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HomeMy WebLinkAbout07-03-14 J 1505611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 14 0018 Harrisburg, PA 17129-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 11152013 03151920 Decedent's Last Name Suffix Decedent's First Name MI MYERS GEORGE F (If Applicable) Enter Surviving Spouse's Information Below Spouse's Las(Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) ❑X 6. Decedent Died Testate © 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) N CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIOWSHOULD BE DIRECTEOy.IOM Name Daytime Telephorie.Ni tuber C__ O ' FRED BACHMAN, TAX OFFICER 717-291-'2636`' r co � _ .t: �. M REGISTER OF INI6LS'USEO "'` d C O First Line of Address I'r1 t FULTON BANK, N - A - 73 Second Line of Address P - O - BOX 3215 City or Post Office State ZIP Code DATE FILED LANCASTER PA 176043215 Correspondent's e-mail address: FBACHMAN@FULT • COM Under penalties of perjury, I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE QF PERSO RESP NSIBLE FOR FILING RETURN DATE 7/1/2014 Vi}S � SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46471000 1505611185 1 1505611285 J REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: M Y E R S GEORGE F RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 • 00 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . 2. 0 • 00 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C), , , , , 3. 0 • 00 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . 4, 301000 • 00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5, 31580 •91 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested , , , , 6, 0 • 00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . 7. 5051327 . 54 8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8 5381908 • 45 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, 27189? - 24 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , , , , , , , , , 10. 51 833 • 10 11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11. 331 730 • 34 12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12. 50 5,178 • 11 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , 13. 0 . 00 14. Net Value Subject to Tax(Line 12 minus Line 13) . 14. 5051178 • 11 TAX CALCULATION • SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)x.0- 0 . 00 15. 0 . 00 16. Amount of Line 14 ..able at lineal rate.... 4r 5051178 . 11 16. 221733 . 02 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19, TAX DUE . . . . . 19, 221733 . 02 20, FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505611285 1505611285 OM4648 3.000 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 14 0018 DECEDENT'S NAME MYERS GEORGE F STREET ADDRESS 100 MOUNT ALLEN DRIVE CITY STATE ZIP MECHANICSBURG PA 17055- Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 22,733 . 02 2. Credits/Payments A. Prior Payments 211400 - 00 B. Discount 1,126 • 32 Total Credits(A+B) (2) 221526 . 32 3. Interest (3) 0 . 00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0 . 00 5. If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 206 - 70 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . X c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . El FX1 d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ❑ 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)(1)], For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116 (a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and 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 21 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 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 beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S.§9116(a)(1.3)]. A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. OM4671 2 000 REV-1507 EX t(&98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHEESIDEM ECEDENTRN RECEIVABLE ESTATE OF FILE NUMBER George F Myers 21 14 0016 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Promissory Note dated March 19, 2007, between George F. Myers & Virginia D. Myers (D/D 12/14/10) (Payees) , and George F. Myers, Jr. , (Payor) 30,000.00 TOTAL(Also enter on line 4,Recapitulation) $ 30,000.00 3W46AG 1 000 (If more space is needed,insert additional sheets of same size) REV-1508 EX,(W12) pennsylvania SCHEDULE E CEPARTMENTOF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX PERSONAL PROPERTY ESTATE OF: FILE NUMBER: George F. Myers 21 14 0018 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I. Commonwealth of PA State Income Tax refund for 2013 792.00 2 Highmark Refund of unearned prescription plan premium 56.60 3 United States