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Home My WebLink About09-22-05 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX! 11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT YOUNG DORIS ANNE 9445 CARLISLE ROAD DILLSBURG, PA 17019 _Unn_ fold ESTATE INFORMATION: SSN: FILE NUMBER: 2105-0028 DECEDENT NAME: WEA VER EDITH MARIE DATE OF PAYMENT: 09/22/2005 POSTMARK DATE: 09/22/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/28/2004 NO. CD 005821 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $23.28 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: TERRENCE BARNA, ESQ CHECK# 9671 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS $23.28 GLENDA FARNER STRASBAUGH REGISTER OF WILLS c,i--:- II 'I II Ii !I II I I I' II JI (:(~ ..- r- (L) (1) '" '" 0' ~" C" "' " ro g v Z :J o ;;- 1...........- irJ vO , Iv') 11~ liu ..J U"i " C;':: Ll,jm O::~ u.. ~ -' c:.::o m O<o~ o...<~ LI,j~9~ Z~UJ< Z-.:!"......Io... <'( ~ ~ v~ tn ~ 0::: a::: -~6~ c.::: f"~ IJ') C "'-' . ~-...J o~~o \ ~ '" ^, ~ ~ ~ ~ ~ ill Ii .J o o 01 OJ , I '::1 U11 U11 I U11 rui l:Ci m! -I rf'I, rui .. I - -J" ~."I' '~ lN3...HOI:fvd cG 1 J i ~~ iO'" I ~~ ~ ['- '~ U1 ~ 0'" '::l - I ~ ~ c Q z o < Z 0 ~ c::)~~ ZI--o;ij :3 c ii:-:--. lrWci;;::S wC:z"" 000:5 :i ...I ffi ' ::) ct '" <' o lr 3 . 3: :!l ~ \,(j w W w " ZlLz ~ -. Register ofWiDs of Cumberland County INVENTORY Estate of Edi th Marie Weaver Also known as Edith M. Weaver Estate No. 21-05-0028 Date ofDeath December 28, 2004 Social Security No. . Deceased Doris Arme Younq ,PCI15OtlalR_nlOlive(s)of the above Estate. d.eceased. verify that the items appearing on the rollowina inventory include all of1be personal assets wherever silua~ and all of th" real estate in the Conunonwealth of PennsylVllnia of said Oeeeden~ thai the valuation place<! opposite each item oC said invenlnry represents its Cair value a. oCtile date of the De<:odent'. death, and that Decedent owned no reol estat. outaid. the COmmonwealth oCPen.asylvania"""ep! tbat which sppes.. in a memotlllldum at the end ofthi. inVOllltlty (PEP ~ 3301). /JWe verilY dtat the ._ments made in this iovenlnry 8M """ and carre<!. VWe undenitand that fid~ statement" herein made are subject to the penattic5 of 18 Pa.C.S. Section 4904 relating to unsworn falsif1C8tion to authoritie;:. Name of Attorney: Niles S. Berm, EsguirEl'ersonal Representative: Doris Arme Young LO.No.: 1 6284 Address: 9445 Carlisle Road Dillsburg, PA 1 701 9 Address: 103 E. Market street, P.O. Box 5185 York, PA 17405 5185 Telephone: 717 -852-7020 -:J;:;; y~ f~t.P~ Signature: Date: Description Value See Attached Sheet ~~::; (,'-J .\ .'-J r.) ~ -",-:'} Total (Atmeh Additional Sheets ifnecessllty) NOTE: TI-= Memorandum ofrea1 tsta1:c ouunde the Commonwealth ofPmnsylvania may, at the election of the pen;onal representative, include the value of each item., bu( such figures should not be extended into the total of Ihe Inventory. RW.4 c.\ _I . , w:. CONTINUA nON OF INVENTORY Estate of Estate No. Page _ Description of Inventory DescriptiDn Value Subtotal Grand Total S $ .. Attachment to Inventory of Estate of Edith M. Weaver No. 21-05-0028 1. Series E United States Savings Bond, serial number Q5186736040E, final maturity 6/2004 130.02 2. Series E United States Savings Bond, serial number Q5186735680E, final maturity 7/2004 130.02 3. Series E United States Savings Bond, serial number Q5201164914E, final maturity 8/2004 130.02 4. Series E United States Savings Bond, serial number Q5207519830E, final maturity 9/2004 130.02 5. Series E United States Savings Bond, serial number Q5213886558E, final maturity 10/2004 130.02 6. Series E United States Savings Bond, serial number Q521388737IE, final maturity 11/2004 131.26 7. Series E United States Savings Bond, serial number Q5221453553E, final maturity 12/2004 131.59 8. PNC Bank checking account, acct # 5140461469, $3,935.29 plus accrued interest to date of death $0.82 3,936.11 9. Van Kampen Investments, account # 59/61752097, 499 shares @ 9.08 per share 4,530.92 10. Anticipated settlement proceeds from York County State Court litigation, Weaver v. Donald K. English, et aI., No. 87-SU-03093-01 7,500.00 11. Noritake China, ] 2 place setting ]2. Stemware, 11 pieces ]3. Nobility silver plate flatware ]4. Seth Thomas mantle clock 15. Service for 6 tea cups and saucers 16. Pattern glass water pitcher and 5 glasses Total 175.00 55.00 65.00 75.00 48.00 65.00 17,362.98 . REV-15OL1EX (a'-ilO) REV-1500 FILE NUMBER 21 05 0028 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT COUNTY CODE YEAR NUMBER