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HomeMy WebLinkAbout05-25-05 REV_1500 EX + (6..(lO) *' w ~ ::ll~(J) u"'~ W~U ~OO u"'~ ~m ~ < OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OLl(05 .... z UJ c UJ u UJ c DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Knight, Kathryn D. DATE OF DEATH (MM.DD-YEAR) FILE NUMBER II 05 COUNTY CODE YEAR SOCIAL SECURITY NUMBER NUMBER DATE OF BIRTH (MM-DD YEAR) 02-22-2005 07-04-1916 198-10-1001 T\..I\S RETURN MUST BE FilED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o o o 3. Remainder Return (date of death prior to 12-13-82) limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Lbllng Trust (Attactl copy of Trust) 5. Federal Estate Tax Return Required B. Total Number of Safe Deposit Boxes (IF I\PPlICABL'C} SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITII\L) ~1 04 06 Original Return 2. Supplemental Return 2450 E. Third Street Williamsport, PA 17701 (1) (2) (3) (4) (5) (6) (7) OFFICIAL USE ONLY Decedent Died Testate (Attach copy of Will) Litigation Proceeds Received None 95,889.52 Nonll None' r., C, ", ~ z w c z o ~ ~ w '" '" o u FIRM NAME (II applica.ble) Woodlands Bank TELEPHONE NUMBER 570-320-2468 11,131.80 None -0- (8) 107,021.32 1. Real Estate (Schedule A) 2.. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4.. Mortgages & Notes Receivable (Schedule D) z o >= :'\ ::J .... ii: <( u UJ '" 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 0 Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) 564.00 1,722.05 c:; 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12.. Net Value of Estate (Line 8 minus Line 11) (11) 2,286.05 (12) 104,735.27 (13) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14.. Net Value Subject to Tax (Line 12 minus Line 13) 0.00 (14) 104,735.27 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0.00 0.00 12,568.23 0.00 12,568.23 20,0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (16) z or transfers under Sec. 9116(a){1..2) 0 >= 16.. Amount of Line 14 taxable at lineal rate 0.00 x .045 (16) i! ::J 0- 17.Amount of Line 14 taxable at sibling rate 104,735.27 x .12 (17) :; 0 u 18.. Amount of Line 14 taxable at collateral rate 0.00 .15 (18) >< x i! 19.. Tax Due (19) >>BE SURE ,TO ANSWER AWQUESTlar-is or-i REVERSE SIOE'ANO' RECHECK, MATH << Copyright 2002 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00: Decedent's Complete Address: STREET ADDRESS Loyalton of Creekview 1100 Grandon Way CITY Mechanicsburg ISTATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 1 g) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 11,939.82 628.41 Total Credits (A + B + C) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due, B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check to: REGISTER OF WILLS, AGENT (3) (4) (5) 0.00 (5A) (58) 0.00 IZIP 17055 (1) (2) 12,568.23 12,568.23 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.... ..........................................-.................. ........................... [!] 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND fiLE If AS PART OF THE RETURN. u enalties of perjury. I declare lha.11 have examined Ihis retum. including accompa~ying schedq\l!t j,n...2 ~lem~ ar.J~ 10 th.e best of my knowledge and belief, it is tNe, correct an.' ome!e De~larationofpreparerotherttmnthepe~onalrepresentallve...!sbasedonanlnformallOno~M ~edge,~~._____,___.__ SIGNAT E~ PO LE R L ETURN ADDRESS T/UIlIt ,i/, .h'~<>M ;';'i.Vj';b~ ,.,/., DA7 . ..[;). 2400 Eolsl <~hk(j :1!cf'f'; ~J.,bID.5 SIGNATURE OF PERSON R"E:SPON5IBLE FOR FILING RETUR~--- ADDRESS ~ltlarnAf,j('rt IJA 17:'01 DATE 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;. ............................................ b. retain the right to designate who shall use the property transferred or its income;......... c. retain a reversionary interest; or.......................................................... ................. d. receive the promise for life of either payments, benefits or care? ...... ................ 2. If death occurred atter December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ...........................................,..... ..................,......... ................ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE -'~---AODRESS Yes ~ o o o o o No ~ ~ ~ ~ DAiE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sUNI\ling spouse is 3% [72 P.S. 99116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse Is 0% (72 P .s. 99116 (a) (1.1) (ii)]. The statute does not exemot 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 twenty-one years of age or younger at de natura! parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (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%, e ~9116 1.2)[72P.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% (72 P.S. 9911 defmed under Section 9102, as an individual who has at least one parent in common with the decedent, whether t NI\?1) 3 f\LOT Rev-1503EX+ {6-981 SCHEDULE B STOCKS & BONDS . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT FILE NUMBER 21-05- ESTATE OF Knight, Kathryn D. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 3133X7PB1 $20,000 Federal Home Loan Bank 3.37% due 7/6/06 99.86 19.972.00 Accrued income on Item 1 through date of death 86.12 2 3133XBC59 $15,000 Federal Home Loan Bank 3.5% due 9/7/07 99.35 14.902.50 Accrued income on Item 2 through date of death 240.62 3 3133XBY71 $20,000 Federal Home Loan Bank 4% due 11/3108 99.73 19.946.00 Accrued Income on Item 3 through date of death 242.22 4 3133X44J7 $10,000 Federal Home Loan Bank 4% due 8/25/09 100.01 10.001.00 Accrued income on Item 4 through date of death 191.08 5 36962GC93 $10,000 General Electric Capital Corporation FRN 98.25 9.825.00 2.843% due 6/11/08 Accrued income on Item 5 through date of death 26.95 6 441B1EC71 $10,000 Household Finance Corporation FRN 4.51 % 101.65 10,165.00 due 1/10/09 Accrued income on Item 6 through date of death 16.08 7 B12404AG6 $10,000 Sears Roebuck Acceptance Corporation 102.12 10.212.00 6.125% due 1/15/06 Accrued income on Item 7 through date of death 62.95 TOTAL (Also enter on Line 2, Recapitulation) 95.889.52 (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rav-150SEX+ (6..gS} *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PiONNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDEtn Knight, Kathryn D. FILE NUMBER 21-05- ESTATE OF Include Ihe proceeds ofliligalion and the date the proceeds were received bylhe eslate All property Jointly-owned with the right of survIvorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Blue Cross of Northeastern PA--medical insurance refund VALUE AT DATE OF DEATH 141.19 2 SEI Daily Income Trust Govt II 10,980.71 Accrued income on Item 2 through date of death 9.90 TOTAL (Also enter on line 5, Recapitulation) 11,131.80 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rav_1510 EX+ (6.98\ *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PE:NNSYLVANIA INHERITANCE TAX RETURN Rl::SIOEKT OECEDEKT Knight, Kathryn D. FILE NUMBER 21-05- ESTATE OF This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV~1500 COVER SHEET is yes ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S TAXABLE EXCLUSION NUMBER INCLUDE NAME OF TRANSFEREE, fHEIR RELATIONSHIP TO DECEDENT ANO VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE 1 Woodlands Bank, trustee under Agreement 0.00 0.00 executed by Kathryn F. Dauphinee dated March 11,1996. Assets of Trust included on Schedule B and Item #2 on Schedule E. Copy of Trust Agrement is attached. TOTAL (Also enter on Line 7, Recapitulation) 0.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-9B) REV_1151 EX-\- {12.-g9} *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT OECEOENT Knight, Kathryn D. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-05- ESTATE OF ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 49.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 515.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 564.00 Copyright tc) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule H (Rev. 6~98) Rev-1502 EX+ (6-98) *' SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERrrANCE TAX RETURN RESIDENT DECEDENT Knight, Kathryn D. IFILE NUMBER 21-05- ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Beaver Urich Funeral Home--cash advances 49.00 Subtotal 49.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev.1502 EX+ (6.9B) *' SCHEDULE H-87 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RES\OEHT OECEDENT Knight, Kathryn D. FILE NUMBER 21-05- ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland County Register of Wills--filing fee-inheritance tax return 15.00 2 Woodlands Bank--inheritance tax return preparation fee 500.00 Subtotal 515.00 Copyright (c) 2002 form software on\yThe Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ {6-gS1 *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Knight, Kathryn D. FILE NUMBER 21-05- ESTATE OF Include unrelmbursed medlc;al expenses. ITEM NUMBER DESCRIPTION 1 Loyalton of Creekview--assisted living room VALUE AT DATE DF DEATH 196.46 2 Omnicare Pharmacy--prescription expenses 613.45 3 Said is, Shuff, Flower & Lindsay--attorney's fee-estate planning 641.50 4 Woodlands Bank--2004 income tax preparation fee 75.00 5 Woodlands Bank--Trustee's Fee 195.64 TOTAL (Also enter on Line 10, Recapitulation) 1,722.05 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule I (Rev. 6-98) REV 1513 EX+ {9-o0} *' SCHEDULE .. COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Knight, Kathryn D. 21-05- NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) 00 Not List Trustee(s} I. TAXABLE DISTRIBUTIONS [include outright sfrousal distributions, and ransfers under Sec. 9116(a)(1.2)J Helen V. Campbell Sister Entire 7902 Windward Drive Remainder of New Bern, NC 28560 Trust Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form soft'Nare only The Lackner Group, Inc. Form PA~1500 Schedule J (Rev. 6-98) TRUST AGREEMENT ,.,+- TRUST AGREEMENT made and executed this II' day of r\A:"'~ 1996, by and between KATHRYN F. DAUPHINEE, of the Township of Loyalsock, County of Lycoming, Commonwealth of Pennsylvania, (hereinafter called the "Settlor"), and WOODLANDS BANK, of the Township of Loyalsock, County of Lycoming, Commonwealth of Pennsylvania, (hereinafter called the "Trustee"). 1. TRUST PROPERTY. Settlor has transferred and delivered to the Trustee all of her right, title and interest in and to the property described 1n the Schedule attached hereto. All property now or hereafter subject to this trust shall constitute the trust estate and shall be held, managed and distributed as hereinafter provided. 