HomeMy WebLinkAbout11-04-13 J 1505610143
REV-1500 �`�°,_,°, �
PA Department of Revenue OFFICIAL USE ONLY
pennsylvania ca,r,cy code Year Fi�e Number
Bureau of Individual Taxes ��*��e
Po eox.2soso� INHERITANCE TAX RETURN 21 13 0735
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
04 13 2013 O1 19 1926
Decedent's Last Name Suffix Decedent's First Name M�
GANNON MARJORIE I{
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M�
C�iNNON EDWARD p�
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' Prior to 12r 3-82j�Date of Death
� 4. Limited Estate � 4a.Future tnterest Compromise 5. Federal Estate Tax Retum R uired
(date of death after 12-12-82) ❑ �1
� g, Decedent Died Testate � Ma' a Living Trust �
(Attad�Copy of wl1) �X (n�tcad,e�topy�o"����st� 8. Total Number of Safe Deposit Boxes
� 9. Litigation Proceeds Received � 10.a�P���_ �ed� Da of Death ��.Election to tax under Sec.9113 A
� ��a��-�-��) � (Attach Schedule O) ( )
CORRE3PONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORNUITION SHOULD BE DIRECTED TO:
Name Daytime Telepho�Number
AMY M MOYA 7]��652 '�'23� ,�
:� _. �.� +�rt
i�'s�el3 OF�LS�E�NLY
-�, '""
First line of address � � � -.� � �
5011 LOCUST LANE � � � -,,.�, ,� �
Second line of address � � � "� �
_ � �"� � rTt
City or Post Office DA ffi FILED �
State ZIP Code
HARRISBURG PA 17109
Cornespondent's e-mail address: Amy�Ledererlaw.com
Under penalties of perjury,1 dedare that I have examined this retum,inGudin�accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,oorre�t and oomplete.Dedaration of preparer other than the persona representative is based on alt information of which preparer has any knowledge.
SI RE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
Q�� a�w�u►ti-� Edward A.Gannon (C'��28'��3
AbDRESS
28 Kensin n S uare Mechanicsbur PA 17050
IG TU OF ER OTHER THAN REPRESENTATNE DATE
� Amy M. Moya �� 8t►�
5011 Locust Lane, Harrisburg, PA 17109
� Side 1
1505610143 150561D143 �
W
J 1505610243
REV-1500 EX
DecedenYs Sociai Security Number
o��'S Name: Gannon, Marjorie K.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Ciosely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. �
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits 8 Miscellaneous Personal Property(Schedule E)............... 5. 10 . 0 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers 8 Miscellaneous rynq Probate Property
(Schedule G) U Separate Billing Requested............ 7. $4 9,7 0 3. 7 2
8. Total Gross Assets(total Lines 1 through 7)........................................................ g. 84 9,713. 72
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 22,8 97 .2 0
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 5,192 . 8 6
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 2 8,0 90. 0 6
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 821, 623. 66
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J).......................................... 13. 34,402 . 73
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... �4, 7$7,2 2 O. 93
TAX COMPUTATION-SEE INSTRUCTIONS F�R APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(�.2)x.o0 161,825. 62 15. O. 00
16. Amount of Line 14 taxable 62 5 3 95.31 16. 2 8 14 2 . 7 9
at lineal rate X .045 � ,
17. Amount of Line 14 taxable
at sibling rate X.12 �. 0� 17. � . �0
18. Amount of Line 14 taxable
at collateral rate X.15 0. 0 0 18. 0. 0 0
19. TAX DUE...................................................................................................... 19. Z 8�14 Z . 7 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Sld@ 2
� 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-0735
Decedent's Complete Address:
DECEDENTS NAME
Gannon, Marjorie K.
STREET ADDRESS
28 Kensington Square
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) � (1) 28,142.79
2. Credits/Payments
A. Prior Payments 26,900.00
B. Discount 1,407.14
Total Credits(A +B) (2) 28,307.14
3. Interest �3�
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 164.35
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}
Make Check Pa able to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred:............................................................................... � �
b. retain the right to designate who shall use the property transfer�ed or its income:.................................. ❑ X
c. retain a reversionary interest;or............................................................................................................... ❑ x
d. receive the promise for life of either payments,benefits or care?............................................................ � x
2. tf death occurred after Dec. 12, 1982, did decedent transfe� property within one year of death without
receivingadequate consideration?.................................................................................................................... ❑ �
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ Ox
4. Did decedent own an individual retirement account annuity or other non-probate property which � ❑
, ,
contains a beneficiary designation?..................................................................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfe�s to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)j. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tauc retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adop6ve parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)).
� The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneflaaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)J.
. The tax rate imposed on the net value of transfers ta or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1508 EX+(��_10)
scH�au�E E
pennsylvania CASH, BANK DEPOSITS, � MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gannon, Ma 'orie K. 21-13-0735
Include the prooeeds of litigation and the date the proceeds were received by the estate.
All property jointly-ovmsd with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Check from CUNA(life insurance premium refund) 10.00
TOTAL(Also enter on Line 5,Recapitulation) 10.00
(if more space is needed,additional pages of the same size)
Copyright(c)2010 forrn software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-1510 EX+(08-Og)
SCHLDULE G
pennsylvania lNTER VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gannon, Ma 'orie K. 21-13-0735
This schedute must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRtPTION OF PROPERTY DATE OF DEATH 96 OF DECD�s �c�usioN TAXABLE
NUMBER �{E DATEE OF TR�AFNSFE�R.SATTACN A COPY OFTTHE DEED F�OREREAL ES ATE. VALUE OF ASSET �NTEREST ��F APPLICABLE) VALUE
1 Annuity Contract No.17156,held at John Hancock, 92,020.96 100.000% 92.020.96
Mary'orie K.Gannon,Owner,Edward A.Gannon,
spouse,beneficiary
2 Annuity Contract No.990998806,held at The Hartford, 69,804.66 100.000% 69.804.66
Marjorie Gannon,owner, Edward Gannon,spouse,
beneficiary .
3 Annuity Contract No.75 612 657,held at New York 30,376.40 100.000% 30.376.40
Life,Marjorie K.Gannon Living Trust,owner,Marjorie
K.Gannon Living Trust,beneficiary
4 1/2 share of real estate located at 28 Kensington 219.700.00 50.000°� 109,850.00
Squar�e,Mechanicsburg,Cumberland County,
Pennsylvania,Parcel No.10-19-1604-217-UC-28,
transferred by Deed recorded in the Office of the
Recorder of Deeds of Cumberland County at Deed
Book 133, Page 796,to Edward A.Gannon and
Marjorie K.Gannon,Trustees,or their successors in
trvst,under the Edward A.Gannon Living Trust dated
January 2,1996,and any amendments ther�eto,and
Marjorie K.Gannon and Edward A.Gannon,Trustees,
or their successors in trust,under the Mary'orie K.
Gannon Living Trust dated January 2,1996,and any
amendments thereto,as tenants in common
(�219,700.00 assessed value x 1.00 common level
ratio)
5 Regular Savings Account No. 105290-00,held at 15,018.89 100.000°� 15.018.89
Members 1st Federal Credit Union,titled to Marjorie K.
Gannon and Edward A.Gannon,Trustees of the
Marjorie K.Gannon Living Trust dated January 2,199
(50.74 accrued interest)
Totai of Continuat�on Schedules See attached
eg
TOTAL(Also enter on Line 7,Recapitutation) 849.703.72
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09)
Rev-1510 EX+(pg.pg)
SCHEDULE G
pennsylvania lNTER-V1VOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Gannon, Ma 'orie K. 21-13-0735
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH °�6 OF DECD'S �CLUSION TAXABLE
NUMBER TME DATE OF TR�AFNSFE�R.SATTACIi A COPR1fEOFTTHE DEED F�OREREA�L ES n��. VALUE OF ASSET INTEREST (�F APPLICABLE) VALUE
6 Money Management Savings Account No.105290-05, 103.616.42 100.000% 103.616.42
held at Members 1st Federal Credit Union,titied to
Marjorie K.Gannon and Edward A.Gannon,Trustees
of the Marjorie K.Gannon Living Trust dated January �
2,1996(a10.22 accrued interest)
7 928.400 shares of Federated Capital Reserves,held in 928.40 100.000% 928.40
Account No.5ZV-033997 at Members 1st Invesbnent
Services,titled to Marjorie K.Gannon and Edward A.
Gannon,Trustees of the Marjorie K.Gannon Living
Trust dated 01/02l1996(�1.00/share)
8 40.000 shares of Bank of the West Instl Ctf Dep,held 39,432.00 100.000% 39.432.00
in Account No.5ZV-033997 at Members 1st
Invesbnent Services,titied to Marjorie K.Gannon and
Edward A.Gannon,Trustees of the Marjorie K.
Gannon Living Trust dated 01/02/1996(�985.80/share),
CUSIP#06426XCY4
9 30.000 shares of Ailegheny Cnty PA Arpt Auth,heid in 31,371.00 100.000°� 31,371.00
Account No.5ZV-033997 at Members 1st Investment
Services,titied to Maryorie K.Gannon and Edward A.
Gannon,Trustees of the Mary'orie K.Gannon Living
Trust dated 01/02/1996(51,045.70/share),CUSIP
#01728LDF6
10 20.000 shares of Lancaster PA Area Swr Auth,heid in 21,436.40 100.000°k 21,436.40
Account No.5ZV-033997 at Members 1st Investment
Services,titled to Marjorie K.Gannon and Edward A.
Gannon,Trustees of the Maryorie K.Gannon Living
Truat dated 01/02/1996(51,071.82/share),CUSIP
#514288J U4
Copyright(c)2009 form soflware only The Ladcner Group,Inc. Form PA-1500 Schedule G(Rev.08-09)
Rev-�s�o ex+�os-o9y
scH�ou�E �
pennsylvania lNTER VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Gannon, Ma 'orie K. 21-13-0735
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH 96 OF DECD�s �(CLUSION TAXABLE
NUMBER �{E DATE�TW�4�NSTFER SATTACIi A COPY OF THE DEED F�OREREAL Es nTE. VALUE OF ASSET ��EREST (IF APPLICABLE) VALUE
11 2755.906 shares of Pimco Income Fund Class A,held 34,669.30 100.000% 34,669.30
in Account No.5ZV-033997 at Members 1st
tnvestment Services,titled to Marjorie K.Gannon and
Edvward A.�annon,Trusfiees of the Marjorie K.
Gannon Living Trust dated 01/02/1996(512.58/share),
CUSIP#72201 F474
12 950 shares of AT�T inc,held in Wells Fargo Account 36,461.00 100.000% 36.461.00
No.2942-8970,titled to Marjorie K.Gannon and
Edward A.Gannon,Trustees,of the Marjorie K.
Gannon Living Trust dated January 22,1996
(538.380000/share),CUSIP#00206R102
13 Dividend,ATBT Inc,held in Wells Fargo Accourrt No. 427.50 100.000% 427.50
2942-8970,titled to Marjorie K.Gannon and Edward A.
Gannon,Trusteea,of the Mary'orie K.Gannon Living
Trust dated January 22,1996; Ex:04/08/13 Rec:
04J10/13 Pay:05/01/13(950 shares at�0.45/share),
CUSIP#00206R102
14 4,100 shares of Credit Suisse Asset Mgmt Income, 17,100.28 100.000% 17.100.28
held in Wells Fargo Account No.2942-8970,titled to
Marjorie K.Gannon and Edward A.Gannon,Trustees,
of tl�e Marjorie K.Gannon Living Trust dated January
22,1996(�4.170800/share),CUSIP#224916106
15 Dividend,Credit Suisse Asset Mgmt Income,held in 108.65 100.000°� 108.65
Welia Fargo Account No.2942-8970,titled to Marjorie
K.Gannon and Edward A.Gannon,Trustees,of the
Marjorie K.Gannon Living Trust dated January 22,
4996;Ex:04/05/13 Rec:04/09/13 Pay:04/15/13(4,100
shares at$0.0265/share),CUSIP#224916106
Copyright(c)2009 fonn software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09)
Rev-1510 EX+(OS-09)
SCH�DULE G
pennsylvania lNTER VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Gannon, Ma 'orie K. 21-13-0735
��M DESCRIPTION OF PROPERTY DATE OF DEATH °jb OF DECD�s �(CLUSION TAXABLE
NUMBER Tr{E DATE OF TR�A�NSE RSATTACN A COPY OFTTHE DEED F�OREREAL EsTn�. VALUE OF ASSET ��EREST ��F APPLICABLE) VALUE
16 1,504 shares of Invesco PA Value Mun income Tr,held 22,180.24 100.000% 22,180.24
in Welis Fargo Account No.2942-8970,titled to
Marjorie K.Gannon and Edward A.Gannon,Trustees,
of the Marjorie K.Gannon Living Trust dated January
22,1996($14.747500/share),CUSIP#46132K109
17 Dividend,Invesco PA Value Mun Income Tr,held in 112.80 100.000% 112.80
Welis Fargo Account No.2942-8970,titled to Marjorie
K.Gannon and Edward A.Gannon,Trustees,of the
Marjorie K.Gannon Llving Trust dated January 22,
1996; Ex:04/09/13 Rec:04/11/13 Pay:04/30/13(1,504
shares at$0.075/share),CUSIP#46132K109
18 1,916 shares of Nuveen Mun Mkt Opportunity Fd,heid 27,699.61 100.000% 27,699.61
in Wells Fargo Account No.2942-8970,titied to
Marjorie K.Gannon and Edward A.Gannon,Trustees,
of the Marjorie K.Gannon Living Trust dated January
22,1996(544.457000/share)(includes dividend of
50.064500/share-Ex:04/11/13 Rec:04/15/13 Pay:
05/01/13),CUSIP#67062W103
19 700 shares of PPL Corp,held in Wells Fargo Account 22,286.25 100.000% 22.286.25
No.2942-8970,titled to Marjorie K.Gannon and
Edward A.Gannon,Trustees,of the Marjorie K.
Gannon Living Trust dated January 22,1996
(�31.837500/share),CUSIP#69351T106
20 525,000 face value Bethlehem PA Area Sch Dist,DTD: 27,025.86 100.000% 27,025.86
11/01/2011,4°�,due 11/15/2027,at;106.459000,held
in Wells Fargo Account No.2942-8970,titied to
Marjorie K.Gannon and Edward A.Gannon,Trustees,
of the Marjorie K.Gannon Living Trust dated January
22,1996(accrued interest�411.11),CUSIP
#087365TX0
Copyright(c)2009 form software only The Ladcner Group,Inc. Form PA-1500 Schedule G(Rev.OS-09)
Rev-1510 EX+(08.p9)
SCHEDULE G
pennsylvania lNTER VIVOS TRANSFERS AND
DEPARTAAENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Gannon, Ma 'orie K. 21-13-0735
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD�s �c�usioni TAXABLE
NUMBER TME pq�pF ET�F SFER SATTACIi A COPY OF THE DEED F�OREREAL Es�E. VALUE OF ASSET �NTEREST ��F APPLICABLE) VALUE
21 Z27,000 face value HSBC Bank USA NA,DTD: 27.299.34 100.000% 27,299.34
03/07/2011,2%,due 03/07l2018,at 5100.908675,held
in Wells Fargo Account No.2942-8970,titled to
Marjorie K.Gannon and Edward A.Gannon,Trustees,
of the Marjorie K.Gannon Living Trust dated January
22,1996(accrued interest�54.00),CUSIP
#40431 GMZ9
22 �40,000 face value Pennsylvania St Tpk Commn Tpk, 42,980.00 100.000% 42,980.00
DTD:0T/28/2010,4.5°k,due 12/01/2038,at
�105.800000,held in Wells Fargo Account No.2942
-8970,titled to Marjorie K.Gannon and Edward A.
Gannon,Trustees,of the Marjorie K.Gannon Living
Trust dated January 22,1996(accrued interest
�660.00),CUSIP#709223ZP9
23 s20,000 face value Pittsburgh PA Sch Dist,DTD: 21,198.87 100.000% 21.198.87
10/01/2004,4.25%,due 09/01/2023,at�105.4985000,
held in Wells Fargo Account No.2942-8970,titled to
Marjorie K.Gannon and Edward A.Gannon,Trustees,
of the Marjorie K.Gannon Living Trust dated January
22,1996(accrued interest�99.17),CUSIP#7252765M
24 555,000 face value Williamsport PA Area Sch Dist, 56,298.89 100.000°� 56,298.89
DTD:11/10/2009,2.8°�,due Si15/2018,at;101.910500,
held in Weils Fargo Account No.2942-8970,titled to
Marjorie K.Gannon and Edward A.Gannon,Trustees,
of the Marjorie K.Gannon Living Trust dated January
22,1996(accrued interest�248.11),CUSIP
#970174PN2
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.0&09)
REV-1511 EX+(10-09) gCH�DULE H
pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
RESIDEN/T DEC DµTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Gannon, Marjorie K. 21-13-0735
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
p, FUNERAL EXPENSES:
See continuation schedule(s)attached 16,497.20
B. ADMINISTRATIVE COSTS:
1. Pe�sonal Representative's Commissions
Name of Personal Representative(s)
Street Address
Cit�r State Zio
Year(s)Commission Paid Waived
2. Attomev°s Fees Law Offices of Susan E. Lederer(estimate) 6,375.00
3. Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation) 10.00
Claimant Edward A.Gannon
Street Address 28 Kensington Square
C;t�, Mechanicsburg state PA zip 17050
Relationshi�of Claimant to Decedent Spouse
4. Probate Fees
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs 15.00
See continuation schedule(s)attached
TOTAL(Also enter on line 9,Recapitulation) 22,897.20
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
Gannon, Marjorie K. 21-13-0735
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral ExRenses
1 Weir Funeral Home 11.516.32
2 1760 Pub and Grille(funeral luncheon) 771.14
3 Keystone Memoriai Company(headstone) 4,031.74
4 Talbots(burial ciothing) 88.00
5 Boscov's(burial ciothing) 30.00
6 Thank you notes and postage 60.00
H-A 16,497.20
Other Administrative Costs
7 Cumbertand County Register of Wills(filing fee-Inheritance Tax Return) 15.00
H-B7 15.00
Copyright(c)2002 forrn software only The Lackner Group,inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-OS)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gannon, Ma 'orie K. 21-13-0735
Report debls Incurred by the dscedent prior to death that mmained unpaid at the date of death,including unroimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Manor Care Rehabilitation(rehab services) 4.908.41
2 West Shore Ambulance(hospital transfer) 51.38
3 Holy Spirit Hospital(medical bill) 80.75
4 Heartland Pharmacy(prescription bill) 152.32
TOTAL(Atso enter on Line 10,Recapitulation) 5,192.86
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule 1(Rev.12-08)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gannon,Ma 'orie K. 21-13-0735
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$)
I TAXABLE DISTRIBUTIONS [inciude outright spousal
• distributions,and transfers
under Sec.9116 a 1.2
1 Edward A.Gannon Spouse Annuities, 161,825.62
28 Kensington Square Schedule G,
Mechanicsburg,PA 17050 Items 1 and 2
Total 161,825.62
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a � riate.
