3i�1end��oa�e��fDeath � �7,Elec[iontota�cunderSec.9113(A)
(Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
DAVID J LENOX 77� 271 73;75
:�
� __. -,� �.,i
RErn61�'i`ER OF VP$LS U6�E�9LY
._ �-, —c= t.,.
�' ;: t - rv
First Line of Address � �
8 TRISTAN DRIVE SUITE 3 � �` _� �� � �
Second Line of Address ` � '—`3 -
�._ . '.;:_ ��
_ ri
� DAT #ILED�� �
City or Post Office State ZIP Code
DILLSBURG PA 17019
CorrespondenYs e-mail address:
Under penalties of peryury,I declare that I have examineC this retum,including accompanying schedules and statements,and to the best of my knowledge antl belief,
it is Vue,corzect and complete.Declaralion of preparer other than the personal representaUVe is based on all information ot which preparer has any knowletlge.
SIGNATURE OF PERSON RESP NSI LE FOR FILING RETURN DATE
� �� Ernest J. Kruse �.,�c�/zc�/ �
AD�RE55 I /
565 Do wood Drive Mechanicsbur PA 17055
SI TUR 0 ER OTH HAN REPftESENTA E DATE
David J. Lenox a �/ �U /
AD S
8 Tristan Drive, Suite 3, Dilisburg, PA
Side 1
L 15�5610143 15U5610143 J
� 1505610243
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... t.
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.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous�{�u;Probate Property �
(Schedule G) U Separate Billing Requested............ 7. 3(Q ,748 . 85
8. Total Gross Assets(total Lines 1 through 7)........................................................ g. 364 ,748 . 85
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 515 . 0 0
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10.
11. Total Deductions(total Lines 9 and 10)................................................................ ��. 515 . 00
12. Net Value of Estate(Line 8 minus Line 11).......................................................... �z, 3 64 ,233 . 85
�3. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to taz has not been made(Schedule J)............................................... 13.
14. Net Value Subject to Tax(line 12 minus Line 13)............................................... �q. 364 ,233 . 85
TAX COMPUTATION•SEE INSTRl1CTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfersunderSec.9116 343 015 . 00 15. 0 . 00
(a)(1.2)X.00 �
16. Amount of Line 14 taxable 21 � 218 . 85 16. 954 . 85
at lineal rate X .045
17. Amount of Line 14 taxable 0 . 00 17. 0 . 00
at sibling rete X.12
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
�s. rnxoue................................................................................................................ �s. 954 . 85
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13
DecedenYs Complete Address:
DECEDENT'S NAME
Kruse, Marjorie J.
STREETADDRESS
565 Dogwood Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
i. Tax Due(Page 2, Line 19) � (1) 954.85
2. Credits/Payments
A. Prior Payments
B. Discount 47.74
Total Credits(A +B) (2) 47.74
3. Interest (3)
q. If Line 2 is greater than line t +Line 3,enter the difference. This is the OVERPAYMENT. (q�
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) 907.11
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
t. Did decedent make a trensfer and: Yes No
a. retain the use or income of the property transferred:............................................................................... � X
b. retain the right to designate who shall use the property transferred or its income:.................................. � �
c. retain a reversionary interest;or............................................................................................................... x
d. receive the promise for life of either payments,benefts or care9............................................................ x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receivingatlequate consideretion?.................................................................................................................... ❑ ❑X
3. Did decedent own an"in trust fo�' 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
conFains a benefciary 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)].
For tlates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets and filin9 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 taz rate imposed on the net value of trensfers from a deceased child 21 years of age or younger at death to or for the use of a naturel 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 decedenYs lineal benefciaries is 4.5 percent,except as noted in
[72 P.S.§9116(a)(1)1.
. The taz 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-1510 EX+�OB-09)
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
�EPARTMENTOF REVENUE
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIOENT DECEOENT
ESTATE OF FILE NUMBER
Kruse, Marjorie J. 21-13
This schedule must be comple�aC and fletl i(ihe answe��o any of questions 1 thmugh 4 on page Nree of�he REV-0500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE O TF RANSFERSATfACl/TA COPVEOF T�HE DEED�OR REAI ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
7 Morgan Stanley Smith Barney IRA(Emest J. Kruse, 5,962.00 5,962.00
spouse, is the beneficiary):
2 Morgan Stanley Smith Barney Trust 664022354 93,274.00 93.274.00
(passesto ErnestJ. Kruse,spouse)
3 Morgan Stanley Smith Barney Trust 664023291 243,744.00 243,744.00
(passes to Ernest J. Kruse,spouse):
4 Thrivent Financial Annuity C2682677(Susan J. 21,768.85 21,768.85
Wallette and Robert W. Kruse,children of decedent
are the beneficaries):
TOTAL(Also enter on Line 7, Recapitulation) 364,748.85
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Ina Form PA-1500 Schedule G(Rev.OB-09)
REV�1571 EX+�10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
RESI�ENTDEC ENT UftN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Kruse, Mary'orie J. 21-13
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N M
A. Fl1NERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
��b State Zio
Year(s)Commission Paid
2, Attornev's Fees DeVld J. LenOx 500.00
3. Family Exemption: (If decedenYs address is not the same as claimanPs,attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 15.00
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 515.00
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Kruse, Marjorie J. 21-13
ITEM
NUMBER DESCRIPTION AMOUNT
Other Admini trativ o t�
1 Register of Wills (filing fee): 15.00
H-87 15.00
Copyright(c)2002 form soRware only The Lackner Group, Inc. Form PA•1500 Schedule H(Rev.6-98)
REV451�EX+(07-10)
pennsylvania SCNEDULE J
DEPARTMENTOFREVENUE
INHERITANCE TA%RETURN BE N E FIC IARI ES
RESIDENT�ECEOENT
ESTATE OF FILE NUMBER
Kruse, Mar'orie J. 27-13
RELATIONSHIP TO
NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER pERSON(S)RECEIVING PROPERTY DECEDENT (WOrds) ($$$)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 12
1 Ernest J. Kruse Spouse 342,980.00
565 Dogwood Drive
Mechanicsburg, PA 17055
2 Robert W. Kruse Son 10,884.43
147 Delaware Ave.
North East, MD 21901
3 Susan J.Wallette Daughter 10,884.42
12 Cochita Trail
Browns Mills, NJ 08015
Total 364,748.85
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9173 FOR WHICH AN ELECTION TO TAX IS NOTTAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. Oi-70)
. _
�
REVOCABLE CO
TRUST AGREEMENT ��'`
MADE this 8th day of July, 2005, by and between Ernest J. Kruse and Marjorie J.
