HomeMy WebLinkAbout08-13-15 (3) J 1505614134
EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOx 2soso� INHERITANCE TAX RETURN 2 1 1 4 1 1 8 9
Harrisbur4,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATtON BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 1 1 2 2 0 1 4 1 2 1 6 1 9 2 4
DecedenYs Last Name Suffix DecedenPs First Name MI
R 0 L L E R J 0 S E P H 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
� 1.Original Return � 2.Supplemental Return � 3. Remainder Return(date of death
Priorto 12-13-82)
� 4.Agricuiture Exemption � 5.Future Interest Compromise(date of � 6.Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
Q 7.Decedent Died Testate � 8.Decedent Maintained a Living Trust 1 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. DeferraUElection 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 T0:
Name Daytime Telephone Number
D A V I D H S T 0 N E , E S Q U I R E 7 1 7 7 7 4 7 4 3 5
First Line of Address
4 1 4 B R I D G E S T R E E T
Second Line of Address
City or Post Office State ZIP Code
N E W C U M B E R L A N D P A 1 7 0 7 � —
Correspondent's e-mai�address: D S T 0 N E a�S T 0 N E L A W•N E T
REGISTER OF WILLS USE ONLY
REGISTER OF WILIS USE ONLY
DATE FILED MMDDYYYY
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C �'�' A fr�
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DA�DE ED STA� � C3
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PLEASE USE ORIGINAL FORM ONLY •-t; --,•�
Side 1 .-3 _ -�
}--.+ -.- C>
rv �' t�'t
I I'�III IIIII IIIII I�I'I'IIII III'I IIII)II'II(III'II�II'III III) � c� a
L 1505614134 1505614134 �
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� 1505614234
REV-1500 EX(FI)
Decedent's Social Security Number
�ecedenrs Name: J 0 S E P H H- R 0 L L E R
RECAPITULATION
1. Real Estate(Schedule A) �• '
. . . . . . . .. . . ... . . .. .. . . . . . .. . . . . .. . . . . . . . . . .
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. 4 8 6 1 � . 4 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. •
7. Inter-Vivos Transfers&Miscellaneous N -Probate Property 5 4 9 4 1 . 2 8
(Schedule G) � Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) .. . . . . . . . . .. . .. . . . . . . . . . . . . 8. 1 0 3 5 5 1 . 6 8
9. Funeral Expenses and Administrative Costs(Schedule H) 9. 7 5 1 0 . 1 7
. . .. . . .. . . . . . . . . . .
10. Debts of Decedent,Mort a e Liabilities,and Liens Schedule I 10. 1 0 0 0 . 4 0
9 9 ( ) . . . . . . . . . . . . .
11. Total Deductions(total Lines 9 and 10) .. . . .. . . . . . .. . . . . . . . .. . . . . . .. . . 11. 8 5 1 � . 5 7
12. Net Value of Estate(Line 8 minus Line 11) . . .. . . . . . .. . ... . . . . . . . . . . . . . 12• 9 5 0 4 1 . �, 1
13. Charitable and Govemmental 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. 9 5 0 4 1 . 1 1
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.0 _ � . � � 15. � . � �
16. Amount of Line 14 taxable
at�inea�rate X.045 9 5 � 4 1 . 1 1 �s. 4 2 7 6 . 8 5
17. Amount of Line 14 taxable
at sibling rate X.12 � . ❑ � 17. � • � �
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 D
19. TAX DUE 4 2 7 6 . 8 5
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Under penalties of perjury,I declare 1 have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,cortect and complete.Declaration of preparer other than the person responsible for filing the retum is based on all infortnation of which preparer has
any knowledge.
