HomeMy WebLinkAbout08-08-14 � 150561�Z05 e
REV-1500 IX t�ss,�F��
PA Department of Revenue p�nsylvania OFFICIAL USE OMLY
Bureau of Indivtduat Taxes �"""'""""""` CouMy Code Year F71e Number
POeOXz8o6o1 INHERITANCE TAX RETURN - -..._._.. ._._..__
Harr�sbu Pa i7sz8-o6oi RESIDENT DE�EDENT �1 � ��j �/ . ;
ENT�R DECEDENT IN�dRMATION BELqW r---l-Y" (,L_ '
Saciak&ecurity Number Date of Death MMDDYYYY Date of 8irih MMDOYYYY
56Q-28-78G5 1 f/11/2072 Oif21/1923
Suffix OecedenYs First Nam�
UItOf► . MI
Stella C
nfMP����e)Enter Surviving Spouse's InEormation Below
Spouss's kast Name Suffix Spouse's Flrst Name
MI
Spouse's:Sociat Seeurity Namber
THlS RETt1RN MUST'BE FILED!N DUPLIGATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRlATE OVALS BELOW
O 1.Originaf Retum p 2.Supplemental Retum O 3. Remainder Retum(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future interest Compromise{date of O 5. Federal Estate Tax Retum Required
death after 72-12-82)
O B.Decedent Died Testate tp 7,pecedent Ma(ntalned a Living Trust 0 g,Tptal Number of Safe Deposit Boxee
{Attach Copy of VVfll) (Attach Copyof Trust;)
O 9.Litigation Proceeds Received O 10.SpousaPPovertyGedit(Date of Death O 11. Etection to Taxunder Sec,91t3(qy
Between 12-31-91 and i-1-95j (Attach 3chedWe O)
COFtRESPONpEA1T-THIS SECTION MUST BE GOMPLETED.AtL GORR�5PONQENCE AND CONFIDENTIqL TAX INFORMATiQN SHOULD BE DIRECTEOTO:
Name
Oaydme Teiephona Number ,.._>
Law O�ce of John C OszuS-�phi i c.Z n `�'
_
(717)243-7437 � �: �
...... . _ . . �,.?
�
�_. � ` ' ��
REGISTER OF WILL �y��y � i �fr
T C� -: � =" � C'�
fttstUneofAddress �,, <` ' r � r�
� GCG, `' � -.) :_i
�104 S Hanover St C�- - c • -:.
C�C �`" �;
Seoond Une ofAddress ��, � ;-� �
�,_.� � �._._, �rt
� � ���
City or PoshOffice State ZIP Code DATE'flLED �.''�
Gariiste PA 17013
CorrespondenYs e-mafl address:
UrMer Pe�akies ot Per�,ry�I declare that l have examined this retum.induding aocompenYin9 sd�edWes and statements,and ro the best af m
it is Uue.cortecF;and compleie.Dedaralion ot preparer other tlwn t�e Rersonai representaGve is ba5ed on all informac(on M which Y k�01N�8 and Deliat�
SIGNAT�p��R NS�gLE FOR FILING RETURN �����Y���
DAT ,2p� ,
kDDRES$ ��- `� a� ' 4�.�'�
t867 ak r.,Traverse Gity,M149686
SIGNA F PREPAR EFi'17{pN REPRESENTATNE
'"- D TE
ADDF2E
?04 Manover St., Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 150561D105 15OS610105 J
J 1505610205
REV-1500 EX(FI)
DecedenYs Social Security Number
DecedenPs Name:
RECAPITULATION
1. Real Estate(Schedule A). .... ... ................ ... ............ ... . .. L
2. Stocks and Bonds(Schedule B) ... . ..... ...... ........................ 2. 1,071,081.20
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. ' '
_ _
4. Mortgages and Notes Receivable(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 88,196.72 ',
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . ... ... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property '
(Schedule G) O Separate Billing Requested........ 7. '
8. Total Gross Assets(total Lines 1 through 7)............................. 8. , 1,159,277.92 '
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. , 10,273.76 '
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)..... .......... 10. 8,420.20 i
11. Total Deductions(total Lines 9 and 10).. .... ..... ... .. ................. 11. 18,693.96
12. Net Value of Estate(Line 8 minus Line 11) .. ... .................. .... ... 12.
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) .......... .............. 13. '
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. ; 1,140,583.96 '
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- ' 15. ''
16. Amount of Line 14 taxable
at lineal rate X.0 45 1,140,583.96 16. ; 51,326.28 '
17. Amount of Line 14 taxable _
at sibling rate X.12 �� ', '
18. Amount of Line 14 taxable _ _ ' _ . � ;
at collateral rate X.15 ; �g
19. T�►x DUE .................. ..... . .................. ....... ... ..... 19. I 51,326.28
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
L 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Stella Cussins Urton
TREETADDRESS
— -_-------- ——__ ___ ---- ---- --
_ ____ _—__ _- -- - --
Bridges at Bent Creek
2100 Bent Creek Bivd Apt 100
- - -- - - -_—_ _ _ ---___--- --
CITY - -- ----- -
STATE ZIP ---
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 51,326.28
2. Credits/Payments
A.Prior Payments 42,750.00
B.Discount ___ 2,250.00
Total Credits(A+g� (2) 45,000.00
3. Interest
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3)
Fill in oval on Page 2,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) 6,326.28
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 ............................................ � �
c. retain a reversionary interest.............................................................................................................................. ❑ �
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?.............................................................................................................. ❑ �
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
containsa beneficiary designation? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after 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 tlecedenYs lineai 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.