Kruse, individuals and residents of Mechanicsburg, Cumberland County, Pennsylvania,
(hereinafter referred to as the "Settlors"), and Ernest J. Kruse individual and resident of
Mechanicsburg, Cumberland County, Pennsylvania, as the Trustee (hereinafter referred to as the
"Trustee").
WITNESSETH:
ARTICLE ONE
(A) Establishment of Trust Estate: The Settlors have transfened and delivered to
the Trustee that properry more fully described in Schedule "A," attached hereto and made part
hereof (the "Properry"). The Trustee shall hold and administer the Property, together with all
other cash or properiy of any kind which the Trustee at any time may acquire from the Settlors
or from others by inter-vivos transfer or pursuant to beneficiary designations by Last Will and
Testament or otherwise, including,but not lunited to, the residue and remainder of Setdors' Estate
as provided for in Settlors' LasbWills and Testaments ("Addiuons"), together with the proceeds,
investments and reinvestments with respect thereto as a trust estate ("Trust Estate") on the terms
and conditions hereinafter set forth.
The name of the Trust herein created shall be the Ernest J. Kruse and Marjorie J.
Kruse Revocable Living Trust.
(B) Distributions to Settlors During Seitlors Lifetime: During the lifetime of the
Settlors, the Trustee shall pay to the Settlors or expend for the Settlors' benefit the entire net
income produced by the Trust Estate ("Income") in convenient installments or otherwise as
Settlors may from time to time direct, together with such portion of the principal of said Trust
Estate as Settlors may from tune to time direct in writing or, if Settlors give no directions, as the
trustee deems advisable to provide for the health, welfare and comfortable support of the Settlors,
and to continue Settlors' accustomed pattern of giving to individuals and organizations. Any
unexpended income shall be added to principal and invested as such.
(C) Distributions of Trust Estate in the Event a Settlor Becomes Inca�acitated:
If at any time a Settlor is under a legal disability, or if by reason of illness or mental or physical
disability a Settlor is "incapacitated," as such term is defined below, and is unable to make or
communicate responsible decisions concerning Settlor's affairs, the Trustee shall use the income
and part or all of the principal of the Trust Estate for the care, comfort and support of the Settlor,
or for any other purpose which the Trustee, in his sole and absolute discretion, deems to be for
the best interests of the Settlor.
1
"Incapacity" of a Settior shall be determined by the existence of one ar more of the
following:
(1) There is a court order, which such Trustee or beneficiary deems to be
jurisdictionally proper and still concurrently applicable, holding a person to be legally
incapacitated to act on his or her own behalf or appointing a guardian to act for him or her, or
(2) There is a duly executed, witnessed, and acknowledged written certificate of a
licensed physician (certified by a recognized medical board), to the effect that the physician has
examined ffie Settlor and has concluded that such person has become incapacitated to act rationally
and prudenfly in his or her own financial best interests, or
(3) there is evidence which such Trustee or beneficiary deems to be creditable and still
currently applicable that the Trustee has disappeazed, is unaccountable absent, or is being detained
under duress where he or she is unabie effectively and prudently to look after his or her own best
interests.
Given the occurrence of such events or circumstances, the affected Settlor shall be deemed
to have become incapacitated. Such incapacity shall be deemed to continue until such court order,
certificates, and/or circumstances have become inapplicable or have been revoked.
Any physician's aforesaid certificate may be revoked by a similaz certificate to the efFect
that the person is no longer incapacitated executed either: (a)by the originally certifying physician
or (b) by another licensed, board certified physician. No Trustee shall be under any duty to
institute any inquiry into the person's possible incapacity, but the expense of any such inquiry
reasonably instituted may be paid from the Trust assets. Payment for such inquiry refers both to
a reasonable inquiry as to the incapacity of such individual and to that inquiry as to the revoca6on
of such a certificate.
(D) Distribution of Trust Estate Unon the First Settlor's Death:
1. Upon the death of the fust Settlor to die, the Trustee is authorized to pay to the
deceased Settlor's personal representative or to expend direcdy, such sums as deceased Settlor's
personal representative shall request in writing to supplement the deceased Settlor's estate in order
to pay particu�ar legacies, debts, funeral expenses, admuristration expenses, estate inheritance and
other taxes in the nature thereof, togetYier with any interest or penalties thereon, becoming due
by reason of the Settlor's death with respect to the property constituting Settlor's gross estate for
death tax purposes, whether or not such properry passes under this Trust Agreement;
PROVIDED, HOWEVER, that no assets shall be used for this purpose which are not otherwise
included in the deceased Settlor's gross ta7cable estate.
2
2. If the surviving Settlor is living on the thirtieth (30th) day following the deceased
Settlor's death, the Trustee shall continue to make distributions to the surviving Settlor as
provided in Paragraphs (B) and (c) of this Article One.
(E) Distributions Following the Death of the Surviving Settlor:
l. Income Distribution Upon Death of Survivine Settlor:
Upon the death of the surviving Settlor, if he/she survives deceased Settlor by at least thirty (30)
days, the Successor Trustee(s) shall pay to the personal representative of the estate of the
surviving Settlor, if such a personal representative is appointed, all income accrued but
undistributed as of the date of death of the surviving Settlor.
2. Distribution of Principal to Estate of Survivin� Settlor to Pav "Death Taxes"
The Successor Trustee(s) shall then make payment to the personal representative, if
appointed,_of the estate of surviving Settlor, out-of the principal of the-Trust,an amount equal to - - - -
the estate, inheritance, transfer, succession or other death taxes ("death taxes") federal, state and
' other, payable by reason of the inclusion of part or all of the trust property in his or her estate.
The determination by the personal representative of the estate of the surviving Settlor, of the
amount payable hereunder shall be final and conclusive. The fmal determination of the amount
due hereunder shall be based upon the values as finally determined for federal estate tax purposes
in the estate of the surviving Settlor. The Settlors hereby direct the Successor Trustee(s) to pay
such amount promptly upon written request of the personal representative of the estate of the
surviving Settlor, and upon payment of the amount finally deternuned to be due hereunder, the
Successor Trustee(s) shall be discharged from any further liabiliry with respect to such payment.
The surviving Settlor may waive the right of his or her estate to payment under this, Paragraph
(E) 2 of Article One, by Last Will and Testament, executed after Settior's death, or in a properly
executed Codicil made part of the Last Will and Testament of the surviving Setflar after Setflor's
death, in which surviving Settlor specifically refers to the right to payment hereby given to the
estate of surviving Settlor.
