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HomeMy WebLinkAbout02-0786IN THE COURT OF COMMON PLEAS c - CUMBERLAND COUNTY, PENNSYLVANIA IN THE MATTER OF ORPHANS' COURT DIVISION Blanche R. Eckert , An Alleged Incapacitated Person No. 071 - ~eZ -- 1 g~p PETITION FOR ADTUDICATION OF INCAPACITY AND APPOINTMENT OF AN EMERGENCY GUARDIAN AND NOW, COMES, Messiah Home, d/b/a Messiah Village ("Messiah Village'), by and through its attorneys, Latsha Davis & Yohe, P.C., and hereby petitions for adjudication of incapacity and appointment of an emergency guardian of the estate and person of Blanche R. Eckert and, in support thereof, represents: 1. The name of the alleged incapacitated person is Blanche R. Eckert. 2. Blanche R. Eckert is 95 years of age and currently resides at Messiah Village, 100 Mt. Allen Drive, Mechanicsburg, Pennsylvania 17055. 3. Petitioner, Messiah Village, a Pennsylvania non-profit corporation, is a residential and long-term skilled nursing care provider, with offices located at 100 Mt. Allen Drive, Mechanicsburg, Pennsylvania 17055. 4. Upon information and belief, Blanche R. Eckert has no adult heirs. 5. Because of Blanche R. Eckert's complete incapacitation and inability to handle her personal and financial affairs, an emergency guardian of her estate and person is sought. (Blanche R. Eckert suffers from severe Alzheimer's disease.) 6. On or about August 16, 2002, Mellon Bank conveyed that it is no longer willing to act as Blanche R. Eckert's attorney-in-fact. 7. At present, Blanche R. Eckert does not have an agent or guardian to consent to or reject the treatment and/or care being rendered to her by Messiah Village. 8. Blanche R. Eckert is in need of emergency medical treatment for aspiration pneumonia. Holy Spirit Hospital has refused to render said treatment to Blanche R. Eckert without authorization from an agent or guardian. 9. Messiah Village has been in contact with Shaun E. O'Toole, Esq., d/b/a Amaryco Guardianship Services, a Pennsylvania sole proprietorship, located at 2813 North Second Street, Harrisburg, Pennsylvania 17110, and he is willing to act as guardian of Blanche R. Eckert's estate and person for an initial fee of Four Hundred Dollars ($400.00) and, thereafter, a monthly fee of One Hundred Dollars ($100.00). 10. Shaun E. O'Toole, Esq., d/b/a Amaryco Guardianship Services, is qualified to act as guardian over the estate and person of Blanche R. Eckert by virtue of his familiarity and experience in acting as guardian for individuals with diminished capacities such as Blanche R. Eckert. 11. Shaun E. O'Toole, Esq., d/b/a Amaryco Guardianship Services, has no interests which are adverse to Blanche R. Eckert's. 12. No advanced directives, wills or powers-of-attorney have been found appointing a guardian for Blanche R. Eckert. 13. Upon information and belief, Blanche R. Eckert was neither a member of the armed forces, nor a recipient of Veterans Administration benefits. 14. No other Court within this Commonwealth, of which Messiah Village has knowledge, has appointed a guardian for Blanche R. Eckert. ~~ozo.i 2 WHEREFORE, Petitioner, Messiah Home, d/b/a Messiah Village, prays that Blanche R. Eckert, be ordered to show cause, if any there be, why Blanche R. Eckert should not be declared an incapacitated person and Shaun E. O'Toole, Esq., d/b/a Amaryco Guardianship Services, appointed emergency guardian of her estate and person. Dated: OZ Respectfully submitted, LATSHA DAMS & YOHE, P.C. <-- Chadwick O. Bogar Attorney I. D. No. 83755 P. O. Box 825 Harrisburg, PA 17108-0825 (717) 761-1880 Attorneys for Petitioner, Messiah Home, d/b/a Messiah Village ~~ozo.i 09%29I2U~f2 18:Stl FA1 )177U122tlB L9ti1f8,U8V1s14Y6G8 CONSENT OF t7[20POS&n G,U,#~tD~ @JUU7%UU7 Shaun E, O'Toole, Esq., d/b/a Amaryco Guardianship Services, does hereby certify that he ig willing to act as emergency guardian ok the estate and person of Blanche R. Eckert, an alleged incapacitated person, if the Court shall so appoint. Purther, Shawn E. O'Toole, Esq., d/b/a Amaryco Guardianship Services, hereby cextifie9 that he is not a fiduciary of any estate in which Blanche R. &ckert has an interest, nor has Shaun E. p"1•oole, Fsq., d/b/a ,q~~,eo Guardianship Services, any interest currently adverse to the alleged inuapacitated person's Dated: OS 2~( 0 2 ~. c4 ~ \ ~~ Shaun S. O'Toole, Esq, Amaryco Guazdianship Services L00'd d80 ~t0 Z0/6Z/80 ZLZO-SiZ(LLL) aiooyp une4S messiah village 7177959566 08/30/02 08:00A P.0('l6 , 08/29/2002 16:07 FAX 7177812288 Latsha,Davle&Yohe @J008 vEiur~cArroly The undersigned hereby verifies that the statements of £act in the foregoing document aze true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in 18 Pa. C. S. § 4904, relating to unsworn falsification to authorities. Dated: b'"I ~~/~~- hn D. inley, Vice President of Resources and CFO, Messiah Home, d/b/a Messiah Village RECEIPT FOR PAYMENT Cumberland County - Orphans Court Hanover and High Street Carlisle, PA 17013 ECKERT BLANCHE R File Number 2002-00786 Remarks LATSHA ET AL DO -------------------- Distribution Of Re Transaction Description Payment Amount PETITION EMG GRDN 15.00 CITATION 10.00 JCP FEE 5.00 Check# 10353 Total Received......... Receipt Date 8/30/2002 Receipt Time 10:43:57 Receipt No. 1020062 ceiPt ------------------------ Payee Name CUMBERLAND COUNTY GENERAL FUN BUREAU OFDRE~EIPTSG&NCNTR M D 30.00 30.00 u8/30/02 10:07 FA% 717 779 4232 Internists Central PA _ -__.. PJ002 me~~l aF+, vi lingo 7177956686 08/90/02 10a 44f1 P.002 IN THE COURT OF COMMON FLEAS CUMBERLAND COUNTY, PENNSYLVANIA THE GUARDIANSHIP OF BLANCHE R. ECKEI2T AFFIDAVIT I, Peter M. Brier, M.D., being duly sworn according to law, depose and say: I am a physician duly trained and specializing in gerontology. 