REV-i5o3 IX+(8-u)
� pennsylvania SCNEDULE B
DEPARTMENTOFREVENUE
INHERITANCETAXREfURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stelia Cussins Urton 21-14-0123
Ali property jointly owned with right of survivorship must be disclosed on Schedule P.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' Morgan Stanley Account(See attachment A)
307,726.23
2 Merrill Lynch Account#273-12315(See attachment B) 763,026.24
3 Accrued interest on item#2
328.85
TOTAL(Also enter on Line 2, Recapitulation) $ 1,071,081.20
If more space is needed,insert additional sheets of the same size
REV-i5o8 EX+(o8-i2)
� pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Stella Cussins Urton 21-14-0123
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
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
1. Bank of America Checking Account#707260226(See attachment C) 11,200.17
2 Bank of America Money Market Account#707442023(See attachment C) 70,776.55
3 Misc personal property 2,350.00
4 Westem Conference of Teamsters Union Pension Annuity Payment 3,096.00
5 2013 Federal tax refund 774.00
TOTAL(Also enter on Line 5, Recapitulation) $ 88,196.72
If more space is needed,use additional sheets of paper of the same size.
REU-1511 EX+ {08-13)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stella Cussins Urton 21-14-0123
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. fUNERAL EXPENSES:
1' Hoffman Roth Funeral Home-Carlisle,PA
2,454.20
2 Food for memorial service 462.00 '
3 Transportation of ashes for internment 397.60
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions
Name(s)of Personal Representative(s)
Street Address
City
-------------_...------......---------_.._.....-------__State_____._._....__ZIP---....._-------
Year(s)Commission Paid:
z• Attorney Fees 6,750.00
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
4• Probate Fees: 40.00
5• Accountant fees:
6• Tax Return Preparer Fees:
�• The Sentinel-legal advertising 94.96
$ Cumberland County Law Joumal-legal advertising 75.00
TOTAL(Also enter on Line 9, Recapitulation) $ 10,273.76
If more space is needed, use additional sheets of paper of the same size.
R�V-1512 E�+;11-12)
� pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCETAXREfURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stella Cussins Urton 21-14-0123
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• The Bridges at Bent Creek monthly nursing care fee 4,800.00
2 Alert Pharmacy 402.87
3 Dental Health of Silver Spring 83.70
4 Bank of America Credit card bill 214.03
5 West Shore EMS 2,002.75
6 Bay Area Credit Service-ambulance charge 413.85
7 2013 PA income tax due 503.00
TOTAL(Aiso enter on Line 10, Recapitulation) $ 8,420.20
If more space is needed,insert additionai sheets of the same size.
REV-1513 EX+(01-10)
��� ��`pennsylvania SCHEDULE ,7
DEPARTMENT OF REVENUE
�� INHERITANCETAXRETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Stella Cussins Urton 21-14-0123
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Da Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec. 9116(a)(1.2).]
1• David Cussins 1867 Oak Dr.,Traverse City,MI 49686 Son 1/3
2 Janice Rose 361 Hickory Rd.,Carlisle,PA 17013 Daughter 1/3
3 Jadean Jones 1371 E.Avenida Ellena,Casa Grande,AZ 85122 Daughter 1/3`'
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 fOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
L
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
L
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
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P.O. BOx 15284
Wilmington, DE 19850 Client service information
I '�) 1.800.MERRILL(1.800.637.7455)
I TDD/TTY users only: 1.800288.4408
ROY&STELLA CUSSiNS 95 TRUST
DAVID E CUSSINS TRTEE il En Espanol: 1.800.688.6086
1867 OAK DR � bankofamerica.com
TRAVERSE CITY,MI 49686-9193
ti Bank of America,N.A.
� P.O. Box 25118
Tampa.FL 33622-5118
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Your Bank of America anking statement summary
for October 17,2013 to November 13, 013
Your deposit accounts AccounUplan number
Ending balance Details on
Interest Checking-Advantage Relationship 0007 0726 0226
55,99739 Page 3
Personal Money Market Savings Money Mar et Savings 0007 0744 2023 S70,780.27 Page 5
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I
REVOCABLE INTER VIVOS TRUST AGREEMENT
The undersigneds, ROY CUSSINS and STELLA CUSSINS, his wife,
sometimes hereinafter referred to as "Settlors") do hereby declare
that they have transferred and delivered to the Trustee hereinafter
named, without consideration, the real and personal property
described in Schedule A attached to this instrument and incor-
porated herein by this reference, subject to the following terms
and conditions:
It is the desire of Husband and Wif�, by this instrumen'�, to
create an inter vivos revocable trust in accordance with the laws
of the State of California whereby they will hold in trust their
community property and their separate property and manage it for
their benef it during their respective lives and provide for their
issue upon the death of the last survivor of Husband and Wife.
Property subject to this instrument is referred to as the
"trust estate" and shall be held, administered and distributed in
accordance with this instrument.
Any community property transferred to the trust shall remain
community property after its transfer. It is the Settlors'
intention that they, as Trustees, shall have no more extensive
power over any community property transferred to the trust estate
than they would have had under California Family Code Sections 1100
an�i 1102 had this trust not been created, and this instrument shall
1
" be so interpreted to achieve this intention. This limitation shall
terminate on the death of either Settlor.
