HomeMy WebLinkAbout08-22-13 isuSeLyyay
J REY��+7V� EX(Obtt)(PI}
pA DOPertment ot Revenue �'�J¢UL USE�ONIY
BuretudlndivttluMTaros �^�1'�� o`'� �ibNUmCm
Qo sax zaoao� 1NHEftITANCE TAX RETURN 21 13 0199
Mar�t6aQUtp.PA f1Y28-080i RESIpENF DECEDENI'
EN"PER dECEDENT INFORMATidN BELOW
SoCiai 3eew'8iy Numbar Date tlf D08th MM6DVYrY 4ate ot Birih MMDUYYYY
1121201c� 013D192d
DeqetlenYa Last M� Sutttz QeCaQe�YS FNSt Fterctie FAf
KBST R. NEL&6N
(If Appliaabie}Errtsr Surv(vtng Spouta's hNOrnufion Beipw
SpousB'B�LBaf Name Suffiz SpDUSe'e Fkst NatMa 471
Spouse's Social Seswnty Number ^ry����Rhi MU$7$E FItED IN Dt1PLICATE WITH THE
- - REGtSTER CfF W1�LS
FRl tX APhROPFnA1'�BBXES BEIOW
� i.6riginai R�um � 2. Suppiemental Retum � 3. Remaindar Retum(Dale�ol Deffih
Psiw fa i2•T3-$21
❑ 4. timited E'state ❑ 4a. Future l�tBCast Compranistt(dete Gf ❑ 5. Federei Estale Tax{2eturn Requiretl
death sfter�i2-i2-82)
� B.ascx6ent£�6Yi�T�te � T. �f�ent�M'aM�tT�ja Llvl�Trust Q.,.. 8. Total Numtier df SOte DeposR�8o„es
❑ 9. lttNi�tiaa Prt�eds Rac�+nd ❑ f D.5pousai POVerty Cro�(6ate a[Oeath ❑ i 1. Eiadion t0 Ta%un+i�Sec.6i M13(A}
Beiween t231-91 eiM 1.1-95) {AttaU�.SrJtadu18�0}
���. CORRE$PON�NT• TWS�CTION MUBT BE COIItP1.ETE0.ALl t�RRESPONDENCE AtM CMIPICENTIAL TAX INFOMMATION SHI%l4.0 BE WREGTED TO:
Neme Daylime�T0lepha�t Number
�
MARK E• HAl.BRUNER, ESQ. 717�3�1-96C1€�-> '"' �"
r� �
c�was��tafofa. rx
� � c � I
� y,. r- r,a � '�
First tit�af Rddre�s r� � � � rv ..:'
cn . r:.
� c r ;� -�-j t�'" -+�i
1013 MUMMA RD, STE E00 �
c-� �' , rx
Seaond Line of Addresa o `--� �--'` ��• rn
-� -�-! ,� Lf; O
Cily ar Part Ofikce S1ate- ZiP Caie �' ta7E t�d -
LEMOYNE PA 1'7043
cnr...vond.erse:mau.dan�s: M�HAl.BRUNERaGATESLAWFIRM.C4M
Undar P4n+�Nu ot PM�M.1 Aeelen tAn t�haw mmbW C�it mWrrt,it�YdinG�V�Y��+9 adMGUMS altti�4.mW b Mu De�d m7 k�MWGauW�ef.
N is twa�wnaet.ane comP�.D`dvstlon of p�aMr�r WMr m�n Ua Patunal.. �� R Ewa ar M InfamWon af wl�kh pnq+ror hu ry knowledpm..
KATHIEEN L- DEBRICK f��� N � ^ r-'6�c,�'� P�lii..,�k�IaLOJ�
��
H56� SCOTLANb ROAD GHAt18 3BUR6, PA 17 2
SGNA7URE�PREPARER 07NER THAN REPRESENTA7NE � DA'fE
MARK E. HALBRUNER, ETQ. � ��(�'3
n�ss
1[]y3 11Uf1MA RD. , STE- 100 �EMOYNE, PA b7[343
RIG! !LL. F l
Sida t
� 15 0 5 61116 5 L.�t7!�[1.i,'t.a� �
� 1505611285
REV-7500 EX(FI)
oecede�es Neme� K 0 S T R N C 0 N
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . � $a.O a
2. Stocks and Bonds(Schetlule B) . . . . . . . . . . . . . . . . . . . . . . . . . p �0 Q�
3. Closely Held Corporation,Partnership or SolaPraprietorship(Schedule C), , , , , 3 $o • 0 O
4. Mortgages and Notes Receivable(Schedule D) , . . . , 4 $0 • o O
5. Cash, Bank Deposits and Mlscelleneous Personal Property(Schedule E) , , , , , 5, $2�9 3 5•�5
8. Jointly Owned Property(SChedule F) � Separate Billing Requested , , , , g O O • 0 O
7. Inter-Vivos Transfers 8 Miscellaneous Non•Probate Property
�s�ned�ie cJ � Separate B�Iling Requested . . . . �. $2 36,3 41 . 8 4
8. Totel Groaa Asseb(total Lines 1 through 7) , , , , , , , , , , , , , B �239�276 • 89
9. Funeral Expenses and Adminiatrative Costs(SChedule H). . . . . . . . . . . . . g, $8,5 9 3• 4 9
10. Debts of Decedent, Mortgage Liabilities,and Liens(SChedule I) , , , , . , . , . �Q $58 4 • �0
11. Total Deduetiona(total Lines 9 and 10), , , , . , , , , , , �� $9,177. 4 9
12. NetValueofEatate(LineBminusLinell) , , , , , , , , , �p, $230,099 • 40
13. Charitable and Governmental BequestslSac 9113 Trusts for which
an election to tax hes not been made(Schetlule J), , , , , , , , , , , , , �3 �0 • 0 O
ib. NetVelueSubjecttoTa:(LInel2minusLinel3) , , . , . , , �q �230�099 • 40
TAX CALCULATION •SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxabla
at the spousal tax rate,or
transfers unyer Sec.9N6
(a)(12)X.OV $� .�� 15. ��.��
18. Amount of Line 14 xable
at�inea�retax.o4� �230�099 . 39 �s. 910�354 . 47
17. Amount of Une 14 ta�mble
atsiblingrateX.i2 �0 . 00 ». �0•00
78. Amount of Line 14 texable
et collateral rffie X.15 $0•0 0 18. $Q • �0
19. TAXDUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. �LO,354 . 47
20. FILL IN THE BOX IF YOU ARE REWIESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 1505611285 1505611285 J
OM9848 3.000
.. _ . _. .. . _.
._. _ _. _ _. . _
REV-1500 EX(FI) Pape 8 File NUI11Mr
Deeedent'sCom IeteAddresa: 21 13 Ob99
�GEDENi'S NAME
STREEI'ADDRESS
CITV STATE ZIP
t1 P A
Tax Payments and Credits:
S. TaxO�e{Page2,tfriet9y t�} �1D�354 .47
2. CreditslPayments
A.Priar Paymenta �L��2 d 0 �0 0
B.O�acount 45]i7.72
r�a�cre�ta+s> tz} $10,717.?2
9. Interest
(3) $� . �0
4. if i.ine 2 is greater than line t+��g 3,ent�fhe tAfferenca This is ihe OVERPAY(�NT.
Piii in baz on Paga$Line 20 to request a rePontl. {4) *3 6 3•2 5
5. It Lin¢1 �Lirte 3 is Oreater tha�line Z,enter Me dNiererice.This IS tAe TAX DUE. (5} �0.��
Make check payabie ta: REGIBTER C?F WILLS, AGENT.
PLE/iaSE ANSWER THE fdLL.OWING QUESTION$BY PI.,ACING AN"X"IN TWE APPRpPRIAtE BLOCKS
1. Did decedant make a tr�sf�and: Yes No
a. retain the uae or income of the property transferced . . . . . . . . . . . . . . . . . . . . . . . . X
b. retain the ripht to desipnate who shell use the property transfe�red or Its InCOme . . . . . . . . . .
c. retsin a reversima�Y IMazest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. raceive the promise for life af elUer peyrrrents,benatits a rare4 . . . . . . . . . . . . . . . . . .
2. If deeth ocwrred sfter Dec. 12, 7982,did decedent lransfer properly wiNin one year of death
without raceiviop adaQuate caisideralian? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ �
3. Did decede�t ow�an°In trust fot'w payaWaupon-0oath bank aceqmt a security at h�or her dsffih9 . ❑
4. Did deCedent own en individuel retirement account,8nnuity,or piber non-probate property,whkh � �
contains a henetleiary desipnalbn? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iF THE ANSWER TO ANY Op THE ABOVE GUESTICiNS IS YE$, YOU MUST COMPLETE SCNEDUIE G AND FlLE IT AS PART OF THE RE7URN.
Far dst�af deeth on qr aft�July t,799d,and before Jan. t.7985,ths tv�rate imposed on the net vslue of transfers ta or 6or the�e of The survlWng spause
is 3 percent(72 P.S.�9118{a)ti.1){i}j.
For datas of Aeath on or after Jan. 1, 7995, the tax rate imposed qn the net value oi trnnsfers to or fa the uee of the survlving apouse is 0 percent
(72 P.S.$8116(ay(7.1){ii)J.Thg 8fatuh daeS nM exempt a transfer to a survNinp s(»use frcrm tax,and tbe staWtory raqWrementx for disciostire of assets and
fiiing a tax retum are stili applica4le even H the survrving spouse is tha oniy 6eneflciary.
IFa datea of death on or aRer July 1,2000:
. • The tex rata impased on the nat value of transters from e deceaeeU chOd 27 yaers ot age ar younqer at death to or for the use of a natwal parent, an
aGeptive psrent or a stepparenY of the chik!ia 6 percent(72 P.S.§81!6{a}{12}�.
• The tex rete imppsaQ on ihe n8t value oi tr�nsfers to at for the use of ihe decedenYS IlnEal b6neFlGetleB IB 4.5 percen�,ezcepl e6 nMed in[72 P.S.§9718(a}(1)].
• The tax rete impoaed on the n�et value ot trensiers to or for the use of the deceAenCa siblings is 72 percent[72 P.S.§9tt8(a)(1.3)].A eibling is detined,
under Sectiwa 9102,as an i�tiividuai wt+a hes at least one parer�t in common with the decedent,whether by bioad or adoptbn.
oM.ery z.aaa I
— _� . I
ftEV-t509EXi(6&12)
pe�nsylvania SCHEDULE E
ceP°"'"+�"'roF�""e GASH,BANK QEPOSITS&MISG.
��T�r"aEr"'R" PERSONAL PROPERTY
ESTATE 4G: PILE NUh�ER:
R. Nslson Koat 21 13 4�49
MUUCe the prooseds ot titipetion md the tlse tha proceedn wae raceived by Me e�ste. —.
pll ro ointi awned with d M of aurvNOnhl must W tlkclwW on Sehaduk F.
ITEM VALUE AT DATE
NUMBER DESCRIPTIQN 4F DEATH
�. Proceeds from sale a£ orqan. $2,000.00
2 PSERfi
final payment $920.21
3 Vallay Rural Electric Cooperative, Zne.
re£und $10.51
G ATST
refund $4.39
I
TOTAL(Aiso enter dn line 5,RecepitulaGOn) f $2,935.05
xwaenD 2.aoo If moro spece is neeEerl,uae add'eionp eheeb d ppqr al the�ame eize.
REV-1510EX+(OB�UB) ��HEdULE G
pennsylvania
�rnatn+ErrroF�+�E INTER-VIVOS TRANSFERS AND
��T^"c�TAxReTUR" MISC.NON-PROBATE PROPERTY
r�si�HroECeoerrr
ESTATE OF ILE NU 8ER
R. NQlson Kast 21 13 0194
This schedu�e must be completed antl filed if the answer to any of questiona 1 through 4 on pepe drree M the REV-1500 Is yae,
I N F PRO RTY
ITEM MFA.iDEREwMEpFitEmnKe£FEE.ItE�RREUTIPNlM➢i00EGE9EMUi OATEOFQEATH %OFDEC{YS �C�USION TAXABLE
M1RR�BE �}fIXtECFiRM6QATtKNACCPV#Th£DEE6lORREtLEBTATE VALUEOFASSET IMEREST FFAI.ICABL VALI,JE
� Suaquehsnna Valley
Eederal Credit Union
Innestment ZRA
Heneficisry: dauqhter,
Kathleen L. Debrick $81,2q8.68 100.0000 $0.00 $81,208.48
2 ING
Annuity No. Iq61901-pW
Owner/Annuitant: R.
