HomeMy WebLinkAbout04-27-05
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IIWII WEINSTEIN LAW OFFICES PC
705 WEST DEK.ALB PIKE
K.ING OF PRUSSIA. PA 19406
(610) 337-3733
FAX (610) 337-3240
FOSTER PLAZA. SUITE 300
651 HOLIDAY DRIVE
PITTSBURGH. PA 15220
(800) 859-9535
FAX (412) 928-4951
April 21, 2005
Register of Wills
Cumberland Courthouse
1 Courthouse Square
Carlisle, P A 17013-3387
~\ -05-b3~D
Re: Billy Shealer, Deceased
To Whom It May Concern:
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Enclosed please find the P A Inheritance Tax Return, along with a check for theC'
amount due, for the above-mentioned Estate. Also enclosed is a separate check for the
filing fees. If you have any questions, or require any additional information, please
contact our office.
Sincerely yours,
> - // ~ ,l h' --. ~":::--
(:-<<-.1 ~ / ~t)V-- -----.J
WEINSTEIN LAW OFFICES PC
Brett B. Weinstein, Esquire
BBW:dha
Enclosures
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-l 162 EXll 1-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BRAUN lAURIE A
955 SOUTH 29TH STREET
CAMP Hill, PA 17011
n_un_ fold
ESTATE INFORMATION: SSN: 166-12-6841
FILE NUMBER: 2105-0390
DECEDENT NAME: SHEAlER BillY
DATE OF PAYMENT: 04/26/2005
POSTMARK DATE: 04/25/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/16/2004
NO. CD 005249
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $29,893.50
I
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TOTAL AMOUNT PAID:
$29,893.50
REMARKS:
CHECK# 4125
SEAL
INITIALS: CCP
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
REY_1500U.{6-40j
.
OFFICIAL USE ONLY
I
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21
COUNTY CODE
o~ 3 <>to
YEAR NUMBER
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
Shea1er, Billy
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
SOCIAL SECURITY NUMBER
166-12-6841
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
10/25/1922
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
09/16/2004
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
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181
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181
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B. Total Number of Safe Deposit Boxes
1. Original Return
3. Remainder Retum (date of death prior 10 12-13-82)
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o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after
12-12-82)
~ 7. Decedent Maintained a Living Trust (Attach
copy of Trust)
o 10. Spousal Poverty Credit (dale of death between
12-31-91 nd 1-1-95
THIS'SECTlON 'MlJSf"BEdOMl"I..!!fE6;)Al..I,'dORRESf!ONOI:NCEANOCQNFiOEN'nAI..l'.A){INF()RMA'nQ/lisH()lJLOaE'OIR.Edn;010:
AME COMPLETE MAILING ADDRESS
Brett B Weinstein
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5. Federal Estate Tax Return Required
4. Limited Estate
6. Decedent Died Testate (Attach copy
of Will)
9. Litigation Proceeds Received
o 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
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IRM NAME (If applicable)
Weinstein Law Offices
705 West DeKa1b Pike
King of Prussia, PA 19406
(1) None
(2) None
(3) None
(4) None
(5) None
(6) None
(7) 690,981.00
(8)
(9) 26,150.00
(10) 531.00
ELEPHONE NUMBER
610/337-3733
1. Real Estate (Schedule A)
OFFICIAL lJSJ;,ONLY
2. Stocks and Bonds (Schedule B)
j.;
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administratiye Costs (Schedule H)
690,981.00
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(11)
26,681.00
12. Net Value of Estate (Line 8 minus Line 11)
(12)
664,300.00
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
664,300_00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate. x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z 664,300.00 .045 (16)
0 16. Amount of Line 14 taxable at lineai rate x
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.. 17. Amount of Line 14 taxable at sibling rate x .12 (17)
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E 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
29,893.50
29,893.50
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
20. 0
F. ::c:: ,~'': ~~. tl)( f' >'>BE. SURE TO'ANSWER'ALt.:.rQUEl\XIONS :ol'l.REiVERSE,$lqE:~D:Rl!CI:lECKMA Tlfe.. ,'i;:I':: . . )0: : ~;; "j :: II: 'i .'
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
801 North Hanover Street
CITY
Carlisle
I STATE PA
I ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
29,893.50
Total Credits (A + 8 + C)
(2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (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.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 29,893.50
(5A)
(58) 29,893.50
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;.................................................................................. ~ ~
~: ~::::~ ~h;e~~~:i:on~~:~~e~~s~~~..~.h~~~. ~~~.~~~.:.~~:..~.~ .tr~~s.~~::~~. ~~.i~.~.~~~~~~::::::::::::: ::::: :::::::::::::: ::::
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?............................................................................................. .......................... D
D
181
181
181
D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?................................ ................. ....................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
DATE
108 Jackoos Lane
Dobson, NC 27017
955 S. 29th Street
CampHill,PA 17011
III
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705 West DeKalb Pike
King of Prussia, PA 19406
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. !l9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. !l9116 (a) (1.1) (ii)J. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filin9 a tax return are still applicable even if the survivin9 spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. !l9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. !l9116
1.2) [72 P.S. !l9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. !l9116 (a) (1.3)J. 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.
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Shealer, Billy
FILE NUMBER
21-04-
ESTATE OF
This schedule must be comDleted and filed if the answer to anv of Questions 1 throuah 4 on Daae 2 is ves.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH '10 OF
Include the name of the transferee. their relationship to decedent and the date of transfer. EXCLUSION TAXABLE VALUE
NUMBER VALUE OF ASSET DECD'S .
Attach a copy of the deed for (eal estate. INTEREST (IF APPLICABLE)
1 M&T Bank 6,596.00 6,596.00
Retirement Account #35-004200210570
2 M&T Bank 6,230.00 6,230.00
Retirement Account #35-004200347745
3 Decedent was trustee and grantor of the Billy Shealer
Revocable Living Trust Agreement in which the following
were assets:
4 Glenbrook Life and Annuity Company 107,269.00 107,269.00
Contract #GA16175288
5 American Investors Life Insurance Company 397,523.00 397,523.00
Annuity Policy #294497
6 American Equity Investment Life 30,785.00 30,785.00
Annuity Contract #304257
7 M&T Bank 131,785.00 131,785.00
Select with Interest Account #570575 .
8 M&T Bank 10,793.00 10,793.00
Market Advantage Account #15004205740027
.
TOTAL (Also enter on line 7, Recapitulation) 690,981.00
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
NHERITANCE TAX RETURN
RESIDENT DeceDENT
ESTATE OF
Shealer, Billy
I FILE NUMBER
21-04-
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
I Monahan Funeral Home Inc. 8,498.00
2 Codori Memorial Inscription 125.00
3 Luncheon Buffet 727.00
.
B. ADMINISTRATIVE COSTS: 4,500.00
1. Personal Representative's Commissions
Laurie A. Braun Lisa M. Cline
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address 955 S. 29th Street
City Camp Hill State PA Zip 17011
-
Year(s) Commission paid
2. Attorney's Fees Brett B. Weinstein 9,120.00
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
5. Accountant's Fees
.
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Travel Expenses 2,497.00
2 Meal Expenses 540.00
Total of Continuation Schedule(s) 143.00
TOTAL (Also enter on line 9, Recapitulation) 26,150.00
.
Schedule H
Funeral Expenses &
Mninisb'aliYa Costs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shealer, Billy
I FILE NUMBER
21 - 04 -
3
Miscellaneous Expenses
143.00
Page 2 of Schedule H
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shealer, Billy
I FILE NUMBER
21 - 04-
Include unreimbursed medical expenses.
ITEM
NUMBER
I
DESCRIPTION
AMOUNT
Drs. Currie & Hecht
Outstanding Medical Bill
90.00
2 Alan C. Huff, DDS 18.00
Outstanding Medical Bill
3 Brockie Pharrnatech 124.00
Outstanding Medical Bill
4 The Church of God Home, Inc. 299.00
Outstanding Bill
TOTAL (Also enter on Line 10, Recapitulation)
531.00
REV.1513 EX+ (9-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shealer, Billy
I FILE NUMBER
21 - 04-
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
- .....
J. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Laurie A. Braun Granddaughter fifteen percent 0 f the
955 S. 29th Street residual
Camp Hill, PA 17011 .
2 Lisa M. Cline Granddaughter fifteen percent of the
108 Jackoos Lane residual
Dobson, NC 27017
3 Jennifer Nickey Granddaughter fifteen percent of the
606 Hummel Avenue residual
Lemoyne, PA 17043
4 Troy K. Shealer Grandson fifteen percent of the
461 Baltimore Road residual
York Springs, P A 17372
See Continuation Schedule{s) attached
Enter dollar amounts for distributions shown above on lines 15 through 18. as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
.
SCHEDULE J
BENEFICIARIES continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shealer, Billy
I FILE NUMBER
21 - 04 -
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT
Do Not List Trustee{s) OF ESTATE
I. AXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under
Sec. 9116(a)(1.2)]
5 John Shealer Grandson fifteen percent of the
929 Dick's Darn Road residual
New Oxford, P A 17350
6 Barry L. Shealer Son twenty-five percent of
4247 Carlisle Road the residual
Gardners, P A 17324
.
.
Page 2 of Schedule J
c
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(
THE BILLY SHEALER
DA~VOCABWwr AG7~.
BET N. BILLY SHEALER,
AS SETTLOR
AND: BILLY SHEALER,
AS TRUSTEE
BILLY SHEALER, a resident of the Commonwealth of Pennsylvania, County of Cumberland, does
hereby establish a Trust upon the conditions and for the purposes hereafter set forth.