Treasury Federal Income Tax refund for 2013 2,166.00 4 Virginia E. Myers Irrev. Trust Final net income distribution received from Trust 566.31 TOTAL(Also enter on line 5,Recapitulation) $ 3,580.91 2W46AD 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER George F Myers 21 14 0018 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY o EXCLUSION TAXABLE ITEM IIL TIP LUJEE EOFTHETRANSFEREE,THEIR REUTIONSHIP TO DECEDENT AND DATE DECD'S DATE OF DEATH NUMBER THE DATEOFTRA'SER.ATTACHAWW of THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IFAPPUCABEE VALUE 1. George F Myers Revocable Deed of Trust dated November 15, 2007 and amended on July 10, 2008 with Fulton Financial Adisors, NA K/K/A Fulton Bank, NA as Trustee. See copy of Trust Agreement. See Trust assets listed below items 2 through 22. 0.00 100.0000 0.00 0.00 2 230.266 Shares Advisers Invt Tr Johcm Intl S1 I Mutual Fund Values Reported To Nasdaq CUSIP: 809271786 4,073.41 100.0000 0.00 4,073.41 3 196.739 Shares Advisors Inner Circle Fd Acadian Emrgn Mutual Fund (As Quoted By Nasdaq) CUSIP: 0075BM162 3,669.18 100.0000 0.00 3,669.18 4 73 Shares Common Stock Fund CUSIP: 999327901 6,486. 97 100.0000 0.00 6,486.97 5 1,162.018 Shares Driehaus Mut Fds Select Cr Fds Mutual Fund (As Quoted By Nasdaq) CUSIP: 262028848 11,875.82 100.0000 0.00 11,875.82 6 Federated Govt Oblig MME' #395 CUSIP: 60934NB07 16,312.00 100.0000 0.00 16,312.00 7 16,260.232 Shares Federated Total Return Sers Totl Ret Instl Mutual Fund (As Quoted By Nasdaq) CUSIP: 31428Q101 179,025.15 100.0000 0.00 179,025.15 Dividend accrued on 11/15/2013 18.43 100.0000 18.43 Total from continuation ached lea . . . . . . 283,866.58 TOTAL(Also enter on line 7,Recapitulation)$ 505 327.54 If more space is needed,use additional sheets of paper of the same size. 9 W46AF 2 000 Estate of: George F. Myers 21 14 0018 Schedule G (Page 2) Item DOD Value Taxable vo. Description of Asset '! Interest Exclusion Value 8 63.175 Shares Harbor Fd Intl Fd Instl Mutual Fund (As Quoted By Nasdaq) CUSIP: 411511306 4,475.32 100.0000 0.00 4,475.32 9 621.101 Shares Ing Mut Fds Glb Real Est A Mutual Fund (As Quoted By Nasdaq) CUSIP: 44980R326 11,676.70 100.0000 0.00 11,676.70 10 85.482 Shares Managers Amg Fds Gw6K Sceq Inst Mutual Fund (As Quoted By Nasdaq) CUSIP: 561709593 2,099.44 100.0000 0.00 2,099.44 11 189.28 Shares Natixis Fds Tr Ii Vn V1 Opp Fd Y Mutual Fund (As Quoted By Nasdaq) CUSIP: 638727828 4,001.38 100.0000 0.00 4,001.38 12 1,402. 95 Shares Northern Lts Fd Tr Prnctn Ft St I Mutual Fund (As Quoted By Nasdaq) CUSIP: 66537V443 11,812.84 100.0000 0.00 11,812.84 13 10.051 Shares Perritt Fds Inc Microcap Oppty Mutual Fund Values Reported To Nasdaq CUSIP: 714402203 381.33 100.0000 0.00 381.33 14 1,887.909 Shares Pimco Fds Pao Invt Mgmt Ser All Asset Inst Mutual Fund (As Quoted By Nasdaq) CUSIP: 722005626 23,353.43 100.0000 0.00 23,353.43 15 2,068.927 Shares Pimco Fds Pao Invt Mgmt Ser Comm Realstr I Mutual Fund (As Quoted By Nasdaq) CUSIP: 722005667 11,503.23 100.0000 0.00 11,503.23 16 8,239. 695 Shares Pimco Fds Pao Invt Mgmt Ser Total Retrn Pt Mutual Fund (As Quoted By Nasdaq) CUSIP: 693390700 89,812.68 100.0000 0.00 89,812.68 Total (Carry forward to main schedule) 159,116.35 Estate of: George F. Myers 21 14 0018 Schedule G (Page 3) Item DOD Value Taxable No. Description of Asset 'h Interest Exclusion Value 17 2,000.621 Shares Professionally Managed Ptfl Oster Str Incm Mutual Fund (As Quoted By Nasdaq) CUSIP: 742935489 23,787.38 100.0000 0.00 23,787.38 18 215.177 Shares Riverpark Fds Tr Wedgewd Instl Mutual Fund (As Quoted By Nasdaq) CUSIP: 76882K306 3,703.20 100.0000 0.00 3,703.20 19 603 Shares Ubs Ag Jersey Brh Alerian Infrst Nyse Arca Equities Exchange CUSIP: 902641646 23,709. 96 100.0000 0.00 23,709.96 20 526 Shares Value Stock Fund CUSIP: 999328008 5,723.50 100.0000 0.00 5,723.50 21 295 Shares Vanguard Bd Index Fd Inc Short Trm Bond Nyse Arcs. Equities Exchange CUSIP: 921937827 23,761. 96 100.0000 0.00 23,761. 96 22 131.852 Shares Vanguard Index Fds Valu Idx Signl Mutual Fund (As Quoted By Nasdaq) CUSIP: 922908462 4,018.85 100.0000 0.00 4,018.85 23 Mass Mutual Annuity #ODY15303951 40,045.38 100.0000 0.00 40,045.38 Payable Upon Death to Decedent's Children: Sally M Erde George F Myers, Jr Melissa M Stock Total (Carry forward to main schedule) 124,750.23 REV-1511 Ex+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS EESIDENTOECEDENT ESTATE OF FILE NUMBER George F. Myers 2114 0018 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1 Myers—Buhrig Funeral Home & Crematory Funeral Expenses 14,381.