HomeMy WebLinkAbout04-09-15 (2) Pennsylvania
1505618627 3M464710.000
DEPARIMENT OF REVENUE Ex(03-14)(TP)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 21 14 1223
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
12032014 06101927
Decedent's Last Name Suffix Decedent's First Name MI
ADRIAN BETTY J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(date of death
prior to 12-13-82)
❑ 4. Agriculture Exemption(date of ❑ 5. Future Interest Compromise(date of ❑ 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
7. Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
❑ 10. Litigation Proceeds Received El11. Non-Probate Transferee Return ❑ 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
❑ 13. Business Assets ❑ 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JAMES K . NOEL, IV, ESQ • 717-581-3709
First Line of Address
570 LAUSCH LANE
Second Line of Address
SUITE 200
City or Post Office State ZIP Code
LANCASTER PA 17601
Correspondent's email address: J N 0 E L a@ M W N - C 0 M C= �. .
C` M
REGISTE4F jWLLS USE O -
REGISTER OF WILLS USE ONLY C { a
DATE FILED MMDDYYYYrn rr,
CD
a> �
DATE_'Fll;EiW STAMP l'— t"-
y CTS
PLEASE USE ORIGINAL FORM ONLY
Side 1
I IIIIII VIII(IIII VIII VIII VIII(IIII(IIII(IIII VIII IIII IIII
1505618627 1505618627
1505618635
REV-1500 EX(TP)
Decedent's Social Security Number
Decedent's Name:ADRIAN BETTY d
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0.110
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2. 0.00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 3, 0-0a
4. Mortgages and Notes Receivable(Schedule D), , , , , , , , , , , , , , , , , , 4. 0.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E), , , , , , 5. 2171030-00
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested. . . . . 6. 0•00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested, , . , . 7. 0.00
8. Total Gross Assets(total Lines 1 through 7) 8. 217,030-0 0
. . . . . . . . . . . . . . . .
9. Funeral Expenses and Administrative Costs(Schedule H), , , , , , , , , , , , , 9. 141338•00
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1), . , , , , , , , , 10, 91498.0 0
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . 11. 23,836-00
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , .. .12; 193,194 •00
13; Charitable and Governmental Bequests/Sec.9113 Trusts for which
an,election to tax has not been made(Schedule J) . ... , , , , , . . . , 13,, 13-00
14. Net Value Subject to Tax(Line 12 minus Line 13), , , , , , , , , , , , , 14. 1931l94 -00
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers udder Sec.9116
(a)(1.2,_01? 0.00 15. 0.00
16. Amount of Line Vexable
at lineal rate X.0- 193,195.00 16. 81694 .00
17. Amount of Line 14 taxable
at sibling rate X.12 0.00 17. 0. 00
18. Amount of Line 14 taxable
at collateral rate x..15 0 1 0 0 18. 0.0 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 81694.00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENTXI
Under penalties of perjury,I declare that I have examined this return,Including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete. Declaration of preparer other than the person responsible for filling the return is based on all information of which preparer has
an knowledge. I ,n
S ATUR QF PERSON RESPO S LE FOR FILING RETURN DATE
DRESS
6 E MAIN 'ST; RICHLAND, PA . 17087 872 MMO D,' PORT ANGELES, WA
SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE 5ETURN Q E
MCNEES WALLACE 8 NURICK_ LLC., BY: ( 5
ADDRESS:..
570 LAUSCH LANE,. SUITE 200, LANCASTER, PA 17601
Side 2
iii�ii�ii
1505618635
3M484810.000
REV-1500 EX(TP) Page 3 File Number
Decedent's Complete Address: 21 14 1223
DECEDENTS NAME
ADRIAN BETTY
STREET ADDRESS
100 MOUNT ALLEN DRIVE
CUMBERLAND COUNTY
CITY STATE ZIP
MECHANICSB G PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 8,694 - 00
2. Credits/Payments
A. Prior Payments 81336 - 00
B.Discount 435 - 00
(See instructions.) Total Credits(A+B) (2) 8'1 7 71 • 0 0
3. Interest
(3) 0 . 00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4) ?? . 00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0 . 00
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑
11
b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . . . . . ❑❑
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . . . . . ❑
EE
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death ❑
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? . . . . . ❑
4. Did decedent own an individual retirement account,annuity,or other non-probate property,which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116 (a)(1.1) (ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a step-parent of the child is 0 percent[72 P.S$9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.$9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S.$9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
3M4671 4.000
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOF REVENUE CASH, BANK DEPOSITS& MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Bett". Adrian 21 14 1223
Include the proceeds of litigation and the date the proceeds were received by the estate.
Al!property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I. PNC Bank Savings Account #5006132154 217,010
Interest accrued to 12/3/2014 15
2 Erie Insurance, refund 5
TOTAL(Also enter on line 5,Recapitulation) $ 217,030
2W46AD 2.000 If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
INHEMTANCE TAX RETURN ADMINISTRATIVE COSTS
RESiDENTDECEDENT
ESTATE OF FILE NUMBER
Betty J. Adrian 21 14 1223
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1, Myers Buhrig Funeral Home and Crematory Ltd.