ARTICLE ONE
Section 1.01. Trust Estate Defmed
This Revocable Trust is formed to hold title to real and personal property for the benefit of the
Settlor of this Trust and to provide for the orderly use and transfer of these assets upon the death of the
Settlor. The "Trust Estate" is defmed as all property, transferred or conveyed to and received by the
Trustee, held pursuant to the terms of this instrument. The Trustee is required to hold, administer, and
distribute this property as provided in this Trust Agreement.
Section 1.02. Defmitions
As used in this Trust Agreement,
a) The term "Settlor" shall mean BILLY SHEALER.
b) The term "descendant" shall mean the lawful issue of a deceased parent in the line
of descent but does not include the issue of any parent who is a descendant of the
deceased person in question and is living at the time in question.
c) The terms "child" and "descendant" include any issue born to decedent or legally
adopted by the decedent or a posthumous child of a decedent, and a posthumous
child is to be considered as living at the time of his or her parent's death.
d)
The term "survives" or "surviving", unless otherwise indicated herein, shall be
construed to mean surviving the decedent for at least sixty (60) days. If the person
referred to dies within sixty (60) days of the death of the decedent, the reference
to him or her shall be construed as if he or she had failed to survive the dpc,li1~pt;
provided, however, that any such person will have during SUCh(gm~od'/th~~iglit to
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REVOCABLE LIVING TRUST AGREEMENT
Page 1
c
the use and the enjoyment as a life tenant of all property in which his or her
interest will fail by reason of death during such period.
e)
The term "issue" will include all natural and adopted children, if applicable, and
descendants and those legally adopted into the line of descent.
f)
The term "per stirpes" means strict per stirpes and does not mean per capita with
representation. Beneficiaries entitled to take under a "per stirpes" clause will
include both natural and adopted children and their descendants.
g)
The terms "Trust Assets" and "Trust Estate" include all assets of any trust created
hereunder and income derived from such assets and all proceeds of any description
derived from the sale, exchange or other disposition of such assets.
h)
When required to give reasonable effect to the context in which used, pronouns in
the masculine, feminine or neuter gender include each other, and nouns and
pronouns in the plural or singular number include each other.
Section 1.03. Trustee Designation
Settlor is hereby designated as Trustee. The term "Trustee" as used in this Trust Agreement shall
refer to Settlor so long as he or she serves as Trustee, and/or to any successor Trustee who assumes the
role of Trustee. These Trustees shall serve in the order as provided in Section 8.01 of this Trust
C. ! Agreement.
Section 1.04. Additions to Trust Pronerties
a) The Trustee, at any time during the continuance of this Trust in his or her sole
discretion after consideration of the possible tax consequences to all concerned, is
authorized to receive into the Trust additions of cash and other properties from any
source whatsoever, whether by gift, will, or otherwise. However, the Trustee
shall accept all assets which any person or persons may give, devise, or bequeath
by Last Will and Testament to this Trust, and shall accept all assets transferred to
this Trust pursuant to the provisions of any other Trust document or documents.
b) In addition, any person or persons may designate this Trust as the Beneficiary,
Primary or Contingent, of death benefits, whether insurance benefits, pension
benefits, or other benefits. Until such benefits mature, the Trustee shall have no
responsibility with respect to those benefits.
Section 1.05. Anoortionment
The Trustee of the Trust is directed to apportion receipts and expenditures of the types described
below between principal and income as follows:
l
REVOCABLE LIVING TRUST AGREEMENT
Page 2
c
c
(
a)
Whenever the principal, or any part thereof, of the trust property is invested in
securities purchased at a premium or at a discount, any premium will be charged
against principal and any discount will be credited to principal;
b) Any stock dividends and rights to purchase additional stock issued on securities
held in trust will be treated as principal, but all other dividends, except liquidating
distributions, will be treated as income; and
c) The amount of any applicable depletion allowance for federal income tax purposes
will be treated as income.
Section 1.06. Discretionary Termination
The Trustee may terminate any trust when, in the opinion of the Trustee, the principal is reduced
to such an extent that it is not in the best interest of the Beneficiary or Beneficiaries to continue the trust.
The judgment of the Trustee with respect to this decision to terminate will be final and not subject to
judicial review. If the Trustee terminates a trust according to this Section, the date the trust terminates will
be deemed the date fixed for termination of the trust, and the Trustee will distribute the assets of the
terminating trust to the Beneficiary or Beneficiaries pursuant to this Agreement.
Section 1. 07. Amendment and Revocation
At any time during the life of the Settlor, the Settlor may, by a duly executed instrument f1led with
the Trustee:
a) Amend this Trust Agreement in any manner; and/or
b) Revoke this Trust Agreement in part or in whole. If the Trust Agreement is
revoked in whole, the Trustee shall transfer title to all Trust property of every kind
and description back into the individual name of the Settlor. The instrument of
amendment or revocation shall be effective immediately upon its proper execution
by the Settlor, but until a copy has been received by a Trustee, that Trustee shall
not incur any liability or responsibility either (i) for failing to act in accordance
with such instrument or (ii) for acting in accordance with the provisions of this
Trust Agreement without regard to such instrument.
c) Withdraw from the Trust Estate all or any part of the principal and accumulated
income of the Trust to satisfy liabilities lawfully incurred in the administration of
this Trust.
Section 1.08. Revocation or Alteration bv Settlor Alone
The rights of revocation, withdrawal, alteration and amendment reserved in this Article must be
exercised by the Settlor, and may not be exercised by any other person, including an agent, a guardian or
a conservator.
REVOCABLE LIVlNG TRUST AGREEMENT
Page 3
C Section 1.09. Irrevocabilitv
Except as otherwise provided, on the death of Settlor, the designation of Beneficiaries of specific
gifts in this Trust shall become irrevocable, and not subject to amendment or modification.
Section 1.10. Settlor Powers
The Settlor shall be the Trustee unless and until she resigns in writing, or is determined
incompetent under the terms provided herein. The Settlor shall retain all absolute rights to discharge or
replace any successor Trustee, so long as the Settlor is competent.
ARTICLE TWO
Section 2.01. Trust Income
During the life of the Settlor, the Trustee shall at least annually, unless otherwise directed by
Settlor in writing, pay to or apply for the benefit of Settlor, all of the net income from the Trust Estate.
Section 2.02. Protection of Settlor in Event of Incaoacitv
(
During the life of the Settlor, should Settlor become incapacitated as defmed in Section 2.03 below,
the Trustee may, in the Trustee's absolute discretion, pay income and principal for the benefit of the
incapacitated Settlor, and may pay to or apply for the benefit of that Settlor such sums from the net income
and from the principal of the Estate as the Trustee, in the Trustee's absolute discretion, believes is
necessary or advisable for the medical care, comfortable maintenance, and welfare of the Settlor.
Section 2.03. Incaoacitv
In the event that any Trustee or any Beneficiary hereunder comes into possession of any of the
following:
a) A jurisdictionally applicable court order holding the party to be legally
incapacitated to act on his or her own behalf and appointing a guardian or
conservator to act for him or her, or
b) Written certificates which are duly executed, witnessed, and acknowledged of two
licensed physicians, each certifying that the physician has examined the person and
has concluded that, by reason of accident, mental deterioration, or other cause,
such person has become incapacitated and can no longer act rationally and
prudently in his or her own [mancial best interests, or
c)
Evidence which such Trustee or Beneficiary deems to be credible and currently
applicable that a person has disappeared, is unaccountably absent, or is being
detained under duress, and that he or she is unable to effectively and prudently
(
REVOCABLE LIVING TRUST AGREEMENT
Page 4
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(
look after his or her own best interests, then in that event and under those
circwnstances:
1) Such person is deemed to have become incapacitated, as that term is used
in this Trust Agreement, and
2) Such incapacity is deemed to continue until such court order, certificates,
and/or circwnstances are inapplicable or have been revoked.
A physician's certificate to the effect that the person is no longer incapacitated shall revoke a
certificate declaring the person incapacitated. The certificate which revokes the earlier certificate may be
executed either (i) by the originally certifying physician or (ii) by two other licensed, board certified
physicians. No Trustee shall be under any duty to institute any inquiry into a person's possible incapacity.
The reasonable expense of any such inquiry shall be paid from the Trust Assets.
Section 2.04. Princioal Invasion
During the life of the Settlor, should the net income of assets contained in this Trust at the time
of the Settlor's death be insufficient to provide for the care, maintenance or support of the Settlor as herein
dermed, the Trustee may, in the Trustee's sole and absolute discretion, pay to or apply for the benefit of
the Settlor, or any of their dependents, such amounts from the principal of the Trust Estate as the Trustee
deems necessary or advisable for the care, maintenance or support of the Settlor.
Section 2.05. Residence
If the Settlor's residence property is a part of the Trust, the Settlor shall have possession of and
full management of the residence and shall have the right to occupy it rent free. Any expenses arising from
the maintenance of the property and from all taxes, liens, assessments, and insurance premiwns are to be
paid from the Trust to the extent that assets are available for payment. It is the intent of the Grantors to
retain all homestead rights available to them under the applicable state law.
ARTICLE THREE
Section 3.01. Death
On the death of the Settlor, the Trustee shall distribute the principal of the Trust and any accrued
or undistributed income from the principal of the Trust in such a manner and to such persons, including
the Estate or the Creditors, as directed in this Trust Agreement.
Section 3.02. Pavment of Death Exoenses
On the death of the Settlor, the Trustee shall pay from the Trust the expenses of the Settlor's last
illness, funeral, burial and any inheritance, estate or death taxes that may be due by reason of the Settlor's
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death, unless the Trustee in his or her absolute discretion determines that other adequate provisions have
been made for the payment of such expenses and taxes.
