HomeMy WebLinkAbout11-08-06
JOAN C. BEREN
FORM 1500
PENNSYLVANIA INHERITANCE TAX RETURN DECEDENT
DATE OF DEATH: FEBRUARY 8, 2006
FILE NUMBER: 21-06-390
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Form 1500
T ABLE OF CONTENTS
1. Rev-1500, Inheritance Tax Return
2. Last Will and Testament dated December 5, 2005
3. Schedule B, Item 1 - Valuation
4. Schedule B, Item 2 - Valuation
5. Schedule E, Item 3 - Valuation
6. Schedule G, Item 1- Valuation
7. Schedule J - Disclaimer of Interest in Residuary Trust
REV-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
Beren, Joan C.
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
02-08-2006
09-07 -1934
OFFICIAL USE ONLY
FILE NUMBER
II 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
390
NUMBER
056-28-9224
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
o 8. Total Nurnber of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
213 Market Street, 3rd Floor
Harrisburg, PA 17101-2121
(1 )
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
None
27,482.53
None
None
97,363.78
None
177,780.02
12,072.17
696.34
13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
OFFICIA~SE ONLY
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
Beren, Daniel E.
[!] 1. Original Return D 2. Supplemental Return
D 4, Limited Estate D 4a. Future Interest Compromise (date of death after
12-12-82)
[!] 6. Decedent Died Testate (Attach D 7. Decedent Maintained a Living Trust (Attach
copy of Will) copy of Trust)
D 9. Litigation Proceeds Received D 10 Spousal PovertY Credit (date of death between
. 12-31-91 and 1-1-95)
THIS SECTION MUST BE. COMPLETED. ALL CORRESPONDENCE A1\1DCONF1DENTIAL TAX1NFORMAnON SHOQLDBE DIRECTED '1'0:
NAME COMPLETE MAILING ADDRESS
Daniel E. Beren
FIRM NAME (If applicable)
TELEPHONE NUMBER
(717) 237-4801
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. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) D Separate Billing Requested
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
120. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
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(8) 302,626.33
(11 )
12,768.51
289,857.82
15.Amount of Line 14 taxable at the spousal tax rate, 251,780.02 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0
i= 16.Amount of Line 14 taxable at lineal rate 18,077.80 x .045 (16)
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a- 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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() i 18. Amount of Line 14 taxable at collateral rate 20,000.00 .15 (18)
x x
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I- 19. Tax Due
(19)
(12)
(13)
(14)
289,857.82
-...- --
0.00
813.50
0.00
3,000.00
3,813.50
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00:
Decedent's Complete Address:
STREET ADDRESS
59 S. Terrace, Wormsleysburg, PA 17043
CITY Wormleysburg
ISTATE PA
IZIP 17043
Tax Payments and Credits:
1 Tax Due (Page 1 Line 19)
2 Credits/Payments
A Spousal Poverty Credit
8 Prior Payments
C Discount
(1 )
3,813.50
0.00
Total Credits (A + 8 + C)
(2)
0.00
3 InleresUPenalty if applicable
D Interest
E Penally
TotallnteresUPenally (0 + E) (3)
4 If Line 2 is greater than Line 1 + line 3, enter the difference This is the OVERPAYMENT (4)
Check box on Page 1 Line 20 to request a refund
5 If line 1 + line 3 is greater than Line 2. enter the difference This is the TAX DUE (5)
A Enter the interest on the lax due (5A)
8 Enter the total of line 5 + 5A This is the BALANCE DUE (58)
3,813.50
3,813.50
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Did decedent make a transfer and: Yes No
a retain the use or income of the property transferred; ~ ~
b retain the right to designate who shall use the properly transferred or its income; x
c retain a reversionary interest; or. -.. [.'xx
d receive the promise for life of either payments, benefits or care?