Funeral expense 3,735
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: 9,781
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 Fees:
6. Tax Return Preparer Fees:
7.
1 McNees Wallace & Nurick LLC
Costs:
Advertising $ 275.00
Travel Exp. 59.11
Postage 17.50
Certified Copy 5.00
Total from continuation schedules . . . . . . . . . 822
TOTAL(Also enter on Line 9,Recapitulation) $ 14,338
3W46AG 2.000 If more space is needed,use additional sheets of paper of the same size.
Estate of: Betty J. Adrian 21 14 1223
Schedule H Part 7 (Page 2)
1 Courier Service 8.75
Photocopy Exp. 20.80 386
2 McNees Wallace & Nurick LLC
Probate Fees 436
Total (Carry forward to main schedule) 822
REV-1512 EX+(t2SCHEDULE
pennsylvania
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Betty J. Adrian 21 14 1223
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Messiah Lifeways
Balance due 9,498
TOTAL(Also enter on Line 10,Recapitulation) $ 9,498
2w46AH 2.000 If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Betty J. Adrian 21 14 1223
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
i. Barbara Adrian
26 E. Main Street
P.O. Box 66
Richland, PA 17087
One Fifth of Residue: 38,639 Daughter 38,639
2 Gail F. Lockhart
872 E. Simmons Road
Port Angeles, WA 98362
One Fifth of Residue: 38,639 Daughter 38,639
3 Lawrence J. Adrian, Jr.
4016 Carteret Drive
Winter Haven, FL 33884-5212
One Fifth of Residue: 38,639 Son 38,639
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
NON-TAXABLE DISTRIBUTIONS
A,SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
i.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0
9W46AI 2.000 If more space is needed,use additional sheets of paper of the same size.
Estate of: Betty J. Adrian 21 14 1223
Schedule J Part 1 (Page 2)
Item
No. Description Relation Amount
4 Deborah A. Burd
105 Hirschmann Road
Biglerville, PA 17307
One Fifth of Residue: 38,639 Daughter 38,639
5 Betty J. Adrian Special Needs Trust
f/b/o Paul M. Adrian
Barbara Adrian, Co-Trustee
26 E. Main Street, P.O. Box 66
Richland, PA 17087
One Fifth of Residue: 38,639 Son 38,639
LAST WILL AND TESTAMENT
OF
BETTY.J.ADRIAN
1, BETTY J. ADRIAN, of Upper Allen Township, Cumberland County, Pennsylvania, do make,
publish and.declare this as and for my Last Will and Testament, hereby expressly revoking all wills and
codicils made by me heretofore,and dispose of my estate as follows:
ITEM 1: 1 direct the payment of my legally enforceable debts and funeral expenses,including
a suitable and proper grave market•,as soon icis conveniently can be done following my decease.
ITEM 2: 1 direct that all State and Federal Transfer Inheritance Tax, Estate Tax, Succession
Tax or any.other taxes, of any:kind whatsoever, including any interest, assessments or penalties thereon,that
may become due and payable by virtue of my death,or by virtue of the passing of any property either tinder
my Last Will and Testament,or in any other manner,shall be paid by my estate,just as if such taxes were my
debts,and no beneficiary shall be required to pay or refund any partthereof Taxes on future interests may be
prepaid.
ITEM 3: 1 give and bequeath all of my articles of household use in my home and my tangible
personal property equally into my children,GAIL F.LOCKHART,BARBARA ADRIAN, LAWRENCE J.
ADRIAN,JR.,DEBORAH A.BURD,and PAUL M.ADRIAN,subject to my specifically bequeathing any
such items unto any other beneficiaries in accordance with the Mernoranduin, if any,attached to this,my Last
Will and Testament. If such property cannot be selected by agreement of the parties involved, my Executor
may divide the same among those involved. An),remaining undivided and undistributed articles of household
use shall pass into the residue of my estate:.
ITEM 4: 1 give, devise and bequeath all of the rest, residue and remainder of my estate, of
NvIialsoever nature and wheresoever situate, equally .unto my children, GAIL F. LOCKHART, BARBARA
ADRIAN, LAWRENCE J. ADRIAN, JR., DEBORAH A. BURD, and PAUL M. ADRIAN, The share of
any thereof deceased at my death with issue surviving shall pass by representation to.such issue surviving.
The share of any thereof deceased at my death without issue surviving shall lapse in favor of the other, if
surviving, or if the other is trot surviving but leaves issue surviving, unto such surviving issue, per stirpes. .I
further direct that any share distributable as a result of my death to PAUL M. ADRIAN, shall instead be
given unto the'Trustce appointed in Item 11, below, to be field in trust and administered and distributed as
follows:
A. Special Necds. For purposes of this Trust, "Special Needs" refers to the non-support
requisites for maintaining the health, safety, and welfare of illy son, PAUL M. ADRIAN, when, in the
discretion of Trustee; such non-support.requisites are not being provided by ally public agency, office, or
department of any local, state, or the federal government.