Section 3.03. Trust Income and Princioal Distribution
a) The Trustee shall apply and distribute the net income and principal of each of the
shares of the resulting Trust Estate, after giving effect to the section of this Trust
Agreement entitled "Special Directives" to the following Beneficiaries in the
indicated fractional shares:
BARRY L. SHEALER
LAURIE A. BRAUN
LISA M. 'STOl:JCII CI-/ Iliff
TROY K. SHEALER
JENNIFER A. NICKEY
JOHN B. SHEALER
25%
15%
15%
15%
15%
15%
b)
If any of the above Beneficiaries, or any other Beneficiary, is under the age of 25
years when the distribution is to be made, the Beneficiary's share shall vest in
interest indefeasibly but the Trustee may, in his or her discretion, continue to hold
that share as a separate trust for such period of time as the Trustee deems
advisable, but not to extend beyond the 25th birthday of the Beneficiary. In the
meantime, the Trustee is to use as much of the income and principal for the
education, comfortable support, maintenance and health of the Beneficiary as the
Trustee determines is required. When the Beneficiary reaches the age of 25 years,
the Trustee shall distribute to that Beneficiary one hundred percent (100%) of the
then balance of the principal of his or her share of the Trust Estate.
c) If all of the Settlor's Beneficiaries and their children should fail to survive the fmal
distribution of the Trust Estate, all of the Trust Estate not disposed of as
hereinabove provided shall be distributed as provided for in this Trust Agreement.
Section 3.04. Princiole of Reoresentation
If a Beneficiary of the Settlor's should fail to survive to collect his or her share, that share shall
pass to the surviving issue of that deceased Beneficiary per stirpes and with right of representation.
ARTICLE FOUR
Section 4.01. Non-Income ProducinJ! Prooertv
During the life of the Settlor, the Trustee is authorized to retain in the Trust for so long as the
Trustee may deem advisable, any property received by the Trustee from the Settlor, whether or not such
property is of the character permitted by law for the investment of Trust funds.
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Section 4.02. Trustee Powers
The Trustee shall have all powers conferred upon a Trustee by law for the orderly administration
of the Trust Estate. If any property is distributed outright under the provision of this Trust Agreement to
a person who is a minor, distribution may be made under the Pennsylvania Uniform Transfer to Minors
Act ("PAUTMA "). The Trustee is further authorized to sign, deliver and/or receive any documents
necessary to carry out the powers contained within this Section.
The Trustee of any trust created under this Trust Agreement (including any substitute or successor
trustee) will have and be subject to all of the powers, duties, and responsibilities granted or ilnposed by
the Pennsylvania Consolidated Statutes, (20 Pa. C.S. ~lOI et seq.) as such Statute may provide at the time
of administration of the trust, except to the extent that the same are inconsistent with the provisions of this
Agreement.
Section 4.03. Svecific Powers of Trustee
In addition, the Trustee will have the following specific powers:
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a) Trust Estate - The Trustee may leave invested, any property coming into its hands
hereunder in any form of investment, even though the investment may not be of the
character of investments permitted by law to trustees, without liability for loss or
depreciation in value. The Trustee may sell, exchange, or otherwise dispose of and
reinvest property which may at any time be a part of the Trust Estate upon such terms and
conditions as the Trustee may deem advisable. The Trustee may invest and reinvest the
Trust Assets from time to time in any property, real, personal, or mixed, including without
limitation securities of domestic and foreign corporations and investment trusts or
companies, bonds, debentures, preferred stocks, common stocks, mortgages, mortgage
participations, and interests in common trust funds, all with complete discretion to convert
realty into personalty or personalty into realty or otherwise change the character of the
Trust Estate, even though such investment (by reason of its character, amount, proportion
to the total Trust Estate, or otherwise) would not be considered appropriate for a fiduciary
apart from this provision, and even though such investment caused part or all of the total
Trust Estate to be invested in investments of one type or of one business or company.
b) Holding Property - The Trustee may hold property in the Trustee's name, as
trustee, or in the name of a nominee without disclosing the Trust.
c) Release of Power - If the Trustee deems it to be in the best interest of the Trust
and its beneficiaries, the Trustee, by written instrument signed by such Trustee, will have
the power and authority to release, disclaim or restrict the scope of any power or discretion
granted in this Trust Agreement or implied by law.
d) Agents, Employees - The Trustee may employ one or more agents to perform any
act of administration, whether or not discretionary, including attorneys, auditors,
investment managers or others, as the Trustee shall deem necessary or advisable. The
Trustee may compensate agents and other employees, and may delegate to them any and
all discretions and powers.
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e) Leases - The Trustee may lease any Trust Assets generally or for oil, gas and
mineral development, even though the lease term may extend beyond the term of the trust
of which the property is a part. The Trustee may enter into any covenants and agreements
relating to the property so leased or any improvements which may then or thereafter be
erected on such property.
1) Common Funds - The Trustee may hold any of the Trust Assets in a common fund
with property from other trust estates and to make investments jointly with any other trust,
the property of which is included in the common fund.
g) Securities - With respect to securities held in the Trust Estate, the Trustee may
exercise all the rights, powers, and privileges of an owner, including, but not limited to,
the power to vote, give proxies, and to pay assessments and other sums deemed by the
Trustee necessary for the protection of the Trust estate; to participate in voting trusts,
foreclosures, reorganizations, consolidations, mergers, and liquidations, and in connection
therewith to deposit securities with and transfer title to any protective or other committee
under such terms as the Trustee may deem advisable; to exercise or sell stock subscription
or conversion rights; and to accept and retain as an investment any securities or other
property received through the exercise of any of the foregoing powers, regardless of any
limitations elsewhere in this instrument relative to investments by the Trustee.
h) Purchases from Estate - The Trustee may purchase property of any kind from the
executor or administrator of our estates.
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i) Lending - The Trustee may make loans, secured or unsecured, to the executor or
administrator of our estates, to any beneficiary of the Trust or to the Trustee. Further, the
Trustee may use Trust Assets to guarantee obligations of any income beneficiary of the
Trust (unless such beneficiary is serving as trustee).
j) Distributions to or for Beneficiaries - The Trustee may make any distribution
contemplated by this Trust Agreement (1) to the beneficiary, (2) if the beneficiary is under
a legal disability or if the Trustee determines that the beneficiary is unable to properly
manage his or her affairs, to a person furnishing support, maintenance or education for the
beneficiary or with whom the beneficiary is residing, for expenditures on the beneficiary's
behalf, or (3) if the beneficiary is a minor, to a trustee of an existing trust established
exclusively for the benefit of such minor, whether created by this Trust Agreement or
otherwise, or to a custodian for the beneficiary, as selected by the Trustee, under the
Pennsylvania Uniform Gifts to Minors Act. Alternatively, the Trustee may apply all or
a part of the distribution for the beneficiary's benefit. Any distribution under this
paragraph will be a full discharge of the Trustee with respect thereto. On any partial or
final distribution of the Trust Assets, the Trustee may apportion and allocate the assets of
the Trust Estate in cash or in kind, or partly in cash and partly in kind, or in undivided
interests in the manner deemed advisable at the discretion of the Trustee and to sell any
property deemed necessary by the Trustee to make the distribution. The Trustee may
distribute gifts of up to $10,000.00 per year per donee out of principal or interest.
(
k) Insurance - The Trustee may purchase new life insurance and to pay the premiums
on existing life insurance on the life of any trust beneficiary and to purchase annuities
(either commercial or private) from any corporation, trust or individual; and to procure and
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pay the premiums on other insurance of the kinds, forms and amounts deemed advisable
by the Trustee to protect the Trustee and the Trust Estate.
I) Borrowing - The Trustee may borrow money from the Trustee and others, and to
secure the repayment thereof by mortgaging or pledging or otherwise encumbering any part
or all of the Trust assets and, in connection with the acquisition of any property, to assume
a liability or to acquire property subject to a liability.
m) Repairs - The Trustee may make ordinary and extraordinary repairs and alterations
in buildings or other Trust Assets.
n) Reserves - The Trustee may establish such reserves out of income for taxes,
assessments, repairs and maintenance as the Trustee considers appropriate.
0) Continuation of Business - The Trustee may continue any business or businesses
in which I have an interest at the time of my death for so long as the Trustee may, in his
or her sole discretion, consider necessary or desirable, whether or not the business is
conducted by me at the time of my death individually, as a partnership or as a corporation
wholly owned or controlled by me, with full authority to sell, settle and discontinue any
of them when and upon such terms and conditions as the Trustee may, in his or her sole
discretion, consider necessary or desirable.
(
p) Retain Property for Personal Use - The Trustee may retain a residence or other
property for the personal use of a beneficiary and to allow a beneficiary to use or occupy
the retained property free of rent and maintenance expenses.
q) Dealings with Third Parties - The Trustee may deal with any person or entity
regardless of relationship or identity of any trustee to or with that person or entity and may
hold or invest all or any part of the Trust Estate in common or undivided interests with
that person or entity.
r) Partitions, Divisions, Distributions - The Trustee will have the power to make all
partitions, divisions, and distributions contemplated by this Trust Agreement. Any
partitions, divisions, or distributions may be made in cash, in kind, or partly in cash and
partly in kind, in any manner that the Trustee deems appropriate (including composing
shares differently). The Trustee may determine the value of any property, which valuation
will be binding on all beneficiaries. No adjustments are required to compensate for any
partitions, divisions, or distributions having unequal consequences to the beneficiaries.
s) Claims, Controversies - The Trustee may maintain and defend any claim or
controversy by or against the Trust without the joinder or consent of any beneficiary. The
Trustee may commence or defend at the expense of the Trust any litigation with respect
to the Trust or any property of the Trust Estate as the Trustee may deem advisable, and
may employ, for reasonable compensation, such counsel as the Trustee shall deem
advisable for that purpose.