3. Power of Ap_pointment Exercisable by the Survivine Settlor: Upon the death of the
surviving Settlor, the remaining principal and any accrued or undistributed income shall be
transferred and delivered to or for the benefit of such one or more persons, corporations or other
organizations, including the estate of the surviving Settlor or to the creditors of the surviving
Settlor, in such portions or amounts and subject to such trusts, terms and conditions as the
surviving Settlor, may appoint by specific reference in the Last Will and Testament of the
surviving Settlor to the power of appointment contained in this, Paragraph (E) 3 of Article One.
If the surviving Settlor does not exercise this power in full, the unappointed principal and
accumulated and undistributed income shall be distributed as hereinafter provided.
4. Distributions of Remaining Income and Principal: Upon the death of the surviving
Settlor, or upon the death of the deceased Settlor, if the surviving Settlor does not survive Settlor
3
by at least thirty (30) days, then the remaining principal of the Trust and any accumulated or
undistributed income shall be distributed as follows:
Specific Distributions from the Trust Estate:
Prior to any distribution of the balance of the Trust Estate, the following specific
distributions shall be made by the Successor Trustee:
NONE
Distribution of the Balance of the Trust Estate:
After provision has been made for the above-noted specific distributions, the
balance of the Trust Estate shall be distributed as follows:
1) One-half(�h) to our daughter, Susan J. Wallete, and,
2) One-half('/x) to our son, Robert W. Kruse.
The above distribution shall be on a per stirpial basis, meaning that in the event
Settlors' son or daughter predeceased the last of the Settlor's to die, then the share of the
predeceased child shall be distributed in equal shares to the then living issue of said child
by representation.
In the event that the surviving Settlor dies without leaving living issue, then the trust
estate shall be distributed as follows:
1) One-half('h) to 7ean Hoffman,and,
2) One-half('/z) to H. William Kruse.
Said distribution shall be on a per stirpial basis, meaning that in the event
an above named heir has predeceased the last of the Setdor's to die, then the share of the
predeceased heir shall be distributed in equal shares to the then living issue of said heir
by representation.
ARTICLE TWO
ADDITIONAL PROVISIONS APPLICABLE TO TRUSTS
(A) Beneficiary Provisions: In the disbursement of funds directed to be
paid to or for the use and benefit oF any beneficiary who shall not have
attained the age of eighteen (18) years, the Trustee (s) may, in their
sole and absolute discretion, make payment of the same to the parent,
4
guardian or such other person, if any, having custody of the
beneficiary who has not yet attained the age of eighteen (18) years at
the time such payments are made, to be used for the health, education,
weifare, maintenance and support of such beneficiary, but without
liability on the part of the Trustee(s) to see the application of said
payments by the payee, and the receipt of any such person shall be a
full acquittance of the Trustee(s) as to any amounts so paid. This shall
be construed as a power only and shall not operate to suspend the
absolute ownership thereof by such beneficiary who has not yet
attained the age of eighteen (18) years, nor prevent the absolute
vesting thereof of such beneficiary.
(B) Perpetuities Savings Provision: Notwithstanding anything to the
contrary herein contained, upon the expiration of twenty-one (21)
years following the death of the survivor of all the beneficiaries herein
named or described who are living at the death of the first Settlor to
die, all Trusts remaining hereunder shall terminate, and the principal
shall be transferred and delivered to the person then entitled to the
income therefrom.
(C) S�endthrift Clause: Neither the principal nor the income of any
portion of the Trust Estate shall be liable or subject to the contracts,
debts, liabilities or torts, now or hereafter made, contracted, incurred
or committed, of any beneficiary or remainderman; nor shall the
principal or income of the Trust Estate be liable to attachment by
gamishment proceedings or other legal process; nor shali any
assignment or order either of principal or income, given by any
beneficiazy or remainderman be valid, but the principal and income
shall be paid by the Trustee(s) directly to or for the use of the
beneficiary entifled thereto, without regard to any assignment, order,
attachment or claun whatever. Every such attempted assignment or
other disposition by any beneficiary or remaindenvan shall not be
merely voidable, but absolutely void, except that this provision shall
not impair or restrict the exercise of any power of appointment granted
hereunder. No payment hereunder shall become the properiy of any
beneficiary or remainderman until it is received by him/her or his/her
guardian.
(D) Disposition of Accrued Income Following Death of Income
Beneficiarv: Upon the death of any income beneficiary, any income
accrued or received by the Trustee(s) subsequent to the last income
payment date shall be paid to the person or persons for whose benefit
5
the principal producing such income is continued in trust or to whom
such principal is distributed under the terms hereof.
(E) Stock Dividends Allocated To Princioal: Corporate distributions
received in shares of the distributing corporation shall be allocated to
principal, regardless of the number of shares and however described
or designated by the distributing corporation.
(F� Characterization of°Income": "Accrued Income": Income accrued
on any property received by the Trustee(s), either at the inception of
the Trust Estate or as an addiUOn thereto, shall be treated as income
and not as principal; PROVIDED, HOWEVER, that any lump-sum
distribution payable to the Trustee(s) under any employee benefit plan
or individual retirement account in which the Settlor kias an interest
shall be treated as principal notwithstanding the options, elections or
privileges that may be exercised by the Trustee(s), the Settlor or any
beneficiary for income, estate or death tax purposes. Upon the death
of any beneficiary of income, any undistributed income then held by
the Trustee(s) for such beneficiary shall be paid to the person or
persons for whose benefit the principal producing such income is
continued in Trust, or to whom it is distributed under the terms hereof.