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 7,500.00 Name(s)of Personal Representative(s) Fulton Bank. NA Street Address One Penn Square City Lancaster State PA zip 17602 Year(s)Commission Paid: 2. Attorney Fees: 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent a. Probate Fees: 203.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Estate Notice 75.00 2 Patriot News Estate Notice 137.24 Total from continuation schedules . . . . . . . . . 600.00 TOTAL(Also enter on Line 9,Recapitulation) $ 27 897.24 9w46AG 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1514E%x(12-12) SCHEDULE pen nsylvania DEPPRWENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER George F. Myers 21 14 0018 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Alert Pharmacy Services, Inc Prescription Balance Due 8.39 2 Fulton Financial Advisors George F Myers Rev Trust Trustee Fee Prorated to Date of Death 222.52 3 Linda McCutcheon Nursing Care 90.00 4 Messiah Lifeways at Messiah Village Skilled Nursing Care 5,370.23 5 Cumberland County Tax Bureau Local Earned Income Tax due for 2013 73.00 6 Melissa Stock - Replacement for stale dated check 10/18/13 Reimbursement for clothing purchased at Boscov's 68.96 TOTAL(Also enter on Line 10,Recapitulation) $ 5,833.10 2w46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+( SCHEDULE J penns nsylvania DEPPRTIOENTOF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: George F. Mvers 21 140018 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE ( TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under Sec.9116(a)(12).] Melissa M, Stock 701 Green Acres Street Mechanicsburg, PA 17055 General Bequests: 10,000.00 Schedule G, Item 23 — Mass Mutual Annuity #ODY15303951 1/3 Share: 13,348.45 One Third of Residue: 145,044.24 Daughter 168,392.69 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES is THROUGH t8 OF REV-1500 COVER SHEET,AS APPROPRIATE, NONTAXABLE DISTRIBUTIONS A,SPOUSAL DISTRIBU110NS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: t. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1, TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 0.00 sw46AI 2.000 If more space is needed,use additional sheets of paper of the same size. Estate of: George F. Myers 21 14 0018 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 2 Sally M. Erde 11 Alling Drive Gray, ME 04039 General Bequests: 10,000.00 Schedule G, Item 23 - Mass Mutual Annuity #ODY15303951 1/3 Share: 13,348.49 One Third of Residue: 145,044.24 Daughter 168,392.73 3 George F. Myers, Jr 1 Rupert Street Waterville, ME 04901 General Bequests: 10,000.00 Schedule G, Item 23 - Mass Mutual Annuity #ODY15303951 1/3 Share: 13,348.45 One Third of Residue: 145,044.24 Son 168,392. 69 41F777-01-9 55 7-fO -0 FI wi1.�- Last Will and Testament OF GEORGE F.MYERS 1, GEORGE F. MYERS, of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS 1 direct the payment of all my legal debts and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE II TANGIBLE PERSONAL PROPERTY I give and bequeath my household furniture and furnishings, books, pictures, jewelry, automobiles, wearing apparel and all other articles of household or personal use or adornment, together with any existing insurance thereon unto my wife, VIRGINIA D. MYERS,provided she survives me. If my wife, VIRGINIA D. MYERS, predeceases me, I give and bequeath such articles of personalty to those persons 1 have listed in a written memorandum, which I intend to place with this, my Last Will and Testament. If no such memorandum is located or received by my Personal Representative within sixty (60) days after taking office as such, after conducting a 1 Page 1 reasonable search for such memorandum, the Personal Representative shall be held harmless for distributing such property as hereafter provided. I give and bequeath such tangible personalty not disposed of by such memorandum, or all of such tangible personalty if no such memorandum is located or received, unto those of my children who survive me, to be divided among them as they shall agree. In case of disagreement among my children, my Personal Representative is authorized to make the division, having due regard for the personal preferences of my children, but making such division is as nearly equal shares as the Personal Representative deems practicable. ARTICLE III REST,RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue and remainder of my Estate, of whatsoever nature and wheresoever situate, unto the Trustee of my Revocable Deed of Trust dated November 15, 2007, as amended on J'✓ly J9 , 2008 (My Revocable Trust), to be administered and distributed in accordance