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t) Merger of Trusts - If at any time the Trustee of any trust created hereunder shall
also be acting as trustee of any other trust created by trust instrument or by trust
declaration for the benefit of the same beneficiary or beneficiaries and upon substantially
the same terms and conditions, the Trustee is authorized and empowered, if in the
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Trustee's discretion such action is in the best interest of the beneficiary or beneficiaries,
to transfer and merge all of the assets then held under such trust created pursuant to this
Trust Agreement to and with such other trust and thereupon to terminate the trust created
pursuant to this Trust Agreement. The Trustee is further authorized to accept the assets
of any other trust which may be transferred to any trust created hereunder and to
administer and distribute such assets and properties so transferred in accordance with the
provisions of this Agreement.
u) Termination of Small Trust - Any corporate trustee which is serving as the sole
trustee of any trust or any share thereof may at any time terminate such trust or share if,
in the trustee's sole judgment, the continued management of such trust or share is no
longer economical because of the small size of such trust or share and if such action will
be deemed to be in the best interests of the beneficiary or beneficiaries. In case of such
termination, the trustee will distribute forthwith the share of the Trust Estate so terminated
to the income beneficiary or beneficiaries, per stirpes. Upon such distribution, such trust
or share will terminate and the trustee will not be liable or responsible to any person or
persons whomsoever for its action. The trustee will not be liable for failing or refusing
at any time to terminate any trust or a share thereof as authorized by this paragraph.
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v) Power to Determine Income and Principal - Dividends payable in stock of the
issuing corporation, stock splits and capital gains will be treated as principal. Except as
herein otherwise specifically provided, the Trustee will have full power and authority to
determine the manner in which expenses are to be borne and in which receipts are to be
credited as between principal and income, and also to determine what will constitute
principal or income, and may withhold from income such reserves for depreciation or
depletion as the Trustee may deem fair and equitable. In determining such matters the
Trustee may give consideration to the provisions of the Pennsylvania Statutes (or its
successor statutes) relating to such matters, but will not be bound by such provisions.
w) Generation-Skipping Taxes and Payment - If the Trustee considers any distribution
or termination of an interest or power hereunder as a distribution or termination subject
to a generation-skipping tax, the Trustee is authorized:
1) To augment any taxable distribution by an amount which the Trustee
estimates to be sufficient to pay such tax and charge the same to the particular
trust to which the tax related without adjustment of the relative interests of the
beneficiaries;
2) To pay such tax, in the case of a taxable termination, from the particular
trust to which the tax relates without adjustment of the relative interests of the
beneficiaries. If such tax is imposed in part by reason of the Trust Assets, the
Trustee will pay only the portion of such tax attributable to the taxable termination
hereunder taking into consideration deductions, exemptions, credits and other
factors which the Trustee deems advisable; and
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3) To postpone [mal termination of any particular trust and to withhold all
or any portion of the Trust Estate until the Trustee is satisfied that the Trustee no
longer has any liability to pay any generation-skipping tax with reference to such
trust or its termination.
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C Section 4.04. Soecial Provision for S Corooration Stock
Notwithstanding what is otherwise provided in this Trust Agreement, if at any time the Trust
contains any stock of a corporation which elects or has elected treatment as an "S Corporation" as dermed
by Section 1361(a)(I) of the Internal Revenue Code (or any corresponding successor statute), such stock
will be segregated from the other assets of such trust and treated as a separate trust. The Trustee will
further divide the separate trust into shares for each Beneficiary and such shares will be distributed outright
or held in trust as herein provided. In addition, all other provisions of this Trust Agreement will apply to
each share held in trust (and constituting a separate trust) except that the Trustee will distribute all of the
income from each separate trust to its beneficiary in convenient installments at least amlUally. It is our
intent that each separate trust will be recognized as a "Qualified Subchapter S Trust" (QSST) under Section
1361(d)(2) of the Internal Revenue Code (or any corresponding successor statute). Notwithstanding any
provisions of this Trust Agreement to the contrary, the Trustee's powers and discretions with respect to
the administration of each separate trust (including methods of accounting, bookkeeping, making
distributions and characterizing receipts and expenses) will not be exercised or exercisable except in a
manner consistent with allowing each separate trust to be treated as a QSST as above described.
ARTICLE FIVE
Section 5.01. Coordination with Settlor's Probate Estate
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a)
At any time during the continuance of this Trust including subsequent to the death
of either Settlor the Trustees may, in their sole and uncontrolled discretion,
distribute to the deceased Settlor's Probate Estate cash and/or other property as a
Beneficiary of the Trust.
b) All other provisions to the contrary notwithstanding, under no circumstances shall
any restricted proceeds, as hereinafter dermed, be either directly or indirectly: (i)
distributed to or for the benefit of the Settlor's Executors or the Settlor's Probate
Estate; or (ii) used to pay any other obligations of the Settlor's Estate. The term
"restricted proceeds" means:
I) All qualified plans, individual retirement accounts, or similar benefits
which are received or receivable by any Trustee hereunder, and which are
paid solely to a Beneficiary other than the Executor of the Settlor's Gross
Estate for Federal Estate Tax purposes; and
2) All proceeds of insurance on the Settlor's life which, if paid to a
Beneficiary other than the Settlor's Estate, would be exempt from
inheritance or similar death taxes under applicable state death tax laws.
Section 5.02. Direction to Minimize Taxes
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In the administration of the Trust hereunder, its Fiduciaries shall exercise all available tax related
elections, options, and choices in such a manner as they, in their sole but reasonable judgment (where
appropriate, receiving advice of tax counsel), believe will achieve the overall minimum in total combined
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present and reasonably anticipated future administrative expenses and taxes of all kinds. This applies not
only to such Trust but also to its Beneficiaries, to the other Trusts hereunder and their Beneficiaries, and
to the Settlor's Probate Estate.
Without limitation on the generality of the foregoing direction (which shall to that extent supersede
the usual fiduciary duty of impartiality), such Fiduciaries shall not be accountable to any person interested
in this Trust or to Settlor's Estate for the manner in which they shall carry out this direction to minimize
overall taxes and expenses(including any decision they may make not to incur the expense of a detailed
analysis of alternative choices). Even though their decisions in this regard may result in increased taxes
or decreased distributions to the Trust, to the Estate, or to one or more Beneficiaries, the Fiduciaries shall
not be obligated for compensation readjustments or reimbursements which arise by reason of the manner
in which the Fiduciaries carry out this direction.
Section 5.03. Judgment and Discretion of Trustee
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In the absence of proof of bad faith, all questions of construction or interpretation of any trusts
created by this Trust Agreement will be fmally and conclusively determined solely by the Trustee,
according to the Trustee's best judgment and without recourse to any court, and each determination-by the
Trustee is binding on the beneficiaries and prospective beneficiaries hereunder, both in being and unborn,
as well as all other persons, firms or corporations. The Trustee, when exercising any discretionary power
relating to the distribution or accumulation of principal or income or to the termination of any trust, will
be responsible only for lack of good faith in the exercise of such power. Each determination may be relied
upon to the same extent as if it were a fmal and binding judicial determination. In the event of a conflict
between the provisions of this Trust Agreement and those of the Pennsylvania Statutes, the provisions of
this Agreement will control.
ARTICLE SIX
Section 6.01. Resolution of Conflict
Any controversy between the Trustee or Trustees and any other Trustee or Trustees, or between
any other parties to this Trust, including Beneficiaries, involving the construction or application of any of
the terms, provisions, or conditions of this Trust shall, on the written request of either or any disagreeing
party served on the other or others, be submitted to arbitration. The parties to such arbitrat~on shall each
appoint one person to hear and determine the dispute and, if they are unable to agree, then the two persons
so chosen shall select a third impartial arbitrator whose decision shall be fmal and conclusive upon both
parties. The cost of arbitration shall be borne by the losing party or in such proportion as the arbitrator(s)
shall decide. Such arbitration shall comply with the commercial arbitration rules of the American
Arbitration Association, 140 West 51st Street, New York, New York 10200.
Section 6.02. Incontestabilitv
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The beneficial provisions of this Trust Agreement are intended to be in lieu of any other rights,
claims, or interests of whatsoever nature, whether statutory or otherwise, except bona fide pre-death debts,
which any Beneficiary hereunder may have in Settlor's Estate or in the properties in trust hereunder.
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Accordingly, if any Beneficiary hereunder asserts any claim (except a legally enforceable debt), statutory
election, or other right or interest against or in Settlor's Estate, or any properties of this Trust, other than
pursuant to the express terms hereof, or directly or indirectly contests, disputes, or calls into question,
before any court, the validity of this Trust Agreement, then:
a) Such Beneficiary shall thereby absolutely forfeit any and all beneficial interests of
whatsoever kind and nature which such Beneficiary or his or her heirs might
otherwise have under this Trust Agreement and the interests of the other
Beneficiaries hereunder shall thereupon be appropriately and proportionately
increased; and
b) All of the provisions of this Trust Agreement, to the extent that they confer any
benefits, powers, or rights whatsoever upon such claiming, electing or contesting
Beneficiary, shall thereupon become absolutely void; and
c) Such claiming, electing, or contesting Beneficiary, if then acting as a Trustee
hereunder, shall automatically cease to be a Trustee and shall thereafter be
ineligible either to select, remove, or become a Trustee hereunder.