NON-TAXAB�E DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
See continuation schedule(s)attached 34,402•�3
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHE 34,402.73
Copyright(c)2010 fonn software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
SCHEDULE J-IIA
SPOUSAL DISTRIBUTIONS UNDER
SECTION 9113 FOR WHICH AN
ELECTION TO TAX IS NOT BEING MADE
continued
ESTATE OF FILE NUMBER
Gannon, Marjorie K. 21-13-0735
ITEM
NUMBER DESCRIPTION AMOUNT
1 Life Estate inberest of Edward Gannon in Survivor's Trust under Article Eight of the Marjorie 34.402.73
K.Gannon Living Trust dated January 2,1996
Subtotal 34,402.73
Copyright(c)2010 fo�rn software only The Lackner Group,Inc. Form PA-1500 Schedule J-IIA(Rev.01-10)
REV-1514 EX+(4.081
SCHEDULE K
� LIFE ESTATE, ANNUITY
COMMONWEALTH OF PENNSYLVANIA & TERM CERTAIN
INHERITANCE TAX RETURN
RESIDENT DECEDENT (Check Box 4 on Rev-1500 Cover Sheet)
ESTATE OF FILE NUMBER
Gannon Ma 'orie K. 21-13-0735
This schedule should be used for all single life,joint or successive life estate and term-certain calculations.For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue.
Actuarial factors can be found in IRS Publication 1457,Actuarial Values,Alpha Volume for dates of death from 5-1-89 to 430-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate the rype of instrument which created the future interest below and attach a copy to the tax return.
❑Will �Intervivos Deed of Trust ❑Other
NEAREST AGE AT TERM OF YEARS
NAME OF LIFE TENANT DATE OF BIRTH DATE OF DEATH LIFE ESTATE IS PAYABLE
Edward Gannon 03/09/1921 92 � Life or ❑Term of Years
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
�. Value of fund from which life estate is payable $ 659,688.04
2. Actuarial factor per appropriate table .05215
Interest table rate- ❑31/2% ❑6% ❑ 10% �Variable Rate 1.4%
3. Value of life estate(Line 1 multiplied by Line 2) $ 34,4�2•73
NEARESTAGE AT TERM OF YEARS
NAME OF ANNUfTANT DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
1. Value of fund from which annuity is payable �
2. Check appropriate block below and enter corresponding number
Frequency of payout�W�kly(52) ❑Bi-weekly(26) ❑Monthly(12) ❑Quarterly(4)
❑Semi-annually(2) ❑Annually(1) ❑Other
3. Amount of payout per period �
4, Aggregate annual payment. Line 2 multiplied by Line 3
5. Annuity Factor(see instructions)
Interest tabte rate- ❑31/2% ❑6% ❑ 10% ❑Variable Rate
6. Adjustment Factor(see instructions) �
7. Value of annuity-If using 31/2%,6%, 10%or if variable rate and period payout is at end of period,
calculation is:Line 4 x Line 5 x Line 6 $
If using variable rate and period payout is at beginning of period,calculation is:
(Line 4 x Line 5 x Line 6)+Line 3
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of the
tax retum.The resulting life or annuity interest(s)should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the retum.
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule K(Rev.4-09)
REV-1647 EX+(9-00)
SCHEDULE M
COMMONWEALTH OF PENNSYLVANIA FUTURE lNTEREST COMPROMISE
INHERRANCE TAX RETURN
RESIDENT DECEDENT (Check Box 4a on Rev-1500 Cover Sheet)
ESTATE OF FILE NUMBER
Gannon, Mar'orie K. 21-13-0735
This schedule is appropriate only for Estates of decedents dying after December 12,1982.
This schedule is to be used for all future interes#s where the rate of tax which will be applicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the tvoe of instrument which created the future interest and attach a coov to the tax retum
❑Will ❑Trust ❑Other
I. Beneficiaries
NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRT AGE TO
NEAREST BIRTHDAY
1. Michael P.Gannon son 06/02/1952 61
2, Patricia A.Brosious daughter 03/O7/1956 57
3, James E.Gannon son 08/03/1960 53
4.
5.
��• For decedents dying on or after July 1,1994,if a surviving spouse exercised or intends to exercise a right of withdrawal within 9
months of the decedenYs death,check the appropriate block and attach a copy of the document in which the surviving spouse
exercises such withdrawal�' qt.
U Unlimited ri ht of withdrawal ❑Limited right of withdrawal
111. Explanation of Compromise Offer:
Under Article Eight of the Marjorie K.Gannon Living Trust,the Trustee must pay the net income to Edward
Gannon during his lifetime. The Trustee may pay principal for the support of Edward Gannon,to him for his
benefit
At Edward Gannon's death,the remaining principal and any undistributed income shall be paid to Michael P.
Gannon,Patricia A.Brosious,and James E.Gannon.
Edward Gannon is at his home. His assets are currently�748,184.00,and his monthly income is approximately
58,000.00. At the present time,his income is adequate to meet his monthly expenses. It js not anticipated that he
will need to invade the principal of the Trust for his benefi�
The mandatory income interest payable to Edward Gannon(wife)during his lifetime under Article Eight of the
Trust should be taxed at the 0%spousal rate.
The remainder interest should be taxed at the 4.5%lineal rate since it will pass to Michael P.Gannon,Patricia A.
Brosious,and James E.Gannon(children).
IV. Summary of Compromise Offer:
1. Amount of Future Interest: 625,285.31
2. Value of Line 1 exempt from tax as amount passing to charities,etc.
(also include as part of total shown on Line 13 of Cover Sheet)
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One❑6% ❑3% ❑0%
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate 625,285.31
❑6°k �4.5%
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate(12%)
(also include as part of total shown on Line 17 of Cover Sheet)
6. Value of Line 1 taxable at collateral rate(15%)
(also include as part of total shown on Line 18 of Cover Sheet)
7. Total value of Future Interest(sum of Lines 2 thru 6 must equal Line 1) 625,285.31
Copyright(c)2002 foRn software only The Lackner Group,Inc. Form PA-1500 Schedule M(Rev.6-98)
Rev-1151 EX(08-12)
pennsylvania SCHEDULE O
DEPARTMENTOFREVENUE ELECTION UNDER SEC. 9113(A)
INHERITANCE TAX RETURN
RESIDENTDECEDENT SPOUSAL DISTRIBUTIONS
ESTATE OF FILE NUMBER
Gannon, Mar'orie K. 21-13-0735
PART A - DEFERRING STATEMENT
For all trust assets reportable for Pennsylvania inheritance tax purposes for which a deferral of tax is being elected under
Section 9113(a),the personal representative responsible for filing the return and the trustee(s)of the trust in question hereby
acknowledge the department's Statement of Policy set forth at 61 Pa.Code§94.3 conceming any potential termination of the
trust under 20 Pa.C.S.§7710.1 that occurs after the return was filed.Specifically,the signatories recognize each individual's
assumption of liability for inheritance tax consequences that result from any termination of the trust under 20 Pa.C.S.§7710.1
that occurs after a retum has been filed.
a�, C�� �-� �,e�.,e.� 4�� �,�
ignature of Person Responsible for Filing Return Signature(s)of Trustee(s)
PART B— ELECTION TO TAX AMOUNTS
Complete this section only if making the election to tax available under Section 9113(a)of the Inheritance�
Estate Tax Act.
If the election applies to more than one trust or similar arrangement,a separate form must be flled for each trust. This ele�tion
applies to the Marjorie K.Gannon Survivor's Trust(marital,residual A,B,bypass,un�ed credit,etc.).
Enter the description and value of all interests for which the Section 9113(A)election to tax is made.
DESCRIPTION VALUE
See continuation schedule(s)attached
'�'O�� 34,402.73
(If more space is needed,insert additional sheets of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Forrn PA-1500 Schedule O(Rev.09-12)
SCHEDULE O
ELECTION UND�R SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
continued
ESTATE OF FILE NUMBER
Gannon, Marjorie K. 21-13-0735
ITEM
NUMBER DESCRIPTION AMOUNT
9113A TrustlElection Made
1 Survivor's Trust under Article Eight of the Marjorie K.Gannon Living Trust dated January 2, 34,402.73
1996,and any amendments thereto
01-B Subtotat 34.402.73
Copyright(c)2012 form soflware only The Lackner Group,Inc. Form PA-1500 Schedule O(Rev.09-12)
'�Mt!f�i'
The _
MARJOItIE K. GANNON -
LIVING TRUST
_
prepared for
MARJORIE K. GANNON -
i
ti,�.
. _ -- -
� JAMES, SMITH & DURK[N -
Attorneys-at-Law �
l34 Sipe Avenue
Hummelstown, Pennsylvania 17036
._.,.
(7l7)533-3Z80 FAX (71?) 533-2795 °
�James,Smith&Durkin
f All Rights Reserved _
�•,... _
�A�J��E K. GANNQN LIVING TRU
�� . S -
T
T'able of Contents
Article �ne Trust Creation . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .__
1-1
Article Two The Trust Estate . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2•1 _
Article Three Appointment of Trustees. . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . 3-1
Article Four Trustor's Lifetime Rights. . . . . . . , . , ,
. . . . . . . . . . . . . . . . . . . . 4-1
Article Five Trust Administration Upon My Death . . . . � ��
. . . . . . . . . . . . . . . . . . 5-1
_ _
Article Six Specific Distributions of Trust Property . . . . , , , . � �� �
. . . . . . . . . . . . . . 6-1
Article Seven Division into Survivor's Trust and Famil -
y Trust. . . . . . . . . , 7_1____ _
Article Eight The Survivor's Trust. . . . . . . . . . . . . :
. . . . . . . . . . . . . . . . . . . . . 8-1
� Article Nine The Family . . . . . . . . _ .
��...�.. Trust . . . . . . . . . . . . . . 9-1
. . . . . . . . . . . . . .
Article Ten Common Pot Trust .
. . . . . . . . . . . . . . . . . 10-
. . . . . . . . . . . . . . . . 1 _ __
Article Eleven Division and Distribution of Trust Pro e
p rty. . . . . . . . . . . . . . . . . . 11-1
Article Twelve Distribution If No Designated Beneficiar'
ies. . . . . . . . . . . . . . . . . . 12-1
Article Thirteen Trustee Administration . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . _
. . 3-1 _ ___ __.
Article Fourteen Trustee Investment Powers . . . . . . . . .
. . . . . . . . . . . . . . . 14-1 _
. . . . . _ _
Article Fifteen General Provisions. . . " : ,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-1
; _
5 .. . �_ -.�.��.
��•
I
� MARJORIE K. GANNON LIVING TRUS
�..., T _
_
Article One, .
_
Trust Creation -
Section 1. Parties to My Trust
�pN 0 Z 1996 .___
_
T'his trust agreement dated is made between MARIORIE K. GANNON the
Trustor, also known as MARJORIE K. GANNON, and the following initial Trustee(s): � _
MARJORIE K. GANNON
_ _.��
EDWARD A. GANNON =
Section 2. Name of My Trust
_ _
This trust may be referred to as the:
MARJORIE K. GANNON LIV[NG TRUST dated �AN � 2 �996
�
' The formal name of my trust and the designation to be used for the transfer of title to the �
�" name
of my trust is:
MARJORIE K. GANNON and EDWARD A. GANNON, Trustees, or their successors in
trust, under the MARJORIE K. GANNON LIVING TRUST dated
1 A� 0 2 19�..� and any amendments thereto
Section 3. Rev�bcable Living Trust
_
My trust is a revocable living trust. •
Section 4. Trustor as Trustee
Unless otherwise provided in this trust agreement, when I am serving as Trustee under this trust
1 may conduct business and act on behalf of my trust without the consent of any other Trustee�
t
�.....
1-1 �
Section 5. My Family __.
��� . _
_
a. Marital Status
I am currently married and my spouse's name is EpWARD A. GANNON. All
references to my spouse in tl�is trust agreement are to him. _._._
A. The name(s) and birth date(s� of the children of MARJORIE K. GANNON are:
N� Birth date _ :
MICHAEL P. GANNON
June 2, 1952
PATRICIA A. BROSIOUS March 7, 1956 -
JAMES E. GANNON AugUSt 3, 1960 _
All references to the children of MAR1oR1E K. GANNON in this instrument are to
these children and any children subsequently born to or adopted by her. , .
� __ __
��...... _
__. _
, _
�.... - -
1-2 -
�,,,.� Article Two - -
The Trust Estate
_
Section 1. Initial Transfer of Property -
I hereby assign, convey, transfer and detiver to my Trustee all propert set forth o
"A", attached hereto, and made part of tllis trust agreement. My Trustee acknowled Scl�edule _
of all assets listed on the attached Schedule, ges receipt
,
AlI assets titled in the name of my trust or in the name of my Trustee, but not listed __.
on Schedule
A", shall be considered a part of my trust estate as if they had been set forth on the
Schedule. attached
Section 2. Additionai Transfer of Pro er
P tY _
My Trustee is authorized to accept additional transfers of r
time in any manner by me or any other person or entity, p operty interests of aIl kinds, at any . - a
All property interests received by transfer, assi nment ift
` g , g , bequest, devise or beneficiary
..,.,.. designation shall become a part of my trust estate unless disclaimed b m Trustee. -
Y Y
Section 3. Composition of Trust Pro er
P tY _
In addition to the property described in the previous Sections
following: , my trust estate shall include the
a• All insurance policies transferred to my trust or olicies in ' -
trust is named as beneficiary plus the proceeds of those oli�hlch my
. p ies,
b.
Any interest in any per�sion, retirement or death benefit, bonus,
profit-sharing or employee's savings plan or any similar contract
created or entered into by a.n employer for the benefit of some or all �
employees which is transferred to my trust or in whicl� my trust is .
named as beneficiary and all proceeds of any such benefit, bOiIUS 1111
or contract; and � P -
_ _
� - __.__. _
�_ _..��_:-
2-1 :
,
�� �• Any other property or interest in property which becomes subject to -
� my trust.
Section 4. Acceptance of Trust Pro er
P tY
_ __
All property transferred to my trust and not disclaimed b m Truste
and distributed according to the terms of this agreement Y e shall be held, administered _
Section 5. Trust Property Scl�eclule
The trust property transferred to my trust is set forth on Schedule "A". -
i
• ,
�.,�„ __: -
�
�..,,,.
_ _. .
2-2 :.
.
�. Article Tliree
Appointment of Trustees - ��
Section 1. Definition of Trustee
_
All references in this agreement to "Trustee" shall be deemed a reference to the er
who is then serving as Trustee and shall include alternate or successor Trusteesp son or entity _
unless the context requires otherwise. or Co-Trustees _
Section 2. Resignation of a Trustee
Any Trustee may resign at any time without court a roval b ivin
. PP Y g g written notice to me or to
my personal representat�ves, If I am not living, written notice shall be ive
Trustee, or if there is no successor, to the beneficiaries then entitled go ecei e y Successor
principal distributions under this agreement,to tlieir res ective ersonal lncome or
beneficiaries then be minors, to the persons havin the care or cu representatives, or if such :
g stody of them. -
� Section 3. Removal of a Trustee
�
Any Trustee may be removed under this agreement as follows:
a• While I am Both Alive and Competent .
While I am both aiive and legally competent, I shall have the ri ht t
any Trustee appointed under this agreement at any time with no reguirement ove �- - .
the removed Trustee receive any reason for such termination. � hat
b• Removal by Others
After my death or legal incompetency, any Trustee ma be r
ma�ority vote of the beneficiaries then entitled to receiveyncome ooved by a
distributions under this trust agreement or their personal representatives at a al
time for cause. Y -
c. _ _ _
Notice to Removed Trustee --
Written notice of removal under this agreement shall be effe ' '
when signed by the person or persons authorized to makeCthe �mmediately
removal and ;
delivered to the Trustee personally or deposit by United States certified m '
, ail, __ _ ,
.. ,.
�w_ _
3-1
return receipt requested. The written notice removing a Trustee shall designate
� _
a successor Trustee.
�• Transfer of Trust Property �
The Trustee so removed shall promptly transfer and deliver to t - �� Y°�
Trustee all property of the trust under its possession and contr he successor ____ _
ol. __
Section 4. Designated Successor Trustees
Whenever a Trustee is removed, dies, resigns, becomes legall inca acitate _ �
unable or unwilling to serve, that Trustee shall be replaced as oilow s d' °r is otherwise_ .
a. _
The Death or Disability of a Trustee While I am Serving as -
Trustee -
I may serve as the only Trustee or I may name any number of Trustee
wrth me. If any of these other Trustees subsequently die, resign, become le al e
�ncapacitated or are otherwise unable or unwilling to serve as a Trustee I may . - _
or may not fill the vacancy. ' y -
i b- Disability Trustees of MARJORIE K. GANNON
.� _
Upon the disability of MAR.toRtE K. GANNON, if she is then servin as ' ' ' �---
T r u s t e e, s h e s h a l l be rep lace d by t he following Disability Truste es ; � i n rt�a l
� ) _
EDWARD A. GANNON
If, for any reason, the Disability Trustee(s)named above are unabl ' '
e or unwilling
to serve, the following successor Disability Trustee(s) shall serve until the �
successor Disability Trustee(s)on the list have been exhausted. Unless otherwise
specified, if Co-Disability Trustees are serving, the next following named
successor Disability Trustee shall serve only after all of the Co-Disability
Trustees cease to act as Trustees.
(1) PATRICIA A. BRQSIOUS; THEN - -
�'
(2) MICHAEL P. GANNON AND JAMES E. GANNON, OR THE SURVIVOR � --
i _
`i►...,. - � .� � - ��... � �_ .
3-2 : :
�- Death Trustees of MARJORIE K. GANNON
��
Upon the death of MARJORIE K. GANNON, if she is then servin as _ -
Trustee, she shall be replaced by the following Death Trustee(s)� � lnitial
._. _
� EDWARD A. GANNON - �
If, for any reason, the Death Trustee(s) named above are unable or ' '
unwilling to
serve, the following successor Death Trustee(s) shall serve until the successor
Death Trustee(s) on the list have beer� exhausted. Unless otherwise s '
if Co-Death Trustees are serving the next following named successore Deed,
ath ---
Trustee shall serve only after all of the Co-Death Trustees cease to act as
Trustees.
_ -_..
(1) PATRICIA A. BROSIOUS; THEN
(2) MICHAEL P. GANNON AND JAMES E. GANNON, OR THE SURVIV4R
� Section 5. Definit�on of Disabili
tY
A Tzustee shall be considered disabled in t�le event that a court
of competent jurisdiction � -
determines that such Trustee is legally incompetent, or in the event that a Trust
adjudicated incompetent but, by reason of illness or mental disabilit ee is not R_
`�,,,� certified by two licensed physicians to be unable to ro erl handle y' such Trustee has been.:_ - _
P P Y his or her own affairs. -
Section 6. No Designated Successor Trustees _
If at any time there is no Trustee acting under this a reement an
designated and qualified as a successor Trustee, a ma'orit of d there is no person or institution
receive distributions of income or rinci al und � y the beneficiaries then eligible to._
P p er thts a�reement or their legal representatives
shall appoint a successor Trustee. If any trust existing under this a reement lack
no successor is appointed pursuant to this Section, the vacancy s�hall be filled a Trustee and -
competent jurisdiction. by a court of
Section 7. Responsibility of Successor
�'rustees .
A successor Trustee shall have the same rightS� owers duti �
2t had been named as initial Trustee under th s a reements, d�scret�ons and immunities as if -
personally liable for any act or failure to act of an g redecess No successor Trustee shall be
to examine tlle records of any earlier Trustee. A successo or Trustee or shall have any duty -
r Trustee may accept the account
r _
�
,,.� :
3-3 __ :
'�, rendered and the property delivered by or on behalf of a predecessor Trustee as a ��
complete discharge of the duties of the predecessor Trustee without incurrin full and _
or liability for so doing, g any responsibility -
[ .
,
..,,�
_ __._
_.__.
! -
''�..... �.
3-4 -
�
Article Four
Trustor's Lifetime Ri hts _
. g .
Section 1. Rights While I am Alive and Le all Com � �
g y petent
During my lifetime while I am legally competent,I sliall have the followin owers
property and my Trustee: g P over the trust
a. .