B. Pur pose. Trustee shall hold, manage, administer, and distribute the principal and income
of the Trust for the erosive benefit of illy son, PAUL M. ADRIAN, during his lifetime. My intent and
the purpose of this "Trust is to supplement and not to supplant the benefits and services that my son,
PAUL M. ADRIAN, may from time to time, be eligible to receive from various governmental and public
assistance programs by reason of age, disability, or other factors. This Trust is not for the primary
support of my son, PAUL M. ADRIAN, nor is it my intention to displace public or private financial
assistance that may otherwise be available to Trim. Trustee shall consider such benefits and services prior
to malting a discretionary distribution from the Trust, and under no circumstances shall my son, PAUL M.
ADRIAN, be considered to be the owner of or have access to the principal Mid income of the Trust.
Trustee's actions shall be directed toward carrying out this intent, and the discretion granted to Trustee
under this agreement to carry out this intent.is absolute. Ill carrying out my intent, the following shall be
instructive but iii no way impair or limit the Trustee's discretionary authority:
I. Background. This Special Needs Trust contains instructions for providing for the
Special Needs of my son, PAUL M. ADRIAN. All actions of Trustee, includingthose with
respect to distributions from this Trust, shall be in Trustee's .sole and absolute discretion; the
information herein is provided merely as guidance in exercising that discretion ill the best interest
of my son, PAUL M. ADRIAN. All parties to this Trust should be mindful of my desire for my
2.
son, PAUL M. ADRIAN, to live as productively and as happily as possible, consistent with the
reasonable protection of his healtli and welfare. Although it is expected that my son,.PAUL,M.
ADRIAN, will always require support and assistance witlr basic living needs, my primary
objective is for my son, PAUL M. ADRIAN, to experience a high level of health and emotional
well-being, and to support him in his efforts to remain as independent as possible.
2. Social Needs. It is important,that my son, PAUL M. ADRIAN, not be isolated
and that he is supported in his efforts to build a fulfilling life that includes meaningful social
activities, social contacts, leisure, recreation, and travel experiences: My intention is for Trustee
to support the participation of my son, PAUL M, ADRIAN, in social activities of all types
(cultural,recreational,sports, etc).
3. Family Activities. Maintaining contact with my f-amily is of the highest priority.
I encourage distributions from the Trust to facilitate regular visits with the family of my son,
PAC7L, M. ADRIAN. I also support distributionsfrom the Trust so that my son, PAUL M.
ADRIAN,may participate in fancily reunions,vacations,or other family events.
4. Memorandum of Intent. The foregoing subparagraphs are meant to give guidance
to Trustee to fulfill the objectives of this Trust. I direct Trustee to consider any Memorandum of
Intent that i may sign to further clarify my wishes of how Trustee shall exercise any discretionary
distributions of funds or resources of this Trust.
C. ,Special Needs the Trustee Shall Consider. My son, PAUL, M. ADRIAN, may have
Special Needs relating to medical and dental care, attendant care support services, supplemental health
care, therapeutic care that governmental assistance programs may not provide, and other non-support
requisites, his access to which is important for his health and well-being. When making distributions,
Trustee is directed to consider but not be limited by the following examples of Special Needs:
I. Medical Needs. My son, PAUL M. ADRIAN, may have basic needs such as,
medical and dental care, diagnostic work and treatment, psychological and psychiatric support
services, attendant su pportsery ices, supplemental health care, plastic surgery, and other care that
3
public benefit assistance programs may not provide or for,which public funding is not available.
Special Needs shall include, but not be limited to, occupational therapy, physical therapy, and
speech therapy not covered by public benefits, medical and dental expenses, supplemental
nursing care and rehabilitative services, appropriate care that assistance programs may not
otherwise provide, annual independent checkups, equipment, programs of training, education,
treatment and rehabilitation, eye glasses, essential supplementary dietary heeds, and medical
procedures that are desirable in the discretion of Trustee, even though they may not be necessary
or.life saving. Special.Needs sliall also include regular medical checkups and general preventive
healthcare, including annual vision and dental cliecks. .I desire for zny son, PAUL M. ADRIAN,
to be periodically evaluated by medical professionals to ensure that lie maintains the best possible
health and well-being. Trustee has complete discretion to-authorize expenditures not covered by
public benefits that relate to identifying, diagnosing, and treating any condition lie may develop,
so that lie can maintain optimal overall fimctiotihig and to minimize hospitalization whenever
possible..
2. :Residential Needs. Trustee should consider distributions for such things as
residential expenses beyond basic rent costs, including private residential care, furnishings,.
utilities (other than .gas, electricity, and Nvater), Internet and computer expenses, telephone and
television service, insurance, and differentials in cost between housing and shelter for shared and
private rooms in institutional settings. Trustee may invest trust assets for the purchase of a
primary r=esidence or the maintenance of an existbigprimary residence. Trustee shall have the
discretion to allow my son, PAUL:M. ADRIAN, to reside in any residence purchased or heldby
the Trust without payment of rent.