SI URE O PERS R ONSIBLE FOR FILING RETURN DATE
� ' ' � 11 -1
ADDRESS
17 OCUST REE NEW CUMBERLAND PA 17�70
NAT P RER H HAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
� �
ADD ESS
41 DGE ST ET NEW CUMBERLAND PA 17070
I II'lll(IIII IIIII'II�I�IIII'IIII(I'll IIIII IIII'II'll�III(I'I Side 2
L 1505614234 1505614234 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21 14 1189
DECEDENTS NAME
JOSEPH H. ROLLER
STREETADDRESS
1710 L OCUST STREET
�in' sraTE ziP
NEW CUMBERLAND PA 17070-
Tax Payments and Credits:
1• Tax Due(Page 2,Line 19) (1) 4,2?6• 8 5
2. Credits/Payments
A.Prior Payments 3,8 0 0 •0 0
B.Discount 2 0 0 •0 0
(See instructions.) Total Credits(A+g) �2� 4,0 0 0 • 0 0
3. Interest
(3) 0• 0�
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fili in oval on Page 2,Llne 20 to request a refund. (4) 0 • 0 0
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2 7 6• 8 5
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 ............................... ❑ 0
' c. retain a reversionary interest ..................................................................................................... ❑ �
d. receive the promise for life of either payments,benefits or carel ....................................................... ❑ ❑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 payabie-upon-death bank account or security at his or her death? ......... ❑ 0
4. Did decedent own an individual retirement acc,rount,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. � ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)�.
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a sunriving 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 decedenCs lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)J.
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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+(OS-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8� MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
JOSEPH H. ROLLER 21 14 1189
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointty owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
� PNC Bank-Checking Acct #5140053641 45,23U• 30
Princ $45,230 •3�, Int $•07
2 PNC Bank-�hecking Acct #5140053641 - Accrued Int 0 •0?
3 The Woods-nursing home refund 1,4??. 99
4 US Treasury-tax refund on decedents 2014 return 1,887. 00
5 Verizon-refund received 15•�4
TOTAL(Also enter on Line 5,Recapitulation) ; 4 8,610 • 4 0
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOSEPH H • ROLLER 21 14 1189
This schedule must be completed and filed ff the answer to any of questlons 1 through 4 on page ihree of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUOE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATfACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST pF naaicne�E) VALUE
� New York Life Insurance-Annuity 54,941•28 100• 00 54,941.28
Policy #75617797 Beneficiary
is Robert H. Roller
TOTAL (Also enter on Line 7,Recapitulation) S 5 4,9 41• 2 8
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOSEPH N • ROLLER 21 14 1189
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNER,4L EXPENSES:
�. Cremation Society of PA-funeral expenses 695• 00
2 Cremation Society of PA-addl funeral expenses 126 •DO
3 Stone 8� Murray Funeral Home-funeral expenses 759 •81
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representadve(s)
SVeet Address
Ci� State ZIP
Year(s)Commission Paid:
2 AttomeyFees: D8V1CJ H Stone, Esquire 4 ,500 •0�
3, Family Exempbon:(If decedents address is not the same as claimanfs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
a. ProbateFees: Cumberland County Reg of Wills 175•50
5 Acxountant Fees:
6. Tax Retum Preparer Fees:
�. US Treasury-paymt on 2013 income taxes 6 • 00
2 Medicare-insurance premium ],04 • 90
3 Mony-insurance premium 11• 83
4 Mony-insurance premium 11• 83
5 Check written by decedent prior to death 25•00
6 Kelly Financial Serv-fee on prep of income taxes 559• Z5
7 Register of Wills-filing Inh tax ret & Inventory 30 - 00
8 Harrisburg Storage Co-shipping items by truck 405•D5
9 Reserve for closing expenses 100• 00
TOTAL(Also enter on Line 9,Recapitulation) S 7,510 - 1?
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8� LIENS
RES�DENT DECEDENT
ESTATE OF FILE NUMBER
JOSEPH H• ROLLER 21 14 1189
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,includ(ng unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
�. Verizon Financial-services at house 91. 94
2 Holy Spirit EMS-debt of decedent 908• 46
TOTAL(Also enter on Line 10,Recapitulation) 5 ],,D 0 0 • 4 0
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JOSEPH H• ROLLER 21 14 1189
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee�s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outrg' ht spousal distributions and transfers under
Sec.91 fs(a)(1.2).]
� ROBERT H ROLLER Lineal 47,52� . 56
1710 LOCUST STREET
NEW CUMBERLAND PA 17070-
2 THOMAS M ROLLER Lineal 47,520. 55
440 CRESTVUEW COURT
CAMP HILL PA 17011-
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S
If more space is needed,use additional sheets of paper of the same size.
�.A�.. �\t�,� -� � � �� ti� � - �
' �,�j� �.LDr:R LAW P.C.
���� 'Y�Y ���L.� �l�� �������1�` .!1
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I, JOSEPH H. ROLLER, having my legal residence at 1710 Locust Street, New Cumberland,
Cumberland County, Pennsylvania, 17070, do hereby declare this to be my Last Will and Testament,
revoking all other Wills and Codicils heretofore made by me.