Section 6.03. Svecific Omissions
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Any and all persons and entities, except those persons and entities specifically named herein, have
been intentionally omitted from this Trust Agreement. If any person or entity shall successfully challenge
any term or condition of this Trust Agreement, then, to that person or entity shall be given the sum of one
dollar ($1.00) in lieu and in place of any other benefit, grant, or interest which that person or interest may
have in the Trust Estate.
Section 6.04. Benefits Confidential
The Settlor further declares that it is his or her desire and intent that the provisions of this Trust
Agreement are to remain confidential as to all parties. The Settlor directs that only the information
concerning the benefits paid to any particular Beneficiary shall be revealed to such individual and that no
individual shall have a right to information concerning the benefits being paid to any other Beneficiary.
ARTICLE SEVEN
Section 7.01. Distribution in Kind or Cash
(
On any division of the assets of the Trust Estate into shares or partial shares, and on any final or
partial distribution of the assets of the Trust Estate, the Trustee, at his or her absolute discretion, may
divide and distribute undivided interests of such assets on a pro rata or non-pro rata basis, or may sell all
or any part of such assets and may make divisions or distributions in cash or partly in cash and partly in)o'
kind. The decision of the Trustee, either prior to or on any division or distribution of such assets, as.J~ \ ,.,1
~hat cOllS!itutes a proper ~ivision ?f ~ch assets of the Trust Estate shall be binding on a\~);soh's
mterested m any Trust proVided for m this Trust Agreement. \J -V\ \) ~o
"I,
\,,'?t
G\I}'\'
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Section 7.m. Spendthrift Provision
Neither the principal nor the income of the Trust shall be liable for the debts of a Beneficiary.
Except as otherwise expressly provided in this Agreement, no beneficiary of any trust shall have any right,
power or authority to alienate, encumber or hypothecate his or her interest in the principal or income of
this Trust in any manner, nor shall the interests of any Beneficiary be subject to the claims of his or her
creditors or liable to attachment, execution or other process of law. The limitations herein shall not restrict
the exercise of any power of appointment or the right to disclaim.
Section 7.03. Defmition of Children
The terms "child" and "children" as used in this Agreement mean the lawful issue of a Settlor.
This definition also includes children legally adopted by a Settlor.
Section 7.04. Handicapped Beneficiaries
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Any Beneficiary who is determined by a court of competent jurisdiction to be incompetent shall
not have any discretionary rights of a Beneficiary with respect to this Trust, or to their share or portion
thereof. The trustee shall hold and maintain such incompetent Beneficiary's share of the Trust Estate and
shall, in the Trustee's sole discretion, provide for such Beneficiary as that Trustee would provide for a
minor. Notwithstanding the foregoing, any Beneficiary who is diagnosed for the purposes of governmental
benefits (as hereinafter delineated) as being not competent or as being disabled, and who shall be entitled
to governmental support and benefits by reason of such incompetency or disability, shall cease to be a
Beneficiary of this Trust. Likewise, they shall cease to be a Beneficiary if any share or portion of the
principal or income of the Trust shall become subject to the claims of any governmental agency for costs
or benefits, fees or charges.
The portion of the Trust Estate which, absent the provisions of this section, would have been the
share of such incompetent or handicapped person shall be retained in trust for as long as that individual
lives. The Trustee, at his or her sole discretion, shall utilize such funds for the maintenance of that
individual. If such individual recovers from his or her incompetency or disability, and is no longer eligible
for aid from any governmental agency, including costs or benefits, fees or charges, such individual shall
be reinstated as a -lJeneficiary after 60 days from such recovery, and the allocation and distribution
provisions as stated herein shall apply to that portion of the Trust Estate which is held by the Trustee
subject to the foregoing provisions of this section. If said handicapped Beneficiary is no longer living and
shall leave children then living, the deceased child's share shall pass to those children per stirpes. If there
are no children, the share shall be allocated proportionately among the remaining Beneficiaries.
ARTICLE EIGHT
Section 8.01. Trustees
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All Trustees are to serve without bond. The following will act as Trustees of any Trusts created
by this Trust Agreement, in the following order of succession:
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First:
The undersigned, BILLY SHEALER.
Second:
eLl ,V~
LAURIE A. BRAUN and LISA M. srfgTT(''Q shall serve as Joint
Successor Trustees.
Third:
In the event that one of my Joint Successor Trustees is unwilling or unable
to serve, then the remaining Joint Successor Trustee shall continue. to
serve.
Fourth:
A Trustee chosen by the majority of Beneficiaries, with a parent or legal
guardian voting for minor Beneficiaries; provided, however, that the
children of any deceased Beneficiary shall collectively have only one vote.
Section 8.02. Allocation and Distribution of the Trust Assets
The Trustees shall allocate, hold, administer and distribute the Trust Assets as hereinafter provided:
a) Upon the death of the Settlor, the Trustee shall hold, administer and distribute the
Trust Assets in the manner hereinafter prescribed.
Section 8.03. Personal ProvertY Distribution
Notwithstanding any provision of this Trust Agreement to the contrary, the Trustee must abide by
any memorandum by the Settlor, particularly that contained in the section entitled "Special Directives"
incorporated into this Trust Instrument, directing the disposition of Trust Assets of every kind including
but not limited to furniture, appliances, furnishings, pictures, china, silverware, glass, books, jewelry,
wearing apparel, and all policies of fife, burglary, property daInage, and other insurance on or in
connection with the use of this property. Otherwise, any personal and household effects of the Senior shall
be distributed with the remaining assets of the Trust Estate.
Section 8.04. Liability of Trustee
The Trustee will not be responsible or liable for any loss which may occur by reason of
depreciation in value of the properties at any time belonging to the Trust Estate, nor for any other loss
which may occur, except that the Trustee will be liable for such trustee's own negligence, neglect, default,
or willful wrong. The Trustee will not be liable or responsible for the acts, omissions, or defaults of any
agent or other person to whom duties may be properly delegated hereunder (except officers or regular
employees of the Trustee) if such agent or person was appointed with due care. The Trustee may receive
reimbursement from the Trust Estate for any liability, whether in contract or in tort, incurred in the
administration of the Trust Estate in accordance with the provisions hereof, and the Trustee may contract
in such form that such Trustee will be exempt from such personal liability and that such liability will be
limited to the Trust Assets.
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Section 8.05. Successor Trustees
Any Successor Trustee shall have all the power, rights, discretion and obligations conferred on a
Trustee by this Trust Agreement. All rights, titles and interest in the property of the Trust shall
immediately vest in the successor Trustee at the time of appointment. The prior Trustee shall, without
warranty, transfer to the successor Trustee the existing Trust property. No successor Trustee shall be
under any duty to examine, verify, question, or audit the books, records, accounts, or transaction of any
preceding Trustee; and no successor Trustee shall be liable or responsible in any way for any acts, defaults
or omissions of any predecessor Trustee, nor for any loss or expense from or occasioned by anything done
or neglected to be done by any predecessor Trustee. A successor Trustee shall be liable only for his or
her own acts and defaults.
ARTICLE NINE
Section 9.01. Pernetuities Savings Clause
Notwithstanding any other provision of this instrument, the Trusts created hereunder shall terminate
not later than twenty-one (21) years after the death of the last survivor of the Settlor and any other
Beneficiary or Beneficiaries named or dermed in this Trust living on the date of the death of the Settlor.
The Trustee shall distribute each remaining Trust principal and all accrued or undistributed net income
hereunder to the Beneficiary or Beneficiaries. If there is more than one Beneficiary, the distribution shall
be in the proportion in which they are Beneficiaries; if no proportion is designated, then the distribution
shall be in equal shares to such Beneficiaries.
ARTICLE TEN
Section 10.01. Governing Law
It is not intended that the laws of only one particular state shall necessarily govern all questions
pertaining to all of the Trust hereunder.
a) The validity of the Trust hereunder, as well as the validity of the particular
provisions of that Trust, shall be governed by the laws of the state which has
sufficient connection with this Trust to support such validity.
b) The meaning and effect of the terms of this Trust Agreement shall be governed by
the laws of the Commonwealth of Pennsylvania.
c) The administration of this Trust shall be governed by the laws of the state in which
the principal office of the Trustee then having custody of the Trust's principal
assets and records is located.
The foregoing shall apply even though the situs of some Trust assets or the home of the Settlor,
a Trustee, or a Beneficiary may at some time or times be elsewhere.
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Section 10.02. Invalidity of anv Provision
If a court fmds that any provision of this Trust Agreement is void, invalid or unenforceable, the
remaining provisions of this Agreement will continue to be fully effective.
Section 10.03. Headinl!s
The use of headings in connection with the various articles and sections of this Trust Agreement
is solely for convenience, and the headings are to be given no meaning or significance whatever in
construing the terms and provisions of this Agreement.
Section 10.04. Internal Revenue Code Terminolol!V
As used herein, the words "gross estate", "adjusted gross estate", "taxable estate", "unified credit",
"state death tax credit", "maximum marital deduction", "marital deduction". and any other word or words
which from the context in which it or they are used refer to the Internal Revenue Code shall be assigned
the same meaning as such words have for the purposes of applying the Internal Revenue Code to a deceased
Settlor's Estate. Reference to sections of the Internal Revenue Code and to the Internal Revenue Code shall
refer to the Internal Revenue Code amended to the date of such Settlor's death.
REVOCABLE LIVING TRUST AGREEMENT
Page 17
c
SPECIAL DIRECTIVES
OF
BILLY SHEALER
I, BILLY SHEALER, a resident of the County of Cumberland, Commonwealth of Pennsylvania,
being of lawful age, and of sound and disposing mind and memory, and not acting under duress, fraud,
or undue influence, hereby make, publish and declare this to be my Special Directive, and I incorporate
this into THE BILLY SHEALER REVOCABLE LIVING TRUST AGREEMENT.