therewith. Any portion of property hereby given to the Trustee of My Revocable Trust which would immediately be subject to final distribution by the Trustee may be distributed by my Personal Representative in its sole discretion directly to the beneficiaries of such Trust to avoid a needless transfer through the My Revocable Trust. If, for any reason, a Court of competent jurisdiction shall declare this testamentary transfer to My Revocable Trust to be invalid, then I direct that my residuary estate shall be held, managed,invested, and reinvested in exactly the same manner described in My Revocable Trust, giving, if the Court shall allow, effect to all then-existing amendments of My Revocable Trust, and in any event giving effect to all terms of My Revocable Trust now in effect, to be managed 2 Page 2 by My Revocable Trustee therein named. Thus, for those purposes, I do hereby incorporate that same Trust Agreement,by reference hereto,into this,my Last Will and Testament. In the event that My Revocable Trust is not in effect, I give, devise and bequeath the rest, residue and remainder of my Estate unto my Personal Representative under this Will as Trustee (without bond)to hold, administer and distribute the same as a Trust under Will the provisions of which shall be identical with those of the My Revocable Trust which provisions are incorporated herein by reference. ARTICLE IV POWERS OF PERSONAL REPRESENTATIVE AND TRUSTEE My Personal Representative and Trustee shall have the following powers in addition to those vested in them by law and by other provisions of my Will applicable to all property, whether principal or income, including property held for minors, exercisable without court approval and effective until actual distribution of all property: A. To have full authority to deal with any business interest as freely as I might in my lifetime. B. To make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as they may determine. C. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. 3 Page 3 D. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. E. 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, for such prices and upon such terms or conditions as they deem proper. F. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. G. To borrow from or to sell to my Trustee even though such Trustee may be my Personal Representative. H. To compromise any claim or controversy. ARTICLE V SPENDTHRIFT PROVISIONS I direct that the interest of the beneficiaries shall not he subject to anticipation or to voluntary or involuntary alienation. ARTICLE VI PERSONAL REPRESENTATIVE I name, constitute and appoint FULTON FINANCIAL ADVISORS, N.A., Executor of this my Last Will and Testament. I direct that no fiduciary appointed hereunder shall be required to post bond for the faithful administration of the duties required in any jurisdiction. a Page 4 IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament,this�� day of^qjkitA 2008. n,,,�✓= h""" (SEAL) GEORC 1A YERS Signed, sealed, published and declared by the above',named Testator, as and for his Last Will and Testament,in the presence of us, who at his request,in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. Wi ss 0 )�,n Wi s :3201140 5 Page 5 ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND We, GEORGE F. MYERS, SU-z-CLnnC J, Ar-4 i U and r(��� fp,� C • the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older,of sound mind and under no constraint or undue 66influence. #EORG6E ' RS U Subscribed, sworn to and acknowledged before me by GEORGE F. MYERS, Testator, and , subscribed Land sworn to before me by SLLZ0.(I IIC.J • f- r&%'bOld and LhG ttpre � -RL' . w'itnesse�ess.�'this 1f�7" day of �U 2008. Edmund G. M rs Attorney I.D. #20558 6 Page 6 COMMONWEALTH OF PENNSYLVANIA . : SS. COUNTY OF CUMBERLAND On this,the _0 714-day of 2008, before me,the undersigned officer, personally appeared Edmund G. Myers, Attorney I.D. #120558, known to me (or satisfactorily proven)to be a member of the bar of the highest court of Pennsylvania and certified that he wus personally present when the foregoing acknowledgement and affidavit was signed by the Testator and the witnesses. IN WITNESS WHEREOF,I hereunto set my hand and official seal. L &:0}2t Notary Public COMMONWEAJH ')I %�wNSVLVANIA NOTAPIAi S[a_ GAIL J. MAHGNF� ar. °antic Lemoyne Sow.,Cun,ueuann County My CommissionExulte:. feh Is.2010 COMMONWEALTH 01?