I declare that I am married to Emma U. Roller and that all references to my wife are to her. I
further declare the following children born to me, Robert H. Roller and Thomas M. Roller, and that all
references to my children are to them.
ITEM ONE: I direct that all my valid debts and the expenses of my last illness and funeral
be paid from my estate as soon as practicable after my death.
ITEM TWO: I give and bequeath all of my tangible personal property to my residuary heirs
under Item Four, below as follows:
A. All items of tangible personal property shall be inventoried and valued at a fair market value.
B. I may leave a Memorandum listing some of the items of my tangible personal property which
I wish certain persons to have and request that my wishes as set forth in the memorandum be
observed by my Personal Representative. Any items of tangible personal property not so
designated shall be divided and distributed among my residuary heirs as follows:
1. Each of my heirs may select one item, in rotation, in order determined by lot, until such
time at which the items chosen by each heir reach such heir's proportionate share of the
total value of my estate, or until such time as each heir wishes to make no further
selections.
1
2. Any items not selected shall be sold and the net proceeds added to the residue of my
estate.
3. To the extent my heirs aze unable to agree, the decision as,.to what may constitute "one
,
item" for purposes of this selection shall be made by my Personal Representative(s).
4. Any disputes concerning this method of allocation shall be resolved by my Personal
Representative(s) in my Personal Representative's sole discretion.
5. To the extent my Personal Representative is unable to resolve a dispute among two or
more of my heirs concerning the in-kind distribution of any of my personal property, I
direct my Personal Representative to sell the disputed property and the net proceeds
there from be added to the residue of my estate.
ITEM THREE: I direct any interest I may own in any real property together with the insurance
thereon shall pass with the residue of my estate. My Personal Representative may either distribute any
real property at its then fair mazket value to one or more of my residuary heirs under and in accordance
with Item Four below, or may sell any such real property and the net proceeds there from shall be added
to the residue of my estate.
ITEM FOUR: I give, bequeath and devise all the residue of my estate, of whatsoever nature
and wheresoever situate, to my wife, EMMA U. ROLLER. In the event my wife fails to survive me or
is determined to be a Supplemental Needs Person as defined in Item Six, below, I give, bequeath and
devise all of the residue of my estate, of whatsoever nature and wheresoever situate, to my children,
ROBERT H. ROLLER and THOMAS M. ROLLER, in equal shares per stirpes. In determining the
value of a beneficiary's share of my residuary estate, I direct that the value of my residuary estate be
augmented by the value of any personal and real property distributed in-kind under Items Two and
Three, above.
ITEM FIVE: Should any beneficiary of mine be under the age of twenty-five (25)years, my
Personal Representative shall hold such beneficiary's share of my estate, as Trustee, IN TRUST and
shall invest, reinvest and distribute the principal and net income of such beneficiary's share as follows:
2
P,. Until such beneficiary attains the age of twenty-five(25)years,my Trustee, in my Trustee's sole
but reasonable discretion, may pay or apply the income and any or all of the principal of such
beneficiary's sliare for the health, maintenance, support and education of such beneficiary
considering all other sources of income available to such beneficiary and known to my Trustee.
Upon such beneficiary attaining the age of twenty-five (25) years, my Trustee shall distribute
the balance of the principal and accumulated income, if any, of each such beneficiary's share to
such beneficiary.
B. Should the principal of the Trust Estate, in the sole opinion of my Trustee, be or become too
small to warrant placing or continuing of such fund in trust or should its administration be or
become impractical for any other reason, my Trustee, in the exercise of their sole discretion,
may pay such share absolutely to the person maintaining such beneficiary or may place such
shares in the beneficiary's name in an interest-bearing deposit in any bank, bank and trust
company or national banking association of his choosing,payable to the beneficiary at majority,
or if said beneficiary has reached his or her majority,then to him or her directly.
C. All shares of principal and income hereby given shall be free from anticipation, assignment,
pledge or obligation of my beneficiary(s), and shall not be subject to any execution or attach-
ment.
