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Home My WebLink About02-0113 Oath of Personal Representative Commonwealth of Pennsylvania County of The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal rE;presentative(s) of the Decedent, Petitioner(s) will well and truly administer the estat according to law Sworn to and affirmed and subscribed `~-^~/~~2c~ z ~lJ~ before me this 30th day of JANUARY 1 ~~~ DECREE OF REGISTER Estate of Thomas D. Caldwell. Jr. Deceased No. 21-02-113 also known as Social Security No: 174-20-3914 Date of Death: 12/21/01 AND NOW, JANUARY 31, 2002 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary ~ of Administration ((c.t.a., d.b.n.c.t.; pender~te life; durante absentia; durante minoriate) are hereby granted to Lenore S. Caldwell in the above estate and that the instrument(s), if any, dated NOVEMBER 25, 1991 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... $ 865.00 Short Certificates{s) ............... $ 15.00 Renunciation ................~,........ $ Extra Pages ( ) ............... $ 6.00 .T.R ....................................... $ JCP Fee ................................. $ 5.00 Inventory ................................ $ Other ...................................... $ TOTAL .............................$ 891.00 ~, -*~' .~ ~ ."Y t,_r r Signature Attorney: Charles J. DeHart, III, Esquire I.D. No: 15617 Address: 3631 North Front Street Harrisburg PA 17110 Telephone: (717) 232-7661 DATE FILED: w c~ -U __s __ -.t REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA OATH OF SUBSCRIBING WITNESS Estate of Thomas D. Caldwell, Jr. No. 21-02-113 also known as , Deceased Cheryl A Swartz and Beth A. Giovanniello (each) a subscribing witness to the 0 codicil(s) lEI will(s) presented herewith, (each) duly qualified according to law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as a witness at the request of the Testator(rix) in her/his/their presence anQXI in the presence of each other 0 in the presence of the ~ sUbscribi:;;tne~s:/ _ .~ ~,~ 546 Race Street Harrisburq PA 17104 (Address) .~ ~G. -0 ~e(Lv (Signature) 520 Bonnymead Harrisburq PA 17111 (A.ddress) Sworn to or affirmed and subscribed before me this 30+1-. day of ;ZAttJUI1/2.Y , c:200:;L . --L'1M~ ~'f ~. Notary Publi My Commiss n Expires: NOTAAlAl SCAl NANCY L. BRE8I<I, ~ Public HarrisbuTg, D8uphin County My CommisSion Exp~'" MaroI116, 2004 NOTE: To be taken by officer authorj~C tp ~mMi!J'tB{IQtNhs. .j'~ase have present the original or copy 6f'ttistf'urnentt'~ a"'d-he ofrM~rizatlon. Y;J --:;[-"J8qUlIlO 'U<3':) (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) it' : ;88 ;);'<)8 RW-2 Ii 21-02-113 LAST WILL AND TESTAMENT OF THOMAS D. CALDWELL, JR. I THOMAS D. CALDWELL, JR., presently residing and domiciled at500 Park Terrace, Harrisburg, Dauphin County, Pennsylvania, declare this to be my Last Will and hereby revoke all wills which I have previously made. ITEM I: I appoint my wife, Lenore S. Caldwell, as the Executrix of my estate. If she is unable to serve in this capacity, or having been appointed is unable to complete the administration of my estate, I appoint Fulton Bank of Lancaster, Pennsylvania, as the Executor of my estate. ITEM I give to my wife, Lenore, whatever II: interest I may have in any tangible personal property. We hold all of our household items as tenants by the entireties, but should there be any question, I give whatever interest I may have in all items of tangible personal property to Lenore. If Lenore should predecease me, I give this gift to our children who survive me, in as near equal shares as possible. All items of tangible personal property not desired by our children shall be liquidated and the proceeds added to my residuary estate. n ITEM III: The residue of my estate, of whatever nature and wherever situate, shall be distributed to Fulton Bank, as Trustee under a certain Inter vivos Trust Agreement executed by me as Settlor on the O?;.4t day of ~~~ 1991, and sUbject to all amendments thereto, to be held by it and added to and administered as part of the trust established by that document. ITEM If my wife and I shall die under such IV: circumstances that the order of our deaths cannot be established, it shall be conclusively presumed for all purposes of this Will, as well as the aforesaid trust, that my wife survived my death. ITEM V: I direct that all federal, state and other death taxes payable because of my death, with respect to the property passing under this Will, shall be considered as a part of the expense of administration of my estate and shall be paid from my residuary estate, subject, however, to the authority given the Trustee under the aforesaid agreement of trust to pay taxes attributable to those assets and subject also to the discretion of the Trustee to advance funds to my Executrix for the payment of such taxes. Ii !j -~ IN WITNESS WHEREOF, I have hereunto set my hand this ~ day of Iz~~ , 1991. ~ l) LU~E.e (SEAL) THOMAS D. CALDWELL, JR. The preceding instrument, consisting of this and two other type-written pages, identified by the signature of the Testator, was on the date thereof signed, published and declared by THOMAS D. CALDWELL, JR., the Testator therein named, as and for his Last Will, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto. Residing at "7 ~Q/7//~ /,;2 ~u..0 &iU.~^ I /.3 ~ .5. .3 to!.- .sfj (l.4rl1fJ/L; /1 A.. Residing at 17()// --'----~...-+.-,.-.-..- :t ;p :Il :Il 0-3 1ii .. () ~ lD C '" ~ ):> ~ :Il .. ~ r 9 '" .. .. 0 ~! \ :!::: ~ I:l g ~ [1\ ;Z -l Z 0 r . ~ ;Z :t ~ ; l , " . 11l .. .. r .. -< :0 .. n \ll r 0 ~ < ~ -I g ,;; , :> .. ~ .. [11 ;Z -l g ):> + ...... > ~ ~;a , ::i ~ - :z ~ (Jl ~ - 9 'Sd - .. . to> to> \:/....! ,=, "-'qUill:,) "u~t~ LC l d Of N\1r ZOo <, ;,yc\[SeH In i"'()jo~.mH -~ "'- 17 -..3 .?' - ;..E BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG~ PA 171ZB-D601 'U:. III ESQ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN DATE ESTATE OF DATE OF DEATH FILE NUMBER " COUNTY ACN *' REY.485 EXAFP <Gl-02l CHARLES J DEHART 3631 N FRONT ST HARRISBURG 11-11-2002 CALDWELL JR 12-21-2001 21 02-0113 CUMBERLAND 201 THOMAS D Allaunt Rellitt.d PA 17110 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account} sub.it the upper portion of this for.. with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ riify-=48Y-EX--AFP-ToI:.-02j-----il.-NOiicE-OF--DETERMiiiAjioN"-iiNIi-iilfsEssMENy------------------------- --- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF CALDWELL JR THOMAS D FILE NO.21 02-0113 ACN 201 DATE 11-11-2002 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 2.822.78 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 2.822.78 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUM8ER INTEREST/PEN PAID c-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR>, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.> PURPOSE OF NOTICE: PAYMENT: To fulfill the requirements of Section 2140 (b) of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and sub~it with your pay.ent to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER Of HILLS" AGENT. REFUND (CR): A refund of a tax credit may be requested by completing an ftApplication for Refund of pennsylvania Inheritanca and Estate Tax" (REY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or fro. the Department"s 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking neads: 1-800-447-3020 (TT only). OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: PENALTY: INTEREST: * Any party in interest not satisfied with the assess~ent of tax as shown on this notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, 80ard of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the mettsr deterllined at audit of the personal representativeJ OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assess.ent Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return far a Resident Decedent" (REV-150l> for an explanation of acW.inistratively correctable errors. The l5X tax amnesty non-participation penalty is computed on the total of tha tax and interest assessed, and not paid before January 18J 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. For dates of death on or after 10-3-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of nine (09) months from the date of death. For dates of death prior to 10-3-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of eightaen (IB) months from the date of death. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (61.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 19B1 will bear interest at a rate whi~h will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Vear Interest Rate Daily Interest Factor Villar Interest Rate Daily Interest Factor 1982 201. .000548 1992 'X .000247 1983 167- .000438 1993-1994 7X .000192 1984 11X .000301 1995-1998 91. .000247 1985 137- .000356 1999 77- .000192 1986 10:< .000214 2000 8X .000219 1987 9X .000247 2001 9% .000247 1988-1991 llX .000301 2002 .X .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issuad after the tax becomes delLn~nt will reflect an interest calculation to fifteen (IS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. 