2 If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? 0 0
3 Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 W
4 Did decedent own an Individual Retirement Account, annuily. or other non-probate property which
contains a beneficiary designation? W 0
IF ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
Unde' pen 0 01 poqUl]/, 1 declare thotl have e.amlned Ihis relum, including a=mpenylng schodules ond slatement" ond to Ihe be,1 of my knoWledge and belief Ills lruo. correcl end
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Da " E. eren . /\ , 59 S.. Terrace
sl~R~f PERSON~15P~Ns~~~i~--tFETDRN--'-------AOf;REs5-~~!~eysbur~..~!.':__.~7043 --._-~...--...IL~5A~1:-
Make Check Payable to REGISTER OF WILLS, AGENT
/2.rA..W tJ J
SIGNAT\JRE OFPREPARER5THER THANREPRESENTATivE-'-'-
R. Michael Daniel
_ m______..._______....._,________ . _._~jilil:. 2.~tJ.~_
AOORESS Cohen & Grigsby, PC 15th Floor, 11 O(tE
Stanwix Street
Pittsburgh, PA 15222
For dales of death on or after July 1. 1994 and before January 1, 1995. the tax rale imposed on the net value of transfers 10 or for the use of the
surviving spouse is 3% [72 P S 99116 (a) (t 1) (i)J
For dates of death on or after January I, 1995, the tax rate imposed on the net value of transfers 10 or for the use of the surviving spouse is 0%
[72 P S. 99116 (a) (t 1) (U)J The statule does not exemol 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 !i9116 (a) (1 2)]
The lax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries Is 4 5%, except as noted in 72 P S
99116 12) [72 P S 99116 (a) (l)J
The tax rate imposed on the nel value of transfers to or for the use of the decedent's Siblings Is 12% [72 P.S 99116 (a) (t 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-1503 EX+ (5-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Beren, Joan C.
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21-06-390
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 Fidelity Account #677-015148 - See attached valuation. 25.267.13
2 116.172 shares of Sensient Technologies Corporation 19.07 2.215.40
TOTAL (Also enter on Line 2, Recapitulation) 27,482.53
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TN< RETURN
RESIDENT DECEDENT
Beren, Joan C.
FILE NUMBER
21-06-390
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the rtght of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 2002 Audi
VALUE AT DATE
OF DEATH
21.000.00
2 Miscellaneous Jewelry and Furs
53.000.00
3 Aetna Life Insurance Policy #G-1390939 insuring life of spouse, Daniel E. Beren -
See attached valuation.
23.363.78
TOTAL (Also enter on Line 5, Recapitulation)
97.363.78
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev-1510 EX+ (6-98)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Beren, Joan C.
FILE NUMBER
21-06-390
ESTATE OF
This schedule must be completed and filed ~ the answer to any of questions 1 through 4 on the reverse side of the REV-150D COVER SHEET is yes
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE
1 Fidelity IRA Account #49009155402 - Payable 177.780.02 177.780.02
spouse, Daniel E. Beren. See attached valuation.
TOTAL (Also enter on Line 7, Recapitulation) 177.780.02
(If mDre space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Beren, Joan C.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-390
ESTATE OF
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
5,904.17
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Social Security Number(s) f EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State Zip
2.
Attorney's Fees
Daniel E. Beren
2,500.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Daniel E. Beren
Street Address 59 S. Terrace, Wormsleysburg, PA 17043
City Wormleysburg State PA Zip 17043
Relationship of Claimant to Decedent Spouse
3,500.00
4.
Probate Fees
168.00
See continuation schedule(s) attached
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL (Also enter on line 9, Recapitulation)
12,072.17
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Beren, Joan C.
IFILE NUMBER
21-06-390
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
At Your Service Limo - Transportation for family members to and from funeral
services
322.00
2
Myers-Harner Funeral Home - Funeral expense
5.319.00
3
Pine Street Presbyterian Church - Reimbursement for funds advanced for food for
memorial service
263.17
Subtotal
5.904.17
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-84
PROBATE FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Beren, Joan C.
IFILE NUMBER
21-06-390
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Register of Wills - Cost of grant of letters testamentary
168.00
Subtotal
168.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B4 (Rev. 6-98)
Rev-1512 EX+ (6.98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Beren, Joan C.