All separate property and quasi-community property, if any, of
either of the Settlors transferred to this trust and the proceeds
thereof shall retain its character as separate property or quasi-
community property, as the case may be, during the joint lifetimes
of the Settlors.
1. NAME OF TRUST.
The trust created in this instrument may be referred to as THE
ROY CUSSINS AND STELLA CUSSINS 1995 TRUST.
� 2. TRUST ESTATE.
The property which is subject to this Agreement (which
property is listed and set forth in Schedule A attached hereto and
incorporated herein by this reference) is and shall be referred to
as the "Trust Estate" and shall be held, administered and distrib-
uted in accordance with the terms of this Agreement.
3 . TRUST INCOME.
During the lifetimes of ROY CUSSINS and STELLA CUSSINS, the
Trustee shall pay to Settlors, or shall apply for their benefit
directly, the entire net income of the trust estate, in quarter
annual or more frequent installments. If the Trustee for any
reason considers the net income insufficient, the Trustee shall pay
to ROY CUSSINS and STELLA CUSSINS, or shall apply directly for
their benefit, as much of the principal of the trust estate as is
necessary in the Trustee�s sole discretion for the proper health,
support, maintenance, comfort and welfare of ROY CUSSINS and STELLA
CUSSINS, in accordance with their accustomed manner of living at
the date of the execution of this instrument and their future
2
Y desires. The Trustee shall exercise in a liberal manner the power
to invade principal contained in this paragraph, and the rights of
the remaindermen in the trust shall be considered of secondary
importance.
4 . DISTRIBUTION UPON DEATH.
Upon the death of the Settlors, the trust estate as then
constituted shall be distributed as follows:
(a) One-third (1/3) thereof to DAVID E. CUSSINS, or if he
fails to survive then in equal shares to JANICE L. ROSE and JADEAN
M. JONES.
� (b) One-third (1/3) thereof to JANICE L. ROSE, or to her then
living issue, by right of representation.
(c) One-third (1/3) thereof to be divided as follows:
(1) Eighty-five (85%) percent thereof to JADEAN M.
JONES, or to her then living issue, by right of representation; and
(2) Fifteen (15�) percent thereof to be divided
equally between JENNIFER A. JORGENSON and JEANNIE M. JONES.
5. REVOCATION.
During the lifetime of ROY CUSSINS and STELLA CUSSINS, this
trust may be revoked in whole or in part, as follows:
By an instrument in writing signed by Settlors and delivered
to Trustee provided, upon such revocation, the Trustee shall
promptly deliver to Settlors all �r the designated portion of the
trust estate. If this instrument is revoked with respect to all or
a major portion of the trust assets, the Trustee shall be entitled
`` to retain sufficient assets reasonably necessary to secure payment
of liabilities lawfully incurred by the Trustee in the administra-
tion of the Trust, including Trustee's fees that may have been
3
earned, unless the Settlors shall indemnify the Trustee against any
such loss or expense.
6. AMENDMENT.
The Settlors may amend at any time during the lifetime of ROY
CUSSINS and STELLA CUSSINS any of the terms of this instrument by
an instrument in writing signed by Settlors and delivered to the
Trustee. No such amendment shall substantially increase the duties
or liabilities of the Trustee or change the Trustee's compensation
without the Trustee's consent, nor shall the Trustee be obligated
to act under any such amendment unless the Trustee accepts it. If
� the Trustee is removed, the Settlors shall pay to the Trustee any
sums due and shall indemnify the Trustee against liability lawfully
_ incurred by the Trustee in the administration of the trust. Upon
the death of the survivor of ROY CUSSINS and STELLA CUSSINS, this
trust may not be amended in whole or in part.
7. POWERS OF THE TRUSTEE.
In order to carry out the provisions of the trust created by
this instrument, the Trustee shall have these powers in addition to
those now or hereafter conferred by law:
A. To invest and reinvest funds in every kind of property,
real, personal, or mixed, and every kind of investment, specifi-
cal.ly including, but not limited to, corporate obligations of every
kind, stocks, preferred or common, shares of investment trusts, •
investment companies, and mutual funds and mortgage participations,
and life insurance policies on the life of any beneficiary that
persons of prudence, discretion and intelligence would acquire for
their own account.
B. To continue to hold any property and to operate at the
risk of the trust estate any business that the Trustee receives or
acquires under the trust as long as the Trustee deems advisable.
C. To have all of the rights, powers and privileges of an
owner with respect to the securities held in trust, including, but
not limited to, the powers to vote, give proxies, and pay assess-
ments; to participate in voting trusts, pooling agreements,
foreclosures, reorganizations, consolidations, mergers, and
4
- - liquidations, and incident to such participation to deposit
securities with and transfer title to any protective or other
committee on such terms as the Trustee may deem advisable; and to
exercise or sell stock subscription or conversion rights.
D. To manage, control, grant options on, sell (for cash or on
deferred payments) , convey, exchange, partition, divide, improve
and to repair trust property.
E. To lease trust property for terms within or beyond the
term of the trust for any purpose, including exploration for and
removal of gas, oil, and other minerals; and to enter into
community oil leases, pooling and unitization agreements.
F. To lend money to any person, including the probate Estate
of ROY CUSSINS or the probate Estate of STELLA CUSSINS.