Right to Trust Income
My Trustee shall pay to me or apply for my benefit all the net income from this � -
trust monthly or in other convenient installments as I may direct.
b• Right to Trust Principal -
My Trustee shall pay to me or apply for my benefit such sums from
principal of this trust as I may direct. I may not, however direct m T �1e
make gifts from trust property to third parties. If my Trustee inadvertentl� -
makes a distribution I intended as a gift directly from the trust to a third party,
that distribution shall be construed as a distribution to me first then a gift to the
_ .�. ____ . _.
'�,,,,.,. third party from me.
�• Right to Add and �temove Property
By written direction delivered to my Trustee, I may add other ro ert t
trust or withdraw property in any amount and at any time. P p y o my
, __
d• Right to Amend or Revoke My Trust
I shall have the right to anlend, modify, alter, revoke or terminate m
y trust or
any separate trusts created under this agreement at any time in whole or in part.
Any amendment or revocation of this trust agreement must be delivered =- -
T r u s t e e i n w r i t i n g. T he power to amend, revoke or terminate this t us t is - �
personal to me and may not be exercised by any other person or entity. - -
After my death, this trust or any trust created by this a reement shal _
8 l be '
irrevocable and not sub�ect to amendment.
••._.
4-1 _
____
�
e.
Delive�y of Property After Revocation
•�a.�••
After any revocation or termination of any trust created b this a r .
Trustee shall promptly deliver the designated trust property to me. eement my _
f• Trustee's Retention of Assets Upon Revocation --
In the event of any revocation of all or part of my trust, my Trustee shall be
entitled to retain sufficient assets to reasonably secure the payment of liabilities -- -
� -
my rustee has lawfully incurred in administering the trust and any fees that � �
have been earned by my Trustee until such time as those liabilities .
discharged and fees paid, unless I indemnify my Trustee a ainst loss o ave been .. __ ,
g r expense. _ _.
_
Section 2. Power to Direct Investments
I shall have the right to direct investments of trust property as follows: -
a• Invest trust funds in specified securities, properties or other form - - .
investment; s of --:
.
b• Retaiii as part of tlie trust estate for s ecified -
p ' periods of time
� securities, properties or otlier forms of investment held in trust under
�..__�..�.
'``-' this instrument; and
�• Sell, encumber, lease, abandon or dispose of any trust ro ert . _ - - -
P P y
My Trustee shall not be liable for any losses sustained as a dir ' ' �
result of any action taken in accordance with the terms of the wr'itte or.indirect - -
All directions shall be in a writing signed by me, s ecif in if a n direction. . :
period of time during which the instructions shall rema' •y g' PPlicable the
any other conditions affecting the directions, ln ln effect and describing
t
��,,,. - _ _
4-2 _
�� Section 3. Trustor's Rights Durin Disabili
�`�+�.�• g . �' -
a• Disability De�ned
I shall be considered disabled in the event a court of com etent 'urisdic '
determines that I am legally incompetent or, in the event that I am t on
t -
a d j u d i c a t e d i n c o m p e ten t bu t by reason o f illness or mental disability, I am in the �
opinion of two licensed physicians unable to properly handle my own affairs.
b• Income and Principal Distributions
My Trustee during the period of a a Trustor's disability shall pay to or a 1 for
that Trustor's benefit as much of the net income and principal of my trust state _ --
as my Trustee in its sole discretion shall deem necessary or advisable.
c. Payment of Obligations -- .
My Trustee during the period of my disability shall from time to time a m
valid obligations, my medical ex enses and � p y y
P provide for my comfortable � - - �
maintenance and welfare taking into consideration my other income or resources.
� d• Income and Principal Distributions for Spouse
�,,,,_
�
My Trustee shall pay to or appty for the benefit of my spouse as much of the
principal and net income of my trust estate as my Trustee in its sole discretion
shall deem necessary or advisable from time to time for my spouse's health -
maintenance, support and education, taking into consideration her other income - �
or resources. --
e• Trustee Guidelines -- -
In making distributions under this Section my Trustee shall ive rima -
consideration to my needs and secondary consideration to the needs of m
spouse. Y
; • _
�:,,,.,.. _
, _
4-3 _: .�_
f. Tax Planning -
�
During my life if I should become disabled, my Trustee may exercise the �
foilowing powers as attorney in fact on my behalf, either alone or in conjunction �
with any other attorney in fact under a durable power of attorney, but the .�
primary coi�cern of my Trustee shall be for my welfa�re and secondarily for the _
welfare of my lineal descendants for tax planning:
1. My Trustee may make additional distributions to my
lineal descendants equally by class for the purpose :
of confinuing any gift program initiated by me . :
which rriy Trustee reasonably determines will
_ ....
achieve beneficial results for estate and/or income
:
tax planning purposes. _
2. My Trustee may initiate a gift program on my - :
behalf which my Trustee reasonably determines will - _
achieve beneficial results for estate andlor income -
tax planning purposes by making distributions to my
lineal descendants equally by class so long as such : -
distributions are made in the form which qualify for ��-
,
and are limited to the annual exclusion for federal --
; gift tax purposes. -
��....�. _
._ T
3. During any period when I am disabled, my Trustee __
shall be under no obligation to initiate, recommend
or consider any tax planning objective or program
for me and any exercise of its discretion in this =�-- -
regard when conducted in good faith shall not
subject it to liability to any person affected thereby.
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Section 4. Exercise of Trustor's Rights and Powers b
�,,�,,,, y Others _
Any right or power that I could exercise personally under the terms of this a ree _ __
power to amend, revoke or terminate any trust created by this agreement may be exere s dt f e -
and on behalf of ine b an attorne or
Y Y y in fact who, at the time of the exercise, is duly appointed
and acting for me under a valid and enforceable dwrable power of attorne exe
if there is no such attorney in fact, by my duly appointed and actin con erva cuted by me or,
to a court of competent jurisdiction. g tor after petition-
The power to amend, revoke or terminate any trust created by tliis a reement is
and may not be exercised by any other person or entity. � Pezsonal to me
Section 5. Rights Concerning Standb Pro er -
Y p ty
It is contemplated that certain assets m$y be added to the trust estate from time '
possession and control thereof retained by or redelivered to me. If I execute and d m�Wlth the
Trustee an instrument effectiveiy transferring such assets to my Trustee together with anerfurther
documentation necessary to effect the record transfer thereof, in the event of m death or - -
incapacity the assets shall be deemed to be assets of the trust estate and he y
ld by me as the
nominee of my Trustee. During the period such assets are in my possession they shall be sub'ect -�-
to the following terins and conditions: �
� _
..� �
a• I may receive directly and devote to my own use and benefit
any dividends, interest, income or distributions from or upon
_ .
such assets and neither I nor my Trustee shall have any duty
of accounting to the other or to any other person with regard -
thereto. -
b• Any sale, exchange or other transfer of such assets b me -�
shall constitute a withdrawal of such assets from the trust
estate and my Trustee shall have no further interest therein
or duties with regard thereto. Though not a condition
precedent to any such withdrawal, I agree to notify my - -----
Trustee of aIl such withdrawals.
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{ �• I shall be responsible for the reporting of the income from
� such assets to the appropriate taxing authorities arid my
Trustee shall have no responsibility for including such .
.
income on any fiduciary returns prepared by it or for the
� _
preparation of any other income tax return with respect
.__--
thereto unless I duly notify my Trustee of such income items �
and a full and adequate accounting thereof is made and .
presented to my Trustee.
d• I shall protect and indemnify my Trustee against all losses, -
liabilities and expenses which may result directly or - �-
indirectl from m use
Y y , possession, management or control -
. _
of such assets. -
_ _
e• Upon my death or incapacity, my Trustee shall be entitled to
the possession thereof and thereafter shall have all the rights,
powers and duties with respect to such assets which are -
otherwise granted to my Trustee herein. It is understood that
my Trustee shall be responsible Qnly for the assets which
actually come into its possession and control. However, it
.
is also understood that my Trustee shall use any reasonable -
and prudent means to secure possession of any trust assets of -
which it has knowled e.
� g My Trustee shall have no duty, -
�'�- accountability or responsibility to me or to any other person
with respect to any assets of which it has no knowledge or '
of which it is unable to obtain possession and controL
Section 6. Trustor/Trustee Bank Accounts -
It is contemplated that I may establish a joint bank account or acco '
create powers of attorney in respect thereof in other persons. De osits �'r Wlth my Trustee and -
by me or other authorized persons into such an account shall const p te �m time to time made- -
and withdrawals therefrom which may be made without the co-si naturefers to the trust estate
constitute withdrawals from the trust estate. However, my ca acit and othe f my Trustee shall =
with respect to any such account shall be that of nominee of m T r authorized persons.
y rustee not co-owner. �At any ---
given time the trust estate shall include the then balance of any such account.
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_ � Section 7, Life Insurance Policies and
.
_ � etirement Plans
Unless otherwise provided in this trust agreement or
insurance policies and retirement benefits owned b elsewhere, I shall have all powers over life
— following, y or made payable to my trust, including the
= a• Payment of Premiums
— I shall be responsible for the payment of premiums and t
policy or insurance owned by or made payable to m ° her charges on each
have no duty to make any payment or be responsible o d ter My Trustee shall
payments have been made. mine whether such
b• Custody of Policies
My Trustee shall not be responsible for the custod
insurance policy before its actual delivery to m T stee S�ekeeping of any life
by its owner. Y nor af'ter its withdrawal
�• Change Beneficiaries
I shall have the right to change the beneficiary and to receiv
► other earnings of such policies or plans without accountabili any dividends or
'`�' Trustee or any beneficiaiy in this agreement. tY therefor to my
�• Assignnient
I may assign any policy or plan benefits to any lender to th
law including my Trustee as security for any loan to me e extent allowed by
or any other person.
e• Surrendered Policies
If aT1y life insurance policy is surrendered or if the beneficiar
changed, this trust agreement shall be revoked with res eCt of any policy is
However, no revocation of the trust with res p to such policy.
to the provisions of the preceding sentence or otherwi y pol�cy whether pursuant
the surrender or change in beneficiary of the polic is acchall be effective unless
company. Y epted by the insurance
Sectior� 8. Undistributed Net Incom
e
Any net income not distributed under the provisions of '
principal. th�s Article shall be added to the trust
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��;�,,, Article Five
Trust Administration U on M
_ p y Death
— Section 1. Trustees Discretion to Pa M Debts
Y y ancl Taxes
After my death my Trustee in its sole discretion may pay all or an
expenses, debts, claims and taxes becoming due or payable by reason Of m�t of my following
y death:
a• My final medical expenses and all funeral costs;
b• �.egally enforceable claims against me or my estate•
�
�• Reasonable expenses of administration of this trust and my robate
estate, if any; P
d• Any allowances mandated by a court of competent'urisdictio
dependent upon me; � n to those
e• Any estate, inheritance, succession, death or similar taxes payable b
� reason of my death; and y
�°�
f• Any penalties or interest on any of the above claims debts
owed by me or my estate. � or taxes
Section 2. Payment by My 'I'rustee or b M
y y Personal Representat�ve
My Trustee in its sole discretion may make distributions a
directly to the person Qr entities to whom payment is owed uthorized under this Article either
my probate estate. Written statements by my personal re resen a�ivhe personal representative of
payable by my estate shall be su�cient evidence of their amount and that such sums are due and
of niy Trustee. My Trustee shall be under no duty to see to the a li propriety for the protection
made to my personal representative. pP cation of any such payments
Section 3. Tax +lectaons
With regard to the payment of any income tax, gift tax estate t
tax required because of my death, my Trustee shall have the ri ht o� �nheritance tax or any other
allowed under the law. My Trustee is authorized to si n and f make any available elections .
of my death. g ile any tax xeturn required because
f
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� Section 4. Payrnent of Death Taxes CI '
_ �,,, , aims and Expenses
a• Payment out of Trust Property
A11 death taxes, claims and expenses payable under tlle provisions of this Article
shall be paid by my Trustee out of the trust estate except as specificall rovided
for eisewhere in th�s agreement. y P
b• Exception for Property Passing Outside of Trust
Notwithstanding any other provision in my trust, aIl death taxes, claims and
expenses incurred by reason of assets passing outside of my trust or probate
estate shall be assessed against those persons receiving such property.
�• No Payment from Survivor's Sliare
Notwithstanding any other provision in my trust uniess ali other assets availabie
to my Trustee have been exhausted,all death taxes,claims and expenses payable
under the provisions of this Article shall not be paid from the Survivor's Trust
as defined in Article Eight or from any property passing to my survivin s ouse
that qualifies for the federal estate tax marita.l deduction. g p
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��,.. Article Six
Specific Distributions of Trust Pro er
� p �Y
Section 1. No Specific Distributions
My Trustee shall make no specific distributions of trust property to an beneficiarie
trust agreement upon zny death. All distributions of trust property shall be made � S under,th�s
that follow. n the Articles
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��� Article Seven
t
Division into Survivor's Trust •
and Fam�iy Trust
Section 1. Division of the Trust Estate
Upon my death my Trustee shall allocate and distribute tl�e remainin
property that becomes distributable or payable to my Trustee at m death nt estate including any
to be identified as the Survivor's Share and the Family Share. y o two separate shares
�• Pro�erty Transferred to the Survivor's Share
The Survivor's Share shall consist of assets having a value e u �
minimum amount necessary to eliminate or to reduce to t�le maxim al to the
possible any federal estate tax at my death, taking into account the follow tent
ing.
I. The net value for federal estate tax purposes of all other
property tliat passes or has passed to my surviving
spouse under this trust agreement, my probate estate or
otherwise that qualifies for the federal estate tax marital
� deduct�on;
�
��
2. AIl federal estate tax deductions actually allowed od�er
than the marital deduction;
3. The unified credit available to my estate;
4. The credit for state death taxes available to my estate, to
the extent that the use of that credit does not result in or
increase any death tax payable to any state; and
5• Any other allowable credits available to my estate,
except the credit for tax on prior transfers from a
"transferor", as defined in Internal Revenue Code
Sect�on 2013, who dies within two years after the date
of my death but oiily to the extent that those credits do
not disqualify this gift from receiving the marital
deduction.
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b• Survivor's Share to be Administered as Survivor's Trust
The Survivor's Share shall be held, administered and distributed accordin to the
� provisions of the Survivor's Trust as set forth in Articie Eight of ths trust
agreement.
�• Property Transferred to the Family Share
The Family Share shall consist of all assets not distributed to the Survivor's
Share.
�• Family Sliare to be Administered as Family Trust
The Family Share shall be held, administered and distributed accordin to the
provisions of the Family Trust as set forth in Article Nine of tl�is trust
agreement.
Section 2. Ailocation and Valuation of Assets
In allocating assets between the Survivor's Share and the Family Share, m Trustee
the trust assets that qualify for the marital deduction between the Survivor's Share shall allocate
� Share �n cash or in kind or artl and the Family
p y in each on a pro rata or non pro rata basis aiid in undivided
'� interests or tiot; subject, however, to the following:
a• Qualification for Marital Deduction
Only assets that qualify for the marital deduction shall be allocated to the
Survivor's Share.
b• Valuations of Allocations in Kind
Assets allocated in kind shall be deemed to satisfy #he marital ded
on the basis of their values as finally determined for federal estate t�n Umount
provided, however, that my Trustee shall act impartially, consist nt pwith
equitable principles requiring impartiality among beneficiaries in allocatin assets
in satisfaction of the marital deduction share so that any distribution of assets in
satisfaction of the marital deduction share shali be made of assets includin cash
fairly representative of appreciation or depreciation in the value of all t'0 er
thus ava�lable for distribution, p p ty
�• Income
The Survivor's Share shail be entitled to a pro rata share of tlie income e
� arned
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on deceased Trustor's residuary probate and trust assets from the date of
4�� deceased Trustor's death ' ' •
including a share of income earned on assets used to
discharge liabilities.
d• Foreign Deatli Tax Credit
My Trustee shall not ailocate assets that qua�ify for the foreign death tax credit
to the Survivor's Share unless all other assets or interests available for allocation
have been so allocated.
e• Insurance on the Life of My Surviving Spouse
My Trustee shall not allocate any policy of insurance on tlle life of my survivin
spouse to the Survivor's Share that is my separate property. g
f• Insurance on the Lives of Others
Any incidents of ownership to a policy of insurance on the life of a erson other
than me shall be allocated to the Family Share, p
g• Lack of Property to Fully Fund the Survivor's Share
; If there is insuf�cient property. quatifying for the federal estate tax marital
,.�.
deduction to fully fund the Survivor's Share, the funding to the Survivor's Share
shall be reduced accordingly.
Section 3. Intention that Survivor's Share Qualif for Marit
Y al Deductian
I intend tliat the Survivor's Share qualify for the federal estate tax marital deduction
agreement shall be construed accordingly. All other provisions of this trust agreement shall h�s
subordinate to that intent. If the granting of any right, power, privile e authori be
to my Trustee or another person and the imposition of any duty upon m Trusteor immun�ty
person by any provision of this trust agreement would disqualify any share or nteres�other
beneficiary hereunder from qualifying for the federal estate tax marital deduction t of a
Section 2056 of the Code, such provision shall be ineffective if and to the extent t provided by
if effective would so disqualify such share or interest. The provisions of this Sec •hat the same
appiy to my probate estate, personal.representative and all beneficiaries, devisees ndSlealI also
Notwithstanding any other prvv�s�on ��l th�s trust agreement to the contra m gatees.
at any time shall have the right to direct my Trustee in writing to con ert w thin �Vtng spouse
time any unproductive trust property to income roducin ro a reasonable
p g p perty.
Section 4. Disclaimer of Property
V,
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7-3
Any property or portion of property that is disclaimed by my survivin s
� administered or distribute . g pouse shall be held
d according to the following terms: '
a• Property Disclaimed
My surviving spouse may disclaim any property held or distributed to or f
benefit of my surviving spouse under this trust agreement. or the
- b• Time to Disclaim
My surviving spouse may disclaim within the time limits and under th
conditions permitted by the laws regulating disclaimers, e
�• Delivery of Disclaimer to My Trustee
A disclaimer by my surviving spouse may be exercised by the deliver to m
Trustee of an irrevocable and unconditional refusal to accept any or all ro erty
interests passing to my surviving spouse or the Survivor's Share. p p y
�• Disclaimer of Survivor's Share
If my surviving spouse exercises a disclaimer with respect to any or all ro ert
i set aside as the Survivor's Share, such disclaimed interest shall be add d o the
��-�- Family Share.
e• Disclaimer of Family Share
If my surviving spouse exercises a disclaimer with respect to any or all ro e
set aside as the Family Share, such disclaimed interest shall be distribut d nder
the relevant terms of this agreement as though my survivin s ouse
predeceased me. g P had
Section 5. Retirement Accounts
If my Trustee is named the beneficiary of an interest in one or more lan
under Internal Revenue Code Section 401 or one or more Individ al Ret hich are qualified
qualified under Internal Revenue Code Section 408(hereinafter"Retirement lrement Accounts
Trustcc shall allocate the benefits payable from such Retirement Account Accounts"),then my
(or a share hereunder) without underfunding the Family Trust if ossi s to the Survivor's Trust
� p ble.