NeZsen Kost
Beneficiary: daughter,
Kathlean L. Dobrick $49,300.00 140.0000 $0.00 849,300.00
FCOST EAMILY TRtTST
3 Reaidence locatsd at 310
Sauth 8raad Street,
Mochanipaburg, Borongh
af Meehanicaburq,
Cumberland Couxxty,
Pennsylvaaia, beinq Tax
Parcel No.
20-24-0785-132; $84,445.25 100.0040 $0.00 $B9,4Q5.25
transf�rred by R. Nelson
Kost ta Kathleen L.
Dabrick, Trustea of The
Kost Eamily Truat dat+ad
,April 5, 2412, by hier
Dead dated April 5,
2012, and recorded in
Cumberland County
Recorder of Depds Office �
on June 13, 2012, at
Instrument xo.
201217627. Valua is rlet
proceade from sale an
Decembwr 5, 2012, plua
equity gifted to buyeas.
see settiement
8tatement.
4 Qrratown Bank
Acct. No. 9901038 $746.00 100.0000 $O.pO $766.00
Tota1 from continuation echod lee . . . . . . . $15,6G2.11
- T87AL{Also enter on Iine 7,Rerspituiatian}$ 236 3II 1.$d
I/more space Ia neetletl,uee adaXion�l�heeb d papx qt iha aame alze.
BW1�AF 2.400
Eatate of: R. Nelson Koat 21 13 0199
3chadule G (Page 2)
It� DOD Value Taxable
No. Deacription of Asaet 8 Intereat Excluaion Value
KOST FAM REV LIV T3T
5 PNC Bank
Checking Acet. No. X2596 $3,091.55 100.0000 $0.00 $3,091.55
6 Suaquehanna Valley Federal
Credit Union �
3avings Account $18. 95 100.0000 $0.00 $18.95
7 3uaquehanna Valley Federal
Credit Union
Certificate of Dapoait $10,420. 96 100.0000 $0.00 $10,620.96
8 Commonwealth Capital Corp.
Income and Growth E�nd, V $2,110.65 100.0000 $0.00 $2,110. 65
Total (Carry forward to main achedule) $15,642.11
R�-,$,tEx,"�' SCHEDULE H
pennsyivania
pEPORTh¢NTOF RE�ENUE FUNERAL EXPENSES AND
ww��r�cerwcRSTOrzN ADMiNISTRATIYE COSTS
�smEHrocr��Hr
ESTATE OF FILE NUMBER
R. N�}�eon Koet 21 13 0199
Deatdent'a Gebb must ba repoMd on Seheduk i.
fTEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALIXPENSES:
�. Orgmniat at funoral aervice $100.00
2 Funera2 luncheon $564.40
Total from continuation echedulas . . . . . . . . , $1,320.54
B. ADMINISTRA't'IVE COSTS:
1. Persoaal Representetive Commissions:
Name(s}of personai Representative(a}
Street Addre�s
Clty $tate ZIP
Year{s}Commissian Paid:
2. Attomey Fee,s: $3,500.04
3. Femily Ezemptian; pf decatlenfs addreae is not tha same as bisfmanfs,sNSOh m�plaoffiionJ $3,500.00
Cleim�t Karsn $. K08t SLYbO}
Street nddresx 310 8. Broad Street
City Mochanicsburc State PA vP 1?Q55
Relationship of Claimant to DecedeM DBUGHTER
4. Prob6te Fees:
5. AccOUntantFeeB:
$. TeX R�um Prepargf FeeS:
7.
1 Postage $13.95
TOTAI iAlso enter on Line 9,Recaptulatian) 8 8 593.A 9
BW�BAG 1.tl00 If mare apeca ia neeCed uea adERional aheets M peper of Me aame size.
Estate of: R. Nelson Koat 21 13 0199
Schedule H Part 1 (Page 2)
Item
No. Deecription Amount
3 Auer Cremation Servicea of PA, Inc.
funeral gooda and aervices $650.27
4 Public Opinion and Patriot-Newa
obituariea $620.27
5 Pastora for funeral aervices $250.00
Total (Carry forward to main achedule) $1,320.54
_ .. _. .. _ __
REV-151T E%+(it-OB)
pennsylvania SCHEDULE I
cePaQn�rrroF rrEVewue DEBTS OF DECEDENT,
a�`�"^�T`x"E"'R" MORTGAGE LIABtLITIES 8 L1ENS
RESqEMCECEDENT
ESTATE OF FILB NUNBER
R. Nelson Kost 21 13 4149
RepoR dedb Incurred by tha tlacadent prior to Aeath that remalnad unppid at Ne dete of Aeath,Ineluding unrelmburoed metlieal axpense�.
�TEM VRLUE AT pATE
MmABER �SCRIP110N OF pEp,TH
� United Statea Tresaury
2012 faderal incoma tax liability $574.06
2 Medical bill $10.00
TCri'AL Also enter on Llne 1p,Rece Hulation f 58A.00
aw�enH 2,aao If more dpaCe is needed,insM addttional aheeta of tha same size. I
REV-t813EX4(Ot-10) SCHEDULE J
pennsylvania
GEPA4iMENTClF REVENUE gENEFlCIARIES
It�RtTPNC;E7AX RETtb?N
AESIOEMDECEDEM
ESTATE 17F: FII.E NUMBER:
A. N lson Ko t 2 144
RELATIONSHIPTOOEGE{7ENT AMOUNTORSHARE
NUMBER �ME AND ADDRESS QF PERSpN(S)RECEMNG PROPERTV Do Npt Llst 7rust»�s) OF ESTATE
1 TA%ABLEDIStRIBUTIONS(I�dutlsMriqhta{wuwldiat�butionaentltranafaau��x
6aC.911$(8}(12}.]
�. Kathleen L. Debrick
3560 Scotland Road
Chamhersburg, PA 17202
ZNG
Annuity No. I6619p1-OW
OwnerlAnnuitant: R. Nelnon
Koat
Heneficiary: daughter,
Kathleen L. Debriek
Invontory Value: $49,300.00
Susquehanna Vailey Federal
Credit Union
Inv�astment IRA
BeaePicisry: daughter,
Kathlaen L. Dsbriek
Inventory Value: $81,208.48
One-Third of Residue:
ENtER DOLL4R AMOlNJfS FOR 019TRIBU110h5 SHOWN ABDVE ON LIFE3157HROUGH YB OF REV-i5tl4 COVER SHEET.AS APPROPRtA1E.
�) N�LTAXABLED15TR18UT�ONS
A.SPpIJ5AL DIS7Ft16UTIONS UNpEft SEC710N 9i 18 FOR WHIGH AN ELEC170N 70 TA%IS NO7 7AKEN:
i.
6.CH4RfiABiE AhD GqVERt�AEMAL OtSTRlBUfiOhtS:
i.
TOTAL OF PART 11-ENTERTOTAI NON-TAXABLE DI5'fRIBUTI0N5 ON UNE 13 OF REV•7500 COVER SHEET. ; $O.00
9W�6AI 2,tl00 If more space is needed,use eddNipnal sheets ot paper oi the eeme size.
Eatate of: R. Nelson Koat � 21 13 0199
Schedule J Part 1 (Page 2)
Item
No. Deacription Relation Amount
1 $33,196.97 Daughter $163,705.45
2 Karen S. (KOat) Labo
1101 Lindham Court, M609
Mechanicsbuzq, PA 17055
One-Third of Reaidue:
$33,196. 97 Daughter $33,196.97
3 James M. Koat
312 S. Broad Street
Mechaniseburg, PA 17055
Ona-Third of Reeidue:
$33,196.97 3on $33,196. 97
_ _ _
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee tbr this certificate, $6.00 „�����������" This is ro ceriify [hat [he information here iven i
��"'� �TH OF p,...._, g
���Ep -- fyy'rr'= duly filed wi�h me asaLo a�1�Reg st a�r.� The o Dinr
.a_,� "�`- -- yi certificate will be forwarded to the State Vit�
E� -�- a= Records Office for permanent filing.
:• + ♦r � �y �
P 18 5 7 r � 3 8 ��`�pqar ,��."`�'�� ��u��- ��,( rw� ' �t/a���l�
MFNr oF ,"'
CertiScation Number ,,,,���"
Local egistrar Date Issued
ryq/V rint In COMMOMWGLTI OF P[NNSYWAMII��OEV/�IITM[NT OF NEAITX•VRAI RFCOIIOS
�m«i�k� CERTIFIGATE OP DEATH
m.w�me .
a.o.e.a.nr.�.i.i ra...�.�c�.a,Mmai.,�...,suni. a,s« a.seci.i s.ou.�n N�m . �,o.�.m o.nn Inno o.v .J tso•n nnnl
R. Nel�on Koci� IZ Male 202-20-1528 NOVSmbar 21� 2012
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[1ah nla�bui P�nn� lv�ni�
84 Mon<M o�y� ryou� ��•4• lgnuary 30� 1928 )O.BIRI�p1�o�Ceunq) CilpD4L'1�S1E
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la.an� • • counq) 312 Soutfi HsoaG SCa�st Ov�a,a�oa.�tnv�a�n M.
Camb�rl�nE p.ti�m�nu(accoe�l 1DOSS mNO.O�eM�MIH�Gw�lbnllmlt�ol nLCh�nic�burQ �iry�bero.
flw�InUSAem�tlRerc�� IO.M��N�ISYN��tTm�MW�a1� M�i�I�G Wlew� S1.SUrvhIMSPO�+wYN�m�IHw1I���lr�vm�0�le�b r�em�r�i���
�Y mN �VnNawn DO c�tl �N N�G �Y
31.R�M1� s N�m��Flnt�MI tl1�.1�rt.5uTa�Ve �13.Mot1��r'�N�m�PNeib FI�R M�r�l��� FIrR,M tl ��4art
R�a Nwlaon Xeet Dorothy HaiQC•
S��.Inlorm�n<'aN�m� UY.I��I�t1pn�AlptoO�c�O�nt rm��rtyM�lln{ • Xti�t�ntlNUmM�.CNy�lb[��LpCetl�
1N.In O
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1 d W MsclfaniuDUr � Penna 1van1� 1�055 Ca�Dail�nd
� ]b�.M1UtM1O o IappfhlOn Sull�l C�em�tlan lbl.��b pbpMltlo l�u �[� Ol�pwhlOn(N�m�Olum�t�ry�etiT�[Ory.o�a[I���O���l)
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. ._ _ ._ . w.00.nie�r�.�..n x .
THE KOST FAMILY REVOCABLE
LIVING TRUST DTD. OCTOBER 30, 1997,
AND
AMENDMENT TO TRUST
DTD. DECEMBER 5, 2006
AMENDMENT TC?THE KCfST FAMILY ItTVOCABLE LiVING TRUST
This arnendment is made the_��day af�e���,E.. 2Q06,by R.NEI,SON
KOST and DQRIS J.KOST,as the grantors and trustees of'THE KOST FAMILY REV OCABLE
LIVING TRUST ("the TrusY'), a revocable inter uivos trust created by agreement dated Oatober
30, 1997:
1. R. Nelson ICost and I7oris J. Rost now resida at 231 Hedge Row Drive,
Chambersburg, Pennsylvania i72Q1, and they desire ta transfer the siYus of the Tsust to Franklin
County, Pennsylvania, and to otherwise conform the Trust to Pennsylva:nia law. The Trust shall
therefore be amended in a11 respects necessary to accomplish these purposes,and the Trust shall be
consttved and regutated in aIl respects hy the iaws of the Cammanwealth of Pennsylvania,
notwithstanding any residence in another jurisdiction by R.Nelson Kost,I7aris J.ICost or any other
beneficiary or trustee of the Trust;provided,however,that the then-acting tnistees o£the Trust shall
have Yhe disoretian to invoka the laws of any jurisdietion wherain Trust property is located in order
to better achiave the gpals of easing the administration of the gantors' estates and minimizing the
Eaxes due by reason of their deaths, Wi#hout limiting ihe scopa of the foregozng general aznendment,
the Trust is speeifically amended by replacing a!1 referenaes ta Flarida law with references to the
co�responding provisians of P�nnsylvania law.
2. The terms provided herein shal] prevail over#he terms o£the Trust (and any prior
addenda and amendrnents to the Trust), Except as expreasly pravided herein, the Trust (and any
prior addenda and amendments to the Trust) shall remain in fuH force and effect.
IN WITNESS WHEREOF,the undersigned have executed this instrument on the date first
written a6ove. ��`/�
� �� 1,��
S ------���-d�—•����� R,NELSt1H KQSx
�� ������-
��SS �a���.��
COMMONWEALTH OF PENNSYLVANIA .
. SS:
COtINTY OF FRANKI.IN .