G. To loan or advance the Trustee's own funds to the trust
for any trust purpose, with interest at current rates; to receive
� security for such loans in the form of a mortgage, pledge, deed of
� trust or other encumbrance of any assets of the trust; to purchase
assets of the trust at their fair market value as determined by an
independent appraisal of those assets; and to sell property to the
trust at a price not in excess of its fair market value as
determined by an independent appraisal.
H. To take any action and to make any election, in the
Trustee's discretion, to minimize the tax liabilities of this trust
and its beneficiaries, and the Trustee shall have the power to
allocate the benef its among the various benef iciaries. and the power
to make adjustments in the rights of any beneficiaries, or between
the income and principal accounts, to compensate for the conse-
guences of any tax election or any investment or administrative
decision that the Trustee believes has had the effect of directly
or indirectly preferring one beneficiary or group of beneficiaries
over others.
I. To borrow money and to encumber trust property by
mortgage, deed of trust, pledge or otherwise.
J. To commence or defend, at the expense of the trust, such
litigation with respect to the trust or any property of the .trust
estate as the Trustee may deem advisable, and to compromise or
otherwise adjust any claims or litigation against or in favor of
the trust.
K. To carry insurance of such kinds and in such amounts as
the Trustee deems advisable, at the expense of the Trust, to
protect the trust estate and the Trustee personally against any
hazard.
- L. To withhold from distribution, in the Trustee's discre-
tion, at the time for distribution of any property in this trust,
without the payment of interest, all or any part of the property,
as long as the Trustee shall determine in the Trustee's sole
discretion that such property may be subject to conflicting claims,
5
to tax deficiencies, or to liabilities, contingent or otherwise,
properly incurred in the administration of the estate.
M. To partition, allot and distribute the trust estate, upon
any division or partial or final distribution of the trust estate,
in undivided interests or in kind, or partly in money or partly in
kind, at valuations determined by the Trustee, and to sell such
property as_ the Trustee may deem necessary to make division or
distribution. In making any division or partial or final distribu-
tion of the trust estate, the Trustee shall be under no obligation
to make a prorata division, or to distribute the same assets to
beneficiaries similarly situated; but, rather, the Trustee may, in
the Trustee�s sole discretion, make a nonprorata division between
beneficiaries, as long as the respective assets allocated have
equivalent or proportionate fair market value.
8. DIVISION OF VARIOUS TRUSTS.
There need be no physical segregation or division of the
� various trusts except as segregation or division may be required by
the termination of any of the trusts.
9. TAXES.
� Except as otherwise specifically provided in this instrument,
or in the Will of ROY CUSSINS or in the Will of STELLA CUSSINS,
federal estate taxes imposed on or by reason of the inclusion of
any portion of the trust estate in the gross taxable estate of ROY
CUSSINS and STELLA CUSSINS under the provisions of any federal tax
law shall be paid by the Trustee and charged to, prorated among, or
recovered from the trust estate or the persons entitled to the
benefits under this Trust Agreement as and to the extent provided
by any applicable tax law or any prorations statutes. Except where
otherwise specifically provided, inheritance taxes shall be paid
and charged to the trust estate or deducted and collected as
provided by law.
10. RE�IISED UNIFORM PRINCIPAL AND INCOME ACT.
Except as otherwise specifically provided in this instrument,
the determination of all matters with respect to what is principal
�
and income of the trust estate and the apportionment and allocation
of receipts and expenses between these accounts shall be governed
by the provisions of the California Revised Uniform Principal and
Income Act from time to time existing. Any such matter not
provided for either in this instrument or in the California Revised
Uniform Principal and Income Act shall be determined by the Trustee
in the Trustee's sole discretion.
11. NOTICE OF EVENTS.
Unless the Trustee shall have received actual written notice
. of the occurrence of an event affecting the beneficial interests of
� this trust, the Trustee shall not be liable to any beneficiary of
� this trust for distribution made as though the event had not
occurred.
12. ADDITIONS TO THE TRUST ESTATE.
Other property acceptable to the Trustee may be added to these
trusts by any person, by the Will or Codicil of ROY CUSSINS or
STELLA CUSSINS by the proceeds of any life insurance, or otherwise.
13 . PERPETUITIES.
Unless sooner terminated in accordance with other provisions
of this instrument, all trusts created under this instrument shall
terminate twenty-one (21) years after the death of the last
survivor of ROY CUSSINS and STELLA CUSSINS and those persons
described in Paragraph 4 hereof. The principal and undistributed
income of a terminated trust shall be distributed to the then
income beneficiaries of that trust in the same proportion that the
beneficiaries are entitled to receive income when the trust
terminates. If at the time of such termination the rights to
income are not f ixed by the terms of the trust, distribution under
�
,
this clause shall be made, by right of representation, to the
persons who are entitled or authorized, in the Trustee's discre-
tion, to receive trust payments.
14. ANTICIPATYON OF TRUST INCOME.
No interest in the principal or income of any trust created
under this instrument shall be anticipated, assigned, encum-
bered, or subjected to creditor's claim or legal process before
actual receipt by the beneficiary.
15. APPLICABLE LAW.
The validity of this trust and the construction of its
beneficial provision shall be governed by the laws of the state of
California in force from time to time. This paragraph shall apply
regardless of any change of residence of Trustee or of any
beneficiary or of ROY CUSSINS and STELLA CUSSINS or the appointment
or substitution of a Trustee residing or doing business in another
state.