Furthermore, if one or more Retirement Accounts are distrib
installment paymen#s, the followin uted to the Survivor's Trust in
g provisions shall apply:
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( a• Amount To Be Distributed
`�„�•
My Trustee shall pay to or apply for the sole benefit of my surviving spouse, at
least quarterly, the greater of(i) all of the net income earned by the Retirement
Account, or (ii) the amount required to be distributed from such Retirement
Account under Internal Revenue Code Section 40I(a)(9). My Trustee shall take
all of the necessary action to cause the Retirement Account to distribute to the
Survivor's Trust the amount required to be distributed to the Surviving Trustor
under this paragraph.
b• Qualifying Income Interest
My Trustee shall take all of the necessary action to assure that tlie interest of m
surviving spouse qualifies as a qualifying income interest for life pursuant to
Internal Revenue Code Section 2056(b)(7).
�• Principal and Income AlIocation
My Trustee shall allocate to the income of the Survivor's Trust all of the net
income earned by the Retirement Account and paid to that trust regardless of
whether the Retirement Account is allocated to principal for trust accounting
purposes. My Trustee shall allocate to principal of the Survivor's Trust all other
, distributions from the Retirement Account.
,.�
d• Underproductive Property
The surviving spouse shall have the power to direct my Trustee to compel any
Retirement Account from which distributions are made to the Survivor's Trust
to be invested in income-producing assets.
e• Power to Accelerate Distributions
�
My Trustee shall elect an option under each Retirement Account which allows
my Trustee in its discretion to accelerate distributions and to receive one or more �
lump sum payments from such Retirement Account so that my Trustee has the
flexibility to withdraw principal i» its discretion from the Retirement Account.
If such an option is not available under the Retirement Account, my Trustee
shall take all of the necessary action to cause such Retirement Account to be
transferred to an Individual Retirement Account which offers such flexibility and
which is titled in the participant's name and is qualified under Internal Reven
Code Section 408; provided however, that such transfer is not treated asua
taxable distribution for income tax purposes.
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�,,,. Article Eight
Survivor's Trust
Section 1. Rights of Surviving Spouse in the Survivo '
r s Trust
My Trustee shall hold, administer and distribute the assets of Survivor's Trust a
s follows:
a• Payment of Income
My Trustee shall pay to or apply for the benefit of the surviving spouse so lon
as the surviving spouse lives the entire net income of the Survivor's Trust in
monthly or other convenient installments agreed upon by the survivin s ouse
and my Trustee, but not less often than annually, g p
If my Trustee is entitled to payments from any Retirement Account, it shall
allocate to income from payments received in any calendar ear an amoun
to the income earned by the account in such year, and an exces t equal
allocated to principal, and if the payments in such ear shall be s shall be
amount equal to t�ie income earned by the account in such e �ess than the
,
spouse shall have the continuing right to require my Trustee to w hdraw fring
the account and pay to him/her as income an additional amount so om
� that he/she
can be paid an amount equal to such income. Notwitl�standing the precedin
sentence, if the Internal Revenue Service should determine that for tl�e
Survivor's Trust to qualify for the marital deduction all of the income earned b
the account does not have to be distributed to my surviving spouse or be sub'e y
to hislher w�thdrawal right, then only the amount required for such ualification
shatl thereafter be distributed to him/her or be subject to his/he rwithdra
right. wal
b• General Power of Appointment Qver Undistributed Net Income
Upon the death of the surviving spouse, my Trustee shall distribute all of t}ie
trust property, including the trust principal and accrued and undistributed
income, to any person or entity and upon any trust, terms and conditions or t
or in favor of the estate of the surviving spouse as the surviving s ouse ma
direct by his or her last will or living trust agreement. No exer s e of th y
general power of appointment shall be effective unless it refers to t ' S
agreement and expressly indicates an intention to exercise this e hls trust
appointment. My Trustee may rely upon any instrument admi g nerat power of
the last will of the surviving spouse in carrying out the ter ted to probate as
appointment and shall not be liable for an ms of the power of
y good faith act in reliance upon that
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f will even if for any reason it is later determined to be invalid with res ect to its
� purported exercise of this power of appointment. If my Trustee receives no
notice of the existence of a will of the surviving spouse within six (6) months
after the death of the surviving spouse, my Trustee may distribute the trust assets
and income as though this power of appointment had not been exercised and
shall in that event be conclusively presumed to have acted in good faith even
if a valid will is thereafter discovered. '
�• Discretionary Payment of Principal
At any time or times during the trust term my Trustee shall pay to or ap 1 for
the benefit of the surviving spouse so much of the principal of the Survi or's
Trust as my Trustee deems proper for the surviving spouse's health
maintenance, support and education. In exercising discretion my Trustee shall
give the consideration that my Trustee deems proper to all other income and
resources then readily available to the surviving spouse for use for these
purposes that are then known to my Trustee.
�• Limited Power of Appointment
By either a last will or by a living trust agreement the surviving s ouse shall
have the limited testamenta p
ry power to appoint to or for the benefit of my
� descendants sonie or all of the principal and any accrued but undistributed net
`� income of Survivor's Trust as it exists at the death of the surv' '
surviving spouse may appoint trust assets under this limited testamentar$e� The
among my descendants in equal or unequal anlounts, either directly or n t ust
as t h e s u r v i v i n g s p o u s e d i r e c t s.
This limited testamentary power of appointment shall not be exercised in favor
of the surviving spouse's estate, the creditors of the surviving s ouse the
creditors of the surviving spouse's estate or in any way which wou d result in
any economic benefit to the surviving spouse.
Section 2. Trustee's Discretion to Pay Debts and Taxes
The Survivor's Trust shall terminate upon tlle death of the surviving s ouse. M
hold and administer the unappointed balance or remainder of the Survv or's y T�stee, shalt
Trust as follows:
a• Surviving Spouse's Debts and Taxes
My Trustee, in its sole discretion, may pay all or any part of the survivi
spouse's following expenses, debts, claims and taxes becomin due or ng
by reason of the surviving spouse's death: g paYable
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� 1. Final medical expenses and all funeral costs;
Z. Legally enforceable claims against the surviving spouse
or the surviving spouse's estate;
3. Reasonable expenses of administratioil of this trust and
the surviving spouse's probate estate if any;
4. Any allowances mandated by a court of competent �
jurisdiction to those dependent upon the surviving
spouse;
5. Any estate, inheritance, succession, death or similaz
taxes payable by reason of the death of the surviving
spouse; and
6. Any penalties or interest on any of the above claims,
debts or taxes owed by the surviving spouse or tlie
surviving spouse's estate.
Section 3. Paymer�t by My Trustee or Personal Re resentative
�
P
~--- My Trustee in its sole discretion may make distributions authorized under this Article either
directly to the person or entities to whom payment is owed or to the personal representative of
the surviving spouse s probate estate. Written statements by the surviving spouse's personal
representative that such sums are due and payable by the estate shall be sufficient evidence of
their amount and propriety for the protection of my Trustee. My Trustee shall be under no duty
to see to the appiication of any such payments made to the surviving spouse's personal
representative.
Section 4. Tax Elections
With regard to the payment of any income tax, gift tax, estate tax, inheritance tax or any other
tax required because of the death of the surviving spouse, my Trustee shall have the right to make
any available elections allowed under the law. My Trustee is authorized to sign and file any tax
return required because of the death of the surviving spouse.
Section 5. Administration of Survivor's Trust Remainder
After payment of debts, expenses and taxes, my Trustee shall hold and administer the
unappointed balance or remainder of the Survivor's Trust as provided in the Articles that follow.
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� Article Nine
Family Trust
Section 1. Rights of Surviving Spouse in the Famii
y Trust
My Trustee shall hold, administer and distribute the assets of the Family Trust as follows:
a• Payment of Income
My Trustee shall pay to or apply for the benefit of my surviving spouse, so Iong
as my surviving spouse lives, the entire net income of the Family Trust, in
monthly or other convenient installments agreed upon by my surviving spouse
and my Trustee, but not less often than annually.
b• Discretionary Payment of Principal
At any time or times during the trust term, my Trustee shall pay to or apply for
the benefit of my surviving spouse so much of the principal of the Family Trust
. as my Trustee, in its discretion, deems proper for my surviving spouse's health,
t
maintenance, support and education.
i�
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�• Guidelines for Trustee's Discretion
No amount paid or applied need thereafter be repaid to my Trustee or restored
to my trust. In exercising discretion, my Trustee shall give the consideration
that my Trustee deems proper to all other income and resources that are known
to my Trustee and that are readily available to my surviving spouse for use for
these purposes. My Trustee shall accumulate and add to principal any net
income not distributed.
d• Surviving Spouse's Right to Withdraw Principal
My surviving spouse shalI have the power to withdraw from the Family Trust
principal each calendar year those amounts that shall not exceed the greater of
five thousand dollars ($5,000) or five (5) percent of the assets, valued as of the
end of the preceding ealendar year. My surviving spouse shall exezcise this
power by a written instrument signed by him or her and delivered to my Trustee.
This power is noncumulative and to the extent it is not exercised by the end of
January of each calendar year, it shall lapse. This power shall exist each ear
until the death of my surviving spouse. y
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Section 2. Termination of the Family Trust
�
On the death of my surviving spouse, the Family Trust shall terminate. All undistributed trust
�,sets, including any, accrued and undistributed net income, shall be held, administered and
istributed in the Art�cles that follow.
,
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� Article Ten �
Common Pot Trust
After the death of the Trustoc my Trustee shall not create a Common Pot Trust. All trust
property that has not been distributed under prior Articies of this trust agreement shall be held,
administered, divided and distributed according to the provisions of the Articles that follow.
�
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�:, Article Eleven
��.
Division and Distribution of Trust Property
Section 1. Division of Trust Property Into Siiares
My Trustee shall divide all trust property not previously distributed into separate shares of equal
market value as follows:
a. One Share for Each Living Child
My Trustee shall create one share for each of my then living children.
b. One Share for Each �eceased Child
My Trustee shall create one share for each of my deceased children who has
then living descendants.
Section 2. Distribution of Trust Sl�ares for My Living Children
�� The trust share of each of my children who survive me shall be held, administered and distributed
��
as follows: '
a. Distribution of Net Income and Principal
My Trustee shall hold the trust share for each of my children who survive me
in trust for five (5) years following my death. My Trustee shall apply to, or for
the benefit of, such beneficiary, at least quarterly, all of the net income from
such trust share.
My Trustee shall distribute the principal in five (5) equal (or as nearly equal as
may be calculated) annual installments to or on behalf of each of my children
who survive me. Additional distributions of principal may be made, as my
Trustee deer�s advisable, over those five (5) years for any emergency health
need of each� of my children wlio survive me.
Upon the �fth anniversary following my death, my Trustee shall pay to each of
my children all accumulated net income and principal from their trust share, free
of the trust.
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b. Distribution Upon Deatli of a Child Who Survives Me
�"�
If any child who survives me dies before the complete distribution of his or her
trttst share, that child's trust share shall terminate and my Trustee shall distribute
the balance of the trust property to sucli child's then living descendants per
stirpes.
If such deceased child has no then living descendants,my Trustee shall distribute
the balance of the trust property to my then living descendants, per stirpes. If
I have no then living descendants, my T'rustee shall distribute the balance of the
trust property as provided for in the Articles that follow.
Section 3. Distribution of Trust Share for Descendant of Deceased Child
My Trustee shall promptly distribute free of the trust all accumulated net income and principal
of the trust share set aside for each of my deceased children to their descendants per stirpes.
If any such descendant dies before the complete distribution of his or her trust share, that
descendant's trust share shall terminate and my Trustee shall distribute the baiance of the trust
property to such descendant's then living descendants,per stirpes. If such descendant has no then
living descendants, my Trustee shall distribute the balance of the trust property to my then livin
t descendants, per stirpes. If I have no then living descendants, our Trustee shall distribute tl e
`�--� balance of the trust property as provided for in the Articles that follow.
Section 4. Distributions to Underage or Disabled Beneficiaries
Notwithstanding any other provision in this trust agreement, if any person otherwise entitled to
receive a distribution of trust property is under 18 years of age or is mentally disabled or legally
incompetent as defined in Article Fifteen, my Trustee shall retain and administer that person's
trust property for his or her benefit as follows:
a• My Trustee's Discretion
My Trustee may pay to or apply for the benefit of such beneficiary so much of
the net income and principal of the trust as my Trustee in its discretion deems
proper for the education and support of such beneficiary considering all other
sources of income and resources available to such beneficiary and known to my
Trustee.
b• Payments Made to Beneficiary or Personal Representative
My Trustee is authorized to make payments under this Section either directly to
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the beneficiary, to the beneficiary's personal representative or to an other
�� person my Trustee ma deem ro er t y
Y p p o be used for the benefit of the
beneficiary.
�. Trustee's De�isions are Final
All decisions by my Trustee as to those it makes payment to, the purposes for
which these payments are made, and the amounts to be paid out of the trust aze
within my Trustee's sole but reasonable discretion.
d• Undistributetl Net Income
All undistributed net income shall be accumulated and added to the principal of
the trust.
e• Termination and Distribution
My Trustee shall distribute the trust property to a beneficiary under this Section
when such beneficiary reaches age 25 or when he or she is no longer disabled
as determined by a court of competent jurisdiction or upon certification by two
licensed physicians that sucl� beneficiary is able to properly care for his or her
property and person or at a later date if other trust provisions in this Article
, direct.
,.,,,.
f• Death of Disabled or Underage Beneficiary
Upon the death of a beneficiary under this Section my Trustee shall distribute
all of such beneficiary's remaining trust share including the trust principal and
accrued and undistributed income to any person or entity and upon any trust,
terms and conditions or to or in favor of the estate of such deceased beneficiary
as he or she may direct by his or her last will or living trust agreement. No
exercise of this general power of appointment shall be effective unless it refers
to this trust agreement and expressly indicates an intention to exercise this
general power of appointment.
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�� Articie Twelve
Distribution if No Designated Beneficiaries
NONE
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� Article Thirteen
Trustee Administration
Section 1. Co-'�rustees to Act by Majority Vote
At any time that there are two or more Trustees serving under this agreement they shall act by
majority vote and any exercise of a power or discretion by a majority of the Trustees shall have
the same effect as an exercise by aIl of them.
If the Trustees are not able to reach agreement on any decision as set forth in this Section t
shall petition a court of competent jurisdiction for instructions and shall take no actio hey
disputed matter until a court order deciding the issue has been rendered. n an the
Section 2. Power to Delegate
Notwithstanding any other provision of this agreement, any one or more of the Co-Trustees
serving under this agreement may from time to time delegate to another Co-Trustee or Co-
Trustees routine acts of trust administration.
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Section 3. No Bond Required
No Trustee under this agreement shall be required to post any bond for the faithful performance
of its responsibilities.
Section 4. Trustee Compensation
My Trustee shall be entitled to reasonable compensation for services rendered a able without
the need for a court order. In calculating the amount of compensation custo a y char es for
similar services in the same geograpluc area for the same time period shall be use as uidelines.
g
My Trustee shall aIso be entitled to reimbursement for reasonable costs and expenses incurred
during the exercise of its duties under this agreement.
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Any corporate fiduciary shall be entitled to receive compensation for its services in accordance
��r,,,.•� with its published fee schedule in effect fr '
om time to t�me.
Section 5. Change in Corporate Trustee
Any corporate successor to the trust business of any corporate Trustee named under this
agreement or acting hereunder shall succeed to the cagacity of its predecessor without re-
conveyance or transfer of trust property.
Section 6. Power to Divide or Combine 'Trusts
My Trustee shall have the power to divide a single trust into se arate shares
administered in accordance with the terms and conditions of the sinl e trust fro each to be
were created when my Trustee in its discretion determines that division is desira m Which they
in view of tax considerations, including considerations related t ble or advisable
estate tax or the eneration-ski in transfer tax or other � �e income tax, the gift tax, the
beneficiaries.
g pp� g objectives of the trusts and their
My Trustee shall not be required to make a physical segregation or division of the various trust
shaxes created under this trust agreement except as segregation or division may be re uired b
reason of the termination and distribution of any of the trusts, but my Trustee shall kee 9 se arat
� P p
�`�- accounts and records for different undivided interests.
My Trustee in its discretion shall have the further power to combine two or more trusts havin
substantially the same terms into a single trust for purposes of administration, when tax or other
factors ind�cate that such combination would be desirable or advisable.
In deciding whether to combine trusts, my Trustee should consider the generation-ski in
"inclusion ratio" of the trusts to be combined. Trusts having the same inclusion ratios map be
combined. Trusts having different inclusion ratios should generally not be combined unless heir
inclusion ratios are maintained unchanged through substantially separate and inde endent shares
of different beneficiaries, within the meaning of I.R.C. Section 2654(b), and he a licable
regulations thereunder. pp
Specifically,my Trustee has the authority to allocate any portion of my exemptions under Internal
Revenue Code Section 2631(a)to property as to whtch I am the transferor, including an ro rt
transferred by me during my lifetime as to which I did not make an allocation prior to mp dath
and my Trustee has the authority to make the special election under Internal Reven e Code
Section 2652(a)(3). If Internal Revenue Code Section 2631(a) or 2652(a)(3) is not inter rete
as to allow a T�rustee to exercise such election, then my personal representatives is authorip d
allocate my exemptions and to exercise the said special election. zed to
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If my Trustee considers that any distribution from a trust or share hereunder, other than u
�,,, to a power to withdraw or a • p rsuant
` ppoint is a taxable distribution subject to the federal
eneration-ski ' '
� pping transfer tax payable by the distributee, my Trustee may increase the
distribution by an amount which my Trustee would estimate to be sufficient to pay that tax and
shall charge the same against the trust or share to which the tax relates. �
If my Trustee considers that any termination of an interest in the trust ro ert hereu
taxable termination subject to the federal enerat�on-ski in transfer t x m Trust nder ts a
g �
t h a t t a x f r o m t h e p o r t i on o f t he pro ert to which th pp g � y e e m a y p a y
P Y e tax relates, without any adjustment of the
relative interests of the beneficiaries.
Section 7. Termination of Small 'Y'rust
My Trustee shall have the power in its discretion to terminate any trust created under this trust
agreement whenever it becomes so small in relation to the costs of administration as to make
continuing administration uneconomical. Upon termination my Trustee shall distribute the
principal and any accrued or undistributed net income to the income beneficiaries in ro ortion
to their shares of the income. If no fixed amount vf income is payable to specific be eftciaries
my Trustee shall distribute the principal and any accrued or undistributed net income in e ual
shares to those beneficiaries who would then be entitled to income payments from the trust
�
��--' Section $. Limit on Trustee's Discretio�i
Notwithstanding.any language purporting to confer absolute,sole or unrestricted di '
Trustee in exercising any discretionar scretion on my
y power with respect to tlus trust, my Trustee shall at all
times act in accordance with fiduciary principles and shall not act in bad faith or in disre ard of
the purposes of my trust. g
Nothwithstanding any other provision in this trust agreement, no individual Trustee who is also
a beneficiary hereunder shall have any rigllt, power, duty or discretion concerning this trust if
such right, power, duty or discretion conferred upon such Trustee under this trust agreement is
determined to be a general power of appointment under Internal Revenue Code Section 204I or
2514 which would cause any assets of this Trust to be included in the estate of such
Trustee benefic�ary. Any such right, power, duty or discretion with such effect shall be null and
void with respect to such Trustee-beneficiary. No Trustee who is under a legal obli ation to an
beneficiary of this trust or other person shall under any circumstances partake in n decisio y
relat�ng to any discretionary distributions of income or principal of this trust which an be used
for any such Iegal obligation to any such beneficiary or other person.
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Section 9. Written Notice to Trustee
�
Until my Trustee receives written notice of any death or other event which tri ers the r'
gg iglit to
payments from any trust created under this agreement it shall incur no liability for distributions
made in good faith to persons whose interests may liave been affected by such event.
Section 10. Duty #o Account
My Trustee shali render accounts, upon request, to the income beneficiaries under this trust
agreement at least annually, at the termination of a trust created hereunder, and upon a change
in the Trustees in the manner required by law.