2. I am Board Certified by the American Medical Association and am licensed by the Commonwealth of Pennsylvania. 3. I am currently in private practice as a physician with Internists of Central Pa. Ltd., 108 Lowther Street Lemoyne, Pennsylvania 17043. 4. I have become familiar with Blanche R Eckert in my capacity as an attending physician at Messiah Village. 5. I personally examined Blanche R. Eckert on August 29, 2002. Staff members of Internists of Central Pa. Ltd., also Pxa,,,l„ed Blanche R. Eckert on August 23, 2002 and July 15, 2002 Those exams were thoroughly discussed with me. 6. During my examinations, I found Blanche R. Eckert to be suffering from severe Alzheimer's disease. 7. It is my opinion, within a reasonable degree of medical certainty, that Blanche R. Eckert does not have the capacity to make rational decisions, including those regarding simple activities of daily Iiving, such as dressing and eatntg, or whether to consent or reject medical treatment. 8. It is my opinion, within a reasonable degree of medical certainty, that Blanche R Eckert does not have the capacity to live independently, nor will she be capab]e of living independently in the future. 9. It is my opinion, within a reasonable degree of medical certainty, that Blanche R. Eckert requires nursing home care. 10. It is my opinion, within a reasonable degree of medical certainty, that Blanche R. ]Ekert does not have the capacity to manage her own financial affairs, nor will she in the future. EXHIBIT ~Ie~i n~ 1 a-3o `o- mass i ~h .~ i l j a~ __ ._ Internists Central PA fifi 003 7177966666 08/30/02 10i 44A P.003 Y1. It is my opinion, within a reasonable degree of medical certainty, that $lanctle R. Eckert does not have the capacity to manage her own medical affairs. 12. It is my opinion, within a reasonable degree of medical certainty, that Blanche R. Eckert requires, for her own well being, a legal guardian to manage her personal and financial affairs. 13. It is my opinion, within a reasonable degree of medical certainty that Blanche R. Eckert is an incapacitated person as defined at 20 Pa. C.S.A. § 5501. 14. It is my opinion, within a reasonable degree of medical certainty, that Blanche R. Eckert's mental condition will be harmed by her attendance at a guardianship hearing. 15. The facts set forth in this Affidavit are true and correct to the best of my personal knowledge. Daked: ~ ~ a0~ v'r- Sworn to nd Subscribed before me this _ day of August, 2002. ~~M~ ~ Peter M. Brier, M.D. 7!030.1 Jennifer R. F~eeland Notary public Upper Allen Twp., Cumberland County My Commission Expires Dec. 13, 2004 Member, Pennsvroania Assodation of Nofanes IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN THE MATTER OF Blanche R. Eckert An Alleged Incapacitated Person ORPHANS' COURT DIVISION No. mil- ~a_~g~ ORDER AND NOW, this _3~ day of ~`'~ 2002, upon consideration of Messiah Village's Petition for Adjudication of Incapacity and Appointment of an Emergency Guardian, it is hereby ORDERED and DECREED that said motion is GRANTED, and Shaun E. O'Toole, Esq., d/b/a Amaryco Guardianship Services, is appointed emergency guardian for Blanche R. Eckert for the~sevent~ n `,"'^^ two (72) hours, which period of time 173a}-17e extended twenty (20) days upon the filingMf tyr ~uw~ .,.- S.t~G.'-(rec. y~ ivu a ~".~'x/ of a petition for plenary guardianship, and is granted all powers necessary to insure Blanche R. Eckert's continued health and financial well being. G _L~ J~ i IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF BLANCHE R. ECKERT, an CUMBERLAND COUNTY, PENNSYLVANIA alleged incapacitated person ORPHANS' COURT DIVISION 21-02-786 IN RE: APPOINTMENT OF COUNSEL ORDER OF COURT AND NOW, this 30th day of August, 2002, Mark F. Bayley, Esquire, is appointed to represent Blanche R. Eckert, the alleged incapacitated person. By the Court, Edward E. Guido, J. Chadwick O. Bogar, Esquire For the Petitioner Mark F. Bayley, Esquire Court-appointed for Blanche R. Eckert Court Administrator srs AUTHORITY TO PAY COURT APPOINTED COUNSEL t. cougr ^ District Justice ."Common Pleas ^ Appellate ^ Other 3 FOR (DJ ~ APPELLATE) 4. AT (CITY/STATE) 6. IN THE CASE OF r,~ 2rz ~ 1310. ~,4~ R. F ~l.~e~ ~- 9. PROCEEDINGS (Describe hriefly) Gue~~-~~c.,>,s~~(~ PERSON REPRESENTED (Full Name) (~ I ~~j7~~~.. T27. ~~ 1,~~-~ Appt Dale - ~~._ V V 11. PERSON REPRESENTED I ^ Delendent~Adult 2 ^ Oelandant~JUVenile J ^ Appellant ^ Appellee 6 ^ Habeas Petitioner 6 ^ Material Witness 7 ^ Parolee Charged Wiln Violation B ^ Prpbalianar Charged With Violation 9 5$ Olnec /-~llo ED, .T-h''CC D ~2a • ~-le J Cey~,ue~t"~ ~r ~vlcl0 NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE s. a. Arraignment and/or Plea b. Prebminery Neanng a Motlona and gepuesta 2 d. Bed Hearinga O, n. Sentence Hearinga O 2 I. Trial Juvenile Meerinps AppBela DOUrt Other (Specity on atltlitlonal [O. a Interviews end conferences LL 0. Obtaining and reviewing records O ¢ H 7 a Legal reaeamh and brief writing ~ O d. Investigative and Amer work (Sped Cr~f l.s le ~./T 7. CHARGE/OFFENSE (PURDON CITATIONI M TOTAL HOURS:. TOTAL HOURS = 1,C~ Multiply rate par noun times total hour! to obtain "In Court" com- pensation. Enter total below. 19A TOTAL IN COURT COMP. i '~~ _ $ _ PERHOUR Multiply rate par hour times total hours. Enter total "Out of Court" compensation below. e.A~ 20A TOTAL OUT OF COURT COMP. On I l~ ~~ HOUR ° 3 7 w S O 210. TOTAL ITEMt2.ED EXP. =s ~ 22. CERTIFICATION OF ATTORNEY/PAYEE Has compensation and/or reimbursement for work In this case prsvlousty been epPlletl fpY! L~ 23. GRAND TOTAL CLAIMED ll yes. ware you paid? ^ YES OYES y N0 n:t //~ O© Has the person represented Oaid a~nyNmonef y to you Orl O ourrekn ~1~ How mucn7 '] Y dge anyone alas, in connection wiN the matter for 24. DEDUCT. PRIOR PYMTS. which you ware appointed t0 plOVide IBprBlBntatlon7 D m S J6(NO If ye0. give details On eddi ionel sheet! 