4n this,ths_,,.��t_..tiay oft fJt�"r7yHt2�C _, 2t�6, befare me, a Notary
Publia, the undersigned officer, personatTy appeared R NELSQN KOST and DURIS J. KOST,
known to me(or satisfactorily proven)to be the persons whose names are subscribed to the within
insUUmsnt, and aclrnowl�ged that they executed the sama for the purpases therein contained.
IN W1T'NESS WHEREQF, I hereunto'set my hand and official seal.
N-- ot-- ����`��'�'�.��
THANA K TNIGG otary Public
Notary Pub11c
CNAM8ER58URG iWP,FRANKIIN COtINTY
My Commisslan Ezpirea Mar i 9,2007
i �
� THE KOST EAMILY
REVOCABLE LIVING TRUST
�
� The Koat Family Revocable Living 1Yust is hereby created and established between
R. Nelson Kost and Doria J. Kost, of Highlands County, Florida, hereafter referred to as
' the Grantor or Grantors, and R. Nelson Kost and Doris J. Kost,Trustees, hereafter referred
� to as the Trustee or Trustees.
� ARTICLE I.
STATEMEI�IT UF PURPOSE
� The Grantors have establiahed t6is Trust in order to provide a means for the
management bf certain of Che Grantors' properties, and perhaps the proceeds of insurance
� upon either of the grantor's lives, for the management of such further property interests as
wmay be deposited wltU the Truatee by the Grantors, and for the maintenance, comfort, and
� support of the Grantors during each of the grantor's lives, and, after the death of both of
the Grantors, for the benefit of the Grantors'children, all in t6e mann�r hereafter provided.
�
ARTICLE II.
� FAMILY STATUS
� For information purposes, at We time of the execution of this Trust Agreement, the
� Grantors' family status is as follows.
� The Grantors are married, and the Grantors have children. The Grantors'
children's names are James M. Kost, Kathieen L. Debrick and Karen Sue Koat.
�
�
�
The Kost Family Revocable Living Trus4
ARTICLE III.
TRUSTEE DESIGNATION
A. The original Trustees of this Tyvst are the Grantors, R Nelson Koat and
Doris J. Kost. Either original Trustee may act independently from the other
in any matter concerning this Trust. Upon the death, incapacity, or
resignation of either of the original Trustees, the remaining surviving Trustee
shali continue to act as the original Trustee. In the event of the death,
incapacity, or resignation of both of the original Trustees, Kathleen L. •
Debrick shall serve immediately as the successor Trustee. In the event of the
death, incapacity, or resignation of the successor Trustee, Karen Sue Kost
shall serve immediately as the alternate successor Trustee. Any reference to
the Trustee herein shall also refer to any successor Trustce.
B. The Trustee shall have sole responsibility for We custody and safekeeping of
all trust assets, for the collection of principal and income, for the keeping of
adequate records and accounts and for the filing of tax returns.
C. Each successor Trustee shall accept We of5ce in writing and shall be vested
with the powers and duties of the trusteeship immediately upon delivery of
the written acceptance to the predecessor Trustee, and if there is none, to one
or more of the beneficiaries of the trust, without the necessity of any other
act, conveyance or transfer.
D. During the time that eiWer of the Grantors is living, any Trustee serving
under this Trust may resign as Trustee by delivering, to the grantor or
Grantors, a written resignation signed by the resigning Trustee. Afcer the
—._.. . ___ _ ..__ Tl�n Ye.c! Re...:k. Da....�..W_ i ��rr_� .. .._
_
��.
�
�
� death of both of the Grantors, any individual Trustce may resign by delivering
�
to the successor Trustee a written resignation signed by the resigning Trustee.
� E. The Grantors waive compliance with any law requiring tl�e qualification of the
MTrustee or the registration of trusts, or administration or accounting by
� Trustee under the supervision of any court. Instead, the Trustee shall furnish,
not less frequently than annually, an accounting to each trust bene5ciary who
� is entitled to receive current distributions of income whether or not distri-
� buted, and whether or not the distribution is discretionary, and to each
beneficiary of a charitable remainder. The accounting shall be only for the
� trust in which the person receiving the accounting is interested. Any person
� entitled to receive an accounting, or a person legally entitled to act for such
person, shall state in writing such objections to an accounting and deliver the
� objections to the Trustee within Wirty (30) days after receipt of a copy of the
� acEOUnting. Failure to object in this manner shall constitute a waiver of
� objections. The waiver shall be binding as to all matters stated in the
accounting, or as ahown by it, upon all persons claiming under the waiving
� beneficiary, whethcr or not in being, w6o are then or thereafter may become
� eligibla to share in either the principal or the iflcome of the trust for which
the accounting is made. ,
� F. No purchaser or other person dealing with the Trustee purporting to act
wunder any power or authority granted in, or given by any Trustee in purported
� compliance with, t6is item or any part or parts of it need be concerned to
inquire into the earistenee of facts upon which the purported power or
� The Kost Family Revocable Living Trust
�
� authority depends or into the question whether the purported power or
authority still exists.
� G. The Trustee shall not be liable for damage or loss caused by honest errors of
� judgment made by the Trustee or the Trustee's agents or employees, or by
� any good faith exercise of the discretion given to them.
H. No bond or surety bond shall be required of any Trustee serving under this
� Trust.
� ARTICLE IV.
TRUSTEE COMPENSATION
Any Trustee is entitled to receive reasonable compensation for such Trustee's
services rendered in the administration of the trust.
As compensation for the Trustee's services, an individual, serving as the Trustee,
shall receive a reasonable fee for the services rendered. Such fees may be charged currently
or deferred, in the discretion of the Trostee.
It is also understood that any Trustee is to be fully compensated for any necessary
and reasonable expenditures made, while c�rrying out the duties of Trustee.
• ARTICLE V.
RECEIPT & COVENANfS OF TFIE TILUSTEE
A. The Trustee acknowledges receipt of tlie property described in Schednle A.
B. The Trustee will manage, invest and reinvest the property described in
Schedule A and will hold any policies of ife insurance deposited with the
Trustee, and will receive, manage, invest and reinvest their proceeds and will
hold, manage, invest and reinvest such additional property as may be
The Kost Family Revocable Living Trust
_ . _._.._._...,,.�„
deposited with and accepted by the Trustee, and all of the proceeds of that
property, upon the uses and for the purpose hereafter set forth.
C. The Trustee will accept and will administer, as part of the Trust Estate,
whatever property is to be delivered to the Trustee under t6e provisions of
either of the grantor's wills to be so administered.
D. 1'he Trustee will use the Trustee's best efforts to collect when due, and
thereafter w.ill administer in accordance with the terms of this document, the
proceeds of all policies of insurance made payable to the Trustee. The
Trustee shall have no responsibility to pay premiums upon those policies, nor
to pay the principal or the interest of any loans secured by them except in the
Trustee's discretion to the extent of income and other assets of the trust. T6e
insurance companies that shall have issued the policies shall have no
responsibility other Wan to pay to the Trustee the proceeds of the policies
when they become due and payable. The Trustee shall not be required to
take any legal proceedings concerning the policies until the Trustee is
indemnified to th� Trustee's sole satisfaction.
� ARTTCLE VI.
LIFETIME RESERVATIONS BY THE GRANTORS
A. During either of the grantor's lives, except during any period of adjudicated
incompetency, either of the Grantors shall have the right, to be exercised
from time to time, by a writing or wtitings signed and acknowledged by either
of the Grantors, or signed by either of the Grantors or both of the Grantors
and the Trustee, to be effective when delivered to the Trustee, or to a
.. . ___. - _._.._... . -. _.._ _..TI__..V_1 D _ !1__ T _ __lf_ i • • T
i
jsuccessor Trostee under this Trust, or to any beneficiary of it if for any reason
there shall be no Trustee:
• 1. To revoke this document entirely and to receive from the Trustee all
iof the trust property remaiaing after making payment or provision for
� payment of all expenses connected with the adminisuation of this
Trust.
� 2. From time to time, to amend Wis document in any and every
� particnlar; provided, however, that the duties, responsibilities and rate
of compensation of a Trustee shall not be changed without the written
� consent of the Trustee.
� 3. From time to time, to change the identity, or number, or the identity
� and number of the Trustee or Trustees.
. 4. From time to time, to withdraw, from the operation of this Trust, any
� part or all of the trust property.
� B. During the liferime of eiWer of the Grantors, the Trustee shall pay to or for
the benefit of the grantor or Gtantors, from time to time, such sums from the
� income and priacipal of this Trust as the Trustee, in the Trustee's sole
� discretion, shall consider necessary or desirable for medical care, comfortable
maintenance, and welfare of the grantor or Grantors, taking into
� consideration the standard of living to which the grantor or Grantors are
� accustomed at this time, and all other income and cash resources known to
� the Trustee without borrowing or making sales of property. In exercising this
discretion, the Trustee shall be concerned only with the interest of the grantor
�
mL_ v--` °--'.__ n _ . .. , . . . ... .
i
� or Grantors, rather than t6at of the remaindermen, and shall pay over to the
grantor or Grantors, or to either of the grantor's written order, whatever part
� or parts or all of the income and of the principal of the trust fund that either
� of the Grantors shall direct from time to time in writing. Until either of the
� Grantors shall direct othervvise, all of We income of the trust shall be
distributed quarter-annually to the grantor or Grantors.
� C. If both of the Grantors become incapable of managing their own affairs,
� because of illness, or for any other reason, then during all those periods of
both Grantors' incapacity; We Trustee then serving under this Trust may use,
� , apply, or expend, for the direct or indirect bene5t of the Grantors, whatever
� part, or parts, or all of the income and principal, or both, of the trust fund
that the Trustee thinks is best for the welfare of t6e Grantors.
� D. Neither the conservator nor the guardian of either of the Grantors, nor any
� person, other than either of the Grantors,except as otherwise provided ia this
� item, may exercise any of the rights reserved to the Grantors by the provisions
of this itam.
� • E. Upon written request by either of the Grantors, the Trustee will assent to or
� join in the execution of any document, presented to the Trustee by either of
the Grantors, which will enable either of the Grantors to exercise any of the
� rights reserved by the provisions of this item.
�
�
�
i �
IARTICLE VII.
DETERMINATION OF INCAPACITY
' For purposes of this Trust Agreement, the determination of whether or not a grantor
� is incapacitated shal] be made, in writing, by two licensed physicians, not related by blood
or marriage to the grantor, or any beneficiary of this Trust. Such determination shall
� remain in effeci unti] a determination that the grantor is no longer incapacitated is made,
� in writing, (1) by two licensed physicians, not related by blood or marriage to the grantor,
or any bene5ciary of this Trust, or (2) by a court of competent jurisdiction.
�
ARTICLE VIII.
� TRUSTEE POWERS
' The Trustee shall hold, manage, care for, and protect the assets of the Trust, and
�� shall have the following powers, and, except to the extent inconsistent herewith, those now
� .
� or hereafter conferred by law:
I!R¢~
` A. To retain any property originally constituting the Trust or subsequently added
�'". thereto, although not a type, quality, or diversi5cation considered proper for
� ;:
� trust investments,
� ,
B. To invest and reinvest the Trust property in bonds, stocks, mortgages, notes,
��; options, limited partnership interests, or other property of any kind, real or
, personal, domestic or foreign, suitable for the investment of trust funds.
i�.'
C. To cause any property, real or personal, belonging to the Trust, to be held or
�
registered in the Trustee's name, in the Trusts's name, in the name of a
F A'�..
nominee, or in such other form as the Trustee deems best without disclosing
�� the Trust relationship.
�.
r:.
rt .
. � ._.... _. .__._ TL.. V..��_^��::...Dri�n.s6la .livinnTmef
�
� D. To vote in person, or by genera] or limited proxy, or refrain from voting, any
corporate securities for any purpose, except that any security as to which the
� Trustee's possession of voting discretion would subject the issuing company
� or che Trustee to any law, rule, or regulation adversely affecting either the
� company or the Trustee's ability to retain or vote company securities, shall be
voted as directed by the Grantors if living, otherwise by the adult beneficiaries
� then entitled to receive or have the benefit of the income from the Trust; to
� exercise or sell any subscription or conversion rights; to consent to and join
in or oppose any voting trusts, reorganizations, consolidations, mergers,
� foreclosures, and liquidations, and, in connection therewith, to deposit
� securities and accept and hold other property received therefor.
E. To lease trust property, for any period of time, though commencing in the
� future or extending beyond the term of the Trust.
� F. To borrow money from any lender, including a Trustee hereunder, extend or
� renew any existing indebtedness, and mortgage or pledge any property in the
Trust.