Section 11. No Court Supervisian
No trust created under this agreement shall require the active supervision of any state or federal
court.
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i.,� Article Fourteen
Trustee Investment Powers
Section 1. Trustee's Powers
To carry out the purposes of the trusts created under this agreement and subject to any limitations
stated elsewhere in this instruinent my Trustee shall have all of the following powers, in addition
to all of the powers now or hereafter conferred on Trustees by law:
a. Retention of Property
My Trustee shall have the power to retain any property received into the trust
at its inception or later added to the trust without regard to whether the trust
investments are diversified as Iong as my Trustee considers that retention is in
the best interests of the trust or in furtherance of my goals in creating the trust.
My Trustee shall have the power to invest and reinvest in any property that may
be considered by applicable state law to be underproductive or unproductive in
nature, and specifically to be exempt from any minimum income requirements
called for under local law.
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b• Additions
My Trustee shall have the power to receive additions to the assets of the various
trusts created under this agreement from any source.
�• Business Participation
My Trustee shall have the power to terminate, to continue or to participate in the
operation of any business enterprise including a corporation a sole proprietorship
or a general or limited partnership and to effect any form of incorporation,
dissolution, liquidation, reorganization including but not limited to
recapitalization and reallocation of classes of shares or other change in the form
of the business enterprise or to lend money or make a capital contribution to any
such business enterprise.
d• Permissible Investments
My Trustee shall have the power to invest and reinvest the assets of the trust as
my Trustee may determine to be in the best interests of the trust without
limitation by any Iaw applicable to investments by fiduciaries. The permitted
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investments and reinvestn�ents may include securities such as common or
� preferred stock, mortgages, notes, subordinated deben
tures and warrants of any
corporation and any common trust fund administered by a corporate fiduciary
or other property, real or personal, including savings accounts and deposits and
interests in mutual or money market funds or investmenfi trusts, annuities and
insurance whether or not such investments are unsecured or of a wasting nature.
� My Trustee shall have the power to obtain, by purchase or by gift (or by
conversion, reissue, consolidation or by any other means), and hold as an asset
of this trust, policies of insurance on my life or any other beneficiary of this
trust. My Trustee is authorized and empowered to exercise, either before or
after my death, all of the rights, options, elections or privileges exercisable in
cotulection with such policies. These rights and options should include, but not
be limited to, disability benefits, the right to borrow money with which to pay
premiums (or other charges) on any policy owned by this trust (including any
automatic premium loan feature)or for any other trust purpose, the right to elect
among settlement options offered by the insurance company which issued such
policy, the right to convert such policy to paid-up insurance, extended term
insurance or to any different form of insurance, and the right to arrange for the
automatic application of dividends in reduction of premium payments (or other
charges), with regard to any policy of insurance held in the trust estate.
� e. Dealing with Property
..�
My Trustee shall have the power to acquire, grant or dispose of property,
' including puts, calls and options (including options on stock owned by the
estate), for cash or on credit including maintaining margin accounts with brokers
at public or� private sale upon such terms and conditions as the fiduciary may
deem advisable and to manage, develop, improve, exchange, partition, change
the character of, abandon property or any interest therein or otherwise deal with
property.
Specifically,my Trustee shall have the power to use and expend the trust income
and principal to conduct environmental assessments, audits, and site monitoring
to determine compliance with any environmental law or regulation thereunder;
to take all appropriate remedial action to contain, clean up or remove any
environmental hazard including a spill, release, discharge or contamination,
either on my Trustee's own accord or in response to an actual or threatened
violation of any environmental 1aw or regulation thereunder; to institute legai
� proceedings concerning environmental hazards or contest or settle any such legal
proceedings brought by any local, state or federal agency concerned with
environmental compliance, or by a private litigant; to comply with any local,
state or federal agency order or court order directing an assessment, abatement
or cleanup of any environmental hazards;to employ agents,consult�nts and legal
�,
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counsei to assist or perform the above undertakings or actions; and in general to
� take all appropriate actions to revent identi
P , fy, or respond to any actual or
threatened violations of any environmental law or regulation thereunder.
No Trustee under this trust agreement shall be liable for any Ioss dr depreciation
in value sustained by this trust as a result of the Trustee retaining any property
upon which there is later discovered to be hazardous materials or substances
requiring remedial action pursuant to any federal, state or local environmental
law, unless the Trustee contributed to the loss or depreciation in value through
willful default, willful misconduct, or gross negligence. Moreover, no Trustee
� shall be obligated to accept any property on behalf of this trust without first
having the opportunity to satisfy itself, in its sole discretion, that such property
�s not contaminated by any hazardous or toxic materials or substances, and that
such property is not being used and has never been used for an activities
directly or indirectly involving the generation, use, treatment, stora e, dis osal
release, or discharge of any hazardous or toxic materials or substan es. F nall �
s u c h T r u s t ee s ha l l have t he power to disclaim an y'
� y power which, in its sole
discretion, will or may cause such Trustee to be considered an "owner" or
"operator" of property held in our trust estate under the provisions of the
Comprehensive Environmental Response, Compensation and Liability Act
(CERCLA), as amended from time to tin�e. This power to disclaim as contained
herein shall apply to any such power, whether actually set forth under this trust
agreement,incorporated by reference herein,or granted or implied by any statute
��.... or rule of law.
f• Borrowing Authority
My Trustee shall have the power to borrow funds from any person including my
Trustee guarantee indebtedness or indemnify others in the name of the trust and
to secure any such obligation by mortgage, pledge, security interest or other
encumbrance and to renew, extend or modify any such obligati�n for a term
within or extending beyond the administration of the term of the trust. No
lender shall be bound to see to or be liable for the application of the proceeds
of any obligation and my Trustee shall not be personally liable for any
obligation.
g• Leasing Autl�ority
My Trustec shall have the power to make, renew or amend for any purpose a
lease as lessor or Iessee for a terni within or beyond the term of the trust with
or without option to purchase.
h• Natural Resources
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My Trustee shall have the power to enter into any arrangement or a reement
� including a lease,poolin or unitization g
, g agreement,for exploration,development,
operation, conservation and removal of m�nerals or other natural resources.
i• Voting Rights
My Trustee shall have the power to vote a security in person or by eneral or
limited proxy, to participate in or consent to any voting trust, reor anization
dissolution, liquidation or other action affecting any securities andg o de osit
securities with and transfer title to a protective or other committee, p
j• Title to Assets
My Trustee shall have the power to Ilold securities and other property in
negotiable form or in the name of a nominee (including "street name" of a
broker) or by deposit to a clearing corporation with or without disclosure of the
Trustee relationship, but my Trustee shall be responsible for the acts of any
nominee or clearing cor�oration in connection with the property.
k. Insurance
My Trustee shall have the power to insure the assets of the trust against an risk
� and my Trustee against liability with respect to third persons. y
��
1• Settlement of Disputes
My Trustee shall have the power to pay or contest any debt or claim and to
compromise, release and adjust any debt or claim and to submit any matter to
arbitration.
m• Payment of Expenses
My Trustee shall have the power to pay any taxes, assessments, reasonable
compensation of my Trustee and other expenses incurred in the collection,
management, care, pzotection and conservation of the trust property.
n• Principal and Incoane
My Trustec shall have the power to allocate items of income or expenditure to
either income or principal and to create reserves out of the income all as
provided by law and to tlle extent not so provided to allocate or create reserves
as my Trustee in its discretion deenls appropriate and my Trustee's decision
made in good faith with respect tl�ereto shall be binding and conclusive on all
persons.
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� Notwithstanding the preceding sentence, if the Survivor's Trust (or a share
�+�... hereunder) is the beneficiary or owner of a Retirement Account, income earned
after the participant's death in the account shall be income of the Trust or share,
and if my Trustee is required to pay all of the trust income to a beneficiary, my
Trustee shall collect and pay the income of the account to the beneficiary at least
quarterly (and to the extent that all of the income cannot be collected from the
account, the deficiency shall be paid from the principal of the trust).
o. Division of Trust
My Trustee shall have the power to make any distribution or payment in kind
or in cash or partly in kind and partly in cash and to cause any share to be
composed of cash, property or undivided interests in property different in kind
from any other share either pro rata or non pro rata without regard to differences
in the tax basis of such property and without the requirement of making any
adjustment of the shares by reason of any action taken pursuant hereto.
Any division, allocation,apportionment or valuation of the property to distribute
the assets to or among any of the trusts or beneficiaries shall be made by my
Trustee and the good faith determination of n1y Trustee shall be binding�and
conclusive on all parties.
� p. Merger of Trust
.,,�
If at any time the Trustees are Trustees of two or more Trusts or Shares with
substantially the same terms and benefiting the same beneficiaries, created
hereunder, or w�der any other instrument by the Trustors or by any other person,
the Trustees may commingle the assets of such Trusts or Shares and hold them
as a single Trust or Share.
q. Litigation
My Trustee shall have the power to prosecute or defend actions, suits, claims or
proceedings for the protection or benefit of the trust and my Trustee in the
performance of my Trustee's duties.
�'- Employment of Agents
My Trustec shall have the power to employ agents including attorne s
accountants, investment advisors, custodians, appraisers or others to advise or
assist my Trustee and to deleg�te to them fiduciary powers and to indemnify �
them against liability�'or positions taken in good faith and with reasonable basis.
s• Corporate Fiduci�ry
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If any stock of a corporate Trustee or of any affiliate or successor of a corporate
� Trustee shall be included in the assets of the tru
st, the Trustee shall have full
authority in the Trustee's sole discretion and notwithstanding any regulation or
rule of law to the contrary to retain the stock and any increases resulting from
stock dividends and stock splits and from the exercise of purchase rights and the
purchase of fractional shares needed to round out fractional share holdings that
may arise concerning the stock. The Trustee shall vote the stock either directly
or by proxy except to the extent the Trustee is prohibited by law firom voting the
stock in accordance with tlle written instructions of a majority of the living
beneficiaries then entitled to cunent distributions of income or their personal
representatives. In the event there are no eiigible beneficiaries to give
• instructions, the Trustee is authorized to vote the stack in the best interests of
the beneficiaries in view of the purposes for which the trust was created.
t• Investment Transactions
With regard to record keeping for investment transactions, my Trustee need not
provide copies of conFrmations or similar notifications each time a trade or
investment transaction occurs, but investment transactions shall be set forth in
my Trustee's periodic accounting.
u• Repairs and Improvements
�
��-...�� My Trustee shall have the power to make ordinary or extraordinary repairs or
alterations in buildings or other structures, to demolish any improvements, to
raze exis"ting or erect new party walls or buildings.
v. Business Personnel
My Trustee shall have the power to elect or employ directors, officers,
employees, partners or agents of any business and to compensate such persons
whether or not any such person is a Trustee, director, officer, partner or agent
of a Trustee or a beneficiary of the trust.
w. Farm or Ranch Property
With respect to farm or ranch property, my Trustee shall have the power to
participate in and operate any farming (including tree farming) or ranch
operation personally or with hired labor, tenants or sharecroppers to lease any
farm for cash or a share of crops under a lease which permits or precludes the
material participation of rny Trustee, to fertilize and improve the soil, to employ
conservation practices,and to participate in government programs and to perform
any other acts deemed necessary or desirable to operate the property. In making
a decision whether to materially participate in farming or ranch o erations m
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Trustee shall consider whether an election should be made or has been made
�� under IRC § 2032A to ualif for
Q y special farm-use valuation.
X• Ancillary Trustees
If for any reason my Trustee deems it advantageous to act through an ancillary
Trustee, iny Trustee may designate an ancillary personal representative or
Trustee qualified to serve in the jurisdiction where such ancillary Trustee is to
act and may delegate to such ancillary Trustee such of the powers grar�ted under
this agreement as my Trustee deems advisable without being chargeable with
loss if any arising out of such designation or delegation. My Trustee may
specify whether any corporate Trustee or any person or persons acting in an
ancillary capacity hereunder shall serve with or without bond. Except as may
be otherwise specifically provided, no ancillary Trustee need comply with the
provisions of any Uniform Trustee's Accounting Act, the Uniform Trust Act or
similar acts in force in any state where the Trustee may be acting.
y Retention of Closely Held Interest
My Trustee shall have the power to retain any real estate interests, closely held
securities or affiliated companies or business interests and to sell or dispose of
such interests only after careful consideration and after determining that sale or
4 disposition is in the existing circumstances in the best interests of the trust or its
'ti-�- beneficiaries.
If at any time, this trust holds any stock in an S corporation, and our Trustee
deems it appropriate for such corporation to maintain its Subchapter S election,
my Trustee may take all of the necessary actions to segregate the S corporation
stock and assets of this trust, and in my Trustee's sole but reasonable discretion,
and otherwise consistent with the terms of this trust to the greatest extent
possible, may form new trusts and may amend the terms of this trust agreement
as would be necessary to establish Qualified Subchapter S Trusts to hold the said
S corporation stock and assets in compliance with Internal Revenue Code
Sections 136I(b) and 136 I(d)(3).
Z• Exercise of Authority
Except as otherwise provided in this agreement,my Trustee shall have the ower
to dv all acts that might legally be done by an individual in absolute ow ershi
and control of property, p
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�, Article Fifteen
General Provisions
Section 1. Spendthrxft Protection
Neither the parincipal nor the income of any trust created or contained under this agreement shall
be liable for the debts of a beneficiary nor shall the same be subject to seizure by any creditor
of a.ny beneficiary under any lien or proceeding at law or equity. Except to the extent otherwise
expressly provided in this agreement, no beneficiary shall have authority or power to sell, assign,
transfer, encumber or in any manner to anticipate or dispose of a beneficial interest whether
income or principal. The limitations herein shall not restrict the exercise of any ower of
appointment or the right to disclaim by any beneficiary. P
Section �2. The Rule Against Perpetuities
Unless sooner terminated or vested in accordance with other provisions of this agreement all
interests not otherwise vested including but not limited to all trusts and powers of a ointment
created hereunder shall terminate twenty-one (Z 1)years after the death of the last surviv or of the
� group composed of ine and my lineal descendants living on the date of my death. At that time
�.,,�,. distribution of all principal and all accrued, accumulated and undistributed income shall be made
to the persons then entitled to distributions of income and in the manner and proportions herein
stated or if not stated equally irrespective of their then attained ages.
Section 3. Incompetency and Disability
: For all purposes under this agreement a person shall be deemed disabled incom
incapacitated if and so long as a guardian or conservator of his or her ersoneorne or legally
' P state duty
appo�nted by a court of competent jurisdiction continues to serve or upon certification by two
Iicensed physicians that such person is unable properiy to care for his or her person or ro ert .
P P Y
Section 4. Income and Principal Payments
All paymcnts vf income or principal shall be made in Such of the following wa s as m Truste
determines appropriate: y y e
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a• To each respective beneficiary in person upon his or her personal
� rece�pt;
b. Deposited in any bank to the credit of such beneficiary in any
account ca�ried in his or her name or�o�ntly with another or others;
�. To the parent or legal representative of the beneficiary;
d. To a Custodian under a Uniform Transfers to Minors Act selected by
my Trustee for such period of time under applicable Iaw as my
Trustee determines appropriate;
e• To some near relative, friend or institution having primary
responsibility for the care and custody of the beneficiary;
f• By my Trustee using such payment directly for the benefit of such
beneficiary; or
g. To my Trustee of any revocable trust of which the beneficiary is the
Trustor.
Section 5. Ed u cation
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For all purposes under this agreement the term "education" shall be given broad interpretation and
may mclude but not be limited to:
, a• High School
Education at public or private elementary or high schools including boarding
schools.
b• College
Undergraduate and graduate study in any and all fields whatsoever whether of
a professional character in colleges or other institutions of higher learning.
�• Specialized Training
Specialized formal or informal training in music, the stage, the handicrafts, the
arts or vocational or trade schools whether by private instruction or otherwise.
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d• Uther Educational Activities
�
Any other activity including foreign or domestic travel which shall tend to
develop fully the talents and potentialities of each beneficiary regardless of age.
Section 6. No-Contest Ciause
If any person or entity, other than me, singularly, or in conjunction with any other person or
entity, directly or indirectly, contests in any court the validity of this trust agreement, including
any amendments thereto, then the right of that person or entity to take any interest in the trust
property shall cease, and that person (and his or her descendants) or entity shall be deemed to
have predeceased me.
Section 7. Disclaimer by Beneficiary .
No beneficiary shall be entitled to accelerate any distribution to the beneficiary or to terminate
his or her trust interest and thereafter receive outright distribution by use of a disclaimer.
Section 8, Simultaneous Death
�
�`"� If any beneficiary under this agreement and I die under circumstances in
deaths cannot be established, I shall be deemed to have survived t Which the order of their
agreement shall be construed accordingly. he beneficiary and this
Section 9. Children and Issue
For purposes of this agreement "children" means the lawful blood descendants in the first de ree
of the parent designated and issue and "descendants" mean the laurful blood descendants in an
degree of the ancestor designated provided, however, that if a person has been ado ted that
person shall be considered a child of such adopting parent and such adopted child and his or her
issue shall be considered as issue of the adopting parent or parents and of anyone who is b
blood or adoption an ancestor of the adopting parent or either of the ado tin y
�� ��• „ „ p g parents. The terms
"child," "children, issue, descendant" and "descendants" or those terms preceded b th e t e r m s
"living" or "then-living" shall include the lawful blood descendant in tl�e first d y
designated even though such descendant is born after the death of such aren gree of the parent
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Section 10. Definition of Death Taxes
�
The term "death taxes" as used in this agreement shall mean all inheritance, estate, succession a
other similar taxes that are payable by any person on account of that person's interest in the esta t
of the decedent or by reason of the decedent s death includin e
� .
the following: g penalties and interest but excluding
a• Any addition� to the federal estate tax for any "excess retirement
accumulation under Internal Revenue Code Section 4980A.
b• Any additional tax that may be assessed under Internal Revenue Code
Section 2032A.
�• Any federal or state tax imposed on a generation-ski in transfer as
that term is defined in the federal tax Iaws unless tl
generation-skipping transfer tax is payable directly out of the assets of
a trust created by this instrument.
Section 11. Words Relating to the Internal Revenue Code
As used in this agreement the words "gross estate," "adjusted gross estate," "taxable esta
te "
; unified credit," "state death ta�c credit," "maximum marital deduction," "marital deducti �
on "
"pass" and any other word or words which from the context in which it or the are �
to the Internal Revenue Code shall have the same meaning as such words have for the sed refer
of applying the Internal Revenue Code to my estate. purposes :
For purposes of this agreement my "available generation-skipping transfer exem tion"
generation-skipping transfer tax exemption provided in section 2631 of the Internal Rev nue ls the
of 1986 as amended in effect at the time of my death reduced by the ag re ate of 1 Code
if any of my exemption allocated to my lifetime transfers b me or b g g � � �1e amount
the amount if any I have specifically allocated to other propert of m �prration of law and (2)
estate tax purposes. Y y g oss estate for federal
For purposes of this trust agreement if at the time of my death I have made '
inclusion ratio of greater than zero for which the gift tax return due date glfts with an
including extensioils and I have not yet filed a return, it shall be deemed tha has not expired
t my generation-
s ipping transfer exemption has been allocated to these transfers to the extent nece
possible to exempt the transfers from generation-ski in transfer tax. $Sary and
PP� g
Reference to Sections of the Internal Revenue Code and to the Internal e
to the Internal Revenue Code amended to the date of in death. R venue Code shall refer
y
� .
�
15-4
� Section 12. Personal Representative
� .