1 swear or aflirm Ne truth or correanasa _ of the above statements Signature of Atto eye t ~-~Z 26.NET AMOUNT CLAIMED 28 n"cnovl o Date : s i JS - Q Q run Signature of Y ruvulnr Judge ~ 27. AMT. APPROYiD -Dats: a f • ~/~ Copy 1 -Mail to Court Administrator at completion of se ice arc u s zaaz ~~ 2. VOUCHER _ _ N` 6937 S.~B{UDGET CODE 8. ^ PETTY OFFENSE ^ FELONY^MISDEMEANOR 12`EFyft-pOCKET NO. o~ pl.laHs ZI-OZ-~~~ 13. CRIMINAL DOCKET NO. 14. APPEALS DOCKET NO. 18. NAME OF ATTORNEY/PAYEE AND MAILING ADDRESS I~s S~ l~Cc~tO/a?d S'+' ,~ 17. TELEPHONE NO. to soaA~secualrr rvo oa erv rvo z~-1 I X070 -Z-~- ~4 3 z F,ki 20(d) 8-30-02 Initial scheduling 8-30-02 Phone w/ Bogar, Esq. 8-30-02 Review order 9-3-02 Phone w/ Bogar, Esq. 9-4-02 Review order 11-27-02 Miscel. & filing Total: 2 1.0 hrs COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOI VIDUAL TA%E8 DEPT. 280601 HARRISBURG, PA 1 ]128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002609 MELLON BANK ATTN: TRUST DEPT. 1735 MARKET STREET POB 7899 PHILADELPHIA, PA 19101-7899 -- ----- lald ESTATE INFORMATION: ssrv: iao-io-ssao FILE NUMBER: 2102-0786 DECEDENT NAME: ECKERT BLANCHE R DATE OF PAYMENT: 05/27/2003 POSTMARK DATE: 05/21 /2003 couNrY: CUMBERLAND DATE OF DEATH: 08/31/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 5437.09 REV-1162 EX111-961 TOTAL AMOUNT PAID: REMARKS: OLGA JAKUBOWSKA C/O MELLON BANK NA CHECK#10511281 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $437.09 DONNA M. OTTO DEPUTY REGISTER OF WILLS -~ - L•~:'J L'1~1! ~ i f ~.s. a ~ > ,. ~~ ~. ~ L ~ PHILgDELPHIq,G F `f ~~~ ~~! r t]CIO~_ I1:3~J 16 ~ Ems.,. ~sioz ros>a- MRY 21. ' 03 '. I HMOUN7 „(~ ~h pp `a r I ~-~' ocoo J1~,Ot? ~? N~a r ,~ '~~ ~ ~.~ coa3-~cs~-o3 - .. ' rst Class Mail a`~ y (1 vs s __ i~~~ I ~I'iil ~ Ali: l-~y~-~ ~' BUREAU OF INDIVIDUAL TAXES INNERITpNCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE iAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF iAX 1: - OLGA JAKUBOWSKA MELLON BANK NA PO BOX 7899 PHILA CUT ALONG THIS LINE REV-1547 EX AFP (01-03] NOT DISA ESTATE OF ECKERT 03 JUi -~ L PA 1910j;[ RETAIN FOR YOUR RECORDS ~ DATE 07-07-2003 ESTATE OF ECKERT BLANCHE R DATE OF DEATH 08-31-2002 FILE NUMBER 21 02-0786 ~' n ; ~O~UNTY CUMBERLAND ACN 101 Anount Rawitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 LLUWANCE OF DEDUCTIONS AND ASS BLANCHE R FILE NO. 21 02-0786 iAX RETURN HAS: (X) ACCEPTED AS FILED AisED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate [Schedule A) 2. Stocks and Bonds Behedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule 6) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) [9) 4,452 .52 10. Debts/Mortgage Liabilities/Liens (Schedule I7 (10) 6.823 99 11. Total Deductions 12. Net Value of Tax Return (11) )1. 76 S1 13. Charitable/Governmental Bequests) Non-alected 9113 crus ts (Schedule J) u2) ( 3,642.45 00 14. Nst Value of Estate Sub3ect to iax 13) . (14) 3,642.45 NOTE: if an assessment was issued previously, lines reflect figures that incl d 14, 15 andior 16, 17, 18 and 19 will u e the total of ASSESSMENT OF TAX: ALL returns assessed to date. 15. Anount of Lina 14 at SDOUSal rate (15] .00 X 00 _ 00 16. Anount of Lina 14 taxable at Lineal/Class A rate (16) .00 045 . 17. Anount of Line 14 at Sibling rate [17) 3,642 45 X . 12 .00 18. Anount of Line 14 ta bl t . X - 437.09 xa e a Collateral/Class B rate (18) .00 15 19. Principal Tax Due X - - .DO TAX C~EDI~ [19)= 437.09 AMOUNT PAID TOTAL TAX CREDIT 437.09 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAyMENi IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A ••CREDIT•• (CR), y0U MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS.) C,~MENT OF TAX ACN 101 [ )CHANGED REY-156) EN RFP (RI-pS( TE 07-07-2003 (1) .00 NOTE: To insure proper f2) .00 credit to your account, (3) .00 submit the upper portion [4) .00 of this form with your (5) 14.918.96 tax payment. [b) ~00 [71 . DO (B) 14,918.96 ~'0' . REV-1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 DEPARTMENT OF REVENUE DEPT.2B0601 INHERITANCE TAX RETURN FILE NUMBER nQ, f7C6& HARRISBURG, PA 17128-0601 RESIDENT DECEDENT ~! . COUNi'f CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Eckert Blanche R 180-10-6950 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FilED IN DUPLICATE DENT 08/31/2002 04/12/1907 WITH THE REGISTER OFWlllS (IF APPLICABLE) SURVIVING SPOUSE'S NAM<' (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER - - 3. Remainder Retum CHECK ~ 1. Original Return ~' Supplemental Return B (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) PRIA TE 6. ~eoent Died Testate 7. Decadent Maintained a living Tn.Jsl 0 B. Total Number of Safe Deposit Boxes (Atlach copy ot Will) (Attach a copy 01 Trust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between 0 11. Election to lax under Sec. 9113(A) 12:-31.91 and 1-1-95) (AttachSch 0) tHIS~j9NMQ$tijeePMP12$'t$};)\t~eb-Rtl.E~~~eQNl"!PENTlNi;fAXjNffQl'lMi!tlQijli$!l6Q!,Qr$$QIR$t.t~\irQ( NAME COMPLETE MAILING ADDRESS COR- Olga Jakubowska 1735 Market St, P_O.Box 7899 RE- FIRM NAME (If Applicable) Philadelphia, PA 19101-7899 SPON DENT Mellon Bank, N.A. , Trustee TELEPHONE NUMBER 215-553-2526 - - c t;:i OF~~SE ONLY 1. Real Eslate (Schedule A) (1) '6,..;60 2. Stocks and Bonds (Schedule B) (2) 0.00 ::; 0.. 3. Closely Held Corporation, Partnel'Ship or Sole-Proprietorship (3) 0.00 =< ~~ 4. Mortgages & Notes Receivable (Schedule D) (4) 0.00 1'-.