ARTICLE THR�E
PROVISIONS WHICH GOVERN THE TRUSTEE
(A) Powers of the Trustee: The Trustee(s) hereunder shall have the
following powers, in addition to and not in lunitation of those granted by law:
1.Accept, Purchase and Retain Assets : To accept assets in kind from the
Settior(s), his/her/their estate or elsewhere, to purchase assets from the estate and to
retain such assets in kind;
2. Sale and Investment of Other Assets: To sell assets and to invest and
reinvest the proceeds and any other cash in any kind of property, real or personal, or
part interest therein, located in the United States or abroad, including interest beazing
accounts in or certificates issued by any firm, including a corporate fiduciary, and
securities underwritten by syndicates of which the corporate fiduciary is a member but
not purchased from the Trustee(s), a11 statutory and other limitations as to the
investment of funds, now or hereafter enacted or in force, being waived;
3. Hold Cash: To hold income cash uninvested until the next regular payment
date, without liability for interest thereon;
6
4. Purchase Life Insurance: To retain or to purchase policies of life
insurance, to pay premiums thereon from income or principal and to exercise all
rights of ownership thereof;
5. Encumber Assets: To pledge, exchange or mortgage real or personal
property and to lease the same for terms exceeding five (5) years;
6. Give Options: To give options for sales, leases and exchanges;
7. Compromise Claims: To compromise clauns and controversies;
8. Vote Common Stock: To vote shares of corporate stock, in person or by
proxy, in favor of or against management proposals;
9. Carrv Securities Without IdentifLg Trust Estate: To carry securities in
the name of a nominee, including that of a clearing corporation or depositary, or in
book entry form or unregistered or in such other form as will pass by delivery;
10. Distribution in Kind: To make division or distribution hereunder either
in cash or in kind; and, in connection therewith, to ailocate to different kinds of, or
interests in, property and property having different bases for federal income tax
purposes, all as the Trustee(s) deem equitable;
11. Investrnent of Trust Estate Assets: To invest and reinvest the Trust Estate
funds (or leave them temporarily uninvested), in any rype of property and every kind
of investment, without regard to any principle of diversification of risk, and without
being lnnited to "legal inveshnents", inciuding (but not lunited to) corporate
obligations of every kind, preferred or common stocks, securities of any regulated
investrnent trust, and partnership interests.
12. Participate in Business Onerations: To pazticipate in the operation of any
business or other enterprise for whatever period of tnne the Trustee(s) deem proper,
with full power to do any and all things deemed necessary or appropriate, including
the power to incorporate any unincorporated business; to vote any and all shares of
stock owned in any such business; to borrow and to pledge assets as security for such
borrowing; to assent to, join in, or vote in favor of or against any merger,
reorganization, voting trust plan, or similar action, and to delegate discretionary
duties with respect thereto; to delegate all or any part of the supervision, management
and operation of the business to such person or persons as may be selected; and to
close out, liquidate, or sell the business or to assign such business interests at such
time and upon such terms as the Trustee(s) deem advisable.
7
13. Deposit Funds: To deposit Trust Estate funds in any commercial savings
or savings and loan accounts, or in "money market" or sunilar accounts maintained
by any corporate fiduciary.
14. Borrow Funds: To borrow money for any reasonable Trust Estate
purpose from any lender, including the power to borrow from the probate estate of
Settlor for the purpose of payment of taxes or on behalf of any separate trust
hereunder from any other separate trust hereunder, upon such terms, including (but
not lunited to) interest rates, security, and loan duration, as he/she/they deem
advisable.
15. Make Loans: To lend Trust Estate funds to such persons and on such
terms, including (but not limited to) interest rates, security, and loan duration, as the
Trustee(s) deem advisable, including the power to make loans to the Settlor(s) during
his/her/their lifetime.
16. Sale of Tmst Estate Assets: To sell or otherwise dispose of Trust Estate
assets, including (but not lunited to) Trust Estate real Property, for cash or credit, at
public or private sale, and with such warranties or indeaurifications as the Trustee(s)
deem advisable.
17. Alteration or DisQOSaI of Tmst Estate Assets : To improve, develop,
manage, lease, or abandon any Trust Estate assets, as the Trustee(s) deem advisable.
18. Hold Property Without IdentifyinQ Trust Estate: To hold property in the
name of any Trustee or any custodian or nominee, without disclosing this trust, but
the Trustee(s) are responsible for the acts of any custodian or nominee the Trustee(s)
so use.
19. Comnensate for Administration: To pay and advance money for the Trust
Estate's protection and for all expenses, losses, and liabilities sustained in its
admuustration.
20. Act as Le a�l Revresentative: To prosecute or defend any action for the
Protection of the Trust Estate, the Trustee(s) in the performance of his/her/ their
duties, or both, and to pay, contest, or settle any claim by or against the Trust Estate
or the Trustee(s) in the performance of his/her/their duties.
21. Hire Consultants, etc: To employ and dismiss agents, brokers,
investment advisors, accountants, attorneys and employees, regardless of whether
they are associated with the Trustee(s), or the Trustee(s) or affiliates or employees
8
thereof, and to advise or assist him/her/them in the performance of hislher/their
du[ies.
22. Allocate Between Principal and Income: To determine what is principal
or income and what items shall be charged or credited to either.
23. Execute Bindin¢ L,enal Instruments: To execute and deliver any
instruments necessary or useful in the exercise of any of the foregoing powers.
24. Retain Non-Income Producing Propertv: To retain, during the lifetime
of the Settlors, for so long as the Trustee(s) may deem advisable any property
whatsoever, regardless of whether or not such property is income producing.
25. Retain Settlor's Personal Residence: Following the death of one of the
Settlors, the Trustee(s) are authorized to retain as pazt of the Trust Estate for the
personal use ofthe surviving Settlor, any property occupied by deceased Settlor and
the Surviving Settlor at the death of deceased Settlor as their principal place of
residence for so long as the surviving Settlor wishes to occupy said residence. During
such period of retention, the Trustee(s) shall pay from the income or principal of the
separate trusts established hereunder as the Trustee(s) may deem to be in the best
interests of such trusts and their beneficiaries, all taxes and assessments levied upon
or assessed againstresidence, and all costs of maintaining,repairing and insuring said
residence.
No obligation of rent shail be imposed upon the surviving Settlor during any period
of occupation of said residence. On written or oral request of the surviving Settlor,
the Trustee(s) may sell said residence and replace it with other property which in the
opinion of ffie Trustee(s) is suitable as a residence for the surviving Settlor, to be
retained in the trust in the same manner as the property which was replaced.
26. Authorit tv o Sien Documents: Either Trustee shall have the power to
execute individually any and all documents necessazy to carry out the powers,
functions, and duties of the position of Trustee. Such power shall include, but shall
not be 1'united to: the signing of checks, the opening of bank or other fmancial
accounts, the disbursement of Trust funds, the execution of contracts, and other such
financial transactions.
(B) Resignation of Trustee: Any Trustee may resign at any time during
Settlors' lifetimes by written notice to Settlors. After the death of the last Settlor to
die, a Trustee may resign at any time, without stating cause, by notice to the
remaining Trustee(s); provided, however that prior to the resignation of a sole
remaining individual Trustee, such Trustee's resignation shall not become effective
9
until after such Trustee has appointed a corporate trustee as successor, and such
corporate trustee has accepted such appointment. Absent such appointment and
acceptance, said Trustee's resignation shall not become effective until said Trustee has
petitioned a court of competent jurisdiction to designate a successor corporate trustee.
