HomeMy WebLinkAbout08-10-15 J REV-1500 Ex o� 0 1505610143
PA�e atlmen�oi Revenue � OFFICIAL IISE ONLV
p pennsyivania �o,,.,rycaee ee, r��ierv�mee,
Bureauoilnd'rvidualTaxes °�'^.°°• .'°'�'"°°
ao eox.zaosoi INHERITANCE TAJ( RETURN 2 1 12 0 0 4 6 2
Harrisburg,PA 1�i28-o601 RESIDENT DECEDENT
ENTER OECEOENT INFORMATION BELOW
Social Security Number Date of Dea�h Da�e of Blrlh
04 10 2012 11 07 1919
Decetlenfs Last Name SURix Decetlenfs First Name MI
JOHNSON DAGMAR
(Ii Applicable)EnlerSurviving Spouse's Informa[ion Below
Spouse'sLasiName SuHix SpousesFirstName MI
Spouse s Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
❑ t. Onqindlft¢Wrn � 2. $upplemen�alReWrn � 3.R¢main0¢rReWm�OdleOftled��
prior to 12-1382J
� <. Limi�aDEstate � pa. F���rem�ares�como�omee � S. FeOeralEstateTVReWrnRequlrea
(aem o�ooe�n mer i2',iaai
0
� 6 �eceaem oim iesa�e � � oeceaeni mam:ainea a�rv�nq-mst . e. Total Number ot 5afe Depost Boxes
(Pnecncopyorwu9 � a Copyminn)
� 9. GtigationPmree4sRecelve0 ❑ ID.petween123�9�ano°�oatgsiraeem � >> eactionm�aruntlerSea9lu(q)
(nmacn scn.o�
CORRESGON�ENT-THIS SECTION MUST BE COMPLETEO.ALL CORRESPONOENCE AND CONFIDENTIAL TAX INFORMATION SMOIILD BE�IRECTE�TO:
Name Day[ime Telephone Number
THOMAS P GACKI 717 237 6000
REGISTER OF W ILLS IISE ONLV
Firs[line ot atltlress
213 MARRET STREET
Secontl line o(atltlress
8TH FLOOR
DAIE:FILED ,�
Ciry or Posl Office Sta[e ZIP Catle
HARRISBURG PA 17101 0 � � m r*�j
1 v � � �
,-� > r�— � cn �
Correspontlan['se-mailaEtlress: �JaCki�ECkEIL5E2T2�5.COr11 ��� O '� n�
Unaerpenal[lesotper�ury I�eclaret�a�I�aveexamineUtM1lsreWm.IncWaingaccompanymgsc�etlWesandsla�emen[s,and�o��eNes�atmykno� nO9el�
ibstme,wrrec[anOmmplele.DeGarationotpreDarerofier�M1an�M1eperwnalreDresenta�rveisbasetlonallm/ormaGonolwh¢M1prcDarerhes�any IeEge:�
SIGNATIIREqFPER50NRE5PON51BL FORFlLINGRRURN ... pPT __ }��
' � G �e q,� � Karen Yeager �=,7j—/� ,_ ��
�o�aess - - ^
S tn o
20 Sunfire Avenue, mp Hill, PA 17011-1020 �
91GNAiJRE AREROT� R RESE AiNE , .� qTE
� Thomas P Gacki �n -� �� �
noor+ess �
21S Market Street, Harrisburg, PA 17101
Sitle t
L 1505670143 1505670143 J ���
J 1505610243
REV-1500 EX
Decetlenfs Social Sea�ity Number
�a�ae�r�r+ama: JOHNSON, DAGMAR
RECAPITULATION ��
1. RealEstate(SchetluleA�.. ._........._ __..... ______ 1.
2. SrocksantlBontls(Schedule8) .____ ......._ _____. 2.
3. QosetyHeldCorporetion,Partnershipo�5ole-Pmprietarship(ScheduleC)._....... 3.
Y. Mortgage58NotesReceivable(SchetluleD) ........... ._____. 4.
40 , 236 . 00
5. Cash,Bank Deposits 8 Miscellaneous Personal PmpeM(Schedule E)_............_ 5.
6. JointlyOwnetlPmpetly�SchetluleF) ❑ SeparateBillingRequestetl______. 6.
1. In�er-Vivos Transfers 8 Miscellaneous Non-Proba�e PmpeRy
(SchetluleG) ❑ SeparateBillingRequested______. �,
g. Total Gmss Asse[s potal Lines 1 ]) ....__. ............. ._____ B. 4 0 � 2 3 6 . 0 0
_ _ _ i , ioo : oo
9. FuneralExpensesBAtlminlstra�iveCosis(SchetluleH)._________......_.............. 9.
10. Deb�s of Decetlen�,Mortgage Liabilities,8 Liens(Schedule I)__.................._____ 10.
i , ioo . 00
11. TOGIDaductions(totalLines9&10)......._ ____. .....___. ��,
�2_ NetValueotEstate(LineBminusLinell). ____. ._____. �p, 39 � 136 . 00
13. CharitableandGovemmentalBequesis/Sec9113Tmsisforwhich
anelectiontotaxM1asno�beenmatle(ScheduleJ).___...__...............__________ �3.
14. NetValueSubjecttoTaz(Linel2minusGnel3)__..................___________.._. �y. 39 � 136 . 00
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES �� �
15. Amounto(Linel4taxable
at the spousal tax rate,or
iransfers under Sec.9116
(a)(12)% AO 15.
16. AmountotLine lataxable 3 9 � 13 6 . 0 0 �6. 1 � 7 61 . 12
af lineal ate X �45
1]. Amoun�otGnel4taxable
atsiblingrate% .12 ��-
18. Amoun�ofLinel4�axable
at collateral rate X .15 18'
19. TazDue .____ ............ __..... _____..
19 1 , 761 . 12
20. FILL IN THE OVAL IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
L 1505610243 1505610243 �
REV-1500EXPage3 FileNumber 2� - 12 - 40462
DecedenYs Complete Address:
DENT' NAM
Johnson, Dagmar
sTReernooREss
9 Rountlhill Road
cin '� srnre zia
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Lina 1B) (1) ��761.1 2
2. CretlifslPaymen�s
A, Prior Paymen�s
B. Discoun�
TotalCredlis(A +B) (Z) 0.00
3- In�erest (3) 135.31
4. If Line 2 is greater[han Line 1 +Line 3,enter the tliRerence. This is�he OVERPAVMENi (4)
Check box on Page Z Line]0 to reques/a refuntl
5. If Line 1 +Line 3 is greaterihan Line 2,en�er the difference. T�is is ihe TA%DUE (S) . � ,896.43
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Ditl tlecetlenl make a Vansfer antl: Yes No
a. re�ain�heuseorincomeofNepmpeMtransferretl ......... __.__ .____ `�'. z��.
b. retain ihe rigM to designate who sM1all use the property Vawferretl or i�s lnwme', _.___ .. iL �I,
c. retain a reversionaryin�erest or .___.. .____ ____. ___._ � �z�'
tl. receive�hepmmiseforliteo(eitherpaymen�s,benefitsorcare> .... .____ �'�J �z
2 If death occurred afler�ecember 12. 1982,tliG tlecetlent hanster propeRy within one year o(Oeath wilhout �
receivingatlequateconsitleration'+ __...... .____ .___.. _..______. �L z�
3. Ditl tlecetlent own an"in Imst(oI' or payable upon death bank account or sewriry a�M1is or M1er deathP......... i�'�, n
4. Dld decetlent own an Indivitlual Ret rement Acmunt annuAy or o�hernon pmbate property whmh
containsa�eneficiarytlesigna�ion� ._.......... .____ .___.. ......... ._.. �z, U
IF THE ANSWER TO ANY OF THE ABOVE pUESTI0N515 YES,YOII MUST COMPLETE SCHEDULE G ANO FILE IT AS PART OF THE RETURN.
For tlates of tleath o0 or aker JulY 1 1994 antl betore Jan. 1, 1995,ihe tax rate imposed on ihe net value of transfers to or for ihe use of the surviving
spouse Is 3 percent p2 P S.§9116�(a)(L�)(p].
For tla�es o(dea�h on or aker Janua 1, 1995,ihe tax ra[e imposed on�he net value of iransfers lo or for�he use otine sumiving spouse is 0 percen�
�]2 P 5.§9116(a)(1.1)(ii�]. The sta�ute tloes not exemp�a Vansfer to a surviving spouse from tax,and�he staWlary requiremen�s for disclosure ot
assels and filing a tax reiurn are s�ill applicable even if Ihe surviving spouse is the only bene(ciary.
For tlates of dea�h on or after July 1,2000�.
•T�e taz rate imposed on the net value of trans(ers from a tleceased chilC 21 vears o(age or younger at tleath to or br Ihe use of a natural parent,an
adoptive paren(or a stepparent of ihe chiltl is d percent p2 P.S.§9116(a)(1_2)]_
•Tha�ax 2�e imposetl on the nelvelue o��2nsfers�o or(or[he use of�he decedenfs lineal bene4claries Is 4.5 percen(except as noted In
]2 P_S.§9118 12)[72 P.S.§9116(a)(i)1.
•The tax rate imposetl on the net value of Vansfers to or tor the use of ihe tlecetlenfs siblings is 12 perceN�72 P.S.69116(a)(i 311. A
sibling is tlefinetl untler Sec[ion 9102,as an intlivitlual who M1as at least one paren�In wmmon wiN the tlecetlent,wFether by blood or atloption.
SCHEDULE E
CASH, BANK DEPOSITS, 8 MISC. .
PERSONAL PROPERTY
� � FILE NUMBER
ESTATEOF �ohnson, Dagmar 2� _ �2-oo4s2
Indutle the proceeds of litigation anC the tla�e the proceetls were receivetl by the eslate. All propeM1y joinHy-ownetl wit�the right of
survivorship must be tlisclosed on schedule F.
NUM ER DESCRIPTION VALUE�AETATHTE OF
1 $10,000 Series EE Savings Bond X-3979034; Issue Date 01/1993 13.412.00
2 $10,000 Series EE Savings Bond X-3979035, Issue Date 01/1993 13,412.00
3 $10,000 Series EE Savings Bond X-3979036, Issue Date 01/1993 13,412.00
TOTAL(Also enter on Line 5, Recapitulation) 40,236.00
�FEOU�H
FUNERAL EXPQJSES&
pEs�oE„.oE�EpE„. AqWNSiRAiNECOSiS
� FILE NUMBER
ESTATE OF JohnSon, Dagm2f i 21 - 12 -00462
Debts of decedent must be reported on Schetlule I.
ITEM
NUMBER FUNERALEXPENSES: DESCRIPTION AMOUNT
A.
B. ADMINISTRATIVECOSTS:
�. Personal Representative's Commissions
Name of Personal Represen�ative(s)
StreetAtltlress
City S�ate Zip
Year(s) Commission paid
z. nnomey'sFees EckertSeamans 1,100.00
3. FamityExemption: Qftlecetlenfsatltlressisnollhesameasclaimanfs,atlachexplanation)
Claimant
Streei Atltlress
Ciry State Zip
Relationship of Claimant to Decedent
4. . Probate Fees
5. Accoun�anfs Fees
6. Tax ReWm Preparer's Fees
). OI�erAtlminisirative Casts '�
� I
TOTAL(Also enter on line 9, kecapitulation) 1,100.00
0.EV-051>E%��11L0) I
SCHEDULEJ
coMmoNvueni*noFaemr�snvnNu BENEFICIARIES
NHEflITANCETA%RETORN
RE6IDEM1T�WEi:ENT
ESTATE OF � � � � � � � FILE NUMBER
Johnson, Dagmar 2� - �2-00462
��� � RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER ��, NAMEANDAOORESSOFPERSON(S) OECEDENT �� (Wortls) ($88)
RECEIVINGPROPERTY ooxo�us*maeNsi
�. TAXABLEDISTRIBUTIONS[includeoutrighispousal � �
tlishibutions antlhansfers
under Sec.9118(a)(1 2)J
1 Steven Omvik Other—Godson 10,000.00
' 3409 Almar Drive ��
Vestal, NY 13850
2 � Karen Yeager � Daughter 100% Residue
20 Sunfire Drive � ��
Camp Hill, PA 17011
��IEnterdollar amounis for tlis�ribulions shown above on lines 15 throug�18 on Rev 1500 cover sheet,as appmpriate. �.