ITEM SIX: Notwithstanding the provisions of Item Four above, in the event my wife,
EMMA U. ROLLER, survives me by one hundred and seventy (170) days and it is determined by either a
court or an authority of competent jurisdiction or in the event my Personal Representative reasonably
believes that my wife will be required to elect against my estate so to prevent her from being ineligible to
receive or to continue to receive any governmental assistance benefits, then I give to my Personal
Representative as TRUSTEE IN SEPERATE TRUST, an amount equal to my wife's statutory elective
share under 20 PA C.S.A. Chapter 22, and I direct the Trustee to retain, invest, reinvest and distribute, any
income and principal of the trust share set aside for my wife, as follows:
A. The Trustee may, in the Trustee's sole discretion, distribute for the benefit of my wife,
discretionary amounts of principal for supplemental needs not otherwise provided by
3
governmental financial assistance and benefits or by the providers of services. Such
amounts shall not be distributed directly to such beneficiary.
B. "Supplemental needs" refer to the requisites for maintaining the good health, safety and
welfare of such beneficiary when in the discretion of my Tnistee such requisites are not
being provided by any public agency, office or department of any state or of the United
States. "Supplemental needs" shall also include, but not be limited to, medical and dental
expenses, annual independent check-ups, equipment, pro�rams of training, education,
treatment and rehabilitation, private residential care, transportation (including vehicle
purchase), maintenance, insurance and essential dietary needs. "Supplemental needs" may
include spending money, electronic equipment such as radios, record players, television
sets,computer equipment, camping, vacations, athletic contests, movies,trips and money to
purchase appropriate gifts for relatives and friends.
C. The Trustee shall have no obligation to expend trust assets for such needs, but if the
Tnistee in its sole discretion decides to expend hvst assets, under no circumstances should
any amounts be paid to or reimbursed to the federal government, any state or any
governmental agency for any purpose, including for the care, support and maintenance of
my wife.
D. No part of the trust share set aside for my wife shall be used to supplant or replace public
assistance benefits of any state or federal agency which has a legal responsibility to serve
persons with illnesses or handicaps which are the same or similar to the disorders of such
beneficiary.
E. No interest in the principal or income of the trust share set aside for such beneficiary shall be
anticipated, assigned or encumbered or shall be subject to any creditor's claim or to legal
process prior to its actual receipt by my wife. My wife is specifically prohibited from any
right to receive, demand, secure, give, assign, transfer, mortgage, borrow against or will any
trust assets or income.
F. It is my intention to conserve and maintain this tivst shaze for the supplemental needs of my
wife. Therefore, no part of this trust share, neither principal nor undistributed net income,
sha11 be subject to the claims of voluntary or involuntary creditors for the provisions of care
4
•
and services, including residential care by any public entity, office, department or agency of
any state or government agency or of the federal government of the United States.
G. In the event it is determined by either a court or an authority of competent jurisdiction
that these trust assets render my wife ineligible to receive any governmental assistance
benefits, or if the Trustee in its sole discretion determines that notwithstanding the
provisions set forth above, this trust shaze may be subject to garnishment, attachments,
execution or bankruptcy proceedings by a creditor of such beneficiary or by the federal or
state government or any agency or subdivision thereof, then my Trustee shall terminate
the trust shaze set aside for wife and distribute the remaining principal and accrued
income pro rata to my residuary heirs under Item Four, above, the contingent
beneficiaries.
H. I request but do not direct that the contingent beneficiaries conserve, manage and
distribute the proceeds of the former trust shaze set aside for my wife in accordance with
the provisions as set forth above. '
I. In deternuning whether the existence of the trust share has the effect of rendering my wife
ineligible to receive any governmental assistance benefits, the Trustee is hereby granted full
and complete discretion to initiate administrative or judicial proceedings for the purpose of
determining eligibility. All costs related thereto, including reasonable attomey's fees, shall
be a proper charge to this trust share of my wife.
J. If my wife should die before the complete distribution of this trust estate, this trust shall
terminate and the Trustee shall distribute the balance of the trust property to my residuary
heirs under Item Four,above,my contingent beneficiaries.
ITEM SEVEN: I appoint, my son, ROBERT H. ROLLER, my personal representative of this
my Will. In the event my son is unable or unwilling to act or continue to act as my Personal
Representative, I appoint my son, THOMAS M. ROLLER, my Personal Representative.
ITEM EIGHT: I appoint my duly appointed Personal Representative(s) Trustee(s) of the
Trust(s) created pursuant to Items Five and Six, above. Notwithstanding the foregoing, under no
5
circumstances shall my wife, EMMA U. ROLLER, serve as a Trustee of any trust created under Item
Six above. .