(C) Successor Trustee(sl : Upon the death, disability, incapacity or
resignation of the original Trustee, then, Susan J. Wallete and Robert W. Kruse
are appointed to serve as the Successor Co-Trustees. In the event one of the named
Co-Trustees is unable or unwilling for any reason to assume the role of successor
trustee, then the remaining tmstee may serve alone without necessitating the
appointrnent of a replacement for the failed appointment. All Trustees named or
appointed are to serve without bond.
(D) Replacement of A Cornorate Trustee: If at any time a corporate trustee
has been appointed during the lifetime of Settlors, the Settlors may replace such
corporate trustee by written notice to said corporate trustee, and may, but shall not
be required to, designate a successor corporate trustee. Following the deaffi of the
Settlors, the individual Trustee(s) may replace a corporate trustee by written notice
thereto, and may, but shall not be required to, designate a successar corporate trustee.
(E) Comoensation of Trustee: The Trustee(s) shall be entitled to receive
annual compensation for services hereunder but not in excess of such compensation
as would be approved by a court of competent jurisdiction. Payment of such
compensation to a Trustee, in his, her or its capacily as such shall not preclude
payment to any Trustee for the rendition of professional services for, or on behalf of,
the Trust Estate. For any services performed by the Trustee(s) in connection with
Settlors' estates, which services are normally performed by the personal
representative, the Trustee(s)shall be entitled to such additional compensation as may
be fair and reasonable under the circumstances.
(F) Authority to Terminate Small Trusts: Should the principal of any Trust
Estate herein provided for, be or become too smail in the Trustee(s) discretion to
make establishment or continuance of the Trust Estate advisable, the Trustee(s) may
make immediate distribution of the remaining principal and income outright to the
income beneficiaries in the proportion to which they are then entided to the income.
The receipts and releases of the distributee will terminate absolutely the right of all
persons who might otherwise have a fixture interest in any portion of the Trust Estate,
whether vested or contingent, without notice to them and without the necessity of
filing an account with the court.
(G) Mereer: The Trustee(s) may merge or consolidate for administrative
purposes any trust established under this Trust Agreement with any other trust
10
established by Settlor of the surviving Settlor having the same Trustee and
substantially the same dispositive provisions.
(I� Division and Delegation of Duties by Trustee : One or more of the
Trustees may, whenever, as often, and for such period as shall be deemed advisable
to do so, delegate to one or more of the other Trustees, any or all ministerial and
administrative duties, including the keeping of books and records, acting as custodian
of the Trust Estate property, and preparing all necessary tax returns, as well as the
authority to exercise in their names and behalf any or all the powers, authorizations,
discretion, and duties vested in or devolving upon them as Trustee under the
provisions of this Trust Estate. Any action taken by the Trustee to which such
division or delegation shall be made shall have the same force and effect as if taken
and exercised by the designating or delegating Trustee(s) acting in conjunction with
the designated or delegated Trustee(s). Any such delegation shall be sufFiciently
evidenced for any and every purpose if contained in a writing, signed by the
designating Trustee(s) and delivered to the designated Trustee(s).
(n Fiduciary Restrictions. Discretion and Elections: The powers and
discretion granted to the Trustee are exercisable only in a fiduciary capacity and may
not be used to shift or enlarge any beneficial interest except as an incidental
consequence of the discharge of fiduciary duties. The Trustee may make
discretionary payments of income and principal in unequal shares to the beneficiaries
of any trust estabiished hereunder, and may, but shall not be required to, consider
other resources available to any beneficiary. The Trustee may make ta�c elections
without regard to the relative interests of any beneficiaries and may, but shall not be
required to, make equitable adjustments among beneficiaries.
ARTICLE FOUR
ADDITIONS TO TRUST ESTATE:
RIGHT TO REVOKE. ALTER AND AMEND TRUST AGREEMENT•
LIFE INSURANCE AND EMPLOYEE DEATH BENEFITS
(A) Additions to Trust Estate: The Settlors or others may, by Last Will and
Testament, inter-vivos transfer or beneficiary designation, add to the Trust Estate,
cash or such property in kind as is acceptable to the Trustee(s) at any tnne during the
term of the present Trust Agreement.
(B) Settlors' Right to Revoke A�reement: The Settlors expressly reserve
the right at any time and from time to tune to revoke this Agreement, in whole or in
part, by written notice delivered to the Trustee(s) during Settlors joint lifetimes. The
11
Surviving Settlor shall have the right to revoke, in whole or in part, the portion of the
present Trust Agreement relating to the Trust created herein.
(C) Settlors' Right to Amend Trust Ag_reement : The Settlors further
reserve the right at any time and from time to time to amend this Agreement at any
time during their joint lives by a proper instrument in writing, executed by the
Settlars and delivered to the Trustee(s) during Settlors' lifetimes and accepted by the
Trustee(s). The Surviving Settlor shall have the right to amend, in whole or in part,
any provision in the present Trust Agreement relating to the Trust created herein.
(D) Life Insurance: If Settlors designate the Trustee(s) as beneficiary of the
proceeds of any policies of insurance on their lives, the duty and responsibility for the
payment of premiums and other charges on such policies during the Settlors' lifetimes
shall rest solely upon Settlors. The only duty of the Trustee(s) shall be the
safekeeping of such policies as are deposited with it, and the Trustee(s)shall be under
no duty to notify the Settlors that any such premium or other charge is due and
payable.
All options, rights, privileges and benefits exercisable by or accruing to the
Settlors during their lifetimes by the terms of the policies shall be for the Settlors'
sole benefit. The Settlors agree, however, not to exercise any opuons whereby the
proceeds would be payable to the Trustee(s) ottier than in one sum. Upon the written
request of the Settlors, the Trustee(s) sY�all execute and deliver such consents and
instruments as may be requisite to enable the Settlors to exercise or avail themselves
of any option right, privilege or benefit granted by any of the policies. Upon the
Settlor's/Settlors' death(s), or at such later time as may be specified in the policies,
the net proceeds of any policies then payable to the Trustee(s) hereunder shall be
collected by the Trustee(s); the receipt of the Trustee(s) for such proceeds shall
release the insurance companies from liability on the policies, and the insurance
companies shall be under no duty to see to the application of such proceeds. The
Trustee(s) may take all steps necessary in his/her/their opinion to enforce payment of
said policies and shall be entided to indemnify themselves out of any property held
hereunder against all expenses incurred in taking such action.
