HomeMy WebLinkAbout08-17-15 (3) pennsylvania 1505618403
OEPARTME "REVEN
r=X(03-14)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 15 0 313
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
03 09 2015 04 11 1926
Decedent's Last Name Suffix Decedent's First Name MI
GONTZ RUTH H
(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
❑X 1. Original Return 2. Supplemental Return 3. Remainder Return(date of death
prior to 12-13-82)
4. Agricultural 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)
N7. Decedent Died Testate 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes
(Attach copy of will) (Attach copy of trust.)
10. Litigation Proceeds Received 11. Non-Probate Transferee Retum 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 D BOGAR (717) 737 8761
First Line of Address
ONE WEST MAIN STREET
Second Line of Address
City or Post Office State ZIP Code
ev
SHIREMANSTOWN PA 17011 e3
c17-11
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bogarC�bogarlaw.com M i
Correspondent's email address: 1 rn � c-� � --• �
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REGISToOl'wl ISS U NLYC'rl r'1
_ "x7 CD
REGISTER OF WILLS USE ONLY
DATE FILED MMDDYYYY C:7 C 3 `� �► -til Ti
N r" M
--I r--
DATE FILED STAM$P
Side 1
I IIIIII ILII IIIII IIIII IIIII IIIII IIIII IIIII ILII IIIII IIII IIII
1505618403 1505618403
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PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Gontz, Ruth H. 21-15-0313
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 personal representative is based on all
information of which preparer has any knowledge.
Signature#2
Name Patricia Gontz Wilson
Address1 PO Box 206
Address2 5579 Elizabethtown Road
City, State,Zip Lawn,PA 17041
Date a ���
1505618411
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: GOntz, Ruth H.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages and Notes Receivable(Schedule D).................................................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).......... 5. 44 ,163 - 71
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............ 7. 386,164 - 71
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 430-e328 - 42
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 35 ,222 - 13
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10.
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 35 ,222 - 13
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 395-,106 . 29
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 395 ,10 6 - 2 9
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.00 15. 0 - 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 395,106 - 29 16. 17,779 - 78
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 1111 18. 11 - 011
19. TAX DUE................................................................................................................ 19. 17,779 - 78
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Under penalties of perjury,I declare 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 filing the return is based on all information of which preparer has
any knowledge.
SIGNATURE OF PERSON F�ESPQyN,�$IBLILING RETURN Barbara J. Gontz D�T/�/�,/
ADDRESS
/
32 Gale Ro d, Camp Hill, PA 17011
SIGNATO=FEPARr�=EPRESENTATIVE James D. Bogar DATE
lei l,S
ADDRESS
One West Main Street, iremanstown, PA 17011
L_
11111111111111111111111111111111111111111111111111111111 IN Side 2 1505618411 J
REV-1500 EX Page 3 File Number 21-15-0313
Decedent's Complete Address:
DECEDENT'S NAME
Gontz, Ruth H.
STREET ADDRESS
5225 Wilson Lane, Ste. 329
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 17,779.78
2. Credits/Payments
A. Prior Payments 15,832.26
B. Discount 833.28
Total Credits(A +B) (2) 16,665.54
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 1,114.24
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;............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ ❑x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ 0
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑x ❑
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 January 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.
Rev-1508 EX+(08-12)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OFPERSONAL PROPERTY
INHERITANCE TAXAXRETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gontz, Ruth H. 21-15-0313
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 BNY Mellon -Checking Account No. 1124720382. Principal balance at date of death 22,659.97
$22,659.97. This account was non-interest bearing
2 M&T Bank-Checking Account No.2679056750. Principal balance at date of death 14,641.03
$14,640.94;accrued interest$0.09
3 M&T Bank-Savings Account No. 15004200920682. Principal balance at date of death 4,131.35
$4,131.27;accrued interest$0.08
4 Furniture and Contents-sold at private sale 500.00
5 John Hancock-refund of long term care premium 2,090.51
6 Nationwide Insurance-refund of overpayment of renter's insurance 80.88
7 PA Media Group-newspaper subscription refund 59.97
TOTAL(Also enter on Line 5, Recapitulation) 44,163.71
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12)
BNY MELLON
WEALTH MANAGEMENT
P.O.Box 3147
Pittsburgh,PA 15230-9414
April 22, 2015
James D. Bogar,Attorney at Law
One West Main Street
Shiremanstown,PA 17011
Estate Of Ruth H Gontz
Date of Death: 03/09/2015
SSN
Dear Sir/Madam:
In accordance with your request, the attached information sheet has been provided in the
above decedent's name as of his/her date of death.
For IL or LC accounts,contact our Loan Department at 1-800-537-5591. For all other inquiries,
please call (412)234-9457.