I- Z W C W U w C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) WEAVER, EDITH M SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN fPLlCA TE WITH THE REGISTER OF ILLS SOCIAL SECURITY NUMBER , I o 3, Remainder Return (""~otd ",pnortoI2-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Dep sit Boxes o 11. Election to tax under Sec. 9113(A) (A1looh Soh 0) .... z w c z o 0.. CIl W '" '" o U NAME Terence J. Barna, Esquire FIRM NAME (If Appll"'ble) Benn Law Firm TELEPHONE NUMBER (717) 852-7020 COMPLETE MAILING ADDRESS Benn Law Firm 103 E. Market Street, PO. Box 5185, York, P 5185 z o !;i I-' ~ c. :E o U g CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT DATE OF DEATH (MM.DD.YEAR) 12/28/2004 DATE OF BIRTH (MM-DD.YEAR) 03/15/1909 0.00 912.95 , ' 0.00 0.00 16,450.0~ 15,780.79 f (8) 19,944.10 5,875.52 (11) (12) (13) i 1366,652.03 I I (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) None w .... ~!;U) ua:~ wo..u :1:00 u",oJ 0..'" 0.. ..: ~ 1. Ori9inal Return D 4 Limited Estate ~ 6. Decedent Died Testate (Altad> ropy of Willi o 9. Litigation Proceeds Received o 2. Supplemental Return D 4a. Future Interest Compromise (data of dea1h after 12-12-82) I8J 7. Decedent Maintained a Living Trust (Altad> OOPY ofT""l) o 10. Spousal Poverty Credit (ds~ofd..",belwe," 12-31-111.nd 1.1.95) (14) 25,819.62 40,832.41 i 30,000.00_ 10,832.41 1 Real Estate (Schedule A) 2 Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 0.00 13,987.46 (19) 13,987.46 3 Closely Held Corporation. Partnership or Sole-Proprietorship z o ~ ~ l- ii: oct u w a::: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash. Bank Deposits & Miscallaneuus 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) (7) 333,508,26 (6) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12 Net Vatue of Estete (Line 8 minus Line 11) 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) SEE INSTRUCTIONS ON REVERSE SIDE 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) 310,832.41 x.O 45 (16) x12 (17) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19 Tax Due pt 'OeceCJent's Complete Address: STREET ADDRESS Messiah Village, 100 Mt. Allen Drive CITY Mechanicsburg I STATEpA r ZIP 170515 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Disccunt (1) 13,987.46 13,265.99 698.19 3. Interest/Penalty if applicable D. Interest E Penalty Total Credits (A + B + C ) (2) 13,964.18 Total Interest/Penalty ( D + E ) (3) 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 (4) 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. (5) (SA) 23.28 B. Enter the total of Line S + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT 23.28 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BL CKS ~ ~ H~ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;HHHHHHHHHHH'H'HHHHHH'HH"'HHH'H'HHHHHHHH'H'HHHH'H" 0 b. retain the right to designate who shall use the property transferred or its income; ''''''''''''''HHH''H'HHHHHHHHH' 0 c. retain a reversionary interest; or."......".".".,,,,,""....H........H.H.H..H........H.H.".....,,,,,."."..H..".H.H..HH."...H."."... 0 d. receive the promise for life of either payments, benefits or care? ""HHH""'''''''''''''''HHHHHH'HHHHH'''H'HH'''''''. 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? '''''''H'''''''''H'H H' HH'H'HH HHHHH'H''''''''H'''''HH' HHHHHHHHH'H"HH 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? """H'''''. 0 4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....... H' H...... H ".. H............ ... ". "...,......... H' H......... H............. H.......... no...... H...... No ~ ~ ~ ~ Under penalties of perjury, I declare that I have examined this retum, including accompanyIng schedules and statements, and 10 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 infonnation of which preparer has any knowledge. SIGNffURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ~C&~!f~ f~ ADDRESS ' ~ris Anne Young, Executrix, 9445 Carlisle Road, Dillsburg, Pennsylvania 17019 SIGNATURE ?F;~~f}.JHAN REPRESENTATiVE ADDRESS '~I ~ Benn Law Firm, 103 E. Market Street, P.O. Box 5185, York, Pennsylvania 17405-5185 DATE 9,a/ 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 surviving spous is 3% [72 PS 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the lax rate irnposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S, 9116 (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 lax return are stil applicable even if the surviving spouse is the only beneficiary. , For dates of death on or after Juiy 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-<lne years of age or younger at death to or for the use of a natural parent, ~n adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)]. I The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.S%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 9116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS. 99116(a)(1.3)]. A sibling is defined, under S ction 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANiA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Edith M. Weaver ITEM NUMBER FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. 