For purposes of this agreement the term "personal representative" shall mean Trustee executor
executnx, administrator, administratrix, conservator, guardian, custodian or any other ty e of
personal representation. p
Section 13. Gender and Number
In this agreement where appropriate except where the context otherwise requires the sin ular
includes the plural and words of any gender shall not be limited to that gender. g
Section 14. Definition of Fer Stirpes
As used in this agreement when a distribution to beneficiaries is "per stirpes" it shall mean that
the distributions are to be divided into as many equal shares as there are then-livin children of
such beneficiaries and deceased children of such beneficiaries who left then-livin des
g cendants.
Each then-living child of the beneficiary shalt receive one share and the shar
to each deceased child of the beneficiary shall be divided equall amon suc e that is allocated
then-living descendants. y g h deceased child's
t
..�.
Section 15. Ca�tions
The captions of Articles, Sections and Paragraphs used in this agreement are for convenie
reference only and shall have no significance in the construction or inter retation o ce of
agreement. P f this
Section 16. Severability
Should any of the provisions of this agreement be for any reason declared invalid such inv ' '
shall not affect any of the other provisions of this agreement and all invalid rovisions shaidlty
wholly disregarded in interpreting this agreement. p ll be
�
��
1 S-5
� Section 17. Statutory References
�
Unless the context clearly requires another construction each statutory reference in this agreement
shall be construed to refer to the statutory section mentioned, related successor sections and
corresponding provisions of any subsequent law including all amendments.
Section 18. Governing State Law
This agreement and the trusts created under it shall be construed, regulated and governed by and
in accordance with the laws of the State of Pennsylvania.
I have executed this agreement on the date set forth on the first page of this agreement.
I certify that I have read the foregoing revocable living trust agreement and that it correctly states
the terms and conditions under which my trust property is to be held, managed and disposed of
by my Trustee(s). I approve this revocable living trust in all particulars and request my
Trustee(s) to execute it.
MA O E K. GANNON, Trustor
l
4
��
•
MARJO lE K. GANNON, Trustee EDWARD A. GANNON, Trustee
t
t�„_,
15-6
�,,,,,, STATE OF PENNSYLVANIA �
- SS
COUNTY OF DAUPHIN � � �
On this th � da of • � --
Y , 19�� , before me,
the undersigned officer, per alIy appeared MAR,1oR1E K. GANNON, Trustor, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within instrument and
acknowledged that she executed the same for the purposes therein contained.
In wi ess whereof I hereu set my hand and official seal.
.
.�� •
Notary Public
N�T�iR�,Ql S��L ._F
Title of Officer r����C�.I��E��t==c�.�tar�Pub►ic
Her,,hey,P�1 Da�E�1�+n t�ounty
A,'.y Gemm�ss:on Cxpir,:,P��y 1�,19�9
STATE OF PENNSYLVANIA �
SS
COUNTY OF DAUPHIN �
� , � ,
''�--� On this the�� day of �(. 1
, ¢�, before me, �,C�
the undersigned officer, pers ,ally appeared EDWARD A. GANN�N, and MARJO IE K. GANNON,
Trustees, known to me (or satisfactorily proven) to be the persons whose names are subscribed
to the within instrument and acknowledged that tlley executed the same for the purposes tl�erein
contained.
In ' ess whereof I her nto set my hand and official seal.
Notary Public .
_� _..-. .
of � �;+:�rF��s^:�.�a���. '
Title Officer � � '
C��f:�It.!..ti�r':;::.�'>>i�y:t/�'�tb�ic
{��i�.ii'�r�F�� l�:1�.�?:31s1i�r'.t��li��l
�•"�;(�n!ti�il�::�;%n�l C;;r�is�'� �P=�'.+.l�.1�"q
��
15-7
o �
FIRST AMENDMENT TO
THE N�4R,JORIE K. GANNON LNIlVG T'RUST
Qn January 2, 1996, I, MARJORIE K. GANNON, signed the 1�ZARJORIE K. GANN
ON
LIVlNG TRUST,as Trustor,more formally known as
�'���RIE K• GANNON and EDWARD A, G�NNON, Trustees or their
�' �d� �e �'�O� K. GANNON LIVING TRUST dated January 2, 1996 and� �
amendments thereto �Y
P�'�t �o the right reserved to me under Article Four of the ori '
referred to above which allows me to amend � � a�eement
my Living Trust in writing at any time, I hereby
amend my trust agreement in the following respects:
1• Article Eleven, Section 2a. of my Trust Agreement is hereby revoked and amended as
follows:
Section 2. Distribution of Trust Shares for My Living
Children
The�rust share of each of my children who survive me sha11 be
held, ��ered and distributed as follows:
a• Distribution of Net Income and Principal
My Trustee shall hold the trust share for each of my children who
survive me in trust for three(3)years following my death. My
Trustee sha11 apply to, or for the benefit of, such beneficiary, at
least quarterly,a11 of the net income from such trust share.
My Trustee shall distribute the principal in three(3)equal(or as
nearly equal a,s may be calculated)annual installments to or on
behalf of each of my children who survive me. Additional
distributions of principal may be made,as my Trustee deems
advisable, over those three(3)years for any emergency health need
of each of my children who survive me.
Upon the third anniversary following my death,my Trustee shall
pay to each of my children ali accumulated net income and
principal from their trust share,free of the trust.
I confirm and readopt the remainixig provisions of my original trust agreement,
reserving to myself the right to amend.further that trust agreement and this amendment thereto.
�
Dated:�'�'j�,�•+�ti-.e�. �. 2006. . .. � ,
�" --ti-'� � s / + e��'' ,
MAR;TO f K.GANNON,Trustor and Trustee
The undersigned Trustee acknovvledges receipt of and consents to the foregoing
amendment as of the day and year last above written.
,.y,
.� ^ r �
��:.<.�,-�c�c:, u.,; `� u�.�,�,-
-EDVVA�RD A, GANNON,Trustee
CQMMONf WEALTH OF PENNSYLVANIA)
)
COUNTY OF DAUPI�N �
We, ���.�-, �, ,1.��,��,� and �.y ��'��, �,e�,�' � ,
— � � . the witnesses
whose names are signed to the atta.ched or foregoing instrument, bein du1
g Y qualified according to
law do depose and say tha.t we were present and saw the trustor sign and execute the i��stru.ment as
the First Amendment to her Revocable Trust;that the trustor signed willingly and executed it as her
free and voluntary a�ct for the purposes therein expressed; that each subscribin witness in the
hearing and sight of the trustor signed the instrument as a witnes�• g
s, and that to the best uf our
knowledge the hv�tor�,�,� at that time eighteen or more years of age, of sound mind and under no
const�raint or undue influence.
�
. : ,
t y�4 ��
�, I v
,.Y�� /
I, 1��IARJORLE K. GANNON, trustor, whose name is signed to the attached or
foregoing instrument, hav�ng been duly qualified according to law, do hereby acknowled e that I
signed and exeCuted the instrument as the First Amendment to m Revocable g
Y Trust; that I signed it
willingly, and that I signed it as my free and voluntary act for the purposes therein ex ressed.
P
.
. .
� �
���0 K. GANNON
Subscribed and sworn to and ackaowledged before me by I��RJORIE K.
GANN,ON, the trustor, and subscribed and swom to before me by ��,�.p�� �
' � ' I \ ��i�i:.
and � • �e�,i►.,.Q �t.��,a C.��-.- witnesses,on � , 2006.
�
, � ��,
/� l /•� //�
�' J
. �
N I'ublic
COMMON AL OF PENNSYLWANIA
Notarial Seal
Am�r M.Moya,Notary Public
Lowcr P�toA Twp.,Dauphin Count�+
My Commission E ires 3an.29,2vu8
Membe�,Pennsylvania Assod�tion of Notaries
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John Hancock Annuities
27 Drydock Avenue,STE 3,Boston,MA 02210-2382 •
Mailing Address:PO Box 55446,Boston,MA 02205-5446
Telephone:(800)6245155
Fax: (617)572-0355
July 1,2013
Susan E Leaderer Law Offices
Atth:Ann Moya
5011 Locust Lane
Harrisburg,PA 17109
RE: Deceased:Marjorie Gannon
Group Annuity Contract#: 17156
Association#:30004
Customer#:38872701
Dear Ann Moya:
This letter is in response to your request for information concerning the above refrenced contract.
pur records indicate the estimated valus of the contract as of April 13,2013 is$92,020.96.this value is based upon
a monthly payment in the amount of 1639.55 which began on May 1,2011.
Please note this estimate is for tax purposes only and is in no way a payable amount.
If you have any questions,please call us at 800-624-5155. Dur Client Service Representatives are available
weekdays from 9:00 a.m.to 5:00 p.m.EST.
Sincerely,
John Hancock Fixed Product Claims
Insurance products are issued by:John Hancock Life Insurance Company(U.S.A.)(not licensed in New York),Boston,MA 02116;
John Hanc;ock Life Insurance Company of New Yo�lc�Vaihalla,NY 10595,he�ein coilectively referred to as John Hancock
�� :
the future is yours Annual PoI1C Statement
John Hancock Li�e tnsurance Cotnpany(U.S.A.)
www.jhlifeinsurance.com
�MMARY OF PO�CY I�ENEWAL STATEMENT DATE : March 8, 2010
A�uitant : MARJORIE GANNON pl� ; p�In
M�ster Contract No. : GA28437 Policy Da�Q : March 8, 1985
Certific�te Nc�nber : 38 872 701 � Annuity Data : March 8, 2011
Anrwity Option : ANNUITY CERTAIN FOR 10 YRS
Single Pre�nium Paid : S15,000.00
POLICY V}11�1 F� : Marc� 8; 20�9 to Msrch 8, 2010
Annuity Value at March 8, 2009 582,584.59
Inferast creditod during last year 53,385.97
Amuity Value at h�rch 8, 2010 S85,970.56
Fo� Your Information
Your naw accumulation period is March 8, 2010 to I�rch 8, 2015, and
the inter�st ratQ is 4.100 % per yaa�r which ancludes s 0.500% psr arxr.n renewal bonus.
Int�rast on the annuity value is credited st this rate, and remains fixed for a five year
period.
YOU f�IILL HAVE A PERIOD OF 30 DAYS AFTER THE AMIIVERSARY TO CNAN6E YOIJR OPTION. AF'TER
30 DAYS, THERE NILL BE A MARKET VALUE ADJUSTM�Ni' FOR ANY TRANSFER OR SURRENDER OF YOl1R
POLICY.
The "single p�niwa paid" amou�t shawr� abave is tfw single praeiun deposit made wh�n you
first purchased your policy adjusted for any withdrawals yas� hsve made since that time.
Ths "annuity valuss" shawn abovQ are also adjusted for amy withdrawsls you have made since
you farst purchaased your policy.
A detailed explsr�ation of d�rgss and adjustMents is provided on Page 5 of your certificate.
ThQ nst caish surriendar value is the smuity vslue less aml adjust�ertts.
With a policy fras John Hancoc�c tU.S.A.I, you're putting a cQntury of oxpsri� to work for you.
Fo� information about your policy, pl�as� contact:
Your r�presQntative OR JOHN HANCOCK (U.S.A.?
SMITH BAWrEY SHEARSON Al�f�IJITY SERVICE CENTERs Z50-9
INSURANCE/At�It1ITY DEPARTMENT P O BOX 600 �
333 I�ST 34TN STREET, 6TH FLOOR BUFFALO NY 14201-0600
ATTN: RE6INALD HARYIN Telephor�e: 1-800-333-2526
• NEN YORK NY 10001
This portion is your notice. Please keep it�or your recor�ls.
0274 1900 32082 038872701 030100000DOODD00000000� OOOOOD0000 4
Polacy N�aaber Branch
38 872 701 062082
JONN HANCOCK (U.S.A.I MARJORIE GAt�Y�ON
APMIUI7Y SERYICE CENTER 250-9 28 KENSIN6TON SQ
P 0 BOX 600 l�CHANICSBURG PA 17055
R BUFFALO NY 14201-Q600
John Hancock Life Insurance Comparry(U.S.A.)
• Option Selection for Matured Policiesl
Retirement Benefit Election for Qualified Plans
John Hancock Life Insurance Company(U,S.A.)
(hereinafter�feRed to as The Compar�y)
Life(nsured(s)I Annuitant(s)Name Policy/Certificate Number Branch Code
• G � _3 a � �
Owner Name Telepho�No.of OHmer
G >✓i1/e - D o
Owner Addr�ess Maturity ate(mmnVddl�yyy)
a 1 C' / ��. .S U o 4 � o
Home Office Maturity Value Accounts Cnedited Amount of First Instailment
Use Oniy
If requesting a ReUred Benefit Election for Qualitied Plans what is the marital status of Annuitant?
❑ N�Niarried ❑ Married-if married,complete Spousal Consent sectron.
Check (✓)�d comp�te only one of A,B,C�D,or E.
a ❑ Single cash payment of= No death benefit wili be payable under the contract.
B• ❑ Maturity date defeRal(This option available for deferr�d annui�es ONLIn Defer date of maturity to � � � � I � I I I �
C. (�d�YYYY)
❑ Depoait Option(Thia optlon NOT availabie for defened annuitiea)
The undersigr�ed he�eby requests The Company to hoid on deposit� �being the maturity
proceeds of the above numbered policy,in accordance with the terms of Option IV of the Optional Methods of Settlement.Such proceeds sha��
be held to the credit of the undersigned and any balance remaining unpaid at the death of the undersigned shall be paid to hislher estate or
administrators.interest wiil be allocated annuaily at current company rates which may change from time to time,but which will be indicated on
the annuai statement.
�• ❑ P�oceeds to another policy iasued by The Company
Singie payment of$______ to be appiied to Policy Number � � � � � �
to be isst�i by The Company.
E. �InstallmeM OpUon(Proof of age required EXCEPT for Certain Annuity) �
The Annully ia to be:(Check (✓)one only)
1. (� Single Life certain period years months
Regular income for life with a minimum payment period of 5,10, 15,or 20 yea�s.�
2. [J Single Lifie with installment refund
Regular income for life with a further provision that should death occur before receiving total income payments equal to the single premium
paid,the beneficiary will receive payments until the total income payments equal the p�emium paid.
3. � Single Life with cash refund
Same as instaNment refund except that the difFerence between the singl� premium paid and the amount paid to you will be paid to your
beneficiary in a lump sum.
4. � Single Life without refund.Regular income far life.
5. �Certain annuity(Not available in Maryland) .S`" years -- months
Regular lncome for a fixed number(5 to 35)of years.
6. (� Joint and Survivor Life,certain period years months
7'. [] Joint and Survivor Life with installment refund
8• (] Joint and Survivor Life without refund
�• ❑ Other�de�ribe fully-subject to approval by The Company)
Installment Frequency ❑ Monthly L�uarterly ❑ Semi-Annually ❑ Annually
Dividends included in Maturity Value are to be: C�Applied to inc�ease installments ❑ Paid in Cash
PS1656(OtI2pp5) Page 1 of 5
;
Annuit�nt If�pFlying�Or Life Annuity,proof of age MUST be aubmitted with application
rvame{Firs�M�dd�e,�ast) Date of Birth(mmm/ddtyyyy) Sex
. � �
ome ress� i ► e 'P Social Security No1Tax .0.No.
� �tv �c. c s �nG l�.� l 7o._S-a - _
Joint AnnuRsnt If applying for Life Annuity,proof of age MUST be submitted with application �
Name(First,M'�ddie�Last) Date of Birth(mmrrVdd/yyyy) Sex
Home Addr�ess, ity,State, ip � Social Security NoJTax I.D.No.
Beneflciary
Primary Relationship to Oumer
L: a
$eCO�dety S � n,9�r�2��1 A. Relaationship to Owner
i
Does the Beneficiary have the right to commute any instaliments payable after the death of the Annu'�tant and Joint Annuitant(if appiicab�)?
[�Yes � No
"The�wr�er(specified on the first page)shali have the right to change the Beneficiary prior to the death of the Annu'�tant or Joint Annu'ita�t.if the Owner is
an individu�,the Beneficiary shail become inevocable on the Owner's death uniess othenMi�specified bebw.
Payee
Pay�ee's Name Home Address City StatelZip Te(ep�one No. S.S.N.ITax ID.No.
- . G �' S �.S u �A o 0� 3-l 6 -O d J�
Payments v+nli be maacle to the Annuitant(whi� living), then a Joint Annuit�t(while iiving), then to the Beneficiary unless otherwise stated:(subject to
approva�by?he Company)
For Corporate or Truat Ownerships-Check box(es)below:
❑ Owr�r to retain the legal right durirx�the term of the contract to dinect payments to Owner. [�Make payments to Ovmer
For JoiM Annuitiea(Select one only) �Annuitant while living�then Joint Annuitant �Annuitants jointty and then the Survivar
Annuity payments to be sent to Payee's: [�Bank Account Complete Request for Bank Deposit betow ❑Home Address
. Reque�t iar B�nk Deposit of Mnuity Payments . �
1 hereby authorize The Comp�y to deposit�until further not�ce,annuity payments due me into my banking account.I agree th�t The Company will have no
further�ility v�th�espect to any payments made in accordance with this authorization�and may at any time discontinue payment as author¢ed herein
and require my personal endorsement. �
I,for myself,my heirs,executors,administrators and assigns do hereby consent and agree that any sum or sums of money so paid to the bank after my
death shall be refurxied to you for distribution to the person or persons, if any, entitled the�eto under the terms of the annuity. Sign and date
autho�ization;if a joint account,both account owners MUST sign.
. ! � �_ _ � /�
Payee's ignahrre Date (mmm/d+�IYYYYI
X 02u.��oC,. Q.�• / -- s' - � t� 11
Other Accour�Owner's Signature Dafe (mmm/dd/yyyy)
Include a check marked"VOID",if annuit�l payments are to be deposited into bank account
Name of Ba�k Telephone Number
l�' �-, �" ��-...l►rK c ���) �7 q.r - � ��a
Bank Address�—s--�� City State Zip Code
--Ev—��-o C S�� 1 kE ��N r4�//c S � G f�- aso
Is your financial ins�tution a member of The National Automated Clearing House Association? Yes �lo.�
If No,payments will be mailed to your flnancial institution for deposit to�rour account.
Check�✓)type of account(one only)
,�Checking(include a check marked VOID� ❑Savinga (]Other
TranaitlRou�ng No. � � 3 o S �T"��cneck oi9i�
Payee's Auount No. j o �3 0 7
Speci�l Requeats
WZP Tax Reporting is to be reported to: [rOwner [] Annuitant-Only in EmployeelEmployer Relationship
PSi656(0��2005) Page 2 of 5
Annuit�;�t !f ap�lying for Life Annuity,proof of�e MUST be submitted wlth appilcation
��,s(F�rs�,n�►tda�e,c.asr� Date of Birth(mmm/ddtyjryy) SeX
Home Address: i �State ip� '� L
G rv s t c �S U/ZG l�f� I 7o..s-v Social Security No.lTax .D.No.
Joint Annuibint If a i n for Life Annu � � �O
PP Y� 9 ity,proof of age MUST be aubmitted with application
Name(Firsf,M'�ddle,Lest) Date of Birth(mmm/dd/yyyy) �x
Home Address, ity,State.Zip . Sociai Security No./Tax I.D.No.
Beneficiary
P��ry Relationship to Owner
L� �
Secondary °
� n�T n,c�� Relationship to Owner
S A-N C. A f�L
�the Benefic'�have the right to commute any installments payable afler the death of the Annuitant and Joint Annuitant(if appiicabl�j?