Sincerely,
Garrett Gree
Mellon Private Wealth Operations 154-0650
Page 1 of 2
Wednesday, April 22, 2015
Account
Number Account Title
1124720382 Ruth H Gontz Date Opened: 01/01/1993 Account Type: DD
Principal Bal Int from Last Account Bal YTD Int to
as of DOD Posting to DOD as of DOD DOD
$22,659.97 $0.00 $22,659.97 $0.00
F
i
i
I
Page 2 of 2
i
Fi
t
t
For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds,
please call Trindle Road at 717-737-2308.
This letter does not include any accounts in which the deceased may have been fisted as Power of Attorney,Custodian of Uniform Transfers,
Representative Payee,or Trustee under a Written Agreement.
Sincerely,
Tomara Williams
Records Management
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF TAX EVENUE
RETURN
INHERITANCE TAX RETMISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gontz, Ruth H. 21-15-0313
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECO'S EXCLUSION TAXABLE
NUMBER THE DATE NAME
F TROANSERSATTACH THEIR COPY OF THE RELATIONSHIP
FFOREREAL ESEDENTTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Nationwide Annuity-Contract No.01564405. Barbara 31,971.11 31,971.11
Gontz and Patricia Wilson are the named beneficiaries
of this account.
2 State Life Insurance Company-Annuity No. 24,107.05 24,107.05
5820032950. Patricia Wilson and Barbara Gontz are
the named beneficiaries of this account.
3 Western 8r Southern Life-Annuity Contract No. 16,371.00 16,371.00
W0020539659. Patricia Wilson and Barbara Gontz are
the named beneficiaries of this account.
4 BNY Mellon Wealth Management-Trust Account No. 313,715.55 313,715.55
10171117BN3. Principal balance at date of death
$313,665.92;accrued interest$49.63
TOTAL(Also enter on Line 7,Recapitulation) 386,164.71
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
Beth Lengel
From: James Bogar
Sent: Tuesday,April 07, 2015 1:12 PM
To: Beth Lengel
Subject: FW: Nationwide Annuity#015644405
Attachments: AAF-0107AO.16.pdf, 015644405.tif
JAMES a BOLA
JAMES D. BOGAR LAW OFFICES
1 West Main Street
Shiremanstown, PA 17011
Office: (717)737-8761
Fax: (717)737-2086
jbogar bogarlaw.com
From: HIRTHEI(cbnationwide.com [mailto:HIRTHEI(a)nationwide.com]
Sent: Tuesday, April 07, 2015 12:16 PM
To: James Bogar
Subject: Nationwide Annuity #015644405
Good afternoon James,
We received the paperwork you submitted 4/6/2015, including a copy of the death certificate for Ruth H. Gontz. We
appreciate you getting these materials to us so quickly. The following are the answers to your inquiries:
Contract#015644405 is the only investment vehicle I see in our business. This contract was not rolled over from another
company. It was opened 2/5/2002. The initial investment was$20,000. The value of this contract as of the date of death,
3/9/2015, was $31,971.11. The earnings on this contract as of the date of death would have been $11,971.11. Since this
contract is still in the market, the value and earnings will fluctuate.
When we received a web claim from your office on 4/2/2015 we sent an initial letter to the address of your law firm. I have
attached a copy of that letter to this e-mail. Please disregard our request for a copy of the death certificate since we have
received one with your correspondence dated 4/6/2015.
Patricia Wilson and Barbara Gontz are equal beneficiaries. In order to resolve this claim, each of them will need to
complete a beneficiary claim form. A copy is enclosed with the letter we have mailed but I have also attached a blank
copy to this e-mail.
If you have any other questions, please feel free to contact me directly using the contact information below. Have a great
day!
IX)R'FLJNE Elizabeth H. Hirth, MBA
Financial Services Representative
Anmity Claims1NatiorvvideFinancial IPSO
BES' W614-435-2B481 F 888-634-4472
VoWn nirtnc1. n,,iiorr,r,ide.com
Nationwide -----°—
r,,,cr�„cg,e�3 r,.^K tom.-ae.+Y rrxCre'ri1.".anf.b nYe.aazr M Oc.i�osv:Xes Y'+S'snrC+e 4=_ie"!�2nz G�^�a^i
1
James Bogar
From: Doniel Kolm <Doniel.Kolm@oneamerica.com>
Sent: Friday,July 24, 2015 9:03 AM
To: James Bogar
Subject: Claim Information for Gontz
Mr. Bogar,
I have received notice that you needed information regarding the value of Ruth Gontz's annuity with State Life Insurance
Company.
Please be advised,as of March 9, 2015,the cash value of the contract was$24,107.05. The cost basis is$20,000.
Please feel free to contact us with any additional questions.