2. DESCRIPTION Series E United States Savings Bond, serial number 05186736040E, final maturity 6/2004 Series E United States Savings Bond, serial number 05186735680E, final maturity 7/2004 3 Series E United States Savings Bond, serial number 05201164914E, final maturity 8/2004 4. Series E United States Savings Bond, serial number 05207519830E, final maturity 9/2004 5. Series E United States Savings Bond, serial number 05213886558E, final maturity 10/2004 6. Series E United States Savings Bond, serial number 05213887371 E, final maturity 11/2004 7 Series E United States Savings Bond, serial number 05221453553E, final maturity 12/2004 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE A DATE OF DE TH 130.02 130.02 130.02 130.02 130.02 131.26 131.59 912.95 REV-150B EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EDITH M. WEAVER SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUM ER 21-05-ob28 ITEM NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 1. PNC Bank checking account, acct # 5140461469, $3,935.29 plus accrued interest to date of death $0.82 DESCRIPTION 2. Van Kampen Investments, account # 59/61752097, 499 shares @ 9.08 per share 3. Miscellaneous personal properly as per appraisals from Mt. Royal Furniture No. 87-SU-03093-01 4. Anticipated settlement proceeds from York County State Court litigation, Weaver v, Donald K. English, et al. TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF EATH 3,936.11 4,530.92 483.00 7,500.00 16,450.03 REV-1509 EX+ (6-98) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EDITH M. WEAVER FILE NUMBER 21-05-0028 an asse was ma 8 0 n w n 0 e year 8 eee n s 0 , SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TC DECEDENT A. Donald E. Weaver 199 River Isles, Bradenton, Florida 34208 son B. y 9445 Carlisle Road, Dillsburg, PA 17D19 daughter Dons Anne oung C JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DA E OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCiAl INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S ALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATIACH DEED FOR JOINTLY-HELD REAL ESTATE. VAlUE OF ASSET INTEREST DECED NT'S INTEREST 1 A 02/12/87 PNC Bank CD, acct # 21001060127, $5,500.00 plus accrued interest 5,520.91 50% 2,760.46 to date of death $20.91 2. B 06103/88 Sovereign Bank CD, acct # 0575134036, $10,000.00 plus accrued 10,013.72 50% 5,006.86 interest to date of death $13.72 3 B 12/07/90 Sovereign Bank CD. aect # 0575137526, $6,000.00 plus accrued 6,008.68 50% 3,004.34 interest to date of death $8.68 4. B. prn-1990 SunTrust Bank CD, acct # 07610212553, $5,000.00 plus accrued 5,014.93 50% 2,507.47 interest to date of death $14.93 5 B. prn-1990 Sun Trust Bank CD, aect # 07610212896, $5,000.36 plus accrued 5,003.31 50% 2,501.66 Interest to date of death $2.95 TOTAL (Also enter on line 6, Recapitulation) $ 5,7BO.79 (If more space is needed, insert additional sheets of the same size) II d j I I 'thl n of Ih d de I' dale I dealh II musl be reported on Schedule G REV-1Sl0 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBATE PROPERTY ESTATE OF FILE NU BER EDITH M. WEAVER 21-05- 028 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 ye . DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELAIIONSHIPTO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH ACOPV OF THE DEED FOR REAL ESTATE VALUE OF ASS~i- INTEREST (IF APPLICABLE) VALUE 1. Edith M. Weaver Funded Revocable Trust, PNC Advisors, Trustee 333,508.26 100 333,508.26 established by Edith M. Weaver as settlor on December 30, 1986; amended on March 24, 1987 and June 2, 1988; account # of trust is 27-27-001- 3139626 I TOTAL (Also enter on line 7 Recapitulation) $ 3 3,508.26 (If more space is needed, insert additional sheets of the same size) I REV-1511 EX+ (12-99* SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & I INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER EDITH M. WEAVER 21-05-0028 Debts of decedent must be reported on Schedule L ITEM AM( NUMBER DESCRIPTION UNT