3. Social Needs. Trustee should consider distributions foo- such things as
transportation (includitig vehicle purchase, rnainteitnnce, and insurance); assistive technology;
electronic equipment and expenses;travel and vacation expenses;companions for travel and other
expenses related to leisure, entertainment, recreation, and cultural enrichment; personal care,
4
exercise classes or equipment, and membership fees for clubs and associations. Special Needs
may also include clothing, computer equipment, audio-visual equipment (e.g., radios, compact
disc and digital video disc players and .media, and television sets), camping, vacations, athletic
contests, movies,travel, money with which to purchase appropriate gifts for relatives and friends,
payments fora companion or attendant, and other items to enhance the self-esteem or situation of
my soil,PAUL M. ADRIAN.
4. 1Education and Vocational Trainin-, Special Needs shall include, but not be
limited to, programs of education, vocational training, and other services not provided by public
benefits or local, state, or federal governmental agencies.
D. Distributions of income and Principal. Trustee shall be responsible for determining what
discretionary distributions shall be made from this 'Crust. Trustee shall provide for the benefit of my son,
PAUL M. ADRIAN, that amount of net income rvhich will not cause my son, PAUL M. ADRIAN, to be
iineligible for governmental financial assistance and benefits, in the event my son, PAUL M. ADRIAN, is
receiving such benefits. Any irndiAributed income shall be added.to principal.. Trustee may distribute
discretionary amounts of principal to or for the benefit of my son, PAUL M. ADRIAN,. for those Special
Needs not otherwise provided by governmental financial assistance and benefits, or by the providers of
services.
E. :Limitations on Distributions. The following limitations sliall apply to each distribution
made from this Trust.
i. 51jecial Needs. No distribution shall be made hereunder except for Special
Needs, and Trustee shall have the sole, absolute, and unfettered discretion to make or refuse to
make distributions of principal and income from this Trust for Special.Needs.
2. Effect on. Public Benefits. Under no circumstances shall the Trust be used to
supplant or replace public assistance benefits or services of any local, state, or federal agency that
provides benefits or services for which my son, .PAUL M. ADRIAN, is eligible. In addition, in
making distributions for the Special Needs of my son, PAUL M. ADRIAN, Trustee shall take
5
into consideration the applicable income and resource limitations of any public assistance
programs that affect the eligibility of illy soil, PAUL, M. ADRIAN, in such program. Any
distribution to or.for the benefit of my son, PAUL M. ADRIAN, shall be limited so that lily soil,
PAUL M. ADRIAN, is not disqualified from receiving public benefits to which she is otherwise
entitled. Trustee shall resist any request for payments from this Trust for benefits and services
that a public or private agency is obligated to provide for my sots, PAUL M. ADRIAN,and under
no circumstances shall any amount be paid to or used to reimburse any local, state, :or federal
government agency for any purpose, including for the care, support,and maintenance of ally soil,
PAUL M.ADRIAN,
3. Trust .Property Not an Available Resource. The Trust shall not be considered to
be available to my son, PAUL M. ADRIAN, for purposes of determining his eligibility fo.r any
public benefits,
4. Request for.Distribution in General. If Trustee is requested to release principal or
income of the Trust to or on behalf of illy soil PAUL M. ADRIAN, to pay foi, equipment,
medication, or services .that a government agency is authorized to provide, or if Trustee is
requested to petition the court or any other administrative agency for the release of principal or
income for such purpose, Trustee is, in Trustee's sole and absolute discretion, authorized to deny
such request and authorized to take whatever administrativo or judicial steps may be necessary to
continue the eligibility of my son, PAUL M. ADRIAN, for public benefits, including obtaining
legal advice about her speciie entitlement to public benefits and obtaining instructions frons a
court of competent ,jurisdiction ruling that the Trust is not available to lily Soil, .PAUL M.
ADRIAN, for eligibility purposes. Its this regard, any expenses incurred by Trustee, including
reasonable attorney fees,shall be a proper charge to the Trust.
S. Request for Distribution —Medicaid. Trustee shall deny any request to(i)snake a
distribution from the Trust to or oil belialf of my son, PAUL,M. ADRIAN, to pay for equipment,
medication, or services that Medicaid could provide if this Trust did not.exist; or (ii) petition a
6
court or an administrative ageney for a distribution from the Trust Property for this purpose.
Trustee may, in Trustee's discretion, take necessary administrative or legal steps to protect the
Medicaid eligibility of my son; PAUL M. ADRIAN, including obtaining a ruling from a court of
competent jurisdiction that the Trust is not available to my son,PAUL M. ADRIAN,for purposes
of determining Medicaid eligibility. If Trustee has denied such a.request, Trustee may lead funds
to my son, PAUL M. ADRIAN, to pay for the equipment, medication, or services that Trustee
believes Medicaid would provide if not for the existence of this Trust, and may take an
assignment of the claim of my son, PAUI...M. ADRIAN,against Medicaid as partial security for
such Ioan: In this regard, any expenses incurred by Trustee, in.cluling reasonable attorney fees,
shall be a proper charge to the Trust.