`NNSYLVANIA NOTAPIAI �EFI GAIL J. MAHONE} '�, Public Lemoyne Boro.,Cu-ouenane County My Commission Expn_s teb.t9,2010 7 Page 7 41F777-01-9 7 - AMENDMENT TO REVOCABLE DEED OF TRUST /0 O $FyryefeP THIS AMENDMENT TO REVOCABLE TRUST DEED OF TRUST is made this /D'1 day of ' 2008, between GEORGE F. MYERS, Mechanicsburg, Pennsylvania "Settlor'') and FULTON FINANCIAL ADVISORS, N.A., ("Trustee"). BACKGROUND A. Settlor and Trustee executed a Revocable Deed of Trust on November 15, 2007 ("Trust"). B. The parties wish to amend the Trust and to set forth their understandings in writing. NOW, THEREFORE, in consideration of the mutual promises and covenants set forth herein,the parties, with intent to be legally bound hereby,covenant and agree as follows: I. Background. The background is incorporated herein. 2. Section 2: Distribution at Death. Section 2: Distribution at Death is hereby deleted and the following substituted therefor: Section 2: Distribution at Death. Upon my death, I direct my Trustee to distribute all net income and principal of the Trust, together with all property distributable to the Trustee as a result of my death, as follows: A. Distributions to Personal Representative. The Trustee shall pay and distribute from the Trust estate to the personal representative of my estate, or in the Trustee's discretion, pay directly, without seeking reimbursement from any person, such sums as may be required by the personal representative to pay legal debts, expenses payable on account of my Page I death, whether arising with respect to assets passing under this Trust or otherwise. All death, succession and transfer taxes may, in Trustee's discretion, be paid from the assets of the Trust to the personal representative for satisfaction thereof in Trustee's discretion. In making such determinations, Trustee may rely upon wTitten instructions of the personal representative of my estate. Such payment(s) shall not require reimbursement or adjustment of accounts of the Trust or of the shares that beneficiaries shall be entitled to receive in income and/or principal. B. Distribution to Beneficiaries. After payment of such sums as may be required under the foregoing paragraph, I direct my Trustee to distribute the sum of TEN THOUSAND (S10,000.00) DOLLARS unto each one of my children,MELISSA M. STOCK, SALLY M.ERDE and GEORGE F. MYERS, JR-, who survives me, and to distribute the balance of the principal and net income unto my wife, VIRGINIA D. MYERS, provided she survives me (and I direct that for purposes of this distribution that she shall be deemed to have survived me unless it appears unmistakably that she predeceased me) and further subject to the provisions of Paragraph D hereafter. If my wife predeceases me, I direct the Trustee to distribute the balance of the principal and net income unto my then-living issue,per stirpes. C. Further Trusts: Beneficiary Lander the Ave of 27. Should any person entitled to a distribution of a share of the Trust not have reached the age of twenty-seven (27) years at the time for distribution to him or her, I direct Trustee to hold such distribution, IN SEPARATE TRUST, and to manage, invest and reinvest the share(s) so received, and to use and apply the income and principal, or so much thereof, as in Trustee's discretion, may be necessary or appropriate for such beneficiary's support and education (including college education, graduate and under graduate and vocational training), taking into account such beneficiary's other resources 2 Page 2 or to make payment for these purposes, without further responsibility, to such beneficiary or to any person taking care of such beneficiary. Trustee shall distribute one-third (1/3) of the then remaining principal and any income accumulated thereon unto such beneficiary when such beneficiary shall reach the age of twenty-one (2l) years and shall thereafter pay the net income therefrom unto him or her. When such beneficiary attains the age of twenty-four (24) years, Trustee shall distribute one-half of then remaining principal and any income accumulated thereon and the balance of the principal and any income accumulated thereon when such beneficiary reaches the age of twenty-seven (27), and the Trust as to that beneficiary shall terminate. If, at the time of funding of any SEPARATE TRUST described above, the beneficiary has already reached an age at which a principal distribution is scheduled to be made, Trustee shall distribute that portion of the principal and net accumulated income unto such beneficiary immediately. If a beneficiary dies before receiving his or her final distribution, Trustee shall distribute to or in Trust for one or more persons or organizations—other than such beneficiary's estate, his or her creditors, or the creditors of his or her estate — as said