A. FUNERAL EXPENSES: 1. Cocklin Funeral Home, P.O. Box 424, Dillsburg, PA 17019 9,315.51 2. Boscov'S - undergarments for burial 35.30 3 Nancy Gunnet - church organist at funeral 50.00 4 Cove Forge United Methodist Church. post funeral dinner 150.00 I B. ADMINISTRATIVE COSTS: 1_ Personal Representative's Commissions 4,500.00 Name of Personal Representative(s) Doris Anne Young Social Security Number(s)/EIN Number of Personal Representative(s) - Street Address 9445 Carlisle Road City Dillsburg State P A Zip 17019 Year(s) Commission Paid: 2005 2. Attorney Fees 4,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State .Zip Relationship of Clairnant to Oecedent 4. Probate Fees 430.00 5. Accountant's Fees 295.00 6. Tax Return Preparer's Fees 0.00 8. The Sentinel - advertising letters testamentary Cumberland County Law Journal - advertising letters testamentary Cumberland County Register of Wills. Inventory Cumberland County Register of Wills. Inheritance Tax Return Mt. Royai Furniture - personal property appraisal fee Cumberland County Register of Wills - Petition filing fee 166.07 75.00 15.00 15.00 35.00 15.00 7. 9. 10 11. 12. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 9,596.88 Continuation of Schedule H - Funeral Expenses and Administrative Cbsts Estate of Edith M. Weaver File Number: 21-05-0028 13. express mail fee to SunTrust Bank regarding cashing of CD 13. 5 14. express mail fee to Sun Trust Bank 13.~5 regarding cashing of second CD I 15. express mail fee to Van Kampen Investments 16. Benn Law Firm - expenses paid 3/29/05 17. Benn Law Firm - expenses paid 9/21/05 REV-1512 EX+ (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EDITH M. WEAVER SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMB R 21-05-0028 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expen es. ITEM NUMBER DESCRIPTION 1. Messiah Village. final bill for rent Mt. Holly Springs, PA 2. Alert pharmacy services - December medicine bill TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE T DATE OF[ EATH 5,762.10 113.42 5,875.52 REV-1513 EX+ (9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EDITH M. WEAVER NUMBER I RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J Doris Anne Young, 9445 Carlisle Road, Dillsburg, PA 17019 1. daughter 2. William Weaver, 510A Main Street, Bentleyville, PA 15314 grandson 3. Donald E. Weaver, 199 River Isles, Bradenton, FL 34208 son I FILE NUMBER 21-05-0028 AMOUNT 0 SHARE OF ES ATE 1/2 n:><::;rl '" am ~ic }-.::ro~ S:!th Cla:k 1/2 n:><::;rl '" ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SH ET 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 1. Cove Forge United Methodist Church, R.D, #1, Williamsburg, PA 16693 per Court Order of 8/24/05 2 Henry's Lutheran Church at Yellow Springs, Henry's Cemetery, RD. #1, Williamsburg, PA 16693, per Court Order of 8/24/05 Attached is copy of Court Order dated 8/24/05 and Trust document evidencing bequest. TOTAL OF PART 11- ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) ~ 0,000.00 10,000.00 < 0,000.00 - IDas! IIill ann (llestam-pnt OF EDITH MARIE WEAVER BE IT REMEMBERED that I, EDITH MARIE WEAVER, of Di ISburg, York County, Pennsylvania, being of sound mind, mem understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making n 11 and void any and all Wills and Testaments and writings in the nature thereof by me, at any time heretofore made. ITEM 1: I direct that all my just debts and expenses be paid as soon after my demise as may be conven"ent. ITEM 2: I give and bequeath the following items of personal property unto my daughter, DORIS ANNE YOUNG: Noritaka China - Service for 12 Crystal Stemware Nobility Silverware - Service for 12 China Tea Set Glass Water Set Diamond Ring ITEM 3: I give and bequeath unto my g~andson, ILLIAM WEAVER, my Seth Thomas Westminister Chime Clock. ITEM 4: All the rest, residue and remainder of my Estate of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath u to my children, DONALD E. WEAVER and DORIS ANNE YOUNG, in equal shares, per stirpes. ITEM 5: I appoint DORIS ANNE YOUNG as Executrix of this my Last Will and Testament. Should my daughter, DORI ANNE is my YOUNG, predecease me, fail to qualify, cease to act or r nounce probate, I then appoint FRED L. YOUNG as Executor of Will and Testament. ;!/;'/cI II, 7{ICL~ /' , ,- C 1 ~:7, C-:Lf...._l_--/t.