G. Manner of Distributions. The following provisions are meant only as guidance: If
my son, PAUL M. ADRIAN, is receiving Supplemental Security .Income, Medicaid benefits, or
benefits through a similar program that has income or resource limitations, then (i)Trustee shall
not distribute cash directly to my son, PAUL M. -ADRIAN; (ii) `i'rustee:shall not reimburse my
son, PAUL M. ADRIAN, directly for any purchase she makes; (iii) Trustee may pay directly for
services, provided my son, PAUL M. ADRIAN, does not receive aiiy.assets as a result of such
expenditure that can be converted to cash; and (iv) Trustee may distribute a gift certificate
directly to my son, PAUL M. ADRIAN, if it. is nontransferable, nonrefundable, and cannot be
converted to cash. Before making any distribution, Trustee may seek the advice of an attorney
who has experience in such matters.
F. Binding Authority. Trustee's discretion in making non-support distributions as provided
for in this Trust is final as to all interested parties, including any state or governmental agency or
agencies, even if Trustee elects to make no distributions at all. The sole and independent judgment of
Trustee, rather than the determination of all interested parties, is intended to be the criterion by which
distributions erre made. Neither a court nor any person shall substitute judgment for a discretionary
decision made by.Trustee.
7
G. Additional Benefits. Because my soil,PAUL M. ADRIAN, is or may become dependent
upo►i the support and aid of others, Trustee sliall, in the exercise of Trustee's discretion,judgment, and
fiduciary.dirty, seek support and maintenance for my sora, PAUL M. ADRIAN, from all available public
resources including, but not .litnited to, Social Security Administration Benefits, ,Supplemental Security
Income ("SSI"), U.S. Civil Service Commission Benefits, Medicaid, Federal Social Security Disability
Insurance ("SSDI"), and any other comparable programs, whether local, state, or federal. If necessary,
Trustee may seek appropriate authority to collect,. expend, and separately account for all governmental
assistance benefits, but shall not commingle them witli the assets 'of tyre Trust. If Trustee is not be
familiar with. the federal, state, and local agencies that have beet! created to financially assist disabled
t}ersoris, Trustee should Seek assistance in ideratif}ririg public and private programs tliat.are or may be
available to my soil,PAUL M. ADRIAN.
H. Anticipation. Prior to actual receipt by my soil, PAUL M. ADRIAN, no interest ill
principal or income of this Trust sliall be anticiliated, assigned, encumbered, or subject to any claims or
legal process of voluntary or involuntary creditors, including for the provision of residential care and
services by any public entity, office, department, or agency of any local, state, or the federal government.
Further, my son, PAUL M. ADRIAN, is specifically prohibited from any right to receive, demand,
secure, give, assign, transfer, mortgage, borrow against, or appoint by will, trust, or otherwise any
principal or income of this Trust.
I.. Discretionar,y,Distributions. If a court or an authority of competent jurisdiction
determines that this Trust renders my son, PAUL M. ADRIAN, ineligible to receive public assistance
benefits or services, theta Trustee is authorized, in Trustee's sole and absolute discretion, to purchase
assets or services that are considered "exempt assets" for purposes of determining eligibility for those
benefits and distribute those assets to nay son, PAUL M. ADRIAN. In determining whether the existence
of this Trust has the effect of rendering nay soil, PAUL M.ADRIAN, ine-ligible to receive governmental
assistance benefits, Trustee is Hereby granted full and complete discretion to initiate administrative or
judicial proceedings for the purposes of determining eligibility.. Trustee shall be mindful that a primary
8
purpose of this Trust is management of assets :for the benefit of my son, PAUL M. ADRIAN, and
ineligibility for public benefits alone should not cause this Trust to be terminated.
J. Early Termination of Trust. If Trustee, in Trustee's sole discretion, determines that,
notwithstanding the terms and provisions of this Trust, the principal and income of the Trust is subject to
.garnishment, attachment, execution, or bankruptcy proceedings by a creditor of my son, PAUL M.
ADRIAN, or by local,state, or the federal government or any agency or subdivision thereof,then Trustee
shall terminate this Trust and shall distribute all remaining Trust Property outright and free of trust to my
son, PAUL M. ADRIAN, or his legal guardian. All costs related thereto, including reasonable attorney's
fees, shall be a proper charge to this Trust.
K. Distribution of Remainder. Upon the death of my son, PAUL M. ADRIAN, or in the
event my son,PAUL M. ADRIAN,fails to survive me,Trustee shall divide the balance then remaining in
the trust and distribute it equally unto my remaining children, GAIL F. LOCKHART, BARBARA
ADRIAN, LAWRENCE J. ADR.iAN, JR., and DEBORAH A. BURD, or the survivor among them. The
.share of any thereof deceased at my death with issue surviving shall pass by representation to such issue
surviving. The share of any thereof deceased.at my death without issue surviving shall lapse in favor of
the other, if surviving, or if the other is not surviving but leaves issue surviving, unto such surviving
issue,per stirpes.
ITEM 5: 1 further direct, anythiirg hereinbefore to the contrary notwithstanding, in the event
any of the distribution of my estate(except as provided in Items 3) be to a beneficiary while he or she is still
wider the age of twenty-five (25) years, that the distribution of the share of each such beneficiary be instead
to the Trustee appointed in Item l l below, in trust,to be held by my Trustee as my Trustee.in a separate and
distinct trust for each such beneficiary for the following purposes:
A. My Trustee shall.accumulate the net income earned on each trust and shall add the
same to the corpus until the beneficiary of said trust has reached the age of twenty-one(21)years.Thereafter,
my '.Trustee shall distribute the net income earned on each trust to the beneficiary of that trust in regular
installments,and at least quarter-annually.
