HomeMy WebLinkAbout10-05-06 (2)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0001
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAl)
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EMRICH LINDA R.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
07/14/2005 10/02/1943
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDlE INITIAL)
JOHN C. EMRICH
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00 1. Original Retum
D 4. Limited Estate
00 6. Decedent Died Testate (AlIachcopyofWil)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum
D 4a. Future Interest Compromise (date of death after 12-12-82)
00 7. Decedent Maintained a Living Trust (Altach copy of Trust)
D 10. Spousal Poverty Credit (daIB of death between 12-31-91 and 1-1-95).
OFFICIAl USE ONLY
FILE NUMBER
2 1 -0 5 0 8 2 4
COONTY"'COO'E -YEA/l- - - NiiMiiER- -
SOCIAL SECURITY NUMBER
2 74- 3 8 - 3 6 9 4
THIS RETURN MUST BE RLED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Retum (dateofdealhprior1ll12-13-82)
00 5. Federal Estate Tax Retum Required
1... 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Altach Sch 0)
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1111$"$lc11tM:lllIllllii..lJililllll'lIs,.I..N..lell'.I','II1U...w...r.iINfilili.i.....i.IIl...I.lliltilltll...'tQ:
NAME COMPLETE MAILING ADDRESS
DAVID W. REAGER REAGER & ADLER, P.C.
FIRM NAME (If Applicable)
REAGER & ADLER P.C. 2331 MARKET STREET
TELEPHONE NUMBER
717-763-1383 CAMP HILL PA 17011
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Joindy Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subjectto Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
243,193.99
205,519.97
0.00
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
19. Tax Due
X _(15)
X .045 (16)
X .12 (17)
0.00 X .15 (18)
(19)
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUrm OF AN OVERPAYMENT
38.081.08;3
OFFICIAL USE ONLY
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746,945.33
(8)
815,247.22
15,397.71
(11)
(12)
(13)
15,397.71
799,849.51
0.00
(14)
799,849.51
> > BE SURE 10 ANMeR ALL QUISTIONS ON REVERR SlOE AND RECHECK MATH. < <
Decedent's Com lete Address:
STREET ArlJRESS
96 Lon wood Drive
CITY
Mechanicsburg
STATE
PA
ZIP
17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
9.248.40
20 000 00
462 42
Total Credits (A + 8 + C)
(2)
20.462.42
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
5.
T otallnteresUPenalty ( D + E )
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)
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
(3)
0.00
4.
11.214.02
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... 00 D
b. retain the right to designate who shall use the property transferred or its income; ...............................:........ 00 D
c. retain a reversionary interest; or ...................................................................................................... 00 D
d. . receive the promise for life of either payments, benefits or care? ............................................................. 00 D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?...................... ..:.. ................. .................................................. D 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 00 D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . ....... ............ :.......... ........................................ ................................ IZ] 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 penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, oorrect and oomplete.
Declaration of preparer other Ihlrllhe personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESpoNSIBLE FOR FILING REIURN
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ADDRESS 96 Longwood Drive
Mechanicsbur
SIGNATURE OF PREPARER OTHER THAN REPRES
DATE
q/I'r ILcIJt
ADDRESS
PA
2 ~ 3 ,
MA-ILL,qr P
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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 spouse is 3%
(72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value oftransfers 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 tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% (72 P.S. ~9116(a)(1.2)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.$. ~9116(1.2) (72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value oftransfers to or for the use of the decedent's siblings is 12% (72 P.S. ~9116(a)(1.3)). A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-';"" EX . (~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
EMRICH LINDA R
FILE NUMBER
21 05
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0824
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
11,898.68
Fidelity Ultra Service Mutual Fund
Account NO. X40-121819
2.
IBM Stock - 320 shares
26;182.40
3.
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
38.081.08
REV-~508 EX' \6.
SCHEDULE E
CASH, BANK DEPOSITS; & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EMRICH LINDA R
FILE NUMBER
21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
0824
ITEM
NUMBER
1.
DESCRIPTION
Diamond Pin - found in safe deposit box with appraisal certificate
VALUE AT DATE
OF DEATH
4,600.00
2.
Vartan National Bank - Certificte of Deposit #3011728
12,334.32
3.
Vartan National Bank - Certificate of Deposit #3011727
12,286.49
4.
Miscellaneous Personal Property
1,000.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
30 220.81
REV.~510EX'!.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EMRICH LINDA R.
FILE NUMBER
21 05
0824
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
ITEM INa.UOE THE NAME OF THE TRANSFEREE, THEIR RElATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPUCAIllE) VALUE
1. US AIlianz - High Five Bonus - Variable Annuity 121,909.23 100. 121,909.23
#DAN02610
2. American Express Financial-IRA 26,129.70 100. 26,129.70
#9310-6084719-7-004
3. Fidelity IRA 20,873.89 100. 20,873.89
#147608530
4. Fidelity Roth IRA 62,086.05 100. 62,086.05
#2AP-40813
5. Minnesota Life - Flexible Annuity 4,194.52 100. 4,194.52
6. US Allianz - High Five Bonus - Variable Annuity 63,037.98 100. 63,037.98
#DAN02577
7. John C. and Linda Emrich Family Trust 897,427.92 50. 448,713.96
0.00
0.00
0.00
TOTAL (Also enter on line 7 Recapitulation). $ 746945.33
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX' \1.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESID NT DECEDENT
ESTATE OF
EMRICti LINDA R
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
05
0824
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Parthemore Funeral HOme & Cremation Services, Inc. 3,119.00
2. Lunch for family following memorial service - Catalano's 135.72
3. Clergy Honorarium 150.00
4. Flowers 75.00
5. Cremation Authorization Fee, Cumberland County Coroner 25.00
6. Certified copies of death certificates 72.00
7. Additional copies of death certificates 45.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. AttomeyFees Reager & Adler, P.C. 6,000.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) 3,500.00
Claimant John C. Emrich
Street Address 96 LonQwood Drive
City MechanicsburQ State P A Zip 17050
Relationship of Claimant to Decedent Husband
4. Probate Fees Cumberland County Register of Wills 177.00
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7. Cumberland Law Journal - legal advertising 75.00
8. The Sentinel - legal advertising 107.99
9. Additional Short Certificates 12.00
10. Investment management fees PNC Bank - date of death to termination of trust 1,904.00
total fee = 3,808 /2 = 1,904.00
- TOTAL (Also enter on line 9, Recapitulation) $ 15397.71
(If more space IS needed, msert additional sheets of the same size)
REV.15~3 "";'...
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
LINDA R 21 n~ nR?d
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s} OF ESTATE
I. TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. John C. Emrich Spousal
96 Longwood Drive
Mechanicsburg, PA 17050
2. Matthew J. Emrich Lineal
104 Joshua Court
North Wales, PA 19454
3. Kara Emrich Lineal
5401-9 Oxford Drive
Mechanicsburg, PA 17055
4. Kristen E. Wycha Lineal
453 Delancy Court
Mechanicsburg, PA 17055
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
..
(If more space IS needed, Insert additional sheets of the same size)
!"':-:':'''''. '*
SCHEDULE M
FUTURE INTEREST COMPROMISE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Check Box 4a on Rev-1500 Cover Sheet
FILE NUMBER
ESTATE OF
EMRICH LINDA R 21 05 0824
This Schedule is appropriate only for estates of decedents dying after December 12,1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
D Will 00 Trust D Other
I. Beneficiaries
NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO
NEAREST BIRTHDAY
1. John C. Emrich Husband 10/12/1942 63
2. Matthew J. Emrich Son 4/16/1975 30
3. Kara Emrich Dauahter 2/28/1978 27
4. Kristen E. Wvcha Dauahter 2/28/1978 27
5.
II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within
9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse
exercises such withdrawal right.
D Unlimited right of withdrawal D Limited right of withdrawal
III. Explanation of Compromise Offer:
Decedent and her spouse created a Living Trust during their lifetimes containing language which created a Family
Trust at the death of the first to die. The language in the Family Trust creates an interest for each of the children
of the decedent along with the surviving spouse. Since the children do not rely on the Family Trust for any support,
the children and the surviving spouse wish to create a life estate for the surviving spouse with the remaindermen
being the children. The children have each signed an Affidavit, attached hereto, indicating that they are self-
sufficient and will not rely on the Family Trust as any means of support.
IV. Summary of Compromise Offer:
1. Amount of Future Interest . . . . . . . . . . . . . .. . . . . " . .. . . . . . .. . . .. . . . . . . . . . . .. . . . $ 448.713.96
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) . . . . . .$
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One 06%, 03%, IX! 0% .. . . . . . . . .. . . . .. $ 243.193.99
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One D 6%. (&:J 4.5% . . .. ... . . ... .. . .. . . . . . $ 205.519.97
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet) ....:.$
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) . . . . . . $
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) .: ... . ... . .. . . . . . . . . . $ 448.713.96
(If more space is needed, insert additional sheets of the same size)
REV-:~.~X {~1-9*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX DIVISION
ESTATE OF
SCHEDULE N
SPOUSAL POVERTY CREDIT
(AVAILABLE FOR DATES OF DEATH 01101/92 to 12/31/94)
FILE NUMBER
This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
PART I CALCULATION OF GROSS ESTATE
1. Taxable Assets total from line 8 (cover sheet) ......................................................................................
2. Insurance Proceeds on Life of Decedent ..............................................................................................
3. Retirement Benefits ................................................................................................................................
4. Joint Assets with Spouse .......................................................................................................................
5. P A Lottery Winnings ..............................................................................................................................
6a. Other Nontaxable Assets: List (Attach schedule if necessary) ..
6a.
6b.
6c.
6d.
6. . SUBTOTAL (Lines 6a, b, c, d) ..............................................................................................................
7. Total Gross Assets (Add lines 1 thru 6) ...............................................................................................
8. Total Actual Liabilities .. ..... ...... ........ ........ ........ ................................ ......... ...... ... ........... ....... ............... ....
9. Net Value of Estate (Subtract line 8 from line 7) ...................................................................................
If 9 . at th $200 000 STOP Th sf t' t f ./>> t c1' th credit If t u t Part
1.
815247.22
2.
3.
4.
5.
6.
7.
815247.22
8.
9.
815,247.22
. . .
PARTII . CALCULATION OF JOINT EXEMPTION INCOME (Attach copies of Fedcral IndiVidual Icoln(
Tax Return for decedent and spouse)
2. TAX YEAR: 19 3. TAX YEAR: 19
2a. 3a.
2b. 3b.
2c. 3c.
2d. 3d.
2e. 3e.
2f. 3f.
Income:
1. TAX YEAR: 19
a. Spouse ............................. 1 a.
b. Decedent ......................... 1b.
c. Joint ................................. 1c.
d. Tax Exempt Income ......... 1d.
e. Other Income not
listed above ..................... 1e.
f. Total................................. 1 f.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(-if)
+ (2f).
+ (3f)
4b. Average Joint Exemption Income ............................................................................................................... =
If line 4(b) is greater then $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part III.
=
(+3)
PART III CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES
1. Insert amount of taxable transfers to spouse or $100,000, whichever is less .....................................
2. Multiply by credit percentage (see instructions) ....................................................................................
3. This is the amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on line 18 of the cover sheet. .............................................................
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate ................ ........................................................................................................
5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal
Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet ..........
1.
2.
3.
4.
5.
, A
REV-1500 Discount, Interest and Penalty Worksheet
.
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death:
20.000.00
Discount:
924.84
Interest Table
I Year Days Delinquent Balance Due Interest
this time period this year this period
Before 1981
1982
1983 --
11984
1985
1986
1987 - -~.
r-1988lhroURh 1991
1992
1_'t~~3 throuGh 1994
1995 through 1998
1999
2000 ~.-_.. ----~-
.2001
2002
2003
2004
1------ - ., . ---
TOTALS
Penalty Calculation
If the decedent's date of death was on or before March 31, 1993, insert the applicable amount:
Total Balance Due on January 17, 1996:
Penalty: ___
..
AFFIDAVIT
I, KRISTEN E. WYCHA, of Mechanics burg, Pennsylvania do hereby swear and affirm
the following to be true and correct:
1. I was born on Febroary 28, 1978 and am 28 years of age.
2. I have not received any distributions from the Linda R. Emrich Family
Trust for any reasons whatsoever.
3. I do not intend to receive any distributions from the Linda R. Emrich
Family Trost in the future as my financial future is not dependent upon any
distributions from the Trost.
4. I hold a Bachelors of Science in Business Administration and am currently
employed as a Programmer Analyst II at Member's 1st Federal Credit
Union since July 10, 2000.
5. I am married to Michael J. Wycha who holds a Bachelors of English as of
May, 2006.
6. My husband and I own our own home and all of our living expenses
including, clothing, food, insurances, utilities and shelter are provided for
solely by us through our combined earnings of approximately $67,500.00.
7. I do not receive any additional financial support from my father, John C.
Emrich.
~~~~
COMMONWEALTHOFPENNSYLVANIA )
COUNTY OF CUMBERLAND )
On this, the ~ay of .h.fU~ . 2006, before me, personally appeared Kristen E.
Wycha, mow to me or satisfactorily proven to be the above-named individual who executed the
foregoing document for the purposes therein contained by Sitg her name thereon.
COMMONWEALTH OF PENNSYLVANIA / ~
Notarial Seal. Notary Pu~lic
Monica D. Zercher, Notary Public
Camp Hill Boro, CU":lberland County
My Commission Expires Feb. 8. 2010
Member Pennsylvania Association 01 Notaries
I
AFFIDAVIT
I, KARA E. EMRICH, of Mechanics burg, Pennsylvania do hereby swear and affirm the
following to be true and correct:
1. I was born on February 28, 1978 and am 28 years of age.
2. I have not received any distributions from the Linda R. Emrich Family
Trust for any reasons whatsoever.
3. I do not intend to receive any distributions from the Linda R. Emrich
Family Trust in the future as my financial future is not dependent upon any
distributions from the Trust.
4. I hold a Bachelors of Science in Education and a Master Degree in
Education and am currently employed by Northern York County School
District since September, 2001 with an annual salary of approximately
$34,000.00.
5. While earning my Master's Degree, I paid for all of my books and
miscellaneous expenses from my own funds. Northern York County
School District paid all of my tuition expenses.
6. lawn my own condominium and all of my living expenses including,
clothing, food, insurances, utilities and shelter are provided for solely by
me through my earnings.
7. I do not receive any additional financial support from my father, Jo1m C.
Emrich.
~/()!~ .(;~
~.Emrich j ~
COMMONWEALTHOFPENNSYLVANIA )
COUNTY OF CUMBERLAND )
On this, the Z~~y of JJ...ufW- if . 2006, before me, personally appeared Kara E.
Emrich, know to me or satisfactortly proven to be the above-named individual who executed the
foregoing document for the purposes therein contained by signing her name thereon.
~zr-
Notary Public
T "PI NSVI.VANIA
Notarial Seal
Morliol O. ZlI'Chtr, Notary Public
Camp HlU Boro. Cumberland County
My Commission Expires Feb. 8, 2010
Meml)er, PennsylvanIa Association of Notaries
AFFIDAVIT
I, MATTHEW J. EMRICH, of North Wales, Pennsylvania do hereby swear and affirm
the following to be true and correct:
1. I was born on April 16, 1975 and am 31 years of age.
2. I have not received any distributions from the Linda R. Emrich Family
Trust for any reasons whatsoever.
3. I do not intend to receive any distributions from the Linda R. Emrich
Family Trust in the future as my financial future is not dependent upon any
distributions from the Trust.
4. I hold a Bachelors of Science in Business Administration and a Bachelors
of Science in Information Systems and am employed full time by Merck &
Co., Inc. as an Application Services Analyst since March 13,2000 with an
annual salary of approximately $73,000.00.
5. All of my living expenses including, clothing, food, health insurance,
utilities and shelter are provided for solely by me through my earnings.
6. I do not receive any additional financial support from my father, John C.
Emrich.
~/~
Matthew J. Emrich
COMMONWEALTHOFPENNSYLVANIA )
COUNTY OF CUMBERLAND )
On this, the 29ty of /ht r.; vi- , 2006, before me, personally appeared Matthew J.
Emrich, know to me or satisfactonly pr ven to be the above-named individual who executed the
foregoing document for the purposes therein contained by signing his name thereon.
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Notary PubUJ
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Monica D. Zercher. Notary Public
Camp Hill Boro. Cumberland County
My Commission Expires Feb. 8. 2010
Member. Pennsylvania Association of Notaries
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LAST WILL AND TESTAMENT
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I, LINDA R. EMRICH, of Mechanicsburg, Cumberland Coun1ys~eimsYJvania~:: ~
which I declare to be my domicile, do hereby make, publish, and declare this to be.piY' LAST(;~bJ~ ~
AND TESTAMENT, hereby revoking all wills and codicils at any time heretofore made b~e.
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LINDA R. EMRICH
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FIRST: IDENTIFJCA TION OF FA MTI ,V. I am married to JOHN C. EMRICH
(my "spouse" or "husband"), and we have three (3) children: MATTHEW J. EMRICH, KARA
E. EMRICH and KRISTEN L. EMRICH (each my "child" and collectively my "children"). As
used in this Will, the terms "my spouse" or "my husband" shall mean only JOHN C. EMRICH. As
used in this Will, the term "my child" or "my children" refers to my natural children and any adopted
children. As used in this Will, the term "issue" refers to all lineal descendants of the indicated person
of all generations, with the relationship of parent and child at each generation determined by the
definition of "child" and "children" set forth in this paragraph. Applicable to this Will are such other
definitions as set forth in Article EIGHTH.
SECOND: P A YMRNT OF DEBTS AND T AXRS. Except as otherwise provided
in this Will, I direct that all my legally enforceable debts, funeral expenses, expenses of the
administration of my estate, and federal estate and state death taxes, including interest and penalties
thereon, becoming payable because of my death (except any generation-skipping transfer tax
imposed by Section 2601 of the Code or any recapture tax imposed by Section 2032A of the Code)
be paid out of my Residue. Notwithstanding the foregoing, if any tax, including interest and
penalties thereon is imposed on property includible in my gross estate by reason of Section 2044 of
the Code or a similar provision of state law, I direct my executor to recover the tax attributable to
that property from the person or entity in possession of or receiving the property as provided in
Section 2207A of the Code or a similar state law.
THIRD: DISPOSITIONS.
A. General. Except as otherwise expressly provided in this Section, I intend to
dispose of all of my separate property.
B. Personal and Household Rffects. I give to my spouse all of my Personal and
Household Effects, or ifhe shall fail to survive me, then to those of my children who shall survive
me, in substantially equal shares, to be divided among them as my executors shall determine, which
determination shall be conclusive and binding upon all persons interested in my estate.
Notwithstanding the foregoing sentence, my executor in ~ts sole and absolute discretion may include
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my Personal and Household Effects directly in my Residue or sell any such property and include the
proceeds in my Residue. I direct that any expenses incurred in obtaining possession, appraising,
safeguarding, delivering, or selling such property be paid from my estate as an administration
expense. If neither my spouse nor any of my children survives me, my Personal and Household
Effects shall be added to my Residue. Any division and distribution made by my executor shall be
binding upon all parties, including my children.
C. Residue. All the rest, residue and remainder of my property, of every kind
and nature and wheresoever situated, whether real or personal (my "Residue"), I give to the trustee
named in a Living Trust Agreement created on III LI\/. 7 , 2000, between myself and my
spouse as grantors and myself and my spouse as co-trustees, to be held, administered and distributed
according to the provisions contained therein. I confirm and ratify the Living Trust Agreement in
every respect, including any amendments that may be made thereto from time to time.
D. Failure of Trust. Ifmy Living Trust Agreement is revoked prior to my death
or if the distribution of any property pursuant to this Will to the Trustee of my said Living Trust
Agreement is invalid under the governing rules oflaw, any property otherwise devised or bequeathed
to the said Trustee shall be bequeathed to my spouse, if my spouse survives me, or if my spouse fails
to survive me, to my issue who survive me, per stirpes.
E. Method of Pa,yment to Certain Beneficiaries. If any beneficiary to whom my
executor is authorized by this instrument to make distributions is under a legal disability or is, in the
opinion of my executor, incapable of properly managing his or her affairs, my executor may make
such distribution in anyone or more of the following ways:
1. To such beneficiary directly;
of such beneficiary;
2. To the guardian, committee, conservator, or other similar official
3. To a relative of such beneficiary to be expended by such relative
for the benefit of such beneficiary;
4. To a custodian selected by my executor under an applicable
Uniform Transfers to Minors Act;
beneficiary.
5. By my executor expending the same directly for the benefit of such
Any person (other than the beneficiary) who receives a distribution for the benefit of the
beneficiary pursuant to the preceding sentences is authorized to give a valid receipt and discharge
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for the distribution. The distribution to such beneficiary or other person to whom payment is made
or entrusted shall be a complete discharge to my executor, and my executor shall be without
obligation to see to the further application of such distribution.
FOURTH: POWRRS OF ADMTNTSTRA TTON. I confer upon my executor all
powers granted to fiduciaries under the laws of the Commonwealth of Pennsylvania, whether my
estate is administered in Pennsylvania or elsewhere. In addition to the powers granted by law, I
authorize my executor or other legal representatives of my estate:
A. To accept additions to my estate from any source.
B. To acquire the remaining undivided interest in property of my estate in which
my executor, in fiduciary capacity, holds an undivided interest.
C. To invest and reinvest the assets of my estate in securities or in real or
personal property, whether within or outside of Pennsylvania or the United States, without the need
for diversification as to kind or amount and without being limited to investments authorized by law
for fiduciaries. More specifically, but not by way of limitation, I authorize and empower my
executor to:
1. Invest in discretionary common trust funds, mutual funds,
investment trusts, unsecured obligations, stocks, bonds, and real estate.
2. Retain as long as my executor deems proper any real or
personal property or any stocks, bonds, notes or other securities (including securities issued by a
corporate executor) which I own at my death or which are subsequently acquired.
D. To effect and keep in force fire, rent, title, liability, casualty or other insurance
to protect the property of the estate and to protect the executor.
E. With respect to any property, real or personal, or any estate therein owned by
my estate, except where such property or any estate therein is specifically disposed of:
same.
1. To take possession of, collect the rents from and manage the
2. To sell the same at public or private sale, and upon such terms
and conditions, including credit, as to my executor shall deem advisable.
3. To lease, mortgage, partition, or subdivide the same, even
where the terms of such lease or mortgage shall extend beyond the administration of my estate.
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4. To abandon property which does not have sufficient economic
value, in my executors' judgment, to make it worth protecting.
5. To repair or improve the same.
six (6) months.
6. To grant options for the sale of same for a period not exceeding
F. With respect to any mortgage held by my estate, to continue the same upon
and after maturity, with or without renewal extension, upon such terms as my executor deems
advisable, or to foreclose, as an incident to collection of any bond or note, any mortgage securing
such bond or note, and to purchase the mortgaged property or acquire the property by deed from the
mortgagor in lieu of foreclosure.
G. To employ any bank or trust company incorporated in the state of my
domicile, any national bank located in the state of my domicile or any private banker duly authorized
to engage in business in the state of my domicile as custodian of any stock or other securities held
as fiduciary, and the cost thereof, except in the case of a corporate fiduciary, shall be a charge upon
the estate.
of a nominee.
H. To cause any stock or other securities to be registered and held in the name.
1. In the case of the survivor of two or more fiduciaries, and except as otherwise
provided in this will, to continue to administer the property of the estate without the appointment
of a succ.essor fiduciary.
J. As substitute or successor executor, to succeed to all of the powers, duties and
discretion of the original executor, with respect to the estate, as were given to the original executor.
K. To contest, compromise or otherwise settle any claim in favor of the estate
or executor or in favor of third persons and against the estate or executor, or to submit the same to
arbitration, without judicial approval.
executor:
L. With respect to any shares of stock or other securities owned by my estate or
1. To vote or refrain from voting, in person or by proxy,
discretionary or otherwise, such shares of stock or other securities.
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2. To pay calls, assessments and any other sums chargeable or
accruing against or on account of shares of stock, bonds, debentures or other corporate securities,
whenever such payments may be legally enforceable against my executor or any property of the
estate or the executor deems payment expedient and for the best interests of the estate.
3. To sell or exercise stock subscription or conversion rights,
participate in foreclosures, reorganizations, consolidations, mergers, or liquidations and to consent
to corporate sales, leases and encumbrances.
M. To execute and deliver agreements, assignments, bills of sale, contracts, deeds,
notes, receipts and any other instruments necessary or appropriate for the administration of the
estate.
N. To make distribution in cash, in kind valued at fair market value of the
proper,ty at the date of distribution, or partly in each, without being required to make pro rata
distributions of such property.
O. To pay all reasonable and proper expenses of administration from the property
of the estate, including the reasonable expense of obtaining and continuing the fiduciary's bond and
any reasonable counsel fees which the fiduciary may incur.
P. To employ and remunerate agents to perform necessary services for the estate
such as, but not limited to: accountants, attorneys, investment advisors, actuaries, appraisers and
custodians.
Q. To borrow in the name of my estate from themselves or others and secure such
loans by mortgage, note, or pledge, at prevailing rates of interest.
R. With regard to any business enterprise which I may own or possess an interest
in at the time of my death, whether incorporated, unincorporated, or operated as a sole proprietorship
or partnership:
1. To retain all or any portion of the business and continue to
operate the same for so long as my executor shall deem advisable.
2. To sell all or any portion of the business, at such time and on
such terms and conditions (including credit), as my executor shall deem advisable. My executor may
sell the business to any person, including a person interested in my estate or a fiduciary serving
hereunder.
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3. To control, direct or manage the business; vote any corporate
shares; select, hire and compensate, or discharge employees, directors and officers of the business;
serve on the board of directors of the business; retain and compensate experts to advise my executor
concerning the management or disposition of the business.
4.
sums of money in the business.
To recapitalize or reorganize the business; invest additional
5. To participate in or consent to any merger, consolidation,
reorganization, dissolution or liquidation of the business.
6. To account for the business as an entity separate from my
estate. In this regard, my executor shall be authorized to retain earnings in the business in
conformity with sound business practice.
7. I exonerate my executor from liability for any loss resulting
from the retention and/or operation of any business enterprise unless such loss shall result from the
executor's gross negligence or willful misconduct.
S. To claim administrative expenses of my estate either as income tax deductions
or as estate tax deductions, in my executor's sole discretion, without regard to whether such expenses
are payable from income or principal, and without the necessity of making adjustments or
reimbursements between principal and income or among the property interests of the various
beneficiaries of my estate. I exonerate my executor from any liability arising from the claim of a
beneficiary of my estate whose entitlement under the terms of my will has been diminished by my
executor's elections.
T. To execute, file and deliver proofs of claim or receipts required to collect all
policies oflife insurance on my life which name my estate as beneficiary; elect any optional modes
of settlement available under such policies; receive, administer and distribute the proceeds of such
policies in accordance with the dispositive provisions of this will. The receipt of my executor shall
constitute full acquittance to any insurance company for policy proceeds paid.
u. To allocate, in their sole and absolute discretion, any amount of the exemption
from generation skipping taxes allowed under Internal Revenue Code, Section 2631 (a), to property
of which I am the transferor, including property transferred during my lifetime to which no
allocation has previously been made, without the necessity of making adjustment or reimbursement
to any person as a result of such allocation.
v. To join with my surviving spouse in the execution and filing of:
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1. a joint income tax return for any period prior to my death for
which I have not filed a return and to agree as to the apportionment of any joint tax liability.
2. a gift tax return on gifts made by my surviving spouse and to
consent to treat such gifts as being made one-half (12) by me, for any period prior to my death.
W. In the event that any of my tangible personal property is doIi'ated to a charitable
organization(s) then my fiduciary is instructed to use the value of said donationes) as an inheritance tax
deduction for any inheritance tax: return which may be required to be filed as a consequence of my death.
X. To disclaim any interest in property which would devolve to me or my estate
by whatever means, including but not limited to the following means: as beneficiary under a will,
as an appointee under the exercise of a power of appointment, as a person entitled to take by
intestacy, as a donee of an inter vivos transfer, and as a donee under a third-party beneficiary
contract.
Y. To file the appropriate election in accordance with Section 2056(b)(7)(B)(v)
of the Code to designate whatever portion of the assets comprising my federal gross estate that the
executor, in the executor's sole discretion, determine should qualify for the marital deduction. In
making this determination, the executor is directed to consider the present and proj ected financial
requirements of my spouse, the expected period of survivorship of my spouse and the assets that
have passed to my spouse other than under the provisions of this Will.
Z. To do all other acts in the executor's judgment deemed necessary or desirable
for the proper and advantageous management, investment and distribution of the estate.
My executor may exercise these powers for any pwpose and upon such terms, conditions and
limitations (whether or not to exist longer than the administration of my estate) which in the
judgment of my executor shall be in the best interest of my estate and the beneficiaries thereof.
FIFTH: PAYMENT OFDRATH TAXRS. I direct that all estate, inheritance,
succession, transfer or other death taxes assessed by any taxing authority, whether foreign or
domestic, in respect of all property taxable by reason of my death or by inclusion of such property
in my gross estate for estate tax pwposes, be paid, without apportionment, as directed in the pour
over indenture of trust, the Living Trust Agreement, created IV 0\1 7 ,2000 between myself
and my spouse as Grantors and myself and spouse as co-trustees. However, the aforesaid
notwithstanding, if, at the time of my death, I am the beneficiary of a qualified terminable interest
property (QTIP) trust, and the principal of that trust is includible in my gross estate for tax purposes,
it is my direction, pursuant to the provisions of Internal Revenue Code, Section 2207 A, that my
executors or the trustee of the trust withhold from the shares of the remaindermen of the trust an
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amount by which the estate tax in my estate exceeds the amount of the estate tax which would have
been payable had the trust property not been included in my estate for tax purposes.
SIXTH: PRRSlJMPTTON TN CASR OF STMlJT ,T ANEOlJS DRA TH. In
determining whether a person who may be interested in my estate has survived me or another person,
(1) my spouse shall be deemed to have predeceased me unless it unmistakably appears by proof that he
survived me; and (2) in all other cases, a person shall not be deemed to have survived me or another
person ifhe or she dies within thirty (30) days of my death or of the death of the other person.
SEVENTH: RXRClJTOR.
A. Appointment. I nominate and appoint my husband as executor of this, my will.
If my husband shall fail to survive me, shall decline to act, or having qualified shall, for any reason
thereafter, cease to act, I nominate and appoint MATTHEW J. EMRICH as successor executor in
his place. Any executor, original or successor, named herein may be referred to herein as my
executor.
B. Accountin~ to Successor Rxecutor. Any successor executor is authorized (but
not directed) to accept the assets delivered by or for a predecessor executor on the basis of the
accounting therefor without requiring any audit or other independent accounting of the acts of such
predecessor executor. Any successor executor shall not be liable for, or liable for failure to rectify,
any act or omission of my predecessor executor.
C. Time and Method of Distribution. Final distribution of my estate shall be
made when my executor determines the time to be appropriate. Prior thereto, partial distributions
may be made whenever my executor shall deem it advisable. Distributions may be made in cash or
in kind, or partly in each, and for this purpose, the determination of my executor as to the value of
my property distributed in kind shall be conclusive.
D. Selection of Asset~ for Distrihution. My executor shall in its sole and absolute
discretion select assets or property to be distributed in satisfaction of any devise or bequest in my
Will without respect to the income tax basis of such assets or property. My executor specifically is
excused from any duty of impartiality with respect to the income tax basis of such property.
E. Conflicts ofTnterest. I realize that, in the course of the administration of my
estate, conflicts of interest may develop between beneficiaries of my estate, the Trustee of my Living
Trust Agreement, the beneficiaries of my Living Trust Agreement, and possibly others. For
example, conflicts may develop because of a choice of alternatives involved in valuing assets for
variou's purposes. In the resolution of any conflict of interest, I request (but do not so direct) that my
executor first make a reasonable effort to determine the overall effect of the conflict on the
administration of my estate and in the distributions to be made to the Trustee of my Living Trust
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Agreement and then make reasonable efforts to resolve the conflict by the mutual agreement of the
respective beneficiaries or recipients. In the event that a mutual agreement cannot be reached after
reasonable efforts, my executor shall resolve the conflict in its sole and absolute discretion.
F. Elections and Options. I confer upon my executor the sole and absolute
discretion to exercise any election or option given to my executor under the revenue laws of the
United States or any state in which this Will may be probated or in which property of which I own
an interest at the time of my death may be located. My executor may exercise such discretion
without regard to the relative interests of the beneficiaries of my estate without compensating
adjustments among the beneficiaries of my estate; and notwithstanding the possibility that such
decisions may increase the amount of my taxable estate. Without limiting the generality of the
foregoing sentence, my executor is authorized, in its sole discretion, to claim any expense of
administration of my estate as an estate tax deduction or as an income tax deduction; to elect to
extend the payment of any tax over such period as may seem appropriate to my executor and
available under law; to elect to value my estate under any alternative valuation formula which may
be permitted under the Code; to select the alternative valuation dates for the valuation of my estate;
to make (or not make) in whole or in part the election under ~2133(a) of the Pennsylvania
Inheritance and Estate Tax Act, 72 Pa.C.S.A. ~9113, to subject property to Pennsylvania Estate Tax
on my death and thereby avoid any such tax on my Spouse's death; to disclaim or renounce, in
whole or in part, any gift, inheritance, life insurance or employee benefit payable to or for the benefit
of me or my estate; to join with my Spouse in the filing of any tax returns for any year or years for
which I have not filed such return or returns prior to my death and pay all or such ratable share of
any taxes (together with any interest and penalties thereon) as my executor shall deem proper; and
to consent to any gifts made by my Spouse prior to my death being treated as made one-half(l/2)
by me for the purpose of any gift tax laws and returns.
G. Encumhered Distrihution. My executor is authorized to distribute to any
beneficiary of my estate or to the Trustee of my Living Trust Agreement or to the beneficiary of my
Living Trust Agreement any asset of my estate subject to any and all indebtedness incurred by me
or by my executor which indebtedness, in the sole and absolute discretion or opinion of my executor,
need not be paid first, or to distribute any such property or asset subject to any and all mortgages,
deeds of trust, or the liens, encumbrances, or obligations created by me or by my executor.
H. Special Rlection and Allocation of Generation-Skippinf Transfer Tax
Exemption. I expressly confer upon my executor the sole and absolute discretion to elect under
Section 2652(a)(3) of the Code (which election permits me to be deemed the transferor of the
property for the purposes of the federal generation-skipping transfer tax and the exercise of which
may be advantageous for purposes of generation-skipping transfer tax planning) to treat me as the
transferor of any qualified terminable interest property with respect to which my estate is allowed
a deduction by reason of Section 2056(b )(7) of Code (which permits a "marital" deduction in
calculating the amount of my taxable estate for federal estate tax purposes). I authorize my executor
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to allocate my generation-skipping transfer tax exemption to and among dispositions of property
with respect to which I am the transferor, whether contained in this Will or otherwise, in such
manner as my executor, in my executor's sole discretion, deems best calculated to secure the most
effective utilization of such exemption, based on circumstances and events either known or
reasonably foreseeable as of the expiration of the time within which such allocation is required to
be made. While equality of treatment among different beneficiaries or beneficiary groups should
be an important consideration in allocating such exemption, it should not be the sole or even the
primary consideration. Any allocation so made by my executor shall be binding on all persons
interested in the dispositions with respect to which I am the transferor and my executor shall have
no liability if, as the result of or in light of subsequent events, the benefits of the exemption fall
inequitably, or different allocation would have protected a higher value of assets from generation-
skipping transfer tax. It is my desire (but not direction) that my generation-skipping transfer tax
exemption be allocated, if my Spouse survives me, to property passing to the Family Trust under my
Living Trust Agreement to the maximum extent possible and to the extent of the generation-skipping
tax exemption in excess of the amount allocated to such Family Trust, to qualified terminable
interest property with respect to which my executor has made an election under Section 2652(a)(3)
of the Code or, ifmy Spouse fails to survive me, to my Residue or where appropriate to secure the
most effective utilization of my generation-skipping transfer tax exemption, to property in a Marital
Trust established for me by my Spouse.
1. Executor's Discretion Controlling. Any decision made under this Section or
any other provision of this Will by my executor with respect to any matter shall bind each
beneficiary of my estate, the Trustee of my Living Trust Agreement, the beneficiaries of my Living
Trust Agreement, and any other person however interested in my estate; and my executor shall not
be required to make any compensating adjustments between income or principal or among any
beneficiaries, trustee, or any other person as a result of my executor's action or inaction.
J. I Jahility of Executor. The executor shall be liable only for its own negligence
or willful misconduct.
EIGHTH: DEFINITIONS.
A. .c..ode. All references in this Will to the "Code" shall mean the Internal Revenue
Code of 1986, as amended, and shall be deemed to refer to corresponding provisions of any
subsequent federal tax law.
B. I,iving Trust Agreement. By my "Living Trust Agreement," wherever used
in this Will, I mean the Trust Agreement executed by me and my spouse on \J~. ..., , 2000,
in which myself and my spouse are named co-trustees. Such reference also shall include any
amendments to such Trust Agreement.
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C. Personal and Household Effects. All references in this Will to my "Personal
and Household Effects" shall mean my jewelry, closing, books, china, crystal and silverware,
furniture and furnishings, objects of art, boats, automobiles, club memberships, and all other
personal property of a nature, use, and classification similar to the foregoing, and includes all rights
that I may have under any insurance policies relating thereto. Expressly excluded from this
definition is any tangible personal property regularly used in connection with any business in which
I own any interest.
D. Per Stirpes. All references in this Will to "per stirpes" shall mean a distribution
in accordance with this Section. Except for discretionary distributions that may be made unequally
among a group of beneficiaries, whenever a distribution is to be made to the issue of any person, the
property to be distributed shall be divided into as many shares as there are (1) living children of the
person, and (2) deceased children, who left beneficiaries who are then living, of the person. Each
living child (if any) shall take one share and the share of each deceased child shall be divided among
his or her then living issue in the same manner.
E. Residue. All references in this Will to my "Residue" shall mean all the
remainder of my property, of whatsoever kind (whether real, personal, or mixed, and whether
tangible or intangible) and wheresoever situated (and including all lapsed bequests and devises
which fail for any reason), not specifically disposed of herein. Should I possess one or more powers
of appointment, however, I call attention to the fact that I do not desire to exercise any such power;
neither such power nor any property subject to any such power shall be regarded as part of my
Residue.
NINTH: MTSCELl,ANEODS.
. A. Bond and Compensation. I direct that no executor or other legal
representative of my estate shall be required to furnish any bond or other security in any jurisdiction.
Any executor named herein or otherwise appointed shall be entitled to reasonable fees commensurate
with its duties and responsibilities, taking into account the value and nature of my estate and the time
and work involved, with regard to any statutory provisions as to fees, and if it is a corporation, then
not less than its then current minimum fee for such services. If any licensed attorney or certified
public account shall serve as executor, such person shall be compensated for services rendered on
the basis of such person's customary charges for legal or accounting services.
B. Will Not Contractual. My spouse and I are executing Wills at approximately the
same time, in which each of us is the primary beneficiary of the Will of the other. These Wills are not
being executed pursuant to any contract to make a Will or any contract not to revoke a Will. The Will
of each of us is revocable at any time, whether before or after the death of the other spouse, at the sole
discretion of the spouse making the Will.
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C. Invalid Provisions. If any part of this Will or my Living Trust Agreement shall
be invalid, illegal, or inoperative for any reason, it is my intention that the remaining parts, so far as
possible and reasonable, shall be effective and fully operative. My Executor may seek and obtain court
instruction for the purpose of carrying out as neady as may be possible the intention of this Will as
shown by the terms hereof, including any term held invalid, illegal, or inoperative.
D. Number and Gender. If required by the context of this Will, singular language
shall be construed as plural, plural language shall be construed as singular, and the gender of personal
pronouns shall be construed as either masculine, feminine, or neuter.
E. Terms. Throughout this Will I direct that the term "give" shall be deemed to
include the term "bequeath" or "devise" when appropriate.
F. Headings. All headings used in this Will to describe the contents of each article,
paragraph, or other division are provided for convenience only and shall not be construed to be a part
of this Will.
G. C...overning T ,aw. This Will shall be construed in conformity with the law of the
Commonwealth of Pennsylvania.
IN WITNESS WHEREOF, I sign, seal, publish and declare this instrument as my
last will and testament on this L day of 'l........~ 4.~ 2000.
L~1~
Signed, sealed, published and declared by the above-named Testator, LINDA R. EMRICH, as
and for her Last Will and Testament, in the sight and presence of us, who, at his request, in her sight and
P2f~d ?wesence ofeachofuer, ha:d:7~~;~be;:;1 i:es.
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COMMONWEALTH OF PENNSYLVANIA )
: SS:
COUNTY OF CUMBERLAND )
I, LINDA R. EMRICH, THE TESTATOR, WHOSE NAME IS SIGNED TO THE
FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO
HEREBY ACKNOWLEDGE THAT I SIGNED AND EXECUTED THE INSTRUMENT AS MY
LAST WILL AND TESTAMENT; THAT I SIGNED IT WILLINGLY; AND THAT I SIGNED IT AS
MY FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED.
SWORN OR AFFIRMED TO AND ACKNOWL~RE ME BY LINDA R.
EMRICH, THE TESTATOR, THIS 1 DAY OF ~ ,2000.
~r~~~
LIND R. EMRICH, Testator
(}l!JM.-L~
t}otary Public
-
Notarial Seal
COMMONWEALTH OF PENNSYLVANIA ) Deborah L. Brenneman, Notary Pubftc
SS Camp Hili BoTO, Oumberland County
: : My commiSSIOn Elq3lfeS June 18, 2002 .
COUNTY OF CUMBERLAND ) Member, Pennsylvania Association at Notanes
WE, th/<.IS+; iJt H. S~h/~1L AND /Z/cCL/C C r ~~kbt//r..2.,
THE WITNESSES WHOSE NAMES ARE SIGNED TO THE FOREGOING INSTRUMENT, BEING
DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THAT WE WERE PRESENT
AND SAW THE AFORESAID TESTATOR SIGN AND EXECUTE THE INSTRUMENT AS HER
LAST WILL AND TESTAMENT; THAT SHE SIGNED WILLINGLY AND THAT HE EXECUTED
IT AS HIS FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED; THAT
EACH OF US IN THE HEARING AND SIGHT OF THE TESTATOR SIGNED THE WILL AS
WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATOR WAS AT THE
TIME EIGHTEEN (18) OR MORE YEARS OF AGE, OF SOUND MIND AND UNDER NO
CONSTRAINT OR UNDUE INFLUENCE.
~~~~~
_~RN OR AFFIRMED TO AND SUBSCRIBED TO BEFORE ME, TIllS --r'^- DAY OF
r ,2000. ~{/~
TNESS
/2~, ~. C: A47'
'WITNESS
~)~f. .~(?MA~
NOT AR Notarial Seal
Deborah L. Brenneman, Notary Public
Camp Hill Boro, Cumberland County
My Commission Elq3lres June 18, 2002
Member, Pennsylvania Association at Notaries
....... '1'!"l"
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... shc\wilrs\emrich.1vt
November 1, 2000
LIVING TRUST
OF
JOHN C. EMRICH AND LINDA R. EMRICH
TIDS LIVING TRUST AGREEMENT, is entered into this 7 day of ~,
2000, by and between JOHN C. EMRICH and LINDA R. EMR1CIIof Cwnberland County,
Pennsylvania, the "Grantors", and JOHN C. EMRICH and LINDA R. EMRICH, as the initial
"Co-Trustees" and collectively "Trustee".
The purpose of the Trust is to provide for the beneficiaries, place the active management and
control of Grantors' assets in the hands of the Trustee, avoid probate, and to minimize Federal Estate
Taxes. The Trustee is willing to carry out the duties enwnerated in this Agreement.
NOW THEREFORE, in consideration of the mutual covenants herein set forth and other
good and valuable consideration, the Grantors and the Trustee, intending to be legally bound, hereby
agree as follows:
ONE: IDRNTIFICA TIONS.
1.01 Grantors. All references in this Agreement to "Grantors" shall mean both Grantor-
Husband and Grantor-Wife.
1.02 Grantor-Husband and Grantor-Wife. JOHN C. EMRICH may be referred to
herein as Grantor-Husband. LINDA R. EMRICH may be referred to herein as Grantor-Wife. By
joining in the execution of this Agreement, each Grantor expressly consents to the terms of this
Agreement. Each Grantor further agrees that all property, originally or hereinafter placed in this
Trust shall be held, administered, and distributed by the Trustee as provided in this Agreement or
in any amendment thereto.
1.03 Defmitions. Several terms are used in this Agreement which are defined in Section
FIVE. The Grantors have reviewed in detail those definitions set forth in Section FIVE and direct
that those definitions shall apply throughout this Agreement unless the context in which a term is
used clearly implies another meaning.
TWO: TRUST PROPRRTY; ADDITIONS; AND DISTRIBUTIONS DURING
GRANTOR'S I JIFRTIMR.
2.01 Funding. The Grantors hereby transfer to the Trustee the cash and/or property listed
in the attached Schedule "A", to be held by the Trustee and its successors, IN TRUST,
NEVERTHELESS, for the uses and purposes hereinafter set forth. The Grantors or either of them
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November 1, 2000
or any other person may by instrument in writing, by Will, or by naming the Trustee as beneficiary
of any life insurance, individual retirement accounts, or qualified or no~qualified retirement plans,
deliver to the Trustee additional assets acceptable to the Trustee. These additional assets shall also
be held, administered and distributed pursuant to this Agreement. Unless otherwise provided in this
trust agreement, each of us shall own a separate share in our trust estate which shall consist of an
undivided one-half (1/2) beneficial interest in our trust estate and such interests shall be held as
tenants in common.
2.02 Distributions. While both Grantors are living, the Trustee shall distribute to or for
the benefit of the Grantors, the net income and principal as the Grantors, or either of them, shall
direct in writing. Initially, and until further written notice from the Grantors, or either of them, to
the Trustee, the Trustee shall distribute to the Grantors the net income of the Trust. In the event of
the incapacity of either of the Grantors, then, notwithstanding any prior written instructions, the
Trustee may distribute to or for the benefit of either Grantor so much of the net income and principal
as the Trustee shall determine in its sole discretion to be necessary or appropriate for the health,
maintenance and support of either Grantor. The Trustee shall, for the purpose of this Section, be the
sole judge of the incapacity of the Grantors; no judicial determination shall be required and the
Trustee shall incur no liability to any person whomsoever for making any distribution under this
Section.
THREE: DISPOSITION OF TRUST PROPERTY ON GRANTOR'S DEATH.
3.01 Death of First Grantor. Upon the death of the first Grantor to die, the Trust shall be
divided into two portions to be designated the Marital Fund and the Family Fund.
Trust.
3.02 Marital Fund. The Marital Fund shall be held as a separate trust known as the Marital
3.02.1 Allocations. The Trustee shall allocate to the principal of the Marital Fund
the following:
(i) Property equal in value to the Marital Deduction Bequest. This may include the
interest in the proceeds of any life insurance, individual retirement accounts, or
qualified or non-qualified retirement plans includible in the gross estate of the first
Grantor to die for federal estate tax purposes which are payable to the estate of the
first Grantor to die, and shall include such proceeds which specifically are made
payable to the Marital Trust.
(ii) Any properties which are made payable to or transferred to the Marital Trust by
the deceased Grantor or others by specific reference in a Will or other written
document.
3.02.2 Income and Principal. During the lifetime of the surviving Grantor, the
Trustee shall pay all the net income from the Marital Trust to the surviving Grantor in quarterly or
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November 1. 2000
other convenient installments, but at least annually. The Trustee shall also pay to the surviving
Grantor such amounts of principal as the Trustee may deem necessary for the health, support, and
maintenance of the surviving Grantor, with such terms to be liberally construed. The Grantors
suggest, but do not require, that principal distributions for these purposes be made first from this
Trust rather than from the Family Trust. In addition to the distribution of principal allowed by the
foregoing standards, the surviving Grantor also shall have the right to withdraw such sums as the
surviving Grantor shall request at any time during the lifetime of the surviving Grantor, even to the
exhaustion of the Marital Trust. The right of the surviving Grantor to make these withdrawals shall
be exercised in each case by the surviving Grantor notifying the Trustee in writing to that effect,
specifying the amount desired to be withdrawn. Within a reasonable time thereafter, the Trustee
shall make the distributions directly to the surviving Grantor. In no event and at no time during the
life of the surviving Grantor shall Trustee pay to or apply for the benefit of any person (other than
the surviving Grantor) any portion of the principal of the Marital Trust.
3.02.3 Termination of Marital Trust. Upon the death of the surviving Grantor, the
Trustee shall distribute the remaining principal and undistributed interest to and among the persons,
corporations, trusts, or estates (including the estate of the surviving Grantor) whom the surviving
Grantor shall appoint by Will. The surviving Grantor shall be regarded as having so appointed this
Trust property omy in the event that the Will of the surviving Grantor refers specifically to this
power of appointment. To the extent that the surviving Grantor shall fail to so exercise the foregoing
power of appointment, the then remaining principal of the Marital Trust and any undistributed
income shall be disposed of as follows:
(i) Administration and Other Expenses of Grantor's Spouse. The Trustee may
distribute from the Marital Trust to the Executor or Administrator of the estate of the
surviving Grantor any amount of the remaining undistributed income or principal
(even to the exhaustion thereof) to pay any legally enforceable debts (excluding debts
secured by real estate) and funeral expenses of the surviving Grantor, the expenses
of the administration of the estate of the surviving Grantor, and the federal estate and
state death taxes which may be due because of the death of the surviving Grantor.
The Trustee shall have the sole and absolute discretion to determine the
appropriateness of and amounts of any such distributions. The Trustee shall not be
responsible for the application of the amounts distributed to such executor or
administrator.
(ii) Other Dispositions. The assets remaining in the Marital Trust after the above
distributions shall be added to and become part of the principal of the Family Trust
as if originally a part thereof, to be continued in trust or distributed as provided in
this Agreement. Notwithstanding the preceding sentence, to the extent that an
allocation of Grantor's Spouse's generation-skipping transfer tax exemption under
Section 2631 of the Code (the "GST exemption" under Section 2631) is not made as
to any asset remaining in the Marital Trust after the above distributions, the Trustee
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November 1, 2000
may set apart, in a separate Trust or Trusts (rather than adding such assets to the
Family Trust), assets equal in value to such assets as to which such election was not
made, with such set apart assets to be continued in trust or distributed as provided in
Sections 3.03 of this Agreement. Any such division into a separate Trust shall be
made on the basis of the value of the assets on the date of such division.
3.03 Family Fund.
3.03.1 Allocations. The remaining trust estate not allocated to the Marital Fund shall
be allocated to the Family Fund and shall be held as a separate trust known as the Family Trust. The
Family Trust also shall contain property allocated to the Marital Fund with respect to which the
surviving Grantor or the personal representative of the surviving Grantor has made a qualified
disclaimer. If the surviving Grantor disclaims property which consists of or included an income
interest in the Marital Trust, then a proportionate share of trust principal shall pass in the same
manner as the disclaimed interest.
3.03.2 Principal and Income. After the death of the first Grantor to die, the Trustee
shall have the power to accumulate and distribute the net income of the Family Trust in quarter- '
annual installments, or more frequently if the Trustee deems it advisable, to or for the benefit of the
surviving Grantor. In addition, at any time and from time to time, the Trustee have the power to
distribute the principal of the Family Trust to or for the surviving Grantor, the Grantors' children,
and the descendants of the Grantors' children in order to provide for their health, support,
maintenance, and education. The Grantors suggest, but do not require, that principal distributions
to the surviving Grantor for these pmposes be made first from the Marital Trust and second from the
Family Trust. In addition, the surviving Grantor shall have the absolute power to withdraw from
the principal such amount in anyone calendar year, which amount shall be up to the greater of Five
Thousand Dollars ($5,000) or five percent (5%) of the aggregate value of the principal of the Family
Trust at the time of such withdrawal as he or she personally may, in writing to the Trustee, demand
at any time and from time to time; this right of withdrawal shall not be cumulative.
3.03.3 Standards for Distribution. It is the Grantors' desire that, in determining
which beneficiaries of the Trust shall receive distributions after the death of the first Grantor to die
and during the lifetime of the surviving Grantor, the Trustee shall give preference to the needs of the
beneficiaries in the following order: first to the surviving Grantor, second to the Grantors' children
and, on a per stirpes basis, the living children of a deceased child of the Grantors, and third to the
Grantors' other descendants. It is the Grantors' intention that the beneficiaries be enabled, insofar
as possible, to maintain the standard of living to which they are accustomed. In determining what
distributions, if any, should be made, the Trustee may (but is not so directed to) take into
consideration all other sources of income or principal available to each beneficiary. The Trustee may
make unequal distributions among the beneficiaries, and no such distributions shall be taken into
account upon final distribution of the Trust properties.
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3.03.4 Property Disclaimed by Spouse. The surviving Grantor shall be deemed
to have survived the first Grantor to die for purposes of this administration of property which was
re-allocated to the Family Fund from the Marital Fund because a qualified disclaimer was made by
the surviving Grantor or the personal representative of the surviving Grantor.
3.03.5 Death of Surviving GrantorlDivision of Family Trust. Upon the death
of the surviving Grantor, the Trustee shall divide and partition the Family Trust into separate
portions of equal value, one portion for each child of the Grantors who survives such event and one
portion for the descendants of each child of the Grantors who fail to survive such event but who
leaves descendants who survive such event. Each separate portion for each child of the Grantors
who survives the Grantors and who is at least thirty (30) years of age at the time of such division and
partition shall be distributed to such child. The portion for each child of the Grantors who survives
such event but who is not at least thirty (30) years of age at the time of such division and partition
shall be held by the Trustee as a separate Trust and each such separate Trust shall be designated by
the name of the particular child of the Grantors. Each such Trust shall be held and administered for
the benefit of the child of the Grantors whose name designates that particular Trust and for that
child's descendants. The portion of the Family Trust for each child of the Grantors who shall fail
to survive such event but who leaves descendants who survive such event shall be distributed to such
descendants, per stirpes; subject, however, to the other provisions of this Agreement.
(i) Distributions of Income and Principal. The Trustee, in its sole and
absolute discretion, shall accumulate the income of each Trust or shall
distribute to and among the beneficiaries of each Trust such amounts of
income and principal (even to the exhaustion thereof) as are necessary for the
health, support, maintenance, and (where applicable) education of the
respective beneficiaries, with such standards to be construed liberally. In
determining what distributions, if any, should be made, the Trustee may (but
is not so directed to) take into consideration all other sources of income and
principal available to each beneficiary. The Trustee may make unequal
distributions among the beneficiaries of each Trust and no such distributions
shall be taken into account in determining the respective shares of
beneficiaries upon the final distribution or division of each Trust.
(ii) Distribution Priorities. It is the Grantors' desire that, in determining
which beneficiaries of each Trust shall receive distiibutions, the Trustee shall
give preference to the needs of the beneficiaries of the Trust in the following
order: first to the child of the Grantors whose name designates that Trust,
second to the descendants of such child whose name designates such Trust
taken on a per stirpes basis at the time of any distribution, and third to the
further descendants of such child whose name designates such Trust.
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3.03.6 Final Distribution of the Family Fund. At the Distribution Date, or as soon
thereafter as is reasonably practicable, the Trustee shall make the following dispositions of the
properties in the Trusts established from the Family Trust. For purposes of this section, the term
"Distribution Date" shall mean the date of death of the surviving Grantor.
(i) Twenty-Five Years or Older. As to any child of the Grantors who has
reached his or her twenty-fifth (25th) birthday at the Distribution Date, the
Trustee shall distribute to such child one-third (1/3) of the principal and
Undistributed income then remaining in the Trust 'of such child. The balance
of the Trust estate shall be continued in trust for the beneficiary of such Trust,
as set forth in Section 3.03.5.
(ii) Younger Than Twenty-Five Years. As to any such Trust created for a
surviving child of the Grantors who has not reached his or her twenty-fifth
(25th) birthday at the Distribution Date, the trustee shall retain such share in
Trust hereunder for such child; and when such child reaches his twenty-fifth
(25th) birthday, the Trustee shall distribute to such child one-third (1/3) of the
principal and undistributed income then remaining in the Trust hereunder for
such child. The balance of the Trust estate shall be continued in trust for the
beneficiary of such Trust, as set forth in Section 3.03.5.
(iii) Termination of Trust at Age Thirty. When any child of the Grantor has
reached his or her thirtieth (30th) birthday, the Trustee shall distribute to such
child the principal and undistributed income then remaining in the Trust of
such child and such Trust shall terminate.
3.03.7 Special Power of Appointment in Child Dying Before Trust Distribution.
As to any child of the Grantors for whom a trust is designated pursuant to Section 3.03.5 but who
dies before reaching his or her thirtieth (30th) birthday, upon the death of such child the Trustee shall
distribute all the principal and undistributed income then remaining in the Trust for such child as
follows:
(i) Exercise of Power. In such proportions and in such manner, outright or
in trust or otherwise, to or for the benefit of anyone or more persons or
corporations as such child may appoint by specific reference hereto in his or
her Will admitted to probate; provided, however, that such child shall have
no power to appoint any principal or any undistributed income of the Trust
to himself, to his or her estate, to his or her creditors, or to the creditors of his
or her estate.
(ii) Non-Exercise of Power. If such child shall not validly and effectually
exercise the foregoing power of appointment with respect to the entire
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November 1, 2000
principal and undistributed income of his or her Trust, then such part as he
or she shall not effectually appoint shall be distributed to the descendants of
such child, living at the death of such child, per stirpes; or, if such child has
no descendants then living, then to my descendants living at the death of such
child, per stirpes.
3.04 Contingent Trust for Persons Less than Age Thirty. Notwithstanding the preceding
provisions of this Agreement, this Section shall apply if any part of any Trust created in this
Agreement would, upon partial or final termination of the Trust, be distributed to a beneficiary (other
than a child of the Grantor) who has not reached his or her thirtieth (30th) birthday, and no other
Trust is created in this Agreement for that beneficiary. If the Trustee, in its sole discretion so elects,
that portion shall be retained by the Trustee as a separate Trust for the benefit of the beneficiary.
Until the beneficiary reaches his or her thirtieth (30th) birthday, the Trustee shall have the power to
accumulate all or a part of the income of that Trust or to distribute so much of the income and
principal ofthat Trust to or for the benefit of the beneficiary as the Trustee, in its sole judgment and
discretion, deems necessary for the health, support, maintenance, and education of the beneficiary.
When the beneficiary reaches his or her twenty-fifth (25th) birthday, the Trustee shall distribute one-
third (1/3) of the then remaining principal and undistributed income of the Trust to the beneficiary.
When the beneficiary reaches his or her thirtieth (30th) birthday, the Trustee shall distribute all of the
then remaining principal and undistributed income of the Trust to the beneficiary. If the beneficiary
dies before reaching his or her thirtieth (30th) birthday, the Trustee shall distribute the then remaining
principal and undistributed income of the Trust to the estate of the beneficiary.
3.05 Spendthrift Clause. All trusts created in this Agreement shall be Spendthrift Trusts.
3.06 Handling "Flower Bonds". Notwithstanding any other provision of this Agreement,
if at the time of the death of either Grantor, the Trustee holds in any Trust in this Agreement any
United States Treasury obligations which qualify for redemption at par in the payment of federal
estate taxes imposed on the estate of the decedent, the Trust shall terminate in favor of the estate of
the deceased Grantor to the extent the obligations can be used for such payment, and the Trustee
shall deliver such obligations to the personal representative of such estate. The Trustee shall not be
responsible for the application of such obligations by the personal representative. In no event,
however, shall the Marital Trust terminate in favor of, or shall distribution of the Marital Trust be
made to or for the benefit of, the estate of the first Grantor to die.
3.07 Undistributed Income Added to Principal. Any income of any Trust except the
Marital Trust not distributed with the first sixty-five (65) days following the end of the taxable year
of the Trust shall be added to the principal thereof and administered as part of such principal.
3.08 Distribution to Beneficiary for Whom Trust Already Established. If any
distribution of any property previously held in trust under this Agreement for any beneficiary is to
be made to another beneficiary (other than the surviving Grantor) for whom at that time the Trustee
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November 1, 2000
holds property in any trust, then such distribution, in the Trustee's sole and absolute discretion, may
be made to the latter beneficiary or may be added to and become a part of the latter beneficiary's
trust.
FOUR: APPOINTMENTS; AMENDMENTS; CHANGE IN TRlJSTEE.
4.01 Appointment of Trustee. The Grantors hereby appoint JOHN C. EMRICH and
LINDA R. EMRICH as the "Co-Trustees" and collectively "Trustee" of this Revocable Living
Trust Agreement.
4.02 Designated Successor Trustee. Upon the death of the first Grantor to die, PNC
BANK, N.A. shall be appointed Co-Trustee along with the surviving Grantor or such other Trustee
as may have been appointed. Upon the death of the surviving Grantor, PNC BANK, N.A., shall
serve as the successor Trustee.
4.03 Powers Reserved by the Grantors. The Grantors reserve, during the lifetime of
both Grantors, the right to amend, modify, or revoke this Agreement, in whole or in part, at any time
or times, by notice in writing signed by both Grantors and delivered to the Trustee, and such
amendment, modification, or revocation shall be effective immediately upon actual delivery to the
Trustee. This Agreement and Trusts herein shall become irrevocable upon the death of the first
Grantor to die.
4.04 Changes Requiring Consent of Trustee. No amendment of this Agreement by the
Grantors (other than the removal of the corporate Trustee by the Grantors) which effects the
Trustee's duties, liabilities, or compensation shall be effective unless accepted in writing by the
Trustee.
4.05 Definition of Trustee; Distribution of Powers. The Trustee, whether one or more,
whether male or female, whether individual or corporate, whether original, successor, or substitute,
is herein called Trustee. Except as expressly provided otherwise, each Trustee shall have the same
duties, powers and discretions.
4.06 Trustee Limitations. Upon the death of the first Grantor, no trustee who is a beneficiary
hereunder shall ever participate in (1) the exercise of, or decision not to exercise, any discretion to pay
income or principal to or to apply income or principal for the benefit of, any beneficiary (including
discretion to allocate funds among a group of beneficiaries and discretion to accumulate income), (2)
the determination whether a beneficiary is disabled, (3) the decision to terminate any trust hereunder,
(4) the exercise of discretion to allocate receipts or expenses between principal and income, (5) decisions
to exercise tax options or (6) the selection of the property to be allocated to the marital trust.
4.07 Resignation of Trustee. Any Trustee may resign at any time without court approval
by giving written notice thereof to the Grantors, or either of them during the life of both Grantors,
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otherwise to those persons who could in the discretion of the Trustee receive income from the Trust
estate and are at such time sui juris. No purchaser from, or other person dealing with, any Trustee
is obligated to examine such Records, and any such person acting in good faith shall be protected
in all transactions with any Trustee whether or not any such replacement has taken place. If the
original Trustee and all successor Trustees named herein, or if any other successor Trustee shall
resign, or otherwise cease or fail to serve during the lifetime of both Grantors or either of them then
the Grantors or either of them shall appoint a successor Trustee in the manner set forth in the next
section of this Agreement.
4.08 Removal of Trustee. Any Trustee may be removed under this agreement as follows:
4.08.01 While both Grantors are alive and legally competent and ifboth Grantors
agree, they shall have the right to remove any Trustee appointed under this agreement at any time
with no requirement that the removed Trustee receive any reason for such termination.
4.08.02 After the death of one of the Grantors or when both Grantors are alive but
only one Grantor is legally competent, any Trustee appointed under this trust agreement may be
removed by the competent Grantor at any time for cause.
4.08.03 After the death or legal incompetency of both Grantors, any Trustee may be
removed by a majority vote of the beneficiaries then entitled to receive income or principal
distributions under this trust agreement or their respective personal representatives at any time.
4.08.04 Written notice of the removal under this agreement shall be effective
immediately when signed by the person or persons authorized to make the removal and delivered
to the Trustee personally or deposit by United States certified mail, return receipt requested. The
written notice removing a Trustee shall designate a successor Trustee.
4.08.06 The Trustee so removed shall promptly transfer and deliver to the successor
Trustee all property of the trust under the Trustees' possession and control.
4.09 Powers of Trustees. In addition to the powers given to them by law, all Trustees in
their fiduciary capacity acting hereunder, whether or not named herein, shall have the following
. discretionary powers applicable to all property held by them, effective without court order and until
actual distribution:
4.09.01 To retain any property received by them without regard to any principal of
investment diversification.
4.09.02 To invest in all forms of property, without restriction to investments
authorized by law and without regard to any principal of investment diversification.
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November 1, 2000
4.09.03 To operate any business; to cause or join in any incorporation, partnership,
or other form of association, recapitalization, merger, reorganization, liquidation or voting trust plan;
to deposit investments under agreements and pay assessments; to delegate discretionary authority
with respect to any of such actions an~ generally to exercise all rights of investors.
4.09.04 To compromise controversies.
4.09.05 To buy, exchange, or sell real or personal property publicly or privately, for
such prices and on such terms as they deem proper; to lease for any term regardless of the duration
of any trust hereunder; and to give options for these purposes without obligation to repudiate them
in favor of a higher offer.
4.09.06 To abandon any property which the disinterested fiduciary, in such
fiduciary's sole discretion, deems to be in the best interests of the trust and its beneficiaries.
4.09.07 To borrow money from any source and to mortgage or pledge estate or trust
assets as security.
4.09.08 To hold investments in the name of a nominee.
4.09.09 To employ and compensate as they deem appropriate, without diminution of
any fiduciary's compensation hereunder, any brokers, advisors, professional persons and other agents
and, in their discretion, to delegate revocably investment and management discretion to any such
broker, advisor, professional person or agents.
4.09.10 To make distributions in cash or in kind or partly in each at fair market values
on the date of distribution.
4.09.11 In any division of principal into separate trust or shares, and in any
distribution of trusts or shares, to allocate to any trust, share, or beneficiary, property different from
the property allocated to another trust, share or beneficiary, as the disinterested fiduciary, using fair
market values on the date of division of distribution, deems appropriate; provided, however, that this
power shall not be exercised in a manner contrary to any specific allocation of property elsewhere
in this instrument or in a manner that renders ineligible all or any part of any gift for any tax
deduction.
4.10 Powers and Duties of Successor Trustee. Upon the appointment and qualification
of any successor Trustee, the same duties shall devolve upon, and the same rights, powers,
authorities, privileges, and discretions shall inure to it as to the Trustee originally designated
hereunder; and all rights, powers, authorities, privileges, and discretion shall be exercised without
the supervision of any court.
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4.11 Reorganization of Corporate Trustee. If a corporate Trustee should, before or after
qualification, change its name; be reorganized, merged, or consolidated with, or acquired by any
other corporation; or be converted into or assign its trust functions to a different type of entity, the
resulting entity shall be deemed a continuation of the former one and shall continue to act as Trustee
or continue to be eligible to become a Trustee, as the case may be.
4.12 Investments in Common Trust Funds of a Bank. Notwithstanding anything
contained in this instrument to the contrary, if any of the Trust estate is invested in a bank's or other
entity's common trust fund, removal of such bank or other entity as Trustee shall be subject to the
following provisions:
4.12.01 The authority of such Trustee to invest in the common trust fund shall
continue, and the transfer or payment of the Trust assets need not be made, until the first valuation
date of the said common trust fund which occurs at least thirty (30) days after written notice has been
given to the Trustee.
4.12.02 If Trust assets are invested in more than one common trust fund, the
authority of such Trustee to invest in the common trust fund shall continue, and the transfer or
payment of the Trust assets need not be made, until a valuation date of each common trust funds has
occurred at least once in the period beginning thirty (30) days after written notice has been given to
the Trustee.
4.13 Compensation. A Trustee shall be entitled to receive reasonable compensation for
such fiduciary's services hereunder. A corporate Trustee shall be entitled to receive compensation
for its services hereunder in accordance with its published fee schedule in effect when the services
are rendered to the trust by the corporate trustee, but not in excess of such compensation as would
be approved by a court of competent jurisdiction.
4.14 Concerning Self-Dealing. No rule of law against self-dealing, dividing loyalty, or
conflict of interest shall be applied to render any transaction effected by the Trustee void, voidable,
or otherwise subject to attack solely for violation of such rule, nor shall the Trustee incur any
liability, nor shall any Trustee commissions for acting hereunder be reduced, solely for the violation
of such rule. Any transaction which involves self-dealing, divided loyalty, or conflict of interest by
the Trustee shall be judged by the rules of law which would apply to the same transaction at arm's
length between strangers free of any element of self-dealing, divided loyalty, or conflict of interest.
Thus, by way of illustration and not of limitation, all Trustees are authorized, without giving any
notice required by statute, to:
4.14.01 Employ and compensate any Trustee or any affiliate as broker, agent, or
professional advisor for any purpose.
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shc\wills\em rich. Ivt
November 1, 2000
4.14.02 Borrow from the commercial department of any corporate Trustee or any
affiliate at current interest rates.
4.14.03 Buy, retain, and sell any debt or equity security issued or underwritten by
any cooperate Trustee or any affiliate and any debt security secured, supported, and/or otherwise
enhanced by a letter of credit issued by any corporate Trustee or any affiliate.
4.14.04 Buy, retain, and sell any security of any investment company or trust
registered under the Investment Company Act of 1940 to which any corporate Trustee or any
affiliate renders services for compensation.
4.14.05 Buy property from or sell property to any beneficiary or Trustee acting
hereunder or otherwise on arm's length terms.
An "affiliate" means any entity which owns directly or indirectly, an interest in any corporate
Trustee, any equity in which any corporate Trustee owns an interest directly or indirectly, and any
entity which any corporate Trustee owns an interest directly or indirectly, and any entity in common
control with any corporate Trustee.
FIVE: DRFTNTTTONS.
5.01 Survive. Except as otherwise provided in this Article Eleventh, paragraph A, for
purposes of this instrument, one person shall be regarded as having survived another only if the
former, survived the latter by thirty (30) days or more. However, if the Grantor-Wife actually
survives the Grantor-Husband, the Grantor-Wife shall be deemed to have survived the Grantor-
Husband whether or not such survival is by thirty (30) days or more. If the order of death of the
Grantors cannot be established by direct evidence, then for purposes of this Agreement, the Grantor-
Wife shall be presumed to have survived the Grantor-Husband.
5.02 Issue, Descendants, and Children. Whenever used in this Agreement, the word
"issue" or the word "descendants" shall mean legitimate descendants of whatever degree, including
descendants both by blood and adoption. Any reference in this Agreement to the Grantors'
"children" shall included not only the natural and adopted children of the Grantors living or deceased
at the date this Agreement is signed, but also any child or children thereafter born to the marriage
of the Grantors or adopted by both of them.
5.03 Per Stirpes. All references in this Agreement to "per stirpes" shall mean a
distribution in accordance with this Section. Whenever a distribution is to be made to the
descendants of any person, the property to be distributed shall be divided into as many shares as
there are (1) living children of the person, and (2) deceased children, who left beneficiaries who are
then living, of the person. Each living child (if any) shall take one share and the share of each
deceased child shall be divided among his or her then living descendants in the same manner.
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November 1, 2000
5.04 Code. All references in this Agreement to the "Code" shall mean the Internal
Revenue Code of 1986, as amended, and shall be deemed to refer to corresponding provisions of any
subsequent federal tax law.
5.05 Education. Whenever used in this Agreement, the term "education" shall include
elementary, secondary, college, and postgraduate study or vocational training or study, so long as
pursued to advantage by the beneficiary at an institution of the beneficiary's choice. In determining
distributions for education, the Trustees may consider the beneficiary's reasonable living expenses.
5.06 Spendthrift Trust. Wherever used in this Agreement, the term "Spendthrift Trust"
shall mean a trust no part of the income or principal of which ever shall be transferred or assigned
by any beneficiary or distributee, or subjected to any judicial process against any beneficiary or
distributee before the same has been paid. No part of the interest of any beneficiary or distributee
shall in any event be subject to sale, hypothecation, assignment, or transfer. Nor shall the principal
or income of any Spendthrift Trust estate be liable for the debt of any beneficiary or distributee. Nor
shall any part of the principal or income be seized, attached, or in any manner taken by judicial
proceedings against any beneficiary or distributee on account of the debts, assignments, sale,
divorce, or encumbrance of any beneficiary or distributee. In accordance with these provisions, the
Trustee shall pay to the beneficiary or distributee the sum payable to the beneficiary according to
the Trust terms, notwithstanding any purported sale, assignment, hypothecation, transfer, attachment,
or judicial process, exactly as if the same did not exist. Nothing contained in this Section shall be
construed as restricting the exercise of any power of appointment granted in this Agreement.
5.07 Marital Deduction Bequest. . All references in this Agreement to the "Marital
Deduction Bequest" shall mean the smallest amount of the principal that will, through use of the
marital deduction, eliminate federal estate tax in the deceased Grantor's estate or reduce it to the
lowest possible figure, after taking into account the unified credit and the credit for state death tax
(but only to the extent state death taxes are not increased thereby), as well as all marital and other
deductions allowed with respect to assets passing under this bequest.
In determining the amount of this pecuniary bequest, if any property not passing under this
Trust is included in the deceased Grantor's gross estate for federal estate tax purposes, and such
property might, if the deceased Grantor's executor so elects, be treated as "qualified terminable
interest property" qualifying for the marital deduction, then all of such property shall be deemed to
be allowed as marital deduction, notwithstanding that the deceased Grantor's executor may in fact
elect to qualify less than all thereof for the marital deduction; with respect to any gift made by the
deceased Grantor during the deceased Grantor's lifetime with respect to which a gift tax return has
not been filed prior to the deceased Grantor's death and which might, if the deceased Grantor's
executor should so elect, be treated as "qualified terminable interest property" qualifying for the gift
tax marital deduction, it shall be assumed that the election in fact will be made; no portion of the
Family Fund shall be deemed qualified for the marital deduction; and with respect to any trust or
similar arrangement to which ~2113 of the Pennsylvania Inheritance and Estate Tax Act would
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November 1, 2000
otherwise apply, it shall be deemed that the deceased Grantor's executor will elect to have that
section not apply to any part of the trust, notwithstanding that the deceased Grantor's executor my
in fact elect to have such election apply to a part or all of the trust.
In making the computations necessary to determine the amount of this pecuniary gift, values
finally determined for federal estate tax purposes shall be used. This allocation may be satisfied in
cash or in kind, or partly in cash and partly in kind. The assets, including cash, hereby allocated
must be selected in such a manner as to have an aggregate fair market value fairly representative of
appreciation or depreciation in the property between the date of valuation for federal estate tax
purposes and the date or dates of allocation. This allocation shall carry with it, as income and not
as corpus, its proportionate share of all net income received during the administration of the
deceased Grantor's estate.
5.08 Qualified Disclaimer. Wherever used in this Agreement, the term "qualified
disclaimer" shall mean an irrevocable and unqualified refusal by a person to accept an interest in
property provided it also meets the conditions of Section 2518(b) of the Code.
SIX: MISCELI,ANEODS.
6.01 Situs of Trusts. The Trusts created herein shall be Pennsylvania Trusts and shall,
in all respects, be governed by the laws of the Commonwealth of Pennsylvania. If, however, the
Trustee, in their sole discretion, determines that a change of situs 'Yould be beneficial to the purposes
of any separate Trust established by this instrument, the Trustee shall have the discretion and
authority to change the situs of any such Trust to another state. If the situs of any such Trust is
changed to another state, then the Trust shall, in all respects, be governed by the laws of the state in
which is the new situs. No such change of situs shall be authorized herein, however, that would
result in a termination of the Trust for federal tax purposes.
6.02 Use of Word. As used in this Agreement, whenever the context so indicates, the
gender of all words shall include the masculine, feminine, and neuter, and the number of all words
shall include the singular and plural.
6.03 Maximum Duration of Trust. Notwithstanding any other provision of this
Agreement, if any Trust herein created or herein authorized (by power of appointment or otherwise)
has not otherwise fully terminated under the terms of this Agreement, then that Trust shall terminate
fully and all principal and undistributed income shall be distributed to the respective income
beneficiary or beneficiaries at the end of twenty (20) years and eleven (11) months after the date of
the last to die of the Grantors and the Grantors' descendants who are living at the date this
Agreement is executed.
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November 1, 2000
6.04 Parties Bound. This Agreement shall extend to and be binding upon the Trustee,
the Grantors, and upon their heirs, executors, administrators, successors and assigns, and the
beneficiaries designated in this Agreement.
6.05 Invalid Provisions. If any part of this Agreement shall be invalid, illegal, or
inoperative for any reason, it is the Grantors' intention that the remaining parts, so far as possible
and reasonable, shall be effective and fully operative. The Trustee may seek and obtain court
instructions for the purpose of carrying out as nearly as may be possible the intention of this
Agreement as shown by the terms hereof, including any terms held invalid, illegal, or inoperative.
6.06 Headings. The headings used throughout this Agreement have been inserted for
administrative convenience only, and do not constitute matter to be construed in interpreting this
Agreement.
IN WITNESS WHEREOF, JOHN C. EMRICH and LINDA R. EMRICH, as Grantors
and JOHN C. EMRICH and LINDA R. EMRICH, collectively as Trustee, have hereunto set their
hands and seals the day and year first above written.
Witness:
(}J-r~
(1J.'f~
~/~~ ~~
;;
~,,4.. c ~..;..
C. Emnch, Grantor
(SEAL)
~""....; ;e &,... A . -4<SEAL)
Li R. Emrich, Grantor -
.
~- -4- 4!!:...~. ..l' ~ At.-
000 C. Emrich, Trustee
(SEAL)
~~ f} ~~~EAL)
a R. Emrich, Trustee
15
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November 1, 2000
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~\.a.vd
)
: ss.
)
On this, ~ day ~~~~, 2000, before me personally appeared 'JOHN C.
EMRICH and LINDA R. EMRICH, known to me (or satisfactorily proven) to be the persons
whose names are subscribed to the within instrument and acknowledged that they executed the same
for the purposes therein contained.
IN WITNESS THEREOF, I hereunto set my name and seal.
~J ".;1~==-
otary Public -
Notarial Seal
oebOf8h L Brenneman. Notary PubI1C
Camp Hili Boro. Cumberland County
My Commission Expires June 18. 2002
MCflTli)eT, PennsylVania AsSOCIation of Notaries
16
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November 1, 2000
EXHIBIT "A"
TRUST PROPERTY
This Exhibit "A" shall govern the contents of the corpus of the Living Trust of John C.
. Emrich and Linda R. Emrich including, but not limited to the following:
All of our joint and individual brokerage accounts or other stocks,
bonds, mutual funds, or treasury bills or other such securities if any.
?J1 ftpoe>
te
~ .:.r:::.
C"c- . ~-"- "~...-
C. Emrich, Grantor .
~ I~ ~~"A . ~,g
Lin . Emnch, Grantor
COMMONWEALTH OF PENNSYLVANIA
. COUNTY OF ~ \a...-d
)
: ss.
)
On this, 'l""" day _~~tf. Ca fA , 2000, before me personally appeared JOHN C.
EMRICH and LINDA R. EMRICH, known to me (or satisfactorily proven) to be the persons
whose names are subscribed to the within instrument and acknowledged that they executed the same
for the purposes therein contained.
IN WITNESS THEREOF, I hereunto set my name and seal.
{Mvit ~~-
Notary Public
Notarial Seal
Deborah L Brenneman, Notary Public
Camp Hili 801'0, Cumberland County
My. CominIsalon Expires June 18, 2002
MioIll',lhJt, Pinnaylvtnla Association of Notaries
.' .
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shc\wills\emrich.lvt
November 1, 2000
PROPERTY AGRREMRNT
This PROPERTY AGREEMENT is entered into on 1 ~ .2000 in the COWlty
of Cumberland, Commonwealth of Pennsylvania, by and between, JOHN C. EMRICH, Grantor-
Husband, and LINDA R. EMRICH, Grantor-Wife.
ONE. FACTUAl, SUMMARY
1.01 Since the date of their marriage, Grantor-Husband and Grantor-Wife have acquired
property as joint tenants with right of survivorship (JTWROS).
.1.02 Grantor-Husband and Grantor-Wife established an estate plan using a Revocable
Living Trust and companion Pour Over Wills, and they wish to convert all joint tenancy property
that will be or has been transferred into the name of the Revocable Living Trust into tenants in
common property.
1.03 Grantor-Husband and Grantor-Wife are aware that they may by agreement convert
their joint tenancy assets to tenants in common which will allow them to have more control over
their respective interests in the property on each of their deaths.
TWO. AGRRRMRNT TO CHANGE JOINT ASSETS TO TENANTS IN COMMON
2.01 As to all joint tenancy property transferred into the name of the LIVING TRUST OF
JOHN C. EMRICH AND LINDA R. EMRICH and outlined in Exhibit A, Trust Property, Grantor-
Husband and Grantor-Wife hereby agree that all such trust property shall be characterized as tenants
in common rather than joint tenancy.
2.02 Grantor-Husband and Grantor-Wife intend this Property Agreement to be binding on
themselves and on all others as to joint tenancy property transferred into the name of the LIVING
TRUST OF JOHN C. EMRICH AND LINDA R. EMRICH.
The parties sign this Property Agreement on the date first written above.
WITNESS:
~;tfG7 -
d<,~~ ~~
~ c::- J:::.~ :'~l
C-re1iN C. EMRICH
fi!Z: ..'&" ~ ~ '-~4
L A R. EMRICH
~ ' .')
shc\wills\emrich.lvt
November 1, 2000
COMMONWEALTH OF PENNSYLVANIA )
: ss.
COUNTYOF CHlb~l~ )
On this, ,~ day _L)~2000, before me personally appeared JOHN C.
EMRICH and LINDA R. EMRICH, known to me (or satisfactorily proven) to be the persons
whose names are subscribed to the within instrument and acknowledged that they executed the same
for the purposes therein contained.
IN WITNESS THEREOF, I hereunto set my name and seal.
J~~
Notary Public
-
Notarial seal Public
Deb0f8h L Brenneman. Noandta~
HI" BolO. Cufri:)eri 2002
~~mlS8lon Expires June 18. .
. Association ot Notanes
MOII,J,,;, Pennsylvan.a
~ '.'~
shc\wills\emrich.lvt
November 1, 2000
IMPORT ANT REMINDER
YOUR I,TVTNG TRUST WILL ONLY CONTROL PROPERTY
WHICH HAS BEEN TRANSFERRED INTO THE NAME OF THE
TRUST. IF PROPERTY IS NOT IN THE NAME OF THE TRUST,
IT MAY BE SUBJECT TO PROBATE COURT PROCEEDINGS
AND MAY NOT PASS ACCORDING TO YOUR ESTATE PLAN.
ALL ASSETS SHOULD BE IDENTIFIED BY LISTING THEM ON
THE SCHEDULES IN THE SECTION OF YOUR T,TVTNG TRUST
ENTITLED "TRUST PROPERTY". COPIES OF CORRESPONDENCE
AND DOCUMENTS OF OWNERSHIPS FOR TRUST ASSETS
SHOULD ALSO BE PLACE IN THAT SECTION.
20
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REY-485 EX (05-04) _~_
SAFE DEPOSIT 'UN'
BOX INVENTORY
PA Department of Revenue
~al Security or Death Certificate Number
48500041046
PLEASE USE ORIGINAL FORM ONLY
Date of Death County Code Year File Number
~ F;m~ GElIEmEJ
~ L'WD
ADDRESS OF 9,ECEDEf'lT l~ 1 ~ I. . CITY:"
~CR G .- w CX) d b 01". V""-e l.- VLtt ~ (.~ t..-VL. V J+
NAME AND ApDRESS OF PE~ON REQUfiSTlNG THE OPENING OF THE SAFE DEPOS BOX
NAME: J<:>h,. fI C. <-uk" c..h. .
STREET ADDjij';SS: L . I ~ IlL I" '". h CITY: "7) ,I'l ~ STATE:
"'1lR WOOd I-J'(". 'V\~'-Vta..bt..US lb1.. F'T ',OSv
. NAME, ADDRESS AND RELA: ONSHIP. (IF ANY) TO DECEDENT, OF PERSON(S) PRES T AT THE BOX OPENING
a. NA:,j ktA C. RE :rIO~~~
STREET tf~RESt: ~~ku...
b. NAM~ Sa.. V\.. R 10
STREET ~~sr:
c. NA~lo'L 1
STREET ADDRESS:
ltz.-\t2...
NAME AND ADDRESS OF FINANCIAL. INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
STATE:
i 10)()
MI
EJ
ZIP CODE:
ZIP CODE:
PlTE:
ZIP CODE:
7aL)
:-II
ne:
ZIP CODE:
-'bt
~;;'M~r
C &UA,q} l~' tffTY: fU--
STATE:
ZIP CODE:
17~f.,
NAME: 1> Nc.... ~4 JJ. t4- .
I
STREET tf~~S{ Co"v1lY{iL ~ l.e..
. NAME O~ PERSON MAKlN~LAST ENTRY
...Joh. . 'z.,MrtC h
DAlE pF CONTRACT TO RENT BOX
l\toV , 1'3 , 'lboO
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
a. NAMEJ' LCC-
vvUI\ . &VVtrt C /1\
STREjii f.DDREJ)S: _ I 'l-..
,lP L-OY\.~ ~OOc l:>r.
CIT'(: 1\ II STATE:
V v I.tC t.1ttVVlC <;,.0l1A. fJyt
ppeTE:
ZIP CODE:
lid II
ZIP CODE:
t . D~O
b. NAMtlvtd~ (I..', ~VVl('iC h
STREE"4;DDRESt UJQjd P yo .
CITY: ch1t<. ~(.sh lJ...t SpAJ4:
Ultl- ~e~J
,11g~~:
NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY 't-., ' ~
, ~I cl- (')/.MA..J1'l
WAS A WILL IN THE BOX? 0 YES Jij' NO If yes, a. Date of will:
b. Name and address of personal representative, If named In the will
NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
c. Name and address of attorney, If any
NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
L
48500041046
48500041046
-.J
.
-~~ ...
REV-485EX SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
Page
of
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by
name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock.
(3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership,
i.e., jointly held, payable on death, ,etc.
(4) Bonds:, Designate by name, amount, serial number, or other designation. (Bearer Bonds), .,,' ,
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank
and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of Indebtedness: List and describe as fully as possible.
(8) All other contents.
(9) Return completed form to: DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
ITEM
NO.
l.
"'2-.
3.
4.
S.
to.
ITEM DESCRIPTION
Ll U l
LAc)-
It> .
lily w~tl "'- bra
\l
\2-.
(-3,
4- t?J lJ2 L 0'Yte, u>6bd b r.
PRINT
~~u,
PRINT TITLE
A-i+cr~
DATE
P E AND CHECK APPROPRIATE BOX BELOW:
-oil Co, CMllCH
CHECK APPROPRIATE BOX:
j(l Executor(trix) D Administralor(trlx)
D Estate Representative D Joint owner of safe deposit box
/0 - ;)../-<:.:J
NOTE: Attach additional 81/a" xii" sheet(s) If necessary or use duplicates ofthls page of form.
The Department is authorized by law, 42 U.S.C. ~5 (c)(2)(CXi), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the
Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information In exchange' of tax information agreements
with Federal and local taxi authorities. The state law rohibits the Commonwealth's rsonnet from disclosi confidential tax information exce t for official rposes.