beneficiary may appoint by a Will containing a specific exercise of this power. In the absence of the exercise of such limited power of appointment, Trustee shall distribute the same unto such beneficiary's then-living issue,per stirpes. D. Disclaimer. If any person otherwise entitled to take hereunder (or such person's legal representative) files a written disclaimer, in whole or in part,with respect to any provision of this Trust, as amended,with my Personal Representative within the period allowed by Section 2518 of the Internal Revenue Code, such person (i) shall be treated as having 3 Page 3 predeceased me for purposes of holding or distributing the disclaimed share, and (ii) shall not participate in any decision to pay or apply the income or principal of the disclaimed share to or for the benefit of any person hereunder, but such person shall not be treated as having predeceased me for purposes of holding, distributing or participating in any such decision under any provision to which the disclaimer does not extend. In the event my wife,VIRGINIA D. MYERS,files such a written disclaimer, in whole or in part, with respect to any property or interest otherwise distributable to her pursuant to this Section 2, Paragraph B, such property or interest so disclaimed shall be held by to my Trustee, IN TRUST, to hold, manage, invest and reinvest the same under the following terms and conditions: A. To pay the net income therefrom at least as often as quarter- annually unto my wife, VIRGINIA D. MYERS, for and during her lifetime. B. As much of the principal of this Trust as my Trustee in its sole discretion may from time to time think advisable for my wife's health, maintenance, and support to maintain her in the station of life to which she is accustomed at my death, or during her illness or emergency,shall he either paid to her or else applied directly for her benefit by my Trustee after taking into account other assets and sources of income available to her. C. Trustee may apply the net income of this Trust for the support of my wife, VIRGINIA D. MYERS, should she by reason of age, illness or any other cause in the opinion of my Trustee be incapable of disbursing it. A Page 4 D. Upon the death of my wife, VIRGINIA D. MYERS, i direct my Trustee to distribute the balance of the principal and net income unto my then-living issue,per stirpes. 3. Ratification. In all other respects, the Trust is hereby ratified and confirmed, except as otherwise expressly amended herein. LV WITNESS WHEREOF. Settlor and Trustee have caused this Amendment to be duly executed on the day and year first above written. Witness: Q SETTLOR: *✓ GiFs�. (SEAL) ��- George F. Myers Witness: TRUSTEE: n !G�( Fulton Financial Advisors,N.A. r1l z By: XA. VICE _1A CS.dew' Title i 32010M 5 Page 5 NMH%882622 1 11'1341' 41F777-01-9 C;)1 i2- L/- a7 Revocable Deed of Trust 6011 • Zloe. 1, George F. Myers, of Cumberland County. Pennsylvania. as settlor. intend to transfer property to FULTON FINANCIAL ADVISORS. N.A., as trustee, and direct that this trustee shall hold this property in trust, together with any other property that may be added to the trust. as provided in this instrument. Section 1. Payments of Income and Principal. During my lifetime: (a) The trustee shall pay me whatever income or principal I request from time to time, (b) If the trustee determines that 1 have become disabled in any way, the trustee shall apply income or principal directly for my benefit or for the benefit of any person I am legally obligated to support. (c) Any income that is not distributed may be added to principal. Section 2. Distribution at Death. Upon my death.the trustee shall distribute all property then belonging to the income and principal of the trust,together with all property distributable to the trustee as a result of my death. to my estate. Section 3. Spendthrift Prot ision. Except as otherwise required by law• no interest of any beneficiary in any property passing under this instrument. whether income or principal, shall be subject to anticipation or assignment by the beneficiary or to attachment or other legal process by any person having a claim against the beneficiary while in the possession of my fiduciaries. Section 4. Administrative Potters. I authorize the trustee, with respect to all property held by the trustee in any capacity under this instrument,to exercise in its sole discretion and without prior authority from any court, in addition to all powers conferred on the trustee by law,the following powers: (a) Power to purchase or otherwise acquire and to retain any property, whether or not authorized for investments by law, and whether or not productive, including stock or other securities of the trustee or the holding company or any other affiliate of the trustee. without diversification as to kind or amount. (b) Potter to transfer, sell• exchange, partition, lease, mortgage,pledge. give options upon, or otherwise dispose of any property, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such terms and conditions.with or without security, and for such price as the trustee may determine. 1 Page 1 K\111'882622.111-13'u? (c) Power to hold cash uninvested in such amounts, at such times,and for such periods as the trustee may determine. (d) Power to hold or register any securities or other property in the name of a nominee or in such form as to pass by deliver}, with or without indicating their fiduciary character. (e) Power to vote any corporate stock in person.through designees, or by proxy, with or without power of substitution, and to execute authority or proxies to one or more designees or nominees. (f) Power to join in and to deposit securities under any plan of lease, mortgage, merger, consolidation, reorganization, foreclosure, or voting trust and generally to exercise all the rights and powers of a security holder of any corporation. (g) Power to borrow money and to pledge property to secure the borrowing without incurring personal liability. (h) Power to compromise or settle claims and other contro\ersies on such terms as the trustee shall determine. (i) Power to invest in an\ common trust fund maintained by the trustee or any affiliate of the trustee. 0) Power to continue or to permit the continuation of any business, whether incorporated or unincorporated, for such period, or to recapitalize or liquidate the business upon such terms, as the trustee shall determine, including power to invest additional sums in the business, power to make loans to the business and to guarantee and to pledge or mortgage property as security for loans made to the business by other lenders,power to act or select other persons to act and to receive or to authorize other persons to receive compensation for acting as directors, officers, or other employees of the business, without regard to whether they are fiduciaries or beneficiaries, and power to make such other arrangements in respect of the business as the trustee may determine. (k) Power to purchase property from the trustees of any trust created by me at its fair market value and to make loans to the trustees of any trust created by me for adequate consideration, upon such terms and conditions as the trustee shall determine. (1) Power to allocate any property received or any charge incurred either to principal or income or partly to each without regard to any law defining principal and income. (m) Power to exercise any tax elections provided by law without requiring adjustment between principal and income for any resulting effect on income or estate taxes. (n) Power to combine any trust created under this instrument with any other trust having substantially similar provisions. whether created under this instrument or created by me or another person under a different instrument. 2 Page 2 NMIV882622 11 1'13:o? (o) Power to change the situs of any trust held under this instrument from the jurisdiction in which the trust is then being administered to a different jurisdiction by a signed instrument filed with the trust records. (p) Power to terminate any trust held under this instrument, if the value thereof does not warrant the cost of continuinu the trust or if its administration would be otherwise impractical,by distributing the principal and an} accumulated income of the trust to me. (q) Power to make distributions in cash or in kind.or partly in each,or by way of undivided interests, without making pro rata distributions of specific assets, and without regard to the income tax basis of specific assets allocated to any beneficiary. (r) Power to distribute any property that shall vest in or become distributable to a beneficiary who is subject to a legal disability,by distributing the property to or for the benefit of the beneficiary directly,without the intervention of a guardian,or by distributing the property to a guardian of the estate of the beneficiary. (s) Power to retain and to pay the fees-and expenses of attorneys. accountants. custodians,investment counsel,and other agents and advisors who may be an affiliate or subsidiary of trustee, without reducing the compensation payable to the trustee. (t) Power to exercise all rights and powers conferred on the trustee