FIRST
The natural object of my affection is:
I)
My child -
BARRY L. SHEALER
SECOND
I direct that all estate and inheritance taxes payable as a result of my death, not limited to taxes
assessed on property, shall be paid out of the residue of my Estate, and shall not be deducted or collected
C from any Legatee, Devisee or Beneficiary hereunder.
l
THIRD
In the event any of my named Beneficiaries should predecease me, all of that person's share of the
Trust Estate is to be divided equally among that person's issue per stirpes.
FOURTH
I direct that before any distribution of the assets of the Trust Estate to the named Beneficiaries
certain specific distributions, if any, shall be made from the assets as set forth on the list attached hereto
and marked "Exhibit A."
REVOCABLE LIVING TRUST AGREEMENT
Page 18
c
(
(
-4
DATED to be effective this //4y of ,~4/ /
.19~7
SETTLOR:
BI~
ACCEPTED BY TRUSTEE:
~~~if~
BILLY EALER
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
This instrument was acknowledged before me on the date herein set forth by BILLY SHEALER
as Settlor and Trustee to certify which witness my band and seal of office.
REVOCABLE LIVING TRUST AGREEMENT
Page 19
LAST WILL AND TESTAMENT
(pour-Over Will)
OF
BILLY SHEALER
IDENTITY
I. BILLY SHEALER. residing in the County of Cumberland, Commonwealth of Pennsylvania, being
of sound mind and memory, and not acting under duress or undue influence of any person whomsoever,
hereby declare this to be my Last Will and Testament, and I do hereby revoke all other and former Wills
and Codicils to Wills heretofore made by me. My Social Security Number is 166-12-6841.
I have the following child: BARRY L. SHEALER, born October 18, 1940 and currently residing
in Mechanicsburg. Pennsylvania.
DEBTS, TAXES AND ADMINISTRATION EXPENSES
I have provided for the payment of all my debts, expenses of administration of property wherever
situated passing under this will or otherwise, and estate. inheritance, transfer, and succession taxes, other
than any tax on a generation-skipping transfer that is not a liability of my Estate (including interest and
penalties, if any) that become due by reason of my death. under THE BILLY SHEALER REVOCABLE
LIVING TRUST executed on even date herewith (the "Revocable Trust"). If the Revocable Trust assets
should be insufficient for these purposes, my Executor shall pay any unpaid items from the residue of my
Estate passing under this will. without any apponionment or reimbursement. In the alternative. my
Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary to pay all
or pan of these items, plus claims, pecuniary legacies. and family allowances by court order.
PERSONAL AND HOUSEHOLD EFFECTS
It is my intent that all my personal and household effects were transferred to the Revocable Trust
as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership
or disposition of these assets. it is my desire that such assets pour into the Revocable Trust. signed by me
this date in accordance with the provisions of the section titled "Residue of Estate".
RESIDUE OF ESTATE
I give, devise and bequeath all the rest, residue and remainder of my propeny of every kind and
description (including lapsed legacies and devises), wherever situated and whether acquired before or after
the execution of this Will, to the Trustee under that cenain Trust executed by me on the same date of the
execution of this Will. The Trustee shall add the propeny bequeathed and devised by this item to the
corpus of the above described Trust and shall hold. administer and distribute said propeny in accordance
with the provisions of the said Trust, including any amendments thereto made before my death.
If for any reason the said Trust shall not be in existence at the time of my death, or if for any reason
a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under
said Trust as it exists at the time of my death to be invalid. then I give all of my Estate including the
LAST WILL A.."ID TESTA..'\iIENT
Page 1
11-
-7-
residue and remainder thereof to that person who would have been the Trustee under the Trust, as Trustee,
and to their substitutes and successors under the Trust, described hereinabove, to be held, managed,
invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to the period
begiruting with the date of my death as are constituted in the Trust as at present constituted giving effect
to amendments, if any, hereafter made and for that purpose I do hereby incorporate such Trust by reference
into this my Will.
EXECurOR
I hereby nominate and appoint LAURIE A. BRAUN and LISA M. STOVCR as my Joint
Independent Executors of this my Last Will and Testament to serve without bond. In the event that one
of my Joint Independent Executors shall be unwilling or unable to serve, then the remaining Joint
Independent Executor shall continue to serve.
Whenever the word "Executor" or any modifying or substituted pronoun therefor is used in this my
Will, such words and respective pronouns shall be held and taken to include both the singular and the
plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the a~ecutor named
herein and to any successor or substitute Executor acting hereunder, and such successor or substitute
Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the
Executor originally named herein.
EXECurOR POWERS
By way of illustration and not of limitation and in addition to any inherent, implied or statutory
powers granted to executors generally, my Executor is specifically authorized and empowered with respect
to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate
between principal and income, assign, borrow, buy. care for, collect, compromise claims, contract with
respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange,
hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise
options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions
in cash or in kind or partly in each without regard to the income taX basis of such asset and in general,
exercise all of the powers in the management of my Estate which any individual could exercise in the
management of similar property owned in its own right upon such terms and conditions as to my Executor
may seem best, and execute and deliver any and all instruments and do all acts which my Executor may
deem proper or necessary to carry out the purpose of this my Will, without being limited in any way by
the specific grants or power made, and without the necessity of a court order.
My Executor shall have absolute discretion, but shall not be required, to make adjustments in the
rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences
of any tax decision or election, or of any investment or administrative decision, that my Executor believes
has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over
others. In determining the Federal Estate and Income Tax liabilities of my Estate, my Executor shall have
discretion to select the valuation date and to determine whether any or all of the allowable administration
expenses in my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions.
LAST WILL AND TESTAMENT
Page 2
~
SPECIF1C OMISSIONS
I have intentionally omitted any and all persons and entitie~ from this, my Last Will and Testament,
except those persons and entities specifically named herein. If any person or entity shall challenge any term
or condition of this Will, or of the Living Trust to which I have made reference in the sections "Household
and Personal Effects" and "Residue of Estate", then, to that person or entity I give and bequeath the sum
of one dollar ($1.00) only in lieu and in place of any other benefit, grant, bequest or interest which that
person or interest may have in my Estate or the Living Trust and its Estate.
SIMULTANEOUS DEATH
If any Beneficiary should not survive me for sixty (60) days, then it shall be conclusively presumed
for the purpose of this my Will that said Beneficiary predeceased me.
This instrument consists of 5 typewritten pages including the Attestation Clause, Self-Proving
Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at thy bottom of
each 0 the preceding pages. This instrument is being signed by me on this II [:L day of
,19 91
-r;;ll'L 7tti~~
BILL SHE ER,
Testator
LAST WILL AND TESTAMENT
Page 3
;,g
-
ATTESTATION CLAUSE
The Testator whose name appears above declared to us. the undersigned, that the foregoing
instrument was his Last Will and Testament, and he requested us to act as witnesses to such instrument and
to his signature thereon. The Testator thereupon signed such instrument in our presence. At the Testator's
request, the undersigned then subscribed our names to the instrument in our own handwriting in the
presence of the Testator. The undersigned hereby declare, in the presence of each of us, that we believe
the Testator to be of sound and disposing mind and memory.
Signed by us on the same day and year as this Last Will and Testament was signed by the Testator.
WITNESSES:
ADDRESSES:
lJt.dIkr.v ~ tv~
fI1 .4 'ff he tt/ i3 fA.} ala dr,'n '7
(Printed Name of Witness) ./
~u l{ fern ;7"N c.{Yy/,de-
/fi /7tJi3
~~ ;./~/~
;{DW nnl?- kon ;<1: L
{Printed name of Witness
.,Boe FE R 1'1/ t9 It....
fit / 7 D i 3
(!Ps-R),$Ic...
LAST Wll..L AND TESTAMENT
Page 4
-!J
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SELF-PROVING CLAUSE
BEFORE ~E, the und~rsigned aUthOri~ on this day personally appeared BILLY SHEALER,
/~/;tf he-I.'" b. Wa,{}P)rl ~?, ,and IJl.i:inne.... ktJnK.t:L known to me to be the
Testator and the wimesses, respe uvely, whose names are subscrIbed to the foregomg mstrument m therr
respective capacities, and all of them being by me duly sworn, BILLY SHEALER, Testator, declared to
me and to the wimesses, in my presence, that the instrument is his Will and that he had willingly made and
executed it as his free act and deed for the purposes therein expressed; and the wimesses, each on his oath,
stated to me in the presence and hearing of the Testator, that the Testator had declared to them that the
instrument is his Will and that he executed the same as such and wanted each of them to sign it as a
wimess; and upon their oaths, each wimess stated further that he did sign the same as a wimess in the
presence of the Testator, and at his request and that he was at that time eighteen (18) years of age or over
and was of sound mind, and that each of the wimesses was then at least fourteen (14) years of age.
tMft;U,--
BILLY SH ALER,
Testator
~ui& 'd'~
Wimess
fH -9 rr ),P-u/ f W ~()(~/, In c;,
(Printed Name of Wimess) ./
/:(~ ;/;-n~
Wime,~
f<oiu nne- ;< DN KE.L
(Printed Name of Wimess)
SUBSCRIBED AND ACKNOWLEDGED BEFORE ME by BILLY SHEALER, Testator, and
sUbscribj{ and sworn to before me by 91tA lfA~ f w~ad;,'.t1J and
{) {CJ h n ~ K 0 h kL , wimesses, this the / / Zff day of
19 9/ .