16. DEFINITIONS.
As used in this instrument, the term "issue" shall refer to
lawful linear descendants of all de}�rees, and the terms "child"
and "children" and "issue" shall inGlude adopted children who were
minors at the date of adoption.
17. ABANDONMENT OF PROPERTY.
The Trustee is authorized to a}�andon any property or interest
in the property belonging to the itrust when, in the Trustee's
discretion, such abandonment is in �the best interest of the trust
and its beneficiaries.
18 . GENDER AND NUMBER.
As used in this instrument the; masculine, feminine or neuter
8
gender, and the singular or plural number, shall each include the
others whenever the context so indicates.
19. SEVERABILITY.
If any provision in this trust instrument is unenforceable,
the remaining provisions shall nevertheless be carried into effect.
20. DESIGNATION OF TRUSTEE AND SUCCESSOR TRUSTEE.
ROY CUSSINS and STELLA CUSSINS are designated as the Co-
Trustees of this Trust. Upon the death of either ROY CUSSINS or
STELLA CUSSINS or if either shall for any reason fail to qualify or
. cease to act as Trustee, then the survivor of them shall act as
� Trustee. Upon the death of the remaining Trustee or if the
remaining Trustee shall for any reason fail to qualify or cease to
act as Trustee, then DAVID E. CUSSINS shall act as Successor
Trustee in his or her place and stead. If DAVID E. CUSSINS shall
for any reason fail to qualify or cease to act as Trustee, then
JANICE L. ROSE and JADEAN M. JONES shall act as co-Trustees in his
place and stead.
21. POWER OF CO-TRUSTEES.
At all times while two or more persons are acting as Trustee,
any one of such persons, in his or her capacity as Trustee, may,
acting alone, exercise any of the powers granted to the Trustee
herein, including, but not limited to, the power to write checks
upon any bank account held in the name of the trust and the power
to withdraw funds from any bank account held in the name of the
trust.
22 . BOND.
No bond shall be required of any person named in this
instrument as Trustee, or of any person appointed as the Trustee in
9
the manner specified herein, for the faithful performance of his or
her duties as Trustee.
23 . TRUSTEE'S COMPENSATION.
The Trustee shall be entitled to pay himself or herself
reasonable compensation from time to time.
24. PAYMENT OF EXPENSES UPON THE DEATH OF ROY CUSSINS AND
STELLA CUSSINS.
Upon the death of both ROY CUSSINS and STELLA CUSSINS, the
Trustee, in the Trustee's sole discretion, may pay out of the trust
- estate, any debts of the Settlor, any estate or inheritance taxes
� which may be payable by reason of the death of the Settlor,
including interest and penalties, the last illness and funeral
- expenses of Settlor, any related attorney's fees and any other
costs incurred in administering the estate of either ROY CUSSINS or
STELLA CUSSINS.
25. NO CONTEST.
In the event any person (with the exception of ROY CUSSINS and
STELLA CUSSINS) , singly or in conjunction with any other person or
persons, shall contest in any court the validity of this trust or
� the last Wills of ROY CUSSINS or STELLA GUSSINS, or shall seek to
obtain an adjudication in any proceeding in any court that this
trust or any of its provisions, or the Wills of ROY CUSSINS or
STELLA CUSSINS or any of their provisions, are void, or seek
otherwise to void, nullify or set aside this trust or any of its
provisions, then the right of that person to take any interest
given to him or her by this trust shall be determined as it would
have been determined had the person predeceased the execution of
this deciaration of trust. The Trustee is hereby authorized to
1J
defend, at the expense of the trust estate, any contest or other
attack of any nature on this trust or any of its provisions.
The undersigned certify that they have read the foregoing
Revocable Inter Vivos Trust Agreement and that it correctly states
the terms and conditions under which the trust estate is to be
held, managed, and disposed of by the Trustee.
We approve this declaration of trust in all particulars and
agree to be bound by the provisions contained herein.
Dated: June ��, 1995
� SETTLOR: �� �G'� .�-'.J�-r��2 SETTLOR: _�c.�Gl�/�-v �� �>vr�
� `
TRUSTEE: ��, �� �/„Jf'�� TRUSTEE• �L�.r� ����d��i�/
State of California, County of Sonoma:
On this � day of June, 1995, before me, a Notary Public
for the State of California, personally appeared ROY CUS5INS and
STELLA CUSSINS, personally known to me (or proved to me on the
basis of satisfactory evidence) to be the persons whose names are
subscribed to the within instrument, and they acknowledged that
they executed the same in their authorized capacities, and that by
their signatures on the instrument the persons, or the entity upon
behalf of which the persons acted, executed the instrument.
��ZC �-
TIM BIRTVIE Notary Public
U Comm. �1048737 n�
� OTARY PUBLlC-�ALIFpRNIA�
so�o�couHn n
Comm.E�q�ins J�n.2.1� �+
ii
SCHEDULE "A"
1. Real property commonly known as 1041 McFarlane Avenue,
Sebastopol, California, and more particularly described in Exhibit
"A" attached hereto and made a part hereof. A. P. No. 004-660-005
2. Real property located in the County of Sonoma, State of
California, and more particularly described in Exhibit "B" attached
hereto and made a part hereof. A. P. No. 060-170-026
3. That certain promissory note dated May 16, 1991, in the
principal amount of $62, 000. 00, executed in favor of Settlors by
Rick Granada and Melonda Granada. Said note is secured by Deed of
Trust recorded June 10, 1991, as Instrument No. 91-109562, Contra
Costa County Records. The real property affected by said deed of
� trust is described as follows:
Lot 8, Map of Tract No. 1018, filed March 25,
1954 , Map Book 53 , page 32, Contra Costa
County Records.