2. DISPOSITIVE PROVISIONS. (a) The net income shall be distributed in quarterly the benefit of the Settlor installments equally to or for during her life. (b) If the payments Settlor is entitled shall from this trus t be insufficient in to which the the discretion of the Trustee to provide for the reasonable support, care, hospitalization and medical expenses of the Settlor, including but not limited to nursing and nurs1ng home expenses, the Trustee may pay to the Settlor or apply for her benefit so much of the principal of the trust as the Trustee may deem proper or necessary for that purpose. (c) Upon the death of the Settlor, the Trustee shall payout of income or principal her last illness and burial expenses, including gravestone, to the extent that these items shall not be paid or responsibility for their payment assumed by some other person or estate. (d) Upon the death of the Settlor, the principal and the undistributed income of this trust shall be paid over, delivered, assigned, transferred and conveyed to my sister, HELEN V. CAMPBELL, if she survives me and if not, the principal and the undistributed income shall be distributed to those of my nieces and nephews who shall survive me at the time of my death. 3. PAYMENTS TO DISABLED BENEFICIARIES. In case the income or any discretionary payments of principal become payable to a person under legal disability or to a person not adjudicated incompetent, but who, by reason of illness or mental or physical disability, ~s in the op~n~on of the Trustee unable properly to administer such amounts, then such amounts shall be paid out by the Trustee in such of the following ways as it deems best: (a) directly to such beneficiary; (b) to the legally appointed guardian or conservator of such beneficiary; (c) to some relative or friend for the care and support of such beneficiary; (d) by the Trustee, using such amounts directly for such beneficiary's care and 4. support. TRUSTEE'S POWERS. In addition to and the Trustee by law, not ~n limitation the Trustee shall of any authority given to have the following powers: (a) To retain as an investment all of the securities including stock issued by the Woodlands Bank, and other property then forming a part of the trust estate or thereafter transferred to the trust estate, whether or not the investments shall be of the character authorized by the laws of the Commonwealth of Pennsylvania for investment of trust funds, or shall be productive of ~ncome, and whether or not anyone security or property should constitute a substantial part of or the entire trust estate. The Trustee hereunder shall not be held liable for the purchase and/or retention of Woodlands Bank stock. (b) To purchase or subscribe for any securities or other property with any cash held by it. (c) To pledge, sell for cash or on credit, redeem, exchange for other securities or other property, or otherwise dispose of any securities or other property held by it. (d) To exerc~se any conversion privilege or subscription right available ~n connection with any securities or other property held by it; to consent to the reorganization, consolidation, merger or readjustment of the finances of any corporation, company or association or to - 2 - the sale, mortgage, pledge or lease of the property of any corporation, company or association any of the securities of which may be held by it, and to do any act with reference thereto, including the exercise of options, making of agreements or subscriptions and the payment of expenses, assessments or subscriptions, which it may deem necessary or advisable in connection therewith, and to hold and retain any securities or other property which it may so acquire. (e) To vote, personally or by general or limited proxy, any shares of stock which may be held by it, and similarly to exerClse, personally or by general or by 1 imi ted power of attorney, any right appurtenant to any securities or other property held by it. (0 To make distribution to any person entitled to a part or all of the principal or accumulated lncome of the trust estate In any securities or other property held by it. (g) To register any securities held by it hereunder in its own name or in the name of a nominee with or without the addition of words indicating that such securities are held in a fiduciary capacity. (h) To compromise, adjust or submit to arbitration any claims of or against the trust estate. (i) To payout of principal or income of the trust estate In the discretion of the Trustee all expenses and disbursements including counsel fees and to allot any property or cash received by way of dividends, interest, rents or otherwise to principal or lncome or to apportion the same between principal and lncome In its absolute discretion. (j) To act hereunder through an agent or attorney duly of the powers attorney-in-fact by and under power of executed by the Trustee, in carrying out any and duties herein authorized. (k) To lease any or all of the real property which may be held by it hereunder for such amounts, upon such terms and In such manner as to it may seem proper and with or without the privilege of renewal. Any lease made In - 3 - i I I I i I I i I ! ! ! pursuance