Doniel Kolm I Claims Specialist,OneAmerica Claims I OneAmerica Companies
P.0 Box 60081 Indianapolis,IN 462061 Phone:317-285-1527 IFax 317-285-1344http://www.oneamerica.com/
OneAmerica®Companies:AUL I State Life I Pioneer Mutual I McCready&Keene I OneAmerica Securities I AUL RMS
This e-mail message is intended only for the use of the individual or entity to which the transmission is addressed. Any interception may be a violation of
law. If you are not the intended recipient,any dissemination,distribution or copying of this e-mail is strictly prohibited. If you are not the intended
recipient,please contact the sender by reply e-mail and destroy all copies of the document.
This e-mail message is intended only for the use of the individual or entity to
which the transmission is addressed. Any interception may be a violation of
law. If you are not the intended recipient, any dissemination,distribution or
copying of this e-mail is strictly prohibited. If you are not the intended
recipient,please contact the sender by reply e-mail and destroy all copies of
the document.
The State Life Insurance Company
ONEAMERIC9 a ONEAMERICA®company
One American Square,P.O.Box 6002
Indianapolis.IN 46209-9104
July 16, 2015
James D. Bogar
Attorney At Law
One West Main Street
Shiremanstown, PA 17011
Insured: Ruth Gontz
Policy: 5820032950
Dear Mr. Bogar
Please extent to the family our sincere sympathy on the loss of their loved one, Ruth
Gontz.
Ms. Gontz's opened a non-qualified annuity that was issued on June 17, 2009 with a
single premium payment of$20,000.00 with State Life Insurance Company,she has
no other policies with us. The balance on her account as of the date of this letter is
$24,36o.21. The interest that has accrued since issue is $4,36o.21. Ms. Gontz has
named her two daughters, Patricia Wilson and Barbara Gontz as her primary
beneficiaries.
Enclosed you will find the necessary forms to file the claim under Ruth Gontz's
Annuity policy held with State Life Insurance. In addition to the attached forms,a
certified death certificate is necessary to complete the processing of the claim.
When the necessary forms and certified death certificate are received,the claim will be
assigned to a claims examiner,who will review the file. The beneficiaries may be
contacted if it is found that additional information is needed for processing the claim.
Completed claim forms,certified death certificate,and any other claim related
correspondence may be mailed to:
OneAmerica Financial Partners,Inc.
Claims Department
PO Box 6008
Indianapolis, IN 462o6-6008
Completed claim forms and any other claim related correspondence may also be faxed
to our office at(317) 285-1344• As an original certified death certificate is necessary
for the claim file,the death certificate should be mailed.
To assist in the prompt processing of this claim,please remember to include all policy
numbers on your correspondence.
Please remember that we are here to assist you in any way we can. If you have any
questions,please do not hesitate to contact the claims department at(800) 833-5569•
Sincerely,
el. 0
Individual Claims Department
Annuity Operations
Western & Southern Life PO Box 2918
Cincinnati,OH 45201-2918
A member of Western&Southern Financial Group toll free 800.926.1702
fax 513.362.2353
June 8, 2015
JAMES BOGAR
ONE WEST MAIN ST
SHIREMANSTOWN PA 17011
Subject: Annuity Contract Number W0020539659 — RUTH GONTZ
Western-Southern Life Assurance Company
Dear Mr. Bogar:
The above contract was originally taken out on May 1, 2006 and $13,487.92
deposited in the name of Ruth Gontz.
The date of death value was $16,731.00 and the named beneficiaries were
Patricia Wilson and Barbara Gontz.
There were no other contracts located.
If you have any questions, please contact Client Services at 1-800-926-1702.
We can be reached Monday - Thursday 8 a.m. to 6 p.m. and Friday 9 a.m. to
5 p.m. EST.
Sincerely,
Annuity Operations Department
Western & Southern Life
DC0316-1407
Western-Southern Life Assurance Company
TRUST AGREEMENT
BETWEEN
THOMAS EUGENE GONTZ AND RUTH H. GONTZ, HIS WIFE,
AND
COMMONWEALTH NATIONAL BANK
OF HARRISBURG, PENNSYLVANIA
DATED: August 27, 1987
Janes D.B—ft
NATIONAL BANK, of Harrisburg, Pennsylvania, hereinafter referred
to as "TRUSTEE".
ARTICLE I
1.01 TRANSFER IN TRUST
The Settlor has transferred and delivered to the
Trustee the property described in Schedule "A", which is
attached hereto and is made a part hereof, the receipt of which
is hereby acknowledged by the Trustee. Such property and all
other property transferred to and received by the Trustee to be
held pursuant to this trust shall constitute the "Trust Estate"
and shall be held, administered and distributed by the Trustee
as hereinafter provided.