-' EDITH M" WEAVER / 4'.. ,:'''_.C. "__/ (SEAL) / -1- ITEM 6: all inheritance, estate, succession and legacy taxes of whatso- I direct my Executrix, or her succesSor to pay ever nature and kind, to which my Estate or the property passing hereunder or otherwise passing demise, may be subject and to charge such taxes ag residuary estate, it being my intention that of any my aforesaid taxes, either federal or state, on any roperty my of the of any state or federal law now in force or hereafter required to be included in my gross estate, under the pr ITEM 7: I direct that my Executrix, or her su cessor, shall be prorated among the persons interested whom such property is or may be transferred or to benefit accrues. shall not be required to give bond for the faithful perflormance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand a d seal this /J/W day Of~~J , 1987. WrTt~~ 'J '( ,: ,'X/O( '. / 1 , I (/ / , /1//1//( ~~', - / :~.~ "'f" . t;-". i 7,,/(/ / c.,.~(. t: '. t "',, (,;I.../' _ /(, ' , " EDITH M. WEAVER SEAL) -2- ~ ACKNOWLEDGMENT COUNTY OF YORK COMMONWEALTH OF PENNSYLVANIA . . : 58. . . We, EDITH M. WEAVER and SHERIE MINICH . the nesses respectively, whose names are signed to the attached 0 fore- going instrument, being first duly Sworn, do hereby dec are to the undersigned authority that the Testatrix signed and e ecuted the instrument as her Last Will and Testament and that she had signed willingly (or willingly directed another to si n for her), and that she executed it, as her free and volunta y act for the purposes therein expressed, and that each f the witnesses, in the presence and hearing of the Testatrix signed the Last Will and Testament as witness and that to the b st of their knowledge the Testatrix was at that time eightee (18) years of age Or older, of sound mind and under no constra'nt or undue influence. Sworn to and subscribed W before me this /1 day OfA!'l~J/JA) , 1987 ~O:AJ~u~ My Commission Expires: JANICE S, HENDLER. NOTARY PUBLIC DlllSBURG BOROUGH, YORK COUNTY MY COMMISSfO,j EXPIRES JULY 8. 1991. Member. PennsylVllni~ Associalion 01 Nolanes It _-":.'; ,,_ < .. .-.. "-,".,.._~., -.- '".-....,~......,~,."'., ~---"".~._. .""'-~.-+ r FUNDED REVOCABLE TRUST AGREEMENT THIS AGREEMENT OF TRUST, executed in duplicate this ~ day of DPremhPr , 19B6, between EDITH M. WEAVER, 9445 Carlisle Road, Di11sburg, Pennsylvania 17019 (hereinafter called Settlor), and CCNB BANK, N.A., of New Cumberland, Cumberland County, Pennsylvania, (hereinafter called Trustee), WITNESSETH FIRST: Settlor grants, assigns and sets over to Trustee and its successors, all the ?roperty described in Schedule A, annexed hereto and said property, together with all other property, real or personal, that may be added to the Trust (such property and additions being hereinafter called principal), shall be held by Trustee, IN TRUST, upon the following terms. SECOND: Trustee shall manage all property comprising the principal of this Trust and shall collect the income therefrom and accretions thereto and shall pay the net income and hold and distribute the principal of said Trust as follows: (A) Trustee shall pay the net income therefrom to Settlor for and during hLs or her lifetime, subject to the provisions of Item FIFTH, in such periodic installments as Trustee shall find convenient but at lease as often as quarter-annually. (B) Upon the death of Settlor, Trustee shall distribute the then remaining principal and any accumulated or undistributed income to Settlor's executor or administrator for distribution as a part of his or her estate. THIRD: The principal and income of this Trust shall be free 'roo anticipation, assignment, pledge or obligation of Settlor and shall not be subject to any execution or attachment or to voluntary alienation. FOL~TH: Trustee shall have the following powers in addition to those vested in it by law and by other provisions of this Trust, applicable to all rroperty, ~hether principal or income, exercisable without court approval, cnd effective until actual distribution of all property: Page One of Four . (' (- (' (A) To retain any or all of the assets of this Trust, real or personal, including stock of Trustee, or of its parent holding co~pany, without regard to any principal of diversification or risk. (B) To invest in all forms of property, including stock, common trust funds and mortgage investment funds whether operated by Trustee, or its parent holding company, without restriction to investments authorized for Pennsylvania Fiduciaries, as it deems proper, without regard to any prinCipal of diversification or risk. (C) 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, for such prices and upon such terms or conditions as it deems proper. (D) To allocate receipts and expenses