of this power shall be valid and effective and binding upon the estate of the Settlor for the entire term thereof, including such part thereof as may extend beyond the date of the termination of the trust created hereby. (1) To reduce the interest rate on any mortgage constituting a part of the trust estate and to consent to the modification or release of any guaranty of any mortgage which it holds 1.n the trust estate or 1.n which it has a partial interest. (m) To continue mortgages upon and after maturity with or without renewal or extension upon such terms as may seem to the Trustee advisable, without reference to the value of the mortgage security at the time of such renewal or extension. (n) To foreclose, as an incident to collection of any bond or note, any mortgage securing such bond or note, and to purchase the mortgaged property or acquire the property by deed from the mortgagor without foreclosure. (0) To set up reserves out of income for taxes and assessments of all kinds and repairs and general upkeep of buildings which may hereafter become a part of the trust estate. (p) To make, execute and deliver any and all deeds, leases, mortgages, conveyances, contracts, wa1.vers, releases or other instruments necessary or proper for the accomplishment of any of the foregoing powers and to do all other acts which, 1.n its judgment, may be necessary or appropriate for the proper and advantageous management, investment and distribution of the trust estate. 5. ADDITIONAL PROPERTY. The Settlor may at any time or from time to time hereafter transfer and deliver to the Trustee cash, securities and other property acceptable to the Trustee, in addition to the property presently transferred and delivered, and such cash, securities and other property shall be held, administered and disposed of by the Trustee in accordance with the prov1.s1.ons of this agreement without the execution of any further instruction or declaration. - 4 - ~. ~..- 6. ACCOUNTING BY TRUSTEE. The Trustee shall render to the Settlor statements of account of its receipts and disbursements as Trustee hereunder at least quarterly. 7. RESIGNATION OF TRUSTEE. Any trustee at any time acting hereunder may resign at any time by written notice to the Settlor. In the event of the resignation, refusal or inability to act of any Trustee acting or appointed to act hereunder, the Settlor may appoint a successor Trustee other than herself to administer the trust estate. Any such successor trustee shall be . clothed and vested with all the duties, rights, titles and powers, whether discretionary or otherwise, as if originally named as Trustee. No successor Trustee shall be liable or responsible 1.n any way for any acts or defaults of any predecessor Trustee, nor for any loss or expense from or occasioned by anything done or neglected to be done by any predecessor Trustee, but such successor Trustee shall be liable only for his or its own acts and defaults in respect to property actually received by him or it as such Trustee; and with the consent of the Settlor may accept the account rendered and the assets and property delivered to him or it by the predecessor Trustee as a full and complete discharge to the predecessor Trustee and shall incur no liability hereunder by reason of so doing. 8. COMPENSATION. The Trustee shall be entitled to rece1.ve fair and reasonable compensation for its serV1.ces. The compensation of the Trustee shall be payable wholly out of 1.ncome or wholly out of principal or partly out of each as the Trustee may from time to time determine in its absolute discretion and shall be payable as of the anniversary date hereof. 9. POWER OF AMENDMENT AND REVOCATION. The Settlor shall have the right at any time and from time to time during her lifetime by instrument in writing delivered to the Trustee to alter, amend or revoke this agreement, either in whole or 1.n part, provided, however, that if altered or amended, the duties, powers and res pons ibi 1 i ties of the Trus tee shall not be substantially changed without its consent. In case of revocation, the trust estate or that part thereof as to which this agreement may be revoked shall be conveyed by the Trustee to the Settlor or in aCcordance with her written directions. - 5 - - ,;:1~~:7c* IN WITNESS WHEREOF, KATHRYN F. DAUPHINEE, has hereunto set her hand and seal, and WOODLANDS BANK, to evidence its acceptance of the trust, has caused its name to be signed by its duly authorized officer, the day and year first above written. ,(\ 1 /) ~fh<<o/'f~i~~f~1jF-v';;O (SEAL) W~N~A~. 1\ i"\ 1111 ~, L.i;) ~~. I -; - V',-",- -!'U->,">""T Title COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF LYCOMING : On this //'l-h day of --7f7CU1--<>I---, 1996, before me, the subscriber, a Notary Public, 1n and for the Commonwealth and County aforesaid, personally appeared KATHRYN F. DAUPHINEE, known to me to be the person whose name is subscribed to the within Trust Agreement and acknowledged that she executed the same for the purpose therein contained. IN WITNESS \~HEREOF, I hereunto set my hand and notarial seal. L~~~c~~ No tary Pubilc ,-.--~ 'n~ __...__. "'.__".'_.__ __.~..____ , L __,___, ,-- -.-" ,... _.-. i ._~l ..~_ - _< . ..':;':-.~.:".':::;~:' _.':~:::'S ..~ SCHEDULE nAn $1.00 In cash.