II. ,NON-TAXABLEDISTRIBUTIONS:
���A.SPOUSAL�ISTRIBUTIONS UN�ER SECTION 9113 POR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL OISTRIBUTIONS
�ITOTAL OF PART IL ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV4500 COVER SHEET O.00
FIRST CODICII. TO WII,L OF
DAGMARJOHNSON
. I, Dagmaz Sohnson,presently of Cumberland County,Pennsylvazua, declare this to be x
Fust Codicil to my Will of Januazy 9, 1998:
1. I hereby delete Pazagiaph 2 of my Will in its entirery, and replace it with the
� following Paragraph 2:
2. Cash Bequest: I give the sum of Ten Thousand Dollazs ($10,000)
to my Godson, Steven Omvik, of 3409 Almaz Drive, Vestal,New York, 13850, if
he survives me. �
2. I hereby delete Paragraph 9 of my Wi11 in its entirery, and replace it with tbe
following Pazagraph 9: �
9. Fiduciaries: I appoint as Executor hereunder my daughter,Kazen
Hollinger. If Kuen is unable or unwilling to serve or to continue seiving, then
Stephanie Kleinfelter, shall serve as Executor hereunder. My fiduciaries shail
serve as guazdian of the property of any minor beneficiaries hereunder, under any
insirument of trust executed by me,under any policies of insurance on my life,
and in any other situation in wluch the power to make such appointment exists
under the laws of Pennsylvania. No individual fiduciary shall be liable of the
acts, omissions or defaults of any agent appointed and retained with due caze or of
any co-fiduciary. No fiduciary named herein shall be requued to fiunish bond or
other security for the proper performance of theu duties hereunder.
3. In al] other respects,my Will of 7anuary 9, 1998, shall remain in full force and
effect
IN WITNESS WHEREOF, I, Dagmaz 7ohnson, set my hand to this First Codicil to my .
last Wil1, typed on two (2) sheets of paper, including the self-proving attestation clause and
signature of witriesses,this 30', day of November, 1999.
,i�o:�/yL.»�, ,/'�4>�/ (SEAL)
'Dagmar Jo"hnson, Testatrix
Witriessed:
i 4
� ��' �� residing at ��; ,in.� � � �7�'
� � � ��
residing at S
-1-
COMMONW�ALTH OP PENNSYLV.4�A .
ss:
COUNTY OF DAUPAIN �
Da�azJohnson, (thetestahix), Sfrp�an;e N/e:.,{� /�.- �d
���id� /✓�. E'�he/mon (thewitnesses),whosenamesazesignedtotheforegoing
instrument,being fust duly swom, each hereby declazes to the undersigned authority that the
testahix signed and executed the instrument as her First Codicil to her Wil1 dated 7anuary 9,
1998, in the presence of the witnesses and that she had signed willingly, and that she executed it
as her free and voluntary act for the purposes therein expressed, and that each of the wimesses, in
the presence and hearing of the testahix, signed the codici] as witness and that to the best of his
or her knowledge the testa4ix was at that time eighteen yeazs of age or older, of sound mind and
under no constraint or undue influence.
WITIVESS: TEST.�TRUY: ,
� `� /-
!��4iG�i%� � 2>�
� D�C:MAR JO � SON
WI SS:
�
Subscribed, swom to and acknowledged before me by Daginaz Johnson, the testatrix, and
subscribed and swom to before me by SFepha �o N/e;��/k� and
/.�' cl e �'✓� sl�z-�ma� , the wimesses, this 30th day ofNovember, 1999.
� / "�('a-.tia l���5/�Lc�
NO7ARIAL 5E4L Notary Public
BLANCA I. KRI3TCH, Notary Public
Hartisbur9, PA Deuphin CouMy
My Commission Expmae Feb. 3, ZW3 (SEAL)
'2_
WILL
�
DAGMAR JOHNSON
I, DAGMAA JOHNSON, presently of Cumberland Caunty, Pennsylvania, declare
this to be my will and hereby revoke all prior wills and codicils made by me.
1. Personaltv. I bequeath such items of my tangible personal
property as are specifically itemized on the list, i£ any, in my handwriting,
signed and dated by me at Che end thereo£, and attached to this, my will, to
the persons named thereon to receive such items. I bequeath all o£ my
remaining tangible personal property not used in business or for the
production of income� including without limitation, fvrniture, £urnishings, � �
clothing, objects of art and decoration, and the like, and any motor vehicles
which I own, together with the insurance thereon, to my husband, Xarl E.
Johnson, if hz survives me. If my husband does not survive me, I bequeath all
such remaining property, together with the insurance thereon, to my daughter,
Karen Iiollinger, or, if my said daughter does not survive me, to those of my
grandchildren who survive me, to be divided as they may agree. If said
grandchildren are not a11 competent adults, or if they cannot agree on the
division, thez my executor(s) shall make the division, into shares that are as
equal as praccicable in the judgmenc o£ my executor�(si,� haviag due .-a5erd £cr
the stated personal preferences o£ said grandchildren, and/or nay se11 any or
all items passing hereunder and distribute the proceeds.
2 . 2 'dence. I£ my husband survives me, and at my death our usual
principal residence is owned in a� manner which will not result ia passage of .
full title to him by operation of 1aw, then I devise to him my entire interest
in said residence, together with all insurance thereon.
3, g�g. I bequeath, devise, and appoint a11 the rest of my
property, o£ whatever nature and wherever situated, including property over .
which I hold a power o£ appointment, except that I do not exercise any power �
of appointmant given to me by my husband, to my husband, Karl E. Johnson, and
my daughter, Karen Aollinger, or the surviwr(s) or successor(s) a£ the
foregoing, as Trustee(s) undez an Agreement of Trust executed by me on
January 9, 1998, to be held by said Trustee(s) and added to and administered �
as part oE the trust established by said Agreement. Said trust is in
existence as of the date of execution of this will, and it is my intention, if
necessary to validate the foregoing gi£t to the Trustee(s) , to incorporate
herein by reference its terms and any amendments thereto. No debts,
administration er.peases or death tazes shall be charged to or reduce any
marital share under said Agreement o£ Trust and all administration expenses
and debts of my estate shall be computed and accounted for be£ore computing
the shares of such Trust. �
4. Survival. I£ any bene£iciary should die within sixty (60) days
after me, then he or she shall be deemed to have predeceased me for all
purposes of this will.
5. 5 dth '£t Clause. No interest (whether in income ar principal,
� whethez or not a Yemainder interest, and whether vested or contingent) of any
beneficiary hereunder shall be subject to anticipation, pledge, assignment,
sale or transfer in any manner, nor shall any beneficiary have power in any
maxssier to charge or encumber his or her said interest, nor shall the said
interest �f any beneficiary be liable or subject in any mazuier while in the
possession o£ rtry fiduciaries for any liability of such beneficiary, whether
such liability arises from his or her debts, wntracts, torts, or other
engagements o£ any type. �
_ Z _
6. F �l't f P t £ M' I 't t d P rsons. Any
amounts or assets which are payable or distributable to a minor or
incapacitated person hereunder may, at the discretion o£ my fidssciaries, be
paid or distributed to the parent or guardian of such minor or incapacitated
person, to the person with whom such minor or incapacitated person resides, to
a trust existing primarily or exclusively for the benefit of such minor or
� incapacitated person, or directly to such minor or incapacitated person, or
may be applied for the use or benefit of such minor oz incapacitated person.
�. Power . In addition to such other powers and duties as may be
granted elsewhere herein or which may be granted by law, my fiduciaries
here+�nder shall have the £ollowing powers and duties, without the necessity of
notice to or consent of any court, but subject to any applicable requirements
of ordinary due care: -
(a) To retain all or any part of my property, real or
� personal, in the fozm in which it may be held at the time o£ its
receipt, including any closely held business in which I have an
interest and the stock of any corporate fiduciary hereunder, if
ever any, as long as in the exercise of their discretion it may be
advisable so to do, notwithstanding that said property may not be
. of a character authorized by law.
(b) To invest and reinvest any funds held hereunder in any
property, real oY personal, including, but not by way o£
limitation, bonds, preferred stocks, common stocks and other
securities oE domestic or foreign corporations or investment
trusts, � mortgages or mortgage participations, mutual funds with or
without sales or redemption charges, and common trust funds, even
� though such property would not be considered appropriate or legal
for a £iduciary apart £rom this provision.
(C) To sell, convey, exchange, partition, give options to �
buy or lease upon, or otherwise dispose o£ any property, real or
. personal, at the time held by them, at public or private sale or
othexwise, for cash or other consideration or on credit, and upon
such terms and for such price as they may determiae, and to convey
such property free of all trusts. .
(d) To borrow money from any person, including any
fiduciary hereunder, for ar.y purpose in connection with the
administration hereof, to execute promissory notes or other
obligations for amounts so borrowed, to secure the payments of
such amounts by mortgages or pledges of any property, real or
. personal, which may be held hereunder, and to receive property
- 3 -
encumbered by debts and mortgages and to take subject to and/or �
assume same.
(e) To make secured loans (or unsecured loans i£ to my
husband, his estate, any trust established by either o£ us, or if
to a descendant o£ mine) , in such amounts, upon such terms, at
such rates o£ interest, and to such persons, firms, or
corporations as they may deem advisable.
(f) To renew or extend the time for payment of any
obligation, secured or unsecured, payable to or by them as
fiduciaries, £or as long a period or periods o£ time and on such .
terms, as they may determine, and to adjust, settle, and arbitrate
claims or demands in favor o£ or against them.
(g) In dividing or distributing any property, real or
personal, included herein, to divide or distribute in cash, in
� � kind, or paztly in cash and paztly in kind.
(h) Without limitation of powers elsewhere granted herein, .
to hold, manage and develop any real estate which may be held by
them at any time, to moztgage any such property in such amounts
ar.d on such terms as they may deem advisable, to lease any such
property for such term or terms and upon such conditions and
rentals as they may deem advisable, whether or not the term o£ any
such lease shall exceed the period permitted by law or the
probable period o£ retention under this instrument; to make
repairs, replacements and improvements, structural or otherv+ise;
in wnnection with any such property, to abandon any such property
. � which they may deem to be worthless or not o£ sufficient value to
warrant keeping or protecting, =nd to permit any such property to
be lost by tax sale or any other proceedings. �
. (i) To employ such brokers, banks, custodians, investment
counsel, attorneys, accountants and other agents, and to delegate
to them such duties, rights and powers as they may determine, and
£or such periods as they think fit.
(j) To register any securities at any time in their own
names, in their names as fiduciary, or in the names of nominees,
indicating the trust character o£ the securities so registered.
(k) with respect to any securities forming a part of my
estate, to vote upon any proposition or election at any meeting o£
the corpozation issuing such securities, and to grant proxies,
discretionary or otherwise, to wte at any such meeting; to join
or become a party to any reorganizatioa,� readjustment, marger,
voting trust, consolidation or exchange, and to deposit any such
securities with any committee, depository, trustee or otherwise,
and to pay out o£ the assets held herevnder, any fees, expenses
and assessments incurred in connection therewith, to exercise
conversion, subscription or other rights, and to receive or hold
any new securities issued as a result o£ any such reorganization,
readjustment, merger, voting trust, consolidation, exchange or
exercise of conversion, subscription or other rights and generally
to take all action with respect to any such securities as could be
taken by the absolute owner thereof.