to principal or income or partly to each as Trustee from time to time thinks proper in its sole discretion. . (E) To hold property in the name of Settlor or in its name without designation of any fiduciary capacity, or in the name of a nominee or unregistered. FIFTH: Trustee may apply the net income of this Trust for the support of Settlor should blLor she by reason of age, illness or any other cause, in the opinion of the Trustee, be incapable of disbursing it: and Trustee is further authorized to extend or apply from the principal of tois Trust such sums as it, in its sole discretion, may, from time to time think advisable for the support of Settlor to maintain ~ or her in the station of life to which he or she is accustomed at the creation of this Trust, or during illness or e~ergency. SIXTH: Subject to the approval of Trustee, anyone may add property, real or personal, to the principal of this Trust by deed, will or othe~~ise. SEVEXIH: Trustee shall receive compensation for the perfor~ance of its functions hereunder in accordance with its standard schedule of fees in effect fro~ time to time during the period over which its services are performed. Page Two of Four . ( r EIGHTH: Settlor reserves to ~f or herself the right by an instrument in writing intended to take effect during Settlor's lifetime signed by Settlor and delivered to Trustee to revoke or amend this Agreement in whole or in part provided that the duties, powers and liabilities of Trustee shall not be substantially changed without its written consent. NINTH: The situs of this Trust for administration and accounting pruposes shall he in the County of Cumberland and Commonwealth of Pennsylvania, and all questions pertaining to the construction or validity of the provisions of this instrument shall be governed by the laws of that Commonwealth. I}, ,.., IN WITNESS WHEREOF, Settlor has hereunto set fl4. hand the day and year first above written and Trustee has executed this instrument and caused its corporate seal to be affixed hereto. " ("/": \1 CCNB BANK, N.A. ATTEST: I "g&!!'4:! _~, and Senior Trust Officer B '/, /" " y ~ i:_ --~";""')(i.o-,'.. Constance E. Stoneroad, Assistant Secret:aIy and Trust Officer (SEAL) Page Three of Four ('- (' C(1~NO\l,EALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) On this, the day of Decari:>er , 19B6, before me a Notary Public, the undersigned officer, personally appeared EDITH M. WEAVER , known to me (or satisfactorily pruven) to be the person whose name is subscribed to the within instrument, and acknowledged that s/he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereto set my hand and notarial seal. COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF Cl1I'lBERLAND ) On this, the ______ day of Decanber 1986, before me a Notary Public, the undersigned officer, personally appeared 00BERr M. LI\NE , who acknowledged himself to be the Vice President ~nn Spn;oT Tnl~r Off;nPT . of CCNB BANK, N.A., a corporation, and that he Vice President as such .and Senior Trust Officer ,being authorized to do so, executed the foregoing instrument for the purposes therein contained by signing the name of the corporation by himself as Vice President and Senior Trust Officer . lN WINTESS WHEREOF, I have hereunto set my hand and official seal. Page Four of Four II (' SOiEDULE "A" 0fECK l"RCM EDI'IH WEAVER IN '!HE /\lIQJNr $165.989.88 0fECK l"RCM EDI'IH WEAVER IN '!HE /\lIQJNr $165.895.32 ~ ( . II #, I ',' ,", " ( c ' ' I !) ~ I f t, " ~ 'C )l.MENDf1ENT TO TRUST AGREEMENT THIS AGREEMENT made this , - vL \'1~ :; ,/f'l day of //,' , 1987 by and between EDITH M. WEAVER, 9445 Carlisle Road, Dillsbur , Pennsyl- Pennsylvania, hereinafter called "trustee," WITNESSETH: vania, hereinafter called "settlor" and CCNB BANK, N.A. of N w Cumberlanc WHEREAS, settlor and trustee entered into a Trust Agree ent dated December 30, 1986; and WHEREAS, settlor desires to amend a provision of the agr ement under the powers reserved to her in Paragraph Eighth. NOW, THEREFORE, under the powers reserved to the settlor contained in Paragraph Eighth and with the concurrence of the trustee, the aforesaid Trust Agreement is amended as follows: 1. Subparagraph (B) of Paragraph Second is amended (B) Upon the death of settlor, trustee shall d.stribute to lvania. lly Weaver, eficiary , ! i i I , i I I I I I the remaining principal and any accumulated or undistributed the following manner: (1) One-third of said balance shall be pai the son of settlor, Donald Eugene Weaver of Duncansville, Penns Should he be deceased, his