1.02 ADDITIONS TO TRUST ESTATE
The Settlor, either during their life or by will at
their death, or any other person, shall have the right at any
time to add other property acceptable to the Trustee to the
trust. Such property, when received and accepted by the
Trustee, shall become part of the Trust Estate.
ARTICLE II
REVOCATION OF TRUST
2.01 REVOCATION DURING LIFE OF SETTLOR
During the life of the Settlor, this trust may be
amended, altered, revoked or terminated, in whole or in part, or
any provision hereof, by an instrument in writing signed by the
Settlor and delivered to the Trustee.
2.02 DETERMINATION OF SETTLOR
Settlor shall have the right to determine whether
Trustee is to retain complete investment discretion.or whether
Trustee shall be required to consult with Settlor concerning any
changes to be made in the investment portfolio.
consent of the Trustee to such amendment.
2.04 TRUSTEE'S DUTIES ON REVOCATION
If the entire trust is revoked by the Settlor, the
Trustee shall transfer to the Settlor all of the Trust Estate
and shall execute and deliver to the Settlor all instruments
which are necessary or appropriate to release all interests of
the Trustee in the trust.
2.05 IRREVOCABILITY OF TRUST ON DEATH OF SETTLOR
From and after the death of the Settlor the trust
created hereby shall become irrevocable and shall not be altered
or amended.
ARTICLE III
DISTRIBUTIONS BY TRUSTEE
3.01 NET INCOME TO SETTLOR
During the lives of Thomas Eugene Gontz and Ruth H.
Gontz, the Settlor herein, the Trustee shall pay to or apply for
the benefit of the Settlor from the net income of this trust,
after deduction of all proper charges and expenses as herein-
after set forth, the sum of Five Hundred Dollars ($500.00) on or
before the 15th day of each month. It is understood that the
within described payment shall be made to either Mr. or Mrs.
Gontz jointly or individually as they request. Furthermore,
upon the death of either Mr. or Mrs. Gontz and, furthermore,
should this trust continue, said payment of income will be made
directly to the survivor thereof in accordance with the provi-
sions herein.
3.02 INVASION OF PRINCIPAL FOR SETTLOR
The Trustee may pay to or apply for the benefit of
the Settlor, in addition to the net income from the Trust
Estate, such amounts from the principal of the Trust Estate, up
Ito the whole thereof, as the Settlor in its discretion may from
2
disability, or by reason of illness or mental or physical
disability is, in the opinion of the Trustee, as certified by
Settlor's personal physician, unable to manage their affairs,
the Trustee shall use the income and such part or all of the
principal of the Trust Estate as it deems necessary or advis-
able, in such manner as it deems best, for the care, support,
comfort And maintenance of the Settlor, or for any. other purpose
the Trustee deems to be in the best interest of the Settlor.
3.03 PAYMENT TO SETTLORIS ESTATE
On the date of death of the Settlor, Trustee shall
pay out of the income or principal of the Trust Estate, at its
discretion, the expenses of the funeral and burial, including a
grave site, marker and perpetual care, if deemed appropriate, of
the Settlor, along with any and all lawful and necessary
administration expenses and Federal and State Inheritance taxes
due, unless the Trustee determines that other adequate provi-
sions have been made for such expenses. Said payment or
payments shall be made to Settlor's estate.
3.04 TERMINATION
It is understood that the within Trust Agreement
represents an agreement with joint settlors, same being Thomas
Eugene Gontz and Ruth H. Gontz. As such, any and all property
transferred and delivered to the Trustee as described in
Schedule "All is deemed to be jointly-owned property. As such,
said property will be transferred in accordance with the
survivorship provisions of property owned jointly as between
husband and wife and in accordance with the respective provi-
sions of the Last Will and Testament of Thomas Eugene Gontz and
Ruth H. Gontz.
3
The Trustee is authorized to retain in the trust for
such time as it may deem advisable any property, including
shares of its own stock, received by it from the Settlor,
whether or not such property is of the character permitted by
law for the investment of trust funds, and to operate at the
risk of the Trust Estate any business or property received by it
from the Settlor.