ITEM NINE: No bond shall be required of any fiduciary hereunder in any jurisdiction. No
fiduciary hereunder shall have any liability for any mistake or enor of judgment made in good faith.
ITEM TEN: I authorize my Personal Representative(s) and Trustee(s) to exercise the
following powers in addition to those given by law,to be exercised in their sole discretion:
A. To retain any or all of the assets of my estate,without regard to any principle of
diversification, risk or productivity;
B. To invest in all forms of property without restriction to investments authorized for any type of
fiduciary;
C. To compromise any claim or controversy;
D. To loan money to or buy property from my estate;
E. To borrow money from any person, including any Executor or Trustee, and to mortgage or
pledge any real or personal property;
F. To sell at public or private sale, to exchange or to lease for any period of time, any real or
personal property, and to give options for sales, exchanges or leases, all for such prices and
upon such terms and conditions as they deem proper,
G. To allocate receipts and expenses to principal or income or partly to each as they deem proper;
H. To repair, alter or improve any real or personal property;
I. To distribute in cash or in kind or partly in each at valuarions fixed by them;
J. To keep reasonable amounts of cash in a bank uninvested if deemed advisable for the protection
of the principal;
K. To subscribe for or to exercise options for stocks,bonds or other investments; to join in any plan
of lease, mortgage, merger, consolidation, reorganization, foreclosure or voting trust and to
deposit securities thereunder, and to generally exercise all the rights of security holders or
employees of any corporation;
L. To register securities in the name of a nominee or in such manner that title shall pass by
delivery;
M. To add to the principal of any trust created by this instnunent any real or personal property
received&om any person by Deed, Will or in any other manner;
N. To exercise all power, authority and discretion given by this instrument after the termination of
any trust created herein until the same is fully distributed;
O. To use their sole discretion in deciding whether stock dividends on stock they hold in trust
should be apportioned to principal or income, except stock dividends of regulated investrnent
companies which shall be added to principal;
P. To commingle the assets of any m�st estate created by this Will in any one or more common
funds for greater convenience and flexibility;
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Q. To employ agents, accountants, engineers and such other persons, professional or otherwise, as
may be necessary for the proper administration of this estate or trust and to pay their
compensation from such funds; and
R. To disclaim all or any interest in a property passing to me or my estate.
ITEM ELEVEN: I realize that Personal Representatives are given discretion by law to
make various elections which affect the income and estate taxes payable by estates and beneficiaries, as
well as the relative shazes of beneficiaries, such as taking administration expenses as deductions for
either estate or income ta�c purposes, selecting options for the payment of employee death benefits,
electing to take a qualified terminable interest as part of the marital deduction, selecting alternate
valuation dates, postponing the payment of taxes, filing joint income tax or gift tax returns and
redeeming corporate stock. The decisions made by my fiduciaries in any of these matters shall be
binding upon, and not subject to question by, any affected persons. I rely upon my fiduciaries to take
into consideration the total income and estate taxes payable by reason of their decisions including those
payable by my survivors, and they are authorized in their discretion, but not required, to make
adjustments between income and principal as a result thereof.
ITEM TWELVE: I direct that all estate, inheritance and other taxes in the nature thereof,
together with any interest and penalties thereon, becoming payable because of my death with respect to
the property constituting my gross estate for death tax purposes, whether or not such property passes
under this my Last Will and Testament, shall be paid from the principal of my residuary estate, and no
person receiving or having a beneficial interest in any such property, whether under this my Last Will
and Testament or otherwise, shall at any time be required to contribute to or refund any part thereof;
PROVIDED, however, that this direction shall not apply to the taxes on any property included in my
estate solely because of a power of appointment thereover which I possess but have not exercised or on
any qualified terminable interest or to any generation- skipping transfer taxes.
ITEM THIRTEEN: No gift or beneficial interest shall be subject to anticipation,
assignment,pledge, obligation, or alienation of my beneficiary(s), whether voluntary or involuntary, and
the income and principal thereof sha11 not be subject to any execution or attachment.