(E) Employee Death Benefits: The Settlors may designate the Trustee(s) as
beneficiary of certain empioyee death benefits. In such case the Trustee(s) shall
collect the proceeds receivable therefrom upon the Settlor's/Settlors' death(s)and hold
them as part of the Trust Estate. The receipt of the Trustee(s) for such proceeds shall
be a full acquittance to the administrator of such benefit, and said administrators shall
not be liable to see to the application of such proceeds. To the extent that such
proceeds are notincluded in the Settlor's estate for federal estate tax purposes, they
shall not be used for the payment of death taxes or any administration expenses of
Settlor's estate. The Trustee(s) may select any option available as to the time and
method of payment of such proceeds and may also exercise any option with respect
12
to the income or death taxes thereon as the Trustee(s) in his/her/their sole discretion
deem advisable, and his/her/their decision in these matters shall be binding upon, and
shall not be subject to question by, the beneficiaries.
ARTICLE FIVE
MISCELLANEOUS PROVISIONS
(A) Incontestabilitv:
The beneficial provisions of this instrument and of Settlors' Last Wills and
Testaments are intended to be in lieu of any other rights, claims, or interests of
whatsoever nature, whether statutory or otherwise, except bona fide pre-death debts,
which any beneficiary hereunder may have against or in.Settlors' estate of the
properties in Trust hereunder. Accordingly, if any beneficiary hereunder asserts any
claim(except a legally enforceable debt), statutory election, or other right or interest
against or in Settlors' estate, Settlors' Will, or any properties of said VJill, or directly
or indirectly contests, disputes, or calls into question, before any court, the validiry
of this instrument or of said VJill, then;
(a) Such beneficiary sha11 thereby absolutely forfeit any and all
beneficial interests of whatsoever kind and nature which such
beneficiary might otherwise have under this instrument and the
interests of the other beneficiaries hereunder shall thereupon be
appropriately and proportionally increased and/or advanced.
(b) All of the provisions of this instrument, to the extent that they
confer any benefits,powers, or rights whatsoever upon such claiming,
electing or contesting beneficiary, shall thereupon become absolutely
void and revoked, and
(c) Such claiming, electing, or contesting beneficiazy, if then acting
as a Trustee hereunder, shall automatically cease to be a Trustee and
shall thereafter be ineligible either to select, remove, or become a
Trustee hereunder. The foregoing shall not be construed, however, to
limit the appearance of any beneficiary as a wimess in any proceeding
involving tlus instrument or said Will nor limit any beneficiary's
appearance in anp capacity in any proceeding solely for the
construction of either of said documents.
(B) Payment of Debts, Taares and Other Charges unon Settlor's Death :
Upon each Settlor's death, the Trustee(s) may pay to or upon the order of Settlar's
personal representative funds needed to pay Settlor's debts, funeral and burial
expenses, costs of administration, death taxes and specific bequests, if any, under the
13
Settlor's Last Will and Testament. The Trustee(s) may rely upon Settlor's personal
representative as to the amount of such charges. The decision of the Trustee(s) about
whether to provide funds shall be final, except that the Trustee(s) shall use any U.S.
Treasury securities that may be redeemed at par to pay federal estate taxes for that
purpose. Assets that are not included in Settlor's gross estate for federal estate tax
purposes shall not be used for such payments.
(C) Payment of Taxes at the Surviving Settlor's Death: If the surviving
SetUor does not negate this provision by specific reference to this pazagraph in the
Last Will and Testament of the Surviving Settlor, the Trustee(s)shall, upon the death
of the surviving Setflor, pay to the estate of surviving Settlor from the principal of the
Trust a sum sufficient to cover the estate and inheritance taxes payable by reason of
the death of the surviving Settlor and attributable to the principal of the Trust.
(D) Disclaimer: Any beneficiary hereunder, or the legal representative of
any such beneficiary shall have the right, within the tune prescribed by law, to
disclaim any benefit or power under this Trust Agreement.
(E) Word Meanines: The words "herein", hereinbefore", "hereinafter" and
"hereunder" refer to this Agreement as a whole and not merely to a subdivision in
which such words appear, unless the context requires otherwise. The singular shall
include the plural, the plural the singular, and the use of any gender shall be
applicable to all genders. The terms "child" "children" and "issue" and similaz terms
shall inciude adopted children, regardless of the date of adoption, with full effect as
if they were the natural children of the adopting parents. The term "minor" shall
mean any person under the age of twenty-one (21) years, regardless of the age of the
majority provided by statute.
(F) Paragranh or Article Headings : Headings contained in this Trust
Agreement are inserted only as a matter of convenience and for reference, and shall
not be construed in any way to define, lnnit, extend or describe the scope of any of
the provisions hereof.
(G) Governing Law : This Agreement shall be deemed to have been
delivered to and accepted by the Trustee in the State of Pennsylvania, regardless of
the jurisdiction in which actual execution may have occurred, and shall be interpreted
and governed in all respects by the laws of said State which shall be applied to any
dispute arising hereunder.
(I� Enforceabilitv: The invalidity or enforceability of any particular
provisions of this Agreement shall noY affect fhe other provisions hereof and this
Agreement shall be construed in all respects as if such invalid or unenforceable
provision was omitted.
14
(I) Change of Agreement: Except as otherwise specifically provided
herein, no change, modification, amendment of, or waiver under, this Agreement
shall be valid unless the same be in writing and signed by all of the parties hereto.
(,n Notices: Any notice, request, direction, instruction or other
communication permitted or requested to be made hereunder by any party to the other
shall be in writing, including telex, telegram or telecopier["fas"], signed by the party
giving such notice and shall be delivered personally, sent by registered or certified
mail, postage prepaid, or by telex, telegram or fax, in each such case followed by
written confirmation to the other parties. The date of personal delivery, the date of
receipt (if mailed), when delivered by the telegraph company or in the case of telex,
telegram, or fax, when received, as the case may be, shall be the effective date of
such�iiatice. Whenever under the terms hereof the time for giving notice or
perfo 'ng an act fails upon a Saturday, Sunday or holiday, such tune shall be
exte ed to the next business day.
Mr. & Mrs. Ernest J. Kruse
565 Dogwood Drive
� Mechanicsburg, PA 17055
IN WITNESS WHEREOF, with the intentions to be legally bound hereby,
the Settlors and the Trustee have executed this Trust Agreement on the day and year
first above written.
\ WITNESS: SETTLOR:
!
� Ernest J. Kru
WITNESS: SETTLOR:
� � ��
Marjorie . Kruse
SS• � TRUSTEE:
� �r
Ci1�2-e?o� --U�.c�c
Ernest J. Kruse
15
COMMONWEAT,TH OF PENNSYLVANIA )
} �S:
t�OUNTY OF YORK )
dn this, the , k 5`� day pf , 2005, before me, a Natary
I'ubiic, personally appeared Ernest J. K se��jorie J. Kruse, known ta me
or satisfactorily proven ta be the persons whose narnes are subscribed to the within
instrument as the Settlors and Trustee and acknowledged that they executed the same
for the pnrposes tt�erein contained.