� G. To sell at public or private sale, contract to seli, convey, exchange, transfer,
and othetwise deal with the Trust property, real or personal, and any
�
reinvestment thereof, and to sell covered options, from time to time, for such
� price, and upon such terms, as the Trustee sees fit.
�; H. To employ agents, attomeys, and proxies, and to delegate to them such
powers, discretionary or othenvise, as the Trustee considers desirable, and to
� designate a deputy for a checking account, savings account, or safe deposit
J. To distribute income and principal, in cash or in kind, or partly in each, and
to allocate or distribute undivided interest or different assets or
disproportionate interests in assets, and no adjustment shall be made to
� compensate for a disproportionate allocation of unrealized gain for federal
I income tax purposes; to value the Trast property and to sell any part or all
t,.
�: thereof, in order to make allocation or distribution; no action taken by the
�: Trustee pursuant to this paragraph shall be subject to question by any
;,
beneficiary.
�� K. To deal with, purchase assets from, or make loans to, the fiducia of an
;;
r!' Y
trust made by the Grantors, or any member of the Grantors' family, or a trust
;� or estate in which any beneficiary under this Trust Agreement has an interest,
:
though a Trustee hereunder is the fiduciary, and to retain any property so
:;
- purchased.
;_ L. To establish, out of income and credit, to principal, reasonable reserves for
:i:
deprGCiation, obsolesc�nce, and depletion.
M. No statute, with respect to underproductive property, shall apply to any trust
��.
deemed to be created hereunder.
;;.
N. To perform other acts necessary or appropriate for the proper administration
t<
of the Trust, execute and deliver necessary instruments, and give full receipts
and discharges.
.. T{.e T7..Da II.....:6. Da.e....nl.ln f i..inn Tn�af
absence of breach of trust, aceount to any court, or obtain th¢ order or appmval of any court,
in the exarcise of any power or discretion hesein given. A person payi�g money, or delivering
any property, to the Trustee, sMall not be required to see to, or be concerned about, its
application or use.
ARTICLE RII.
BINDING EFFECT
This Trust shall extend to and be binding upon the heirs, personal representatives,
e�cecutors, administraWrs, and assigns of the undarsigned Grantors and Trustees, and upon any
successor Trostces.
' ARTICLE XIII.
TRUST REVOCATION & AMENDMENTS
The Grantors reserve, and shall have the exclusive right, at any time, and from rime to
time, during either of their lifetimes, to amend or revoke, in whole or in part, the trust created
hereunder, including the right to eliminate any designated beneficiary, and the right to designate
different beneficiaries, without the consent of any designated beneficiary, and without giving
notice to any beneficiary d�signate� herein.
The sale, withdrawal, liquidation, or disposat, in any manner, by the either of the
Grantors, of all, or of any part, of the property held in tsvst hereunder shalt constitute, as to all,
or w such part, a revocation of this Trust.
ARTICLE RN.
DEFINITIONS
Wheaever the word Trustee, or any modifying or substituted pronoun therefor, is used
in the trust, such words and respective pronouns shall be held and taken to include
___... _ . . . . __ .. .__._ _Tho.Knah Rnmilv.Rnvnnnldw.T iveno.Tniat . . .. _ . . .. .__._.
both the singular and the plural, the masculine, feminine and neuter y,ender thereof, and
shall apply equally to the Trustee named herein and to any successor or substitute Trustee
acting hereunder, and such successor or substitute Trustee shall possess all the rights,
powers, dutias, authority, and responsibility conferred upon the Trustee originally named
herein.
ARTICLE XV.
GOVERNING LAW
This Trust shall be governed and construed at all times according to the laws of the
State Of Florida,
The Kost Family Revocable Living Trust
DECLARATION BY THE GRANTORS & ACCEPTANCE BY THE TRUSTEES
On the 30th day of October, 1997, in the presence of the undersigned witnesses, we
sign this document and declare it to be The R. Neison Kost and Doris J. Koat Revocable
Living Trust.
�'�.���.�---
R. Nelson Kost - Grantor
.�.✓f� . �.�'--
� Doris J. Koat - antor
� �
Nelson 1£oat - ruatee
i��% �i�•v�--r
Doris J• Kost - rustee
On the 30th day of October, 1997, in our presence, R Nelson Kost and Doris J. Kost
signed this document and declared it to be The & Neleon Koet and Dorta J. Kost
Revocable Living Trust. t�•the pr�soaoe of�R. Nelson Koat and Dnria J. Kost, and in the
presence of each other, we hereunto sign our names as attesting witnesses.
�_�~ ��
Witness
. � ,
i�
_.. __T7�__V__` C_�'L_ fi______�f_ .r ._!_ _ m___. . . .. . . . . .. .
State Of Florida
County Of Highlands
On the 30th day of October, 1997 personally appeared before me:
R Nelson Kost
[ �who is personally known to me, or
( ) who produced a driver's license as identification
and
Doris J. Kost
[ vj'who is personally known to me, or
[ J who produced a driver's license as identification
R. Nelson Kost and Doris J. Kost, after being given the oath, acknowledged signing the
foregoing document.
,----------
`
}«a««�a�tia«�«tat�ha�aaa«�«���tiaa�
Notary Public om���� W.Roy Wilkea <
State of Florida at Large ;:��� NotaryAiblic,StaroefFiori� ;
Commie�ion No.CC�7�32I <
•�., +'�wRO�`MyComminbnLxpircsON2U/99 �
Commission Number & Commission Expiration Date: " �-�3.�Tµr•Fl��rs.���ww� �AL)
:1i7lUli!!(!!!!!(Kf!!!i!f!u'r;;.'�:...8.i:..u< :.�
The Kost Family Revocable Living Trust
THE KOST FAMILY TRUST
DATED APRIL 5, 2012
THE KOST FAMILY TRUST
THIS TRUST ACREEMENT is executed on the�_day of�,2012,
by and between R. NELSON KOST, a resident of Cumberland County, ennsylvania (herein
refened m as"Scttlor"�and KATNLEEN L.DEBRICK(herein referred to as "Trustee").
ARTICLE I. TRUST ESTATE
1.01. Initisl Princi@$L Settlor, desiring to establish an irrevocable hvst, does hereby
irrevocably Vaz�sfer,assign and deliv�to the Trustee and her successors and assigns the assets listed
a�Schedule"A",attached hereto and made a part hereo£ As fuither evidence of such assignment,
the Settlor has execated or will acecute or cause to be e�cecuted such otber instruments as may be
ra�uired for the purposes of completing the assignment or uansfer of title to such praperty to the
Trustce. The Trusta acxepts such transfer and agsigament to herself as Trustee, and the Trustee
imdertakes to hold,manage, invest and reinvest tfie assets of this Trust and to distribute the income
and princi�l of the Trust in accordance with the provisions of this Agramart.
1.02. Additiooal PrincioaL The Settlor and any other person(s�with the consdrt of the
Trustee, shall have the right at any time to make additions to the corpus of this Tnist or acty share
thereofheroby established. All such additions shall be held,governed and distributed by the Trustee
in accordance with the terms and conditions of this Agreement. The Trustee,in her sole discretion,
may t�equire, as a prera�uisite to accepting property, that the transferring party provide evidence
satisfactory to the Trustee that (i) the property is not contaminated by azry hazardous or toxic
materials or substances; and (ii) the property is not being used and has never been uscd for any
acdvities direcfly or indirxtly imolving the generatiary use,treaknent,storage,disposal,release or
discharge of aay hazerdous or toxic materials or substances.
1.03. �. The Tcustee shall have the right to disclaim, in whole or in pert,prior
to acceptance by the Tnistee, any intaesis in propeity for any reason, including but not limited to
a concem that such property could cause potential liability under any faieral, state or local
eovironntemal law.
� ARTICLE II. IRREVOCABiL1TY OF TRUST
2.01. Irrevocabilitv. Setilor has been advised of the consequences of an imevocable tivst
and hereby dxlares that this Trust shall be irrevocable end shall nat be altered,amended,revoked
�terminated by Settlor or any other person(s).
� ',`:�/ f J—" ) (
ARTICLE TII, LII�'E INSURANCE PCILICIES
3A1. General Prov�. If any insurance policies are ttansPcrred inta this Tn7st, the
Tnrstee shalt be vested with atl right,kitle and intcrest in and to dYC transfcrned policies of insurance,
and is authorizeci anc4 ompowe�d ta acarcise snd e�joy,for the p�ofthe Ttust tter�in c�+eated
and as sbsalute owner af such paiicies af insurance,all the optione>benefits,rights and priviicges
under such policies,including the righi to borrpw upon anci to plcdge thern for a loan or loans. The
Titutee takes ali rights,titie and inter�t in a�!to�e abt>ve staud iffiuranee policies sub;jset to any
priar split-dailar life insurance agree�ment and assigmnerrts,which may be in effdct at the Yime of
transfer. The insuisnee compaaies which have issued policies are hereby authorized and directed
to reeognize tfu Trustee as absolute awner of st�polioies af insura�e and as fuTly ernitled to aI!
options, rights, privileges and interests undcr auch policies, and any receipts, releases, and other
insu�uments oxecuted by the Trusbee in connection with such palicies shal! be binding upon all
ptrsons interested in this Tmst. T�Settlar hereby relinquis2�s all rigltts,titie,iuterest a�i pawers
in such polioies of insurance which Settlor muy own and which rights,6dt,intertst and powtrs are
not assigoabte, and will, at the request of the Trustee, execute all othar instruments reasonably
reqaired to effecxuate this rcls`nguishmcnt.
3.Q2. �y�ent of P�iums. Tht Tmstee shall be under na ob6gation to pap the
prem iums wlvch may becvmc d�and peyable�ttx�ovisic�ofazry policy of insurance whiciz
may be trsnsferred or assigned to this Trust,or to make certain 13�ect such premiums ere paid by the
transferor of such poiicy, ar to notify any persons of the non}�ymeiR of such pcxamitiuns, snd the
Trustx shall be imdor no nesponsibility or fiabiiity of aay kind in t�tse s�h premiu�tns ac+e r�t paid,
except the Trustee shall apply any dividends rectived on such palicies to the payment of pc7dmiums
thtrcAn. Upon notice at any time during the ccrntinuance of this Trust tl�t the praniums due upon
such policies a�e in default,ar that prerniums which witl become dcu wiil not be paid,eithtr by the
riansferor or by any other persan,the Trustee,within 6er sok discretion,maY ePP�3'�Y�h'�'��
amibutable to such policy to the purchase of paid-up insurance or of extended insurance,or may
b�row upon suc�palicy far tt�e payme.nt afpremiums dtiec t2ureon,or may a�ept il�cash val�
of snch policy upon the policy's forfeit�u�e. Tn the evont tbat the Trusta roceives tht cash value of
such policy upon its forfcit�ue for ncmgayma�t afpremiums,tho amount received shall be added t4
tt�e epc�s of this Trust s�staall be administered accarding ta fhe t,erms of this Agreement. if the
insw+cd undar such palicies of insutat�ce becomes totally and permaner►tiy disabled within the
mcaning of any golicies and because thereof the payraemt of prcmiums, or any of them, shall be
waivtd during the gendency of such disability,then upon r8ceipt of such knawledgo,t�Trustee
shall prompdy notify the insurance compatry which has issaed such policies and shall take any and
all steps neces,4ary to rnake such waiver of gremium pravision effcctive.
3.03. Dube�QF Tra��,�W�'��„�ard to Life Inaurae��Policics. The Trustee shall be
undtr no obligation ar duty whutsoevtr excepk wi2h respoct to the safekceping of such poHcies of
inswance and the duty to receive suoh sums as mey�paid to the firustce, in accardance with the
Z
requirements ofthis Trust,bythe companies issuing such polici�,and to hold,manage and disburse
such proceeds subject to the urms of this Agreement. Upon the death of the insured,the Trusue
shall make reasonable efforts to carry out the provisions of this Agreement, including the
maintenance or defense of any suit; provided, however, the Trustee shall be under no duty to
maintain or enur into any litigation unless the Trustee's expenses,including counsel fees and costs,
have been advanced or guaranteed in an amount and in a ma�mer reasonably saNsfactory to the
Tn�stee. 'Ihe Trustee may repay any advances made by her or reimb�nse herself for any such fees
and costs from any corpus or income of this Trust
ARTICLE IV. TRU3T DISTRIBUTIONS
4.01. Trsst Princioal. T'he entire corpus of this TYust, including the assets initially
transfe�reci to this Trust, subsequent additions to triis Trust, and the proceeds ofany sale,exchange
or investment of such Trust assets,shail be used for the pwposes herein coirtained.