> -..l 5. Cash, Bank Deposits & Miscellaneous Personal - Property (Schedule E) (5) 14,918.96 ~ -" 6. Jointly Owned Property (Schedule F) t,:.l .':) 0 - Separate Billing Requested (6) 0.00 '.0 RECA- PITULA- 7. InterNivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or l) (7) 0.00 B. Total Gross Assets (total Lines 1-7) (8) 14,918.96 9. Funeral Expenses & Administrative Costs {SchedulaHI (9) 4,452.52 10. Debts of Decedent, Mortgage Uabilities, & Uens (Schedule I) (10) 6,823.99 ". Total Deduc,ions (total lines 9 & 10) (11) 11,276_51 12. Net Value of Estate (Line 8 minus Line 11) (12) 3,642_45 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) 0.00 has noJ been made (Scheduie J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 3, 642.45 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of line 14 taxable at the $.pCusal1ax rate, or transfem under Sec. 91'& {a)(1.2) 0.00 X.O 0 (15) 0.00 TAX 16. Amount 01 line 141axabla at lineal rate 0.00 x.O 0.045 (16)' 0.00 - COMPU- 17. Amount of Line 14 taxable at sibling rate 3,642.45 X .12 (17) 437.09 TATlON 18. Amount alline 14 taxable at collateral rate 0.00 x.15 (18) 0.00 19. Tax Due (19) 437.09 20. 0 !OfeitRBeR$)~'i:Qti~r@IQug$'Hij$;A!l$f\)NPipfmp~j;jiijllYMel@il }1- \i+ L-I"'p """"""',?}('*"a!i!il'lQl'll'Nl!Q~a'I:'APWQQI:i$1;IQW$P.N",A~~2'Affl'tI'l~QH12PKMAllf!**, ""'.;':". :.:.;.::,.;.:.:.:.:.:.;<:,.:.:-:.:;:.:,'-:'....-'...... '"""""""':':".,.",.,.:.,..:-." o PA 15001 NTF 29755 Copyrighl2000 Graalland/Nelco LP . Forms Software Only PA REV-1500 EX (6-00) , C Page 2 Decedent's omolete Address: STREET ADDRESS 100 Mt. Allen Drive Cumberland CITY I STATE I ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 437.09 0.00 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 Total Interest/Penalty (D + E) 4. If Line 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 5. If Line 1 + line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS. AGENT (3) 0.00 (4) 0.00 (5) 437_09 (SA) 0.00 (5B) 437.09 I~Cg~ggX~g!~~~Ag~8EE8!1~~8d~g~;8~~~~~t;!21~~~~"~;:I!~~~X~~~3~~1~~~~c62k~ 1. Did decedent make a transfer and: Yas No a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . I ~ :: ~:::~ ~;e~~~;i:~:~:~~;:S~~~ ~~~I.~~~ ~~~ ~~~~~~ ~r~,n~~~~r~~ .~r,i~~ i.n~~~~;. . . : .':.' .' .... .' ....:.'.".. ,"' . d. receive the promise for life of either payments, benefits or care? ..... . . . . . . . . . . . . , , , . . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ... ............,.... .....,.. ........,............" 8 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? B9 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. Under penalties of perlury, 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 0 preparer other than the personal representative is based on information of which preparer has any knowledae. SIGNATURE OF PERSON RESPONSIBLE FOI}IJLlNG RETURN r.f DATE Mellon Bank, N.A., Trustee UV l-~ ~ ADDRESS 1735 Market St, P.O.Box 7899 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE o ~ Philadelphia, PA 1910-7899 DATE ADDRESS [72 P.S. Ii 9116 (a)(l.l)(i)]. . For dates of death on or after January 1, 1995,tha tax rate is imposed on the nat value of transfers 10 or for the use of the surviving spouse is 0% [72 P.S. Ii 9116 (a) (1.1) (ii)]. The statute does nOf eXAmnl a transler to a surviving spouse from lax, and the statutory requirements for disclosure 01 assets and fiJing a tax return are still applicable evan if the sUlViving spouse is Ihe only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value oftransfelS from a deceased child twenty-one years 01 age or younger at death 10 or lor the use 01 a nahJraJ parent, an adoptive parent, or a stepparent 01 the child is 0% 172 P .S. 19116(a)(1.2)1. The tax rate imposed on the net value oltransfelS to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72.P.S. 19116(1.2) [72 P.S. 19116(a)(1)]. The tax rate imposed on the net value of transfelS 10 orforthe use of the decedent's siblings is 12% [72 P.S. I 9116(a)(1.3)}. A sibling is defined, under Section 9102, as an individual who has at leasl one parent in common with the decedent, wI'lether by blood or adoption. o PA 15002 NTF 29756 Copyright 2000 GreatlandlNelco lp. Forms Software Only REV-150B EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Blanche R. Eckert SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include proceeds allitigation & date proceeds were received by the estate ITEM NO. 11. Blue Cross/Blue Shield DESCRIPTION All prop. jointly-owned with right of survivorship must be disclosed on 5ch. F. VALUE AT DATE OF DEATH 241.78 2 Cash 12,523.66 3 PNC Bank, N.A. Trust Division-Funeral A/c #24647 0.00 4 PNC Bank, N.A. Trust Division-Funeral A/c #24647 2,153.52 9 PA15081 NTF 10875 CoPyright 1999 GreatlandlNelco Lp. Forms Software Only TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 14,918.96 REV.',510 EX + ('.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Blanche R. Eckert SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes, ITEM NO. ,. DESCRIPTION OF PROPERTY INCLUDE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECD & DATE OF TRANSFER. ATTACH COpy OF THE DEED FOR REAL ESTATE. Blanche R. Eckert created a Trust under Deed, dated July 23, 1996 and amended October 3, 1996, May 11, 1998 and June 28, 1999. Assets of the trust are as reported on Schedule E, Item #2. (Copies of Trust Instrument and amendments are enclosed) . DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE V ALU E TOTAL (Also enter on line 7, Recapitulation) S 9 PA15101 NTF loan (If more space is needed. insert additional sheets of the same size) Copyright 1999 GreallandINeJco LP - Forms Softwam Only 0.00 REV-'.511EX + (1.