��hIN WI'I' SS WFiEREOT I hereunta set my hand and officia[ seal this
�=day of , 2005.
jl�t"1 � e ��,�w�7
Notary Pub c
My Coznrttission Expires:
���ryy�m pp pENNSYLVANIA
��
GwGavmG���'�'��
D0W�u9�°���2009
MyCommksiarF�p �Y
themb�,Pentreylvania Assaciailon flt NotarFes
16
DECLARATION OF INTENT
The undersigned, hereby declare that, Ernest J. Kruse and Marjorie J. Kruse, as
Settlors of the Ernest J. Kruse and Marjorie J. Kruse Revocable Trust, are
transferring to the Trustee of said trust who will hold in Trust, all items listed on
Schedule A attached hereto and incorporated herein as amended from tune to time as
well ashousehold furnishings, automobiles,jewelry,bank accounts,securities,bonds,
clothing and other personal property of any kind in their names and henceforth such
assets shall and will belong to said Trust and not to them individually. They further
declare that, except to the extent of the interest provided to them under the terms and
provisions of said Trust; they have no personal interest in any of the above itemized
personal properties, it being intended that this Declaration constitutes and affirmation
of Trust ownership which shall be binding on their heirs, administrators, executors
and assigns.
IN WITNESS WHEREOF, the undersigned has executed this instrument this 8thth
day of July, 2005.
y ��, ���
By: ✓u-P/J By�9'l�� Q ilStlL��C,
Ernest J. Krus , Settlor Marjorie Kruse, Se or
By: " .,•�F.�B�- �_
Emest J. Kr se, Trustee
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF YORK .
On this the ��ay of �, 2005, before me, a Notary
Public, personally appeued Ernest J. use adfd Marjorie J. Kruse, known to me
or satisfactorily proven to be the persons whose names are subscribed to the within
instrument as the Settlors and Trustee, and acknowiedged that they executed the same
for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my and official seal.
c COMMONWEALTH OF PENNSYLVANIA
N TARY P �LIC
MY COMMISSION EXPIRES: �"���
S.Dawn GladfeNe4��N Pubfro
DGlsbur9 B°�°�Yres May 17,2009
My Convni�'sbn E�
Member,Pennsy�vania Associa�ion af Notaries
17
SCHEDULE "A"
PURSUANT TO ARTICLE ONE, (A) OF THE REVOCABLE TRUST
AGREEMENT BETWEEN SETTLORS AND TRUSTEE, AND THE
"DECLARATION OF INTENT° WHICH IS ATTACHED THERETO, THE
FOLLOWING IS A LIST OF THE PROPERTY OF SETTLORS WHICH HAS
BEEN TRANSF'ERRED TO THE TRUST:
ITEM: DESCRIPTION:
Accounts Present Acct.No:
Morgan Stanley 652 047660 066
PNC Bank - Checking 50-0202-6354
PNC Bank - Money Market 50-8003-2178
Charles Schwab 5260-9846
Other Assets: General Household Fumishings
, M3y. 7_7.2013 09:45 AM THRIVENT FINANCIAL 17172546349 PAGE. 3/ 4
�Thrivent Financial
for Lutherans°
Death Benefit Information Variable Annutty Contract: C2862677
DeceaSed: Marjorie J Kruse Date of Death: 0428/2013
Qate Prepared: D5107/2013
Claim Num6er. 511309
�eath Beneft
Cast Basis $ 5,Op0.00
Taxable Gain $ 18,768.85
Enhanced Beneflt $ 0.00
Approximafe Death Benefit S 27,768.85
Beneficiary Designatian
ease Goverage: �'3B� �,� r�� ��`
Primary:Susan J Wallete, Robert W Kruse,Child(ren}
First Contingent: Ernest&Marjorie Kruse Revocabis Living Trust,dated 07-08-2005, Inter vivos
Trust(Living Trust)
Spec{al Measages
1. ATTENTION ""'ATTENTION'""'ATTENTION ""`"`ATfEN710N Variable Product lnformation—
Very Important—Plsase Read: The daath benefil guarantee matures vn the date we receive proof
of death. The death benefit amount is calculated as of that date. in the event accumulatetl values
are less than the guarantee,we wiU increase accumufated values to the guarantee amount as of
that data. IMPORTANT: We are required to keep the calculated death benefit emount fn Ihe
market, allocated to the same subaccounts selected by the decedent, until we receive proper
insuuction from sach benefidary(the beneficiary s claim form in good order), This means that the
death proceeds,which include the guarantee amount(if applicable)remain subject to the
investment experienee of the variable account which may inaease or decrease daily.
2. IMPORTANT TAX REQUIREMEMS: Each beneflciary wiil be subject to federal income tax
withholding fpr their share of the taxable gain. Each beneflciary needs to complete the Notification
for Federal and State Income Tax Withholding section on the Claimant s Statement. If NO
withholding is desired,the first 6ox in the Withholding section shoultl be checked. If the beneflciary
DOES want withholding,the appropriate se�tion should pe complated.
3. To assist the beneficiary in selecting a distrlbution method,you should refer to Mnuitant and Owner
are the Same Beneficiary Dpdon Guide-Non-Qualified. This guide can be printed fram FieldNet,
Products &Marketing, Know Yaur Product,Annuities, Claims,Annuity Beneficiary Option
Guides/Death Tax Charts.
AL�INPORM0.ilONONTHiBPME�SfpamYEk.WLUSEON�Y. PE9B J OI J Deceased's CuSi0IT19Y ID; 507898885
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Pee fur �hi. cerlil�icnlc. �.6.i1U . ,-,,,— 'i'hi,a is to cer[ifi Iha� the intoimation here kiven is
' p�TNOFpf
. o�y,t�.. �'y,rl•, dul}e�d�d (��itti1m�'asJLur I'ReE tra��' Th�(ongint I
�q���`"�-�G
'�9 ccrtiticate will be forµ�arded to [he State Vital
,. z�
� u � ` O��q9rdlfNT OE,�dP~n` RecorJt O(fice foi permnnent filing.