4.U2. Distribations Darin�t6e Settlor's Life. The Trustee shall distribute all ofthe net
u►come of the Trust to, or for the benefit of, the Settlor for and during the remainder of his life;
provided thai if the Sedlor is admitted inW a long-tecm cere facility for a period of time grrater than
thirty(30)days, then the TTUStce shall discontinue disuibution of income to the Settlor, and the
Tnistee shall accomulau suy and all of the net income of the Tmst and shall add such net income
to the principal of the Tnut. The Trustee shall make no distributions of principal to, or for the
benefit of,thc Settlor.
4.03. Special Irstrnctions R�aerdina Real Pro�. The Settlor acknowledges that his
daughter, KAREN SUE KOS7', contributed ninety thousand and 00/100 dollars ($90,000.00)
toward the purchase price of the real properry at 310 South Broad Shroet, Mxhanicsbwg,
Climberland Counry,Pennsylvania,and the Settlor subsequently paid eight thou4and,three hundred
and 00/100 dollars($8,300.00)on behalf of his daughter,KAREN SUE KOST, for certain debts
of hers. Accordiagl}+,the Settlor acknowledges an obligation w repay his daughter,KAREN SUE
KOST, a debt of eighty-oae thousand, seven hunclred and 00/100 dollars ($81,700.00) upon his
death, or sooner if said real property is sold during the Settlor's lifetime.
If the real property at 310 South Broad Street, Mechanicsburg, Cumberland County,
Pennsylvania, is sold during t6e Settlor's lifetime or aRer the 5ettlor's death, then the Settlor's
daughter, KAREN SUE KOST, or if she is deceased, then her issue in equsl shares, per stirpes,
shall receive the sum of eighty-one thousand, seven hurdred azid 00/100 dollars (581,700.00) at
setdement of the sale, and the balance of the sale proceeds shall be added to the trust estate.
3
4.04. Distributions Followieg the Settlor's Death. Upon tt� Settlor's death, this trust
shall terminate, and the nvst estate shal! be distributed as follows:
(A) The aforesaid debt of eighty-one thousand, seven hundred and 00/]00 dollars
($81,700.00)shall be repaid to the Settlor's daughtea,KAREN Sl7E KOST,or if she is deceased,
then to her issue in equal shares,per stirpes,if the debt has not already bea�n�id upon the sale of
the aforesaid reai groperty;and
(B) The residual trust estate shall be distributed in equal shares to the Settlor's children,
KATHLEEN L. DEBRICK, KAREN SUE KOST and JAMES M. KOST; provided that the
share of any deceased child shall be distributed to that chilil's issue in equal shares, per stirpes.
(C) Any beneficiary who dies within sixty (60) days after the Settlor's death sl�all be
considered not to have survived the Settlor.
[D) The share of any beneficiary who is at least twtnty-five (25) years old shall be
distributed outright to the beneficiary as soon as reasonebly practical. The st�are of any beneficiary
who is less ihan twenry-five(25)y�rs old shall be held in separate tcust for the beneSciary umil the
bene6ciary becomes twenty-five(25)years old,and in the meantime the Trusta shall use as much
ofthe income and the pri�ipal ofthe separate trust as the Trusta,in the Tmstee's sole aed absolute
discretion,deems necessary to provide forthe proper health,maintenance,support and education of
the beneficiary, taking into account other resources available to or for the beneficiary. If the
beaeficiary dies before becoming twenty.five(2�years old,the baIance of the scparate trust shall
be r�allocated to the beneficiary's then-living issue in equal shares,per stirpes,and ifthe beneSciary
has no then-living issue,the separate nust balance shall be ro-allocated according to thi s S�tion 4.04
as if the bcneficiary had not survived the Settlor.
4.05. Limited Geaeral Power of AnooLbn�t The Settlor's daughter,KATHLEEN
L. DEBRiCK, is hereby ganted the general power to appoint some or all of the}xincipal of this
Tnuttoherselfand/orany lineal descendants ofthe Settlor,in suchproportions and upon such terms
(in tnist, outright gifts or in any other manner) as she deems auivisable; and if she dies, becomes
incapacitated, is removed or disclaims the power under this Section 4.05, then the Setdor's son,
JAMES M. KOST, shall take her place in holding this power of appoinhnent; provided t6a3 the
Settlor may execuu a written instnunent removing any person holding this power of appoimment
and/or designating additional or substitute person(s)to hold this power of appointment;and further
provided that the power of appoiMment may onty be exercised in favor of�e or more of the
Settlor's lineal descendants. This power of appointment shall not be exercisable under the Wiil of
any person holding the power. !f the person(s)holding the power of appointment fail(s), either in
whole ar in part, to exercise the power, then the unappoiM� principal shall continue in trust and
shall be administered according to the terms of this 'Crust. In onder to exacisc this powa of
appoimm�ent,the person(s) acting hereunder shall provide written notice of the proposed�ercise
4
w the Settlox and to the Trustee if someone odrer than the Settlor is than serving as Tn�stee. T�
Settlor shall have the right for ten (lp) days from the date of receiving said notice to veto the
proPosed c�rc�cise. Tfth�Settl�r fails to veto thc pmpc�sed euercise in a writing delivered within said
ten(10) days to ihe person(s)exercising the power, and delivera!within said ten(10) days to the
Trustee if sarneone other than the Settlor is thtn serving ag Trustee,then d�e Tcvstee shall e,xecute
the pow�afa�poin#ment as req�. The Se�ttor may waivo the ten (2U} day veto ppw�by
delivering eycpress written approva]of the requested exercise to the peison(s)exencising the power
and ta the Tnastce if someone other than the Settlor is then servitig as Tnistee.
AR'fICLE V. POWERS 06 TRUSTEE
SAI. �aeat Pawers. In additian to such ather powers and duties as may havt been
gramted elsewhere in this Tn�st,but subject to aay limitatians contained elsewhere in this Trust,the
Trustce shail have the following powors a�dnties:
(A) ln the rnaziagament, care and disposition of this Trust, the Trustte shall have the
power to do al! things and ta e�cecute such dceds, insa�uments and ottra� documa�s as may be
dtemed nxessaryarn3proper,includingtlufollowingpowe�s.atl ofw2richmaybeexercised without
order of or n�port to any court:
(i} To sell,exchange or otherwise dispase of any property,mal,personat
or mixed,whoxesoevtr located,at arry rime hold or acquiral hereuntla,at pnblic or
private sate, for c�sh �on tem�s as may be d�minal by the TnsEee, without
advertisemeut, including Uie iight to ltest for any ferm nOtwithstsndiug the period
of the Trust, and to grent options, including an option for a period beyond the
duialion of�t Tnest. The Settlor maY�PY�Y��Pe;'�Y rnmed by zhis Tn�st
as long as he promptty pays a12 reai property taxes aad utility charges during the
periad of occupaacy; pravided that(a)the right of occupancy shall not pr4wcnt the
sale of any real�roperty owned by tfiis Tn�sz,(b}the Sc�ti�and his estate shall�t
be entitted to any portion of the proceeds from thc seie of any real property owned
by this Tnut;and(c)said right ofoccupenoy shall tertninate ifthe Settlor is admitted
into a icmg-ierm csre facility fa�a period of time greater than thirty(34}days.
(2) T'o invcst all mandes in such stocks, bonds, securities, invcstment
camp�anies c� trust sharrs, morigagas, uotes, chc�ses in action, reai estate,
impravements thereon and other property as tho Tnistee may dcem best, without
regard to any law now or hereafter in force limizing investunents of fiduciaries.
(3) To retain for imes�ent any pmperty depositod with the Trustee
herewnder.
5
(4) To votc in persan or by proxy any corporate stock or other secwiry
and to agree to or takc any other actian in regand to any reorganiza6on, merger,
consal'sdati�, liquidatiocy, haz�ktvptcy or�er gracedurc or proceedings affecting
any stock,bond,note crc other s�vcurity hold by this Tnast.
(5} To uce Iawyers,neat estate brokers,acc�untants and an}r otltcr sgents
if such employment is deemed necessary or desitable, and to pay reasanable
comper�aation for their seivices.
(� To compromise,stttle or adjust any cisim ordemand by or against the
Trust and to agrce to eny rescission or modificatiaa of airy conta�ct or egrccmant
affecting the Tnasi.
(7a Torenew any indabtedness,asweti as to barraw mcmey,andtosecwe
the same by mortgaging,Pledgiug ar conveying any property ofthe Tzust,inciuding
the pawer to borrow fiman the Tnistce (in the Trostee's individual capacity) at a
- reasonabto ratt of inu,�st
(8) To retau� any business imerest Uransferred to the Truskee, as
shareholder,secutity hoider,creditAr,pariner ar athcrwise.
(9) To registes any stack,bond or other sxurity inthe nsrne ofa naminee,
withont #he addiiion af words is�icating that such security is �ifl in a fiduciary
�P��Y,bui accurate records shall be maiutain�d showing khat the stock,bond or
other security is a trust esset,and the Trustee sha11 be responsible for tfie acts of the
ntamitue.
(10) To set aside as a separau tYVSt,to be held and administered npon the
sa�c�B#e�ms as thaSe grnerning ttu remainitig trust property.any interests in P��3`�
for any reason,ineiading but not limited to a concem that such property couid cause
potential liability under any federel,state or]ceal environmeutal law.
{Bj Tn making distribudons from the Trust ta or for the benefit of any m'snor or pther
person under a legal disabiliry,thc Tnistte nead nat requirt the ap�winmreirt of a guar�Mian,but st�all
be auti�i�ed to pay or defiver tl�distributian to tlte custodian of st�ls person,w gay or deliver the
distribution ta such person without the inrtervendon of a guardian,ta pay or deliver the distribution
to the legai guardian af suct► person if a guardian has already been appointed, or te usc the
distribntion for i}u ba�fit of such persan.
(C) Tn the distributian of the Trust and any division into separate trvsts and shares,tY►e
Ttvstee shatl bs suthoria.ed W make the dis#ribntian and division in m�ey or in kind or in laoth,
6
regardless af the basis for income ta�c purposes pf any property disonbuted or divided in kind,and
the disinbutian and division rnade and the va7ues esiablished by the Tn►stee shall be binding and
conalusive on a!I p�sons taking hereunder. 7't�Trustee may in making snch d i�ribnrian or division
aliak w�dividod inte►+ests in the same praperry to several trusts ot shares.
(D) 'I'he Tcuste.e shall be authorized to Iend ar borrow, includiag the right to lend to ar
borrow from the Settlor's estste,at an adequate rake of interest and with adcquate securiry sind upon
soch terms and conditions as thc Trustee shatl deem fair and equitable.
(E) The Tnastee shall tx suthorize�3 to sell ar purchase, at the fair market value as
deYe�mined by the Tnutee, ar�}'i�oPerty to or fram the SCttlor's estate or sny t�st creaud by the
Settlar durizfg life or by will,even though the same persan or corpora6on may be acring ss executor
of the Settlor's estate or as uvsta of any other such tnLats and as the Txvstee of tlris Trust.
(F} 'Ihe Tn�stee shatl have discretion to deterrnine who#her":tems shottld be etsarged or
credited to income or principal ox allocated betwecn incarne and priacipal as the Trustee may deem
equitable and fair uadcr ail thc oir�wnstances,including ttu powcr to amnortize or fail to smortize
�Y P�or al2 of any premium or discauttt, to tmat any psrt or al� af the profit resalting frnm ihe
maturiry or salo ofanyasset,whetherpurchased ata premiuqi orat a discout�t,as incc�me orprincipal
or a{�wrtion the same bezwcen iacome anci principat, to apporti� the sales prsce of any asset
betwe� income and principal, to treat any divid�nd or other distn`hvtian on smy investmenc as
incorne or prirrCipal or to apportion the same bckween inCpme ar pmim►cipal,to charge any expense
against income or pr'rnoipai or spportipn the same.aad ta�ovide or fail to pmvide a ieasonablt
reserve against depreciatian or absolesecnce on any asset subject to depreciation or obsoles�cence,
all as khe Trustee may reasonably deem cquitable end just under all of the circumstances.
�, {G} TheTrustxishctebysutharizedandempaweredtopruchascsuchinst�rancepaticies
as the Trustec deems appropriate.