one-third share shall be divided equ among his wife, Shirley M. Weaver, and his children, William E. Charlene Cherok, and Carolyn Weaver, the share of a deceased be to be divided among the remaining beneficiaries. ARNOLD & SLlKE, A1TORNEYS'AT,LAW, 210.9 MARKET STREET, CAMP HILL, PA 170.11 .. " j (- ( (2) Onethird of said balance shall be paid to settlor's daughter, Doris Anne Young, Dillsburg, Pennsylva ia. Should she be deceased, her one-third share shall be divided equally among her husband, Fred L. Young, and her children, LeighAnne You g and Shawn A. Young, the share of a deceased beneficiary to be d.vided among the remaining beneficiaries. (3) The remaining one-third of said ba be paid to settlor's daughter, Doris Anne Young, in recogni loving care and assitance given to me by her and her family declining years. Should she predecease me, said share shal to her husband, Fred L. Young, in recognition of the loving assistance he has given to me in my declining years. Shaul predecease me, said one third share shall be divided between of Doris Anne Young and Fred L. Young. ance shall ion of the in my be paid care and they both the childre:: seals the day and year first above appearing. IN WITNESS WHEREOF, the parties have hereunto set their hands and WITNESS: .-. '- , ,-.., \, L.L-~A_l.-iL -'1,-" I i-; L' _ t.. ...; _ t.-. "_: Edith 1-1. Weaver ATTEST: (SEAL) By: ~t/~~~~ sst. Sec. and Trust Offl.cer By: ARNOLD & SLIKE. ATTORNEYS-AT. LAW, 21~ MARKET STREET, CAMP HIll, PA 1701 J r I I i I i I I I I I I I I j (~ (-- COI1MONl'lEALTH OF PENNSYLVANIA) ~"c) V I~- : -:7 1113IJRLW9) SSe COUNTY OF On this, the c y'i- ;-I) day of ~J! {< .\ ~['- , 1987, before me, a notary public, the undersigned officer, personally IN WITNESS WHEREOF, I have hereunto set my hand WEAVER, known to me (or satisfactorily proven) to be son whose name is subscribed to the within instrument, and acknowledg executed the same for the purpose therein contained. seal. / / COUNTY SSe OLlNllA M. WHHINOTON. NOTARY PUB IC DIWcoqG eOROUGH, YORK COCl'HY lilY CO;.!:~:S~~':iN EXPiRrS vre. 27, 19 0 Member, Peilr.sY'~ania Association 01 No ries COMMOWNEALTH OF PENNSYLVANIA) OF CUMBERLAND) On this, the f)fJOday of fipe, L~, 1987, before m, the undersigned officer, personally appeared ROBERT 11. LANE, who cknowledged himself to be the Vice President and Senior Trust Officer of CNB Bank, N.A., a corporation, and that he, as such Vice President and enior Trust Officer, being authorized to do so, executed the forego'ng instrument for the purposes taerein contained by signing the ame of the corporation by himself as Vice President and Senior Trust Officer. IN WITNESS WHEREOF, I hereunto set my hand and notarial s ale J(fl(ij _ ...;,l!S ARNOLD &: SLlKE, A1TORNEYS-AT-LAW, 2109 MARKET STREET, CAMP Hill, PA 17011 . r r , , . SECOND AMENDMENT TO TRUST AGREEMENT THIS AGREEMENT made this 0"& day of ~lL , 1988, by an between EDITH M. WEAVER, 9445 Carlisle Road, Dillsburg, sylvania, hereinafter called "settlor" and CCNB BANK, N.A. of New Pennsylvania, hereinafter called "trustee," WITNESSETH; WHEREAs, settlor and trustee entered into a Trust AGree ent dated December 30, 1986, as amended by agreement dated March 24, 1987; and WHEREAS, settlor desires to further amend the agreement nder the powers reserved to her in Paragraph Eighth. NOW, THEREFORE, under the powers reserved to the settlor contained in Paragraph Eighth and with the concurrence of the trustee, the afore- said Trust Agreement is amended as follows: 1. Subparagraph (b) of Paragraph Second is amended 0 read: (B) Upon the death of settlor, trustee shall d.stribute the then remaining principal and any accumulated or undistributed income in the following manner: :\R.\.' OLD & 5LJ KE. .\TTOR:'\EYS-AT-L-\W 2109 \I.-\RKET STREET, C\\IP HIll P-\ r /(ill r (' (1) Trustee shall retain the lesser of the sum of $30,000 or 15% of the remaining principal and any accumula ed or undistributed income IN FURTHER TRUST, for the following u es and pur- poses: (a) Two-thirds of the net income 0 the trust shall be paid at least annually to Cove Forge United Method'st Church, Woodbury Township, R. D. #1, Williamsburg, PA. shall be paid at least Catharine Township, R. the maintenance of the (b) One-third of the net income of annually to Henry's Lutheran Church D. #1, Williamsburg, PA, to be used cemetery. the trust emetery, y them for (c) Should Cove Forge United Metho Church cease to exist or merge with another church, its right to i come shall cease and the entire income of the trust shall be