0
"The Owner(sp�,cified on the first page)shail have the right to cha e the Beneflcixy prior to the death of the Annuitant or Jant Annuitant.if the Owner is
an individu��the Beneficiary shaii become irrevocable on the Owne�s death uniess otherwise specified below.
Payee
Pay�ee's Name Home Address City State/Zip Telep��ne No, S. .N.Rax iD.No.
� ' C S �.S u � laG 0_3-16 -Od/�
Payments will be made to the Annuitant(while livin g), then a Join t A n n u i t�t(w h i� l i v i n g�, t h e n t o t h e B e n e fi c i a ry u n l e s s o t h e r w i s e s t a t e d: (s u b J e c t t o
approv�by The Company)
For Corporate or Truat Ownershipa-Check box(es�below:
❑ Owner to retain the legal right during the term of the contract to dir�ect payments to Owner. [�Make payments to Owner
For Joint Annu�ies(Select one only) []Annuitant while living,then Joint Annuitant �Annuitants jointly and then the Survivor
Annuity payments to be sent to Payee's: �nk Account Com lete R ueat for Bank De
P eq pos�t below ❑Home Addreaa
. Request�or 8ank Deposit of Annuity Paymenta �
I her�by authorize The Comp�ty to depos��untii further notic;e�an�uity payments due me into my banking acxount.i agree that The Company wiil have no
fu�ther liabilit�r with respect to any payments made in accordanc�with this authorization,and may at any time discontinue payment as authorized herein
and require my personal endo�sement.
I,for myself,my hei�s,executors,administrators and assigns do he�eby consent and agree that any sum or sums of money so paid to the bank after my
death shall be refurxied to you for distribution to the person or persons� if any� en�tleci thereto under the terms of the annuity. Sign and date
authorization;if a jofnt account,both account ownera MUST sign.
X _ � -� -s"� - � o i I
� Payee's ignatur� Date (mmm/dd/yyyy) �
X ��u�� Q�. ! �-- � - ,� o �1
Other Account Owners Signafure Date (mmm/dd/yyyy)
Include a check ma�ked"VOID"�if annuity payments are to be deposited into bank account
Name of Bank Telephone Numbe�
�- Tr �-�-NK c '7/71 '7 9s 1 7�a
Bank Addresss-s-�� C�ty State Zip Code
-�.�� C s�� (�!kE ��N r4�✓ c S u G fi� c�sa
Is your financ�al institution a rr�mber of The National Automated Clearing House Association? Yes .`�1.10.
If No,payments will be mailed to yaur financial institution for deposit to your account.
Check�✓}type of account(one only)
,.[�Checking(include a check marked VOID� ❑Savings []Other
TranaiURou�ng No. � � � o s �Transit ABA Check Digit .
Payee's Account No. � o � 0 7
�w
Special Requesta
1N2P Tax Reporting is to be reported to: [✓]�Owner � Annuitant-Only in Employee/Employer Relationship
PSt656(01�1005) Page 2 of 5
Jun 17 Z813 1Z:8Z:28 EDT FROM: F2M/28698B77Z55 MSG# 74177893-886-1 PAGE 883 OF 883
�
���2�����,,� ��. ��`�'� �.
,
THE
HART�GIRD
June 17,�013
Attn:Amy M Moya
Fax:717 652 734Q
Reference: ?he Hartford Annuity 990998806
Marjorie Gannon,Decedent
Doar Amy M AZoya,
?hank you for y our correspondence regarding the above annuity contract
The death benofit payable undar this contraot is not considered��life insurance"reportable on IRS Form 712,{lifc
insuranee statemont}.Pleaso find the belo�v informatian in rospon�e to ypur rcquest.
Contract Number 990998806
O��ner Marjorie Gannon
D000dent 141arjoric Gannon
Social Securii}�Number XX-X�-OG18
Date of Death uaed far values Apri113,2U13
Cash�Talue on the date of death $69,406.69
Death$enefit Value on thc date of death $69,804.66
Ef�ective Date:06/15�1993
Bcneficiary(s): Edward Gannon 100°�
Tha Dcath Boncfit Value un the date of death displayod sbovo may insludc a Death Bcnefit Adjustmo�d ss outlincd in the Aimuity Contract�This figure is boing
pro�tided for iliustration pwposes ar►d ia not equivalent to the IInel death benefit.The death be�t will be calculated on all corr►trraets associated with this client
the day ae receive due pmof oP death.Once the death benefit ie calculeted,the benefSt amount remains invested and is subject to market fluctuation uniil
complctc sctticmcnt instructions arc rc�oivcd.
Please contact your Inveatment Profesaional or one of our rinnuity Specialiets with any queationa or concerna.You
may reach The Hartford by calling 1-840-862-6668,Monday through Thuraday from 8 a.m.to 7 p.m and Friday
from 9:15 a.m.to 6 p.m.,Eastarn Time.
l�iank you for the opportunit3 to help provide for your financial needs.
Sincerel3�,
Thc Hattfvtd�'V�alth Managcmcnt—C#Ivba1 Annuitios
?�5 West New Circle Rnad
Inveatment Product Ser�lcea Building 2oo,1�t Ftoor
ICS Annuity Benefit Servicea Team Lexington,KY 40511
Hartford Life and Annuity Insurance C�npany
Mailing Address;
PO Box 14293
Laxington,KY 40512-4293
vnlin�,hartfardlifc,com
r
_ -�_.:���� � ��-��-, 3
�
� � Winner of the
DALBAR Service Award
T11F.COMPANY Y'Ol•'AkF.P• from 2000-2012
July 2,2013
Susan E. Lederer
Attn:Amy Moya
5011 Locust Lane
Harrisburg, PA 17109
Policy: 75 612 657
Decedent: Marjorie K.Gannon
Dear Amy Moya:
We have received your request for information on the above referenced policy.Please
find requested information below.
• Product:New York Life Income Annuity—Singie Life with Cash Refund
• Initial Premium:$50,000.00
• Owner.Marjorie K.Gannon Living Trust
• Annuitant:Marjorie K.Gannon
• Benefi�iary:Marjorie K.Gannon Living Trust
• Death Benefit:$30,376.40
� The claim was processed to the Trust on June 19,2013.
If you have any questions or concerns,our Client Services Re��esentatives arp
available Monday through Friday from 8:30 a.m.to 5:30 p.m.Eastern Time at
1-800-762-6212.
On Behalf Of New York Life,
�i �- � f
t:- • ���T
�-,. .r' , .�.... �t,,,.,
Garce e Lewis
Senior Representative
New York Life Annuity Service Center•P.O.Box 9859•Providence, RI 02940• 1-800-762-6212
Annuities are issued by New York Life Insurance and Annuity Corporation(NYLIAC)(A Delaware Corporation)
Variable annuities are distributed by:NYLIFE Distributors LLC, Member FINRA/SIPC
NYLIAC and NYLIFE Distributors LLC are wholly owned subsidiaries of New York Life Insurance Company
51 Madison Ave, New York, NY 10010
���:�.�C�� C I��� y
_ _ �,
��, _ �
�eed
.J/ud iad�tw+�, made the ��day o! January, in the yQar of '�
our Lord one thousand nine hundred and ninety-tive (1996),
03v�ar�rsit � .
Edward A. Gannon and Marjorfe K. Gannon, husband and wife,
of Cumberland County, Penneylvania, Grantors
�
Edwaxd A. Gannon and Marjorie K. Gannon, Trustees, or their
succeasors in truat, under thQ Edrrard A. Garu�on Livinq Trust
datad January Z, 1996 and any amendmsnts thsreto and
Marjorie K. Ganiton and Sdraid A. Gannon, Trust�ss, or their
sucaassora in trust, under the Marjorie K. Gannon Livinq
Trust datad January Z, 1996 and any amendments thereto, as
� Tenanta in Co�mnon, Grantaea
W'�d6�th, That the aaid Grantors, for �nd in
consideration o= the sua of one and No/loo ($�.00) noilars,
lawful money ot tha UnitQd Ststes o! A�erica, uato them Weil and
truly paid by the said Granta�s at or belore the sealing and
' delivery hereot, the recsipt whereot is hareby acknowledged, have
qrantad, barqained and sold, releasad and conffr�asd, and by these
presents do qrant, bargain and sell, release and aonlirm unto the �
said Grantees, their hairs, personal repr��entatives and assiqr►s.
ALL THAT CERTJ►IN trdct or parcel ot land and premises,
situate, lying and being in tha To�,mship of Ha�pd4n, in the
County ot Cunberland, and Crnmaonw�alth ot Pennsylvania, being
more partiaularly bounded and described on Exhibit "A" attached
hereto:
BEING the same premisea rrhich Anthony Aqosta and Hildeqard
Agosta, husband and witQ, by Deed dated Decembar 9, 1992 and
recorded in Deed Book , Page
, n the Of! ce ot the Recordez of Deeds in and for
Cu�oberland County, Pannsylvania, granted and conveyed unto Edward
A. Gannon and l+iarjorie R. Gannon, husband an4 wi�e, the Grantors
herein.
UNDER AND SUHJECT to a�l restrictions, eaaements, covenants,
conditions and agreements ot record. •
b00K 1�3 PAGE �96
..
TOGETHffit with all and singular t2is buildings and �
improveaents, vays, streetffi, alleys, passag�s, watQrs, water-
courass, riqhts, lib�rtiea, privileqaa, hezaditaaants and
appurtenances, whatsoevor unto the haraby grantad pramisas
belonginq, or in any wi:s appertaining, and the reveraions and
retnainders, rents, iasues and pratits thRreotl and all the
estate, riqht, titla interest, property, claim and dema�nd
whatsoaver ot them, ths said Grantors, as well at law as in
equity, of, in and to the et►me.
Ta HAVE I�ND TO HOLD ths said lot or piece of qround above
desaribad, rrith tt�e aessuaga or tsnemant thoreon nrected,
hereditaa�nts and preaises h�r�by grantsd, or aentioned and
intended so to ba, with the appurtnnancea, unto the aaid
Granteee, thair heirs, p�rsonal repr�s�ntatives asaigns, to and
!or tihe only proper use and behoo! ot ths said Crantaes, the3.r
heirs, personal representntives and aasigna, Sorevar.
]�iD thQ said Grantors, for themselves, tneir heirs, perscnal
rapr4s�ntativ4s and asaigns, do covanant, praAise and agrea, to
and aith tha aaid Grantass, their h41ra, par�onal representatives
and as�igns, by thase prasants, that thoy, tha said Grartor�,
their hairs, persoral rapresontatives and aetsiqns, all and
singular tt►e horeditaaents and preais�s hareby granted or
mentioned and intendad so to be, with the appurtenances, unto the
said Grantees, thsir heirs, personal reprasontatives and assigns,
against tham, the said Grantora, their heirs, perr�onal
repro��ntativas and assiqns, and ngninst all and 4very person and
peraona vhamso4ver lavtully clai�inq or to clain the same or any
part thereot, by, lrom or under hi�, her, them or any o! them,
shall and will, Sub3ect as atorosaid, WARRJ�NT and forever DBFEND.
,Jis wi�na� a�+ao`, ths Grantors have hareunto set their
hands and seals. Dated the day and year first �bove written.
8�aisd sad Delivar�d
in ths �r�s�ac� o!:
X`YL-�:.r� P °��.,.> �G�4/bt��. 1�4�_wo�`/ (SEAL)
dward �►. Gan on
�•e..a.7C.�� ,LTO=C�.�� iew.t,te,�e:+ .�! ,�7�r�e-nJ (SBAL)
or e�C^Gannon
-2-
goox 133 pacE 797
. .
��o o�I'C�did�nc.e
I hereby certify that tha precise residence of the Grantees
herein is as tollows:
c/o Edward A. Gannon and Marjorie K. Gannon, Trustees
28 Rensinqton Square, Mechanicsburq, PA 17055
�r"�=--� -?.2�-�— t�.
Attorney for Granteea -`--
�.eow[e�enee,r.�
co�ato�a►Lrs or rasatssi.vu��► :
: sa
COQl1TY OP Dl►UpRIp � ;
On this, the O"� day ot January, betore me, a Notary Publi�:
fn and for the Coaqaonwealtb of Pennsylvania, the undersiqned
officer, pezsonnlly appeared Edward A. Gannan and Marjarie K.
Gannon, husband and vite, known to me (or satisfactorily proven)
to be the persons whose names are subacribed to the within
instrument and acknowledqed that they executed the same f '�"'=
purposes tharein contained.
IN WITNESS WHEREOF, I hereunto t my hand an o tic� �L•- -
seal. / , � � �'.�,'
.i •:
(�,K•�.L�� •,�;Y::
,ry�h�.`
Notary blic
t�G►i.N:'r�.
COMlIO�1�E7�bT8 OF PEAI(BYL9JI�TI]1 ) � C�"B!�L.R�f::c.�':�:: ..
Het�h�sy.Hl�i?c;�!•��t�a;n�, `
� SS i + Ic�y C41ri:1�3".�ci3 Cx�i''•''�'a`�
COUPI'PY Op CIIKBE3tI+i1ND ) .._--..»..... ....
RECORDED in the Office of the R c rder of Dee i and for.. •..�.�,_••
Cunbez7.and County, in Record Book � , Page �`r,� ;�' � ��t:
WIT SS my hand and offfcial seal this `'> day;';jo�,�� •'�'�^�'
O • .��`�- . ,,.. •'��•-
���:?r�.�:.x;'��+:e+"+,,,."'+�tT.!,,; I:1
ww:+N. .r. :;��:.�%-r ; ..
REC OF DEEDS""iO '� ''
N `. ���'' , �
�y�y'r • •� .
•�•qM�7 �♦����� .
YT•���wy�±+�Y=+J .
. .dt«{y..�:. ' .
-3-
eoox 133 r�c� 798
EZ8ZSIT �*71��
ALL TtiAT CSRTAIN Unit in ths propqrty kaown, nam�d and identifiad � "
ln tha Daalaration xel�rrsd to belaN as "Kens ing ton Sqyare Condoninium,"
looatsd i� the Villag• ot N�stover, 1laa�pd�a Towty�hip, Cumbsrland County�
Pennsylvlania, nhiah has haretofore been eubmitted to the provieions
of the Pean�ylvani� Unifo�w Cond�ninium Act, 68 Pa.C.S.A. 3101 et
seq., by the raoording in the Ofliae of the Recordar o! Deado of
Cua�berlaad County of a Deelaration datsd May Z6� Ig83, and recorded
op June 7, 1983, in l�lisoellaneous Book 287, paqe 69, ee tho rame
shall bw aa�nd�d trqn ti�ns tc ti�a�, bsinq and d�signated in suah
Lealaration, as ths •axa i� aa�nd�d fro� tiAS to t�n�, as Unit No.
C-28, togather attd inoludipq the qaraga, baing sad d�•ignatsd in suoh
Declaration� se ths sama �ay be atp�ndsd from time to time, �s Unit
No. C-28-G� whlch seid Unir and garage, b��,nq part o# eaid Unit, ie
more ZulZy desoribod in said Dsciaration, as the ann�e mey bs aa�e�ded
fron� time tc ti�s� tog�t�e� Mith 4 proportionat� undivided iaterest
in tha Commoa 81�p�ents (as dsfin�d ia •aid Dsalaration) of 4.607�.
Keeley Aa�lty, Ina. rsserv�� ths riqht, in �aoordance with said
Doolaration, to raduao and rasllocate arantse�s proportionate,
undivided intsr�st in t6e Co�wwn Bls�snte as provided in tl�e
Dealaration, ae tho aa�s �asy bs aa�ended fzom tim� to time.
cc
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a�c �3a r�cE 799 � �
�rv.�u a�:�' . J� -__.. ..»... _.. . .
RECOi101R'S USf ON!'�^
REALTY TRANSFHR TAX �M `'�' _�r
co,rwowwu►�n�a►eN►�snrM+i� STATEMENT O�VALUE �
Df�A�iMENtOf RlvtMl! ��, .._. ..__ .
w�t�u o�u�nw��t�sn ' "
N�uaa�ww.��ii��aa� S��Rw�n�ie�Instruelioes � «• —.�......__... .
Cen�pht�wd�t�oiee rnd RI�in dup�'iew�wNb��eard�r eI ONdi wlrn(1��fu�velw/as�std�reU�n h�a u►/enh i�►M dt�d.(��..Mn Ai�d�ec
�.Wqhew eeesid�nNe�,e�by yiN.r��J��1e��x�p1IM u d�iwNl.A SIs1�Mt�F Vaiw i�a�1 nqYk�d i IM hon�fK i�whep�•�sanh�l.nM�.:.
ba�am�l�IM�y r�fodonddp a�I�1�wblt MWip��al.M wx��po�e i�nMd�,�eddMe�sl ti�n���,
s �� . .� �
N�
SUSAN E. LEDERER •r.e c.e.� 717 ; 533-:f 2iii!
SM�N A ,.�, � ... .__._..rP�_....
. p.o. Box Hershey. PA i?�33
_ • � .M •--- - �
'� war . Gannon and ar or �'�'
Edaard A. 6annon and Mar rie 1C G Gannon. Trustees. or their gucceseors lu cru�c.
M ��� G
28 Kensin ton S uare Z ��n5 oi�e �' G�i�oa ��i� vac'�8C
CrusC
b �a U !t' ! O! � . A�OiI ..L V i It i
Hechanicsbur , pA • TtuaC dat�d 1/2 9 aa Teaants ir Co.mwn '
.�, . . � �
Sr«r aW,�
28 Kenain ton Square Haa den T
°'"h' e�t wc�l Nwi« —..._..._».............
Cu�erland
� .
i.Aa�wl �{� .
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�. w�r M��rai V�Iw � ._.............. ... ..
�13,71�.00 1 � • ,�
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tooz ioos
t.Gwck APpnprial�i�x sd�w(er En��wpllen Cloim�d
❑ Wiq w:�I��ee��.ua��sioe
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❑ TroedN ro Indvurial DNdepm�n�Ag�nry.
❑ Troe�F�r re o irv��.(Aned+canpin�eop�.ef nv�r eyn«n«n id.nN(pinp aA b.�.Neiori��.�
❑ iron�F�►b�hrHn prineipal end aq�n�.{Altod�eompl�l�eopr of aqmryJurer Parfr agn�n�t.�
❑ Tro�rFrt u 1M CenMnenw�opM,ll+�UnA�d 51ai�s ad ImlevnNnrolNt��b�qiit.d�dkaHon,mnd«mwflon or in fi�u ef coml�mnouoa.
(IF tw�dwwna�ien er in tiw ef eond�emlee.enod�eepr af nseluNon.{
❑ iron�4r kem n�ortyogo►ro a holdK of o nwrtqog�in d�fodl.lMehgog�600k Nw�b�r ,Pag�Numbx... _.. ..�
❑ Corr�Oiv�or ton(innelery dNd.iAlletk tanplM�cepy eF Ih�prisr d��d b�ing corr�cHd or confirm�d.l
❑ S�owlory<orperot�conioGdallon.m�ry�t e►drvi�ion.(Anact+tepr ot adid�s.)
l�Y�►OIMr�il�ap��eplain u�a�pliaa tloiw�d,iF wh�r thon N�Nd ebw�.) Trany�f,��,�.Sn a Revocahl� TrLtt. n i i r,r�j;_-�,�;
beneficiaries oE vhich vould ba axaspt transferees Eor purposea of state aad locat
real estate tronsfar tases.
Und�r p�nalli�s�f lew.I d�elen dwe 1 hw��aarwie�d Ihb Shl�naee.Indudinq oRe�wpawrin9:nlem�altew.end�e�6.b.st of�ny knewl•dq.
and b�N�f.if is few.an�ai ewd e��wpl�l�.
nNM�• �eN wl o • ��r Oet� �'..._^.••.�• .. ._.