5.02. P er tp,�,jeai wit� En�irnnme�tal H�+yrd�, The Tnutee shail have the pnwer to
use and eupend the trust incomo and principal ta(ij conduct environmeraal assessmenis,sudits and
site m�itoring w dct�rmine compii�nnce with any envinamncni�l law a�regutation ihereundor,{ii}
take all appropriate rrznedia3 aclion ta contain, clean up or remave any environmental haxard
including a spill, release, disclt�qge or cnntamination,eithcr on its awn accozd or in responsc to an
actual or t}u�ca�vio3ati�of any�vironm�tal]aw ar regutation thercnnder,{iii}i�titerte legs[
procccdings concerning environmentai hazerds orcontest or settie Icgal proce,edings brought by any
local,state,or federal agency concerned with environmental compliance,or by a private litigant;(iv}
coicepty with any loeal, sta#e rn federal agcncy or+�der ar eowt order �recting azc assessment,
abatement or cl�nup a£atry environmenWl hazards; and(v)emplay agemts, consultants and legal
counsel to assist or perform the above undertakings or actions. Any expenses incurred by the Trustee
under this pat�graph may l�charged against i�ome or prirtcipa]ac ihe Tnastes shall deteimmine_
7
AR'T'ICLE'Vl. SPENDTARTE�"TPROVISION
bAl. General Provis�sian. Na beneficiary shai!tsave the power ta anticipatc,encumtxr or
uansPer his interest in the tmst estate in any manner other than by the valid acercise of a pawer of
appointrnent. Na paR of the tivst estate shali be liabie for or cherged with any debts, coniracis,
Iiabilities or torts of s bene�ciary or subject to seizure or oWer Froe�sg hY anY c�reditor af a
benBficiary.
ARTTCLE VII. CUNSTRUCTfUN O�TRUST
7.Ul. Cho�e o�Law. 'This Tn�t sha31 be adm4niste�and irsterpr�ted in aecrordance with
the laws of the Commonweaith of Pennsylvenia.
7.02. Code. lJntess oiherwise stated,all references in this Tn�st ta secticm aiui cJ�apter
numbers aretothoseaftheinternatRevenue Codeof 198G,as amended>orcarrespomiin8 Provisions
of anq subsequieirt fedcrul tax laws applicable to this Trust.
7.03. Other'j'�:rms. Unless thc come�ct atherwise requires,the uise af one ar more genders
in the text inoludes all ather genders, and t6e use of either the singular ar the plural in zhe te�ct
inctudes both ttu singuiar a�d ttte pJutal.
7.04. �, The captions set forth in this Agr�eeme�nt at the beginning af the vartous
divisions ha�eofare far aanverrience ofrcfa�cuce only aiu3 shslt not be deunui to���limit the
provisions herr�af or ta a1�'ect in any way their constructian end application.
7.05. ,"�itns of Trost The T�t�t si�ll have iis legal siws in Cummberlau�d County,
Pera�sylvania,
ARTTC'[�E VIIL
COMPEN3ATION OF TRUBTEE AND
APPOINTMENT OF SUCCESSOR TRLTSTEE
8.01. �'geuenastlou. The Tnrstee sha11 receive rtasonable compensatipn for services �
performed htrauider,and the Trustee shall teceive reimbursomem for m.asonabte expenses incurred
o�s l�etcalf of the Tn�st A Trustc�may waive the cainpensation for hisfier s�vices.
&02. �movsl p� ation pf Trastee The Settior rnay remove any Tn�stee at any
time,with or uvitt�utcause,upon tt�'vty{3Q}days writtennotice givento the eumntTrustee{s). Any
Trustee may resign at any time upon thirry(30)days written notice gtiven to the S�ttlar,or after the
Settlor's death, upon thirty(30)days written notice given to the cument beneficiaries.
8
8.03. 'ntmgg�,pj Su�r,,e,�sor Twnstee. LTpon the death, resignatian, remaval or
uuapacity of the Trustee,the Settlor's sa:,JAIYJES M.KOST,shall serve as Successor Trustee.
Additional or substitute Successor Trustxs rnay be appointed by the Sedlor. T}►e Successar
T1U3lee(S)511811 SuCCOCd tA 811 t11e rlghtSy d►rties and powera�, including discr�tionary Xaowers,horein
grantcd to thc Trutet. Whenever used in ihis Ttust Agre�nent,"Tnutee"a�`"fn�stetx"shati refer
to ihe Trustee(s}or Successor T'custee(s}who are acting art any given timc.
8.U4. Exon�mtion af Trastee. AIo Tn�stce shall be liab2e for any loss ar depreciatian in
value sustained by the Tzust as a resutt ofthe Trustetsetaining any propeaty upon which there is tater
discaveredta be hazardous matarials orsubstancts requiringremedial acxionpursueat toazryfederal,
statc,or locai cnvirorrmentat law,untcss thc Tn�,ciee contributed to the ic�s nr deprtcistion in vst�
thraugh wiliftil defauit,wiliful misconduct, or gross negligence.
$.45. �tieation of Tru�Gee IT�� Dis�tbu�. Notwithstanding any Conirary
pmvision in this Trust Ageane�►t, the'Cmstee may withhotd a distributian w a bcneficiary until
receiving frprn the beneficiary an indemnification ag�ecntent in which thc beneficiary agrees to
irxiemnifythe Tzusstee a�ainst auy claiu�s filed against the Trustee as an"owcut"or"opetator"under
the Campre}kansive Emironmecrtal Resp�crose,Garnpensatinn and Liabiiity Act of t 980,as from time
to tirne amended, or any regulatiion thercunder.
ARTCCLE IX.
Y'AYMEPVT OF TARES,FUNERAL
EXPENS�S AND EXFENSES UR Ai}MII+TISTRATION
4.01. �}��,p,�,of Dcat6 Taxes and Other Est:te Stttlemmt Ca�ts. The Trustte shall
ast�tain frmn ti�pers�al representative ofihe Settlor's estate wheihertha petsanal rtpresattsttive
has sufficieat assets w pay the legacy,s�cession,i,nheritance,orensfcr,estate ard other death taxes
or duties ltviecl or asstssed against the Settlor's estate(including all intenest and penalties thondon},
ail of which taaces, �tDet+est and pensltics ase hereafter referred to as the desth tsates, interest and
penattics. Ifthe persanai represeirtative advises the Trusiee that ins�cicnt fimds oxist to pay all
the dcath ta�ce�a,interest and penatdes,thc Trustee shall tlxen pay to the personal repn�senffidve from
themm�stpropaly,an arnovnt equsi to a2t tFie death ta�ces,intesest and penalties in e�cctss oft3u fur�ds
available to the personsl represeatative fpr this pwpose, which payments are to be made without
apporiionment. ln making the payments,the Trusta shall use only those assets o�r their proceeds
which�e includabk in ttu Settlor's gross estate fo�pncposes of thc Unita�Statcs cstate tatc,
Ifthe persona]rapresernative ofChe Settlor's estate,in her sole discretion, shall deteYmine �
thaE ap�xopriateas�#safSe�tlor's ostateareac�availabio in sufficientamaunttopay{1}tlx Settlar's
funeral expenses and(2)the e�c,penses of administering the Settlor's estate, the Truxtce shall,upon
the request of the persanal representa6ve,contribute fi�We principa!ofthe ttusE estate the amouns
of such dcficiency;and in coimectian witk airy such actio»t�Trust�shall rsiy upern thc writtca�
9
statement of the persanal represantative as to the validity and correciness of the amouats of any such
expenses and shal} fiwnish funds to the personal r�presentative so es to enabie hex ta dischazge the
sazne,ar to discttsrge any part�ail therarf by makin8 PgYn►ent directly to tt�perscsn e�►tiUed ar
claiming to be entitled to receive payment ther+eaf, No consideration nxd be required by the T,rustee
from the personal representarive For the disbursernent made by she T7ustee pur�nt heneto,tar shali
thcre be azry obligatian upan the pasaaai rep�s�tative to repay to the Tn�tee azry of die funds
disbwsed hcreunder, and all amonnts disbursed by the Trustet pursuant to the enthority hereby
confermd shait be disbursed wittwwt any right in or duty upcm the Trustee to sak or obiain
conrribution pr reimbursemen2 fx�n anY P�'tt �'P��N on accowrt af such payment. The
TmsUce shall not be responsible for the application af any fiunds dclivered to the persona!
ropresentative pursusnt to the authority herein granted,nor shali the Tr+ssie�be s�tbject ta liability
#a etty beneficiary hereunder on account of anY payment made piuguant ta tt�provisions hereof.
As used herein, "expenses of administering thc Settlor's estatc" shall not mean debts owed or
claimed ta beowrd by tha Settlor f�scrvices,goods,maneytxbenefitsreceiv�duringhis lifetime,
ineludiag withaut limitatiat a�claims made by a nwsing home oc similar in4titution or any claims
made by the Ptnnsylvania Departmart of Public Wel fare pr any odaer govcrnmernai body(federaI,
state or local) for maiic�l assisiance benefits ar bene8is of auy kind�id to �on behelf of ti�
5ettlor,and na part of ihe Mist estate shafl be paid directly or indiratly toward sudi clsims.
iN WITNESS WHEREOF,the Srxtfor and Tre�tee have hece�nto set their h�nds and seais
as of the day and year frst written above.
WITNESS:
t�--�--^—
" �C' �'�'�?� ���
R NELSOIV KOST,SETTL R
C4MMONWEALTH OF PBNNSYL'YANIA .
. SS:
COLTNTY OP PRANKLIN .
i
On tltis, the 5�+ day of � � , 2012, before mq a Notary Public, the
undersigned ot�icer, personaily a R NELSOIV KOST, known to me (or satisfactarily
� pmven} to be tt�e person wh� aame is subscribcd ta the within Trust Agreement, and
acknawledg�d that he eycecuted the samc for the purposes therein contained.
,..
IN WI'IIYLSS WHEREUF,I have set my and official
`,
Notary blic
�+e�rw sd
10 � lMdNk D Mqr►,llodrY Pub1c
07i�� Oa. 2�D14
_ .
The foregoing Trust Agreement was delivercd,and is hereby accepted on. /'� � 5 2012.
W]TNESS:
' - ��.� �.�
KATHLEEN L. DEBRICK,TRUSTEE
11
__ - -
SCAEDULE "A"
SCHEDULE
REFERRED TO 1N THE ANNEXED TRUST AGREEMENT
DATED Aqrt 1 „ti` . ,2Q12
FROM R NELSON KOST,SETTLOR
TO KATHLEEN L. DEBRiCK,TRUSTEE
PROPERTY DESGRIPTION:
The rea]propaty lacated at 310 South Broad Street,Mechanicsburg Bomugh,Cumberlarid
County, Pennsylvania,and identified as Tax Parcel No.20-24-0785-132.
PA REV-1500
SCHEDULE E
CASH, BANK DEPOSITS &
MISCELLANEOUS PERSONAL
PROPERTY
BILL OF SALE
DATE: December 3, 2Al2
SELLER: Nelson R. Kost,per Kathleen L. Debrick, POA
3560 ScoUand Road
Chambersburg, PA 17202
PURCHASER: C. R.Williams, Incorporated
10228 Governor Lane Blvd.
Suite 3012
Williamsport,MD 21795
DESCRIP'I'ION: 1 - Used Allen ADC-221 Organ, Pedalboard and Bench,
Serial No. 63052
PRICE: $2,000.0(1
It is matoalty sgi�eed tLat Seller makea no eacpress or implied warranties on the above
merchsndise.
�
)
� M I I
�
Nelson R. Kost, C. R. �ams,Incorporaud,
per Kathieen L.Debrick, POA PURCHASER
SELLER
PAYMENT RECEIVED: �� /��al�/ a Check Number: 8526
PSERS To14Free- 1-888-773-7748 (1-888-PSERS4U)
5 N 5th Street Loea/-717-787-8540
�„nw�..r"w
�� Harrisburg PA 17101-1905 WebAddress: www.psers.state.pa.us
December 21, 2012
KATHLEEN DEBRICK
3560 SCOTLAND RD
CHAMBERSBURG, PA 17202
RE: R Kost
SSN: XXX-XX-1528
Dear Ms. Debrick:
The Pubiic School Employees' Retfrement System is processing the benefit of R Kost. Please
accept our condolences on your loss.
PSERS issued the following monthiy retirement benefit(s) prior to processing the death benefit:
Check Date Check Amount
November_2012 $980.73
- --- - - - " -- _ . . _ _
R Kost was entitled to a prorated amount of$920.21 for the month of November.
Therefore, please reimburse PSERS $60.52, which represents the total of the monthly benefit
payments and debts (if applicable) listed above, minus the prorated amount. Please make
your check or money order payable to Public School Employees Retirement System.
Please retain this information for preparetion of the member's fina!tax retum.
if you have a�y questions, please contact the PSERS Member Service Center by calling
toli-free 1-888-773-7748 (1-888-PSEf2S4U). Harrisburg local callers, please use
717-787-8540. To contact PSERS by e-mail, use the following address:
contactPSERS@pa.gov. For your convenience, the Member Service Center is staffed each
business day from 8:00 a.m. to 5:00 p.m. For more general information, you may visit PSERS
online at: www.psers.state.pa.us.