(1) To engage in sales, leases, loans, and other
transactions with the estate of my husband or any trust
_ 4 _
� established by either of us, even i£ they are Eiduciaries or
bene£iciaries thereof.
(m7 �. To exercise a11 elections which they may have with
respect to income, gift, estate, inheritance and other taxes,
including without limitation execution of joint income t�
returns, election to deduct expenses in computing one tas or
another, election to split gifts, and election to pay or to defer
payment of any tax, in all events without their being bovnd to
require mntribution £rom any other person.
(n) To operate, own, or develop any business or property
held hereunder in any form, including without limitation sole
proprietorship, limited or general partnership, cosporation,
association, [enancy in common, condominissm, or any other, whether
or not they have restricted or no nanagement rights, as they in
their discretion think best.
e . Taxes. I diiect that all estate, inheritance, and succession
taxes that may be assessed in consequence of my death, o£ whatever nature and
by whatever jurisdiction imposed, other than generation-skipping taxes, shall
be paid out of the principal oE my general estate to the same effect as if
said tases were e�cpenses oE administration, except that any such additional
tases (and interest and penalties thereon) imposed on accovnt of my interest
in or power over any trust established by my husband shall be paid out of the
property held in such trust, and a11 other property includable in my taxable
estate for federal or state tax purposes, whether or not passing undex this
wi11, shall be free and clear thereof; provided, however, that my executor (s)
may in the discretion o£ my executor(s) request that any portion or all o£
said taxes (i.e. , any or all taxes to be paid out of the principal o£ my
general estaqe�? sY,all insYead be paid out o£ the orincipal of a�y trust
established by me, to the extent expressly authorized ssnder the terms of said
trust.
g, F;d I appoint as Executor hereunder my husband, Rarl S.
Johnson. If my husband is unable or unwilling to serve or to complete the
administration of my estate, then my daughter, Karen Hollinger, shall serve in
his place, or if my said daughter should be unaSle or unwilling to serve cr to
- 5 -
mmplete the administration of my estate, then my son-in-law, Brad Hollinger,
shall serve as Executor hereunder. My fiduciaries shall serve as guardian oE
the property of any minor bene£iciaries hereunder, under any instrument of
trust executed by me, under any policies of insurance on my li£e, and in any
other situation in which the power to make such appointment exists under the
laws of Pennsylvania. No individual fiduciary shall be liable for the acts,
omissions or de£asslts of any agent appointed and retained with due care or of
any co-Eidssciary. No £iduciary �amed herein shall be required to furnish bond
or other security for the proper performance of their duties hereunder.
10. I t t t' n. Unless the context indicates otherwise, any use
of the masculine gender herein shall also include the feminine and neuter
genders, and vice versa, and the singular shall include the plural and the
plural the singular.
IN WZTNE55 WfiEREOF, I, DAGMAR JOHNSON, herewith set my hacd to this, my �
last Will, typewritten on seven (�) sheets oE papex i(n�cluding the self-proving
attestation clause and signatures of witnesses, this %�n day of January,
1998.
�/ .�iC-c� �' l�lG/"��9 (SEzw)
n soEursox �
Witnessed:
��/' / �� / � ////
�i,Q�/L(�v� � "✓I-'� residing at "Tl�/�2'UJ6�'�'�'�! P�
%yq �7/C o [:CDAR �<cqv /e'>
� � 1 residing at °�i+'P �i��� 7`fl . /7d//
- b -
COMMONWEALTH OF PENNSYLVANIA .
55:
COUNPY OF DAIIPHIN .
nacrta.R sOHNSON, (the testatrix) , SHARON R. PAXTON
and CLAYTON P. ARNOLD (the witnesses) , whose names are
signed to Che foregoing instrument, being first duly swom, each hereby
declares to the undersigned authority that the testator signed and executed
the instrument as her last will in the presence of the witnesses and that she
had signed willingly, and that she executed it as her free and volvntary act
for the purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the testaerix; signed the will as witness and that to
the best of his knowledge the testatrix was at that time eighteen years o£ age
or older, of sound mind and under no constraint or tssidue in£lssence.
WITNESS: � TESTAIRIX:
l
��� � �����, ' ��� ���
. DA- �� SOHNSON
WITNESS:
� � ���
Subscribed and swora to before me by DAGMPS2 SOFIN50N, the testatrix, and
- subscribed and swom before me by SHARON R. PAXTON and
CLAYTON P. ARNOLD the witnesses, this 9th day of Sanuary,
1998.
,YJ"i 4 X ' ,� � !� ki - � � . �. .
Notary Public
(SEAL) . ' ...
� NOTAflIALSEAL
MAFLENE A.RHINE,Notary Public
� � Harrishurg PA Dauphin Coumy
�My Commisslon Expires Juty 28,1999
NIRST AIVIENllMEnT TO THE
DAGb1AR JOHI�ISON AGREEMENT
OF'LRUST DATED JANUARY 9, 1995
I, Dagmar Johnson,prescntly of Cumberland Counry, Pennsylvania, dedaze tlus to be a
First Amendment to my Agreement of Trust dated January 9, 1998 ("TrusY'):
1. I hereby delete Subpuagraph 4(g) of my"frust in its entirety, and�eplace it witli
Lhe following Subpazagraph 4(g):
(g) Altemative Dishibution. Any property held in tcust hereunder
when no issue of Settlor aze then living,which is not effectively
disposed of elsewhe�e herein,shall be dishibuted equally to Sloan
Kettering Insdtute (Hospifal) for Cancer Research, located at 68'"
York Street,New York,New Yoik, and fhe Childrens Inn at Nih
T.C.I.,Bethesda, Marylarid (affiliated with the National Insti[ute of
Health), oi its successors. If such organization(s), or its
successor(s), is not in existence at the time of distribution,theu my
Trusfee shall select and distribute the respecrive shaze hereunder to
one or more exempt organizatioos within the meaning of Section
501(c)(3) of the Intemai Revenue Code of 1986, as ameuded from
time to time, or any coiresponding section of any futuie federal tax
code.
2. I he�eby delete Pazagraph 8 of my Tmst in its entirety, and replace it with the
following Paragraph 8:
8. Trustees. If Settlor's husband is unable or unwilling to serve or to
complete the administration of any trust hereunder,no successor shall be
appointed to serve in his place. If Settloc's daughter is unable or unwilling to
serve or to complete the admuustration of any trust hereunder, then Stephanie
ffiemfeltec shall serve in hec place. The then survivmg Tmstee(s) of any trust
heieunder may at any time, acting unanimously by written instrument, appoint
-I-
onc or mo�e individual(s) anNoi a wrporation with fiduciary powers to scrve as
Trustee(s) hereuudcr if and when all Trustee(s)named above aze unable or
unwilling to serve or to conti�ue serving, and/or so appoint an individual and/or a
co�poration with fiduciary powers as a special, limited oc RII co-trustee at a�y
time. In additioq the individual Tmstee(s) then servi[tg may so remove any
corporate trustee then serving hereunder and/oi replacc any such cocporate tcustee
with another independent coipora[e trustee. Notwithstanding the above,no then
cunent income beneficiary shall servc as fhe sole Tmstee of a trust created
hereunder foc his or hei beoefit, and no bcneficiary sha11 par[icipate as a Co-
Trustee in any decision if the power to do so would constitute a general power of
appointment for fedecal estate taY pucposes.
A trustee may resign at any bme upon giving not less than t6ir[y(30)
days' written notice to the other Trustee(s) (o�, if none, to the then cuxrenf income
beneficiary(ies) of the specific trust),provided that the resignation of a Trustee
may not take effect until a soccessor Trustec, if required he�eunde�, is able and
vrilling to begin acting as such. Successo�Tmstee(s) shall have the same dghts
and powecs hereunder as the initial Trustee(s). No successor Trustee shall be
chazged with any default occurring prior to their becoming a Trustee hereunder.
No fiduciazy hereunder shall be required to fiunish bond or other securiry for the
pcoper performa�ce of theii duties hereunder. The Trustee(s) shall serve as
guardian of the property of any minor beneficiary hereunder, as necessary. No
individual fiduciary shall be liable for the acts, omissions or defaults of any agent
appointed and retained with due care or of any co-fiduciary.
Kuen Hollinger and any othe�individual Tmstee(s) who are beneficiaries
of any hvst established hereunde� shall serve as such without compensation for
their services hereunder. All other individual Trustee(s), if ever any, shall be
entitled to reasonable compensation for their services heceunder. Tk�e
compensation of any eorporate Trustee, if ever any, shall be in aceocdance with its
ooimal fee schedule in eftect for like Wsts when serviees are xendezed heceunder.
Notwithstanding the foregoing all Trusfee(s) hereunder shall be enriiled to
reunbursemen[for any and all costs and expenses actually and reasonably
incurred by them in serving as Trustee(s).
3. In all other respects,my Trust of January 9, 1998, shall remain in full force and
effect.
-Z-
1N VJITN�SS WHEREOF, I,Dagmaz Johnsoq set my hand to this First Amendment to
my Agreemeut of Tmst dated January 9, 1998, typed on foui(4) sheets of paper, including the
sdf-proving attestation clause and signa[u�e of witnesses,fhis 30`" , day of November, 1999.
SETTLOR:
i
� :
` t r'Ci�;:z l;ii_z+,zi✓� (SEAL)
Dagcnar Tohnson���'
Witnessed:
ii
�� �-r.-� / �.�, ' ; i , _residingat 1 �,��_�.,, , !'-.- � 1' l-r.
� i
q.�,��esiding at S �
TRUSTEE: �-�
,� /� //� ,
� j %�i,<L!,l, lr - ( ('�<�:'i"��SEAL)
Ka�en Hollinger ��
-3-
COMMONRJEALTHOFPENNSYLVANIA .
ss:
COUNTY OF DAUPHIN �
Dagmaz Johnson, (Settlor), 5��haNe ��e:,-�/e/¢i a�d ,(,,' u,lc� i'"� . E�he�.na.-�
(the witaesses),whose names aze signed to the foregoing instrument,being fi�st duly swom, each
hereby declues to the undersi,�med authority that the Settlor signed and executed the instrument
as her Firsf Amendment to hez(revocable)Agreeme�t of Trust dated 7anuary 9, 1998, in the
presence of the wih�esses and that she had signed willingly, and that she executed if as her free
and voluntary act foi the pueposes Lhe�ein expressed, and that each of the wihiessee, in fhe
presence and hearing of the Settlor, signed the First Amendment as witness and that [o the best of
his or hei laiowledge the Settlor was at that time eighteen years of age or older, of sound mind
and under no constraint or undue influence.
WITNESS: Settlor:
�_
— - � ; r�._..� u,--- e%<-F CG� > r,';:.a !G,%��l�
. � � � �� DAGMARJOHriSON
W"�NESS:
�
Q
�
Subscribed, swom to and acknowledged before me by Dagmaz Johnson,fhe Settlor, and
subscribed and swom Yo before me by 5{e�lw�%e ����C/4- �d /,,:�da m- c�e%,a� ,
the wimesses, ttus 30`" day of November, 1999.
--�-- �P �P�-1�.��
�B�p�q N�I��{, � Publ� �� Notary Public
ertieyurg,p,q DeupMn County �
i My Commisaion E�npleee Feh. 3, 2003 �
_- _-----« "`."" (SEAL)
-4-
AGREEMENT OF TRUST
BY THIS AGREEMENT, executed on Sanuary 9, 1998, DAGMAR JOHNSON, of
Cumberland County, Pennsylvania, as Settlor, hereby establishes a trust, and
Settlor's husband, ICARL S. JOHNSON, and Settlor's daughter, ICAREN HOLLING£R,
as Co-Trustee(s) , hereby agree to hold the initial trust principal, ar.d such
, additional property as may be placed in trust hereunder (whether during
lifetime or by testamentary act) by Settlor or (with the consent of the
Trustee(s) ) any other person, in trust subject to the tern:s and conditions set
£orth below.