�
ITEM FOURTEEN• If any beneficiary, person or entity in any manner, directly or indirectly,
contests or attacks this Will or any of its provisions, or objects to the accounts or actions of my fid�t d to
without probable cause, such beneficiary, person or entity shall pay all costs, including bestate such trust
attorney
s' fees,arising in connection with such contest, attack or objection incurred by my �
ersonall In the event that such beneficiary, person or entity does not prevail in such
or such fiduciary p Y•
action, any share or interest in my estate or such trust which would otherwise pass to such benefic aze
consistin of such s
person, entity or remainderman under this Will shall be revoked and �e pon or enti had predeceased me
shall be disposed of in the manner provided herein as if that contesting pers t5'
without surviving issue.
ITEM FIFTEEN: Should any of the provisions of my Will be for any reason declared
invalid, such invalidity shall not affect any of the other provisions of this Will and all invalid provisions
shall be wholly disregazded in interpreting this Will.
ITEM SIXTEEN: This Will shall be construed, regulated and governed by and in
accordance with the laws of the Commonwealth of Pennsylvania.
IN WITNESS WHEREOF, I have at Mechanicsburg, Pennsylvania, on December 13, 2011, set
my hand and seal to this my Last Will and Testament consisting of eight (8) pages plus any witness,
acknowledgement, affidavit and certification pages.
�; � � , y1 ' SEAL
1 SE H H. ROLLER
8
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i�
SIGNED, SEALED, PUBLISHED AND DECLARED BY JOSEPH H. ROLLER, the above named
Testator, as and for his Last Will and Testament, in the presence of us, who, at his request and in his
presence, and in the presence of each other, have hereunto subscribed our names as witnesses.
Witnes Witness
��!r's ��
P�
Address Address
9
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SELF-PROVING AFFIDAVIT
VWEALTH OF PENNSYLVANIA :
. SS:
OF CUMBERLAND :
We, J SEPH H. RQL�ER, �2,�\ C 1 ����' � �d
�.U;� �J�s� , the Testator and the witnesses
ly, whose names aze signed to the attached or foregoing instrument, being first duly sworn, do
clare to the undersigned authority that the Testator signed and executed the instrument as his
and Testament that he had signed willingly (or willingly directed another to sign for himJ, and
ecuted it as his free and voluntary act for the purposes therein expressed, and that each of the
in the presence and hearing of the Testator, signed the Will as witness and that to the best of
�ledge the Testator was at that time eighteen years of age or older, of sound mind and under no
� or undue influence.
!�
OSEPH H. ROLLER
C?,
WITNESS
/
WITNESS
Subscribed, sworn to and acknowledged before me by JOSEPH H. ROLLER, the Testator
tnesses, on December 13, 2011.
�
���T�ti�l�e �2�� ��(�':���'-�
Notary Public or PA Attorney
NOTARIAL SEAL
MARCIA M NESBIT
Not�ry Public
UPPER ALLEN TWP.,CUMBERLAND COUNTY
My Commia�lon Expins Jun 4,2014
10
������ ��l�Jl��l�l� �L.J� ��
��e���� �. ������
This informal letter of instruction to my family and Personal Representative serves to
y my personal wishes concerning distribution of selected personal effects. In any situation
the provisions of this letter may be deemed to be inconsistent with or contrary to the terms
• Will, or other formal Estate Planning Documents, it is my desire and intent that the
�ions of my Will and other formal Estate Planning instnunents shall govern and be
�Iling since I do not intend that this letter shall serve in any respect as a Will nor shall the
of this letter override the provisions of a Will or a Trust executed by me whether it w�s
i prior or subsequent to the date of this letter.
Distribution of Personal Property
Description of Propertv Beneficiarv
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
. 11.
12.
i
�,��
�,��.R.����_:�.,�
Descrintion of Proaertv Beneficiarv
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Other Directions To My Family:
2
�
STONE LAFAVEI3 & SHEKLETSKI
ATTORNEYS AT LAW
4I4 BRIDGE STREET
DAVID H• STONE POST OFFICE BOX E
OFCOUN3EL
GERAI,.D J. SHEKLETSKI NEW CUMBEHLAND,PA 170"70 CNARLES H. STONE
www.stonelawnet JON F.LpFAVER
TEI.EPHONE(7t7)77q_7493
FACSIMILE (717)774-3869
February 6, 2015
Pennsylvania Department of Revenue
H arrisburg District Office
L obby, Strawberry Square
H arrisburg, PA 17128-0101
Re: Estate of Joseph H. Roller
Date of Death: November 12, 2014
Social Security No. : 205-12-9798
Estate No: 21-14-1189
G reetings :
Please find enclosed an original Safe Deposit Box Inventoryfor
B ox No. 453 .