1'J~5%'-/8 ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIOUAl. TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171ZB-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX CHARLES J DEHART 3631 N FRONT ST HARRISBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-11-2002 CALDWELL JR 12-21-2001 21 02-0113 CUMBERLAND 101 III ESQ *' REV-1547EXAFPC01-02J THOMAS D PA 17110 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER DF WILLS CUMBERLAND CD CDURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... REV=i5'4-j-iif-AFP-ioFiizY-NCi'fici--o,:-YN"HiifiTANCi-TAX-APPRAiiiiMENT-;-AL.L-OWANCi-oR"----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CALDWELL JR THDMAS D FILE NO. 21 02-0113 ACN 101 DATE 11-11-2002 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate US) 16. Allount of line 14 taxable at Lineal/Class A rat. (16) 17. Allount of Line 14 at Sibling rat. (17) 18. Allount of line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. Stocks and Bonds (Schedule 8) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Trans~ers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 1.821.939.15 .00 .00 202.167.51 .00 371.103.37 (B) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value o~ Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule JJ 14. Net Value of Estate Subject to Tax (9) (10) 9,923.25 .00 (11) (12) (13) (14) NOTE: .00 62,728.52 .00 .00 X 00 : X 045: X 12 : X 15 : (19): NOTE: To insure proper credit to your account, submit the upper portion o~ this form with your tax payment. 2,395,210.03 Q.Q?3 ?Ii 2,385,286.78 2,322,558.26 62,728.52 19 will .00 2,822.78 .00 .00 2,822.78 TAY C ITS: to, AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 09-09 2002 CDOO1602 .00 2,822.78 TOTAL TAX CREDIT 2,822.78 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TDTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVAlIOH: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferrBd in possession or enjOYNent to Class B (collateral) bBneficiariBs of the dBcedBnt after the expiration of any estate for life or for YBars, the Co.-onwealth hereby B~pr.ssly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: "",Ie" j,',," To fulfill the requirements of Section 2140 of tho Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the roverse side. --Make check or money order payable to: REGISTER OF MILLS, AGENT A refund of a tax credit, which waS not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inharitance and Estate Tax" (REV-13l3). Applications are available at the OffiCII of the Registar of Wills, any of the 23 Revanue District Offices, or by calling the spacial Z4-hour answering service for for.s ordering: 1-800-362-2050; services for taxpayers with special hearing and I Dr speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or intorest) as shown on this Notice must Object within sixty (60) days of receipt of this Notice by: --written probst to the PA Departlllent of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should ba addressed in writing to: PA Depart.ent of Revenue, Bureau of Individual Taxes, ATTN: Post Assess.ent Raview Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (7171 787-6505. Se8 page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of ad_inistrativaly correctable errors. If any tax due is paid within throe (3) calendar months after the decedent.s death, a five percent (5Xl discount of the tax paid is allowed. The 15X tax a~nest.Y non-participation penalty is COMputed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after tha end of tha tax a.nesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has baen assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) .onths and ona (1) day fro. the date of death, to the date of pay.ent. Taxas which beca.e delinquent before January 1, 1982 bear intarest at tha rata of six (6X) percent per annum calculatad at a daily rata of ~000164. All taxes which becaMe delinquent on and aftar January 1, 1982 will bear intarast at a rate which will vary from calendar yoar to calendar yaar with that rata announced by the PA Departmant of Revanue. The applicable interast ratas for 1982 through 2D02 ara: Yoar Interest Rata Daily Interest Factor Ygar Intarest Rata Daily Interest Factor 1962 ZIlX .ODD548 1992 .X .000247 1983 16X .00043B 1993-1994 7:': .000192 1984 11X .000301 1995-1998 .X .000247 1985 13X .000356 1999 7;: .000192 1986 lOX .000274 2000 ax .000219 1987 'X .000247 ZOOl 97- .000247 1988-1991 11;: .000301 2002 6X .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAIO X NUNBER OF DA~S DELINQUENT X OAIL~ INTEREST FACTOR --Any Notica issued after the tax beco.es delinquent will raflect an interast calculation to fifteen (15) days beyond the date of tha assess~ent. If pay_ent is made after the interest cOMputation date shown on the Notice, additional intarest must be calculatad~ PROBATE 0 JBA 0 DATE:11f1f02 REV-1470EX (S.S8} '* INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Thomas D. Caldwell, Jr. 2102-0113 ACN 101 SCHEDULE ITEM EXPLANATION OF CHANGES NO. F 1,2 Property which was held by the decedent as a tenant in common with others is a probate asset -. . --.- which should be reported on Schedule E. Schedule F should be used only for property which was held with the right of survivorship. Schedule E has been increased to $202,167.51. .-' . J II-A Line 13 Increased to include the value of a qualified Section 9113 trusts for which an election to --.-. tax has not been made on a timely filed tax return as required by Section 9113. . -------- The value of the trusts will be subject to tax in the estate of the surviving spouse at the value as of her date of death. The value of the assets in the qualified trusts has not been verified by the Department as the asset value is not relevant to the taxable value of the estate. ------ Please be reminded that you should not report the value of qualified non-elected trusts on Line 15 f------ of the inheritance tax return. Such trusts should be reported on Schedule J, Part II, Section A, as - described in the REV-1501 (8-00) Instructions for Form Rev-1500, page 15. -- . . ---------.------------------- -.. - . - .. -. -- ------ - ---- - TAX EXAMINER: Shawn E. Young PAGE 1 * COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-Q601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT c, OFFICIAL USE ONLY i1-3~-IY --_._..~_._._-- FILE NUMBER '1\ I - 0 ;j, 00 I ""'CO'liNWCODE ~A-r- - - N'Ui:iBER-- I ,-5 I- Z W C W () W o DECEDENTS NAME (LAST, FIRST, AND MIDDlE INJTJAl) Caldwell Thomas D. Jr. DATE OF DEATH (MM-DD-Year) DATE or: BIRTH (MM-DD-Year) 12/21/2001 10/24/1928 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Caldwell Lenore S. SOCIAL SECURITY NUMBER 174-20-3914 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w " ",-<n ,,"'''' w"" ",00 ,,"''''' it"' .. [Xl 1, Original Return o 4. Limited Estate [RJ 6. Decedent Died Testate {Attacn copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date 01 death after 12.1HZ) [Xl 7< Decedent Maintained a Living Trust (Attach copyofTrusl) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1.1-95) o 3. Remainder Retum (date of death prior to 12.13-8.2) l:RJ 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach $ch O} TillS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAl< INFORMATION SHOULD BE of ECTED TO: NAME COMPLETE MAILING ADDRESS Charles J. DeHart IllEs ulre 3631 North Front Street FIRM NAME (If Applicable) CALDWELL & KEARNS TELEPHONE NUMBER 717 232-7661 Harrisbur PA 17110 r ,~-:'. OFFICIAL USE ONLY z o ~ ..J ::> l- e. <( () w a:: z o ~ I- ::> e. :!! o () ~ I- Z W o z o .. <n w '" '" o " 1. Real Estate (Schedule A) (1) 2 Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (S} (Schedule E) 1,821,939.151 I. 202,167.511 371,103.37L. 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8, Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (line 8 minus line 11) (8) 2,395,210.03 9,923.25 13. Chardable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of line 14 taxable at lineal rate 17. Amount of Une 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19, Tax Due x _(15} 62,728.52 X ~(16) X 12 (17) X .15 (18) (19) 20.0 CHECK HERE IFYOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (11) (12) (13) 9.923.25 2,385,286.78 (14) 2,385,286.78 2,822.78 2,822.78 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < o d . C A ece ent s omplete ddress: STREET ADDRESS 66 South Terrace CITY I STATE I ZIP Wormleysburg PA 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credil B. Prior Payments C. Discounl (1) 2,822.78 Total Credits (A + B + C) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty (0 + E) (3) 4. If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total at Line 5 + 5A This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 2,822.78 2,822.78 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... 0 IZl b. retain the right to designate who shalt use the property transferred or its income; ........................................ 0 IZl c. retain a reversionary interest; or ...................................................................h................................. 0 00 d. receive the promise for life of either payments, benefits or care? ........ ................................... ..... 0 IZl 2. If death occurred after December 12, 1982, did decedenl Iransfer property within one year of death without receiving adequate consideration?...... ........ ........ ...... ................................ .... ......" ..,................... 0 00 3. Old decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 IZl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .' ............ ...........,........................ ... ............ .....,............,................... ~ 1iI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties 01 perjury, I declare that I have examined this return, including accompanying schedules and statements, and 10 the best of my knowledge and belief, it is true, correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge SIGNATUR 0 ERSON RESPONS LE FILING RETURN DATE ADDRESS SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE rp """'---- '--A'''''- DATE ADDRESS Charles J. DeHart. ill orth Front Street Harrisburg, Pennsylvania 17110 <->L For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers 10 or for the use of the surviving spouse is 3% [72 PS ~9116 (a) (1.1) (I)]. For dates of death on or after January 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (it)]. The stalute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adopti've parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)]. The tax rate imposed on Ihe nel value oHransfers to orfor the use of the decedent's lineal benetldaries is 4.5%, except as noted in 72 P.S. 99116{1.2) [72 P.S. 99116(a)(I)]. The tax rate imposed on the nel value of Iransfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(I.3)]. A sibling is defined, under Section 9102, as an indivJdual who has at least one parent in common with the decedent, whether by blood or adoption. REV.1503EX.II_91\,* ' ' , I -~' . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN Rl::slDENT DEl EDEN I SCHEDULE B STOCKS & BONDS FILE NUMBER ESTATE OF Caldwell Thomas D. Jr All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 85,038 shares common stock Fulton Financial Corporation @ $21.425 per share VALUE AT DATE OF DEATH 1,821,939.15 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1821939.15 REV-J508EX+11-97)'_~~. ,:~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Caldwell Thomas D.. Jr Include the proceeds of litigation and the date the proceeds were received by the estate. All property joinfly-owned with the right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 5, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) REV-l?OOEX"(1-97)'_~..._ ,:~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL V-OWNED PROPERTY ESTATE OF Caldwell Thomas D. Jr If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G. FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. William W. Caldwell Brother B Martha Diffenderfer Sister c JOINTLY-OWNED PROPERTY LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deedforjointly-heldrealestale. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. &6. 1993 Salomon Smith Barney Accl #724-21711-001 350,094,95 33. 115,531.33 (See attached statement) 2. A, 1993 Salomon Smith Barney Acct. #724-21710-001 173,272.35 50. 86,636.18 (See attached statement) TOTAL (Also enter on line 6, Recapitulation) $ 202167,51 (If more space IS needed, Insert additional sheets of the same size) REV-\?10EX+(1-97)'_~._, "~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC, NON-PROBATE PROPERTY ESTATE OF Caldwell Thomas D, .Ie. FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1lhrough 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE. TI-lEIR RElATIONSHIP TO DECEDENT A NO THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ATTACH A COPY OF THfDEEDFQRRE.I\L ESTATE VALUE OF ASSET INTEREST /IFAPPUCABLEi 1. Fulton Bank IRA Account #90-F27601B9 - Date-of-death 62,72B,52 100, 62,72B,52 value (see attached statement) Designated beneficiaries - Ellen C. Brown and Suzanne C. Orris (daughters) 2, Fulton Bank IRA Rollover Account #90-F513-01-5 - Date-of- 214,643.56 100, 214,643,56 death value (see attached statement) Designated beneficiary- Lenore S, Caldwell (surviving spouse) 3, Fulton Bank Deferred Compensation Plan - Date-oF-death 86,062,86 100, B6,062,B6 value (see attached statement) Designated beneficiary - Lenore S. Caldwell 4, Fulton Financial Corporation Deferred Compensation Plan - 7,66B.43 100, 7,668.43 Date-of-death value (see attached statement) Designated beneFiciary - Lenore S, Caldwell TOTAL (Also enter on line 7, Recapitulation) $ 371 103.37 (If more space IS needed, Insert additional sheets of the same size) RE\I.'511EX+(1-97)1_~_ "~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Caldwell Thomas D Jr FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1 Trefz & Bowser Funeral home, Inc. 4,510.90 B. ADMINISTRATIVE COSTS: 1 Personal Representative's Commissions Name of Personal Representative (5) Lenore S. Caldwell - Waived Social Security Number(s) I EIN Number of Personal Representative(s} SlreelAddress 66 South Terrace City WormleysburQ State PA Zip 17043 Yea~5) Commission Paid: 2 Attorney Fees Caldwell & Kearns 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Lenore S. Caldwell SlreetAddress 66 South Terrace City WormleysburQ Slate PA Zip 17043 Relationship of Claimant to Decedent Spouse 4. Probate Fees 1,750.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal - legal advertising 75.00 8. Carlisle Sentinel - legal advertising 87.35 TOTAL (Also enler on line 9, Recapitulation) $ 9923.25 (If more space is needed, Insert additional sheets of the same size) "",""m."'.i. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Caldwell Thomas 0.. Jr. FILE NUMBER [ndude unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION AMOUNT TOTAL (Also enler on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) R~X-'513EX;'* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Cal",^,oll T .n.1c RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Lenore S. Caldwell Spouse (a) spousal trust - 66 South Terrace Road $612,271.48 Wormleysburg, PA 17043 (b) residuary-$1,710,287 2. Ellen C. Brown (1/2 IRA Account Balance) Daughter $31,364.26 5529 North River Road Harrisburg, PA 17110 3. Suzanne C. Orris (1/2 IRA Account Balance) DaughtAr $31,364.26 1284 Hillside Drive Lancaster, PA ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space IS needed, insert additional sheets of the same size) SALOMONSMITHBARNEY 717-780-1700 . 800.237~1700 Amemberof CltlQrou,sT" March 8, 2002 Attorney Charles J. DeHart, ill 3631 North Front Street Harrisburg PA 171I0-1533 In reference: Thomas D. Caldwell, Jr. Dear Mr. DeHart: Pursuant to your requested, I have enclosed valuations for the accounts at Smith Barney of which Thomas D. Caldwell, Jr. had an interest as of December 21,2001. Our account number 724-2 I 7 I ().. I 0-00 I is in the name of William W. Caldwell and Thomas D. Caldwell, Tenants in common, 50% ownership to each PartY. Account number 724-2171\-19-001 is in the name of William W. Caldwell, Thomas D. Caldwell, Jr. and Martha C. Diffenderfer, Tenants in common, 33 1/3% to each PartY. Should you require any additional information, please contact our office. m'~~ baron L. Pugh Business Development Associate Bernard J. Orbach Senior Vice President - Investments Financial Consultant ~::;:w~ -., >-._~ enclosures THE INFORMATION HEREIN HAS BEEN OBTAINED FROM SOURCES WE BELIEVE TO BE RElIABLE, BUT DO NOT GUARANTEE ITS ACCURACY OR COMPLETENESS. SALOMON SMITH BARNEY INC. 11 North 3rd Street, 2nd Fir., Harrisburg, PA 17101-1702 FAX 717-233-2090 12/21izooi 12/21/2001 02/16/2002 Date'of Death: valuation Date: Processing Date: THOMAS D CALDlillLL IRA Account: 90~F276019 Report 'l'ype: Date of Death Number of Securities: 5 Fi Ie 10: CALDWELL TItQMAS JR IRA Shares or Par Security Description Low/Bid Mean and/or Div and Int Security Adjustments Accruals Value High/Ask 1) 2185.968 SEI INSTL MANAGED TR (783925506) CORE FXD INC A. NASDAQ 12/21/2001 10.32000 Sid 10.320000 22,559.19 2) 992.586 SEl INSTL MANAGED TR (783925100) LARGE CAP VAL A NASDAQ 12/21/2001 18.23000 Bid 18.230000 18,094.84 3) 911.288 SEI INSTL MANAGED TR (783925662) LARG CAP GRW A NASDAQ 12/21(2001 19.41000 Bid 19.410000 17,688.10 4) 121.969 SEI INSTL MANAGED TR (783925688) SML CAP VAtU A NASDAQ 12/21/2001 16.50000 Bid 16.500000 2,012.49 5) 152.554 SEl INSTL MANAGED TR (783925837) SML CAP GRW A NASDAQ 12/21(2001 15.14000 Bid 15.140000 2,309.67 Total Value: Total Accrual: Total: $62,664.29 $62,664.29 $0.00 P /IMJ-SLL SJuf /f,'ill.,Ob/'dohm mmp T ~t/,d3 J1 (PJ,1Jt5J --- Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300. (Revision 6.4.0) Date ~of Death: Valuation Date: processing Date: 12/21/2001 12/21/2001 02/16/2002 TJ/QMAS D CALDWELL ROLLOVRR IRA Account: 90-P513-01-5 Report Type: Date of Death Number of Securities: 3 Fi Ie In: CALDWELL THOMAS ROLLOVER IRA Shares or Par Security Description High/Ask LoW/Bid Mean and/or Div and Int Security Adjustments Accruals Value 1) 75000 DAIMLERCHRYSLER NA HLDG INT NT (2338E8DF3) OTe DTO, 11/29/2001 Mat, 11/15/2003 4.55% 12/21/2001 99.88060 Bid 99.880600 74,910.45 Int, 11/29/2001 to 12/21/2001 208.54 2) 1500 CITIGROUP CAP V (17306K209) TRUPS 7% NYSE 12/21/2001 25.52000 25.13000 H/L 25.325000 37,987.50 3) 50785.366 FEDERATED TOTAL RETURN SERS (31428Q606) ULTRA ED INST NASDAQ 12/21/2001 1.96000 Bid 1.960000 99,539.32 Total Value: Total Accrual: Total, $p'l'~ Gj F/YJfAl/uJ.5f<Tru-t-S oh'd /Y)(nF $212,437.27 $208.54 -f d .:2Dtp.;)9 , - JI 0>) 4- ~ Y3.51. 