1. I 'C' 1 Trust Pronertv. The Settlor has this date contributed to
this trust the funds and/or assets listed in Appendix A hereto, the receipt
whereof is hereby acknowledged by Trustee(s) . Said assets £crm the initial
principal o£ the tsvst.
2. D' S tt� '£ t'me. During the lifetime o£ the Settlor,
the relationship between her and the Trustee(s) shall be as £ollows:
(a) The trust may be revoked by the Settlor at any time by
written notice to the Trustee(s) , and in case of such revocation,
. all property then held in trust shall be given over to her.
(b) The trust may be modified, altered or amended by
written agreement between the Settlor and the Trustee(s) .
(c) The net income, if any, generated from trust assets in
Settlor's lifetime shall be the property of the Settlor and shall
be paid to or Eor the bene:it of the Settlor at least quarterly.
(d) The Trustee(s) sha11 from time to time pay from the
princiFal of the trust such sums, including any or a11 of the
principal, that the Settlor may request in writing. In addition,
the principal of the trust may be distributed to or Eor the
benefit of Settlor from time to time as needed, in the discretion
o£ the Trustee(s) , £or her health care, maintenance and support,
and/or to maintain the standard of living now maintained by her,
and any property held in trust herevnder may be made available £or
use and/or possessioa by Settlor.
(el A11 incidents of ownership in any life insurance
policies in which the Trust has an i�terest as a designated
beneficiary, including but not limited to the right to change
beneficiaries, shall at all times be held by the Settlor. The
Settlor shall at all times retain the right to possess and use
said policies without iimitation, including but not limited to the
right to se11, pledge, assign, receive cash value or otherwise
dispose of, any or all of said policies without liability to
account for the proceeds of any such disposition or action. All
premiums on the policies shall be paid by the Settlor, and the
Trustee(s) shall not in any way be liable for the failure to make
such payments or Eor any loss in value of the policies which may
result from such failure. Settlor does not ia any way obligate
herself to make any premium payments, and no such payments may be
enforced by the Trustee(s) or any beneficiary hereof.
3 . Al1 ation of Assets. The primary puspose for the establishment
of this trust is to provide £or Settlor's husband and descendants in the event
of her decease. The Settlor anticipates that a signiPicant portion of her
estate may be distributed and/or administered hereunder as a result o£
bequests to .he Trustee(s) contained ia her will. Upon Settlor's death, if
Settlor's husband, Karl E. Sohason, survives her, the assets held or received
by the Trustee(s) shall be distributed, held and administered as follows:
(a) There sha11 be distributed outright to Settlor's
husbanc, Karl E. Johnson, the amount, if any, equal to the greater
o£ (i) (A) the ma�cimum amount that could be sheltered from Federal �
_ z _
Ectate Tax by Settlor's husband at the time oE Settlor's deatri
through utilization of him then remaining uni£ied credit or
applicable credit amouat less (B) the aggregate fair market value
of all assets and property owned outright by him immediately after
Settlor's death, including without limitation all property passing
to him by right of survivorship, all proceede of life insurance on
Settlor's 1ife, and so forth (other than assets passing
hereunder) , with any such assets which were included in part or in
whole in Settlor's taxable estate for federal or state death tax
purposes being valued at the Einal value as determined for such
death tax purposes, and with the Trustee(s) accepting and relying
upon the reasonable writ[e� sCatement of Settlor's husband (or his
personal representative) as to the value of his remaining assets,
and (ii) (A) the minimum amovnt, after taking into account all
deductions other than the marital deduction and applying all
available credits, which is necessary as the marital deduction to
reduce to the lowest possible amount the federal estate tax
payable by reason o£ Settlor's death and any £ederal generation-
skipping tax on any transfer with respect to which Settlor is the
deemed transferor, minus (B) the value of all other assets
included in Settlor's gross estate for federal estate tax pusposes
which walify for the marital deduction and which pass, have
passed or will pass to Settlor's husband under Settlor's Will, by
operation of 1aw, survivorship or otherwise, including without
limitaCion life insurance proceeds on Settlor's life if included
in Settlor's gross estate for Eederal estate tax purposes. It is
Settlor's intention that all property passing to her husband under
this subparagraph shall qualify for the marital deduction for
; '
federal estate and gi£t tax purposes, and any prwision herein or
in Settlor'c Wil1 which may appear to con£lict with or in any way
defeat such intention for the full amount passing to Settlor's
husband shall be construed or applied to accomplish that
intenLion. In addition, Settlor directs that debts and expenses
o£ admimwstration be paid or accovnted for out o£ Settlor's
general estate before mmputation oE shares hereunder and that,
notwithstanding anything contained herein to the contraxy, no
debts, administration e�cpenses or death taxes sha11 be paid out of
any share allocable to Settlor's husband vnder this subparagraph.
(b) The remainder o£ the property held and received
hereunder (or, if Settlor's husband does not survive her, all of
such property) shall be allocated to and held in the Family Trust
(Paragraph 4 below) .
4. Fa '1 Trust. Any and all assets allocated to the Family Trust
shall be held, administered and distribvted as Eollows:
(a) Income. The net income shall be paid at least
quarterly to or for the benefit of Settlor's husband, Karl E.
Sohnson, for life. Thereafter, if Settlor's daughter, Karen
Hollinger, does not survive the surviwr of Settlor and her
husband, the Trustee(s) shall from time to time pay any or all oE
said income to or for the benefit of any or all of 5ettlor's
issue, in such pronortions or amovnts as in the sole discretion of
the Trustee (s) seem necessary to prwide for their support,
maintenance, health care, and education ("education" includes
elementary, secondary, preparatory, vocational, undergraduate and
graduate levels for all trust(s) established under this
Agreement) , taking into account the other sources of income,
- 4 -
support and estate available to them. Without intending to create
any legal rights, Settlor would approve distribution of income to
those beneficiaries in lower [ax brackets, even if that would
require invasion of principal for other beneficiaries. Any net
income not paid or distributed to Settlor's issue, as aforesaid,
shall be accumulated and added to principal at the end of each
taxable year. Settlor's husband shall not participate as a Co-
Trustee i� any decision with respect to the application oE this
subparagraph (a) .
(b) Prin i . During the lifetime of Settlor's husband,
the Trustee(s) shall from time to time pay such sums Erom the
principal of the Family Trust to or for the beneEit of Settlor's
husband alone as may in the discretion of the Trustee(s) seem
necessary for his support, mai�tenance and health care, or £or the
maintenance by Settlor's husband of the standard of living
maintained by him during Settlor's lifetime. Thereafter, if
Settlor's daughter, Karen Hollinger, does not survive the svrvivor
of Settlor and her husband, the Trustee(s) shall £rom time to time
pay such sums from the principal oE the Family Trust to or £or the
benefit of >ny or all o: Settlor's issue as may in the discretion
o£ the Trustee(s) seem necessary £or their support, maintenance,
health care and education. For all distributions hereunder to
Settlor's issue, the Trustee(s) shall take into account the other
sources o£ income, support and estate available to the distributee
and the needs and resources of all the beneficiaries. Any of the
£aregoing distributions to or for the benefit of Settlor's issue
sha11 be based on their needs, ra[her than a desire to maintain
absolute equality of payments amcng them. Settlor's husband shall
5 -
not participate as a Co-Trustee in any decision with respect to
the application of thi� subparagraph (b) .
� (c) L 1 S t Obl' ation. No payment shall be made
under subparagraphs (a) or (b) abwe which would discharge to any
extent the legal obligation o£ any person £or the support o£ the
recipient of such payment.
(d) b d' R' ht E withdrawal. In addition to the
£oregoing, during any calendaz year Settlor's husband shall have
the unquali£ied right in his sole discretion to demand in one or
more writings delivered by him to the Trustee(s) that he be paid
£rom the principal an amount not in excess of the greater of Five
Thousand Dollars ($5, 000.00) or five percent (5;) of the aggregate
market value o£ the assets in the trust as o£ Decembex 31 of the
calendar year during which such demand is made. The right
permitted Settlor's husband under this subparagraph (d) must be �
exercised by him as herein provided on or before December 31 of
the calendar year to which applicable, and any amount as to which
such right is not exercised for any given calendar year shall
lapse and shall not accum�late or carry over to any future
calendar year. If this right is exercised for an amount in excess
of $5,000.00 prior to December 31, the withdrawal sha11 be at the
disctetion of the Trustee(s) (other than Settlor's husband) and,
i£ permitted, shall be based on an estimated value and shall be
adjusted as necessazy on December 31 of that year.
(e) Aft H b d ' f t' L' 't=d P £ F ointment
b H b d. Upon the death of the survivor of Settlor and her
husband, i£ he survives her, the Trustee(s) shall pay the balance
held in trust, outright or in trust, in such amounts or
- 6 -
proportions as Settlor's husband may direct in his last valid Will
� naking specific reference to this Family Trust, but only among any
or all o£ Settlor's issue and/or their spouses.
(fl �t�bution. To the extent Settlor's husband faile
to exerc'_se effectively his limited power of appointment, or if he
predeceases Settlor, then upon the death of the survivor of
Settlor and her husband, the Trustee(s) shall distribute the
zemaining balance then held in the Family Trust outright to
Settlor's daughter, Karen Hollinger. I£ Settlor's said daughter
does not survive the survivor of Settlor and her husband, then,
until Settlor's daughter's youngest living child reaches the age
of twenty-five (25) years, the Trustee(s) shall retain the assets
in the Family Trust and pay such sums from the income and/or
remaining principal to or for the bene£it of Settlor's issue £or
the purposes and subject to the considerations and other terms set
£orth in subparagraphs (a) , (b) and (c) above; and when Settlor's
daughter's you�gest living child has reached the age oE twenty-
£ive (25) years, the Trustee(s) shall distribute the remaining
balance in the Family Trust per stirpes to those o£ Settlor's
issue who are then living; p=ovided, however, that if any such
issue is then under the age o£ thirty (3o) years, his or her share
� shall be held for him cr her in a separate trust hereunder tinder
the terms oE Yaragraph 5 below. IE no issue oE Settlor are then
living, the remaining balance shall be distributed as provided in
subparagraph (g) below.
(g) Alt m t D' st 'bution. Any pzoperty held in trust
hereunder when no issue o£ Settlor are then living, which is not
effectively disposed of elsewhere herein, shall be distributed to
� _
Settlor's son-in-law, 8rad Hollinger, or, if he is not then
living, in equal shares (per capita) to those nieces and nephewc
of Settlor's daughter, Karen Hollinger, and her husband, Hrad
Hollinger, wno are then living.
5. S rat Trusts. The income and principal o£ a separate trust in
which a share is to be held for a bene£iciary under the terms of this
Paragraph 5 shall be held, administered a�d distributed as £ollows:
(a) �come, Until the bene£iciary reaches the age of
eighteen (16) years, the Trustee(s7 shall from time to time pay
such sums £rom the income of the separate trust to or £or the
beaeSit of the beneficiary, as may in the discretion of the
Trusteels) seem necessary for his or her support, maintenance,
health care and education, taking into account the beneficiary's
other sources o£ income, support and estate and his or her income
tax bracket. Any net income which is not ezpended as set forth
above shall, at the end o£ each taxable year, be added to the
principal o£ the separate trust. For all quarters ending after
the beneficiary's eighteenth birthday, trie Trustee(sI shall pay
a11 of bhe net income at least quarterly to or £or the bene£it o£
the beneficiary. Notwithstanding the foregoing, no payment shall
be made under this subparagrapri (a) which would discharge to any
extent the legal obli5ation of any person for the support oE the
beneEiciary.