4.02 MANAGEMENT OF TRUST PROPERTY
The Trustee shall with respect to any and all
property which may at any time be held by it in trust pursuant
to this Agreement, whether such property constitutes principal
or accumulated income of any trust provided for this Agreement,
have power, exercisable at the Trustee's discretion at any time
and from time to time on such terms and in such manner as
Trustee may deem advisable, to:
(A) Sell, convey, exchange, convert, improve,
repair, manage, operate and control;
(B) Lease for terms within or beyond the term of any
trust provided for in this Agreement and for any purpose,
including exploration for and removal of gas, oil, and other
minerals; and enter into any covenants and agreements relating
to the property so leased or any improvements which may then or
thereafter be erected on such property;
(C) Encumber or hypothecate for any trust purpose by
mortgage, pledge or otherwise;
(D) Carry insurance of such kinds and in such
amounts at the expense of the trusts provided for in this
Agreement as the Trustee may deem advisable;
(E) Commence or defend at the expense of any trust
provided for in this Agreement such litigation with respect to
jany such trust or any property of the Trust Estate as it may
9
the character permitted by law for the investment of trust
funds, specifically including, but not by way of limitation,
interests in any common trust fund or funds now or hereafter
established and administered by the Trustee solely for the
investment of trust funds;
(G) Vote and give proxies to vote any securities,
including stock of the Trustee, held by it in trust pursuant to
this Agreement, having voting rights;
(H) Pay any assessments or other charges levied on
any stock or other security held by it in trust pursuant to this
Agreement;
(I) Exercise any subscription, conversion or other
rights or options which may at any time attach, belong or be
given to the holders of any stocks, bonds, securities or other
instruments held by it in trust pursuant to this Agreement;
(J) Subject to any limitations expressly set forth
in this Agreement and the faithful performance of its fiduciary
obligations do all such acts, take all such proceedings, and
exercise all such rights and privileges as could be done, taken
or exercised by an absolute owner of the trust property.
4.03 POWER TO BORROW MONEY
The Trustee shall have the power to borrow money from
any person, firm or corporation, for any trust purpose on such
terms and conditions as the Trustee may deem proper and to
obligate the trust to repay such borrowed money.
4.04 POWER TO LOAN MONEY TO TRUST
The Trustee is authorized to loan or advance its own
funds to the trust for any trust purpose at the rate of interest
being charged by the Trustee at the time such loan or advance is
made to other persons having a net worth equal to that of the
ITrust Estate for similar loans or advances. Any such loan or
5.
4.05 DEALINGS WITH SETTLOR'S ESTATE
The Trustee is authorized to purchase securities or
other property from and to make loans and advancements from the
Trust Estate with or without security to the executor or other
representative of the Settlor's estate.
4.06 MANNER OF HOLDING TRUST SECURITIES
The Trust may hold securities or other property
subject to this Agreement in its name as Trustee under this
Agreement, in its own name without a designation showing it to
be Trustee under this Agreement, in the name of its nominee, or
the Trustee may hold such securities unregistered in such
condition that ownership will pass by delivery.
4.07 DETERMINATION OF PRINCIPAL AND INCOME
Except as otherwise specifically provided in this
Agreement, the Trustee shall have full power and authority to
determine, in its discretion, what shall constitute principal of
the Trust Estate, gross income from the Trust Estate and net
income of the Trust Estate distributable under the terms of this
Agreement.
4.08 TAXES AND EXPENSES OF TRUST
All property taxes, assessments, fees, charges and
other expenses incurred by the -Trustee in the administration or
protection of the trusts created by this Agreement, including
the compensation of the Trustee provided for in this Agreement,
shall be a charge on the Trust Estate and shall be paid by the
Trustee prior to final distribution of the Trust Estate in full
out of the principal or in full out of the income of the Trust
estate, or partially out of the principal and partially out of
the income of the Trust Estate, in such manner and proportions
as the Trustee may deem advisable.
6
Whenever the right of any beneficiary to payments
from the net income or principal of the Trust Estate shall
terminate, either by reason of death or other cause, any accrued
or undistributed net income from the Trust Estate undistributed
by the Trustee on the date of such termination shall be held,
administered and distributed by the Trustee in the same manner
as if such income had accrued and been received by the Trustee
after the date such beneficiary's right to receive payments from
the trust terminated.
5.02 OTHER INCOME OF BENEFICIARY FOR
DISCRETIONARY PAYMENTS
In exercising its discretionary authority under this
Agreement to make payments to or for the benefit of any benefi-
ciary from the net income or principal of the Trust Estate, the
Trustee shall take into consideration any income or other means
of care, maintenance, support or education available to such
beneficiary from sources outside the trust that may be known to
the Trustee.
5.03 SPENDTHRIFT PROVISION
Except as otherwise expressly provided in this
Agreement, no beneficiary of any trust provided for in this
Agreement shall have any right, power or authority to alienate,
encumber or hypothecate his or her interest in the principal or
income of such trust in any manner, nor shall such interest of
any beneficiary be subject to claims of his or her creditors or
liable to attachment, execution or other process of law.
5.04 PAYMENTS TO INCOMPETENTS
In any case where payment is to be made to an
incompetent, the Trustee may make such payment to the guardian
for the person of such incompetent.
7
this Agreement may be exercised by such person at any time
during his or her life, except that if a guardian for the person
or estate of any such person has been appointed by a court of
competent jurisdiction then neither such person nor any such
guardian shall have any power to exercise any powers granted
such person by any provision of this Agreement.