1- ~ Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (BIB) 313-6300. (Revision 6.4.0) ENT BY: FFA WEALTH MOM FULTON; 231 7747; MAR-1-02 11 :28; PAGE 3/5 YUf .'UL TON nNANCIAL CORPO~110N DEFERRW COMPENSATION PLAN FtJLTON BANK STA IT.MENT OF ACCOUNT BAL.ANCE ASOfDECEMBERll 2001 ()1"IgI..... Amount Deferred 200] Activity Bal. nee 111101 Addltlonl Withdrawal. In_ Balance 12131101 Thornalii D. Cal!Jwcll Jr. R..n FultoN Ra"k 1985 $5,550.00 $14,936,91 SO.OO ($14,936.91) $0.00 1986 5,600.00 14,028.07 0.00 (930.53) 986,60 1987 6,250.00 14,568.0' 0.00 0.00 657.02 1988 7.125.00 15,329.12 0.00 0.00 691.34 1989 7.'00.00 14.919.88 0.00 0.00 672.89 1990 7,500.00 13,834.23 0.00 0.00 623.92 199] 6.000,00 10,257.73 0.00 0.00 462.62 Total $45,525.00 $97.873.99 $0.00 ($15.867.44) $4.094.39 Iflt- thrcx...t- 1.;2./31 - ~+ 1D \@\.;1\ DaD SO.OO 14,084.14 15,225.07 16.020.46 15,592.77 14,458.15 10,720.35 DDD Vak' S86,1 00. 94 L 1,D9Y31 ') -rt.},{)5l,.3} Q'tp DUd. glp I ~ - ENT BV: FFA WEALTH MGM FULTON; 231 7747; MAR-1-02 11 :2B; PAGE 2/5 FULTON FlNANCIAL CORI'ORATlON DEFERRED COMPENSATION Pl..AN STATEMENT 0" ACCOUNT BALANCE AS m' DECEMBER 31 2001 Year OnEiDa1 AmouQt Dorerr'" 'llll>n"a, D. C.ldv,:ell. lr. E.",. Full()l~ Financial Ouporation: 1?90 1991 $2,250.00 4,SOO.lJlJ Total $6,750.00 2001 Amvll)' Balance 1/1/01 Inle"," Balance 1Z/31/01 AdditioDs Withdrawal. 51,041.01 7,692.10 SO.OO 0.00 ($I,04I.0J) 074.81) 0.00 361.93 $O.lX) 7,679.11 sa,733.] I $0.00 ($1,415.82) $361.?3 S7.61?ll J--tr '/hro~a~ JlhI13~)1~ .711 f /z; /~J;;I !JO() 7"3.51.1'1 - Do D 1!b./~ I), {g~t 1/3 :It ( REVOCABLE INTER VIVOS TRUST AGREEMENT OF THOMAS D. CALDWELL, JR. . ~il' THIS REVOCABLE INTER VIVOS TRUST AGREEMENT, made th~s .:15 day of )J~ , 1991, between THOMAS D. CALDWELL, Jr., of HarriSburg, Pennsylvania, hereinafter called "Grantor" and FULTON BANK, of Lancaster, Pennsylvania, hereinafter called "Trustee". For purposes of clarity and understanding the Trust Agreement has been drafted in the first person singular. PURPOSES OF THE TRUST This trust is established as an Inter vivos Trust to meet the several desires that I, Thomas D. caldwell, Jr., have as Grantor: A. As a management vehicle into which I may deposit funds from time to time for investment purposes and derive income or a part of it for myself and my family during my lifetime. B. In the event of my death to provide for the security of my wife and family, in the same manner to which they have become accustomed and to assure them of a continuing protection for their financial estates. c. To take the maximum advantage which is allowed me under the Federal Estate Tax Law to conserve against the impact of death taxes. D. In the event of my death, to enable my wife, Lenore S. Caldwell, to reliably consult an institutional Trustee to guide her not only in the financial matters that are pertinent to this trust arrangement but also other financial matters in which she is interested. At the present time, the members of my immediate family are as follows: my wife, Lenore S. Caldwell; my daughter, Ellen C. Brown, and my daughter, Suzanne c. Orris. At my death the Trustee will receive certain proceeds of life insurance policies on my life. I have also provided a "pour-over" provision in my will for the residue of my probate estate to be distributed to the Trustee. This Trust Agreement provides that upon my death a trust known as the Lenore S. Caldwell Marital Trust shall be created for the sole benefit of my wife, as well as a trust known as the Caldwell Family Trust 2 for the benefit of my wife with eventual distribution to our family. My philosophy for the administration of the trust is stated as follows: A. I desire that my wife, Lenore s. Caldwell, be relieved of the burdens of financial management in the event of my death. B. Lenore S. Caldwell shall receive liberal benefits from the respective trusts and both income and principal may be used to provide these benefits. C. Although the Trustee shall exercise its sole discretion in the distribution of benefits from the Caldwell Family Trust, considerable emphasis should be accorded my wife's suggestion in this regard. I do not intend hereby to invest in Lenore S. Caldwell any power of appointment or control over the distribution of benefits from the Caldwell Family Trust, but I do direct that the Trustee shall reliably consult her in all matters concerning benefits which flow from that trust fund. D. The trust arrangement provides the opportunity for my wife to consult the Trustee concerning business matters. I J encourage this and would expect the highest degree of cooperation on the part of the Trustee in this regard. B. In essence, I want my family financial matters managed by the Trustee, and after consultation with Lenore S. Caldwell, in the same way that a careful and prudent husband would so manage his own affairs. THEREFORE, in view of the purposes stated, I set forth the following instructions and directions which the Trustee accepts and agrees to perform to the best of its ability. ITBM I. During my lifetime, to the extent that I have funded this trust: A. The Trustee shall dispose of such part or all of the net income and principal as I may direct from time to time whether for the benefit of myself, any member of my family or any other person or institution. B. If in the opinion of the Trustee I become incapacitated through illness, age or other cause to properly handle my family financial affairs, the Trustee may, in its discretion, while it believes such incapacity to continue, apply all or any part of the net income or principal of this trust for my benefit or for the benefit of any of my family 4 members as it may determine, and without regard to any other financial means available to me. C. Any net income in any year which is not disposed of by the terms of the preceding paragraphs of this Item I shall be added to the principal of the trust at the end of each year. D. The Trustee shall render an account of income and principal at least annually and my written approval of this account will be binding upon all who are then or may thereafter become entitled to any benefits from this trust fund. ITEM II. FOllowing my death, after insurance proceeds are collected by the Trustee as well as my net distributable probate estate and all other benefits that would accrue to this trust by virtue of my death, the Trustee shall hold such assets in further trusts as follows: A. THE LENORE S. CALDWELL MARITAL TROST. If Lenore S. Caldwell survives me (and for purposes of this paragraph she shall be presumed to have survived me unless it appears unmistakably that she predeceased me), the Trustee shall set aside in a separate trust, a pecuniary amount which would reduce the federal estate tax liability of Grantor's federal estate to the lowest possible amount taking into account all credits and deductions available to Grantor. 5 1. Trustee shall only allocate to the marital trust assets which will qualify for the marital deduction. To the extent there is sufficient other property, Trustee shall not allocate to the marital trust any asset which would produce a tax credit in my estate or which is described in section 691 of the Internal Revenue Code. 2. Grantor understands and acknowledges that there may be taxable gains recognized upon funding the pecuniary amount described above and that fluctuations in my estate during its administration may affect the amount of property available to fund the family trust. Further, it is my express intention and desire to provide a specific pecuniary amount to fund the marital trust herein and that all risks of loss and benefits of gain shall inure to the family trust and that the family trust shall bear the cost of any tax consequences upon funding the marital trust. 3. Trustee shall hold the marital trust as a separate trust and administer it as follows: &. During Lenore S. Caldwell's lifetime she shall be paid the income at least quarter-annually together with so much of the principal as the Trustee may deem desirable for meeting the liberal requirements of her health, maintenance, support, comfort and welfare, and in addition so 6 much of the principal as she shall from time to time request in writing delivered to the Trustee. b. Upon Lenore S. Caldwell's death the remaining values in the Lenore S. Caldwell Marital Trust shall be paid to such person or persons, including her estate, in such manner and for such estates as she may appoint by her Last will specifically referring to the power hereby conferred. c. If Lenore S. Caldwell fails in whole or in part to effectively exercise the above power, there shall be paid out of the principal not effectively appointed, an amount equal to any increase in taxes and administration expenses payable by her estate because of the inclusion in her gross estate of the principal of this trust such payments to be made upon the certification of her personal representative of the sums due. The remaining principal of the trust not effectively appointed shall then be added to the principal of the Caldwell Family Trust hereinafter set forth. d. I further give Lenore S. Caldwell the power to withdraw such amounts from the principal