(b) Princinal. The Trustee(s) shall from time to time pay
such sums from the principal of the separate trust to or £or the
benePit of the beneficiary as may in the discretion of the
Trustee(s) seem necessary £or his or her support, maintenance,
health care and education, and such additional sums as in the sole
- 8 -
discretion o£ the Trustee(s) seem proper to help establish him or
her in a bvsiness or profecsion and/or to acquire and/or £urnish
and/or remodel a home £or him or her, taking into accovnt the
other sources of income, support and estate available to the
beneficiary, his or her income and estate tax brackets, the
desirability o£ the transaction �(if any) , and the possible
application of a�y generation-skipping tax. No payment shall be
made under this subparagraph (b) which would discharge to any
extent the legal obligation oE any person for the support of the
beaeficiary.
(c) D' t 'b t� f S t Trvsts.
(i) � when the beneficiary has reached the age of
twenty-five (25) years, the Trustee(s) shall
distiibute to him or her at his or her written request
one-half (1/2) of the remaining principal balance t4en
held in his or her separate trust; and when the
beneficiary has reached the age o£ thirty (30) years,
the Trustee(s) shall distribute to him or her at his
or her written request the entire balance then held in
his or her separate trust.
(ii) If the beneficiazy should die before Einal
distribution of all assets held in his or her separate
trust hereunder, the remaining balance then held in
such separate trust shall at his br her death be
- distributed per stirpes to his ar her issue, or, if no
such issue survive him or her, per stirpes to the
issue of his or her parent who was a child or more
remote descendant of Settlor, or, if no such issue
- 9 -
survive him or her, per stirpes to those of Settlor's
issue who survive him or her, with the share o£ any of
such issue for whom property is then held in or
payable to a separate trust under this Paragraph being
added to and administered with the other assets of �
such separate trust. If no issue of Settlor are then
living, the remaining balance in the separate trust
shall be distributed as provided in Paragraph 4 (g)
above.
(d) D� �t� U A 1' t' f R le Aaainst
p t �t'es. Notwithsta�ding the foregoing, if during the
lifetime of a person for whom a separate trust under this
Paragzaph was established the interest o£ such person therein
becomes void under the applicable rule against perpetuities, then
the balance in such separate trust shall then be distributed
outright to such oerson.
6. S 'val la + e. If any bene£iciary hereunder should die within
sixty (60) days after Settlor, or within sixty (60) days a£ter any other
person the survival of whom determines his or her rights hereunder, then such
beneficiary shall be deemed [o have predeceased Settlor or such other person
for all purposes herevndez.
p, ow rs. In addition to such other powers and duties as may be
granted elsewhere herein or which may be granted by 1aw, the £iduciaries -
hereunder shall have the following powers and duties, without the necessity of
notice to or consent by any Court, but subject to any apolicable requirements
of ordinasy due care:
(a) To retain all or any part of the property o£ Settlor,
real or personal, in the form in which it may be held at the time
of its receipt, including any closely held business in which the
Settlor has an interest and the stock of any corporate £iduciary,
i£ ever any, as long as in the exercise of their discretion it may
- 10 -
be advisable so to do, notwithctanding that said property may not
be o£ a character authorized by law.
(b) To invest and reinvest any £unds held hereunder in any
property, real or personal, including, but not by way of
limitation, bond�, preferred ctocks, common stocks, and other
securities of domestic or £oreign corporations or investment
trusts, mortgages or mortgage participations, and common trust
£unds, even [hovgh such property would not be considered
appropriate or legal for a fiduciary apart from this provision.
(c) 'Po sell, ccnvey, exchange, partition, give options to
buy ar lease upon, or otherwise dispose of any property, real or
personal, at any time held by them, with or without order of court
at their option, at public or private sale or otherwise, for cash
or oCher consideration or £or such credit tesms as they think
proper, and upon such terms and for such prices as they may
determine, and to convey such property Eree of all trusts.
(d) To borrow money from any person, including any
Eiduciary hereunder, for any purpose in connection with the
administration hereof, to execute promissory notes or other
obligations for amounts so borrowed, and to secuze the payments o£
such amounts by mortgages or pledges of any property, real or
personal, which may be held hereunder, and to receive property
encumbered by debts and mortgages and to take subject to and/or
assume same.
(e) To make secured loans, or unsecured loans if to
Settlor's husband, his estate, a trust created by either Settlor
or her husband, or if to a descendant of Settlor, in such amounts,
upon such terms, at such rates oE interest, and to such persons,
firms or corporations as they may deem advisable.
(f) To renew or extend the time for payment of anfor as
obligation, secured or unsecured, payable to ox by them, �
long a period of time and o� such terms, as they may determine,
and to adjust, settle and arbitrate claims or demands in favor of
or against them.
(q) In dividing or distributing any property, real or
personal, included herein, to divide or distribute in cash, in
kind, or partly in cash and partly in kind.
(h) To hold, manage, and develop any real estate which may
be held by them at any time, to mortgage any such property in such
amounts and on such terms as they may deem advisable, to lease any
Such property for such term or terms, and upon such conditions and
rentals as they may deem advisable, whether or not the term of any .
such lease shall exceed the period permitted by law or the
probable period of retention under this instrument; to make
repairs, replacements, improvements, structural and otherwise, in
connection with any such property, to abandon any such property
which they may deem to be worthless or not oE suf£icient value to
warrant keeping or protecting, and to permit any such propezty to
be lost by tax sale oz any other proceedings.
(i) To employ such brokers, banks, custodians, investment
counsel, attorneys, accountants and other agents, and to delegate
to them such duties, rights and powers as they may determine, and
for such periods as they think fit.
- 11 -
(j) To register any securities at any time in their names
as fiduciary, or in the names of nominees, indicating the trust
chazacter of the securiCies so registered.
(k) With respect to any securities held hereunder, to wte
upon any proposition or election at any meeting o£ the person or
entity issuing such securities, and to grant proxies,
discretionary or otherwise, to vote at any svch meeting; to join
or become a party to any teorganization, readjustment, mergex,
voting trust, consolidation or exchange, and to deposit ar.y such
securities with any committee, depository, trustee or otherwise,
and to pay out of the trust created herein, any fees, expenses,
and assessments incurred in connection therewith; to exercise
conversion, subscription or other rights, and to receive or hold
any new securities issued as a result of any such reorganization,
readjustment, merger, voting trust, consolidatioa, exchange or
exercise of conversion, subscription or other rights and generally
to take all action with respect to any such securities as could be
� taken by the absolute owner thereof.
(1) To engage in sales, leases, loans, and other
transactions with the estate o£ Settlor, the estate o£ her
husband, or any trust established by either of them, even i£ they
are also fiduciaries or beneficiaries thereof.
(m) To make all necessary pzoofs of death under the
insurance policies (if anyl o£ which ehey are the bene£iciary, to
execute any receipts for the proceeds and to institute any action
to collect said proceeds and to make adjustments of any claim
thereunder; provided, however, that they need not institute any
action unless they shall have been indemniEied against all
expenses and liabilities to which triey may become subject as a
result thereof. If, however, they desire to institute such action
without indemnification, they are hereby authorized to be
reimbursed for all expenses and liabilities incurred as a result
thereo£ from any amounts which may be held in trust hereunder then
or therea£ter.
(n) To operate, own, or develop any business or property
held hereunder in any £orm, including without limitation sole
proprietorship, limited or general partnership, cosporation,
association, tenancy in common, condominium, or any other, whether
or not they have restricted or no management rights, as they in
their discretion think best.
(o� To make any and all elections available to the
Trustee(s) for purposes of any or all income, estate, inheritance,
gift an3/or succession taxes.
(p) If the Trustee(s) are serving as Trustee(s) of another
trust with terms- and provisions substantially similar to any trust
esta6lished herein, the Trustee(s) are empowered, in their sole
discretion reasonably exercised, to consolidate the trust(s)
herein created with such other trust(s) , insofar as it is
practicable, not in substantial conflict with the terms of this
trust or of such other trust, and not in derogation cf any t�-
saving provision of azy applicable state or federal law.
Provisions of a trust established herein and of such other trust
or multiple trusts shall be considered substantially similar even
if there are minor variations as to the management and
distribution of the trusts. The determination by the Trustee(s)
as to any consolidations hereunder shall be final and conclusive
upon all oarties.
- 12 -
(q) IE the Trustee(s) are acting as Trustee(s) of a trust
esta6lished heneunder (other than the Family Trust) which is of a
size or amossnt which they reasonably conclude no longer justifies
the continuation of such trust, the Trustee(s) are hereby
authorized to terminate such trust and distribvte all amovnts held
in such trust to the then current income beneficiary thereof,
without a court accounting. If there is more than one income
beneficiary, the Trustee(s) shall make the distribution to the
income beneficiaries in the proportion in which they are to
receive the principal upon distribution of the trust.
g. Trustees. If Settlor's husband is unable or unwilling to serve or
to complete the administration o£ any trust hereunder, no successor shall be
appointed to serve in his place. If Settlor's daughter is unable or unwilling
to serve or to complete the administration of any trvst hereunder, then
Settlor's son-in-law, Brad Hollinger, shall serve in her place. The then
serving Trustee(s) of any trust hereunder may at aay time, acting unanimously
by written instrument, appoiat one or more individual(s) and/or a coxporation
with £iduciary powers to serve as Trustee(s) hereunder i£ and when all
Trustee (s) named above are unable or unwilling to serve or to continue
serving, and/or so appoint an individual and/or a corporation with fiduciary
powers as a special, limited or full co-trustee at any time. In addition, the
individual Trustee(sI then serving may so remove any corporate trustee then
serving hereunder and/or replace any such corporate trustee with another
independent corporate trvstee. Notwithstanding the above, no then current
income beneficiary shall serve as the sole Trustee of a trust created
hereunder for his or her benefit, and no beneficiary shall participate as a
Co-Trustee in any decision i£ the power to do so would constitute a general
power of appointment for federal estate tax purposes.
A Trustee may resign at any time upon giving not less than thirty (3�)
days' written notice to the other Trustee(s) (or, if none, to the then current
income beneficiary(ies) of the specific trust) , provided tk�at the resignation
of a Trustee may aot take eEfect until a successor Trustee, if required
hereunder, is able and willing to begin acting as such. Successor Trustee(s)
�3 _
shall have the same rights and powers hereunder as the initial 'Trustee(sl . No
successor Trustee shall be charged with any de£ault occurring prior to their
becoming a Trustee hereunder. No £iduciary hereunder shall be requixed to
furnish bond or other security Yor the proper per£ormance of their duties
hereunder. The Trustee(s) shall serve as guardian o£ the property of any
minor beneficiary hereunder, as necessary. No individual fiduciary sha11 be
liable for the acts, omissions or defaults of any agent appointed and retained
with due care or of any co-£iduciary.
Karen and Brad Hollinger and any other individual Trustee(s7 who are
beneficiaries of any trust established hereunder shall serve as such without
compensatioa for their services hereunder. A11 other individual Trustee(s) ,
if ever any, shall be entitled to reasonable compensation for their services
hereunder. The compensation oE any corporate Trustee, i£ ever any, sha11 be
in accordance wi[h its normal fee schedule in e£Eect £or like trusts when
services are rendered hereunder. Notwithstanding the foregoing,- all
Trustee(s) hereunder shall be entitled to reimbursement for any and all costs
and espenses actually and reasonably :ncurred by them in serving as
Trustee(s) .