� ♦ `
� 196 ? � �, 42 ° � �� �y���� APR�ao2�-
---Culific�tion 'Vwnher -- �.�
� . """""' Local Regisvar Date Issued
3
P.io.�,,.�., �oMMO��.E«, a .��....a.�oaos
J"ei;k;,`,k` � CERTIFICATE OF DEATH� sa.<.meru�,.,e�.:
«e.�rv,me�Fi..<mmm�,�a..,smn„) �.nv rv,,,..e�, m�moio.vn.�waen�.�o�
Marjorie J. Kruae F. 3483-30-9877 �Jzile28� 2013
.ne=-�a�<eo-enea�<.r:) se.u�a�,i v�., sc.ooae,i o s.oa�e or eirtn Imo�o.v/veap tsaen mo�ml eirtn m«ec a scxe opoAr�is�ce��ml
o.,m o.�: �Phi�adel hia
'`�I m 83 a.>«o.ro.eieMCO�„� Hau 5 ,e �au a H Nov�nber 18 192 o�aa..,.u„�e^e�Tnvia=e ico� .v� i d 1 lii
v. ry) Hb.Reiltlence(St utlePp<NO.� 8c. Itl i�Ipi
Penns lvania gQr ..e«<e�,.<u��ai„a �PPer Allen
aa.neaa�,.a�ca m 565 Do wood IIr. — � -- "'
C:�vnberland �.ne:ie��a rzia coa.� o�o,e«<e�,.�m�e..i�ni�u,.,�e.ar �v�eo,,,.
mee ro �.a .m .r s<ac�:ae r�,..�or o�am ma�n�a o wmo�„ea �„ s o � ...u� w ., g�� �
ov uW� o� ��oo �ea om iea ou 1�Fs-nestUJ.�Kruse. � ••�@P•��•"na.m,.�„
az. CSn�r.rv,.��evi wmme.�a:<,s�rnn�V� z.�i.a�1��.•t mmme,�a:�)
Csrl Metz:�.er 33.Lillian Lo�an�M
i�ro.�..�r.rvz�,e nic m oe�eae�e .i � a�r.r.n.m�e nearess Iso-ee�.�e N ,�ne.,ci
.v,s...�,zic coaei
g Ernest J. Kn�se 15 0.ouse 16C565mDO wood Drl� Mechariicsbur PA 17055
C _ _in o _ _ 6_ _ _ _ _ _ _ _ _ _ _if oe.m o - -e s6me.,.ne.eben�.�Tn.,.a v' � _ _ _ _d r - b o ' _ _
s �o e �.c���.tlnoo,.�io„ �o �.a o„n..�...� ° o�� .�u�.v «<e��.,ro�.,e
o.,s-r�.,.,c inw.o e o o .�sa�ny��
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� REV346EX(03-09) 34600�7120
ESTATEINFORMATION
SHEET
pennsylvania FOR REGISTER'S OFFICE USE ONLY
T T CountyCotle Vear FileNUmbe�
DECEDENT INFORMATION: Enter daw as itwi��appear on all
documenu submitted to the Department. 21 13
DecedenYs Sociat Security Number Date of Death Date of Birth
483 30 9877 04 28 2013 11 18 1929
Last Name Su�x First Name MI
KRUSE MARJORIE J
TYPE FILING: Enter mark(x)to indicate the nature of the retum to be filed with the department.
❑ Probate Return ❑ Joint Assets Only � Non-probate Assets Only ❑ Litigation Purposes(No Other Assets)
LETTERS GRANTED: Enter mark(x)to indicate the nature of the proceedings at the register of wills office.
(Attach additional sheets if explanation is necessary.)
� Testamentary � Administration � No Letters � Other(Please Explain) non-probate
ATTORNEY/CORRESPONDENT INFORMATION: Enter all data concerning the attorney or other individual to receive all Wx
� intormation and correspondence.
Last Name Suffix First Name MI
LENOX DAVID J
Supreme Court I.D.# Telephone Number
Attorney/Corrrespondenfs e-mail address:
06298 717 271 7175
First line of address
8 TRISTAN DRIVE, SUITE 3
Second line of address
City or Post Office State ZIP Code
DILLSBURG PA 17019
PERSONAL REPRESENTATIVE INFORMATION: Enter a�l data conceming the personal representative�s)of the estate
Executor/Administretor authorized by the Register of Wills.
Social Security Number Telephone Number
717 691 8594
Last Name Suffix First Name MI
KRUSE ERNEST J
First line of address
5G5 DOGWOOD DRIVE OFFICIAL USE ONLY
Second line of address TRANSACTION COUNii I I
« � i
City or Post Office State ZIP Cotle
MECHANICSBURG PA 17055
Complete generel estate informatlon questions,and indicate additional personal representatives on reverse side.
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 3460007120 34600U7120 �
COMMONWEALTH OF PENNSYLVANIA REV 1162 EX�11-96)
DEPARTMENT OFREVENUE
BUREAU OF INDIVIDUAL TAXES
DEPL 280601
HAFPISBURG,PA 1)128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 017673
KRUSE ERNEST J
565 DOGWOOD DRIVE
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
"____ mia ___"_"
101 � 5907.11
ESTATE INFORMATION: SSN: aa3-3o-98�� I
FILE NUMBER: 2113-0604 I
DECEOErvr rvaME: KRUSE MARJORIE J �
DATEOFPAYMENT: 05/29/2013 I
POSTMARK DATE: 05/24/2013 �
CouNTY: CUMBERLAND �
DATE OF DEATH: 04/28/2013 I
�
TOTAL AMOUNT PAID: 5907.11
REMARKS: RECEIPT TO ATTY
CHECK# 3276
INITIALS: HEA
sEn� RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILIS
David J. Lenox
r�ttarney �4tLaw
8 Tristan Drive, Suite 3, Dillsburg, PA 17019
717-271-7175 (phone)
?17-27t-7i78 (fax}
May 24, 2013 �
Re�ister of Witls
Cumberland County Cowthouse
One Courthouse Squaze
Carlisle, PA I7013
In Re: Marjorie J. Kruse, deceased
Aear Register:
Enelosad for filing please find an inheritance t�rehun in duplicate,alang with a eheck
in the amount of$907.11 represenking the tas due, and a check in the amount af$15.00
for the filing fee. I am also enclosing an original death certificate for Marjorie J. Kruse.
The only taxable asset of thzs estate was an annuity wherein the decedenYs two children
were named as primary beneficiaries.
Please return the recording receipt to rny offxce. I am providing an envelope for your use.
Thank you for your coaperarian.
el��
.�` `
David J. Lenox, squire
DJI.1sdg
Bncl.
Davidl. Lenax, Esq: Ext SQi, Iaw(."asdavidjlenox.comcastbiz.net
S. Dawn Gladfelter, Office Adm.: Ext. 102, Dawn@davidjlenox.camcastbiz.net
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