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Blanche R. Eckert SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 1 Malpezzi Funeral Home Funeral Expense $2,153.52 Balance due forinscription 100.00 2,252.52 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN No. of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Stale Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Mellon Bank, N.A. Compensation for administering estat 2,200.00 TOTAL (AlsO enter on line 9, Recapitulation) $ 4,452.52 (If more space is needed, insert additional sheets of the same size) 9 PA15111 NfF10878 Copyrig'n\'999 GreallandINelco lP - Foi'll'lS Software Only REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Blanche R. Eckert Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER DESCRIPTION AMOUNT 1. 1 Messiah Village Nursing Home Medical institutional services 6,314.31 2 PA Department of Revenue 2002 PA personal income tax due 1.00 3 Paul D. Dalbey, DPM Professional medical services 30.00 4 Pharmerica Drugs and medical supplies 478.68 TOTAL (Also enter on line 10, Recapitulation) 9 PA15121 NTF 10874 (If more space is needed, insert additional sheets of the same size) COPyright 1999 GreatfandINelco lp. Forms Software Only $ 6,823.99 REV-1613 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Blanche R. Eckert NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J 1 1. ~rma M. ELicker Messiah Village P.O. Boxc 2015 Mechanicsburg, PA 17055 ~OO% Residue, 3,642_45 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) Sister AMOUNT OR SHARE OF ESTATE 3,642.45 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV-I500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 DISTRIBS. ON LINE 130F REV-1S00 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) 0.00 o PA15131 Copyright 2000 GreatlandINe(co LP - Forms Software Only NTF 33293 AMENDMENT TO REVOCABLE TRUST ()F BLANCHE RECKERI' I, BLANCHE R ECKEHT, of Messiah Village 100 Mt. Allen Drive, - ' Mechanicsburg, Pennsylvania, do hercb:; amend Item II. Provision at Death. of a certain Revocable Trust A"reement dated .I11iy' 23, [<106 a:id as amended Mav 11 1998 between o ,,' , myselfo.s Settlor and rvf'CLLON BANK, N;\', as Trustee to read as follows: II. PROYLQIONS ,IT DEATH Upon my deatb, the balance of the said Trust Fund, together wIth any incom'~ \,'/hich may be acclllcd thereon, shall continue to be held in trust hy my s.1id Trustee fo,' the benetit of my sister, ERMA M ELICKER, if she survives me ~:aj mv Trustee shall continue to invest and reinvest said trust , . funds as heretofo: e and shall apply th~ income derived therefrom to the comfortabie care, sapport and JT\~intenance of my sister, for and during the term of her natural life. and in addition thereto, my said Trustee shall have sole authority and discretion to expend principal of said trust fur:d, ~s well as the income therefrom, to ensur~ her proper care and maintenance at all times thereafter. IJpon the death of my sister, ER.iVIA M ELICKER, or should she predecease me, then upon my death. said tru,[ shall cease and terminate and I direct that the principal of said trust fund, together with any income that is undistributed be paid out and distributed to the following individuals and institutions in the amounts and/or proportions as hereinafter set forth, to wit: (a) I give an bequeath the sum of One Thousand Five Hundred ($1,500.00) Dollars to the per;j.~tual care endowment fund of THE IvlECHANICSBURG C'~l\1IETEK ,{ ASSOCIATION, of Mechan:.,~,o:.l,g. Pennsylvania. (b) I give and bequeath the sum of One Thousand Five Hundred ($1,500.00) Dollars to the perpetual care endowment fund of MT. PLEASAt'\lT CEtvrETERY ASSOCIATION, of Monaghan Township, York County, Pennsylvania. (c) I give and bequeath the sum of Two Thousand Five Hundred ($2,500.00) Dollars to the SHRINERS CRIPPLED CHILDREN'S HOSPITAL and BURN CENTER, which is located nearest to Mechanicsburg, Pennsylvania (d) I give and bequeath the sun of One Thousand ($1,000.00) Dollars to EUREKA LODGE NO. 302, FREE AND ACCEPTED MASONS, of Mechanicsburg, Pennsylvania in memory of my brother, R. A1arlin Eckert, and my brother-in-law, Wilbert G. Elicker, the same to be paid over to its building fund and applied to the general use of said fund. (e) I'he balance ot' said trust Itmd remaining after payments of the amounts directed under items (a), (b), (c), and (d) immediately above, shall be paid out and distributed as follows: (I) I give a bequeath twenty (20%) percent of my residuary estate to MESSIAH VILLAGE ENDOWMENT FUND, 100 Mt. Allen Drive, Mechanicsburg, Pennsylvania. (U) [ give and bequeath fifteen (15%) percent of my residuary to my nephew, CHARLES E. ECKERT, or to his issue who sUI~/ive me, per stirpes, shDuld he not survive me. (1lI) I give and bequeath fifteen (15%) percent of my residuary estate to my nephew, GERALD A. ECKERT, or to his issue who survive me, per stirpes, should he not survive me. (IV) I give and bequeath fifteen (15%) percent of my residuary shall be divided between my great-niece, TAMMY ECKERT, my great-nephew, /l,fICHAEL ECKERT, and my great-nephew, GUY ECKERT, or to the survivor of said three (3) legatees who survive me. (V) I give and bequeath the remaining thirty-five (35%) percent of my residuary estate to the l\!lECHANICSBURG PRESBYTERIAN CHURCH, 01'304 East Keller Street, Mechanicsburg, Pennsylvania. The share under a paragraph which has no beneficiary who survives me to receive that share shall be paid, pro rata, to the beneficiaries who receive part of the remaining balance under this paragraph