A. P. No. 413-071-010
4. American Savings, Cleveland Avenue Branch, Santa Rosa,
California, account numbers: 21426218, 233500, 565209-3, 232501-6,
145502-7.
5. Smith Barney, account number 55110588-19 106
6. Edward D. Jones & Company, account number 86401376-1-1
12
EXHIBIT "A"
Real property located �n the County of Sonoma, State of California,
and more particularly described as follows:
Commencing at the Northwest corner of Lot 5, as same is
shown on the map hereinafter referred to; thence South
89° 58' East along the Northern line of said Lot, a
distance of 130 feet to a point; thence South 352.7 feet
to a point on the southern boundary of said Lot 5; thence
along said boundary, South 78° 22' West, 132.2 feet to
the southwest corner of said Lot to a point in the center
of a 40 foot County Road; thence North 0° 05� West, a}.ong
the center of the said road, 370 feet to the point of
� commencement, being the Westerly portion of Lot 5, as
same is shown on that certain Map of Fir Crest, in
� Sections 1 and 2, Township 6 North, Range 9 West, M.D.M. ,
Sonoma County, California, filed in the office of the
County Recorder of Sonoma County, California on April 6,
1910 in Book 24 of Maps, page 6, Sonoma County Records.
-- Said lot being also designated as Lot 13, on the Record
of Survey Scudder Subdivision, made by Walter F. Adams,
C. E. on f i le in the of f ice of the County Recorder of
Sonoma County, in Book 51 of Maps, page 5, Sonoma County
Records.
EXCEPTING THEREFROM that portion thereof conveyed by Deed
from C. L. Tebow, et ux, to Hubert B. Scudder, et ux,
dated August 28, 1943 and recorded September 1, 1943 in
Book 585 of Offic�.al Records, page 254, Recorder's Serial
No. B-65202 , Sonqma County Reco�ds.
EXCEPTING THEREFROM Lot 2 as shown on City of Sebastopol
Parcel Map No. 123 recorded in Book 2587 of Official
Records, page 248, Sonoma County Records.
A. P. No. 060-170-026
= EXEIZBI i ''R"
PARC�L ONE;
Lot S, as nwnber�ci and desi�ated upon the recorded ma of Woodl
Subdivision, filed July 9� lgg� P �nd Estates
��� C�.� ��o�s. , in Book 400 of Maps, pages 24, 25, 26 and 27,
���ING THaZEFKOM, with the right to convey to others,• a 10.00 foot private
storm drain eaSement aPPur���t to Lots 1, 2 and 3,4;together with the right
to repair, repJ�Ce � ��tain the facilities within such easement, as
shown upon the recorded maP of W�l� �tates Subdivision, filed in the
office of the County Recorder on July 9, 1987, in Book 400 of Maps, pages 24,
25, 26 and 27, Sonom� County records.
PARCEL TS+�:
__
A NON-EXCLUSIVE 10.00 foot private storm drain easer�nt ove�,, I�ts 4,5,6,7 and
8,9,as shown upon the recorcied map of y,loodland Estates Subdivision, filed in
the office of the County Recorder on July 9, 1987, in Book 400 of Maps, pages
�"-�_25 t 26 arKl 2 7. Sonorr►a Countrv Records.
����CT T0: Convenants. conditions anci restrictions as recorded in an instrlunent
�t �entemi�r 3, I987, docwrn,nt #87-083106.
. �
� �
�
�
RESTATEMENT OF
THE ROY CUSSINS AND STELLA CUSSINS 1995 TRUST
I, STELLA CUSSINS URTON, declare:
1 . I am the Surviving Settlor of THE ROY CUSSINS AND
STELLA CUSSINS 1995 TRUST created by ROY CUSSINS and me on June
19, 1995 .
2 . The original trust agreement has been lost.
3. A copy of said trust is attached hereto and made a
part hereof. By execution of this document, I restate and
renew THE ROY CUSSINS AND STELLA CUSSINS 1995 TRUST.
Dated: !�1�-;-` l-i t;; , 2008
r� '�. .
��_�-'�1��� �,�i_!�:i'..�.���� �''���
i'v� �7"'��
�'� 'STELLA CUSSINS URTON
State of California, County of Sonoma:
. �.�
On this ;. day of ,j'�`�L��� ;;� , 2008, before me, TIM
BIRNIE, Notary Public, personally appeared STELLA CUSSINS URTC�N,
who proved to me on the basis of satisfactory evidence to be the
person (.� s whose name (s) is/a�e- subscribed to the within
instrument, and acknowledged to me that t�/she/�-ey executed the
same in l�is-/her/-�-�ir authorized capacity(�-e�s) , and that by
1�-s/her/t�reir signature (�s-) on the instrument the person (s) , or
the entity upon behalf of which the person (s-� acted, executed the
instrument.
I declare under PENALTY OF PERJURY under the laws of the
State of California that the foregoing paragraph is true and
correct .
WITNESS my hand and official seal .