9. A t' d T The Trustee(s) shall keep accurate books o£
account with respect to a11 trust(s) established hereunder and shall render an
account of the administration thereof as and when required by law or more
frequenely as determined by the Trustee(s) . Trustee (s) shall also cause to be
prepared and sent to the applicable beneciciaries, annually, all in£ormation
necessary to enable such beneficiaries to prepare and Eile federal and state
inrome tas returns on a timely basis. The accounts of the Trustee�s) may be
settled and the Trustee(s) , their successors and assigns, Eully discharged
from all liability to the Settlor and other persons, including all
beneficiaries, whether or not now in being, who have or claim to have any
- 14 -
beneficial interest in the income or principal, by the joint written action oE
the Trustee(s) and all of such persons who are beneEiciaries and who are thea
competent to act. The Trvstee(s) may rely upon the authenticity and accuracy
of any document, instrvment or signature presented to them, provided such
reliance is in good faith, and the Trustee(s) shall have no obligation to
investigate the application or use of any £unds paid by them in accordance
with this Agreement. with respect to any distributioZ pursuant to the
exercise of any power of appointment arising vnder this Agreement, if any, the
Trustee(s) shall be fully protected in relying upon any instrument admitted to
probate in any jurisdiction as the last wi11 and testament of the party
holding cuch powex or in acting upon the assumption that the party died
intestate in case the Trvstee (s) have no votice of the existence of a probated
will within six (6) months after the date of the person's death.
10. dth '£t Clause. No interest (whether in inmme or principal,
whether or not a remainder interest, and whether vested or contingent) of any
bene£iciary hereunder shall be subject to anticipation, pledge, assignment,
sale or transfer in any manner, nor shall any bene£iciary have power in any
manner to charge or encumber his or her said interest, nor shall the said
interest of any beneficiary be liable or subject in any manner while in the
possession o£ the fiduciaries Por any liability of any such beneficiary,
whether such liability arises £rom his or her debts, contracts, torts, or
other engagements of any type.
11. F '� �t f P t f M' I 'tated Persons. Any
amounts which are payable or distributable hereunder to a minor cr
incapacitated person may, at the discretion of the fiduciaries, be paid or
distributed to the parent or guardian of such minor or incapacitated person,
to the person with whom such minor or incapacitated person resides, to a trust
existing primarily oz exclusively for the benefit of such minor or
- 15 -
incapacitated person, or directly to sucri minor or incapacitated person, or
may be applied for the use or benefit o£ such minor or incapacitated person.
12. Death Taxes. Estate, inheritance and succecsion taxes that may
have 6een assessed in consequence of Settlor's death, of whatever r.ature and
by whatever jurisdiction imposed, whether or not on account o£ property
pascing hereunder, other than genesation-skipping taxes, may on request of
Settlor�s personal representative(s) and consent oE the Trustee(s7 be paid out
of the principal held hereunder, as iE said taxes were expenses of
administration hereof; provided, however, that no such taxes sha11 be paid out
of assets that are not includible in the federal gross estate o£ Settlor.
13. I t t t' IInless. the context indicates otherwise, any use
o£ the masculine gender herein shall alco include the £eminine and neuter
genders, and vice versa, and the singular shall include the plural and the
plural the singular.
14. L G This Trust shall be administered and interpreted
in accordance with the laws o£ the Commonwealth of Pennsylvania (excluding
con£licts of laws) . Jurisdiction and venue for the resolution of any and all
disputes arising hereunder, and/ar for intexpretations hereof, shall lie only
with the Common P1eas Court for Cumberland County, Pe�nsylvania, and/or the
vnited States District Court for the Middle District of Pennsylvania. The
- 16 -
situe oP this trust shall be in Cumberland County, Pennsylvania, by agreement
of the parties hereto, to the fullest extent permitted by law.
IN WITNESS WHEREOF, and intending to be legally bound heseby, the
Settlor and the Trustee (s) have hereunto set their hands and seals on the date
£irst menCioned above.
WITNESS: SETTLOR:
i /�
--�I'�2;',y,i �< �'..� fy'z;� �i¢f-crc�, .i�-�-r-���. �(ssai.l
DF}GMAR JOHNSON"�
TRIISTEE(S) :
�! /� � � � /� �� / �
-/��L���Cn � / '����'"l 1�i�{ (� � C.ei..: l7li::i-'r',1.iG(s�as.l
unai E. JOEiN��
�`s/��v'ti%�l ��-� ��IC'..l .
(SEAI.)
N HOLLINGER �
- 1/
APPENDIX A �
One Dollar ($1.00) - Attached below
I, the undersigned DAGMAIi JOHNSON, this 9th day of Sanuary, 1998, do
hereby acknowledge that in my capacity as Settlor of the accompanying
Agreement of Trust I have paid to Karl E. Johnson and Raren Hollinger as
� Trustees thereof One Dollar ($1.00) in cash, such payment representing the
initial fundizg of such Trust.
� ����
.i�./����CG+,r� i%/��L!-Y39
DAG JOHNSON ��'�
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- ie -
COMMONWPALTH OF PtiNNSYLVANIA . -
SS:
COUNTY OF DAUPHIN .
On this, the � day of .Tanuary, 1998 before me, a Notary Public, the
undensigned officer, personally appeared DAGMAR JOHNSON, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within
instrument, and acknowledged to me that she executed the same for the purooses
therein contained.
IN WITNESS WHEREOF, Z hereunto set my hand and official Seal.
t
� �n��.,� p � �„� :.. �_
Notary Public
(SEAL)
NOTARIALSEAI
MAFLENEA.RHINE,Notary Public
Hartlsburg,PA Dauphln ComM1y
My CAmmisswn Fxpires Juty 28,1999
19 -
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R03E0.i W_MAIICK JR JOAN G MAIICK
THE ESiATE OF OAGAIARJONNSON
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' � PENNSYLVANIA INHERI7ANCE TAX
INFORMATION NOTICE
euvEnu oF rHoxviow� 1axEs FILE ND. 21
ro eox aaoco� pennsylvania AN� ACN 12129170
w�xacseuaern �r�za-asoi �qM�� ,� ,,. �E�� TAXPAYER RESPONSE DATE 05-02-2012
TVPE OF ACCOUNT
EST. OF �A6MAR JOHNSON , ❑ sav[nss
SSN 5]9-62-0692 ❑ vxeoexqc
OATE OF ➢EATH o4-10-2012 ❑ *ausr
WUNTY CIIMBERLANO X❑ cEanF.
REMIT PqYMENT AND F00.M5 i0:
KAREN E YEAGEk REGISTER OF WILLS
20 SIINFIRE AVE 1 COURTHOIISE Spl1ARE
CAMP HILL PA PO11-1020 CARLISLE PA 17013
WELLS FARGO pmvlEed [M1e tlepa�[ment witA [�e IDformatlon �e1ou. rMcl', r xeE in calcNating tM1e in�eritinre tax du^.
aem-os indsca4 IDat a[ [ne Eeat� of tne aoove n metl ae�etlent, you u a jaint o r/penenciary ol :MSUa wL IT you e tM1e SDouse oT tM1e
deceasetl anJ ny amomt othe� t�an xe�o isa�eflec[e4 belov en tM1e PotenHal Tax �ue Hne, note�no tax may be tlue, but you must
tlfy the Uepa�tment f you� relatlonsM1ip Lo tM1e Jeceasetl by c0eck1n9 6ox C in PART 1 belou and w iting "spouse" 1n PART 2.
I! you believ¢ t�P 'nfo�matlon 'S inwfrt[L [lea5¢ o�[d1n uritten c r ection from t�e flnancldl m5[1NLioo, attecM1 a c py to tMz IDrm dnE rew�+
tt to L�e aS �e a4Cres . P1 se oall ]ll-]8]-832] u1t� pu¢stions �
LOXPLETE PART�'1 BELOW � .SEE REVERSE SIDE FOR FILIN6 ANO PAYMENT INSTROCTIONS
ao�o��e Ha. 247402073709487 oate OB-13-2006 7o e� «.a.< <e cn. .� o��x, mo
Establisn.a uov mi:erotice nu:t a
ent to Ma ReB�sb� af Mi11s.�anMake cMck
A<count Balance g 22,249.30 oavable io "Regisfer of Wills� 1eenP'.
cercenc raaaeie X 50.000
xore: �r <� o e�e� e . ..n: .s�ne� en�..
amomt sue�e�t to ra: S 11.124.65 o„en: or en. a �.ae�r: oao. or a..<n,
Tax aaee X .15 aea�« a s o .�e as:�o��a o� m. ass e�e.
Pokential Taz Oue 1,668.70 Am anM1e�itance taz tlue rill bec �e Oelinwmt
S n ne mont�s efte� kFe tlake a£ Geat�.
PAar TAXPAYER RESPONSE
0
n. � rn. .eo.: .�m�m.no� .oe �az e�: .: � ��.�i.
x...e o .oe eo en. a«a..�.� os w.u: ��en e..o � er enf: oetio: �o oea..�
CHECK • m:�o��o o� : oaa me.�e:�, o� �:e��� ma: �oes�.3eo m. aea.�e.� e� wiii: .�e
CONE � an o£HSial a5xe5ment ulll bo fimetl M Me P� pepe�ben[ of Nevenue.
BLOCK e. � m. :eo.. a ::o m: e.:� o .au n. � o�<.e .�a caz Pa.a „sm en. pa��:vi•.�.a e�ne�.�a��. ea. .Qe�r�
ONLY r.iee er m. eana�e �eo�exen�anv..
C. � The abore inPorna is ncor t anNor Eebks anE EeEuctions uee'e oaiL.
Ca�pleb PFRT �2 'anE/o�'P/.RTr�O lelow.
ppRT 1f intlicating a Eiffe�ent [ar �afe, please SSate
o �e�a�.o�=�=o ,o ae�ade�t
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOIlNTS
LINE l. Oate Es[ab1S5M1eE I
2. Accowt Balance 2 5
3. Percent Taxable 3 X
4. Pmovnt Sub]ec[ [o Tax 4 S
5. OeEts and Detluc[ions 5
6. Amounf Ta[able 6 `�
]. Tax Rate ] X
e. TaX Oue 8 S
�t
PpRT DEBTS AND DEDULTIONS LLAIMEU
0
DATE PAIO PAVEE DESCRIPiION AMOUNT PAID
TOTGL (Entar on Line 5 af Taz Computation) '0
Untler penalties af oeriury, I tleclare t�at Me facts I reporteE aEave are frue� co��ect antl
complete to t�e Eest af my knovletlee an0 �elief. HOME ( J
WORK C J
TA%PAVER SIGNATIIRE TELEPNONE NUMBER OqTE
GENERAL INFORMATION
L FAIW0.E i0 RESPONO WILL ftESULT IN AN OFFICIAL TAX ASSESSMENT uitp auPlicable intemzt tasetl on info�mation
rvbmitteE by [�e financial inxtikution.
2. InM1eritance tas Lecones a¢linvu¢nt n onthz a£b� tM1e EeceCmt'S Oete o eat�.
3. q leint a unt iz <azabla e rM1en'tfiemOeceGen['x n aEtletl a eaHe� o{ c nven
4. Acc mtz (Sn<luElnp t�ose �elEn�etveen M1uzGanE antl vi£e) lM1e JeceOent put m ]oini nanes vithin one yea� pao� <o
a:a�n . e rmiv �ax.ei..