Sincerely,
�ilB�lC ,SClOOe `i�x�Ced� �C2YJtfiKCK� .S�
i�N��ii�������aw�H�i�������i�i�iwi i�M�r�������������wrN�i�M��w�w���M���N�i�
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PA REV-1500
SCHEDULE G
INTER-VIVOS TRANSFERS and
MISCELLANEOUS NON-PROBATE
PROPERTY
_ ___ ---
11/27/2012 21: 83 7177099653 M&S HARLEY-DAUIDSON PAGE 06/19
Account Summary Pagc 1 of 1
Overview Accaunt Access Bill Pay SeM Senrice
Aecourrt Summary I Tranater Funds 1 Scheduled Transters I Transier History I History Search
Account Summary
AccourK ���- �YPe � , Actusl ..�
•4591�0 Sevings S 5.00
"4591=11 Shdre IRA a 0.�
-q5g1�5yic#�pggq Imrestment IRA $81,203.48
Quick Transfer
From Not Set '
To Not Set '
_ •
Amo�nt
,__....,,.....,.,,--_.,
Transfer . I
�_....,.,----
�
Susquehanna Valky Fedsral Credit Union
1-BOa9A8-1464
https://www.netiL�inancial-net.eom/svfcu/c�i-bin/ebs?OLB CMD-SHB-041 11/27/2012
' ��a� ' ���
��� ���
PARCEL N0.20-24-0785-132 00 0 �
MECFIANICSBURG BOROUGH
PREPARED BY AND RETURN TO:
MARK E.HALBRLINER,ESQ.
GATES HALBRUNER HATCH&GUISE PC
1013 MiJMMA ROAD, SUITE 100
LEMOYNE PA 17043
TELEPHONE 717-731-9600
DEED
THIS DEED is made the 5�day of i � ,in the yeaz two thousand twelve(2012),between:
R NELSON KOST, a single individual, party of the first part, GRANTOR,
AND
KAT LE�DEBRICK, TRUSTEE OF THE KOST FAMILY TRUST DATED
, � ,2012,parry of the second part, GRANTEE.
WITNESSETH,that said party of the first part,for and in consideration of the sum of ONE AND
00/100 DOLLAR($1.00),lawful money of the United States of America,well and truly paid by the
said party of the second part to the said party of the first part, at or before the sealing and delivery
of these presents,the receipt whereof is hereby acknowledged,has hereby granted,bargained,sold,
aliened,enfeoffed,released,conveyed and confirmed,and by these presents does grant,bazgain,sell,
alien, enfeoff, release, convey and confirm unto the said party of the second part, her heirs,
successors and assigns,
ALL THAT CERTAIN tract of land situate in the Borough ofMechanicsburg,Cumberland County,
Pennsylvania, bounded and described as follows, to wit:
BEGINNING at a building line on the west side of Broad Street and at comer of land now or
formerly of W illard R.Beil and Geraldine E.Beil,his wife;thence by the building line of said Broad
Street,northward seventy-five(75) feet to lot now or formerly of Charles R. Slaybaugh;thence by
the line of said lot,westward one hundred forty(140)feet to an a11ey;thence by said alley,southwazd
seventy-five(75)feet to a point on said alley and corner of lot now or formerly of Willard R. Beil
and Geraldine E.Beil,his wife,aforesaid;thence by the line of said lot,eastwazd one hundred forry
(140) feet to a point on the building line of said Broad Street, the place of beginning.
BEING all of I,ots numbered 27 and 28,and the northern fifteen(15)feet of Lot number 29,on the
plan of lots recorded in Plan Book No. 1 at Page 31 in the Cumberland County Recorder of Deeds
Office.
HAVING THEREON ERECTED a dwelling house known and numbered as No.310 South Broad
Street, Mechanicsburg, Pennsylvania 17055.
UNDER AND SUBJECT, NEVERTHELESS, to any conditions, covenants, restrictions,
reservations, easements and rights-of-way of record or visible upon an inspection of the premises.
BEING the same premises which Jeffrey A.Miller and Lori Ann Miller,husband and wife,by their
deed dated January 14, 20]1, and recorded January 19, 2011, in the Cumberland County Recorder
of Deeds O�ce as Instrument No. 201102324, granted and conveyed unto R.Nelson Kost,a single
individual, the Grantor herein.
This is a deed for nominal consideration to the trustee of an ordinary trust where the transfer
of the same property would be exempt if the transfer was made directly from the Grantor to
all of the possible beneficiaries of the trust,whether or not such beneficiaries are contingent
or specifically named. The trust beneficiaries are the Grantor and t6e Grantor's children and
lineal descendants. 72 P.S. §8102-C.3(8).
TOGETHER with all and singulaz the buildings and improvements,ways,streets,alleys,driveways,
passages, waters, watercourses, rights, liberties, privileges, hereditaments and appurtenances,
whatsoever unto the hereby granted premises belonging, or in any wise appertaining, and the
reversions and remainders, rents, issues and profits thereof; and all the estate, right, title, interest,
property, claim and demand whatsoever of the said Grantor, as well at law as in equity, of, in and
to the same.
TO HAVE AND TO HOLD the said lot or piece of ground above-described,with all and singulaz
the buildings and improvements thereon erected, hereditaments and premises hereby granted, or
mentioned and intended so to be, with the appurtenances, unto the said Grantee, her heirs and
assigns,to and for the only proper use and behoof of the said Grantee,her heirs and assigns forever.
AND the said Grantor,for himself,his heirs, executors and administrators,does covenant,promise
and agree, to and with the said Grantee, her heirs and assigns, by these presents,that they,the said
Grantor and his heirs, all and singular the hereditaments and premises hereby granted or mentioned
and intended so to be,with the appurtenances, unto the said Grantee,her heirs and assigns, against
them, the said Grantor and his heirs, and against all and every person and persons whomsoever
lawfully claiming or to claim the same or any part thereof, by, from or under him, her,them or any
of them, shall and will, subject as aforesaid, SPECIALLY WARRANT AND FOREVER
DEFEND.
THE LAW FIRM OF GATES, HALBRUNER, HATCH & GUISE, P.C. HAS ACTED AS
SCRIVENER ONLY AND HAS NOT SEARCHED THE TITLE TO THE PREMISES
HEREIN CONVEYED.
IN WITNESS WHEREOF,the said party of the first part has hereunto set his hand and seal, the
day and yeaz first written above.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE F
-� � 1
...-�1cL Z- __ ���� /� � ,��,�,-y. 1���
WIT�ESB'� �— R NE�OST
COMMONWEALTH OF PENNSYLVANI�, .
. SS:
COUNTY OF FRANKI.IN .
On this, the �� day of �' � , 2012, before me, a Notary Public, the
undersigned officer,personally appeared R NELSON KOST,a single individual,known to me(or
satisfactorily proven) to be the person whose name is subscribed to the within instrument, and
aclrnowledged that he executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I hereunto set my d and o�cial eal.
�.
No ublic ����I^
i
Mldble D.WoNF,NodrY PubNc
QMmbNMwrp Boro,FnM4n Caunty
GomnillMoe Da.10 201�
M VNQA OF 1qTM1F5
CERTIFICATE OF RESIDENCE
I hereby certify that the present residence of the Grantee herein is as follows:
The Kost Family Trust
c/o Kathleen L. Debrick, Trustee
3560 Scotland Road
Chambersburg PA 17202 ��/�'�"""'l
� �
Mazk E. Halbruner,Esquire
Attomey for Grantee
REVa83 EX(oqao)
REALTY TRANSFER TAX RECORDER'S USE ONLY
State Tax Paid
�i pennsytvania STATEMENT OF VALUE
oev�nTnErvtorneveNU[ Book Numbef
BureauoflnMvldualTaxes Page Number
70 BO%z8o6o3
Harrisbur9,PA 1yi�8-o603 Se2 f@VQ(S2 fOf 11lStfUCtlOf15. Da[e Recorde0
Complete each section and file in duplicate with Recorder of Deeds when (1) the full value/consideration is not set forth in the deed, (2) the
deed is without consideration or by gift, or(3) a tax exemption is claimed. A Statement of Value is not required if the[ransfer is wholly exempt
from tax based on family relationship or public utility easemeM. If more space is needed, attach additional sheets.
A CORRESPONDENT—All inquiries may be directed to the following person:
Name Telephone Number:
Mark E. Haibruner, Esq. (717) 731-9600
Mailing Address City State ZIP Code
1013 Mumma Road Suite 100 Lemoyne PA 17043
B. TRANSFER DATA C. Date of Acce tance of Document oalosn2
Grantor(s)/�essor(s) Grantee(s)/Lessee(s)
R. Nelson Kost Kathleen l. Debrick, Trustee of the Kost Family Trust
Mailing Address Mailing Address
310 South Broad Street 3560 Scotland Road
�i�y State ZIP Code City State ZIP Code
Mechanicsburg PA 17055 Chambersburg PA 17202
D. REAL ESTATE LOCATION
Street Address City,Township, Borough
310 South Broad Street Mechanicsburg Borough
County School Dfstric[ Tax Parcel Number
Cumberland County Mechanicsburg Area 20-24-0785-132
E. VALUATION DATA -WAS TRANSACTION PART OF AN ASSIGNMENT OR RELOCATION? � Y � N
1. Actual Cash Consideration 2. Other Consideration 3.Total Conside2tion
1.00 t 0.00 = 1.00
4. County Assessed Value 5. Common Level Ratio Pactor 6. Fair Market Value
183,500.00 X 1.00 = 183,500.00
F. EXEMPTION DATA
Sa. Amount of Exemption Claimed lb. Percentage of Grantor's Interest in Real Estate Sc. Percentage of Grantor's Interest Conveyed
100� 100% 100°h
Check Appropriate Box Below for Exemption Claimed.
❑ Will or intestate succession.
(Name of Dxedent (Estate File Number)
� 7ransfer to a trust. (Attach complete copy of trust a9reement identifying all beneficiaries.)
❑ Transfer from a trust. Date of transfer into the trust
If trust was amended attach a copy of original and amen e rus .
❑ Transfer between principal and agent/straw party. (Attach complete copy of agency/straw party agreement.)
❑ Transfers to the commonwealth, the U.S. and instrumentalities by gift, dedication, condemnation or in lieu of con-
demnation. (If condemnation or in lieu of condemnation, attach copy of resolution.)
❑ Transfer from mortgagor to a holder of a mortgage in default. (Attach copy of mortgage and note/assignment.)
❑ Corrective or confirmatory deed. (Attach complete copy of the deed to be corcected or conflrmed.)
❑ Statutory corporate consolidation, merger or division. (Attach copy of articles.)
� Other (Please explain exemption claimed.)Transfer for nominal consideration to trustee of an ordinary trust where
trensfer of same property would be exempt if made directly by settlor to beneficiaries. 72 P.S. Section 8102-C.3(8).
Under penalties of law, I declare that I have examined this statement, including accompanying information, and to
the best ot my knowledge and belief, it is true, correct and complete.
Signature of Correspon nt or Responsible Pa Date
� , 06/11/12
FA LURE TO COMPLETE THIS FORM PROPERLY OR ATTACH REQUESTED DOCUMENTATION MAY RESULT IN
THE RECORDER'S REFUSAL TO RECORD THE DEED.
— --
ROBERT P. ZIEGLER
RECORDER OF DEEDS
CUMBERLAND COUNTY
1 COURTHOUSE SQUARE '_ -
,
CARLISLE, PA 17013 J �,
717-240-6370 - '' ' �
'� ; �
Instrument Number-201217627
Recorded On 6/13/2012 At 12:41:11 PM *Total Pages-5
*Instrument Type-DEED
Invoice Number- 110468 User ID-MSW
*Grantor-KOST,R NELSON
*Grantee-KOST FAMILY TRUST
*Cuetomer-GATES&ASSOCIATES
*FEES
STATE wxiT xax So.so CertificationPage
STATE JCS/ACCESS TO $23.50
JUSTICE DO NOT DETACH
RECORDING FEES — $12.50
RECORDER OF DEEDS This page is now part
PARCEL CERTIFICATION $10.00
�ES of t6is legal document.
AFFORDABLE HOUSING $11.50
COUNTY ARCHIVES FEE $2.00
ROD ARC8IVE3 FEE $3.00
I+�CHANICSBURG SC800L $0.00
DISTRICT
MECHANICSBURG BOROUGB $0.00
TOTAL PAID $63.00
I Certify this to be recorded
in Cumberland County PA
���� ��
"-Information denoted by an asteriak may change during
the verification process and mey not bc rofleMed on this page.