of this marital deduction trust during her lifetime as she may desire, including the right to withdraw all of the principal, but such withdrawals are to be evidenced by an instrument in writing signed by her and delivered to the Trustee. Further, if the Trustee should in its honest judgment believe Lenore S. 7 Caldwell to be incapable of handling her financial affairs, it may, in the exercise of its discretion decline to distribute principal upon her written direction until her ability or inability to handle her financial affairs is determined by three competent individuals, one to be appointed by Lenore S. Caldwell, one to be appointed by the Trustee and these two individuals to appoint a medical physician as a third. The compensation of these individuals shall be paid from the Caldwell Family Trust, hereinafter provided. If the panel of individuals should determine either that Lenore S. Caldwell is incapable of handling her financial affairs or that she may become the victim of designing persons, by a majority vote of the panel, the principal of the Lenore S. Caldwell Marital Trust shall not be distributable to her upon her request but the Trustee thereafter shall apply, for her benefit, such amounts of principal as it may determine will liberally provide for her comfortable requirements. e. If any provisions relating to this Lenore S. Caldwell Marital Trust shall result in depriving my estate of the marital deduction for federal estate tax purposes, such provision is hereby revoked and the provisions relative to this trust shall be read as if any portion thereof inconsistent with the allowance of the marital deduction is null and void. 8 B. CALDWELL PAMILY TRUST. After the Trustee has distributed to the Executor of my probate estate such amounts as it deems appropriate and proper to assist in the payment of death taxes or costs of administration, the balance of my trust estate shall be devoted and distributed to the Caldwell Family Trust for the following uses and purposes: 1. The Trustee, in its sole discretion, shall distribute amounts of income and principal to my wife, Lenore s. Caldwell, in such a manner that together with other benefits that are available to her, she will be enabled to maintain a comfortable standard of living in the matters of support, health, education and general welfare. The Trustee shall consult closely with Lenore S. Caldwell in determining distributions of income and principal for her needs in order that the benefits from the fund will take into consideration her individual needs. It is my desire and direction that the Trustee so apply the benefits of the Trust, after consultation with Lenore S. Caldwell, that her financial affairs will be handled in the same manner that a prudent and careful husband would manage them. 2. with regard to distributing principal from the trust to Lenore S. Caldwell, the Corporate Trustee should be cognizant of the fact that it would be advisable for her to liquidate principal in her own name and also the principal 9 established in the Lenore S. Caldwell Marital Trust before requesting any major sums of principal from the Caldwell Family Trust. 3. Upon the death of my wife, Lenore S. Caldwell, the Trustee shall divide and distribute the accumulated income and principal then remaining in its hands unto my children, in equal shares, share and share alike or their issue per stirpes. Should either of my children predecease Lenore S. Caldwell, but not survived by issue, then the amount which would have been paid to that child or her issue, shall go to my surviving child, or her issue per stirpes. 4. My wife shall have the power, at any time and from time to time, to make gifts of the principal or income of this Trust, in whole or in part, in such manner and in such proportions as she sees fit to the children of the Settlor, as she may in writing set forth, both during her lifetime and following her death, excluding the right to execute this power in favor of herself, her creditors, her estate or the creditors of her estate. XTEM XXX. Trustee Administrative Powers. I authorize the Trustee and any successors in trust to exercise the following powers in its sole discretion which shall be effective without court order or approval: 10 A. To retain any or all of the assets which it may receive from my probate estate, if any, without regard to any principal of diversification, risk or productivity. B. To invest in all forms of property without restriction to investments authorized for any type of fiduciary. c. To compromise any claim or controversy. D. In its sole discretion, to loan money to or to purchase assets from my probate estate, and also to pay from any assets received directly by the Trustee by virtue of my death, except assets that are exempt from any federal estate tax, any inheritance tax, estate or other tax imposed by reason of my death and particularly any such financial burden requested by my Executor. E. To borrow money from any person, including the Trustee and to mortgage or pledge any real or personal property. F. To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales, exchanges or leases all for such prices and upon such terms and conditions as it deems proper. G. To repair, alter or improve any real or personal property. 11 H. To distribute in cash or in kind or partly in each at valuations fixed by it. x. To purchase investments at premiums and to charge premiums to income or principal or partly to each. J. To subscribe for or to exercise options for stocks, bonds, or other investments; to join in any plan of lease, mortgage, merger, consolidation, reorganization, foreclosure or voting trust and to deposit securities thereunder; and to generally exercise all the right of security holders or employees of any corporation. K. To register securities in the name of a nominee or in such manner that title shall pass by delivery. All voting and proxy powers of said securities shall be vested in the Trustee. L. To assume continuance of the status of my beneficiary with reference to death, marriage, divorce, illness, incapacity or other change in the absence of information deemed reliable, without liability for disbursements made on such assumption. M. To add to the principal of the trust funds any real or personal property received from any person by deed, will or in any other manner. N. To exercise all power, authority and discretion given by this instrument after the termination of any trust created herein until the same is fully distributed. 12 o. To commingle the assets of the trust funds in anyone or more common funds for greater convenience and flexibility. P. To employ attorneys, accountants, engineers and such other persons, professional or otherwise, as may be necessary for the proper administration of this Trust Agreement and to pay their compensation from the Caldwell Family Trust. Q. To carry any type of insurance policy on beneficiaries of this Trust Agreement and to pay premiums thereon from the Caldwell Family Trust. R. To pay such amounts from the income or principal of the Caldwell Family Trust which shall determine as proper and reasonable to compensate the guardian of the person of any child or grandchild of mine under the age of eighteen (18) years. S. To terminate any trust herein created if, in the sole opinion of the Trustee, said trust is too small to administer relative to the administrative fee charged by the Trustee. ITEM IV. Revoke or Amend. I reserve the power to amend or supplement, in whole or in part, or to revoke this trust any time by giving written notice to the Trustee. The consent of the Trustee shall be necessary in the event of amendment or supplement but it shall not be necessary in the case of revocation. I further reserve the right to revoke any will which contains pour-over provision of 13 my residuary estate into this trust. I also reserve the right to fund this trust with property of any kind subject to the consent of the Trustee to accept the same. XTEM V. Xnsurance Policies. All rights of every nature which accrue to me under the terms of the respective insurance policies which would fund this trust upon my death I hereby retain and if the consent of the Trustee is necessary at any time to effect any of these rights the Trustee agrees to give its consent and this consent shall bind all the beneficiaries of this Trust Agreement. Specifically, but not by way of limitation, I reserve the following rights: A. To add other insurance to the trust "by making the policy available to the Trustee. B. To receive and apply dividends. c. To obtain from the respective insurance companies such advances or loans on account of the policies that may be available. D. To sell, assign or pledge a policy. E. To change the beneficiary of a policy. F. To withdraw a policy in order to exercise the reserved right or for any other purpose. XTEM VX. xnstitutional Trustee. I empower my wife, Lenore S. Caldwell, so long as she is 14 competent, to request the resignation of the institutional Trustee appointed herein so long as another institutional Trustee is willing to accept the fiduciary responsibilities as set forth in this Inter vivos Trust Agreement. The designated Trustee accepts this trust with this understanding. ITEM VII. Minority and