. ��<, ..<aen.nea e � n�.ea„e a�e .,i�a . .e ena� a e eeaen ��e �o< <a:am�.
e. n�=o��t: neie nv a a.�.a:��Y��.� o-�:x ror• a�omer o� oene�s a�: +�uv aa.am:.�
REPORiING INSTkIlCTIONS - PART 1 - TAXPAVER RESPONSE
�. e�oce a - �r an. ��rorm.tio� .m =eio�iesso� co cn. �oes�: : re�t ��a eee��e.o�. a �oe n�e�s <iai.<e, oia�. a ..x.•
n Block /. of Ya�f 1 oi Me "iazpme� R�iponsa" sectlon. Si9n bre c antl zubmit Men vl[� a c�eck tor' [M1e ae vnt ef
kax [o Ihe � iste� ot vlllz of t�e c unty SnEica2eG. iM1e PA �epartnen4 0£ Revenue vill issue an officiel essessmenY
(Po�� FEVQ548 IX) u0an rtui0t o£ IDe r'¢kurn fr'om Me �egizte� of �ills.
2. BLOLR B - I£ tM1e a zei z ci£ietl on this notice �as Leen o rill be � ortetl anC taz paiE vStM1 t�e Pennrylvanie in�e�itence
ie� return fi]eG by fM1e eztake'z � entative. plare a '%" in llock E of Par't 1 of t�� "iazpaye� Re50onie" sec<ion. $ign Mo
�oP.e� a�a �ac��� m m. �.oi.c:� orf.eu: ev m. �o��cv.oee�ame.
e. e�ocx c - ir <na �ou�. .�ro�m.�.o� . e=e a�vo� a:e�otio�: a : e:s�a �ias.ea, me�k eio�e e a�a � aoie<. Pa�e. z a�a s
o�as�g io me .o:�r��oio�= e¢io.. Ss.g��mo � aoa :�emi� m.. .fen vo m.�t ro� <ne a �oe or e� o vaei: oo m. � �:ae�
o£cu1115 of tM1e c unH intl3catetl. iM1a PA OeOa�tnenf5af R¢venue uill isxua anuo£Hclal aisessemf (Fo�o REV-154B IX) uoon rec¢ipt
of iM1e return tron tFe �ea�zL� af u�lls.
TA% RETURN - PART 2 � - TA% CALCULATION
.u�:e
�. eooer m: e e en. a �oe o �aur . .eis,nea o� e,uea a� en. . .:�e�u a� aa�. ar ee,m.
HorE: ror a�ae�eae�c��no e.:e:ro:�iznziaz, a ��e� me ae�eee�< o�<ai .o� o mam� o or ee,en .
f�ii. <azaei. xo� mer .=i�� � �a< eo �:�eee oa,000 oe� o-a�:reae. .es=�me„or me .ai�aeov
xn: .==o��< a� ene ��oeer or .o�o��e:�neta.��
�f e ao�m. a:e.�.:k n.� a : ne�ere r � +;�.e � � m. aoa�e:: oo.�.00 ot mi: �oti=e. ene r3,000 a.�i�:ao�
.., a.a��eae e.o. m. a�oo��<�esi,�a ns �eoo�e�a e. tn:r.�a��.ai s�:�smno�.
z. e�ee� en. eoeai naza�<. or ene . ��e ,�m�aa�s .�eo�e�� a ��ea m m: aaxe ov e
e. rne o .�caze of <n: n ��t xnae e� <�em. m ea�n , : aexe.omea n: mn�,,:
a. me�oe��.oeao. �a.am. at ie.�< =s�e« •.<aeis�n�e .o�:�u.� o�e ve,r nr.or eo me ee�eaa�r� aaaxn:
1 OIVIDE� BY TOTFL NOXDER OF OIVIOE� BY iOiAL NUXBER OF XULiIYLIEO BY 10� = PERCENT iAYA6LE
JOSNt OWNER$ SURVIYIHG JOINi IXYNERS
Enaople: R ioinf asset �e isb�eO in [�e nane ot Me tleceEent anE hv o[M1e� Oersons.
1 �[VIOEO LY 3 (JOINi CWNERS) OIVI�E� BV 2 (SORVIV�R9 = .161 X IOY = 16.] pe�cent <iR%ABLE ID FACH SOfNIVOR)
p. LM1e p eniaBa tazaEle fo� a setx c eateE �iMin o o£ t�e Gece�ent'i Eeaf� ar accountz ornetl pv [�e EeceOent Out ne1G
.� e��,� eo� aooane� .�ea..a�a�c�i n�,,.e ee��n�.a�se:�'
] �IVIDEO 9V iOTAL NIIMEFfl OF SORVIVING JOINL XIILTIPLIEO 9Y I00 = PERCENi TAYABLE
GAHERS OR iRI1Si BENEFI[IRRIES
Fie�ole: Jo]n[ a wi �episte�etl in tM1e nano af t0e 4eceEenf antl ho otFer' oersonx anE eitabliSM1eE vlt�in ona yee� o£ Eaat� Ly
�n. a.�eee�<.
i orvmeo ax z csuavrvorzs� _ .so x ioo = so o:��eo< <rnw.e�E Foa caox sumrvou�
s. m. : vnc xueiec< m caz ai�e a� .: aeie�omee ev m�iHobina ue aao�m eala��e eu�e n m tn. c.�ant tueel. aioe v.
S En[e�mt�e tota] af t�e tleLtz anE Ectluctians ltsteE in Park i.
6. T�e a unt bxable [Line 6) 3x tlot¢n1neE Ey SUEtrac[in9 Me tlebtz antl tletluctions (Line Sl t�am t�e anomt SUCiecf [o tu (Line 41.
z s��e�mene ap �e .seee eaz �ae. u,�. » a: aeaei.s�ea eei�,.
Oate of OeatF Spouse L1nea1 Sibling Colla[e�al
0)/O1/94 to 12/3V94 3 pe�cen[ 6 percent IS percent IS Oe�cenf
O1/�1/95 to 06/30/00 0 pe�cent 6 pe�cen[ 15 pe�can< l5 pe2ent
OT/OV00 Fo p en[ 0 pP�cenL 4.5 percent + l2 pe�<Pn[ I$ pB�cenk
.rn: xaz �exe � � ena �.e .ai�: or �r.�:r:r: rro. a ae�e.:.e �naia zi . or a ae
a.am xo o� m�anae�.. or a �.o��:i o.r:�o, .� .aooti.. o.�e�< o� . ,neooar.��aos m« �n.ie .:�o o.�o:.t.
rn. i.�eai �ia,: or n<v�s i .�aoa�.�a:, n a�<s <n.iare� a�e oen.r ia�e.i e .�ae�e.. ^cn.ia.ao•• a��ma.: oa��ra� �naie�.o
„n.me� o �o< <na na.: eee� eeoo<en m. om.�:, seoo�.e �niiar:� soa :�:o rnitare�. e�medi ae,�:oao�c:• .o<i�e:: au �mie�e� or en:
�a<��ai P e�x: aoe nneir ee:�e�ee�t:. .nero.� o ooe �nev na.a o..� aaootea ov o�ner:; aaovicea ee:�eoa.�c: am onm� e<:�e�ea�e:;
a�e :mo-e.:�.�m�t:. ^seis�9:• a . a.smee . �ooi.ia�a. .no n..e .e iaa.e o�. oa�e�e i� �o�aoo .inn m. o:aaeot, .nern.r ev eiooa
o� eeoouo�. rn. eov:tern =�a:. of n.s�: s��i�a:: aii omer oeoera�.arse:.
CLAIMED DEDULiIONS - PART 3 - OEBTS ANO DEDUCTIONS CLAIMEO
nuo.aei. eeex: .�a a.a��e.o�: are e:�e'.mee a: roim..:
n. vo� e . ien+i�r r iime ro� om�.e�b er m. e�eace .,,ee.�e io aaes�;�i�ano� ev a o:�:o�at �en.ese�x.et.e �: .�:�rri�.e�t
m o v m. e.n��cnei.�se....
e. vo� a�m.ii> oa.e xn. e.et: :rt:r rna ae.m or m. e:�.e.�n aoe o � f���i:n n oot e� e e�<.
e. neo�: oei�a �iaa..a .�:e e. a�..i::o t�iir a� r.rx a. �f aaevs�ai :oa�. .: o..e:e. �:: e vr• : tr� :nee< ot oane�. P�oor ot
o ..�e .av e. �:e�.:xen ev rn: va oeoa�c..oe oe a:.:��..
.._ . � :�. . ��.
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N_
� PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
evauu oF xeo�vmua� rnxcs FILE ND. 21
Po eox zeosoi enns Lvania AND
xaaaiseuec an niza�ow� PE�.a,„�„Y„_���� TAXPAYER RESPONSE /�CN 1212798�
�� DATE p4-26-2012
TVPE OF ACCOUNT
EST. OF �A6MAR JOHNSON ❑ sqviqcs
SSN 5]9-62-0692 Q cHccKxxc
DATE OF DEATH o4-la-2o12 ❑ taus.
COUNTY � CUMBERLAND ❑ [ERnr.
REMIT PAYMENT ANO FORMS T0:
KAREN E YEAGER REGISiER OF WILLS
9 ROUNO HILL RD 1 COURTHOUSE SpOARE
CAMP HILL PA 1]011-2636 CARLISIE PA 1]013
cirezervs aaHe oc pervesr�vaxia ��o,�eee cne eepa�omma wien cn. ,�ro�man,o� eeiow. .m�n .as .�e ; �:icman�.a ene , ne�,ca��e na. e�e.
aemros ineicate t�at at xne aearn f tne above-namea eece�en0. you uer a jo�nc orner/benefic�ary r tM:�a�cwnA If you are tAe spouse of tM1e
tleceased antl ny amount other tM1an ze�o is reflectetl below o the Potential Tax Oue 11ne. note o tax may be Eue. Eut you must
notlTy tM1e Eeyartment of you� relaHonsM1ip to the deceaseC by cAecking Box C in PAAT 1 below anE w�itin�g "sDouse" m PART 2.
If yuu �elie�e t�P 1nfp�0dtlon i �pc[, p e 5 �ta1n Mft[Len c � ecti0n f�Om IM1e finanC�dl ip5.ltution, a[La[� d c py IQ I�15 f0�m an0 t¢LYr'n
i[ to [�e e�ove address. Vleas•�call�A]-]6]-0i2]�ri[M1 QuesNons.
COMPLETE PART 1 BELOW t SEE REVERSE SIDE FOR FILING ANO PAYMENT INSTRIICTIONS
n�munt rvo. 6224556494 oate �4-14-2009 ro e� �Qaat m ua a ��t, no
[staeiisn:a Uot cna�e„oes�e .�:e ,
nccount eaiao�e 4.359.96 e�t to �n. xaai�<er ar wai��a�waua �n.�k
5 paya0le to "Fegiake� af Wills. AgenC.
Per<en[ ia:aDle J( 50.000
nmount sue�e�t m raz uore: �t x� ow.e�t: . . .sa. .seni� m�e�
� 2• 1�9.98 enms oe ma a.�.eenrs aae. ef aeam,
Tax Rate X . 1[-j Cetluc[ a 5 o ent Ciscount oo [�e taz Eue.
Poten[fal Taz Oue /•�v inFentance taz Eue vill Eecone Eelinemnk
$ 327.00 „ oou: aeeer tn. e.<. or a:atn.
raar TAXPAYER RESPONSE ne •
� FA3i:�7It�.9,a7�;�S�ONL�i31 E9�i�������
� '27 Fz'3L3'A����JISSESSMEN�
e. � rn: ano.. mror�a�.o� a�e <az me : oo��.«. »•.�a
Remi[ o ent to t�e Reaista� of Wills vit� tvo c of f�iz notia to eb<ain
CHECK . a.:�o��e o� a ma a�te�e:e, o �e<„�� tm: oou�eleo en. x.o.:eo� oe w.ii: :�e
ONE ore;�.a� a��.r:oeoe �.ii e. :..�pe ev en. Pn oeo.rx..�n ar xe.e��e.