FILE NUMBER
21-06-390
ESTATE OF
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Cingural Wireless - Telephone service
VALUE AT DATE
OF DEATH
36.34
2 Emergency Life Team EMS - Medical services rendered
480.00
3 Medical Staffing Network - Medical services rendered
180.00
TOTAL (Also enter on Line 10, Recapitulation)
696.34
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc,
Form PA-1500 Schedule I (Rev. 6-98)
REV 1513 EX+ (9 00)
ESTATE OF
NUMBER
I.
1
2
3
4
5
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Beren, Joan C.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions, and transfers
under Sec. 9116(a)(1.2)]
FILE NUMBER
21-06-390
RELATIONSHIP TO
DECEDENT
Do Not Ust Trustee(s)
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
Daniel E. Beren
59 S. Terrace
Wormleysburg, PA 17043
Spouse
251,780.00
Day C. Beren
119 Mabry Street
Sebastian, FL 32958-5737
Son
6,025.93
Jane S. Beren
313 Aronimink Drive
Royersford, PA 19468
Daughter
6,025.94
Beth McKinley
Niece
5,000.00
Sandra Beren
3204 Shawnee Green
Ambler, PA 19002
Daughter
6,025.93
See continuation schedule attached Continuation 15,000.00
Total 289,857.80
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Joan c. Beren 056-28-9224 02/08/2006
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
6 Davis Trimmer
Nephew
7 Julia Trimmer
Niece
8 Lloyd Trimmer
Nephew
5,000.00
5,000.00
5,000.00
Total 15,000.00
1
Estate of Joan C. Beren
PA File Number 21-06-390
Calculation of Schedule J
Net Value of Estate
Daniel E. Beren, Spouse
Personal Property
IRA
$ 74,000.00
177,780.02
Cash bequests per Article One
Beth McKinley
Davis Trimmer
Julia Trimmer
Lloyd Trimmer
Daniel E. Beren disclaimed interest in
residuary trust; therefore, shares
distributable outright to:
Day Beren
Sandra Beren
Jane Beren
$ 289,857.82
251,780.02
$ 38,077.80
5,000.00
5,000.00
5,000.00
5,000.00
$ 18,077.80
6,025.93
6,025.93
6,025.94
WILL
Cu ;rJ,e~L&uD
I, JOAN C. BEREN, of~in County, Pennsylvania, make this will, hereby
revoking all my former wills and codicils.
ARTICLE ONE
SPECJFIC BEQUEST OF TANGIBLE PERSONAL PROPERTY AND CASH BEQUESTS
S 1.1 I bequeath all my tangible personal property, exclusive of any such
property used in a trade or business, in accordance with the terms of a signed and dated
memorandum I may prepare. If no such memorandum is located or received by the executor
within sixty (60) days after being appointed as such, after conducting a reasonable search for
such memorandum, the executor shall be held harmless for distributing such property as
hereinafter provided.
S 1.2 I bequeath any such property not disposed of by such memorandum, or all
of such property if no such memorandum is so located or received, to my husband, DANIEL E.
BEREN, ifhe shall survive me. If my said husband shall fail to survive me, I give such property
to our children who survive me to be divided among them a they may agree. In the event they
fail to agree, the oldest child shall select one item to be followed by the next oldest child who
shall likewise select one item to be followed by the youngest child. The selection process shall
continue in a like order (oldest to youngest) until all items have been selected.
S 1.3 I direct that the expenses of storing, packing, shipping, insuring and
delivering any such property to the beneficiary entitled thereto shall be paid by the executor as an
administrative expense of my estate. In addition, to the extent practicable in the executor's sole
discretion, I bequeath any policies of insurance on such property to the beneficiary entitled to
such property.
S 1.4 I bequeath five thousand dollars ($5,000) to my following named nieces
and nephews who survive me: LLOYD TRIMMER, DAVIS TRIMMER, JULIA TRIMMER
and BETH MCKINLEY.
ARTICLE TWO
MARITAL DEDUCTION TRUST
S2.1 If my husband, DANIEL E. BEREN (hereinafter referred to as the
Beneficiary), survives me, or is presumed to have survived me as hereinafter provided, I devise
and bequeath to the trustee hereinafter named an amount equal to the value of the residue of my
estate, (determined on the basis of the values finally determined for federal estate tax purposes)
reduced by the maximum amount, if any, which will produce a federal taxable estate of a value
that, after allowing for my available applicable credit amount (also known as the unified credit)
will result in the minimum amount of federal estate tax being imposed on my estate. This trust,
to be known as the Marital Trust, may be composed of cash, or partly of cash and partly of
property in kind, and shall be funded only with property which qualifies for the federal estate tax
marital deduction in my estate, valued at the date of distribution, and which, to the extent other
property is available, shall not include property for which a foreign death tax credit is available.
S2.2 The trustee shall hold, manage, invest and reinvest the trust property, shall
collect the income thereof and shall distribute the net income in quarter-annual installments, or
more frequently if the trustee deems it advisable, to or for the benefit of the Beneficiary.
- 2 - .
92.3 The trustee shall distribute to the Beneficiary such amounts from the
principal of the trust property as the Beneficiary shall from time to time request, without any
limitation in amount.
92.4 The trustee shall distribute to or for the benefit of the Beneficiary so much
of the principal of the trust property as the trustee shall from time to time deem necessary or
proper for the Beneficiary's health, maintenance, comfort and support, taking into account other
available funds, including the Beneficiary's assets, and it is my desire that the trustee make liberal
expenditures for such purposes.
92.5 Upon the Beneficiary's death, the trustee shall distribute the trust property
to such persons or corporations (including the Beneficiary's estate), in such amounts and upon
such trusts, terms and conditions as the Beneficiary by the Beneficiary's last will may appoint by
specific reference to this general power of appointment. Any property not so appointed shall be
added to and distributed as part of the portion of my estate disposed of by ARTICLE THREE of
this will.
ARTICLE THREE
DISPOSITION OF RESIDUE
93.1 I devise and bequeath to the trustee hereinafter named the balance of the
residue of my estate for the benefit of my husband, DANIEL E. BEREN (hereinafter referred to
as the Beneficiary), in trust, for the following purposes:
93.2 The trustee shall hold, manage, invest and reinvest the trust property, shall
collect the income thereof and shall distribute the net income in quarter-annual installments, or
more frequently if the trustee deems it advisable, to or for the benefit of the Beneficiary.
- 3 -
93.3 The trustee shall distribute to or for the benefit of the Beneficiary so much
ofthe principal of the trust property as the trustee shall from time to time deem necessary or
proper for the Beneficiary's health, maintenance and support, taking into account other available
funds, including the Beneficiary's assets; provided, however, it is my wish and not my direction
that no such distribution be made until the principal of the trust created by ARTICLE TWO of
this will is expended or exhausted.
93.4 Upon the Beneficiary's death, the trustee shall distribute the balance of the
trust property to such one or more of my issue, in such amounts and upon such trusts, terms and
conditions as the Beneficiary by the Beneficiary's last will may appoint by specific reference to
this special power of appointment. Any such property not so appointed shall continue, or upon
my death if the Beneficiary does not survive me all the residue of my estate shall be held, as one
fund for the benefit of my then living issue, in trust for the following purposes:
93.5 The trustee shall divide the trust property into the same number of equal
shares as there are children of mine then living and deceased children of mine with issue then
living. One (1) such share shall be distributed to the then living issue, per stirpes, of each
deceased child of mine, subject to the provisions of ARTICLE FOUR of this will, and one (1)
such share shall be held for the benefit of each of my then living children, in trust for the
following purposes:
93.6 The trustee shall hold, manage, invest and reinvest the trust property, shall
collect the income thereof and shall distribute the net income in quarter-annual installments, or
more frequently if the trustee deems it advisable, to or for the benefit of such beneficiary.