5.06 DEFINITION OF "INCOMPETENT" AND "INCOMPETENCY"
The terms "incompetent", "incompetency" or other
words of similar import shall be construed as used in this
Agreement to refer to all cases where a guardian for the person
or estate of any person having rights under this Agreement has
been appointed by a court of competent jurisdiction for any
reason except minority of such person. Any person having rights
under this Agreement shall be deemed "competent" and his
"competency" shall be unquestioned by the Trustee until a court
of competent jurisdiction has appointed a guardian for the
person or estate of such person.
5.07 DISTRIBUTION IN KIND OR IN CASH
On any final or partial distribution of the assets of
the Trust Estate the Trustee may distribute or divide such
assets in kind or make distribution or division in cash or
partly in cash and partly in kind.
5.08 TAX PROVISION
If upon the death of the Settlor any inheritance,
estate, transfer or succession taxes are assessed against or by
reason of the assets of this trust or the interest of any
beneficiaries thereof, the Trustee shall pay such taxes, -includ-
ing any interest and penalties thereon, out of the principal of
the trust estate as a whole, or make provision for such payment,
without charging them against the interest of the several
lbeneficiaries. If any such tax is assessed in part by reason of
8
into consideration deductions, exemptions and other factors
which it deems pertinent, and the judgment of the Trustee as to
what is a fair and reasonable apportionment shall be conclusive
upon all parties interested in this Trust Estate.
ARTICLE VI
RESIGNATION AND COMPENSATION OF TRUSTEE
6.01 RESIGNATION OF TRUSTEE
The Trustee shall have the right to resign at any
time and on such resignation, the Settlor shall appoint a
successor Trustee. In the event of the failure, refusal or
inability of the Settlor to appoint such a successor Trustee,
the Trustee or any beneficiary of any trust provided for in this
Agreement may secure, at the joint expense of all trusts
provided for in this Agreement and then in existence, the
appointment of a successor Trustee by a court of competent
jurisdiction.
6.02 RIGHTS AND POWERS OF SUCCESSOR TRUSTEE
Any successor Trustee appointed as provided in
Section 6.01 of this Agreement because of the death, resignation
or other act of the Trustee shall, on such appointment being
made, immediately succeed to all title of the Trustee of the
Trust Estate and to all powers, rights,discretions, obligations
and immunities of the Trustee under this Agreement with the same
effect as though such successor were originally named as Trustee
in this Agreement.
6.03 COMPENSATION OF TRUSTEE
The Trustee shall be compensated for services •
rendered under this trust in accordance with its schedule of
fees for services in effect at the time services are rendered.
6.04 BOND
No bond shall be required of the original Trustee
9
The Trustee shall make an annual accounting to the
primary beneficiary or beneficiaries of the trust created by
this Agreement. The accounting shall include a report of the
receipts, disbursements and the distributions since the last
accounting, and the status of the principal and any undistrib-
uted income on hand at the date of the accounting. The approval
of any account by such primary beneficiary or beneficiaries
shall be final and binding upon all persons as to the matters
and transactions shown in that account. Notwithstanding the
foregoing, the Trustee may at any time apply for judicial
settlement of the accounts. Any primary beneficiary shall have
the right to inspect the books and records of the Trustee
relating to the trust, and the Trustee shall make such books and
records available for inspection by beneficiary, or by the
representative of such beneficiary, at all reasonable hours.
ARTICLE VII
CONSTRUCTION OF TRUST
7.01 APPLICABLE LAW
The trust created by this Agreement has been accepted
by the Trustee of the Commonwealth of Pennsylvania, will be
administered by the Trustee in Pennsylvania, and the validity,
construction and all rights under this Agreement shall be
governed by the laws of the Commonwealth of Pennsylvania.
7.02 INVALIDITY OF ANY PROVISION
Should any provision of this Agreement be or become
invalid or unenforceable, the remaining provisions of this
Agreement shall be and continue to be fully effective.
IN WITNESS WHEREOF, the Settlor has hereunto set
their hands and seals and the Trustee has caused the execution
10
WITNESS: p�
(SEAL)
Thomas Eu0pne Gontz
JJ f�
(SEAL)
Ru h H. Gontz
ATTEST: COMMONWEALTH NATIONAL BANK
OF HARRISBURG, PENNSYLVANIA
BY (SEAL)
U, C. FINK
sr:i `Int Vice President Sr, Trust O iat
eni-r Trust Officer
11
undersigned officer, personally appeared THOMAS EUGENE GONTZ and
RUTH H. GONTZ, known to me (or satisfactorily proven) to bethe
person whose name is subscribed to the within instrument and
acknowledged that they executed same for the purposes therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and
official seal.