[ BLOCK ] e. � me see.e ,sse� nae eee� a .i11 ee �.00�<ea ana tss oa.e ..en me aennsvi.anie mne�.ea��. �ax �e<���
ONLV f,1ea ev �ne ert.ea �Qo�esen�anv..
c. � rn. aea.e a�m�.. .: ��o� a .�vo� e.ee. aoa a.e�«.o�� .e�e oa.e.
Canuleke PAfti �,anE/o�'PpRif�O Ealou'.
pppT If intlicaking a Oifferent [am �ate� pleasa state '
Oreiationsnie ta aeceaeni:
TAX RETURN - CqLCULATION OF TAX �N JOINT/TRIIST ACCOUNTS -
�xHE i. oa<. Esxaeiisnea i
z. nao��c eaian�e z S
i. oarcent Ta:aeia a X
4. Amount sue5ecc to rax 4 5 ...• . _. .• . .:.,- ....:
5. Oebts antl DeOucffons 5
6. qmount Tasapla 6 S
]. Tax Rate ] X
e. Tax Oue 9 S
. r..-n��.n•.u:-z.;..-m .e�ca.�:�.meexs+=c-.+�..a.w.msre:�
PART DEBTS ANU OE➢UCTIONS CLAIMEU
0
OATE PAIO PAYEE DESCRIPTIDN AMOIINT PAID
� �
I
TOTAL (Entar on Lane 5 of Taz ComputationJ 6
llntler penal[3es of per]ury� I tlecla�e L�at [�e fac[s I �e0o�tetl above are t�uer co��eck antl
complefe ta Y�e Eesf of mY knavleE9e antl beiaef. HOME � )
WORK ( J
TAXPAYER SIGNATURE TELEPHONE Nl1MBER ❑ATE
GENERAL INFORMAiION
t. FARUkE TO RESPON� WILL RESULT IN AN OFFICIfLL TA% ASSESSMENT NtM1 aa�lvcable interezk bazee an m�ormatvon
:�em.c�¢e s> <ne r.�a��;ai : <.���so�.
z mne�aea�oa x : neoo.e: ammo�e�n � o�<n. �ree� m. a.�eae�r.. eae. ov aeam.
o. n e .�e a ��e �. <a�ae�e e .n.��rn:�e.<eee�r. � aeaea . .,a�ee� ov � �.a� .
a. e«o��t: u�oi�m�a ano:. n:ia�eee.ee� n�:nn�e a�a wiro m. a��aae�e o�c :� �o.,�c �aae: �ain.� o�e ve�� o�.e. <a
am e . rmiv �.:ame.
. n«o��e� e.eaei.,nea � o n�..ea�e a�a ..ee . e <ne� e � co a.acn a�e �o< <axeeie.
6. Accounls M1e1C bv a tlecetlen[v'yn[trust Por' anoMe� o� aiM1ers are PollYatmable.
REPORTING INSTRl1CTI0NS - PART 1 - TAXPAVER RESPONSE
�. e�ocK a - �e ene .�ro�.aua� am �.m��a<io� s� ma oo�i�. a re�x .�a a:a��no�: a �oe ne;�s �iasmea, oia�e n •x••
91ock 1 of Parf 1 of Me "iupaye� R¢sPonse" section. Sien tuo c an0 SubeII lM1e� v3tM1 a c�eck fo� t�e aq unt af
Sas to [�e r irte� of ullls of tM1e c unty inaicated. IDe PR �epartmen<nf Revenue rill izzue an o££lcial assessoent
(Porm REV-154p IX) uoan �ecelpt of tM10 refu�n I�oe tpe �epis[e� a£ vllls.
2. BLO[K 9 - If Ma a set i <i£LE m t�is n s Deen a vlll be r ortetl a a tax OaiG vlt� tM1e Pennsylrania in�e�itance
tm �eiurn £IIeG by Me ¢5[aie's r' e entafive.nOlace a '%" vn Elocko0 e{ part 1 of Me "Tazpayeo Reroense^ sectlan. Sign kua
�owie. a�a �e<��� eP me rev.:ce. ot wni: os <n. �o��e.�a�ea�.am.
a. e�oee e - if m. � mro�.auo� . .�e a�uor a:o�<oio�: a a na,�s �iaiAea. me�x emok e a�a � .oi.ee ra�« a r�e a
oe'tling to SM1e inst�uctioni belaM. SSignobo c anp SULnit IMn ✓itM1 yo cM1eck fe� Me a unt af tax P vable <o k�¢ � �ste�
ofcwi115 of tM1e c unH intlim<eE. T�e P1 �epartment5of Re�enu¢ rill issue an o£He3a1 azsessment (Fo�m REV-1548 IX) upon �eceip[
of Me rtWrn f�o� lM1e �egizke� e£ vills.
TAX RETIIRN - PART 2 - TA% CALCULATION
LINE
i. e�<e� me me. m< . �o� or.ei�ai�v � eaeti:nea or uu.a m en. m .:osoe .� aaoe or e�ain.
�oo a. es a��er e=
xore: ro� : e:�.ee�c �no eiee .rt.riznziaz, a �oe: m. ae�aee�e o�x � a�e o �enn�� o os ee�en .
emir �a.aei:. xo�:.:�, me�. : .�m:.o� �ox xo ::�..a a3,000�oer ara�:re.ee, �eua�ei��:ot roe .ame�oe
me a«o��� e� m. o�.e.� ef a==o��t:en:ia.
�t a eo�ei. a:c:�ssk u.� e : terore v � r.�:e � � <ne aae.ess oo�uo� or en�. �oea�e, me ee,000 .>u�:.o�
.a: a:a�«<e r�o. m. a«o��<n.i.��e a: �worna ev <n. r:�a��sai e�:o.maso�.
z s�xe. ene <e<:i eaia��. ov en. a ��� .��i�a.�a mea�.sc a ��ea <o me moe oe eeaen.
s. m: n e�eae• ot me a ��t rn.a�.: xssaeia xo .a�n � : ae�e�m�ee a: roiio..:
n. m.�o.��.�<sa• <�aei. af �o.�� .:::n: e:<aev�nea .o�.en.� o�e vea. o�.a� io cn. a��eee�r� aesen:
I �SVI�E� BV IDiPL NOX9ER OF �IVIOE� BY iOTAL NOXlEF OF MVLLIPLIEO BV 100 = pER[EHT TAY�BLE
JOINi UYNERS SIIRVIVING JOIXT LWNERS
c:..oi.: e eoi�� a::.e �a :.ee�ea m tne �ar�e or me ee�eee�< a�a e.e ome� o o�:.
1 OIVIOEO 6Y 3 (JOIHT WNERS) OIVIDEp 0Y 2 (SVRVIVOR9 = .16] X 100 = 16A�pe�ant (iF%RBLE ID EACH SIIftVIVORI
E. iM1¢ o mtaga tmablr Po� a zetr c�eafe4 uitMn o o£ Me Eecetlen['i Geat� o� accouniz ounetl py tp� Eecetleni buf �¢]E
.� xr�:i ro� .�o�na� s�a..sa.aie,> exr�s� oeoer.�.ars::>'
i oiv�oeo er rolu runeEa oF suuvrv�x� �o�rvr nu�1eP��Eu er ioo = vExeExr ruae�E
RYNERS OR TROSi BENEFICIA0.SE5
Esanple Joint a unt �egsske�¢0 in tbe naee of t�a tlecetlent anE be af�e� pe�sons entl eziablizFeE rit�in one y¢a� of Deak� Yy
mo ee�.ee�e.
i orvmEn ev z <sumrvous� _ .so x ioo = so oe��e�e ernue�e voa enw suxvxvou>
�. rne a �oa :�ea.« m �� u.�e a> f. aeee.q��.a ev .�i�.eivs�s me a«o��t o:iaoa a.�. z� ev ene oer�e�x x�.ei. cuoe a�.
s. eoter m. m�.i or m. aaee. a�a aea��eso�: is:�ee m aa�� a.
s. m: a ��e essaei. cu�e s> s: aeter.s�en ov :�eo-a�ims ue a.ee. a�a oea��noo: cuo: s> o-o. me a.o�m :�we�n m eaz ui�e v.
i. e�t:r�ne .00�eo�.aca <a. �.<e tuoe >> .: eecaM.�.e neia,.
➢ate of Deatp Spouse Lineal SlElin9 Colla[e�al
01/O1/94 fo 12/33/94 3 Oe�cent 6 percent 15 pe�cm[ 15 pe�cent
OVO1/95 to 06/30/�0 0 pa�cent 6 pe�cenf l5 pe�cenf L5 pe�cen[
0'//O1/00 [o preSenL 0 percent 4.5 percent a 12 pefcen[ I$ p¢�CPM
•iM tar reb 6 setl on the nek �elue of trans£e�s £�oe a tleaaze4 c�ilE ¢1 v of a a[
eaM Sa o� fo� tM1e use of a vku�al oa�eni. an a4opIIve pa�eni o� a e e a�en4 a£ t�e <M1i1E izu090 ent.
rne i.�.ai m.. r ne. ��i�e:: .�« nvia�e a�e a�ne� is�eai ae. ^cn.iere ��i,m.. ,i�ra �n.iare
�neene� e �oe <n.. n..e5eee� .aoo�.eaev oen.�5, aeoo<ea��naa.e��am :�eo =nae�e�. ^�s�eei�a e�oe�ci^�.�nam.. an miiar.� or ena
�.���.i o .�e: soe en..� ee,�em.��:. .n.�n:� o �o< xno. na.a nee� .a000ea ey ou��.; aaooeee ee��eoaeoa: ��e mea� ae.�e�a.��:;
a�e :e.o-ae:�:oa.�x:. •smii�s:^ . . e.smea . ��aa.aa�az: .no na.e ae iea.e o�e pare�t �� <or,�oo mu ene ae�eae�t .noma� n. eiooa
or amotao�. m. eeiido.raz �ia:: os net�s i�u�oe: azi oone� eeoeu�.a�ae:.
CLAIMEU �EDUCTIONS - PART 3 - OEBiS ANO OEOOCTIONS CLAIMED
niio+.ei. e.ot: .oe e:a��e.o�: e�e ae<e,..�¢a a. roiiw::
a. ro� a e �¢yanr � secie ro� oar..�t o� ene e:t.te :�eie« eo aa..�.stratio� ev + o:r:aoaz �oo�.�e�<ata.e i: ��:�ra�.e�<
to n r m: nea��noi.�.eem..
a. vo� a�e�aiiv vasa ue a.ex: :fee� xn. e:.0 or m. apo.a:�o .m o � r���i�n o oot of o e�e.
L Oebts beine claineJ �ust Ea itenxetl fullv in Pat i. I£ atltl5t5onal mace as nee0ea, vze 0 I/8' r I1" sM1eet of oape�. P�oof of
piy�en< �M be �leuez<eE Ly tM PA Oepart�ant of Rarenue.
^- "�""`�-�� ��a���`��R�l€1��`�ssssrnHrE � -�*,ir '�`r�`�'�� � .: � ���r��
3F� ,NEE➢ fl1R7kE8 3,NF;71jl11�YiD]+} f7�;ASSiS3ANC_E> yTONSAC!`AN REG`I57ER OF 7UiLLS ,����:
PA+DEP7F.739EN�,�3F �R�VENUE"�3S�RY�3;AFF3CFt (1H 3,HE BU2EAU.. DF�NDIYiDUAL 7A7lES ;,A�' �.,, a ¢,`�
C�'17 �327='"',SERV2L£S�£{iR'�37U(�AY�RS"'�1{tlI�.H 3PECIAI }7EARIHG AN➢JA1��P�aAc%��IG".NEEOS
liN4Y""��$UL�44�302�U��.�' �:'.`�,-'�f', ��'`�t '�'"�'+�... -� .>i'''�,�'';,�xvr��'n t'?�?�. -as"'�� .�` �V�(�"'i:'bc'�".: