HomeMy WebLinkAbout08-16-06
REV-15oo EX (5-00)
e
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
...1L
COUNTY CODE
-.9L 0092 ___
YEAR NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ OSMUN MADELINE
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ 1/11/2006 6/22/1918
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
C
R
SOCIAL SECURITY NUMBER
183-12-3178
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
Decedent Died Testate (Attach copy of Will)
Litigation Proceeds Reeeived
o 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82)
o 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Required
[X] 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes
o 10. Spousal Poverty Credit (dote of death between 12-31-91 end 1-1-95) 0 11. Election to tax under See. 9113(A) (Attach Sch 0)
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09
Original Return
Limited Estate
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
...
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Lowell R. Gates, Es .
FIRM NAME (If Applicable)
Gates, Halbruner & Hatch, PC
TELEPHONE NUMBER
717-731-9600
Gates, Halbruner & Hatch, PC
1013 Mumma Road, Suite 100
Lemo e, PA 17043
o
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o
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2,604
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Ir"---'::-
1. Real Estate (Schedule A)
(1)
OFFICIAL USE G"N\- Y
,
2. Stocks and Bonds (Schedule B)
(2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
Z 6. Jointly Owned Property (Schedule F) (6)
0 o Separate Billing Requested
i=
~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
::::) (Schedule G or L)
l-
n: 8. Total Gross Assets (total Lines 1-7)
OIl(
0
W 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
0::
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
- .,
C',,)
N
133,798
(8)
13,318
914
(11)
(12)
(13)
(14)
L(15)
45 (16)
(17)
(18)
(19)
136,402
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for >MIlch an election to tax has not been
made (Schedule J)
14,232
122,170
o
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 0
z rate, or transfers under Sec. 9116 (a)(1.2) x .0
0
j:: 16. Amount of Line 14 taxable at lineal rate 122,170 x .0
c(
~
::;) 0
l1. 17. Amount of Line 14 taxable at sibling rate x .12
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0 0
u 18 Amount of Line 14 taxable at collateral rate x .15
)(
c( 19. Tax Due
~
122,170
o
5,498
o
o
5,498
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W4645 1.000
Estate of
Executors
Name
Address
Tax ID
e
e
183-12-3178
(Page 1)
Community Trust Company
3907 Market Street
Camp Hill, PA 17011-
251-68-9949
Decedent's Complete Address:
SlREET ADDRESS
1700 Market Street
Cumberland
CllY
Cam Hill
STATE
PA
ZIP
17011-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
5,498
o
4,000
200
Total Credits (A + B + C) (2)
4,200
3. Interest/Penalty if applicable
D. Interest
E. Penalty
o
o
TotallnteresUPenalty (0 + E) (3)
o
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)
o
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
1,298
A. Enter the interest on the tax due.
(SA)
o
B. Enter the total of Line 5 + SA. This is the BALANCE
Make Check
(5B)
1,298
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
[K]
[K]
D
D
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penallies of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge,
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 after December 12, 1982, did decedent transfer property within one year of death
No
D
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og
~
09
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
Co""unit., Trust Company By'?'~c. j,/~ liP
ADDRESS /
3907 Market S t Camp Hill, PA
SIGNATURE OF PREPAR ER THAN RE ENTATlVE
,AY~
DATE
17011
ADDRES
D
~ / 06
1013
100
For dates of dell. 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 spouse is 3%
(72 P.S. S 9916 (a) (1.1) (i)J.
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. S 9116 (a) (1.1) (iI)]
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even ~
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 death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. S 9116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P .s. 99116(1.2) [72 P.S. 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 P .s. 9 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.
3W4646 1.000
REV-1502 EX + (6-98)
e
SCHEDULE A
REAL ESTATE
e
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
MADELINE R. OSMUN
21 06 0092
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jolntfy-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1. None
DESCRIPTION
VALUE AT DATE
OF DEATH
3W4695 1.000
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
o
REV-1503 EX + (6-98)
e
SCHEDULE B
STOCKS & BONDS
e
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
MADELINE R. OSMUN
21 06 0092
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1. None
DESCRIPTION
VALUE AT DATE
OF DEATH
3W4696 1.000
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
o
REV-1504 EX + (8-98)
e
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR SOLE-PROPRIETORSHIP
ESTATE OF
FILE NUMBER
MADELINE R. OSMUN
21060092
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting infonmation to be submitted for sole-proprietorships.
ITEM
NUMBER
1 . None
DESCRIPTION
VALUE AT
DATE OF DEATH
3W4697 1.000
TOTAL (Also enter on line 3, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
o
REV-1S07 EX + (6-98)
e
e
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MADELINE R. OSMUN
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
FILE NUMBER
21 06 0092
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
None
TOTAL (Also enter on line 4, Recapitulation) $
o
3W46AC 1.000
(If more space is needed, insert addttionaJ sheets of same size)
e
REV-1508 EX + (6-98)
COMMON'lVEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
MADELINE R. OSMUN
FILE NUMBER
21 06 0092
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Belco Community Credit Union
Checking Account #743050
5
2
Belco Community Credit Union
Checking Account #743050
1,877
3
Refund from Belvedere Medical
Corporation
35
4
Pension Benefit Check from
Federated Department Stores
92
5
Refund from Myers-Harner Fruneral
Home
595
3W46AD 1.000
TOTAL (Also enter on line 5 Recaoitulation\ $
(If more space is needed, insert additional sheets of the same size)
2,604
REV-1S09 EX + (6-98)
e
e
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MADELINE R. OSMUN
SCHEDULE F
JOINTL V-OWNED PROPERTY
FILE NUMBER
21 06 0092
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
B.
c.
JOINTL Y -OWNED PROPERTY:
lETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF F1NAf\CIAL INSTITUTION AI\{) BAAl< ACCOLNT DATE OF DEATH DECD'S VALUE OF
NUMBER JOINT N...MSEROR SIMILAR IDENrlFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENTS INTEREST
lENA.NT JOINTLY-l-ELD REAL ESTATE
1. A.
NOnE
TOTAL (Also enter on line 6 Recaoitulation1 $ 0
3W46AE 1000
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
e
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMON\l\lEAL TH OF ?ENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MADELINE R. OSMUN
e
FILE NUMBER
21 06 0092
ITEM
NUMBEIi
1.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
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.
DESCRIPTION OF PROPERTY
IN:llOE TrE NA.ME OF TI-E TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AAO
n-e DATE OF TR.AN5FER. ATTACH A COPY OF TI-E: DEED FOR REAL ESTATE.
Community Trust Company -
Trustee of The Osmun Family
Trust U/A dated 01/30/1997 -
Account #2100207 - Market Value
on 01/11/2006
133,798 100.0000
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert addijional sheets of the same size)
3W46AF 1.000
EXCLUSION
flF APPLlCABLE\
TAXABLE
VALUE
o
133,798
133,798
REV-1511 EX + (12-99)
e
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MADELINE R. OSMUN
ITEM
NUMBER
A.
B.
1.
FUNERAL EXPENSES:
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
DESCRIPTION
Myers-Harner Funeral Home Inc.,
Camp Hill, PA - Funeral
Arrangements
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Community Trust Company
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 3907 Market Street
Claimant
Street Address
City
Relationship of Claimant to Decedent
4.
Probate Fees
City Camp Hill
Year(s) Commission Paid: 2006
2.
Attorney Fees
State PA
Zip 17011
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
3W46AG 1,000
5. Accountant's Fees
6.
Tax Return Preparer's Fees
7.
1
Inventory Filing Fees
State
Zip
e
FILE NUMBER
21 06 0092
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
AMOUNT
7,907
2,500
2,500
71
325
15
13 318
REV-1512 EX + (12-03)
e
e
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MADELINE R. OSMUN
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 06 0092
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
Manor Care Health Services - Final
Balance Due
512
2
PA Department of Welfare -
Division of Third Party Liability
- Claim against the probatable
estate in the amount of
$271,411.74 for restitution of
medical assistance.
1
3
Pennsylvania Department of Revenue
- balance of 2005 personal income
taxes
401
3W46AH 2.000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
914
REV-1513 EX+ (9-00)
e
SCHEDULE J
BENEFICIARIES
e
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MADELINE R OSMUN
FILE NUMBER
21 06 0092
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
E. Richard Osmun (40% Trust Ben.)
Old York Road
Dillsburg, PA 17019
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
NUMBER
,
Son
48,868
2
Neil C. Osmun (60% Trust Ben)
170 Fickes Road
Dillsburg, PA 17019
Son
73,302
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
3W46AI 1.000
TOTAL OF PART \1- 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)
$
o
.
.
Estate of Madeline R. Osmun
Pennsylvania Inheritance Tax Return
Form :REV-1500
EXHIBIT A
Copy of the Certified Death Certificate of the Decedent
'''> 1 to,
-ch.:'al I<.egJ<
\ i.1
;c InforlnaL
1, ".'" 'S ~rc',
i;:"~_,_ ij~ 1. L\.J~l~,',_l'
t~~ \. tOl'\Vall-~'_'t
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frO!Tl an \
."'clte at d
for pern
;11
\\'ith
T'!
,:ginal certlt
(t-
'<"te Vital R..:COids
1err
WARNiNG: it is [legal to dupiicate t' '. copy by photosts' ']'1' photograi='
t-e['
this certificak S6(;'
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.1 Name 01 Decedenl (FiISI. mlCldle, lasl)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE FILE NUMBER
5 Age (last bir1hday)
-, Dale or9ir1h Monlh.da . ear
3. SOCIal Security Number 4. Dale 01 Dealh (Monlh. day. yeal)
Madeline R. Osmun
183-
12
January 11,2006
8. Birlh lace G andslaleDllofe
87 v"
Bb. County of Death
22 1918
Other"
o EPJOul lienl 0 DQA :Hi NUfSin Home 0 Residence 0 Other. S
9. atN~ec~en~~ ~,~:::.~~r~n~UbaT\. 10. 1~:~;16r'can Indian, Black, Whne. ale
Manor Care Health Services M..",".P"rtoRicao..'o,) White
Cumberland
Camp Hill
, 2 Was Decadenl ever in the US
ArmedFOICl!S?
DYes }b No
Decedenl's
Aclual Residenc~ l7a. S:ale
13. Decedent'sEdlica(ion S ec" 'on hi esl radeco leted
ElpffiP.nlarylSeco'ldary(Ci-12) Coftege (lJ,or 5+1
12
14. Marital Stalus: Married. Never married,
Widowed, Oivorced (Specifyj
Widowed
15. SUlVrving Spo~e (II wile, giYe maiden namel
1700 Market Street
Pa
Cumberland
Did Decedenl
live in a
Townsh~?
17e. 0 Yes. Decedenllivect in
17d.li No. Dect'dant Uvlld wilhin
.AdualUmilsol
Twp.
1B
17b. County
Camp Hill
"CilyiBofo
. 19. Molher'SName}i~lrrrr~'1fraUy~ski
20a. Ink:!f!Tl2nl'~ Name' fType.ipr.;,,!)
Neil C. Osmun
(('.t, ln~')r,'05I1I':; Mailing Addl6S~ (.'3!18f1t c~y,'1(l""'n, ~l<lle, lip r:(l(t(l}
170 Fickes Road Dil1sburg,Pa 17019
o Removal from Slale
o Donahon
21C_ Place of Disposilion (Name 01 Ceffili!lery. cremalory or olhel place)
21d. Localion {Cityllown, stale, zip code)
emorial Park
Funeral Home rne
'){\.,',
26,
Cam Hill Pa
1903 Market Street
Hill, Pa 17011
23c_ O~le Signed (Monlh, day, yeafl
"",Iex_,\" II ,) U( L-
CofTl)lel e 238-C only when cerlilying
physician is nol available al time 01 dealh 10
cetlily cause of death.
bams 24.26 musl be COrf'4)leled by person
who pronounces death.
2'
o lhe basi of rr"f knowl~, ~,.d'~,_ th OC~~"8d aIIJ'" ~.d.'..od ,Iec' ".,'" (S~",'"" ao' ""l)
(U'ClCl... ' " ,C;}L i ILt7U'{,L' k fl_
25. Dale P~l1OUnced Dead (Month. day. year)
,.___.)O'.!L Ji ,)(0 L:
EATH (See inslructions and examples)
Rem 'n. Pan I: Enlellhe ~ - diseases, injuries, or complicalions - ihat difectly callSed the death. DO NOT snler lerminal eYenls sucli as caufiac arresl.
fcsp;ralory anest, orvenlricl.llar Ibrillalion without ShoWflg lhe etiology. DO NO a eviala. Enler on one ay:;e on a line
IMMEDIATE CAUSE (Final disease 01
COOlfwn f8Sufting in dealh) ---7 a.
: Approximate inlerva!:
: onsel10 dealh
o Yes IQ; No
Parlll: Enler olher sianificant conditions conlribulina 10 dealh,
bUl nol resulllng in the underlyirlg cause given in Part I
28. Did Tobacco Use Conlrbule 10 Dealh?
o Yes ~~bly
o No",.JiT Unknown
29 UFemale:
o Nol pregnant wilhill pasl year
o Pregnanl al lime 01 death
o NoI plegnalll. bul pregnari wilhin 42 days
oldealh
o Not pregnant. but pregnanl 43 days 10 1 year
beloredealh
o UllkflOWl\ if pregnanl wilhilthe pasl yeal
32c. Place 01 Injury: Home, Farm. Stree!. Faclof'J. Office
Building, elc. (Specify)
Due 10 (01 as a consequence oQ'
Sequenlially lisl conditions. if any,
leading to lhe cause lisled on Line a
Enler Ihe UNCERl 'fING CAUSE
(disaaseor Injutylhal in)ialed the
evenls resulting in dealh) LAST.
Due \0 {Ol' as a consequence oQ:
Due 10 lor as a consequence oQ
32a.Oaleollnjury{Month,day,year)
32b. Descrcli: how Injury Occurred
308. Was an Auloosy
P"',,,n"'7 /
o Ye~o
,
n. Were AulOPSY Fll'Idings
Ava~able Prior 10 Completion
OfCauseo~~
DYes YNo
o Accidenl
o Suicide
o Homicide
o Pendinqlnvestigation
o Could Nol Be Oelerrrined
32d_ Time 01 Injury
321.
~ ~'-~-;;di t
338. Certifier (check only one)
Certifying physician (Physiciancertilymg cause of death when another physician has pronounced death and COlTllleled lIem 23)
To Ihe best of my koowledge, dealh occurred due 10 Ihe cause{s) and nunner as slaled_
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F,state of Madeline R. Osmun
P"'nns'-'l\'<:lnloa Inherltancp T<:lV Upturn
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Form REV-1500
EXHIBIT B
Copy of the Last Will and Testament of Madeline Ro Osmun
Dated January 30, 1997
..
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LAST WILL AND TESTAMENT
OF
MADELINE R. OSMUN
I, MADELINE R. OSMUN, now of 203 Pennsylvania Avenue, Camp
Hill, Cumberland County, Pennsylvania 17011, do publish and declare
this to be my Last Will and Testament, hereby revoking all other
prior wills and codicils made by me.
FIRST: Family Background and Appointment of Executor.
(A) Family and Background Information. I am not married. My
children are E. RICHARD OSMUN and NEIL C. OSMUN. Throughout this
Will, E. RICHARD OSMUN and NEIL C. OSMUN will be referred to as "my
children". The word "issue" will include my children as well as my
other descendants (excluding adopted issue) .
(B) Appointment of Executor. I appoint as my Executor and
successor Executor (all hereinafter referred to as Executor or
Executor (s) under this Will, the following named persons or
corporations to serve without bond and without being required to
account to any Court:
Executor: PENNSYLVANIA FIDUCIARY AND ESTATE SERVICES,
INC., now of 1013 Mumma Road, Suite
202, Lemoyne, Pennsylvania 17043.
(C) Inter Vivos Trust. The inter vivos trust agreement
referred to in this will is entitled "THE OSMUN FAMILY TRUST", by
and between myself as Settlor and PENNSYLVANIA FIDUCIARY AND ESTATE
SERVICES, INC., now of 1013 Mumma Road, Suite 202, Lemoyne,
Pennsylvania 17043 as Trustee, as now in effect or as may hereafter
be amended.
SECOND: Funeral and Last Illness Expenses; Taxes.
(B) Taxes. I direct my Executor to pay any and all e
my
(A) Expenses of Funeral and Last Illness. I
Executor to pay my funeral expenses and the expenses
illness from my estate.
duties, by whatever name called, including any and all inte
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LAST WILL AND TESTAMENT
OF
MADELINE R. OSMUN
PAGE 2
penalties thereon, imposed under the laws of any jurisdiction by
reason of my death upon or with respect to any and all property
included in my gross estate for the purpose of such taxes, whether
such property passes under or outside of this Will. Without any
apportionment otherwise required by law and without being prorated
or apportioned among or charged against the respective devises,
legatees, beneficiaries, transferees, or other recipients of any
such property or charged against any property passing or which may
have passed to any of them, I direct that any taxes so paid shall
be charged against my residuary estate. My Executor shall not be
entitled to reimbursement for any portion of any such taxes from
any such person. The foregoing provisions of this Article SECOND
shall not apply to such portion or portions of said taxes, interest
and penalties which may be required to be paid, or are actually
paid or reimbursed, by the Trustee of the Trust described in
Paragraph FIRST (C), above.
THIRD: Tanqible Personal Property. Except for those items
excluded below and those items enumerated in the Letter of
Instruction, I bequeath all my tangible personal property,
including but not limited to clothing, jewelry, heirlooms,
furniture, household furnishings, personal effects, motor vehicles,
and all other similar articles, which I own, and the insurance
thereon, to my children, living at the time of my death, to be
divided between them as they may select in as nearly equal shares
as is practical. Tangible personal property shall not include:
(1) any and all property used by me in any business, (2) cash on
hand or on deposit in banks, (3) stock or securities, (4) any type
of evidence of indebtedness, and (5) any life, health or accident
insurance policies.
If my children do not survive me, I leave such tangible
personal property to the issue of my children per stirpes. If
there is any disagreement as to distribution, I direct my Executor
to make such distribution. The decision of my Executor shall be
final and binding. Any items not selected or any items which my
Executor considers unsuitable for my children may be distributed or
sold in the sole discretion of my Executor and, if sold, t~het
proceeds therefrom shall be added to the residue of my estate _ y
such article allocated to a minor may I as my Executor e~ms
advisabl~, eicher be delivered to che minor or to a~ Lo
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LAST WILL AND TESTAMENT
OF
MADELINE R. OSMUN
PAGE 3
safeguard on behalf of the minor.
Notwithstanding any other provisions in this Article THIRD, I
may leave a separate, dateq and unsigned Letter of Instruction,
which I shall place with my Will, containing directions as to the
ultimate disposition of certain of the property bequeathed under
this Article THIRD, and such Letter of Instruction shall determine
the distribution of such items.
FOURTH: Residuary Estate. I devise and bequeath all of the
rest, residue and remainder of my estate, real, personal and mixed,
of whatever nature and wherever situated to which I am legally or
equitably entitled, to the then-acting Trustee of the Trust
described in Paragraph FIRST (e) of this Will, to be held,
administered and distributed pursuant to the terms thereof, as the
same may be amended from time to time. By this devise and bequest
of my residuary estate I hereby exercise all Powers of Appointment
I possess at the time of my death except any power of appointment
which I possess under the Trust described in Paragraph FIRST (C) of
this Will.
FIFTH: Powers of Executor. In addition to the powers and
duties as may have been granted elsewhere in this Will, but subject
to any limitations ~tated elsewhere in this Will, the Executor
shall have and exercise exclusive management and control of the
Estate and shall be vested with the following specific powers and
discretion, in addition to the powers as may be generally conferred
from time to time upon the Executor by law:
(A) In the management, care and disposition of the Estate,
the Executor shall have the power to do all things and to execute
such instruments, deeds, or other documents as may be deemed
necessary or proper, including the following powers, all of which
may be exercised without order of or report to any Court:
(1) To sell, exchange or otherwise dispose of any
property at any time held or acquired hereunder, at public or
private sale, for cash or on terms, without advertiseme t,
including the right to lease for any term notwithstandin he
period of the Estate, and to grant options, includi ny
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LAST WILL AND TESTAMENT
OF
MADELINE R. OSMUN
PAGE 4
that, in lieu of any binding shareholder agreement or buy/sell
agreement to the contrary, the Executor shall not be permitted
to sell the stock or any other ownership interest in any
business owned by me, or held in trust, at my death, without
first offering the same for sale to my children, or without
next offering the same to the corporation or business
represented by such ownership interest for redemption.
(2) To invest all monies in such stocks, bonds,
securities, mortgages, notes, choses in action, real estate or
improvements thereon, and any other property as the Executor
may deem best, without regard to any law now or hereafter
enforced limiting investments of fiduciaries, except that the
Executor may not invest in any securities issued by the
corporate Executor, or issued by a parent or affiliate company
of such Executor, or any stock in a company which the
corporate Executor or their parent or affiliate holds as an
asset, either individually or in a fiduciary capacity.
(3) To retain for investment any property deposited with
the Executor hereunder; except that the Executor may not
retain for investment any stock in the corporate Executor, or
in a parent or affiliate company of such Executor, or any
stock in a company which the corporate Executor or their
parent or affiliate holds as an asset, either individually or
in a fiduciary capacity.
(4) To vote in person or by proxy any corporate stock or
other security and to agree to or take any other action in
regard to any reorganization, merger, consolidation,
liquidation, bankruptcy or other procedure or proceedings
affecting any stock, bond, note or other security.
(5) To use attorneys, real estate brokers, accountants
and other agents, if such employment is deemed necessary or
desirable, and to pay reasonable compensation for their
services.
(6) To compromise, settle or adjust any claim or d
by or against the Estate and to agree to any
modification of any contract or agreement
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LAST WILL AND TESTAMENT
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MADELINE R. OSMUN
PAGE 5
Estate.
{7} To renew any indebtedness, as well as to borrow
money, and to secure the same by mortgaging, pledging or
conveying any property of the Estate.
(8) To retain and carryon any business in which the
Estate may acquire an interest, to acquire additional interest
in any such business, to agree to the liquidation in kind of
any corporation in which the Estate may have an interest and
to carryon the business thereof, to join with other owners
in adopting any form of management for any business or
property in which the Estate may have an interest, to become
or remain a partner, general or limited, in regard to any such
business or property and to hold the stock or other securities
as an investment, and to employ agents and confer on them
authority to manage and operate the business, property or
corporation, without liability for the acts of such agent or
for any loss, liability or indebtedness of such business if
the management is selected or retained with reasonable care.
(9) To register any stock, bond or other security in the
name of a nominee, without the addition of words indicating
that such security is held in a fiduciary capacity, but
accurate records shall be maintained showing that such
security is a Estate asset and the Executor shall be
responsible for the acts of such nominee.
(B) Whenever the Executor is directed to distribute any
Estate assets in fee simple to a person who is then under twenty-
one (21) years of age, the Executor shall be authorized to hold
such property in Trust for such person until he/she becomes twenty-
one (21) years of age, and in the meantime shall use such part of
the income and the principal of the Estate as the Executor may deem
necessary to provide for the proper support and education of such
person. If such person should die before becoming twenty-one (21)
years of age, the property then remaining in trust shall be
distributed to the personal representative of such person's estate.
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(e) In making distributions from the
benefit of any minor or other person under a
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LAST WILL AND TESTAMENT
OF
MADELINE R. OSMUN
PAGE 6
Executor need not require the appointment of a guardian, but shall
be authorized to payor deliver the same to the custodian of such
person, to pay or deliver the same to such person without the
intervention of a guardian, to payor deliver the same to a legal
guardian of such person if one has already been appointed, or to
use the same for the benefit of such person.
(D) In the disbursement of the Estate and any division into
separate trusts or shares, the Executor shall be authorized to make
the distribution and division in money or in kind, or both,
regardless of the basis for income tax purposes of any property
distributed or divided in kind, and the distribution and division
made and the values established by the Executor shall be binding
and conclusive on all persons taking hereunder. The Executor may
in making such distribution or division allot undivided interests
in the same property to several trusts or shares.
(E) The Executor shall be authorized to lend or borrow,
including the right to lend to or borrow from any trusts which I
may have established during life or by will at an adequate rate of
interest and with adequate security, and upon such tems and
conditions as the Executor shall deem fair and equitable.
(F) The Executor shall be authorized to sellar purchase at
the fair market value as determined by the Executor, any property
to or from any trust created by me during life or by Will, even
though the same person or corporation may be acting as Executor of
my estate or as Trustee of any of my other trusts.
(G) The Executor shall have discretion to determine whether
items should be charged or credited to income or principal or
allocated between income and principal as the Executor may deem
equitable and fair under all the circumstances, including the power
to amortize or fail to amortize any part or all of any premium or
discount, to treat any part or all of the profit resulting from the
maturity or sale of any asset, whether purchased at a premium or at
a discount, as income or principal or apportion the same between
income and principal, to apportion the sales price of any sset
between income and principCl.1, to treat any dividend or 0 her
distribution of any investment as income or principal, or a 0 tion
the same between income and principal, to charge /, ense
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LAST WILL AND TESTAMENT
OF
MADELINE R. OSMUN
PAGE 7
against income or principal or apportion the same, and to provide
or fail to provide a reasonable reserve against depreciation or
obsolescence on any assets subject to depreciation or obsolescence,
all as the Executor may reasonably deem equitable and just under
all the circumstances. If the Executor does not exercise the above
discretionary power, the cash or accrual allocation shall be in
accordance with Chapter 81 of Title 20 of the Pennsylvania
Consolidated Statutes, or the corresponding provisions of
subsequent state law.
(H) If at any time the total fair market value of the assets
of any trust established or to be established hereunder is so small
that the corporate Trustee's annual fee for administering the trust
would be the minimum annual fee set forth in the Trustee's
regularly published fee schedule then, in effect, the Trustee in
its discretion shall be authorized to terminate such trust or to
decide not to establish such trust, and in such event the property
then held in or to be distributed to such trust shall be
distributed to the persons who are then or would be entitled to the
income of such trust. If the amount of income to be received by
such persons is to be determined in the discretion of the Trustee,
then the Trustee shall distribute the property among such of the
persons to whom the Trustee is authorized to distribute income, and
in such proportions, as the Trustee in its discretion shall
determine.
(I) Except as otherwise provided in this Will, when the
authority and power under this Will is vested in two (2) or more
Executors or Trustees, the authority and powers are to be held
jointly by the Executors or Trustees, respectively. A majority of
the Executors or Trustees may exercise any authority or power
granted under this Will or granted by law, and may act under this
Will. Any attempt by one such Executor or Trustee to act under
this will on other than ministerial acts shall be void. The action
of one such Executor or Trustee under this will may be validated by
a subsequent ratification of the act by a majority of the Executors
or Trustees.
(A) No bond or other security
Executor and Trustee I
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LAST WILL AND TESTAMENT
OF
MADELINE R. OSMUN
PAGE 8
Executor.
(B) This instrument always shall be construed in favor of the
validity of any act or omission by any Executor, and any Executor
shall not be liable for any act or omission except in the case of
gross negligence, bad faith or fraud. Specifically, in assessing
the propriety of any investment, the overall performance of the
entire Estate shall be taken into account.
(C) Each Executor shall be entitled to receive reasonable
compensation for services actually rendered to my estate, in an
amount the Executor normally and customarily charges for performing
similar services during the time which he/she performs the
services.
SEVENTH: Tax Elections.
(A) In determining the estate, inheritance and income tax
liability relating to my Estate, the Executor's decision as to all
available tax elections shall be conclusive on all concerned. If
the Executor joins with my spouse in filing income tax returns, or
consenting for gift tax purposes to having gifts made by either of
us during my life considered as having been made one-half by each
of us, any resulting liability shall be borne by my Estate and my
spouse in such proportions as they may agree. In accordance with
IRe Section 2632(a) and without regard to whether a Federal estate
tax return is actually filed, my Executor shall allocate so much of
the Federal Generation Skipping Transfer (GST) exemption amount as
will fully exempt any generation skipping transfer which may occur
under this Will.
(B) The Executor may, in its discretion, determine the date
as of which my gross estate shall be valued for the purpose of
determining the applicable tax payable by reason of my death.
(C) The Executor may, in its discretion, decide whether all
or any part of certain deductions shall be taken as income tax
deductions (even though they may equal or exceed the taxable income
of my estate and whether or not claimed or of benefi~mY
estate's income tax return) or as estate tax deductions h a
;~iC; i:~available; and in the event that all or any e:~1r~~h
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LAST WILL AND TESTAMENT
OF
MADELINE R. OSMUN
PAGE 9
deductions are taken as income tax deductions, no adjustment of
income and principal accounts in my estate shall be made as a
result of such decisions.
EIGHTH: Spendthrift Provision. No beneficiary shall have the
power to anticipate, encumber or transfer his or her interest in
the estate in any manner other than by the valid exercise of a
power of appointment. No part of the estate shall be liable for or
charged with any debts, contracts, liabilities or torts of a
beneficiary or subject to seizure or other process by any creditor
of a beneficiary.
NINTH: Definitions and General Provisions.
(A) Survival. Any beneficiary who dies within sixty (60)
days after my death shall be considered not to have survived me.
(B) Captions. The captions set forth in this Will at the
beginning of the various articles hereof are for convenience of
reference only and shall not be deemed to define or limit the
provisions hereof or to affect in any way their construction and
application.
(C) Children. As used in this Will, the words "child" and
"children" shall include persons who are legally adopted and the
issue of said persons, whether born in or out of wedlock, so long
as any person born out of wedlock is acknowledged in a written
instrument executed by the one of their natural parents who is a
descendant of mine to be the child of said descendant. The word
"issue" shall include descendants of all generations including
adopted persons. A posthumous child shall be considered as living
at the death of his parent. The birth to me or the adoption by me
of a child or children subsequent to the execution of this Will
shall not operate to revoke this Will.
(D) Code. Unless otherwise stated, all references in my Will
to section and chapter numbers are to those of the Internal Revenue
Code of 1986, as amended, or the corresponding provisions of any
subsequent federal tax laws applicable to my estate. ~
~ (El Other terms. The use of any gender inclUd~e~s .t17~r
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LAST WILL AND TESTAMENT
OF
MADELINE R. OSMUN
PAGE 10
genders, and the use of either the singular or the plural includes
the other.
{F} Powers of Appointment are Exercised. By this Will I
exercise any and all Powers of Appointment which I possess at the
time of my death except any power of appointment which I possess
under the Trust described in Paragraph FIRST (C), above.
IN WITNESS WHEREOF, I, MADELINE R. OSMUN, the Testatrix, have
to this my Last Will and Testament, typewritten on eleven (11)
pages, including the Acknowledgment and Affidavit, set my hand and
seal this 30th day of January, 1997.
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MADELINE R. OSMUN
Signed, sealed, published and declared by the above-named
Testatrix, as and for her Last Will and Testament, in the presence
of us, who have hereunto subscribed our names at her request, as
witnesses hereto, in the presence of the said Testatrix, and in the
pres en of each other. Each of us further declares that he or she
believ; s the Testatrix to be of sound mind and memory. The
prece i instrument consists of this and ten (10) other
cons cu ively numbered typewritten pages including the
Ackn w edgement and Affidavit.
residing at
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ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
The Testatrix and the witnesses whose names are signed and
subscribed to the attached or foregoing instrument, being first
duly sworn and qualified according to law, do hereby acknowledge,
depose and say to the undersigned authority, that the Testatrix
signed and executed the instrument as her Last Will in the presence
of the witnesses; that she signed it willingly or willingly
directed another to sign it for her; that she executed it as her
free and voluntary act for the purposes therein expressed; that
each of the witnesses were present and saw the Testatrix sign and
execute the instrument as her Last Will; that each subscribing
witness in the hearing and sight of the Testatrix signed the will
as witnesses; and that to the best of their knowledge the Testatrix
was at that time eighteen years of age or older, of sound mind and
under no constraint or undue influence.
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Wi"tness
Sworn to or affirmed, subscribed to, and acknowledged, before
me by the above-named Testatrix and witnesses, this 30th day of
January, 1997.
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r My Commlssion Expires:
Notarial Seal
Stacey L. Nace, Notary Public
Fermanagh Twp., Juniata County
I My Commission Expires Oct 16, 1999
Member, Pennsylvaoi3 Association of Notuies
.
.
Estate of Madeline R. Osmun
Pennsylvania Inheritance Tax Return
Form REV-1500
EXHIBIT C
Copy of the Short Certificate Letters Testamentary
issued on January 31, 2006
05/21/2005 15:4g
71 77377834
.
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
es ta te of MADELINE R OSMUN
IFi,st, Mlddl., L.st)
COMMUNITY TRUST CO
.
PAGE 02
SHORT CERTIFICATE
I,
GLENDA FARNER STRASBAUGH
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 31st day of January, Two Thousand and Six,
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
t la te of CAMP HILL BOROUGH
in said county{ deceased, to COMMUNITY TRUST COMPANY
and that same nas not since been revoked.
IN TESTIMONY WHEREOF, I bave hereunto Bet my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 31st day of January
Two Thousand and Six.
File No.
PA File No.
Vate of Death
2006~00092
21-06-0092
7/11/2006
183-12-3178
s.s. #
(7- ~'J,
.. M-<1CC&'~~L~" N 7--~
./ Register 0 Wills
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NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
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.
Estate of Madeline R. Osmun
Pennsylvania Inheritance Tax Return
Form REV-1500
EXHIBIT D
Copy of The Osmun Family Irrevocable Trust
Dated January 30, 1997
.
.
THE
OSMUN FAMILY
TRUST
COpy
THIS TRUST AGREEMENT is executed in triplicate on this 30th
day of January, 1997, by and between MADELINE R. OSMUN, now of 203
Pennsylvania Avenue, Camp Hill, Cumberland County, Pennsylvania
17011 (hereinafter called "Settlor") and PENNSYLVANIA FIDUCIARY AND
ESTATE SERVICES, INC., now of 1013 Mumma Road, Suite 202, Lemoyne,
Cumberland County, Pennsylvania 17043 (hereinafter called "Trustee"
or "Trustees").
ARTICLE I. TRUST ESTATE
1.01. Initial Principal. Settlor, desiring to establish
an irrevocable trust, does hereby irrevocably transfer, assign and
deliver to the Trustee and its successors, and assigns the assets
listed on Schedule A, attached hereto and made a part hereof. As
further evidence of such assignment, the Settlor has executed or
will execute or cause to be executed such other instruments as may
be required for the purposes of completing the assignment or
transfer of title to such property to the Trustee. The Trustee
accepts such transfer and assignment to itself as Trustee, and
undertakes to hold, manage, invest and reinvest the assets of this
Trust, and to distribute the income and principal of the Trust in
accordance with the provisions of this Agreement.
1.02. Additional Principal. The Settlor and any other
person or persons, with the consent of the Trustee, shall have the
right at any time to make additions to the corpus of this Trust or
any share thereof hereby established. All such additions shall be
held, governed, and distributed by the Trustees in accordance with
the terms and conditions of this Agreement.
ARTICLE II. IRREVOCABILITY OF TRUST
2.01.
consequences
Trus t shall
revoked, or
Irrevocabili ty. Settlor has been advised of the
of an irrevocable trust and hereby declares that this
be irrevocable and shall not be altered, amended,
terminated by Settlor or any other person or persons.
ARTICLE III. LIFE INSURANCE POLICIES
3.01. General Provisions. If any insurance policies are
transferred into this Trust, the Trustee shall be vested with all
right, title, and interest in and to the transferred policies of
.
.
insurance, and is authorized and empowered to exercise and enjoy,
for the purposes of the Trust herein created and as absolute owners
of such policies of insurance, all the options, benefits, rights
and privileges under such policies, including the right to borrow
upon and to pledge them for a loan or loans. The Trustee takes all
rights, title, and interest in and to the above-stated insurance
policies subject to any prior split-dollar life insurance agreement
and assignments, which may be in effect at the time of transfer.
The insurance companies which have issued policies are hereby
authorized and directed to recognize the Trustee as absolute owner
of such policies of insurance and as fully entitled to all options,
rights, pri vileges, and interests under such policies, and any
receipts, releases, and other instruments executed by the Trustee
in connection with such policies shall be binding upon all persons
interested in this Trust. The Settlor hereby relinquishes all
rights, title, interest and powers in such policies of insurance
which Settlor may own and which rights, ,title, interest and powers
are not assignable, and ..-lill, at the request of the Trustee,
execute all other instruments reasonably required to effectuate
this relinquishment.
3.02. Payment of Premiums. The Trustee shall be under no
obligation to pay the premiums which may become due and payable
under the provisions of any policy of insurance which may be
transferred or assigned to this Trust, or to make certain that such
premiums are paid by the transferor of such policy, or to notify
any persons of the nonpayment of such premiums, and the Trustee
shall be under no responsibility or liability of any kind in case
such premiums are not paid, except the Trustee shall apply any
di vidends received on such policies to the payment of premiums
thereon. Upon notice at any time during the continuance of this
Trust that the premiums due upon such policies are in default, or
that premiums which will become due will not be paid, either by the
transferor or by any other person, the Trustee, within its sole
discretion, may apply any cash values attributable to such policy
to the purchase of paid-up insurance or of extended insurance, or
may borrow upon such policy for the payment of premiums due
thereon, or may accept the cash values of such policy upon the
policy's forfeiture. In the event that the Trustee receives the
cash value of such policy upon its forfeiture for nonpayment of
premiums, the amount received shall be added to the corpus of this
Trust, and shall be administered according to the terms of this
Agreement. If the insured under such policies of insurance,
becomes totally and permanently disabled within the meaning of any
policies and because thereof the payment of premiums, or any of
them, shall during the pendency of such disability, be waived, the
Trustee, upon receipt of such knowledge, shall promptly notify the
insurance company which has issued such policies, and shall take
any and all steps necessary to make such waiver of premium
2
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.
provision effective.
3.03. Duties of Trustees With Reqard to Life Insurance
Policies. The Trustee shall be under no obligation or duty
whatever except with respect to the safekeeping of such policies of
insurance and the duty to receive such sums as may be paid to them,
in accordance with the requirements of this Trust, by the companies
issuing such policies, and to hold, manage and disburse such
proceeds subject to the terms of this Agreement. Upon the death of
the insured, the Trustee shall make reasonable efforts to carry out
the provisions of this Agreement, including the maintenance or
defense of any suit, provided, however, the Trustee shall be under
no duty to maintain or enter into any litigation unless its
expenses, including counsel fees and costs, have been advanced or
guaranteed in an amount and in a manner reasonably satisfactory to
the Trustee. The Trustee may repay any advances made by them or
reimburse themselves for any such fees and costs from any corpus or
income of this Trust.
ARTICLE IV. TRUST DISTRIBUTIONS
4.01. Trust Principal. The entire corpus of this Trust,
including the assets initially transferred to this Trust,
subsequent additions to this Trust, and the proceeds of any sale,
exchange or investment of such Trust assets, shall be used for the
purposes herein contained.
4.02. Income Distribution. During the Settlor's lifetime,
the Trustee shall distribute all of the net income of the trust to,
or for the benefit of, MADELINE R. OSMUN. The Trustee shall make
no distributions of principal to MADELINE R. OSMUN.
4.03. Principal Distributions. Upon the death of the
Settlor, the Trust shall terminate. Upon termination, the
remaining trust estate shall be divided into two separate shares,
with one share being sixty (60%) percent of the remaining trust
estate and one share being forty (40%) percent of the remaining
trust estate. The sixty (60%) percent share shall be distributed to
Settlor's son, NEIL C. OSMUN, per stirpes. The forty (40%) share
shall be distributed to Settlor's son, E. RICHARD OSMUN. If either
of the Settlor's children predecease the termination of this Trust,
the predeceased child's share shall be distribute equally to the
predeceased child's issue, per stirpes. If either of Settlor's
children predecease the termination of this Trust without leaving
issue, then such predeceased child's share shall be distributed
equally to the then-living children of Settlor, per stirpes.
4.04. General Power of Appointment. Settlor's son, NEIL
C. OSMUN is hereby granted the general power to appoint some or all
3
.
.
of the principal of this Trust to himself, his estate, his
creditors, the creditors of his estate, in such proportions and
upon such terms (in trust, outright gifts, or in any other manner)
as he deems advisable. This power shall not be exercisable under
his Will. In the event that Settlor's son, NEIL C. OSMUN, should
predecease the Settlor or becomes incapacitated prior to the
Settlor's death, then Settlor's son, E. RICHARD OSMUN, shall be
granted the general power of appointment subject to the same terms
and conditions of this Article 4.04. If Settlor's children fail,
either in whole or in part, to exercise this general power of
appointment herein granted, the unappointed principal shall
continue in trust and shall be administered according to the terms
of this Trust.
4.05. Broad Special Power of Appointment. MADELINE R.
OSMUN is hereby granted the special power to appoint, at any time
and from time to time, the principal of.this Trust, in whole or in
part, and in any manner and in such proportions as she deems
advisable to whomever she desires. This power shall be exercisable
by her Will, specifically referring to this special power of
appointment in this paragraph 4.05 of this Trust. This special
power of appointment does not grant to MADELINE R. OSMUN the power
to appoint the principal of this trust to herself, her estate, her
creditors, or the creditors of her estate. If MADELINE R. OSMUN
fails, either in whole or in part, to exercise this special power
of appointment herein granted, the unappointed principal shall
continue in trust and shall be administered according to the terms
of this trust.
ARTICLE V. POWERS OF TRUSTEES
5.01. General Powers. In addition to such other powers
and duties as may have been granted elsewhere in this Trust, but
subject to any limitations contained elsewhere in this Trust, the
Trustee shall have the following powers and duties:
A. In the management, care and disposition of this Trust, the
Trustee shall have the power to do all things and to execute such
deeds, instruments, and other documents as may be deemed necessary
and proper, including the following powers, all of which may be
exercised without order of or report to any court:
(I) To sell, exchange, or otherwise dispose of any
property, real, personal or mixed, wheresoever located,
at any time held or acquired hereunder, at public or
private sale, for cash or on terms as may be determined
by the Trustee, without advertisement, including the
right to lease for any term notwithstanding the period of
the Trust, and to grant options, including an option for
4
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a period beyond the duration of the Trust.
(2) To invest and reinvest all or any part of the
Trust Estate in any cornmon or preferred stocks, shares of
investment trusts and investment companies, bonds,
debentures, mortgages, deeds of trust, mortgage
participations, notes, real estate, or other property the
Trustee, in the Trustee's discretion, selects; provided
that the Trustee may not invest in any stock or
securities issued by the corporate Trustee or issued by
a parent or affiliate company of such Trustee; in the
manner that, under the circumstances then prevailing
(specifically including, but not limited to, the general
economic conditions and the anticipated needs of the
Trust and its beneficiaries) , persons of skill, prudence,
and diligence, acting in a similar capacity and familiar
with those matters would use in the conduct of an
enterprise of similar character and similar aims, to
attain the Settlor's goals under this trust agreement.
(3) To retain for investment any property deposited
with the Trustee hereunder; except that the Trustee may
not retain for investment any stock or securities in a
corporate Trustee or in a parent or affiliate company of
such corporate Trustee.
(4) To vote in person or by proxy any corporate
stock or other security and to agree to or take any other
action in regard to any reorganization, merger,
consolidation, liquidation, bankruptcy or other procedure
or proceedings affecting any stock, bond, note or other
security held by this Trust.
(5) To use lawyers, real estate brokers,
accountants and any other agents, if such employment is
deemed necessary or desirable, and to pay reasonable
compensation for their services.
(6) To compromise, settle or adjust any claim or
demand by or against the Trust and to agree to any
rescission or modification of any contact or agreement
affecting the Trust.
(7) To renew any indebtedness, as well as to borrow
money, and to secure the same by mortgaging, pledging or
conveying any property of the Trust, including the power
to borrow from the Trustee (in the Trustee's individual
capacity) at a reasonable rate of interest.
5
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(8) To retain and carryon any business in which
the Trust may acquire any interest, to acquire additional
interests in any such business, to agree to the
liquidation in kind of any corporation in which the Trust
may have any interest and to carry on the business
thereof, to join with other owners in adopting any form
of management for any business or property in which the
Trust may have an interest, to become or remain a
partner, general or limited, in regard to any such
business or property and to hold the stock or other
securities as an investment, and to employ agents, and
confer on them authority to manage and operate the
business, property or corporation, without liability for
the acts of any such agent of for any loss, liability or
indebtedness of such business if the management is
selected or retained with reasonable care.
(9) To register any stock, bond or other security
in the name of a nominee, without the addition of words
indicating that such security is held in a fiduciary
capacity, but accurate records shall be maintained
showing that the stock, bond or other security is a trust
asset and the Trustees shall be responsible for the acts
of the nominee.
B. Whenever the Trustee is directed to distribute any trust
principal in fee simple to a person who is then under twenty-one
(21) years of age, the Trustee shall be authorized to hold such
property in trust for such person until he becomes twenty-one (21)
years of age, and in the meantime shall use such part of the income
and the principal of the trust as the Trustee may deem necessary to
provide for the proper support and education of such person in the
standard of living to which he has become accustomed. If such
person should die before becoming twenty-one (21) years of age, the
property then remaining in trust shall be distributed to the
personal representative of such person's estate.
C. In making distributions from the Trust to or for the
benefit of any minor or other person under a legal disability, the
Trustee need not require the appointment of a guardian, but shall
be authorized to payor deliver the distribution to the custodian
of such person, to payor deliver the distribution to such person
without the intervention of a guardian, to payor deliver the
distribution to the legal guardian of such person if a guardian has
already been appointed, or to use the distribution for the benefit
of such person.
D. In the distribution of the Trust and any division into
separate trusts and shares, the Trustee shall be authorized to make
6
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the distribution and division in money or in kind or in both,
regardless of the basis for income tax purposes of any property
distributed or divided in kind, and the distribution and division
made and the values established by the Trustee shall be binding and
conclusive on all persons taking hereunder. The Trustee may in
making such distribution or division allot undivided interests in
the same property to several trusts or shares.
E. If at any time after Settlor's death the total fair market
value of the assets of any trust established or to be established
hereunder is so small that the corporate Trustee's annual fee for
administering the trust would be equal to or less than the minimum
annual fee set forth in the Trustee's regularly published fee
schedule, then the Trustee in its discretion shall be authorized to
terminate such trust or to decide not to establish such trust, and
in such event the property then held in or to be distributed to
such trust shall be distributed to the persons who are then or
would be entitled to the income of such trust. If the amount of
income to be received by such persons is to be determined in the
discretion of the Trustee, then the Trustee shall distribute the
property among such of the persons to whom the Trustee is
authorized to distribute income, and in such proportions, as the
Trustee in its discretion shall determine.
F. The Trustee shall be authorized to lend or borrow,
including the right to lend to or borrow from the Settlor's
estate, at an adequate rate of interest and with adequate security
and upon such terms and conditions as the Trustee shall deem fair
and equitable.
G. The Trustee shall be authorized to sell or purchase, at
the fair market value as determined by the Trustee, any property to
or from Settlor's estate, the estate of Settlor's spouse, or any
trust created by Settlor or Settlor's spouse during life or by
will, even though the same person or corporation may be acting as
executor of Settlor's estate or the estate of Settlor's spouse or
as trustee of any other such trusts and as the Trustee of this
Trust.
H. The Trustee shall have discretion to determine whether
items should be charged or credited to income or principal or
allocated between income and principal as the Trustee may deem
equitable and fair under all the circumstances, including the power
to amortize or fail to amortize any part or all of any premium or
discount, to treat any part or all of the profit resulting from the
maturity or sale of any asset, whether purchased at a premium or at
a discount, as income or principal or apportion the same between
income and principal, to apportion the sales price of any asset
between income and principal, to treat any dividend or other
7
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distribution on any investment as income or principal or to
apportion the same between income or principal, to charge any
expense against income or principal or apportion the same, and to
provide or fail to provide a reasonable reserve against
depreciation or obsolescence on any asset subject to depreciation
or obsolescence, all as the Trustee may reasonably deem equitable
and just under all of the circumstances.
I. The Trustee is hereby authorized and empowered to purchase
such insurance policies as it deems appropriate.
5.02. Votinq by Trustees. When the authority and power
under this Trust is vested in two (2) or more Trustees or Co-
Trustees, the authority and powers are to be exercised jointly by
the Trustees or Co-Trustees. A majority of the Trustees or Co-
Trustees may exercise any authority or power granted under this
Trust Agreement or granted by law, and-may act on behalf of the
Trust. Any attempt by one such Trustee to act for the Trust on
other than ministerial acts shall be void. The action of one such
Trustee on behalf of the Trust may be (but need not be) validated
by a subsequent ratification of the act by a majority of the
Trustees or Co-Trustees.
5.03 Trustees Power to Deal with Environmental Hazards.
The Trustee shall have the power to use and expend the trust income
and principal to (i) conduct environmental assessments, audits, and
site monitoring to determine compliance with any environmental law
or regulation thereunder; (ii) take all appropriate remedial action
to contain, clean up or remove any environmental hazard including
a spill, release, discharge or contamination, either on its own
accord or in response to an actual or threatened violation of any
environmental law or regulation thereunder; (iii) institute legal
proceedings concerning environmental hazards or contest or settle
legal proceedings brought by any local, state, or federal agency
concerned with environmental compliance, or by a private litigant;
(iv) comply with any local, state or federal agency order or court
order directing an assessment, abatement or cleanup of any
environmental hazards; and (v) employ agents, consultants and legal
counsel to assist or perform the above undertakings or actions.
Any expenses incurred by the trustee under this paragraph may be
charged against income or principal as the trustee shall determine.
ARTICLE VI. SPENDTHRIFT PROVISION
6.01. General Provision. No beneficiary shall have the
power to anticipate, encumber or transfer his interest in the Trust
Estate in any manner other than by the valid exercise of a Power of
Appointment. No part of the Trust Estate shall be liable for or
charged with any debts, contracts, liabilities or torts of a
8
.
.
beneficiary or subject to seizure or other process by any creditor
of a beneficiary.
ARTICLE VII. CONSTRUCTION OF TRUST
7.01. Choice of Law. This Trust shall be administered and
interpreted in accordance with the laws of the Commonwealth of
Pennsylvania.
7.02. Code. Unless otherwise stated, all references in
this Trust to section and chapter numbers are to those of the
Internal Revenue Code of 1986, as amended, or corresponding
provisions of any subsequent federal tax laws applicable to this
Trust.
7 .03. Other Terms. Unless the context otherwise requires,
the use of one or more genders in the text includes all other
genders, and the use of either the singular or the plural in the
text includes both the singular and the plural.
7.04. Captions. The captions set forth in this Agreement
at the beginning of the various divisions hereof are for
convenience of reference only and shall not be deemed to define or
limit the provisions hereof or to affect in any way their
construction and application.
7.05. Situs of Trust. The Trust shall have its legal
situs in Cumberland County, Pennsylvania.
ARTICLE VIII.
COMPENSATION OF TRUSTEES AND
APPOINTMENT OF SUCCESSOR TRUSTEES
8.01. Compensation. The Trustee shall receive as its
compensation for the services performed hereunder that sum of
money, based on an hourly charge or percentage rate, which the
Trustee normally and customarily charges for performing similar
services during the time which it performs these seD/ices.
8.02. Removal of Trustees. Settlor may remove the
Trustee, or any of them, at any time or times, with or without
cause, upon thirty (30) days written notice given to the current
Trustee. Upon the death of the Settlor, a majority of the current
income beneficiaries may remove the Trustees, or any of them, at
any time or times, with or without cause, upon thirty (30) days
written notice given to the current Trustees. Upon the removal of
the Trustees, or any of them, a successor Trustee (s) shall be
appointed in accordance with the terms set forth in Paragraph 8.03.
9
.
.
8.03. Appointment of Successor Trustees. The Trustees, or
any of them, may resign at any time upon thirty (30) days written
notice given to the Settlor if Settlor is living, or in the event
of Settlor's death, upon thirty (30) days written notice given to
the current income beneficiary or beneficiaries (including a
beneficiary's natural or legal guardian or legal representative),
hereunder. Upon the death, resignation, removal or incapacity of
the Trustees, or any of them, a successor trustee(s} may be
appointed by the Settlor during Settlor's lifetime, or, after
Settlor's death, by a majority of the current income beneficiaries.
Notwi thstanding the foregoing provisions respecting the appointment
of a successor trustee(s}, if and in the event that one Trustee
shall die, resign, be removed, or be adjudicated incompetent, the
remaining Trustee shall exercise the powers, and carry out the
duties, of Trustee individually until such time as a successor
trustee is appointed. Settlor prohibits the appointment of Settlor
as Trustee and any attempt to do so shall be without authority
under this Agreement. Any successor trustee (8) shall be a
financially sound and competent corporate trustee or a trustee
agreed to by written consent of all income beneficiaries. Any
successor trustee(s} thus appointed, or, if the corporate trustee
shall merge with or be consolidated with another corporate
fiduciary, then such corporate fiduciary, shall succeed to all the
duties and to all the powers, including discretionary powers,
herein granted to the Trustees.
ARTICLE IX. PERPETUITIES CLAUSE
9.01. General Provision. Notwithstanding anything to the
contrary in this Trust, each disposition the Settlor has made here,
legal or equitable, to the extent it can be referred in its
postponement of becoming a vested interest to a duration measured
by some life or lives in being at the time of Settlor's death is
definitely to vest in interest, although not necessarily in
possession, not later that twenty-one (21) years after such lives
(and any period of gestation involved); or, to the extent it cannot
be referred in any such postponement to such lives, is to so vest
not later than twenty-one (21) years from the time of Settlor's
death.
ARTICLE X.
ACQUISITION OF UNITED STATES TRID~SURY BONDS
ELIGIBLE FOR TAX PAYMENT; PAYMENT OF TAXES, FUNERAL
EXPENSES, AND EXPENSES OF ADMINISTRATION
J.O. OJ.. Acauisi tion of Bonds. The Trustee may, at any time,
without the prior approval or direction of the Settlor and whether
or not the Settlor is able to manage Settlor's own affairs, acquire
United States Treasury Bonds selling at a discount, which bonds are
10
.
.
redeemable at their par value plus accrued interest thereon for the
purposes of applying the proceeds to the payment of the United
States estate tax on the Settlor's estate; and the Trustee may
borrow from any lender, including themselves, with or without
security, to so acquire these bonds.
10.02. Payment of United States Estate Tax bv Bond
Redemption. The Settlor directs that any United States Treasury
Bonds which may be redeemed at their par value plus accrued
interest thereon for the purpose of applying the proceeds to the
payment of the United States estate tax imposed on the Settlor's
estate, and which are held by the Trustee, shall, to the extent of
the amount determined to be required for payment of the estate tax,
be distributed to the legal representative of the Settlor's estate
to be used by the legal representative ahead of any other assets
and to the fullest extent possible to pay the estate tax.
10.03. Payment of Death Taxes and Other Estate Settlement
Costs. After the Trustee has complied with paragraph 10.02, above,
and ascertained from the legal representative that all such bonds
have been redeemed in payment of the United States estate tax, the
Trustee shall also ascertain from the legal representative whether
the legal representative has sufficient assets to pay the remaining
legacy, succession, inheritance, transfer, estate and other death
taxes or duties (except the additional estate tax imposed by
Section 2032 (c), or corresponding provisions of the Internal
Revenue Code of 1986 applicable to the Settlor's estate and
imposing the tax) levied or assessed against the Settlor's estate
(including all interest and penalties thereon), all of which taxes,
interest and penalties are hereafter referred to as the death
taxes, interest and penalties. If the legal representative advises
the Trustee that insufficient funds exist to pay all the death
taxes, interest and penalties, the Trustee shall then pay to the
legal representative from the trust property, an amount equal to
all the death taxes, interest and penalties in excess of the funds
available to the legal representative for these purposes, which
payments are to be made without apportionment.
If the Executor of the Settlor's estate, in such Executor's
sole discretion, shall determine that appropriate assets of
Settlor's estate are not available in sufficient amount to pay (1)
the Settlor's funeral expenses, and (2) expenses of administering
the Settlor's estate, the Trustee shall, upon the request of the
Executor of the Settlor's estate, contribute from the principal of
the trust estate the amount of such deficiency; and in connection
with any such action the Trustee shall rely upon the written
statement of the Executor of the Settlor's estate as to the
validity and correctness of the amounts of any such expenses, and
shall furnish funds to such Executor so as to enable such Executor
11
.
.
to discharge the same, or to discharge any part or all thereof
itself by making paYment directly to the person entitled or
claiming to be entitled to receive payment thereof. No
consideration need be required by the Trustee from the Executor of
Settlor's estate for any disbursement made by the Trustee pursuant
hereto, nor shall there be any obligation upon such Executor to
repay to the Trustee any of the funds disbursed by them hereunder,
and all amounts disbursed by the Trustee pursuant to the authority
hereby conferred upon them shall be disbursed without any right in
or duty upon the Trustee to seek or obtain contribution or
reimbursement from any person or property on account of such
payment. The Trustee shall not be responsible for the application
of any funds delivered by them to the Executor of the Settlor's
estate pursuant to the authority herein granted, nor shall the
Trustee be subject to liability to any beneficiary hereunder on
account of any paYment made by them pursuant to the provisions
hereof.
IN WITNESS WHEREOF, the Settlor and Trustee have hereunto set
their hands and seals as of the day and year first above written.
WITNESS:
d:CY- ~
/ . .
/
~~I7/tc~.~'uR< Ua~l-J
MADELINE R. OSMUN, SETTLOR
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF CUMBERLAND
On this, the 30th day of January, 1997, before me, a Notary
Public, the undersigned officer, personally appeared MADELINE R.
OSMUN, known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within Trust Agreement, and
acknowledged that she executed the same for the purposes therein
contained.
IN WITNESS WHEREOF, I have set my hand and official Seal.
~~~l(ltt~
My Commission Expires:
12
Notarial Seal
Stacey L Nace, Notary Public
Fermanagh Twp.. Juniata County
My Commission ,Expires Oct. 16. 1999
Member, Pennsylvania ASSOciation ot Notaries
.
.
The foregoing Trust Agreement was delivered, and is
accepted....at Lemoyne, Pennsylvania, on January 30, 1997.
\
ATTEST
hereby
PENNSYLVANIA FIDUCIARY AND ESTATE
SERVICES, INC., TRUSTEE
/...~/LIl.;-
VICE-
.,./
------
13
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SCHEDULE nAn
SCHEDULE
REFERRED TO IN THE ANNEXED
TRUST AGREEMENT
DATED: JANUARY 30, 1997
FROM MADELINE R. OSMUN,
SETTLOR
TO PENNSYLVANIA FIDUCIARY AND ESTATE
SERVICES, INC., TRUSTEE
Property Description:
14
.
.
Estate of Madeline R. Osmun
Pennsylvania Inheritance Tax Return
Form REV-1500
EXHIBIT E
Copy of the Pennsylvania Inheritance and Estate
Tax Official Receipt No. CD 006549 issued on 04/12/2006
For Prepayment of Estimated Inheritance Tax
REV-1162 EX(11-96)
. ,.----:"_._--------_.~._--~----~
lio-) Ii: iL~ ~ n \fl [E mil
II ~ I~,
PENNSYLVANIA illn t-\YI-/ 1 4: 2006 I ~ II
INHERITANCE AND ESTATE TAX i .l._j:
~ .
OFFICIAL RECEIPT ~ _ t
i_:::!~/ --.:-J~JO~.-:GGbQ-Q6 549
COMMONWEALTH OF PENNSYLVANIA
OEP ARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 28D601
HARRISBURG, PAl 7128-0601
.
RECEIVED FROM:
COMMUNITY TRUST COMPANY
3907 MARKET STREET
CAMP Hill, PA 17011
_____n_ fold
ESTATE INFORMATION: SSN: 183-12-3178
FILE NUMBER: 2106-0092
DECEDENT NAME: OSMUN MADELINE R
DATE OF PAYMENT: 04/12/2006
POSTMARK DATE: 04/10/2006
COUNTY: CUMBERLAND -
DATE OF DEATH: 01/11/2006
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,000.00
I
I
I
I
I i.--.
I
-,-
-I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK#15245
SEAL
INITIALS: MG
RECEIVED BY:
TAXPAYER
$4,000.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
.
.
Estate of Madeline R. Osmun
Pennsylvania Inheritance Tax Return
Form REV-1500
EXHIBIT F
Documentation of Assets
OS/21/2005 15:49
71 1'.834
COMMUNITY TR~CO
PAGE 05
BELCO COMMUNITY CREDIT UNION
DeCEDENT ESTATE INFORMATION
1. Name(s) in which the account was held:
MADELINE R OSMUN
2. Account number: 743050
3. Balance as of date of death: 1/11/2006
Balance Accrued Dividends YTD Dividends
For 1/11/2006
Regular Savings: $ $5.00 $ $0.00 $0.00
Christmas Club: $ $ $
Whatever Club: $ $ $
Checking: $ $1.876.90 $ $0.00 $ $0.00
Money Markel: $ $ $
Certificates: Balance Accrued Dividends YTD Dividends Certificate Number
For
$
$ $
$ $ $
$ $ $
4. Date the account was initiated: 10/30/1996
5. Name(s) in which Safe Deposit Box was held: N/A
6. Dale the box was initIally rented: N/A
7. Branch address at which the box is located:
8. loan Information: Balance Accrued Interest Per Diem Int
Unsecured Loans:
$ $
B. Secured Loans: $ $
$ $ $
C. Mortgage Loans: $ $ $
$ $ $
Miscellaneous:
05/21/2005 15:49
71 77377834
.
COMMUNITY TRUST CO
.
REPORT OF ASSETS
COMMUNITY TRUST COMPANY TRUSTEE OF
THE OSMUN FAMILY TRUST
DATED 01/30/97
ACCOUNT 2100207 AS OF 01/11/2006
BONOS
OTHER OBLIGATIONS
1. FEDERATED
INTERMEDIATE
CORPORATE BOND
FUND #303
TOTAL BONDS
STOCKS
MUTUAL FUNDS
2. FED STOCK TRUST FUND
#019
3. FEDERATED MAX-CAP
FUND #39
4. FED MID~CAP FUND
#151
5. FED MINI-CAP
INSTITUTIONAL #149
#149
6. VANGUARD
INTERNATIONAL GROWfH
#081
TOTAL STOCKS
TOT AL CASH
4,724.88
Units
Market Value
Price 01/11/2006
1,962.1460
10.0000
19,621.46
19,621.46
PAGE 03
PAGE
1
Book Value
20,047.32
20,047.32
1,230.2080 32.2100 39,625.00 39,993.91
603.2740 25.6100 15,449.85 11,309.13
1,426.6560 23.1700 33,055.62 23,582.75
837.9920 16.4800 13,810.11 8.77017
342.9680 21.9000 7,511.00 6,510.90
109,4$1.58
TOTAL INVESTMENTS
.,NCOME CASH ON HAND
"PRINCIPAL CASH ON HAND
TOTAL ASSETS
;29,073.04
2.914.43
1,810.45
133,797.92
.. Income and principal cash are held in
FEDERATED GOVT OBLIGATIONS FD #395
Interest rate as of 01/11/06 is 3.868161 percent
90,166.86
110,214.18
2,914.43
1,810.45
114,93906
.
.
Estate of Madeline R. Osmun
Pennsylvania Inheritance Tax Return
Form REV-1500
EXHIBIT G
Documentation of Expenses
.
RECEIPT FOR PAYMENT
.
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Receipt Date:
Receipt Time:
Receipt No. :
1/31/2006
10:50:35
1043217
OSMUN MADELINE R
Estate File No. :
Paid By Remarks:
2006-00092
COMMUNITY TRUST CO
VZ
------------------------ Receipt Distribution ------------------------
Fee/Tax Description
PETITION LTRS TEST
SHORT CERTIFICATE
WILL
JCP FEE
AUTm.1ATION FEE
Payment Amount
20.00
8.00
15.00
10.00
5.00
Payee Name
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
Check# 14843/8
Total Received.........
$58.00
$58.00
-
05/23/2005 13:35
717"518
MYERS HARNER~
PAGE 02
MYERS-HARNER FUNERAl, HOME, INC.
1903 MARKE1' STREET
R,OBER,T H. HARNER
sVP{.RV1.5QR
CAMP HILL, pgNNSYlVANIA 17011
LOCALLY OWNED ANO
OPERATED
TE.LEPHONE
7 \ 7.7$7.9961
January 18, 2006
Allianz Life Insurance Company of North America
Administrative Officer
P 0 Bo)\: 19078
Greenville SC 29602-9078
Services for Madeline R. Osmun
January 16, 2006
Charges for Services Selected
Professional Services
Use of Facilities
Automotive Equipment
$ 3,990.00
$ 3,990.00
Charges for Merchandise Selected
Casket
Vault
Go~'T1
$ 2,395.00
980.00
135.00
$ 3,510.00
Cash Advanced
Newspaper Notice/Local
Clergy
Certified Copies
Flowers
Hair Dresser
$
42.00
100.00
60.00
163.00
45.00
$ 410.00
Total:
$ 7,910.00
---------...-
~
.
.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG. PA 17105.8486
May 12, 2006
,,~,~i~,,1J 'm 11~,fl\.I,'!"
'I n) ,I
1,. I i\ '; ,. -; I ~
Iuu ",,-; i 1 J 2006 rUJi
IBy J
TRUST COMMUNITY
PATRICIA WALTER
3907 MARKET ST
CAMP HILL PA 17011
Re: MADELINE OSMUN
CIS #: 750145136
SSN: 183-12-3178
Date of Death: 01/11/2006
Dear Ms. Walter:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $271,411.74 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $26,334.62, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $245,077.l2,
is to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
r'J r r ' .
--:J~ G. 0l}.j~
Sharon E. Smith
TPL Program Investigator
717-772-6397
717-772-6553 FAX
Enclosure