paid to Henry's Lutheran Church Cemetery for the maintenance of the cemeter . (2 ) lated or undistributed Paragraph (B)(l) shall The remainder of income, after the be distributed as the principal establishment follows: y accumu- trust in (a) One-third of said balance shall be paid to the son of settlor, Donald Eugene Weaver of Duncansville, PA Should he be deceased, his one-third share shall be divided equally am ng his wife, Shirley M. Weaver, and his children, William E. Weaver, Charlene Cherok, and Carolyn Weaver, the share of a deceased benefici ry to be divided among the remaining beneficiaries. e paid to he be er hus- awn A. the (b) One-third of said balance shall settlor's daughter, Doris Anne Young, Dillsburg, PA. Should deceased, her one-third share shall be divided equally among 1 band, Fred L. Young, and her children, Leigh Anne Young and S Young, the share of a deceased beneficiary to be divided amon remaining beneficiaries. (c) The remaining one-third of said shall be paid to settlor's daughter, Doris Anne Young, in rec gnition of the loving care and assistance given to me by her and her fam'ly in my declining years, Should she predecease me, said share shall e paid to her husband, Fred L. Young, in recognition of the loving care and assis- tance he has given to me in my declining years. Should they oth pre- decease me, said one-third share shall be divided between the children of Doris Anne Young and Fred L. Young. AR!\iOLD & SLIKE.-HTOR.,\EYS_:.I,T_L.-\V: 2109 \f.-\RKET :.fREET (-I,\IP HILL. P-\ linr! ""~~'?:/;; . ':' I ---_.-,,~,.._...__.- ~~",\-'" ,: -~:-",',';~""'",', .-, . (. ."~ ", \. r '~. (' 2. In all other respects the settlor does hereby ratify and confirm her Trust Agreement dated December 30, 1986, as am nded March 24, 1987. IN WITNESS WHEREOF, the parties hereto have set their h nds and seals the day and year first above appearing. WITNESS: , ;' /' I ~ .. !.' ./ r .1 .~;. / Edith M. Weaver (SEAL) CCNB BANK, N.A. ATTEST: By: (!fd41LL.:. t.-OZ cZ.... r. /N>\StJ \.;eCREr~}7 ... AR.'\'OLD & SLIKE. ,J" fTOR,""TYS-ATL.-\W_ '2109 \l.-\RI\FT STRl[T_ C\,\.lP HILL. P_-\ i 701 J - ~ , , ;"'~.'-<:'t:J -------..--.-- r r COMMONWEALTH OF PEN~Y.LVAN~A. Iat- . YeRK COUNTY OF On this, the dfJD day of ~(~ , 1988, before me, a notary public, the undersigned officer, personally ap eared EDITH M. WEAVER, known to me (or satisfactorily proven) to be the erson WhOSE names are subscribed to the within instrument, and acknowled ed that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and ial seal. QIAtltlA l. rAYNE. NorARY PUBliC CAMP /flU O~::a. CUMBERt.A//O courm 111 COMrdl~SION EXPIRES SEPf. 15. 1990 Melnbtl. ~t:'IMYlvan!a AS~OClJho)" 01 Nolall COMMONWEALTH OF PENNSYLVANIA) COUNTY OF SS, CUMBERLAND) IN WITNESS WHEREOF, I hereunto set my hand and under- dged NB Bank, ust rument orpora- AR.\:OLD & SLIKE. '\TTOR."'" FYS-.-\ T-L.-\\\'. 2J0"1 \lARKET S1;9tEFT. C.-\.\IP HilL. P.-\ 17ClII ty I I.' DIANNA l. PAYNE. NOTARY PUBliC CAMP HI!.! nORO. CUMBE~IANO COUNT MY COMMISSION EXPIRES SEPf. /5 199 Mrn: ;- rr.:l.,":~l:vallla AS!OCI:dltJlI 01 NlJta ies ~BENNLAWFJRM L,-- C~, r,.-, 1 '_1 - ) :---: L_=- [____ f (:_~" . 1 03-1 07 E. MARKET ST P.O. BOX 5185 YORK, PA 17405-5185 -.. II II I RETE IVIE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION In re: Estate of Edith M. Weaver No. 21-0S-()028 Petition to Terminate Trust under 20 Pa. C.S.A. ~ 6102 DECREE NOW, TO WIT, this2.1IAYOf~ \/6. "I~ ~ - 2"05 J Au!,;! f u'\' ~ ,2005, in con:;lcherat on of the attached Petition, it is hereby ORDERED and DECREED that the C:harilalble or to be created under the "Second Amendment to Trust Agreement" ofEdiith . Weaver, dated June 2, 1988, is hereby terminated and the Trustee, PNC Advisors" i$ ord red to distribute 2/3 of the principal dedicated to the said Charitable Trust, or $::2()"OOO. 0, to Cove Forge United Methodist Church, and 1/3 ofthe principal dedicated to the Clharit ble Trust, or $10,000.00, to Henry's Lutheran Church Cemetery, the said $10,000,00 Ito be used by Henry's Lutheran Church Cemetery for the maintenance ofthe cemetery_ -".' /.. _ c..:: C.,.- '---- ~ , ,') (--"'1 (..') c.~- f-'I- -' ~-. -~ '. - -~j Co... "'" (~) Altq. L6, OS mId iD 0 RJ)tP"..JC : "'.'\01(" It.,.~ \lr! I \.!(:. 1/1..'1\.'.) nN 1\1 t::: IUl..U ~Li) lCi\i11LV C. VJ f2J'-(V L1~ ! ^ '" . 11~ ,AGDpf[('f - -- ! . .. (["/"- J.'"'" 0(, It-'1 ''7' .I~ I, ---lr-:-t..7,.-,I{ , . '~r'i ,.ilj t:: I U ;\q c) I:: \i.\ '! J ]..-.1),1 h ~ \J'ti" )+LlJi J-r J, /*'T,jJ.) . 'l::I~ENCt:J 13uiI<J.,i I, E:SG. . :.1(7 ~! -l- i ;_