9
B. In the sole and uncontrolled discretion of my Trustee, my'Trustee may utilize bout
the income and/or principal of each trust for the health,maintenance,education and support of.tile beneficiary
Of that trust. It is my desire, but not my direction,that my Trustee encourage any and all of the beneficiaries
of the trusts created by this Will to further their education along those lines Nv hich interest each beneficiary,
and provide for higher education (college, professional, technical or any other forms of higher education)of
any or all of my beneficiaries,up to the extent or limit of principal and income of the trust of which he or she
is a beneficiary.
C. My Trustee may pay over from time to time such of the principal of the
beneficiary's trust as lie or she may request in writing, provided the intended use is for a purpose which the
Trustee believes will promote his or her welfare, such as the downpaynlent for the purchase of a horne or
establishing a business or profession.
D. My Trustee may pay the reasonable burial expenses, including a suitable and proper
grave marker, for the beneficiary of any trust which has not been terminated by previous distribution, and if
my Trustee, in the exercise of her sole discretion, chooses to pay the same, she shall charge the expense
thereof against the trust of that beneficiary.
E. The beneficiary of each such trust shall have the right to withdraw in one or more
installments the balance of his or her trust after attaining the age of hventy-five(25)years.
F. In the event any beneficiary or beneficiaries subject to the provisions of this Item
dies prior to having received full distribution of his or her trust, leaving issue surviving, my Trustee shall,
divide the balance then remaining in the deceased beneficiary's trust into as many equal shares as the
deceased beneficiary leaves'issue surviving and shall hold each portion, so divided,in a.separate and distinct
trust for each such issue under the sante terms and conditions as trey'Trustee held the trust of the deceased
beneficiary which was divided pursuant to this provision.
G. In the event any beneficiary or beneficiaries subject to the provisions of this Item
dies prior to having received full distribution of his or her trust, without leaving issue surviving,the balance
of his or her trust shall go first to the surviving brothers and sisters of said beneficiary and the surviving issue
10
of any deceased brothers or sisters of said beneficiary, per stirpes; and in the event said beneficiary leaves
none of the aforesaid surviving, second, to my then-living children find to the then living issue of any of my
deceased children,per stirpes,provided,however,that any share distributable to my son, PAUL M.ADRIAN
shall be held in trust pursuant to ITEM 4 above. The share of the.recipient shall be added to the trust already
existing for said recipient and shall be administered and/or distributed in accordance with its terms, providing,
however, that if such trust has already been terminated by prior distribution, then said shares shall be
distributed outright to such recipients. And if no trust already exists for any such recipient who is under the
age of twenty-one(2 1)years,the share of such.recipient shall be held in trust,administered and distributed by
the'Trustee herein named and in the manner herein provided for beneficiaries of trusts.
I-I. And in the event there.are no beneficiaries who qualify under the provisions of the
previous paragraph by representation or otherwise, then all balances remaining shrill be distributed in
accordance with the provisions of ITEM 4 above.
ITEM 64 In the administration of my estate and the trusts herein created, my Executor and
Trustee shall have the following powers without leave of Court iii addition to, but not in limitation of, the
powers granted by law to the Executors and Trustees of estates and trusts, which powers sliall continue atter
the termination of my estate and the trust or trusts provided for herein until actual distribution of the assets:
A. To be guided by the Prudent Investor Rule and not by any other statutory or judicial
rules as to the handling of estate assets and trust assets,said investment authority to include the right to invest
in any Discretionary or Legal Common Trust bund that may be administered and managed by a Corporate
Executor or Corporate.Trustee.
B. To receive in tine estate and to receive and .retain in the trusts any assets, real or
personal,which I may be entitled at the time of my death, which my Executor or Trustee may deem for the
best interest of the estate or trusts without being required to convert said assets.
C. To sell or buy real estate without Corot order at public or_private sale; to make,
execute and deliver or receive good and sufficient deeds of conveyance and give or receive good title
therefore; to reinvest the proceeds as if they had originated in personal property; to.mortgage or enctunber
11
any real estate held in trust, or comprising part of lily estate, borrowing the necessary fiords frorrr itself or
from any other source; to improve any property or otherwise expend principal fluids for the upkeep and
welfare of any properties; to release, vacate and abandon the sanrc; to grant and acquire licenses and
casements with respect thereto; to make improvements to or upon the some; and in general to do all things
necessary in the management of the proper•tics as if it is the owner thereof, including the Dight to let property
and to make leases for ally term including beyond the terms of the trusts.The purchaser shall not be required
to see to the proper application of proceeds but may pay the same over to the Executor or Trustees selling`the
sallre.
DTo make distribution hereunder in cash or of property and securities in kind at fair
market :value at the time of such distribution and in such a manner as to be fair, equitable and just to all
concerned..