TIM BIRNIE - ��, ;� ' ' ' , , ''
� '- , COMM.#1766327 � Notary Public '
� No�uwv�euc•c.�o�nua (�
� sonio�u coun,N �
Mr�n►�pres sa�.e,20»
� �
�
�
FIRST AMENDMENT TO �
THE ROY CUSSINS AND STELLA CUSSINS 1995 TRUST
Dated June 19, 1995
I, STELLA CUSSINS URTON, Surviving Settlor and the Trustee
of said trust, declare this to be the First Amendment to THE ROY
CUSSINS AND STELLA CUSSINS 1995 TRUST dated June 19, 1995.
FIRST: I revoke Paragraph 4 . DISTRIBUTION UPON DEATH, as it
appears in the Trust Agreement dated June 19, 1995, and
substitute the following:
4 . DISTRIBUTION UPON DEATH.
Upon the death of STELLA CUSSINS, the trust estate as
then constituted shall be distributed as follows :
,._
(a) LUTHER URTON shall have the right to reside in the
home at 1041 McFarlane Avenue, Sebastopol, California, for
as long as he desires. During the period of this residency,
he shall be responsible for payment of all insurance, taxes,
maintenance and upkeep on the home. This right shall
terminate if he is out of the home for a period of thirty
(30) days .
(b) One-third (1/3) of the residue of the trust estate
shall be distributed to DAVID E. CUSSINS, or if he fails to
survive Settlor, then in equal shares to JANICE L. ROSE and
JADEAN M. JONES.
1
(c) One-third (1/3) of the residue of the trust estate
�
shall be distributed to JANICE L. ROSE, or to her then
living issue, by right of representation.
(d) One-third (1/3) of the residue of the trust estate
shall be distributed to JADEAN M. JONES, or to her then
living issue, by right of representation.
SECOND: I hereby add the following as Paragraph 26 of the
Trust Agreement dated June 19, 1995:
6. EXERCISE OF SETTLOR' S RIGHTS AND POWERS BY OTHERS .
Any right or power that Settlor could exercise
personally under terms of this instrument, except the power
to amend, revoke, or terminate any trust created by this
instrument, may be exercised for and on behalf of the
Settlor by any attorney in fact who, at the time of the
�
exercise, is duly appointed and acting for the Settlor under
a valid and enforceable durable power of attorney executed
by the Settlor under the Uniform Durable Power of Attorney
Act, or any successor statute, or, if there is no such
attorney in fact, by a duly appointed and acting conservator
of the Settlor, after petition to the court in accordance
with California Probate Code Section 2580, or any successor
statute. The power to amend, revoke, or terminate any trust
created by this instrument is personal to the Settlor and
may not be exercised by any other person or entity.
THIRD: In all other respects I confirm and republish THE
2
ROY CUSSINS AND STELLA CUSSINS 1995 TRUST dated June 19, 1995.
FOURTH: I approve this First Amendment to THE ROY CUSSINS
AND STELLA CUSSINS 1995 TRUST and agree to be bound by the
provisions contained herein.
Dated: � � `:, 2008
�
��� �l
l-a���r/{�(/�/��'��ir--�/��J�/
STELLA CUSSINS URTON, Settlor '
-/J G�l--�-��` C�i' .. ,.�
STELLA CUSSINS UR ON, Trustee /� /
State of California, County of Sonoma:
On this da of �" �� r �
BIRNIE, Notary ublicy perso�a' 2008, before me, TIM
� who proved to me on the basis ofysatpsfact�oryEevAdenceIto beT�he
person (s-) whose name (-s) is/a-�-e- subscribed to the within
instrument, and acknowledged to me that •#e/she/�-�ey executed the
same in �/her/t-�i-e-rr authorized capacity (�.�) , and that by
�rs/her/t-�e�r signature (s-) on the instrument the person (�) , or
the entity upon behalf of which the person (s-) acted, executed the
instrument.
I certify UNDER PENALTY OF PERJURY under the laws of the
State of California that the foregoing paragraph is true and
correct.
WITNESS my hand and official seal.
:�t,ti�l�-: (.Y yi� L �
r t�
1�M BIRNIE Notary Public
v m �-=��:=-,:. co��w�. #i��2� �
� �'"_:'�•�"� NQTArvr-�
Yr. ��%-CALI�q (�
�..' �ONOlWt C;�tlN1y �a
�t�`Amr".�;re.s sear.a zo�,
�-
3
RESIGNATION OF TRUSTE�
� STELLA CUSSINS IJ�TON,Trustee of THE ROY CUSSINS AND STELLA
�tJSSINS 1995 TRUST dated June 19, 1995,hereby resign as such Trustee and appoint DAVID
E. CUSSIONS as Successor Trustee in my place and stead.
�
Dated: �� L , 2013
,��fG��� r,:�
�
�STELLA CUSSINS URTON '
I,DAVID E. CUSSINS, hereby accept the above appointrnent and agree to act as
Successor Trustee.