- 4-
S3.7 The trustee shall distribute to or for the benefit of such beneficiary so
much of the principal of the trust property as the trustee shall from time to time deem necessary
or proper for such beneficiary's health, maintenance, support and complete education, including
college and graduate education, and professional, vocational or technical training, and to assist
such beneficiary with his or her reasonable wedding expenses, in the purchase of a principal
residence or in the establishment of a profession or of a business considered a good risk by the
trustee, taking into account other available funds, including such beneficiary's assets.
S3.8 At any time after such beneficiary attains thirty (30) years of age and prior
to attaining thirty (35) years of age, such beneficiary may withdraw such sums as do not exceed
one-third (113) of the market value of the principal of his or her trust as constituted on his or her
thirtieth (30th) birthday, or on the later establishment of his or her trust.
S3.9 At any time after such beneficiary attains thirty-five (35) years of age and
prior to attaining forty (40) years of age, such beneficiary may withdraw such sums as do not
exceed one-half (1/2) of the market value of the principal of his or her trust as constituted on his
or her thirty-fifth (35th) birthday, or one-half (1/2) of the market value of the principal of his or
her trust as constituted on the establishment thereof if such beneficiary's trust is established on or
after his or her thirty-fifth (35th) birthday.
S3.10 At any time after such beneficiary attains forty (40) years of age, such
beneficiary may withdraw any or all of the principal of his or her trust.
S3.Il If such beneficiary dies before the complete termination of his or her trust,
the trustee shall distribute the property then held in trust for such beneficiary to such one or more
of my issue, in such amounts and upon such trusts, terms and conditions as such beneficiary by
- 5 -
his or her last will may appoint by specific reference to this special power of appointment. Any
property not so appointed shall be distributed to such beneficiary's then living issue, per stirpes,
or if none, to my then living issue, per stirpes. If I have no issue then living, the trustee shall
distribute the trust property as though my husband and I had then died unmarried and intestate,
each seized and possessed of one-half (112) of such property and residents of the Commonwealth
of Pennsylvania.
ARTICLE FOUR
TRUST FOR BENEFICIARY UNDER 35 YEARS OF AGE
94.1 Except as otherwise provided in this will, if any beneficiary (other than a
child of mine or an appointee under any power of appointment granted by this will) is entitled to
receive a mandatory distribution of property (other than trust income), and is under thirty-five
(35) years of age, the trustee shall hold such property for the benefit of such beneficiary, in trust,
for the following purposes:
94.2 While such beneficiary is under twenty-one (21) years of age, the trustee
shall hold, manage, invest and reinvest the trust property, shall collect the income thereof and
shall apply to or for the benefit of such beneficiary so much of the net income and, if the net
income is insufficient, so much of the principal of the trust property as the trustee shall deem
necessary or proper for such beneficiary's health, maintenance, support and complete education.
The trustee shall annually accumulate any net income not so distributed and add the same to the
principal of the trust property.
94.3 After such beneficiary attains twenty-one (21) years of age, the trustee
shall continue to hold, manage, invest and reinvest the trust property, shall collect the income
- 6 -
thereof and shall distribute the net income in quarter-annual installments, or more frequently if
the trustee deems it advisable, to or for the benefit of such beneficiary.
g4.4 After such beneficiary attains twenty-one (21) years of age, the trustee
shall distribute to or for the benefit of such beneficiary so much of the principal of the trust
property as the trustee shall from time to time deem necessary or proper for such beneficiary's
health, maintenance, support and complete education, including college and graduate education,
and professional, vocational or technical training, and to assist such beneficiary with his or her
reasonable wedding expenses, in the purchase of a principal residence or in the establishment of
a profession or of a business considered a good risk by the trustee, taking into account other
available funds, including such beneficiary's assets.
g4.5 At any time after such beneficiary attains twenty-five (25) years of age and
prior to attaining thirty (30) years of age, such beneficiary may withdraw such sums as do not
exceed one-third (1/3) of the market value of the principal of his or her trust as constituted on his
or her twenty-fifth (25th) birthday, or on the later establishment of his or her trust.
g4.6 At any time after such beneficiary attains thirty (30) years of age and prior
to attaining thirty-five (35) years of age, such beneficiary may withdraw such sums as do not
exceed one-half (112) of the market value of the principal of his or her trust as constituted on his
or her thirtieth (30) birthday, or on the later establishment ofms or her separate trust.
g4.7 At any time after such beneficiary attains thirty-five (35) years of age, such
beneficiary may withdraw any or all ofthe principal of his or her trust.