Eli Tin Executor's and/or Trustee's sole discretion,Executor and/or Trustee may continue
to operate any business or businesses'whiell I may o%vrr or in which I may have an interest, whether as sole
owner or as partner or as shareholder for such period or periods as Executor acid/or Trustee, in .Executor's
and/or Trustee's sole discretion,may consider the same available, including the right to delegate discretionary
powers to any manager or employee, without any resimisibility or liability to lily estate or trustee, lily heirs,
legatees, devisees or remaindermen for errors in judgment during the operation thereof by virtue of the
Authority granted Executor and/or Trustee render the provisions hereof. hu (lie operation of said business or
businesses, Executor and/or Trustee, in Executor's and/or Trustee's sole discretion, may continue to operate
such business or businesses the same as I have hone prior to lily death or may expand or eontract said
business, iuclUding the might to merge said business with any other business or to incorporate said business,
by 'Itself or jointly with otlneirs, as Executor and/or Trustee may then find advisable, in Executor's and/or
Trustee's sole discretion, under the then business conditions. This authorization is intended to be construed
broadly so as not to hamper all business decisions in connection therewith, it being lily intention to authorize
Executor and/or Trustee to do and take whatever steps are necessary in the conduct of said business or
businesses.
12
F. Income aecrued on any property received by Trustee either at the inception of the
trusts or as an addition tllcreto shall be treated as income and not as principal. Upon the death of any
beneficiary of income any undistributed income in the hands of Trustee held for such beneficiary at the tinge
of his or her death shall be paid to the person or persons for whose benefit the principal producing such
income is continued in trust or whom it is distributed under the terms of this Will.
G. To exercise any election or privilege given by the federal and other tax laws,
including but not limited to,the consent on gift tax returns to have any gift made by my spouse considered as
matte in part by me for gift tax purposes, the payment of any portion of income or gift tax dile under such.
returns,tlue exercise of a disclaimer that complies with the provisions of Section 2518 of the internal Revenue
Code and Chapter C2 of the Pennsylvania Probate, Estates and Fiduciaries Code,tile election of the alternate
valuation for federal estate tax purposes, the election to claire deductions for fcderal estate tax or for federal
income tax purposes,and the election of the inetliod of payment'of pension, profit-sharing,HR-10,individual
retiremePt accounts, and any other similar benefits. In addition, my fiduciaries in their sole discretion, relay
make or not make equitable adjustment among the beneficiaries,without the consent of the beneficiaries,for
the exercise or non-exercise of any election or privilege,
ITEM 7: No assignment or order by any beneficiary by way of anticipation of any of tile
Principal or income of,the trusts herein created shall be valid; but the income and principal shall be paid
directly to the beneficiaries entitled to receive it, and the income and principal shall not be subject to
attachment, execution, levy,sequestration, hypothecation, garnishment or other process while ill the hands of
Trustee.
ITEM 8: if .for any reason a guardian over the estate of a beneficiary or beneficiaries is
needed or required, illy Trustee shall be the guardian of the estate of such beneficiary or beneficiaries, with
the sante rights,powers,privileges,duties and responsibilities as l have given them as'Trustee.
ITEM 9: For purposes of interpreting this,my bast Will and Testament:
A. A disposition under this Last Will and Testament to, the descendants of a person
"per stirpes"shall be deemed to require a diivisio.n into a sufficient number of equal shares to make one share
1.3
for each child of such person living at the time such,disposition becomes effective and one share for each
them deceased child of such person having one or more descendants then living, regardless of whether any
child of sucli Berson is then living;with the same principle to be applied in any required further division of a
share at a more remote generation.
B. All references in my will to children and issue shall include those born or adopted,
either before or after the date of my will. Adopted persons shall be considered as children of their adoptive
parents,and they and their descendants shall be considered as issue of their adoptive parents,regardless of the
(late of the adoption.
C. Wherever the context requires, the masculine gender shall include the feminine and
neuter gender,and vice versa,and the singular shall include the plural,and vice versa.
ITEM 10: I nominate, constitute and appoint my daughter, BARBARA ADRIAN and my
daughter, GAIL F. LOCKHART, Co=Executors of this Will. If"either'Co-Executor is wiable or unwilling to
act or continue as Co-Executor,for any reason whatsoever and whether before or after my death, I nominate,
constitute and appoint my son, LAWRENCE J. ADRIAN, JR., as alternate successor Co-Executor of this
Will.
ITEM 11: 1 appoint illy daughter, BARBARA ADRIAN and my son, LAWRENCE J.
ADRIAN,JR.,collectively as my'Trustee,to serve as the Trustee of all trusts established under Meru 5 above.
Should either BARBARA ADRIAN or LAWRENCE J. ADRIAN,JR. be unable or unwilling to so act or to
continue serving, I nominate, constitute and appoint my sister,DEBORAH A. BURD, to serve as successor
Co-Trustee of all trusts established ruiner Item 5 above. My individual Trustee sliafl have the authority to
appoint a Corporate Trustee to serve as Co-Trustee with her or hind, or alternatively, to serve as leer or Iris
successor.