Not Public
My Commission Expires:
My Carnniw,2Dn Zxplres c.b-I.",
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
On this, the 27th day of August, 1987, before me, the
undersigned officer, personally appeared LOIS B. COPELAND, of
commonwealth National Bank, known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within
instrument and acknowledged that she executed same for the
purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and
official seal.
No%Ary Public
My Commission Expires:
JOAN E.BROTHFKS, Pu:4v-
Shiremartstown,Cumberiand Co.,Pa.
MY COMMission Expires Feb,12,1990
AS or
13,358 Units Fund A-1 $ 13,558.00
1,180 Units Mellon DF
Goverment Securities Fund $107,372.00
1,513 Mellon DF Stock Fund $ 68,291.00
$25,000 U.S. Treasury Note
9.875% due 5/15/88 $ 25,477.00
B Y ME LON
April 17,2015
Mr. James D.Bogar
One West Main Street
Shiremanstown,PA 17011
RE: Estate of Ruth H. Gontz
Dear Mr. Bogar:
I would like to take the time to thank you for your letter dated April 6,2015 informing us of the
details surrounding the death of Mrs. Ruth Gontz. In accordance with your request,I have
enclosed the date of death values for her account no. 10171117BN3 with BNY Mellon Wealth
Management.
Should you have any questions in this regard,please do not hesitate to call me at 215-553-3041,
or email me at Kevin.Cannon@bnYmellon.com.
Sincerely,
i
i
Kevin Cannon
Senior Portfolio Officer
215-553-3041
Kevin.Cannon@BNYMellon.com
Estate Valuation
Date of Death: 03/09/2015 Estate of: GONTZ RUTH H T/A
Valuation Date: 03/09/2015 Account: 10171117BN3
Processing Date: 04/14/2015 Report Type: Date of Death
Number of Securities: 12
File ID: 1117BN3
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals value
1) 16512.46 CASH & CASH EQUIVALENTS (CASH) 16,512.46
2) 1015.747 BNY MELLON FOS TR (05569M73I)
NAIL SIT MUN M
Mutual Fund (as quoted by NASDAQ)
03/09/2015 12.87000 Mkt
12.870000 13,072.66
Accrual as of 03/09, payable 03/31/2015 2.60
3) 5843,919 BNY MELLON FDS TR (05569M715)
PA INTR MUN M
Mutual Fund (as quoted by NASDAQ)
03/09/2015 12.49000 Mkt
12.490000 72,990.55
Accrual as of 03/09, payable 03/31/2.015 47.03
4) 4214.074 DREYFUS FAMILY OF FDS (26186X817)
YLD ENH STRG Y
Mutual Fund values reported to NASDAQ
03/09/2015 12,55000 Mkt
12.550000 52,886.63
5) 1496-681 BNY MELLON FDS TR (05569M855)
EMERGING MKT M
Mutual Fund (as quoted by NASDAQ)
03/09/2015 9.30000 Mkt
9.300000 13,919.13
6) 762.517 BNY MELLON FDS TR (05569M509)
MDCP MLT STRG
Mutual Fund (as quoted by NASDAQ)
03/09/2015 15.37000 Mkt
15.370000 11,719.89
7) 1795.212 BNY MELLON FDS TR (05569M442)
SMALL/MID CP M
Mutual Fund (as quoted by NASDAQ)
03/09/2015 13.13000 Mkt
13.130000 23,571.13
8) 2582.743 BNY MELLON FDS TR (05569M434)
TXSN LGCAP M
Mutual Fund (as quoted by NASDAQ)
03/09/2015 15.51000 Mkt
15.510000 40,058.34
9) 3350.61 DREYFUS FAMILY OF FDS (26188X858)
ALT DIV STRT Y
Mutual Fund values reported to NASDAQ
03/09/2015 12.95000 Mkt
12.950000 43,390.40
10) 120.408 DREYFUS INVT FDS (26203E646)
DIVERS EMGMK Y
Mutual Fund values reported to NASDAQ
03/09/2015 20.21000 Mkt
20.210000 2,433.45
11) 1624.072 DREYFUS PREMIER INVT FDS INC (261986632)
DVRSF INT CL I
Mutual Fund (as quoted by NASDAQ)
03/09/2015 11.37000 Mkt
11.370000 18,465.70
12) 355.983 DREYFUS STK FDS (26201F777)
INTL SM CAP Y
Mutual Fund values reported to NASDAQ
03/09/2015 13.05000 Mkt
13.050000 4,645.58
Page I
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.0)
Date of Death; 03/09/2015 Estate of: GONTZ RUTH H T/A
Valuation Date: 03/09/2015 Account; 10171117BN3
Processing Date: 04/14/2015 Report Type: Date of Death
Number of Securities: 12
File ID: 1117BN3
Total Value: $313,665.92
Total Accrual: $49.63
Total: $313,715.55
REV-1511 EX+(08-13) SCHEDULE H
pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DEC D NTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Gontz, Ruth H. 21-15-0313
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 10,140.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State ZiD
Year(s)Commission Paid
2. Attorney's Fees Bogar& Hipp Law Offices 10,320.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 495.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 14,266.63
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 35,222.13
Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Gontz, Ruth H. 21-15-0313
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Catholic Cemeteries-grave opening 1,090.00
2 Myers Harner Funeral Home-funeral bill 9,050.00
H-A 10,140.00
Other Administrative Costs
3 Anerman Ginder&Co.-2014 tax preparation fee 225.00
4 Bethany Village 6,934.00