Disability. Any income or principal payable to any beneficiary who is a minor or to a beneficiary who, in the sole judgment of my personal representative, is mentally or physically incapacitated, shall be held in trust by Fulton Bank, Trustee, during such minority or incapacity. Trustee is authorized, in its exclusive discretion, to expend from income or principal such sum or sums as may be necessary for the proper care, maintenance and support of such minor or incapacitated beneficiary directly, without the intervention of a guardian or committee; or Trustee may pay the same to any person having care or control of said beneficiary or with whom the beneficiary resides, without any duty on the part of Trustee to supervise or inquire into the application of the funds by any person to whom payment is so made. Any income and principal not so expended by Trustee shall be retained by Trustee and paid to the beneficiary upon termination of the incapacity (including minority), or to the estate of the beneficiary if he or she dies before reaching the age of majority or while still 15 incapacitated, as the case may be. For purposes herein contained, the age of majority shall be twenty-one (21) years. ITEM VIII. Protection or Benericiaries. Benefits from the trust fund may be distributed directly or applied on the beneficiary's behalf as the Trustee deems appropriate. All shares or principal and income hereby given shall be free from anticipation, assignment, pledge or Obligation of the beneficiary and shall not be subject to any writ of attachment or execution. ITEM IX. Compensation or Trustee. The compensation of the Trustee when ~cting hereunder shall be established in accordance with its standard schedule of fees as may be in effect from time to time. ITEM X. Discretionary Distributions. Grantor hereby orders and directs that any individual Trustee who is a beneficiary hereunder shall not participate in any decision involving the discretionary distribution application, or accumulation of income or principal, or in the discretionary distribution of whether any receipt or disbursement shall be allocable to income or principal. 16 ITEM XI. Bond. Grantor directs that any fiduciary action hereunder shall not require the entry of a bond or other security in any jurisdiction in which said fiduciary may be called upon to act. ITEM XII. Situs of Trust. Lancaster County, Pennsylvania is hereby designated as the situs of the trust herein created and all questions pertaining to the validity and construction of this Inter Vivos Trust Agreement or the administration hereunder shall be determined in accordance with the laws of Pennsylvania, regardless of the jurisdiction in which this trust may at any time be administered. ITEM XIII. Additions to the Trust. The Grantor, or any other person, may at any time or from time to time, with the approval of the Trustee, transfer to the Trustee, by lifetime gift or by will, any securities or other property. All such additions shall be subject to all of the terms and conditions of this Agreement. 17 IN WITNESS WHEREOF, I, THOMAS D. CALDWELL, JR., the Grantor of this Trust Agreement, have set my hand and seal the day and year first above written and the Trustee has thereafter caused it to be accepted by an appropriate and authorized officer and its corporate seal affixed. WITNESS: ~cd.4 ,,~ lJ. ~.a. Thomas D. Caldwell, Jr., "Grantor" Accepted this ___ day of , 1991. ATTEST: FULTON BANK By Authorized Officer "Trustee" 18 , . LAST WILL AND TESTAMENT OF THOMAS D. CALDWELL, JR. I THOMAS D. CALDWELL, JR., presently residing and domiciled at500 Park Terrace, Harrisburg, Dauphin county, Pennsylvania, declare this to be my Last Will and hereby revoke all wills which I have previously made. ITEM I: I appoint my wife, Lenore S. Caldwell, as the Executrix of my estate. If she is unable to serve in this capacity, or having been appointed is unable to complete the administration of my estate, I appoint Fulton Bank of Lancaster, Pennsylvania, as the Executor of my estate. ITEM II: I give to my wife, Lenore, whatever interest I may have in any tangible personal property. We hold all of our household items as tenants by the entireties, but should there be any question, I give whatever interest I may have in all items of tangible personal property to Lenore. If Lenore should predecease me, I give this gift to our children who survive me, in as near equal shares as possible. All items of tangible personal property not desired by our children shall be liquidated and the proceeds added to my residuary estate. . . ITEM III: The residue of my estate, of whatever nature and wherever situate, shall be distributed to Fulton Bank, as Trustee under a certain Inter vivos Trust Agreement ~ . executed by me as Settlor on the ~.4t day of ~ , 1991, and subject to all amendments thereto, to be held by it and added to and administered as part of the trust established by that document. ITEM IV: If my wife and I shall die under such circumstances that the order of our deaths cannot be established, it shall be conclusively presumed for all purposes of this Will, as well as the aforesaid trust, that my wife survived my death. ITEM V: I direct that all federal, state and other death taxes payable because of my death, with respect to the property passing under this Will, shall be considered as a part of the expense of administration of my estate and shall be paid from my residuary estate, subject, however, to the authority given the Trustee under the aforesaid agreement of trust to pay taxes attributable to those assets and subject also to the discretion of the Trustee to advance funds to my Executrix for the payment of such taxes. ". . . 'L~ IN WITNESS WHEREOF, I have hereunto set my hand th1s ~ day of ~ , 1991. ~ ~aI~ (SEAL) TH MAS D. CALDWELL, JR. The preceding instrument, consisting of this and two other type-written pages, identified by the signature of the Testator, was on the date thereof signed, published and declared by THOMAS D. CALDWELL, JR., the Testator therein named, as and for his Last Will, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto. /,,;2 L3!L10.~ I 1.35 a5. .3/sJ. 9, ~.4tltflIU II Id... Residing at 17011 . . . STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, MARY C. LEWIS Register for the Probate of Wills and Granting Letters of Administration &c. in and for said County of CUMBERLAND the 31st day of do hereby certify that on January A.D., Two Thousand and Two, estate of CALDWELL THOMAS D JR (LAbl, rlKbl, M1UUL~) Letters TESTAMENTARY in common form were granted by the Register of said County, on the , late of WORMLEYSBURG BOROUGH in said county, deceased, to CALDWELL LENORE S (LAbl, rlKbl, M1UUL~) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 31st day of January A.D., Two Thousand and Two. File No. 2002-00113 PA File No. 21-02-0113 Date of Death 12/21/2001 S.S. # 174-20-3914 ~/I//(l~ >fn//d~/}uj /t/(J .-1/. ]$''' '7 Register NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL '\ REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA t!" INVENTORY Estate of Thomas D. Caldwell, Jr. No. :A J - O:A - 113 , Deceased Date of Death December 21,2001 Social Security No. 174-20-3914 also known as Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to Unsworn falsification to authorities. Personal Representative: Name of Attorney: Charles J. DeHart, III, Esquire 1.0. No.: 15617 Lenore S. Caldwell 3. ~P7' , 5 ~ 0 'c/<'hYf< Dated 9- dlf- d:J... Address: 3631 North Front Street Harrisburg PA 17110 Telephone: (717) 232-7661 Description Value Real Estate - None Personal Property: 1. 85,038 shares common stock Fulton Financial Corporation @ $21.425 per share 1,821,939.15 Total (Attach Additional Sheets if necessary} 1,821,939.15 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 COM/'v'IONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DEHART CHARLES J III ESQ 3631 NORTH FRONT ST HARRISBURG, PA 17110 nnn_~ fold ESTATE INFORMATION: SSN: 174-20-3914 FILE NUMBER: 2102-0113 DECEDENT NAME: CALDWELL THOMAS 0 JR DATE OF PAYMENT: 09/09/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/21/2001 NO. CD 001602 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,822.78 I I I I I I I I TOTAL AMOUNT PAID: $2,822.78 REMARKS: LENORE CALDWELL C/O CHARLES J DEHART III ESQ CHECK# 1005 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV~1-5~b-13 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 2 0 0 1 3 couj;j"rYC'05E -YEA~ - - "NuM"BER-- I- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Caldwell, Thomas D., Jr. DATE OF DEATH (MM-OQ-Year) 12/21/2001 SOQl\l SECURITY NUMBER DATE OF BIRTH (MM-DO-Year) 174-20-394 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 10/24/1928 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Caldwell, Lenore S. SOCIAL SECURITY NUMBER w >- ~:!cn ,,"'''' w"-" rOo ufiil "- '" o 1, Original Return o 4, Limited Estate o 6. Decedent Died Testate (Attach Copy of Will) o 9, Litigation Proceeds Received IKI 2. Supplemental Return o 4a, Future Interest Compromise (date of death after lZ-12-8Z) o 7. Decedent Maintained a Living Trust (Attach copy afTr\lst) o 10, Spousal Poverty Credit (date of deall1 between 12-31-91 and 1-1-95) o 3. Remainder Return (dale ofdeath prior to 12-13-82) o 5. Federal Estate Tax Return Required _ B. Total Number of Safe Deposit Boxes o 11. Election to lax under Sec. 9113(A) (Attach Sch O} tl-lIs,sl<i1l'l'lOl\IiMlIS'1',sa.i1lOl\lPtEtEtK.M.L.CORReSI'oI\lDl!Ncl!ANDCQNli'WENtiAL'l'AJell\l!'ORMA'l'lOl\I,Sl-lQIILO$Et)lREC'l'ElltO; NAME COMPLETE MAILING ADDRESS Charles J. DeHart, III, Es uire 3631 North Front Street FIRM NAME (If Applicable) CALDWELL & KEARNS TELEPHONE NUMBER 717 232-7661 Harrisbur PA 17110 >- z w o z o "- \0 W '" '" o " 1. Real Eslate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule OJ (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) g. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule J) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (line 8 minus line 11) z o i= <( ...J ::> l- ii: <( u W iii:: ::") r OFFICIAL,USE ONLY "-, CO 255,284.40 .-- (8) 255,284.40 (11) (12) (13) 255,284.40 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 255,284.40 z o i= ~ ::> 0.. :!i o u ~ I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1,2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 255,284.40 ...2.... (15) 0 - X X _(16) X 12 (17) X .15 (18) (19) G 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: - / ~ STREET ADDRESS 6 6 South Terrace CITY I STATE PA I ZIP 17043 Wormleysburg Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) (1) 2. Creditslpayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty Total interesUPenalty (0 + E) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1Une 20 to request a refund (4) 5. If Une 1 + Une 3 is greater than Une 2. enter the difference. This is the T M DUE. (5) A. Enter the interest on the tax due (5A) 8. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; ........................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 c. retain a reversionary interest; or ................................................ ................... ...................... ......... 0 d, receive the promise for life of either payments, benefits or care? . ............................... ... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of dealh without receiving adequate consideration?"....".....,....................,..... ........,.........,... ,. ...."....',..... ,.... ......... 0 3. Did decedent own an 'in trust for" or payable upon death bank aceeunt or security at his or her death? ................. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....... ". ...',....',.....,......,......',.................',......... ....',....,.....,.... ............ 0 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Er ~ GY ~ if IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEOULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has af'ly knowledge SIGNATUR~ 0 PERSON RESPONS L R FILING RETURN DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE C ADDRESS Charles J. DeHart, 1lI 3631 North Front Street Hafflsbura. Pennsylvania 17110 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate impcsed on the net value of transfers to or for the use of the surviving spcuse is 3% [72 PS 39116 (a) (1.1) (i)]. For dates ofdealh on or after January 1, 1995, the tax rate impcsed on the net value of transfers to or for the use of the surviVing spouse is 0% [72 P.S. 39116 (a) (1.1) (ii)]. The statute does not ex.empt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fHing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on tne net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 39116(a)(I.2)]. The tax rate imposed on the net value of transfers to or for the use 01 the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 39116(1.2) [72 P.S. 39116(a)(I)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 39116(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. .REy.,508:X'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Caldwell Thomas D Jr FILE NUMBER 21 02 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 00113 ITEM NUMBER 1. DESCRIPTION Settlement proceeds (Net) received by the Estate of Thomas D. Caldwell, Jr., from litigation filed on behalf of the Estate for injuries sustained in an accident dated June 5, 2001 (see attached statement relative to the survival proceeds) VALUE AT DATE OF DEATH 255,284.40 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 255,284.40 REV~i513E"{';O~_ . .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER ./1 T ,no .Ir 71 02 """~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee!s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 lal (1211 1. Lenore Caldwell Surviving spouse 255,284.40 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET lI. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PARTII- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) CALDWELL 6. KEARNS JAMES R. CLIPPINGER CHARLCS J. DEHART. 111 JAMf:S D. CAMPBELL, JR. JAMES L. GOLDSMITH JEF~REY T. McGUIRE- STAHLE'!' J. A. LASKOWSKI DOUGLAS K. MARSICO BRETT M. WOODBURN DOUGLAS E. HERMAN RAY .J. MICHALOWSKI . "LSO ,., MEMBER OF NJ BAR ATTORNEYS AT LAW A PROFESSION!-L caRPORATIQli 3631 NORTH FRONT STREET HARRISBURG. PENNSYLVANIA 17110-1633 August 8, 2003 Estate of Thomas D. Caldwell, Jr. Date of Accident: June 5, 2001 Settlement amount OF COUNSEL RICHARD L. KEARNS CARL Go WASS THOMAS D. CALDWELL. .JR. 11928-2001) 717-232-7661 FAX: 717_23.2_2766 thefirmOc:aldweltke~rns.com $1,630,000.00 --------------------------------------------------------------- Medical Liens (estimated payments) Medicare ($204,731.05 less ]/3 fees & costs) Blue Shield ($9,377.591ess 25% fees & costs) Sanat Mandai, M.D. ( $1,485 Medicare rate) Costs Advanced Copies (2,728 @ $0.25) Fax Expense Recordex (medical records) Harrisburg Blueprint Nursing Consultation Services Recordex (medical records) David A Smith (Photographs) Prothonotary (Writ) Hershey Medical Center Harrisburg Blueprint Nursing Consultation Services Harrisburg Blueprint FYJ Healthserve (medical records) Hughes, Albright, Foltz & Natale Nursing Consultation Services Harrisburg Blueprint Recordex (medical records) $135,186.61 6,973.61 1,061.62 $ 68200 36.00 629.55 2]2.84 1,500.00 26964 878 90.00 15.00 233.58 1,044.00 ]39.61 124.94 324.30 2,797.00 41.80 65.08 $ ]43,221.84 , . Video Images Prothonotary (stipulation) Socolow Photography Prothonotary (subpeona) Thomas Jefferson Hospital Blakey, Bupp, Yost Prothonotary (Discontinuance) Hughes, Albright, Foltz & Natale Total Caldwell & Kearns fees Medicare (1/3) Blue Cross (25%) Dr. Mandal savings Balance of fee Total Total Expenses Net Settlement Survival Proceeds (20%) Payable to Estate of Thomas D. Caldwell, Jr. Wrongful Death Proceeds (80%) Payable to Lenore S. Caldwell Payable to Ellen Caldwell Brown Payable to Suzanne Caldwell Orris 330.00 14.25 54.86 3.00 75.00 1,012.50 8.75 $ 643.70 $ 68,243.68 2,344.40 423.38 $128,988.54 $ 255,284.40 $1,021,137.58 $ 10,356. J 8 $ 200.000.00 $ 353,578.02 $ J ,276,42198 $ 255,284.40 $ 340,379.20 $ 340,379.1 9 $ 340,37919 We, the undersigned, acknowledge receipt of the above distribution statement and the listed distributions. We filrther understand that the Medical Liens are estimated and that in the event the escrowed amount is insufficient to cover the compromised lien we agree to refund our proportionate amount to satisfy the liens. e/z/()j Dated! (~rl'/ ~CJ'h//(f}i Lena e S. Caldwell r/9h 3 Dated I ' frl r/ D!J I I Dated' 01-438 56924 ~ "'lOt'..... ~.,", ~. / /- ,-::7- /::' BUREAU, Of INOIVIDUAL TAXES . INHf~ItANCE TAX DIVISION OEPr: 2801,(,'..1 HARRISBUR~~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE Of INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE Of DEDUCTIONS AND ASSESSMENT Of TAX CHARLES J DEHART 3631 N FRONT ST HARRISBURG III ~i~lJ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-21-2003 CALDWELL JR 12-21-2001 21 02-0113 CUMBERLAND 101 '*' t/ REY~1!i41 Ell iFP (DJ-D3l THOMAS D Allount R...itted PA 1711 0 ',':\ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... REV=is4-j-Eif-Aj:P--foY=cm--iioTicE--ciF-YNiiEifiTA~fcE-TAX-APPRAisEifEii;"~--AL1-ciwAi"-CE-cfC--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX THOMAS D FILE NO. 21 02-0113 ACN 101 ESTATE OF CALDWELL JR TAX RETURN WAS: ( ) ACCEPTED AS fILED ( X) CHANGED SEE DATE 10-21-2003 ATTACHED NOTICE NO. 01 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. R..l Estate (Schedule A) (1) 2. stocks and Bonds (Schedule 8) (2) 3. Closely Held stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule DJ (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule fJ (6) 7. Transfers (Schedule G) (7) 8. Total Assets .00 .00 .00 .00 255.284.40 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad... Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule !) (lO) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax .00 .00 (11) (12) (13) (14) NOTE: I~ an assessment was issued previously, lines reflect ~1gures that include the total o~ ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rat. (15) 16. A.ount of Line 14 taxable at LIn..l/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Cless B rate (18) 19. Principal Tax Due TA CDS: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax paym.nt. 255,284.40 00 255,284.40 255,284.40 62,728.52 14, lS and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = 62,728.52 X 045 = .00 x 12 = .00 x 15 = (19)= + AMOUNT PAID 2,822.78 DATE 09-09-2002 NUMBER CD001602 INTEREST/PEN PAID [-) .00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 2,822.78 .00 .00 2,822.78 2,822.78 .00 .00 .00 . If PAID AfTER DATE INDICATED, SEE REVERSE fOR CALCULATION Of ADDITIONAL INTEREST. ( If TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. If TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REfUND. SEE REVERSE SIDE Of THIS fORM fOR INSTRUCTIONS.) , . <' RESERVATION: Estates of decedents dying on or before Dace_bar lZ~ 1982 -- if any future interest in the estate is transferrad in possBssion or enjoyment to Class B (collateral) beneficiaries of the decadant after the expiration of any estate for life or for years, the Co..onw8s1th hereby Bxpressly reserves the right to appraise and aSSBS5 transfer InheritancB Taxes at the lawful Class B (collaterall rate on any such future interBst. PURPOSE OF NOTICE: To fulfill the require.ents of Section 2140 of tha Inheritance and Estate Tax Act, Act Z3 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Reglstsr of wills printed on the reverse side. --Make check or lIIo11ey order payablEl to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, .ay be requested by completing an "Application for Refund of Pennsylvania Inherit~nos and Estate Tax" CREV-l313). Applications are available at the Office of the Register of WillS, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for for.s ordering: 1-800-362-2050j services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any par~ in interest not satisfied with the appraise.ent, allowance, or disallowance of deductions, or asseSSMent of tax (inclUding discount or interest) as shown on this Notice must object within sixty C60} days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, HarriSburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this asseSSMent should be addressed in wrIting to: PA Depart.ent of Revenue, Bureau of Individual Taxes. AITN: Post Assess.ent Review Unit, Dept. 280601, HarriSburg, PA 17128-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-ISO]) for an explanation of adldnistratively correctable 8rrors. DISCOUNT: If any tax due is paid within three C3} calendar .onths after the dscedent's death, a five percent (SZ) discount of the tax paid is allowed. PENALTY: The 1570 tax a~nesty non-participation penalty is computed on tha total of the tax and interest assessed, and not paid before January 18, 1996, tha first day after the end of the tax amnesty period. This non-participation penal ty is appealable in the $SU Banner and In the the same tima period as YOU would appaal tha ta)( and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nins (9) aonths and one (1) day frOB tha date of death, to the date of payment. Taxes which became dalinquant before January 1, 1982 bear interest at the rate of si)( (670) percent par annum calculated at a daily rate of .000164. All taxas which bacama delinquent on and after January 1, 1982 will bea~ interest at a rate Which will vary fro. calendar year to calendar ygar with that rate announcad by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Intgrest Daily Interest ~~ Yaar ~~ Year ~ Daily Factor ~ 1982 20X .000$48 '987 9. .000241 1999 n .000192 1983 1670 .000438 1988-1991 1170 .000301 2000 OX .000219 1984 1170 . .000301 1992: 9X .000247 2001 9X .000247 1985 137- .000356 1993-1994 7X .000192 2002 1M .000164 1986 1070 .0002:74 1995-1998 970 .000241 2003 5X .000137 --Interest is calculated as fOllows; INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued aftar the tax becomes delinquent will reflect an interest calculation to fiftaen (15) days beyond the date of the assessment. If payment is made aftar tha interest computation date shown on the Notice, additional interest must be calculated. REVt1470 EX (6-68)' *' INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENrS NAME CALDWELL THOMAS DJR. FILE NUMBER REVIEWED BY J Paul Dibert ACN 2102-0113 101(01) ITEM SCHEDULE NO. EXPLANATION OF CHANGES The value of the net survival action passes into the marital trust for the surviving spouse. The estate has chosen not to tax the trust in this estate. Therefore, the net asset shown in this return has been moved to line 13 as a non-elected marital trust funding. ROW Page 1 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Thomas D. Caldwell. Jr. Date of Death: 12/21/01 Will No.2002-00113 Admin. No. Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I . State whether administration of the estate IS complete: Yes X No 2 . If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3 . If the answer to No. I is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No X b . The separate Orphans' Court No. (if any) for the personal representative's account is : c . Did the personal representative state an account informally to the parties in interest? Yes X No d . Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 11/18/03 /1~ " Signature Charles J. DeHart. III. Esquire Name (Please type or print) 3631 North Front Street Harrisbura PA 17110 Address ;-., ( 717 ) - 2327661 Tel. No. Capacity : Personal Representative X Counsel for personal representative , ./ (/ c!< /7-3d.-.?- /3 '\; BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG~ PA 17128-0601 CHARLES J DEHART III ESQ 3631 N FRONT ST HARRISBURG PA 17110 ' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN *' .EV-1U Ell 'FP (Dl~D21 12-15-2003 CALDWEl L JR 12-21-2001 21 02-0113 CUMBERLAND 202 THOMAS D AMount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account I sub.it the upper portion of this for.. with your tax PRy.ent. CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR FILES .... Ri;:V=;36-Ei(AFP-Tor:.-02i-----iii-i,iiffici;:--OF--IiETERtiiNAfioN"-AN-Ii-AlfsESifMENY---------------------- - - - - -- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF CALDWELL JR THOMAS D FILE NO.21 02-0113 ACN 202 DATE 12-15-2003 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 2,822.78 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 2,822.78 5. Pennsylvania Estate Tax Due .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEI PT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 "IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, VDU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.J PURPOSE OF NOTICE: PAYMENT: To fulfill the rQquirements of Section 2140 of the Inheritance and Estate Tax Act~ Act 23 of ZOOO. (7Z P.S. Section 9140J. Dstach the top portion reverse side. -- Make check or ~oney of this Notice and submit with your payment to the Register of Wills printed on the order payable to: REGISTER OF HILLS, AGENT. REFUND (CR): A refund of a tax credit /laY be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available et the Office of the Register of Wills~ any of the 23 Revenue District Offices or from the Departgent.s Z4-hour answering service for forms ordering: 1-800-36Z-2050; services for taxpayers with special hearing andlor speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: PENAL TV: INTEREST: ,^,,,.. ~., Any party in interest not satisfied with the assessment of tax as shown on this notics .ay Object within sixty (60) days of receipt of this Notice by: --written pl'"otest to the PA Deparbent of Revenue.. Board of Appeals~ Dgpt. 281021~ Harrisbur-g~ PA 17128-1021, OR --electing to have the matter determined at audit of the per-sonal representative~ OR --appeal to the Orphans' Court Factual errors discovered an this assessment should be addressed in writing to: PA Department of Revenue. Bureau of Individual Taxes. ATTN: Post Assessment Revigw Unit. Dept. 280601~ Harrisburg~ PA 17128-0601~ Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inh~ritance Tax Return for a Resident Decedent.. (REV-1501) for an explanation of ad.inistratively correctable errors. The 157. tax a.nesty non-participation penalty is computed on the total of the tsx and interest assassed~ and not paid before January 18~ 1996, the first day after the end of the tax a.nesty periOd. This non-participation penalty is appealable in the same manner and in the the saMe time periOd as you would appeal the tax and interest that has been assessed as indicated on this notice. Additional Pennsylvania Estate Tax assessed as a result of a change on the Federal Estate Tax closing letter beco.es delinquent at the expiration of one (I) _onth frog the date the final notice of the increase in Federal Estate Tax is received. Taxes which became delinquent before January 1. 1982 bear interest at the rate of six (670) percent per annum calculated at a daily rate of .000164. All taxes which beca.e delinquent on or after January 1~ 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 2070 .000548 1992 9;': .000247 1983 1670 .000438 1993-1994 n .000192 1984 1170 .000301 1995-1998 9% .00024.7 1985 1370 .000356 1999 n .000192 1986 1070 .000274. 2000 8% .000219 1987 970 .000247 2001 9% .000247 1988-1991 1170 .000301 2002 6% .000164 --Interest is calculated .s follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF OAYS DELINQUENT X OAILY INTEREST FACTOR --Any Notice issued after the tax beco.es delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of ths assess.ent. If pay.ent is .ads after the interest computation date shown on the Notice~ additional interest .ust be calculated.