~4.8 If such beneficiary dies before the complete termination of his or her trust,
the trustee shall distribute the property then held in trust for such beneficiary to such persons or
- 7 -
corporations (including such beneficiary's estate), in such amounts and upon such trusts, terms
and conditions as such beneficiary by his or her last will may appoint by specific reference to this
general power of appointment; provided, however, any portion of the trust property not subject to
such beneficiary's power of withdrawal immediately prior to his or her death may only be
appointed to such persons or corporations (other than such beneficiary's estate, his or her
creditors or the creditors of his or her estate), in such amounts and upon such trusts, terms and
conditions as such beneficiary by his or her last will may appoint by 'specific reference to this
special power of appointment. Any property not so appointed shall be distributed to such
beneficiary's then living issue, per stirpes, or if none, to my then living issue, per stirpes. If!
have no issue then living, the trustee shall distribute the trust property as though my husband and
I had then died unmarried and intestate, each seized and possessed of one-half (1/2) of such
property and residents of the Commonwealth of Pennsylvania.
ARTICLE FIVE
APPOINTMENT OF FIDUCIARIES
95.1 I appoint my husband, DANIEL E. BEREN, executor of this will. Ifhe is
unable or unwilling to act or continue as executor for any reason whatsoever, I appoint my
children, DAY BEREN, SANDRA B. RITTER and JANE BEREN, successor executors.
95.2 I appoint my husband, DANIEL E. BEREN, trustee of any trust created by
this will. Ifhe is unable or unwilling to act or continue as trustee for any reason whatsoever, I
appoint my children, DAY BEREN, SANDRA B. RITTER and JANE BEREN, successor
trustees.
95.3 I appoint my husband, DANIEL E. BEREN, guardian of the estate of any
minor beneficiary of my estate. Ifhe is unable or unwilling to act or continue as guardian of the
- 8 -
estate, I appoint my children, DAY BEREN, SANDRA B. RITTER and JANE BEREN,
successor guardians of the estate.
95.4 Every successor or additional trustee shall have all rights, powers,
privileges and duties, whether discretionary or otherwise, herein given to the original trustee and
shall be subject to the same reservations, limitations, terms and conditions.
ARTICLE SIX
COMPENSATION OF FIDUCIARIES
96.1 An individual fiduciary shall be entitled to receive reasonable
compensation for such fiduciary's services hereunder.
ARTICLE SEVEN
POWERS OF FIDUCIARIES
97.1 No fiduciary under this will shall be required to give bond or other security
for the faithful performance of the fiduciary's duties.