Thank you for your attention in this matter. Should you have
any questions, please feel free to contact me.
Very truly yours,
STONE aFA SHEKLETSKI
�
,
l,
1
i t
D . � E�quire
DHS/j am
Enclosures
cc : Robert H . Roller, Executor
Linda M. Minor, AVP Branch Manager of PNC Bank
1 .
� 48500041046
REV-485 EX(OS-04)
SAFE DEPOSIT
BOX INVENTORY
PA Department of Revenue PLEASE USE ORIGINA� FORM ONLY
Sociai Security or Death Certificate Number Date of Death County Code Year File Number
205-12-9798 11/12/2014 21 14 1189
Decedent's last Name Suffix First Name MI
Roller Joseph H
�ADDRESS OF DECEDENT STREET: CITY: STATE: ZIP CODE:
1710 Locust Street New Cumberland PA 17070
NAME AND ADDRESS OF PERSON RE(]UESTING THE OPENING OF THE SAFE DEPOSIT BOX
NA"'E. David H. Stone, Esquire
STREETADDRESS: CITY: STATE: ZIPCODE:
414 Bridqe Street New Cumberland PA 17070
�NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT OF PERSON(S)PRESENT AT THE BOX OPENINCa
a. NAME: RELATIONSHIP:
Robert H. Roller son
STREET ADORESS: CITY: STATE: ZIP CODE:
1710 Locust Street New Cumberland PA 17070
b. NAME: RELATIONSHIP:
STREETADORESS: CITY: STATE: ZIPCODE:
c. NAME: RELATIONSHIP:
STREETADDRESS: CITY: STATE: ZIP CODE:
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPO3IT BOX 13 LOCATED
NAME:
PNC Bank
STREETADDRESS: CITV: STATE: 21P CODE:
1104 Carlisle Road Cam Hill PA 17011
. NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY
Jose h H. Rolier 10/28J11 0:00 am
: DATE OF CONTRACT TO RENT BOX ' NUMBER OF BOX 1 TITLE UNDER WHICH BOX IS REOUESTED
01/16/1987 453 Jose h H. Roller
NAME AND ADDRE33 OF PERSON(S)HAVING ACCESS TO BOX
a. NAME: b. NAME:
Joseph H. Roller
STREET ADDRESS: STREET ADDRESS:
1710 Locust Street
��TY STATE: ZIP CODE: CITY: STATE: ZIP CODE:
New Cumberland PA 17070
NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY
Laura M. Minor
WAS A WILL IN TNE BOX7 ❑ YES � NO If yes, a. Dats of will:
b. Nams and address of personal representativs,if named In ths will
NAME:
STREETADDRESS: CIN: STATE: ZIPCODE:
c. Name and addreas of attomey,it any
NAME:
STREETADDRESS: CITY: STATE: ZIPCODE:
� 48500041046 48500�41046 �
t � -
REV-485EX SAFE DEPOSIT BOX INVENTORY Page 2 of z
INSTRUCTIONS
(1) Cash:Report total only.
(2) Stocks:List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by
name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock.
(3) Obiigations of U.S.Government: Number of items,date of issue,face value,names in which registered and type of ownership,
i.e.,jointly held,payable on death,etc.
(4) Bonds: Designate by name,amount,serial number,or other designation.(Bearer Bonds)
(5) Bank and Savings and Loan Passbooks:State name of depositor, number of book,last date appearing in book,name of bank
and branch,and balance.
(6) Jewelry,Coins,Stamps,Manuscripts,etc: List and describe as fully as possible.
(7) Deeds,Mortgages,Current Insurance Policies or othe�evidences of indebtedness:List and describe as fully as possible.
(8) All other contenta.
(9) Return completed form to: DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT.280601
HARRISBURG,PA 17128-0601
ITEM
Np, ITEM DESCRIPTION
EMPTY
�
I CERTIFY UND PENALTY P RY TH THE ABOVE RECORD IS PERSON RECEIVING COPY OF
CORRECT AN COMPLETE O H ST O KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY:
SIGNATURE SIGNATURE
PRINT NAME PRINT NAME AND CHECK APPROPRIATE BOX BELOW:
David H. Stone, Es uire
PRINT TITLE DATE CHECK APPROPRIATE BOX:
Attorney for Estate 02/06/2015 ❑EXe°�`°n`"x� ❑Administretor(Mx)
�Estate Representative �Joint owner of safe deposit box
NOTE:Attach additlonal 8'I="x 11"sheet(s)if necessary or use duplicates of this page of form.