002030
I IIIIIIIN�Ih NIINII
�. Settlement Statement HUD -1 OMB Approval No.2502-0265
Type of loan . 8.File Number �
1 FHA � 2 FmHA ❑ 3 Conv.Unins. � 7.Loan Number 401121
4 VA ❑ 5 Conv.Ins. � 8.Mo Inwnnce Caee No.
rssliwnMnbrinMmMbW WTOwutlwanotlnWE�EbNSMW.
, BOROwef: Jelhey R.EAbd Shanan K.Elfiolt
310 South Broed SVeat,Mechanicsbu PA
Selkr Katliken L.Dsbrkk,TrusW of Me Kwt Family 7ruM dsEetl April 5,2012
3580 Scotland Roed Clwmbersbu PA 17202
Lender: AAembe�a tat Federal Credit Union
5000 Louise Drive Meehanicsbu PA 17055
. Proparty Address: 310 South Broad Street TownehiplMunldp�r: Borough of Meehaniceburg
Meehanicsbu PA 17055 C CumberlaM
Settlement qqenk �g�Halbruner,Hefch&Guisa,P.C.7013 Mumma Road, uite 100,
. Lemoyne,PA 17043(717)731-9600 Fax:(717)731-9627
Attom 's Name: Clifton R.Guiae,Es .
Settlement Dale 1Z/05/12 '
Summa of Borrowefa Tnnsactions K Summa of SeNer's Transactions
0o Grae Amoant Dae Ihron Borrower roe Grae Mwet Dre To Selkr
oi Convut Sales Pria S 780,000.00 ao�C�tract Seles Price S 180 000.00
oz Perooml S� � �P� �
03 Setflement C es S 6,490.85 ro3 S
0o t �oo S
os S eos S
i'usmwnt for[tema Paid b Seller in Advmce Ad'us�ent for Iums Paid Seller m Advence
06 Townshi Tazes frotn 12/OS/12 W 12/31/12 S 406 Towashi Tm;es from 12/OS/12 to 12/31/12 S
m Coun Texes from 17/OS/12 to 12/3l/12 S 59.21 ao7 Cam Tvca 6nm I7105/12 W 1?l31/12 S 59.21
06 Aa�wment from 17I05/12 to 12/3l/12 = ro[Aaeesement Gom 12/OS/12 to 17J31/12 S
09&hoolTaxes from 12/OS/12 W 06/30/13 S 1,209.37 eov 3choolTaxes fram (2/OS/12 to 06/30/13 S 1,209.37
�o Sewu ftom 17J05/12 w 12/31/12 S 24.29 ato Sewu from t2/OS/12 W 11/31/12 S - 24.29
u T�ash from 12/05/12 w 12/3V12 S 12.38 au 17ash Gom 12/OS/12 w IL3t/12 S 12.38
i: S aiz S
�3 S a�3 3
�a au S
zo Gross Amowt Due Fran Bortower S 187,796.70 �xo Groas Amowt We to Seller S 181 305.25
�o Moaeh Paid b or i�Behalf ot Borrower xo ReduMioee i�Aso��t Doe to Sclkr
ot sin 5 501 itHeld 3eller $
Dz Princi Amamt of New Loau S 1M,000.00 302 3ettlemant Chv a W Seller S 91 860.00
03 E ' ' Loaos Talcw Sub' t to E sm ' I.oens TJ�3ub'ect ro S -
04 GiR of i 5rom Twt E 38,000.00 sa Gift of ' from Ttue[� S 36 000.00
os A Pee Crcdit embeta lat FC E 425.00 sos � S
o� S sm S
o� sm S
oe S soe E
Ad'us�rnb for Items U Seller Ad'uslmmb for ltems U 'd Sella
m Ci Tuces from Ol/Ol/12 to 12/OS/12 j s�o Ci Taxa 5om Ol/Ol/12 to 1?103/12 S -
u Cam Texes trom Ol/Ol/12 to 12/OS/l2 S su Cow Taxes from Ol/Ol/12 to 17/OS/12 S -
a n.��eoc som oiroviz ro izrosnz s s�z n���c � oiro�n2 ro tvosnz s
i3 SchaolTaxes 6om OVOV12 w 12/OSA2 S 5�3 SchoolTuees from 01/01/12 ro 17J05/12 S -
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16 j 516 f '
17 S Sl7 Z '
to Totel Peid /for Bwrower $ 180 425.00 s10 Total Reductions in Amowt Due to Selfer E 127,860.00
0o Cu!at SeHleoeul FromlTo Borro�ver 6a C»h at SeHlemeot TolFeoo 3e@er
o� Gross Amount Due Fean Borrowv S 187,798.10 60� Gross Amowt Due ro Sellu S 181,305.25
ox Less Amount Peid /for Bmrower $ 180,425.00 6ox Leas Raductions in Amount Due to Sellet S 127 880.00
oa Cash Gom Borrower t 7,�71.10 em Cash to Seller f �.�•�6
� L. SEI7S.EMEN7'CNARGFB
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ea wlFee ro MemberelrtFade�alCrzditUnion S 425.00 eamaFeN3 S 425.00 S
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903 INWNCCPRmiYm fOf moWWto trmGFEM3 T t
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��w . ' dMemiellitkivuaoce 'woro axa.wRnur.Nrmsauix.eC S 732.50
IIIOUodwwdeYa ' ofNebWCOemeimmro StewutTitle S 572.50
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um Dad S 62.00 Mo S 94.00 Rek�ee S S 136.00 S
1]03 Trwa@rTec f oP¢a S I 800.00 S i H00.00
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�3m arsa cm � m�u ro ICueo3ueKoet rt�aFe� S S 61700.00
13U3 � �IRFCC (0 �k � 8�0�[ BmOPEY s 12.00 S
I30/�1CfOW(W LOf A�Ih00 f0 CiMC }�IbI10Cl E1tICh&4111 P.C. &m OFEY S S 230.00
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Date: Da[e
)etSeY R.Elliott S6onen K.Elliou
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11/27/2012 21:03 7177099653 M&S HARLEY-DAUIDSON PAGE 04/19
Account �utatmary Page 1 of l
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_„ . _
AceouM Summary I Transfer Funds I Schedule0 Tramfers I Tronsfer Wistory I Wistory Search
Account Summary
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httne://www.netit.fnancial-net.com/svfcu/cei-bin/ebs70L� CMA-SfIB-041 11/27/2012
PA REV-1500
SCHEDULE H
FUNERAL EXPENSES and
ADMINISTRATIVE COSTS
� �sP �NS�°,°�N AUER CIiEMATION SERVICES OF PENNSYL��v�, I�c.
a��—
•o�p���C+� 4100 Jonestown Road • Hazrisburg,PA 17109 • 1-800-720-8221 • Fax 717•541-9943 • Shawn E.Carper,Supervlsor
$h'NSYLYAN«'
121221 MCR-5
Nov 23, 2012
Mrs. Kathy Debrick
3560 Scotiand Road
Chambersburg, PA 17202
R. Nelson Kost, II - Deceaeed
SPECIAL CHARGES $1 ,695.00
X Direct Cremation 350.00
X Nationwide Guarantee Program $
Worldwide Travel Protaction
TOTAL SPECIAL CHARGES $2.045.00
PROFE5SIONAL SERVICES
X Servtcea ot Funeral Director & StaEE Included
Other Preparation of the Body
Facilities & Staf! for Memorial Service
Staft & Equipment Lor Memorial Service
Witnassinq the Cremation
Private Famiiy Viewing/Witnessinq Cremation
X Packaginq Attd Forwarding Cremated Remaina $65 . 00
Personal Delivery o! Cremated Remains
Scattering o! Cremated Remains
Medical Documents/Courler Fee
TOTAL PROFESSIONAL SERV=CES S65.00
AUTOMOTZVE EQUIPMENT
X Removal Vahicle Included
Lead Car/Clergy Car
Family Car
Servlce Vehicle $� 0@
TOTAL AUTOMOTIVE EQUIPMENT
a.�. �,.�.
MERCHANDISE
Register Book
Memorial Cards
Thank You Cards ,
Remembrance Package
Cremation Container
X Zvory Plastic Container $35 .00
Urn Burial Vault
Veterans Elag Case
Grave/Memorial Marker
TOTAL MERCHANDISE $35 . 00
CASH ADVANCED ITEMS
Grave Opaninq
Cemetery Equipment
X Chambersburq Public Opinion ' $177 . 40
X Harrisburg Patrlot News Sz42 . 87
Vault Service Charge
Clergy
' Church/Organlst/3ololst
Flowers
X Crematory Charge Included
X Cumberiand County Coronar Cremation Fee $25 .00
X 25 CertlLied Copiea of Death Certificate ' S150.00
TOTAL CASH ADVANCED ITEMS $595 . 27
SUMMARY OF CHARGES '
Special Charqes $2 ,045:00
ProEesaional Services $65:00
Automotive Squipment $0.00
Merchandiae $35.00
Cash Advanced Items 5595.27 ,
SUB TOTAL $2 , 740.27
CREDITS " ' -5990:00
AMOUNT PREPAID Date Oct 9 , 2002 -$1 ,215 :00
TpTpi, 5 5 35. 2 7
AKOUNT PAID Date Nov 27 , 2012 -S535 . 27
BAI,ANCE DUE $0:00
THIS STATEMENT HAY NOT REFLECT ALL NEWSPAPEA CHAR(3ES
DAD's Death Expenses
1. Organist: $100
2. Meal afrer service: $160
3. Crematorium—additional expenses not already paid for: $1 I 5
4. Obituaries (two): $177.40(Chambersburg Public Opinion), $242.87 (Harrisburg Patriot)
5. Pastor at St John's main service($I50)
6. Pastor at St Paul LTM Columbazium service($100)
7. Mail house papers to Mazk overnight; $12,95
��(� ,T 8. Doctor Bill 26 Dec: $10.00
p e c e�(:P� E
��eU t
Total Spent out of my own pocket: 1008.22
PA REV-1500
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES
and LIENS
DAD's Death Expenses
1. Organist: $100
2. Meal after service: $160
3. Crematorium—additional expenses not already paid for: $115
4. Obituaries (two): $177.40(Chambersburg Public Opinion), $242.87(Hazrisburg Patriot)
5. Pastor at St John's main service ($150)
6. Pastor at St Paul iJM Columbarium service($100)
7. Mail house papers to Mazk overnight: $12.95
�C� ,= 8. Doctor Bi1126 Dec: $10.00
peced�v, E
I�ela t
Total Spent out of my own pocket: 1008.22
" LAW OFFICES OF
GATES, HALBRUTIER, HATCH i'SL {�rUISE, P.C.
� 1013 MUMMA ROAD•SUITE 100�LEMOYNE, PENNSYLVANIA 17043
{�»��s�-ssoo•Fnx:{�nf �si-ssz�
LQWE4�H.6ATES.It..M. CORRESPONDENCE AODRE$S: gA����E'
LL.M.�n tenation lamoynB Otfice 3 WEST MONUMENT SWARE,SUITE 36i
MARK 8.MALBRUNEfl LEWISTpWN,PA 1]04}
WEBBITE: (]17 048�6809
CRAI@ R.MA7CH,C6LA www,GatesLawFirm.com �
CarlMletl as an Eitler�aw Atlorney by STACEY L.NAFE
iha N9flonei EIGar Ww Foundfltion pe�e�gyph�b{a�agq�
CLIF1'OH fl.6U18E TRACF l.SEPKQV�C
Also AdmMetl�o preClkre Oafore�he Perefepel
U.9.Patent 8 Tratlemerk Oifice
TNl1p L.HILFERDING
, Parelegel
Aug�sc ar,Zois
Cumberland County Register of Wills
One Courthonse Square
Roarn 102
Carlisle PA 1?dl3
RE: Estate of R Neisan Kost II
D$te of Death: November 21,201Z
Deaz Register of Wil1s:
Enclosed for filing is the (non-probate) Pennsylvania inheritance ta�c return for R. Nelson
Kost II. A aheok in the amount of$15.00 is enciosed as the filing fee.T'hera is no taac owed with tha
filing of this return. Please time-stamp the additional photacopy and return it ta me in the enclosed
c� ,
envelope. e �; � �
3 � �-� M
.�
Thank you for your assistance in this matter. � =c :7 � ;:; ,-�°,
r )"' r" r� �± o
` ^' � r+r
f�
Sincerely,
_° ;;
^�/� ���� v � � _�
! � ,-., n
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� '
Mark E. Halbruner v "' -°n
MEHltls
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