LAST WILL AND TESTAMENT
Page 5
It-
04/20/2005 09:21
7176123105
GOVERNMENT DIVISION
PAGE 09/10
r:\1 M&rBartk
,- ...~ .~'.-;:~-:~~, ~';~;'~:' :::;';~';- :~~::,-~ ".:~,~I~:.I"...~'r :'~: ~ 2~,~ ;{;;:~.'~'~:f:'~i!~':
. .......' ..... ---r-..........-.- _-' :r._..r-_...\J ..:.:;J;......--.~_...,.J,..-.:..JW.. ,',
. . .' . 1-..... '.: "<.j...:.' ::".,. ~". .' '1.
INDIVIDUAL RETIREMENT ACCOUNT
M&T BANK AS TRUSTEE FOR
4319 .,3,278
BILl. If SHEALER
955 S 29TH ST
CAMP HILL PA 17011
1~;~~;~BA1fK;W;:tt\lM_;:~f:~ii1 16-0538020 J
M&T
TELEPHONE BANKING CTR
PO BOX 767
BUFFALO, NY 14240
800-829-1924
1~!~~::~j~!;~~!~tfj~t~!!~~!1='1;~1 1 0 - 25- 22
li~~;~~~:~~;7,;~~~~;;;~;;;;;;;~51ij;;;,,~;:e~;~t?;:j1~f:~;~;~;;!~!~tlQ~QE'UR1P,flOJf~f:;;;;;;;;;@~1~5i!;~t~~~~;~;iij;iA'MQV,t<<:=f:~~f:~~~m;if::;~~~.!~~!~;i1~ii:i~f:~;~!~l~t!if:!!f:~1
ACCOUNT NO 35-004200210570 ACCOUNT TYPE 30-36 MONTHS RATE 5.440
MATURING 12-31-04 REGULAR IRA
01-01-04 BEGINNING BALANCE
03-30-04 INTEREST
04-23-04 TRANSFER IN-INTERNAl.
05-03-04 PAYOUT DISTRIBUTION
06-30-04 INTEREST
09-20-04 INTEREST
09-20-04 TRANSFER OUT TO BENEFICIARY
59.15
38.30
426.85-
58.21
51.17
6,646.79-
6,866.81
6,925.96
6,964.26
6.537.41
6.595.62
6.646.79
.00
TYPE 18-24 MONTHS
IRA
ACCOUNT NO 35-004200306139 ACCOUNT
MATURING 09-30-04 REGULAR
01-01-04 BEGINNING BALANCE
02-02-04 PAYOUT DISTRIBUTION
03-31-04 INTEREST
04-23-04 INTEREST
04-23-04 TRANSFER OUT-INT~RNAL
426.85-
9.87
.03
38.30-
RATE 1. 190
455.25
28.40
38.27
38.'50
.00
ACCOUNT NO 35-004200347745 ACCOUNT TYPE 30-36 MONTHS RATE
MATURING 12-31-06 REGULAR IRA
01-01-04 BEGINNING BALANCE
06-30-04 INTEREST
06-30-04 ACCOUNT RENEWED
08-02-04 PAYOUT DISTRIBUTION
**~ CONTINUED NEXT FORM ***
L007 (11iP'l1
121.68
426.85-
3.200
6,534.91
6,656.59
6,229.74
..,..:L.'.
. . .,.,' .~i~~;{.~;.';~f,~:~:"'.':~
,'i..... ""..:
04/20/2005 09:21 7176123105
~ M&fHank.
GOVERN~~NT DIVI?I~. . PAGE 10/10
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.. -- - -. . -..... ---. J - ~ '---"-)J '-" .'. _J._.,l~_J\J..J ... ...
" . .. ',,: . . t.. ".' ....;.:: ':,' "
;i.;!;~;\;C;t~i~:m~"IJ;iHU.~J!:!iR!~:;~1~;;i;jii. ';;!':'J:!~!1J"~;lI:;:;NOi~gi!~:
166 12-6841 0166126841
INDIVIDUAL RETIREMEMT ACCOUNT
M&T BANK AS TRUSTEE FOR
MIH
TELEPHONE BANKIHG CTR
PO BOX 767
BUFFALO, NY 14240
800-829-1924
4319 43,279
BILL V SHEAlER
955 S 29TH ST
CAMP MILL PA 17011
H;~~~~~AKf(ijD';IN!lMIleR'I;;!~~1 16-0538020
ti~,,,~~il~i;Bi~:ttij~T;e:!~~~~\'~iill 1 0 - 2 5 - 2 2
;;,l;;~~:;!ir,1~;::~;,i;;;:!!rIU;Ei~~~;~~!ii~i;~~l:~;:;i;ij'.i ii!;;g~;;;?j;~QN!!l1mJ;1l!'~fP'E~~RIP.JlJ01t"~5'ii;iI~n!;~~~;~I;[;;;;iilj~~i;;;";;~ ~r.l,,~,';:;;;'g3~~!i~;~tiAliI E~;;;ifj~;::::~,\~j~~
;:iI;if;I;i;;
09-20-04 INT~REST 46.19 6,275.93
09-20-04 TRANSFER OUT TO BEN~FICIARV 6,275.93- .00
B~GIN PLAN BAL
PLUS DEPOSITS
NET INTEREST
LESS DEDUCTIOMS
PLAN
13,856.97
.00
346.30
14,203.27
SUMMARY
DISBURSEMENTS
FED TAX WITHHELD
ST TAX WITHHELD
TOTAL PLAN VALUE
1,.260.55
.00
.00
.00
2004 IRA CONTRIBUTION INFORMATION
THE FalLOWING IS YOUR FORM 5498 TOTALS. BECAuse THE
AMOUNTs ARE ZERO, NO REPORTING TO THE I.R.S HAS OCCURRED
BOX 1 - IRA CONTRIBUTIONS IN 2004 OR 2005 FOR 2004 0.00
BOX 2 - 200~ ROLLOVER CONTRIBUTIONS 0.00
BOX 5 - FAIR HARKET VALUE OF PLAN AT END OF 2004
0.00
.. .~.__. ... __H.____.... __,_,_,__,_"_, ,'"
" .~:' -
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,
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LOOTI11""!
64/26/2665 69:21
7176123165
GOVERNMENT DIVISION
PAGE 62/16
~
Allstate.
Glenbrook Life and Annuity Company
PO Box 94042
Palatine IL 60094-4042
Telephone; 1-800-755-5275
Fax: 1.847-402-5313
REV LIVING TRUST OF BILLY SHEALER
955 S 29TH STREET
CAMP HILL PA 1701 Hl805
September 29, 2004
jij;~i'i\~~jm:;~r!~~~i~~~~~~~~~i~t.l!r!l~)~~j,;;
RICHARD S CONKLIN III
M & T SECURITIES, INC.
1601 W HARRISBURG PIKE
MIDDLETOWN PA 17057-4913
(717)558-1619
Allstate. Select 2000 Annuity Statement
# GA16175288
Beginning Account Balance 06/28/04 .................. _ _ . _ . . . . . . . . . . . . . . . . . . . . . . . . .. $ 106.355.36
Interest Earned 06/28/04 thru 09/28/04 ........... _ . . . . _ _ _ . . , . . . . . . . . . . . . . . . . . . . i . . . . . . .. $ 913.16
Ending Account Balance 09/28/04 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . _ . . . .. $ 107,266.54
~H~i;~\~:1f.j~j;;\i!~~1;;:,~;1)Ai1)!';::r,:::;i:\ ::~t! :~~W;~~~~~bij\rl~~Lij~:p'~~!~:~!:qp:;i~~f~~,;jf\i;~,;i~l;g~;r;i:~;;ji~~;;/!~:i:,':: :::::/:..:',
.~ .1.
. ,"
Current
Rate
Fund
Value
3.45%
$ 107,268.54
New effective annual rates for each fund will be determined when the current guarantee expires.
..:-:----.-- -.""';. ."-"-
If you have any questions concerning your annuity please contact your 'representatIVe at your financial institution.
Glenbrook Life and Annuity Company issues fixed and SEe-registered insurance products. SEC-registered
insurance products are underwritten by ALFS, Inc. Both Glenbrook UI. and ALFS are wholly owned
subsidiaries of Allstate Life Insurance Company.
~
~
B1408NHD.NOl
1..1IOfIlt1'~NO,"'~
04/20/2005 09:21
71 761231 05
GOVERNMENT DIVISION
PAGE 03/1I:l
i\merUs Annuity Group Co.
555 Soutb l<aJ1SM Ave '
Topeka. KS 66603
l-800-ANNUITY
September 25, 2004
AMERUS
Annuity GrQup
Lori Braun
955 S 29th St
Camp Hill. PA 17011
Re: American Investors Life Insurance Company
Policy Number - 295597
Annuitant - Billy Shealer (Deceased)
Dear Ms. Braun:
We were sorry to learn of the death of Billy Sheeler and offer our deepest sympathy to his family and
friends.
Please read the enclosed General Instructions for Completion of Annuity Death Claim Form. These
instructions list the documents required to process the claim on Policy #295597.
Our records indicate the benefioiary designation is the Billy Sheeler Revocable Living Trust
Agreement dated April 11, 1994. The Death Benefit provided by this policy is the Accumulated Value
($407,484.93) applied under a fixed period equal to five years or longer. We have enolosed an
illustration of a five-year payout with monthly benefits for your review. Annual, seml-annual and
quarterly payouts may also be chosen. We will be pleased to provide illustrations of alternative payout
options for your review. In lieu of the Accumulated Value under a fixed period. the BenefiCiary may
elect to receive the Cash Surrender Value ($397.523.30) in a lump sum.
The death benefit will be paid with interest from the date of death to the date of payment or other
settlement at the same rate that the Company would have credited jf the Annuitant had not died. The
credited rate Is currently 3.00 percent.