eel. (e) Any property passing under this trust to a person under 2 I years of age shall be paid to his or her parent as custodian for that beneficiary under the Uniform Transfers to Minors Act of Pennsylvania. If his or her parent for any reason fails to qualify or ceases to act as custodian, my trustee shall appoint the custodian in his or her place which may include my trustee. RATIFICATION: I hereby ratify and confirm my Trust Agreement of July 23, 1996, in all other respects and to all intents and purposes not inconsistent herewith. Witness my hand and seal this ;2.1 day of June, 1999. j . \ /1) I I) .A i~'-1 / i Witness I I :Ja..u:;~ , l-' &Ie' J {I / t3J&~0 ft.. O:/l-Z Blanche R Eckert COMMONWEALTH OF PENNSYLVANIA} } S.S. COUNTY OF CUNffiERLAND } On this AP day of June, 1999, before me, the undersigned officer, personally appeared BLANCHE R ECKERT, known to me (or satisfactorily proven) to be the person whose name is sub;:cribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WIT~'ESS WHEREOF, I have herelliitO set my hand and notarial seal. .~lladw.. Ib - Notary Public . My commission expires: Notalia! Seal Martha H. Heil, Notary Public tJamsblirg, Dauphin Ccunty My Commission Expires Feb. 4, 2002 . IS. A8SOCl8. at .. sa AMENDMENT TO REVOCABLE TRUST OF BLANCHE R. ECKERT I, BLANCHE R. ECKERT, of Messiah Village, 100 Mt. Allen Drive, Mechanicsburg, Pennsylvania, do hereby amend Item II Provision at Death. of a certain Revocable Trust Agreement dated July 23, 1996, between myself as Settlor and MELLON BANK, N.A., as Trustee, to read as follows: () . CII/"Y1 r. I . ~ ' ~~ ((~ck~~ :1) ~ cAo1d1 '" ~~~ r!k~?- eA(M~ ? II. PROVISIONS AT DEATH: Upon my death, the balance of the said Trust Fund, together with any income which may be accrued thereon, shall continue to be held in trust by my said Trustee for the benefit of my sister, ERMA M. ELICKER, if she survives me, and my Trustee shall continue to invest and reinvest said trust funds as heretofore and shall apply the income derived therefrom to the comfortable care, support and maintenance of my sister, for and during the term of he natural life, and in addition thereto, my said Trustee shall have sole authority and discretion to expend principal of said trust fund, as well as the income therefrom, to ensure her proper care and maintenance at all times thereafter. Upon the death of my sister, ERMA M. ELICKER, or should she predecease me, then upon my death, said trust shall cease and terminate and I direct that the principal of said trust fund, together with any income that is undistributed be paid out and distributed to the following individuals and institutions in the amounts and/or proportions as hereinafter set forth, to wit: (a) (b) (c) (d) The sum of One Thousand Five Hundred ($1,500.00) Dollars shall be paid over to the perpetual care endowment fund of the MECHANICSBURG CEMETERY ASSOCIATION, of Mechanics burg, Pennsylvania. The sum of One Thousand Five Hundred ($1,500.00) Dollars shall be paid over to the perpetual care endowment fund of the MT. PLEASANT CEMETERY ASSOCIATION, of Monaghan Township, York County, Pennsylvania. The sum of One Thousand ($1,000.00) Dollars shall be paid over to EUREKA LODGE NO. 302, FREE AND ACCEPTED MASONS, of Mechanicsburg, Pennsylvania, in memory of my brother, R. MARLIN ECKERT, my brother-in-law, WILBERT G. ELICKER, and the same shall be deposited in the building fund of said Lodge, and applied to the general use of said fund. The sum of Two Thousand Five Hundred ($2,500.00) Dollars shall be paid over to the SHRINERS CHILDREN'S HOSPITAL AND BURN CENTER, which is located the nearest to Mechanicsburg, Pennsylvania. (e) The sum ofTen Thousand ($10,000.00) Dollars shall be paid toRobertC.Updegraff,of 5229 Royal Drive, Mechanicsburg, Pennsylvania. (t) The balance of said trust fund remaining after payment of the amounts directed under items (a), (b), (c), (d) and (e) immediately above, shall be paid out and distributed as follows: (I) Twenty (20%) percent of said remaining balance shall be paid to the MESSIAH VILLAGE ENDOWMENT FUND, 100 Mt. Allen Drive, Mechanicsburg, Pennsylvania. (II) Fifteen (15%) percent of said remaining balance shall be paid to my nephew, CHARLES E. ECKERT , or to his issue who survive me, per stirpes, should he not survive me. (III) Fifteen (15%) percent of said remaining balance shall be paid to my nephew, GERALD A. ECKERT, or to his issue who survive me, per stirpes, should he not survive me. (IV) Fifteen (15%) percent of said remaining balance shall be divided between my greatniece, TAMMY ECKERT, my greatnephew, MICHAEL ECKERT, and my greatnephew, GUY ECKERT, or to the survivor of said three (3) legatees who survive me. (V) Thirty-five (35%) percent of said remaining balance shall be paid to the MECHANICSBURG PRESBYTERIAN CHURCH, of 304 East Keller Street, Mechanicsburg, Pennsylvania. The share under a paragraph which has no beneficiary who survives me to receive that share shall be paid, pro rata, to the beneficiaries who receive part of the remaining balance under this paragraph (t). (g) Any property passing under this trust to a person under 21 years of age shall be paid to his or her parent as custodian for that beneficiary under the Uniform Transfers to Minors Act of Pennsylvania. If his or her parent for any reason fails to qualify or ceases to act as custodian, my trustee shall appoint the custodian in his or her place which may include my trustee. RATIFICATION: I hereby ratifY and confirm my Trust Agreement ofJuly 23, 1996, in all other respects and to all intents and purposes not inconsistent herewith. Witness my hand and seal this 1/ i-A.