Dated. �!I Z 2013
���.��� ---�
DAVID E. CUSSINS
State of California, County of Sonoma:
On tlus Z� day o 2013,before me, TATE BIRNIE, Notary Public,
personally appeared STELLA CUSS URTON and DAVID E. CUSSINS,who proved to me
on the basis of satisfactory evidence to e the person(s) whose name(s) ' �r'e subscribed to the
within instrument, and aclarowledged to me that h�executed the same in his�er�h'�
authorized ca aci ies and that by l�s+� eir i atur s on the instrument the person(s)or
P �� ), � � � )
the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTy OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
1'ATE BIRNIE
� COMM.#1843403 n
v e,ornRr��c-cnuFOtt��a, �
Notazy Public Z �rr���zo�a ''
THE AMENDED AND RESTATED ROY CUSSINS
AND STELLA CUSSINS 1995 TRUST
This amended and restated trust agreement(Agreement)dated this I S��day of August
2013 by and between STELLA CUSSINS URTON(SETTLOR) and Successor Trustee
DAVID E. CUSSINS (Trustee)amends and restates that certain Trust Agreement dated
June 19, 1995, which Trust Agreement was restated and amended in 2008 and for which
Trustee DAVID E. CUSSINS became Successor Trustee for STELLA CUSSINS
URTON in 2013.
WHEREAS, ROY CUSSINS , now deceased,having died on January 25, 2005 and
Settlor entered into the Original Trust Agreement dated June 19, 1995 wherein they were
named as Settlors and Trustees thereunder;
WHEREAS,the original Trust(1995)was restated in its entirety in 2008;
WHEREAS,there was a First Amendment made to the original Trust executed on March
6, 2008;
WHEREAS, STELLA CUSSINS URTON, Trustee of the ROY CUSSINS and STELLA
CUSSINS Trust dated June 19, 1995 resigned as Trustee and DAVID E. CUSSINS was
appointed as Successor Trustee on January 21, 2013;
WHEREAS,Article 6 of the Original Trust Agreement provides that the Settlors reserve
the right to amend any of the terms of this instrument by delivering a written statement to
the Trustee;
WHEREAS,the Settlor hereunder desires to amend certain provisions and restate certain
provisions of the Original Trust Agreement and the Trustee is agreeable to the
amendments contained herein; and
WHEREAS, unless otherwise amended herein the Original Trust Agreement,the 2008
Restatement, the 2008 Amendment and the 2013 resignation of STELLA CUSSINS
URTON and the appointment of DAVID E. CUSSINS sha11 be incorporated by reference
herein as if they were fully restated below.
NOW,THEREFORE, intending to be legally bound, the Original Trust Agreement, the
Restated Originai Trust Agreement, the Amended Trust Agreement and the appointment
of Successor Trustee documents are amended and restated as follows:
Article 1 Restated in its entirety
Article 2 Restated in its entirety
Article 3 Restated in its entirety
Article 4 Restated as provided in First Amendment to ROY CUSSINS and STELLA
CUSSINS 1995 Trust(Amendment dated March 6, 2008)
Article 5 Restated in its entirety
Article 6 Restated as provided in First Amendment to ROY CUSSINS and STELLA
CUSSINS 1995 Trust(Amendment dated March 6, 2008)
Article 7 Restated in its entirety
Article 8 Resta.ted in its entirety
Article 9 Restated in its entirety
Article 10 Amended to read: "Any such matter not provided for in this instrument or in
applicable state laws relating to a11 matters with respect to what is principal and income
of the trust esta.te and the apportionment and allocation or receipts and expenses between
these accounts shall be determined by the Trustee in the Trustee's sole discretion."
Article 11 Restated in its entirety
Article 12 Restated in its entirety
Article 13 Restated in its entirety
Article 14 Restated in its entirety
Article 15 Amended to read: "This Trust agreement shall be administered and
interpreted in accordance with the laws of the Commonwealth of Pennsylvania. This
Agreement may be executed in any number of counterparts and by electronic means.
Article 16 Restated in its entirety
Article 17 Restated in its entirety
Article 18 Resta.ted in its entirety
Article 19 Restated in its entirety
Article 20 DAVID E. CUSSINS is designated as Trustee of this Trust. JANICE L.
ROSE and JADEAN M. JONES are designated as successor co-Trustees if DAVID E.
CUSSIlVS is unable or unwilling to act as Trustee
Article 21 Restated in its entirety
Article 22 Restated in its entirety
Article 23 Restated in its entirety
Article 24 Resta.ted in its entirety
Article 25 Resta.ted in its entirety
IN WITNESS WHEREOF,the Settlor and Trustee have hereunto set their hands and
seals the day and year first written above on this Amended and Restated ROY CUSSINS
and STELLA CUSSINS 1995 TRUST.
Witne � ` �C-
tella Cussins Urton, Settlor r
Sworn to and subscribed to before me by Stella Cussins Urton COMMONifVtAL7H UF PENNSYLVANIA
Notarlal Seal
� qmberl�r R Leo,Ndary Publk
Nota,�'Public �N�B0�°,�ara�°„�N
---,� ~~�' My Commisslon 6cW�Od.1�,2�13
�_-----._
GIn.V..�.�. �...s��
rtne s David E. Cussins Trustee
Sworn to and subscribed to before me by David E. Cussins
�� v�-�' Notary Public �MMONWEALTH OF PENNSYLVANIA
Notanal Sea�
10mbe�iy R.Leo,Notary Publk
Caiilsle Boro,Cumberland County
r'N�m�On E�ires Oct 10,2013
The beneficiaries named hereafter have joined in this Amended and Restated Agreement
for th urpose o�ac�}s� � and consenting to the amendments listed above.
.
.�-�-���
rtnes avid E. Cussins
,,,�_
�
Witnes L. Rose
Witness Jadean M. Jones