If you should have any questions or need additional assistance, please do not hesitate to contact our
Customer Service Department at 1-686-ANNUITY.
Sincerely,
$rd..L.. G., D~~
Sarah A. Crawford
Claims Specialist
Enclosure
1-888-ANNUITY
((;I l$"fT)MER SF.iIMCE)
AMERllS
tift
1-811R-252-S530
f(:t~STm."'CIJ)
AMERICAN]ilYESTORS Un;
.1_""",,,,,,...'''--
04/20/2005 09:21
7176123H'5
n
AM
October 25, 2004
BILLY SHEALER RLT DTD 4-11-97
C/O LAURIE BRAUN & LISA CLINE
TRUSTEES
955 S 29TH STREET
CAMP HILL, P A 17011
Re: Billy Shealer . Deceased
Annuity Contract No. 304257
Dear Bi.lly Shealer Rlt Dtd 4-1 ] -97;
GOVERNMENT DIVISION
PAGE 13&/113
Please find enclosed our chec.k in the amO\U1t of $27,485.67 representing the total claim payable
for the above named contract. The claim check amount was calculated as follows:
Gross Claim Amount
3% Interest from Date of Death
Less Federal Tax Withholding
Less State Tax Withholding
Less Surrender Charges
Total Check Amo\U1t
$30,785.39
$86.67
$0.00
$0.00
$3,386.39
$27,485.67
As a result of this payment of proceeds, $485.67 will be reported as income to the Internal
Revenue Service (IRS). You will receive a 1099R tax fonn reflecting the distribution amounts.
We hope this claim has been handled as desired. If you have any questions, please contact our.
office at
1-866-661-7] 25.
Sincerely,
~~
Roberta OePorter, AAPA
Senior Annuity Analyst
Special Services Division
cc; Gentry
enclosure
P.O. Box 71216' Des Moines, IA 50325. Phone (516) 221.0002' 1 (888) 221-1234' Fax (515) 221-9947
www.amerioan-equity.com
~] IVl&:l' J:Sa1lK
ACCOUNT NO. ACCOUNT TYPE
570575 M&T SELECT WITH INTEREST
STATEMENT PERIOD
PAGE
DEC.24-JAN.21,2005
1 OF 1
00 0 04350M NH 017
56648
BILLY SHEALER REVOCABLE LIVING TRUST
TUA DTD 4/11/97
BILLY SHEALER, TTEE
955 S 29TH ST
CAMP HILL PA 17011
INTEREST PAID YEAR TO DATE
10.47
TRINDLE ROAD OFFICE
BEGINNING DEPOSITS & OTHER .. CURRENT ENDING
. BALANCE OTHER ADDITIONS .. CHECKS PAID. .... SUBTRACTIONS . INTEREST PD . BALANCE
NO. I AItOUNT NO. I AMOUNT NO. I AMOUNT
131,174.78 01 0.00 or 0.00 o I 0.00 10.47 131,785.25
ACCOUNT SUMMARY
POSTING . ... .... . . . DEPOSITS,INTEREST CHECKS & OTHER DAILY
.DATE . .. . TRANSACTION DESCRIPTION .. ...... ililTilERADDITIONS SUBTRACTIONS. BALANCE
12-24-04 BEGINNING BALANCE $131,774.78
01-21-05 INTEREST PAYMENT 10.47 131,785.25
ENDING BALANCE $131,785.25
ACCOUNT ACTIVITY
ANNUAL PERCENTAGE YIELD EARNED = 0.10 %
FOR QUESTIONS ABOUT YOUR ACCOUNT CALL 1-800-724-2440.
DO YOU HAVE "LESS-THAN-PERFECT" CREDIT OR ARE YOU SELF-EMPLOYED1
It&T'S ALTERNATIVE LENDING MORTGAGES ARE DESIGNED FOR THOSE:
- WITH HIGH MONTHLY BILLS.
- WHO HAVE DIFFICULTY DOCUMENTING THEIR INCOME.
NOW AVAILABLE IN NEW YORK, PENNSYLVANIA, MARYLAND, VIRGINIA AND WASHINGTON DC.
TO FIND OUT MORE, CALL US AT 1-800-436-0798. It&T IS AN EQUAL HOUSING LENDER.
L0118A (1/03)
"::.,
mJ M&rBank
ACCOUNT NO. ACCOUNT TYPE
15004205740027 M&T MARKET ADVANTAGE
STATEMENT PERIOD
PAGE
NOV.04-FEB.03,2005
1 OF 1
00 0 04350M NM 017
17720
BILLY SHEALER TUA DATED MM/DD/YY
LAURIE BRAUN, TRUSTEE
955 S 29TH ST
CAMP HILL PA 17011
INTEREST EARNED FOR STAlt:MEI'tT PERIOD
INTEREST PAID YEAR TO DATE 405.68
5i12.44
TRINDLE ROAD OFFICE
BEGINNII'tG DEPOSITS & WITHDRAWALS &.OTHER CURRENT . ENDING .
BALANCE OTHER ADDITIOtlS .. SUBTRACTIONs . INTEREST PAID BALANCE
NO. I AMOUNT NO. I AMOUNT
10,793.32 11 399,450.15 11 200,000.00 502.06 210,745.53
ACCOUNT SUMMARY
POSTING DEPOSITS,INTEREST W/DRAWALS & OTHER DAILY
DATE . TRANSACTION DESCRIPTION . .... & OTHER ADDITIOtlS SUBTRACTIONS BALANCE
11-04-04 BEGINNING BALANCE $10,793.32
11-19-04 DEPOSIT 399,450.15 410,243.47
11-26-04 CUSTOMER WITHDRAWAL 200,000.00 210,243.47
12-03-04 INTEREST PAYMENT 96.38 210,339.85
01-03-05 INTEREST PAYMENT 178.72 210,518.57
02-03-05 INTEREST PAYMENT 226.96 210,745.53
ENDING BALANCE $210,745.53
ACCOUNT ACTIVITY
ANNUAL PERCENTAGE YIELD EARNED
1.11 7.
DO YOUR TAXES ONLINE WITH TURBOTAXIR) FOR THE WEBISM), SERVICE BROUGHT TO YOU
BY M&T! IT'S EASY, THERE IS NO SOFTWARE TO DOWNLOAD OR INSTALL. FILE YOUR
RETURN ELECTRONICALLY TO GET YOUR REFUND FASTER. THE EASYSTEPIRJ INTERVIEW ASKS
YOU SIMPLE QUESTIONS AND PLACES YOUR ANSWERS INTO IRS APPROVED FORMS. THERE IS
NO RISK - TRY IT BEFORE YOU PAY! GET STARTED AT WWW.MANDTBANK.COM/TURBOTAX5!
TURBOTAX AND EASYSTEP ARE REGISTERED TRADEMARKS AND TURBOTAX FOR THE WEB IS A
SERVICE MARK OF INTUIT INC.
LOOBA (1/U3)
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Payments J
Date Patient Patient ID Description Charges ~djustments Bal.
09/02/04 Billy Shealer 41715 Single Tooth Extraction # 21 90.00 0.00 9
Keep this portion for your records
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Current 31.60 61.90 91.120 121+ Unapplied Total Current Balance 90.00
90.00 0.00 0.00 0.00 0.00 0.00 90.00 Less Pending Insurance 0.00
Drs. Currie & Hecht Due Now $ 90.00
Oral & Maxillofacial PC
For billing Inquiries call: 117.249.7007
Thank you for your prompt payment.
DATE
o g Jz;~/{)'1
ALAN C. HUFF, DDS
100 Shell Street
Harrisburg, PA 17109
1-866-807-7161 (Toll Free)
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SERVICES RENDERED
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TOTAL
FEE
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BROCKIE PHARMATECH
209 NORTH BEAVER STREET
YORK, PA 17403
A FINANCE CHARGE OF 1.50 % PER MONTH
(AN ANNUAL PERCENTAGE RATE OF 18.00 %) WILL B~
C~ARGED ON ALL AMOUNTS 30 DAYS OR MORE PAST
, DUE
PHONE: 717-854-9028
STATEMENT OF ACCOUNT
STATEMENT DATE:0 9 /24 /2004
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iJh:Avot"~ ;:"F:tJ4~NFE',!CH~R~ES;P;L E p,SE . PAXiBY;'T H E
fHEfO,L Lp"Jnrif:'l'101'{FH~'-' 'j'HANK:':'YDU 1-_
- - - . ,
SHEALER. BILLY
LAURIE BRAUN
955 SOUTH 29TH STREET
CAMP HILL PA 17011
SHE ABA
GRP-CG
PAGE 2
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AMOUNT PAl
BROCKIE
17403
1124.39
MED. OED.
FOR r10rl fH
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LEGEND
FOR 1'10rHH
.00 15.00
.00 5.90
~00 27'.52
.00 5.70
.00 6'.00
.00 25.78
.00 6,00
.00 1.14
.00 15.00
.00 16.35
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NON-LEGEND
FOR i'10NTH
242.89
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BILLY SHEALER
LAURIE BRAU~ Y
16 RIDDLE RD. PH. (717)975-1772 ""'_ '77-0 60-29&1313
CAMP HIll, PA 17011 Date ,L c7" 4335
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CHURCH THE CHURCH OF GOD HOME, INC.
OF GOD SOl N. HANOVER STREET
HOME CARI.1SU:. PA 170U
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LAURIE BRAUN
955 SOUTH 29TH STREET
CAMP HILL PA 17011
PLr::ASE :lCTACH ,L\ND L;r.:TI.):.:.i'~ "l"HIS POFiT!CH V'.j:T~j YOUR FAY~\..1Er.n
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