- day of May, 1998. . fjt/1ft:l-:C -Wt~7t-.tLk) ~Jg,~~ K. r!LtiAL) Witness Blanche R. Eckert -2- COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) On this, the /.1..!tctay Of/);CVj-r 1998, before me, the undersigned officer, personally appeared BLANCHE R. ECKERT, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. S8 IN WITNESS WHEREOF, I have seal. hereunto set my hand and notarial '--; } Jcu4 t( Ij-,J.J Notary Public My commission expires: NoIal1aJ Seal Martha H. Heil, Notary Public Ham....rg. Oaupllln County My CommiSSkln E>l>ires Fob.~. 2002 emcer, .. AssocIation Ol nos - 3 - AMENDMENT TO REVOCABLE TRUST OF BLANCHE R ECK""ERT 1. BLANCHE R. ECKERT. of Messiah Village, 100 Mt. Allen Drive. \!i:chalucsbur>!, Pennsvlvania.. do herebv amend item n., Provisions At Death, of a cer-.ain - . Revocable Tnm Agreement dated July 23. 1996, between myself as Settlor and "'IELLON BA..c"lK N. A.. as Trustee. to read as follows: II. PROVISIONS AT DEATH Upon my death., the ba!ance of the said Trust Fund, tOgether with any income which may be accrued thereon. shail continue to be hdd in trust by my said Trustee for the benefit of my sister. ERMA M.ELICKER. if she surll'les me, and my Trustee shall continue to invest and reinvest said trust funds as heretofore w"1d shall appiy the income derived therefrom to the comfortable care. su?port and mamtenailce of my sister. for and during the term of her natura! life, and in ::ddition thereto. my said Trustee shall have sole authority and discretion to expend principal .of said trust f!lnd, as well as the income therefrom. to ensure her proper care and maintenance at all times hereafter. Upon the death of my sister. ER.cvlA M. ELICKEK or :hOl:id she preciece:J.:;'" me, then upon my death., said trust shali cease and terminate and I direct that the pr";lcipa! of said truSt fund, together with any income which is undistributed be paid out a::ld distributed to the following individuals and institutions in the amounts and/or proportior,s as hereinafter set forth. to wit: (a) The sum of One Thousand Five Hundred ($1,500.00) Doilars shail be paid over to the perpetual care endowment fund ofTIiE ?vfECHANICSBURG CEMETERY ASSOCIATION, of Mechanics burg, Pennsylvania. (b) The sum of One Thousand Five Hundred ($1,500.00) Dollars shail be paid G',e, to th~ perpetual care endowment funJ 0f t~.e :,U. PLEASANT CEJVJETERY ASSOCIATION, of Monaghan Township, York County. Pennsylvania. (c) The sum of One Thousand ($1,000.00) Dollars shall be paid over to EUREKA LODGE NO. 302, FREE AND ACCEPTED MASONS, of Mechanicsburg, Pennsylvania, in loving memory of my late brother-in-law, WILBERT G. ELICKER, and my brother, R. MARLIN ECKERT, the same shall be deposited in the building fund of said Lodge, and applied to the general use of said fund. (d) The sum ofTwo Thousand Five Hundred ($2,500.00) Dollars shall be paid over to the SHRINERS CRIPPLED CHILDREN'S HOSPITAL A.ND BURN CENTER, which is located the nearest to Mechanicsburg, Pennsylvania. (e) The sum of Ten Thousand ($10,000.00) Dollars shall be paid into the building fund of the MECHANICSBURG PRESBYTERIAN CHURCH, 304 East Keller Street, Mechanicsbulll Pennsvlvania. -' . ) '1 (D The balance of said trust lima remaining after payment of the amounu directed under Items (a), (b), (el, (d) and (e) immediately above, shall be paid aut and distributed as f.::l!OW$: (1) Eight (3%) percent cf said remauung balance shall be paid to tile::- MESSIAH VILLAGE ENDOWME-iT FUND, 100 Ml. Allen Drive, Mechanicsburg, Pennsylvania. \Uj Two ,2%) pcrcen: of saie remaining balance shall be paid to ROBERT C. "lJPDEGRAr""""F, 0[5229 Royal Drive. MechaI'JcsDurg, Pennsylvania, ifhe survives me. (ill) Fony (40%) pcrcent of said remaining balance shaJl be paid to my nephew, CHARLES E. ECKERT, or to his issue, who survive me, per stirpes, should he nat sUrYIve me. (IV) F any (40%) perce:n of said remaining balance shaJl be paid to my nephew, GERALD A. ECKERT, or to his issue. who survive me. per stirpes. should he not sUl"'.n.ve me. (V) Tcn (10%) percent of said remaining balance shall be paid to those of my great-niece, TA.,,\1MY ECKERT, my great-nephew, MICHAEL ECKERT, and to my great-nephew, Gi..i'Y ECKERT, who survive me share and share alike. The share under a paragraph which has no beneficiary who survives me to receive that share shall be paid, p..o rata, to the beneficiaries who receive part of the remaining balance under this paragraph (t). (g) Any propeny passing ur:der this trust to a person under 21 years of age shall be paid to his or her p"nat as ~; ;,,'!odian for that beneficiary unJe. tne 1I,,;form Transfers to Minors Act of Pennsylvania. Ifhis or her parent for any reason fails to qualifY or ceases to act as custodian, my trustee shall appoint the custodian in his or her place which may include my trustee. RATIFICATION: I hereby ratify and confirm my Trust Agreement of July 23, 1996, in all ather respects and to all intents and purposes not inconsistent herewith. Istdayof~~1996. Witness my hand and seal this ~Yl1Ae~' , Witness . f3,L "~./..' -A. ~EAL) Blanche R. Eckert 2 I STATE OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) On this, the --19f day of ~ 996, personaJ1y appeared before me, a Notary Public, Blanche R. Eckert, known to me ( or satisfactor'Jy proven) to be the~ person whose name is subscribed to the within Amendment to Revocable Trust_ Agreement and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. , 111 I/V ',L/ ~Y7 - I '" f....Jl.,t 2-.,l.... / / (. --==--Lu.A.-?'tJ./\ Notary Public , , (SEAL) \' ~~otariat Seal . Karen 1\1. TlJ:nef. Nc;a.ry PublIC Upper AJ!r>n T ./0.. Cumoenana Coun"lV . My coml~ :S'~:l C,;plres May 29. 