I appoint illy daughter, BARBARA ADRIAN and my son, .LAWRENCE J. ADRIAN, JR.,
collectively as my"Trustee,,to serve as the Trustee of all trusts establislied under Item 6 above. Should either
BARBARA ADRIAN or LAWRENCE J. ADRIAN, JR. be tunable or unwilling to so act or to continue
serving, I nominate, constitute and appoint my sister, DEBORAH A. BURD, to serve as successor Co-
14
Trustee of all trusts established under Item 6 above. My individual Trustee shall have the authority to appoint
a Corporate Trustee to serve as Co-Trustee with her or him,oar alternatively,to serve as her or his successor.
My individual Trustee may be reasonably compensated for his or her services, taking into
consideration of his engagement of an investment advisor to,provide investment advice to his or her for the
1panagement of tile trust assets.
Any corporate trustee shall be compensated in accordance with its schedule of'Pecs in elTect at the
time such services are performed includijig applicable milni muni'fees without judicial authorization-Any such
fees payable fr6hl income may be paid from current or accumulated income, Any individual trustee may be
compensated for his or her services provided said compensation is reasonable.
Any Trustee may resign from office without leave of court at any time for any reason by giving sixty
(60)days advance written notice. Such resignation shall be duly acknowledged and delivered in person or by
certified mail to thelegal representatives of ni.y estate or to the beneficiary of a trust established hereunder if
illy estate has beell,concluded.
The individual trustee serving,heedundershali have the right to appoint corporate trustee to serve as
a co-trustee, if one has not already been appointed. Any corporate trustee may be removed by the individual
trustee upon sixty(60)days prior written notice.
ITEM 12: 1 direct that no fiduciary appointed in my Last Will and Testament shall be required
to give or to enter into any bond or security in anyjurisdiction,regardless of the state of their-residency,
15
IN WITNESS"WIIEREOI?;.I have hereunto set my hand and seal this 6Z day of January,2012.
BETTY J.A alAN
Signed, sealed, published, acknowledged and declared by the above-flamed Testatrix, BETTY J.
ADRIAN, as and for his Last Will and Testament, itt the presence of its., who,:at her request, in her presence
and.in the presence of each other,have hereunto subscribed our names as witnesses thereto.
16
COMMONWEALTH OF PENNSYLVANIA,
SS;
COUNTY OF DAUPHIN
I, BETTY J. ADRIAN, Testatrix, who sighed the foregoing instrument, having been duly qualified
according to law,acknowledge that I signed and executed the instrument as my free and voluntary act for the
purposes therein Contained.
Sworn to or affirmed and
acknowledged before 1ue by
BETTY J.ADRI N,the BETTY J ,. RIAN
Testatrix,this,30 day
of January;2012.
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Jeanne M [i burg,D,Notary ou ty
City of Harrisburg,Dauphin County
toy Commission Expires lune 7,2015
Notary Public
COMMONWEAL;M OI<.PENNSYLVANIA
SS:
COUNTY OF DAUPHIN
We,the undersigned witnesses who sighed the foregoing instrument, being duly qualified according
to law, depose and say that we were present and saw Testatrix sign and execute rite instrument as her Last
Will and Testament; that she signed and executed it willingly as her free and voluntary act for the purposes
therein expressed; that each of its in her sight and hearing signed the Will as witnesses; that Testatrix is
known to each of its; and that to the best of our knowledge and observation the Testatrix was at that time of
sound mind and under no constraint or undue influence.
Sworn to or affirmed and
„sob cribed to be ore ne by
ri .. M60
witnesses,thi ` c ay of
January,2012,.
tLL
Notary Publ.rc
COMMONWEALTH OF.PENNSYLVANIA
Notarial Seal
Jeanne M.Irarnhart,Notary Public
City of Harrisburg,Dauphin County
My Commission Expires June 7,7015
17
February 10, 2015
David E Gruver
McNees, Wallace &Nurick, LLC
100 Pine St
PO Box 1166
Harrisburg, PA 17108-1166
RE: Name: Betty J Adrian
SSN:
DOD: 12-03-2014
Dear Mr. Gruver:
In response to your request for Date of Death(DOD) balances for the customer noted above, our
records shone the following:
Checking Account
Account#5005985542 Established: 03-10-2012
BETTY J ADRIAN
DEBORAH A BUND
DOD balance: $ 18,477.31 +0.07 accrued interest
Interest paid 01/01/2014 thru: 12/03/2014 $ 0.57 YTD
Savings Account
Account# 5006132154 Established: 01-07-2011
BETTY J ADRIAN
DOD balance: $ 217,010.31 + 15,22 accrued interest
Interest paid 01/01/2014 thru 12/03/2014 $410.12 YTD
Please note that this office provides date of death balances for deposit accounts(IRAs,CDs,Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance with
any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A,
Member FDIC
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contain information that is privileged, confidential and exempt from disclosure under applicable law.
,lf the reader of this message is not the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient,you are hereby notified that any dissemination,
distribution or copying of-this communications is strictly prohibited rf you have received this
communication in error,please notify me immediately by reply or by telephone at 800--76.21775 and
immediately destroy this faxed document..
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