either by this instrument or by law in respect of all property held by the trustee in any capacity under this instrument until the property is fully distributed. Section 5. Concernine the Trustee. (a) The trustee shall not be required to give a bond or other security in any jurisdiction. (b) The trustee shall be entitled to rcceivc compensation for its services in any fiduciary capacity under this instrument in accordance with its published schedule of rates from time to time in effect when the services are performed, (c) The trustee may,make court accountings, but the approval of an account by the interested beneficiary or beneficiaries shall be a full discharge of the trustee. (d) The trustee shall not be liable for any breach of trust except a breach of trust committed in bad faith.or intentionally, or with reckless indifference to the interests of the beneficiaries of the trust. Section 6, Revocabilitv. The trust created by this instrument is revocable. and this instrument may be amended or revoked by me at any time and from time to time by written instrument signed by me and delivered to the trustee. The duties,powers,and liabilities of the trustee shall not be changed by amendment. however. without the written consent of the trustee. 3 Page 3 NNIH182622.1 I t:13 07 Section 7. Communication. Communication with the trustee, including but not limited to the delivery and receipt of notices that may be required hereunder,may be through the trustee's designated account officer. The designated account officer,in his or her discretion, may accept my instructions,whether such instructions are communicated orally, by telephone, by facsimile,by electronic mail,or otherwise, which the designated account officer believes to be genuine, and the trustee shall not be liable for the designated account officer accepting any such instructions in good faith. Section 8. Situs and Governin Law. The initial situs of the trust created by this instrument shall be in Cumberland County, Pennsylvania, and all questions regarding the validity, effect, or interpretation of this instrument or the administration of any trust created under this instrument shall be governed by the la%es of Pennsylvania. I have signed this instrument on this date: Witn s: Settlor: �)��r�'1✓a I.j��z� eorge r. rvtyers' 4 Page 4 N\11 188'6)2 111 13 07 FULTON FINANCIAL ADVISORS, N.A. hereby acknowledges that it has received the property listed on the attached schedule and accepts the trust created by this instrument on this date: T7P CC!Ab c( "Z U---1 FULTON FINANCIAL ADVISORS, N.A. Authorized Officer 5 Page 5 1-0 ca /UOte -PtT aomtiA /UtlrtQ 0311�1�07 Gym ,fit $30,000.00 _ M-)�-kLk 1, 2007 Mechanicsburg, PA PROMISSORY NOTE FOR I'ALUE RECEIVED, and intending to be legally bound, the undersigned promises to pay to the order of George F. My.:rs and Virginia D. Myers, husband and wife ("Payees"), the principal sum of Thirty Thousand t$30,000.00) Dollars no 1-a!,-,r than sixty (60) days after the �I appointment of the excoutor of the V'ili of the survivor of the Payees. IN WITNES,J WHEREOF, the undersigned duly executed this Promissory Note on the day of �� , 2007. Signed, sealed and delivered in the presence of: 2, - (SEAL) George F. Myers, Jr. :290587 yi-F797- a� - q Olf 3611 y c,cLa MassMu/u^l 1295 S husclls Mlnunl Lifcld MA01Cumpuny nnJ nlliliulcs MA I` 'C•ILIL 1295 Sucel,SpiinglielJ MA 0111 t-0001 W w W.I1m5falu1llaLeQm FINANCIAL GROUP' January 30,2014 "'F2005"' NANCY RIVERA NANCY RIVERA@RAYMONDJAMES.COM Dear Ms. Rivera: Re: Contract No(s). ODY15303951; Annuitant—George F Myers; Issuing Company- Massachusetts Mutual Life Insurance Co(referred to herein as"MassMutual") You recently requested the following: 1. Type of account—This is a non-qualified plan. 2. Account number—There is no account number,our contract number is listed above. 3. Date of death balance-Date of death value is$40,045.38. 4. Accrued Interest (if applicable)—N/A. 5. Names in which the account is listed—George F. Myers. 6. Date the account was originally opened with your bank—N/A. 7. Maturity date—N/A. 8. Current rate of interest—N/A. We do not have interest rates specifies in the claims department; if you need this information please call our service center at 1-800-272-2216. Sincerely, /4W C_0 Jane Gentles Claim Examiner US1G—Claims Operations 02013 Massachusetts Mulunl Lire Insunnce Company,Springlicld,MAUI 111.0001. All rights reserved,www.mmshngtual.cnm.MassMutual Financial Group is a marketing name for Massachusetu Mutal Life Insunnce CompanY(MassMutua))and"hs afalimed companies and sales representatives. Page 1