20...0 _c. fenns,lVarua AssOCl3Don 01 Nolanl'$ My commission expires: The foregoing Amendment to Revocable Trust Agreement was delivered and is hereby accepted in Pennsylvania on this ~ day of (JJI~H ~ , , 1996, by the undersigned Trustee under said Agreement. Mellon Bank, N.A. By Ji:.d t:- / .. .. '-~ V Ice Preslc;;:n , j 3 I REVOCABLE LIVING TRUST OF BLANCHE R. ECKERT 1. Blanche R. Eckert, of Mechanicsburg, Pennsylvania, transfer to MELLON BABK, ,"A as trustee the property described in the annexed schedule to be held IN TRUST under Pennsylvania. lJ.w as follows: I. Lifetime Trust: During my lifetime my trustee shaH invest and manage the property, and make distributions as follows: ,A. Payments: A:: much~ even if an, of the ne~ inCCITie and principal J.S ! may from. t1.r'..1c to time direct in viriti..g shall be paid eIther to me or as I may sp~ciiY; B. Balance: Any remaining net income shall from time to time be accumulated and added to principal; however, c. Disability: If my trustee believes I am incapable of handling my own affairs it need not follow my previous directions regarding payments during my lifetime. Instead, my trustee may apply part or ail of the principal and income in any way it bdieves will benefit me or any person dependent upon me. II. Provisions at Death: Upon my death my trustee shall pay the then remaining principal and a....ly undistributed net income to or in trust for such one or more persons or organizations on such terms as I may appoint by a will specifically referring to this power of appointment or, insofar as it is not effective, to my personal representative for distribution as part of my estate. III. Manal!ement Provisions: I authorize my trustee: A. Retain/Invest: To retain and to invest in any form of real or personal property anywhere which, in m y ,.~Istees's opinion, is appropriate fer f'"1;I truSl, without being required to diversify; B. Nominee: To hold property in the name of a nominee. I have been informed of SEC Rule 14b-l (c) which enables corporations for corporate communication purposes to learn the identity and holdings of the beneficial owners of the corporation's securities where securities are held by banks and registered in "nominee" name. I direct that my trustee not disclose the information to those corporations; C. SelVLease: 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 or leases; and D. Distribute: To distribute in cash or in kind. These provisions shall continue in full force until the actual distribution of the property. The investment provisions and all the other provisions, authorities and discretion given under my trust shall be in addition to those granted by law, shall continue until the distribution of the property, shall be exercisable without court authorization, and, unless exercised in bad falth, shall be conclusive upon all the beneficiaries. -1- IV. Protective Provision: To the greatest extent permitted by law, before actual payment to a beneficiary no interest in income or principal shall be (i) assignable to a beneficiary or (ii) available to anyone having a claim against a beneficiary. V. Accountin1!: My tmstee shall send me statements at least quarterly showing the tmst's transactions. Unless I am incapable of handling my own affairs, I must report any errors to my trustee inch:ding the non-receipt or" a statement, within 90 days after I normally receive a statement. Othe;v,~se. L at my trustee's discretion., may be deemed to have accepted the transactions as stated. VI. provisions Re\!ardinl! My Tnmee: I direct that: A. Il1struction~: My trustee may consider oral instructions as if they were written as long as my trustee believes in good faith they are genuine and any distribution is made only to me or to any account in which I have an interest; B. Contlicts of Interest: T]lC fact that my trustee is active in any aspect of the investment business as that business is broadly understood shall not be deemed a conflict of interest. Purchases and sales of investments may be made through any department or affiliate of my bank trustee. My trustee may pay the firm its usual charges for the service. Any income beneficiary or his or her legal representative may cancel this power by a writing delivered to my trustee; C. Resignation: My trustee may resign by paying all the funds to the income beneficiary or beneficiaries or, if a beneficiary is a minor, any distribution or payment may be made to his or her parent or anyone as custodian for the minor under the Uniform Gifts to Minors Act; and D. C:;mpensa,:on: My trustee shall receive c:)mp",nsll:i::.1 in accordance with its standard schedule of fees in effect while its services are performed. VII. Ri2hts Reserved: I reserve the right to revoke this trust by writing other than a will, and the right to amend this trust or add to this trust with my trustee's approval. Dated }, ~ 03 ,19 'l t. ~ ~~~, [~.r Blanche R. Eckert Witnesses: , ,l. ""Pd< 1// /; ~.~~Y'Ur~.. -' _~ }J" ~. ~2. STATE OF 5S. COUNTY OF On -r ~ CJ.3 _--' ! 9 if Co, before me, the undersigned notary public, personally appeared Blanc R. Eckert. who acknowledged th.:: foregoing tmst to be that person's act and desired that the trust might be recorded as such. Witness my signature .md notarial seal cn the above date. f '-,/] ?) . r / a-1l-v.!-OL( ~<L/uJ..iLt -V Notary Public l' M C ,. ~ . ~:OTARIAL SEAL y omrmsslOn .cxplr s: \~',CY L SHOLLY, Notarv Public 1;3rriscurg, Dauphin COI.mt'y' ~,'ly C0:TimiSsion Expires June 30,1997 The foregoing trust was delivereci, and IS hereby accepted, in Pennsylvania, on ~.QO ~o .19~ lyj~f';LLON BAl\'K, N.A. <:-,--, IJ Y By ~/lL--tf , -J-