_��� oouK 133 PM�c 800 � i— � y w
,,.—� •-- i .
fAIIURE TO CQlN►LETE THIS FORM HtO�ERLY OR A1TACl1 A��UCAdI�DOCUMENTATION MAT RESULt IN THS RECOROiR'S IIEFUSAt
TO RE�ORO THi DEtD.
.._
-- - - _ _
. __ _
' '•""'�� '�• BILL#: 03560
RETURN THIS PORTION WITH A PAYMENT FOR 3ECOND INSTALLMENT BILL#: 03�0
Michael Lan�an,TreasureNTax Coilector GANNON UV TR,EDWARD A ETAL
230 S.Sporting Hill Road
Mechanicsburg,PA 17050 BILL DATE: PrOP��Location OFFICE HOURS
7/1/2012 10-19-1604-217-UG28 dune tnrougn octobec
28 KENSINGTON SQUARE Mon.,Tues.,d�Thun.-9 am to a•.3o pm
KENSINGTON SQUARE Frt-.s�s��2.w�d..a���r�2.Fr;.,erau�2
CONDOMINIUM e"�F�.,��'�12.9 em to 4:3°�r"
UNIT C-28&G28-G PB 46 PG 9 ciosed weanssdars,Frldaye,and hd�daya.
sxcept as noted above.
GANNON LIV TR,EDWARD A ETAL Phone:T17-737-4822
28 KENSINGTON SQ Please Indicate:
MECHANICSBURG, PA 17050-2364 � secowo INSTALLMENT O SECOND INSTALLMENT VYITH pENA�7'Y
NO DiSCOUNT
If paid on or before 9/15/12 $618.80
If pald after 9/15/12 $680.68
PAYABLE TO: Bil�#: 03560
RETURN THIS PORTION WITH A PAYMENT FOR F1NAL INSTAL�MENT BILL#: 03560
GANNON LIV TR,EDWARD A ETAL
Michaei Langan,Treasurer/Tax Collector
230 S.Sporting Hill Road Property Locatton OFFICE HOURS
Mechanicsburg,PA 17050 BILL DATE: 10-19-1604-217-UC-28 June thraigh Oc�ober:
7/1/2012 28 KENSINGTON SQUARE �'��T�•��T�•-8 am to 4;3o pn
KENSINGTON SQUARE Fn.,�u,wed.,en�r�Z,F�.,ar��►tz
and Fri..�/14/1Z-9 em to 4:30 pm
CONDOMINIUM
UNIT C-28&G2&G PB 46 PG 9. C�W�"��•F��,��ays,
except aa naed above.
�Please Indicate: �
Phone:717-737-4822
GANNON LIV TR,EDWARD A ETAL 0 �Na�iNS�.aw�n�t. � FINqL 1NSTALLMENT 1NRIi PENALTY
28 KENSINGTON SQ
MECHANICSBURG,PA 17050-2364
NO DISCOUNT
if paid on or befare 10/15/12 $618.80
If paid after 10/15/12 $680.68
PAYABLE TO: BILL#: 03560
Michael Lan�an�Treasurer/Tax Collector Hours:See Reverse MUNtCIPAUTY:Hart�pden Twp. BILL N0:03560
230 S.Sporbng Hiil Road Phone:717-737-4822 PROPERTY:28 KENSINGTON S(�UARE BILL DATE:7M1Z012
Mechanicsburg�PA 17050
MAP CODE:10-19-1604-217-UG28 GANNON W 1R�EQWARp A ETAL
NOTICE OF PROPERTY TAX RELIEF ASSESSMENT �0 a219,700 5219,T00
Your enclosed tax bilt includes a tax reduction for your homestead andlor fannstead
property. As an eligible homestead and/or fartnstead property owner, you have HOMESTEAD EXCLUSION sg ggg
received taoc reiisf through a homestead and/or farmstead exdusb which is� STEAD EXCLUSION sp
provided unde� the Pennsyivanfa Taxpayer R ' �� ���'*r�ihe�"' RATE 8.715 8.718
Pennsylvania General Assembly designed to redu , p� ��� S• �� 3 FULL SCHOOL R/E TAX
. $0.00 a1,914.69 31,914.89
THIS TAX IS DUE AND PAYABLE.YOU ARE HEREBY REQUESTED �ss tioMES�cR�orr 58, g
TO MAKE PAYMENT THEREOF. � ;��� LESS FARMSTEAD CREDIT
��L � G `i '
,, ��-�-
,���'1�V11�3= TAX AMOUNT DUE S�s�9.2� 5�,858.40 52,042.04
���� if Paid On or Before 8/31/12 1Q131/12 t21171t2
GANNON LIV TR,EDWARD.A ETAL -���{����E:C��r
28 KENSINGTON SQ NO CHECKS ACCEPTED AFTER DECEMBER 17,2092
MECHANICSBURG�PA 17050-2364
$618.80 $618.80 $618.80
On or before 8115/12 On or before 9/15N2 On or befan 1 W1 Sl12
.� �/� /�
"'� ' ^ T�'f.�' �-"�c
c �..��v..� � 1 � �
st �
MEMBERS ist
�
FEDERALCREDIT'[JrTION
ACCOUNT TITLE: MARJORIE K GANNON LIVING TRUST
REGULAR SAVIN�S ACCOUNT:
Account Number/Suffix 105290-00
D-ate Account Established 02/25/2009
Principal Balance at Date of Death $15018.15
i�►ccrued inierest to Date of Death �..74
Total Principai and Accrued Interest $15018.89
Name of Trustee Edward Gannon
MONEY MANAGEMENT SAVINGS
Account Number/Suffix 105290-05
Date Account Estabiished 08/26/2010
Principal Balance at Date of Death $103,606.20
Accrued Inte�est to Date of Death $10.22
Total P�incipal and Accrued Interest $103,616.42
Name of Trustee: Edward Gannon
MEMBERS 1ST FEDERAL CREDIT UNION
.t,:; r-. � ._.._.. ..:_.....
•'���i' ;�.l�'
•�-
.
Gere Anderson
`Lending Insurance Support Specialist
June 18,2013
Estate of:Marjorie Gannon
Date of Death:04I13/2013
Sacial Security Number:203-16-0618
5000 Louise Dri�Te • P.O. Box 40 • Mechanicsburg,Pennsjrlvania 17055 • (800) 283-2328 • wwwmemberslst.or�
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' ' Wells Fazgo Advisors,LLC
Three Lemoyne Drive
• R # - Lemoyne,PA 17043
Tel:717-761-7344
Fax:717-975-8426
Toll Free:800�t68-8685
June 21,2013
Attn:Amy M.Moya
Susan E.Lederer Law Of�ces
5011 Locust Lane
Harrisburg, PA 17109
RE:Trust Estate of Marjorie K.Gannon
DOD:4/13/2013
. SSN: 203-1b-0618
Account No.: 2942-8970
Dear Ms. Moya:
In response to your letter dated 6/11/2Q13,the information you requested is provided below.
Please be advised that at the time of Mrs. Gannon's death on April 13, 2013, she maintained a
Trust account at Wells Fargo Advisors.
Title: Marjorie&Edward Gannon Trust U/A Dtd 01/22/1996
Date Acct. Opened: July 19, 1999
Bene. Designations: None
DOD Value: $301,179.Z9 (See attached Estate Valuation for details.)
Change of Registr.: None
Do not hesitate to contact me with any questions or if you require further information.
Si ely,
�
,
.
, �����
; ody l� tz
�� Client Associate
.
THE INFnRMATION CONTnINCD HEREiI�HA5 13EEN OBTAINED CROM SOURCLS BCLIEVED R�LIABLE SUT NOT 1VL-.(;ESSAR(LY COMPLGTF
AN1)CANNOT f3C GUARAN'TEED.l�H15 REPUK`f IS NOl"]'HE OCFLCIAt.RGCORU�F YOUR ACCOUNT.YUUK WLLI,S I�AKGO ADVISOKS CI.IEN`I"
STAI'L-'��.CNT IS T[l�OkFICIA[,KF.COR�Ut�lr'OUK ACCOUN"T'.
. . ... . �. %
�
,
Member FINRA/SIPC .._� ��✓ .._ • s � - -
Bstata Valuation
Marjorie & BdwarB Qannoa Truat
U/A DTD Ol/22/1996
Date of Death: 04/13/2013 Eatate of: btarjori4 �. Gaaaon
Valuatioa Date: 04/13/2013 Account: 2942-8970 Trust
Processinq Date: 06/21/2013 Report Type: Date of Death
Number ot Securities: 10
Pile ID: Ganaoa, Marjorie K. 2942-8990
Shares Security Meaa and/or Security Div aad Iat
Identifier or Par Dascription High/Ask Loa/Sid Adjuatmenta Value Accruals
1) 00206R1Q2 950 AT&T INC
COM
New York Stock Exchanqe
04/12/2013 38.64000 38.42000 H/L
04/15/2013 38.55000 37.91000 H/L
38.380000 36,461.00
Div: 0.45 Ex: 04/08 Rec: 04/10 Pay: OS/Ol/13 427.50
2) 224916106 4100 CREDIT SUISS$ AS88T MGMT INCOM
COM
NYSB AMBX 8quities
04/12/2013 4.19000 4.16000 H/L
Q4/15/2013 4.19000 4.14320 H/L
4.170800 17,100.28 �
Div: O.OZ65 Bac: 04/05 Racs 04/09 Pay: 04/15/13 108.65
3) 46132K109 1504 INVSSCO PA VALUB �UN INCOMB TR
COM
Nea York Stock Bxchaage
04/12/2013 14.79000 14.69000 H/L
04/15/2013 14.80000 14.71000 H/L
14.747500 22,180.29
Div: 0.075 Ex: 04/09 Rec: 04/11 Pay: 04/30/13 112.80
4) 67062W103 1916 NtNBBN MUN irIICT OPPORTUNITY FD
COM
Nep York Stock Exchaage
04/12/2013 14.45000 14.37000 H/L
04/15/2013 14.44000 14.31000 H/L
14.392500
Div: 0.064500 Rx: 04/11 Rec: 09/15 Pay: 05/Ol/13 + 0.064500
14.459000 27,699.61
5) 69351T106 700 PPL CORP
COM
Near York Stock Exchange
04/12/2013 32.03000 31.85000 H/L
04/15/2013 31.97000 31.50000 H/L
31.837500 2Z,Z86.25
6) 087365TR0 Z5000 SBTSLBBEM PA ARBA SCH DIST
Iataractive Data Corporatioa
DTD: 11/O1/2011 Mat: li/15/2027 4$
04/12/2013 106.42100 Mkt
04/15/2013 106.49700 Mkt
106.459000 26,614.75
Int: 11/15/2012 to 04/13/Z013 411.11
i) 4��:.iGtia a 3 `70Cu H$B� �:+I�"'a. �SA ni+
Interactive Data Corporation
DTD: 03/07/2011 Mat: 03/07/2018 2$
09/12/2013 100.90625 A/B
04/15/2013 100.91110 Mkt
100.908675 27,245.34
Int: 03/07/2013 to 04/13/2013 54.00
Nota: Put Optioa oa DOD
8) 709223ZP9 40000 PENNSYLVANIA ST TP1C COb�i TPK .
Interactive Data Corporatioa
aTn: o�/2s/soio Mat: ia/oi/�oas 4.5�
04/1Z/2013 105.80100 Mkt
04/15/Z013 105.79900 Mkt
105.800000 42,320.00
Int: 12/Ol/2012 to 04/13/2013 660.00
Page 1
* Plsase see the fiaal page for IMPORTANT INFORMATION ABOUT THS BSTATS VALUATION RBPORT. *
wella Fargo Advisors does not render tax or legal advice. If you have any questiona please consult rvith your tax
and lagal adviaors. Wella Fargo Advisors is tha trade aume uaed by three saparate registerad brokar-dealers: t�alla Fargo
Advisors, LLC, VQells Fargo Advisors Fiaancial Netpork, LLC and �alls Pargo Investments, LLC, �embers SIPCr aoa-baak
affiliatea of �ells Fargo & Company.
Date of Deatb: 04/13/2013 Estate of: Marjoria R. Gaaaoa
Valuatioa Date: 04/13/2013 Accouat: 294Z-8970 Trust
Procesaing Date: 06/21/2013 Aeport Typo: Date of Death
Numbar of Sacuriti�s: 10
File ID: Ganaoa, Marjorie K. 2942-8970
Shares Security Mean and/or Security Div and Int
Ideatifier or Par Description High/Ask Low/Bid Adjuatments Value Accruals
9) 7Z52765M7 20000 PITTSBURGH PA SCH DIST
Interactive Data Corporatioa
DTD: 10/O1J2004 �(at: 09/01/20Z3 4.259c
04/12/2013 105.50400 Mkt
04/15/2013 105.49300 bfkt
105.498500 21,099.70
=nt: 03/01/2013 to 04/13/2013 gg,l�
10) 970174PN2 55000 1PILLIAI�SPORT PA AREA SCH DIST
Interactive Data Corporation
DTD: 11/10/a009 Mat: 08/15/2018 2.8$
04/12/2013 101.89900 Mkt
04/15/2013 101.92Z00 ldkt
101.910500 56,050.78
Int: 02/15/2013 to 04/13/2013 248.11
Total V�lue: $299,057.95
Total Accrual: $Z,121.3�
Totals $301,179.29
Page 2
* Please see the fiaal page Por IMPORTANT INFORMATION ABODT THE ESTATB VALUATION RBPORT. *
Wells Fargo Advisors does aot reader tax or legal advice. If you have any queationa plQase conault with your tax
and leqal advisors. Wella Fargo Advisors is the trade name used by three asparate registered broker-Sealeras �9�lls Farqo
Adviaora, LLC, Yiells Pargo Advisora Fiaancial Notpork, LLC aad Well� Fargo Iaveatmeats, LLC, Members SIPC, aon-bank
aftiliates of Wells Fargo & Coa�pany.
Date o! Daath: 04/13/2013 Eatata of: Marjoris K. Ganaon
Valuatioa Date: 04/13/2013 Accouat: 2942-8970 Trust '
Proc�ssing Date: 06/Zl/2013 Report Type: Date of Daath
Numbar of S�curitioa: 10
File ID: Gannoa, Marjorie �. 2942-8970
Portfolio Endnotes
IMPORTANT IN80R1tATION ASOVT T88 83TATE V1�LIIATION RBPORT
T2►e informatfoa in thia $stata valuatioa Report (refmrenced balovr as the Report) ie based on the Bstat• Valuation
�lorkaheet providad to us by tha Financial Advisor requesting tho Report. We have not uasd clieat etatamanta, iateraal
accouating data, or any othor reaources to iadepeadently veri�y the idsntity or quantity of sacurities hold, tha data of
death, or tha alteraate valuation data, if applicable.
The Report may include assats that you currently hold saay from our firm, which may or may aot be identified as being hald
aNay. Infosmatfoa on assets held aMay trow Nalla Fargo Advisors was provided by you and may not be covered by SIPC.
Wella Fargo Advisors makes no repreaentation with respect to accuracy of information on outcida holdinQa.
Ia most cases, �ve usQ 8atate Val, a valuation and priciag program, to provide information oa th� value of •ecuritias on
tha rtqusstsd data. Batate Val software is provided by Betate valuationa � Pricing Systema, Iac., (8VP), a third-party
vandor unrelatad to Wells Pargo Advisora. Th� pricing sad valustioat geaorated by EVP are deriv�d trom sourc�s it
believes to be reliable, but the accuracy and completenass of this information ia not quaraataed.
Dspeadiag oa how the Report Nill be used, the pricing qanarated by Evp for aome securities may Marraat additioaal
coasideration. Vaers may Maat to supplameat or adjuat the values provided for certaia typas of securities. For axampls:
- Brokersd C9rtfficatss of D�poe3t, �� certa;a honda, m�y �aaseas a dsath put fAdltllX6, TaVP prn•►ides � Yrlue wbi.ch doea
not accouat .for the poasibility that a succeasor orvaer may be ab1Q to put the sacurity back to tha issuer st par, upon the
death of the original orvaer.
- Treasury Inflatioa proteetion Sscurities (TIPS) are oftan not identified aa such ia the Report, so the iaflation taCtor
may not be retlected ia ths valua aad accrued interast showa.
- Variable rate auction socurities may be reported by 8VP at par, without reflectfng accruad intarest or markst
eonditioas. Other typea of variabla rate socuritiea may not raflect aceruad interest.
The databaass usod by EvP do not enc�paes all marketa or typea o! investmeats. For example, 8stats Val does aot provida
valuation data oa inveatmeata such as aaauitiea, equity optioas, limit�d partnerahipa, or managad tutures luada, amoag
others. It tha Finaacial Jldvisor is able to obtaia priciag or valuation data fram othar sourc�s with respsct to auch
iav�atmeats, we may includa that data in tha Report for iatormational and coavanienca purpoaes. We aill identify such
iav�stsant� in the Report. �a do aot audit or indegsadeatly verify the data provided to us, and atake no represtntatioas
as to thn accuracy or completeaesa of informatioa provided to us by others.
This Report do•s not ia aay aay auperaede the intormatioa contained ia client atatements aad trada coafirmatioas, phich
are the official racord of account positioas and activity.
We maka no rapres�ntationa that the iaformstioa contained in thia Asport ia suitable for any particular purpose. It is
the r�spoasibility of the clieut, together aith his or her tax and legal advisors, to dstermine the appropriato
iaformation to iaclude on aay tan return, iaventory, or other accounting.
Page 3
* Please a�e the fiaal page for IMPORT7INT INFORMATiON 71AOUT TH8 ESTATB VALUATION R�PORT. *
Wells Fargo Advisors does not reader tax or iegal advice. If you have aay questioa8 pleass consult aith your tax
and legal advisors. weila Fargo Advisors is the trade aame used by three aeparate registered broker-dealers: Nells Fargo
Advisors, LLC, walls Fargo Advisors Finaacial Network, LLC aad wells Farqo Inveatmants, LLC, Membera SIpC, noa-baak
affiliatas of Welle Fargo & Company.
j i. �.._,�� .�,wy
� ..� �'1
October 29,2013 ���r�}
ca � � �
� � � � �
� �
� � � � ��
ir` � � —� ,"�s
Register of Wills �'
Courthouse � � � �° � �
Cumberland County � �-, � �; � �
1 Courthouse Square � � �' ,_-� � �
" Carlisle,PA 17013 • �'° '� � �
y � � � �
� �
�
RE: TRUST ESTATE OF MARJORIE K. GANNON
, SOCIAL SECURITY NO.: 203-16-0618
DATE OF DEATH: 4/13/2013
FILE NO.: 21-13-0735
Ladies and Gentlemen:
Enclosed for filing with your office please find two (2)completed Form REV-1500 with
the following attachments:
• Date of death valuations;
• Copy of the Marjorie K. Gannon Living Trust; and
■ Copy of the First Amendment to the Marjorie K. Gannon Living Trust;
Also enclosed is a check made payable to"Register of Wills"in the amount of$15.00 for
the required filing fee. Please advise if any additional fees or expenses are due with regard to
this matter.
One(1) additional photocopy of the front-page of the completed REV-1500 form is
enclosed. Please time/date stamp this copy as received and return it to me in the envelope
provided.
If there are any questions or further requirements regarding this return,please do not
hesitate to conta.ct me.
ry truly your. ,
,
,
� ;�;
;
,
Amy M. Moya
Enclosures
5
O11 Locust Lane • Harrisburg,PA 17109 • Phone 717.652.7323 • Fax 717.652.7340 • susan@ledererlaw.com
www ledererlaw.com
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