The Department is authorized by law,42 U.S.C.§405(c)(2)(C)(i),to require disciosure of Social Security numbers in connection with administering state tax laws.The Department uses the
Social Secunty number to identify the decedent and personal representaUves of the estate.The Commonwealth may also use the information in exchange of tax infortnation agreements
with Federal and local taxin authorities.The state law rohibits the Commonwealth's personnel from disclosin confidential tax information exce t for officiai purposes.
Jan. 13. 2015 9. 26AM PNC Ba�k No. 247� P, 1/2
. :_
_ . .,
r iF
���
r�� �3, �o�s
David H Stone�sq.
Stone Lafavicer& Shekletski
p0 Box E
414 Bridge Street
Ne�Cumberland PA 17070
RE: Joseph H Roller
SSN: 205-12-9798
]70D: 1 I-12-2014
Dear Mr. Stone:
In response to your request for Date of Death (DOD)balances for the custorner noted ab��re, our
records show the following:
Checking Actount
,Account#5�40�5364� Established: 01-01-1978
JOSEPH H ROLLER.
DOD balance: $45,230.30+0.07 accrued interest
rnterest paid O 1-O 1-2014 thru 1 I-12-20I4 $4.46 Y'TT)
Safe Deposit Boa
The decedent maintained safe deposit box#453
J(7SE�'H H�OLLBR
T,ocated at: Cedar Cliff Ma11
1104 Cazlisle Rd
c�p�pAi�o�1
(717)7b1-3180
Piease note that this office pro�vides date of death balancas for deposit accounts(1�tAs,CT7s,Checldng az�d
5avings). We do not process any financial transactions or provide statements, If�ou need assistance with
an�of these icems,please call 1-888-pNC-BAN�.(1-888-762-2z65)or stop by your 1oca1 PN'C Baz�c branch
office.
Sincerel�,
National Financial Services Center
PNC Bank,N.A.
Member�]7rC
Fage 1 a�2
Jan. 13. 201� 9 : 26AM PNC Bank No, 2Q75 P, 2/2
This message is intenc�'ed'fnr the use af the individual or entity to whicla it is addressed ar�d may
contain information that rs privileged, cdnfidential and exempt from disclosure u�zder appl'ica�le law.
If the reader of this message is rwt the intended recipient or the ernployee or ager�t responsibte for
delivering this message to the intended recYpient,you are hereby norifred rhar�ny dissemination,
distribution or co�yirig of thfs commurzzcations is strictl'y prohibited. If you have received this
com�nurzfcatior� rr�error,please r►nrify me immediately by reply or by telephone at 800�762�1775 and
immediatel'y desi'r�oy rhis faxed afocument.
Page 2 0£2
�� Winner of the Dalbar �"���
Service Award from ;
�
Z000-2013
January 20, 2015
David H Stone, Esquire
414 Bridge Street, Box E
New Cumberland, PA 17070
Policy Number: 75617797
Decedent: Joseph H Roller
Dear Mr. Stone,
Thank you for your recent inquiry regarding the date of death value on the above policy.
As of November 12, 2014 the value of the above-referenced policy was$54,941.28.
If you have any questions, our Client Services Representatives are available Monday
through Friday from 8:30a.m.to 5:30p.m. Eastern Time at 1-800-762-6212.
On Behalf of New York Life,
��-� ts
Kenneth Quella �O�t �l
Service Associate Tr
Ro��.
New York Life Annuity Service Cerrter• P.O. Bcuc 9859 •Prnvidence, RI 02440 • 1-SQO-762-6212
Annuities are iss�d by New York l.ife Inse,rance and Annu�ty Corporation (NYLIAC) {�,Delaware Corporat3orr}
Variable annuities are distributed by. NYLIFE Distrib�rtors LLC, Member FINRAfSIPC
EV'YLJAC and NYUFE Distributors LLC are whotly owned sut�sidiaries of t,iew Yark Life Insur�nte Comparry
51 Madison Ave, New York, NY 1Q�10