5 Bethany Village 3,536.82
6 Flagship Rehabilitation 207.42
7 Hampden Physician Associates 24.39
8 PA Department of Revenue-2014 Personal Income Tax 1,108.00
9 PA Department of Revenue-2015 1st quarter taxes 280.00
10 RESERVES:-Costs to conclude administration of estate,including preparation and filing of 1,500.00
2015 Personal Income Tax Returns and Fiduciary Income Tax Returns
11 US Treasury-2014 Personal Income Tax 451.00
H-137 14,266.63
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
REV-1613 EX+(41-18)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gontz, Ruth H. 121-16-0313
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S)RECEIVING PROPERTY
0 (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
• distributions,and transfers
under Sec.9116(a)(1.2)]
1 Barbara J.Gontz Daughter one-half of rest,
32 Gale Road residue and
Camp Hill, PA 17011 remainder
2 Patricia Gontz Wilson Daughter one-half of rest,
PO Box 206 residue and
Lawn, PA 17041 remainder
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as appropnate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
RUTH H. GONTZ
I, RUTH H. GONTZ, of 50 Kensington Drive, Camp Hill,
Cumberland County, Pennsylvania, make, publish and declare this as
and for my Last Will and Testament, hereby revoking all other
Wills and Codicils heretofore made by me.
FIRST: I give and bequeath my household furniture and
furnishings, my personal effects, jewelry, clothing, automobiles
and all other tangible personal property, including all insurance
policies covering those items, to my husband, THOMAS EUGENE GONTZ,
provided he survives me by sixty (60) days; or, if he does not so
survive me, to my children who survive me, to be divided between
them equally as they may agree.
SECOND: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any and all property held in trust for me by Common-
wealth National Bank, Harrisburg, Pennsylvania, in accordance with
an inter vivos trust, same being entitled "Trust Agreement", dated
August 27, 1987, together with any insurance policies thereon,
unto my husband, THOMAS EUGENE GONTZ, provided he survives me by
sixty (60) days.
THIRD: Should my husband, Thomas Eugene Gontz,
predecease me or die on or before the sixty-first (61st) day
following my death, I devise and bequeath all the rest, residue
and remainder of my estate of whatever nature and wherever
situate, together with any insurance policies thereon, unto my
children, PATRICIA L. GONTZ and BARBARA J. GONTZ, in equal shares.
FOURTH: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all property,
exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease, for
L'
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and to
receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate and
to enter into agreements concerning the partition, subdivision,
improvement, zoning or management of real estate and to impose or
extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee stock
ownership plan, or any other type of qualified plan) to the extent
the plan or the law permits them to do so, and to exercise any
other rights which they may have under the plan, in whatever
2
:I
payable by reason of my death, whether or not with respect to
property passing under this Will, shall be paid out of the princi-
pal of my residuary estate.
SIXTH: All interests hereunder, whether principal or
income, which undistributed and in the possession of the fiduci-
aries acting hereunder, even though vested or distributable, shall
not be subject to attachment, execution or sequestration for any
debt, contract, obligation or liability of any beneficiary, and
furthermore, shall not be subject to pledge, assignment, convey-
ance or anticipation.
SEVENTH: I nominate and appoint my husband, THOMAS
EUGENE GONTZ, Executor of this, my Last Will and Testament. In
the event of the death, resignation or inability to serve for any
reason whatsoever of the said Thomas Eugene Gontz, I nominate and
appoint PATRICIA L. GONTZ and BARBARA J. GONTZ, or the survivor
thereof, Co-Executrixes of this, my Last Will and Testament. I
direct that my Executor or Executrix, as the case may be, and
their successors, shall not be required to post security or a bond
for the performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
to this, my Last Will and Testament, this 27th day of August,
1987.
(SEAL)
Ruth'-H. Gontz
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in our
presence, who, at her request, in her presence and in the presence
of each other, have hereunto subscribed our names as attesting
witnesses.
�rL�.J �• �tdctd
Address
Address
3