97.2 Any such fiduciary shall have the following powers, in addition to those
given by law:
97.3 To invest in, accept and retain any real or personal property, including
stock of a closely held corporation or stock of a corporate fiduciary or its holding
company, without restriction to legal investments; provided, however, if any
property that forms a part of the principal of the trust established by ARTICLE
TWO oftrus will is unproductive, my husband, DANIEL E. BEREN, may at any
time and from time to time by a written notice require the trustee of said trust
either to make any or all of such property productive or to convert such property
within a reasonable time after the trustee receives such notice;
97.4 To sell, exchange, partition or lease for any period of time any real or
personal property and to give options therefor for cash or credit, with or without
security;
97.5 To borrow money from any person including any fiduciary acting
hereunder, and to mortgage or pledge any real or personal property;
- 9-
97.6 To hold shares of stock or other securities in nominee registration form,
including that of a clearing corporation or depository, or in book entry form or
unregistered or in such other form as will pass by delivery;
97.7 To engage in litigation and compromise, arbitrate or abandon claims;
97.8 To make distributions in cash, or in kind at current values, or partly in
each, allocating specific assets to particular distributees on a non-pro rata basis,
and for such purposes to make reasonable determinations of current values;
97.9 To determine the apportionment of receipts and expenses, including
extraordinary cash dividends, stock dividends, capital-gain dividends of regulated
investment companies and proceeds and expenses of the sale of unproductive real
estate, between income and principal, such apportionment to be made so as to
balance fairly the interests of any income beneficiary and the remaindermen;
97.10 To make elections, decisions, concessions and settlements in connection
with all income, estate, inheritance, gift or other tax returns and the payment of
such taxes, without obligation to adjust the distributive share of income or
principal of any person affected thereby;
97.11 To payoff any loans I may have taken against any life insurance policies
owned by me that remain unpaid at the time of my death;
97.12 To merge any trust created hereunder with any other trust or trusts created
by me or my spouse under will or deed, if the terms of any such trust are then
substantially similar and held for the primary benefit ofthe same person or
persons;
97.13 To allocate, in the executor's sole and absolute discretion, any portion of
my exemption under section 2631(a) ofthe Internal Revenue Code to any property
as to which I am the transferor, including any property transferred by me during
my lifetime as to which I did not make an allocation prior to my death;
97.14 To disclaim any interest I may have in any estate if the executor deems
such disclaimer to be in the best interests of my estate and the beneficiaries
thereof; and
97.15 To allocate between the trusts established by ARTICLE TWO and
ARTICLE THREE of this will any property that is not includible in my estate for
administration purposes, but which is paid directly to the trustee and is not
otherwise designated for a specific trust, in such shares as the trustee deems
appropriate, except that a sufficient amount of such property shall be allocated to
the trust established by ARTICLE TWO of this will to enable my estate to take
advantage of the federal estate tax marital deduction to the extent indicated;
provided, however, any portion of such property that does not form a part of my
- 10 -
gross estate for federal estate tax purposes shall be allocated to the trust
established by ARTICLE THREE of this will and shall not be used for the
payment of death taxes, debts or administrative expenses.
ARTICLE EIGHT
PROVISION FOR TAXES
~8.1 All estate taxes, inheritance taxes, transfer taxes and other taxes of a
similar nature payable by reason of my death to any government or subdivision thereof upon or
with respect to any property subj ect to any such tax, and any penalties thereon, shall be paid by
the executor out of the principal of that portion of my estate disposed of by ARTICLE THREE of
this will, and all interest with respect to any such taxes shall be paid by the executor out ofthe
income or principal or partly out of the income and partly out of the principal of such portion of
my estate, in the absolute discretion of the executor, without reimbursement from or
apportionment among the beneficiaries, recipients or owners of such property for any such taxes,
penalties or interest; provided, however, except as hereinafter indicated, the executor shall not
pay any such taxes, penalties or interest attributable to any property included in my estate solely
because of a power of appointment thereover which I possess but have not exercised or any
qualified terminable interest property.
ARTICLE NINE
MISCELLANEOUS PROVISIONS
99.1 Any term used in the singular or plural, or in the masculine, feminine or
neuter form, shall be singular or plural, or masculine, feminine or neuter as a proper reading of
this will may require.
- 11 -
99.2 As used in this will, the term "Internal Revenue Code" shall mean the
Internal Revenue Code of 1986, as amended from time to time, or the corresponding provision of
subsequent law.
99.3 If at the time a mandatory distribution of property from any trust created
by this will would otherwise be made to a beneficiary for whom there is in existence any trust
(other than the trust from which such distribution is made) created by this will for the benefit of
such beneficiary, the property otherwise to be distributed to such beneficiary shall be added to,
form a part of, and be distributed in accordance with the terms of the trust herein created for such
beneficiary.
99.4 Whenever the trustee is authorized or directed to distribute property "to or
for the benefit of' any beneficiary under the age of twenty-one (21) years, the trustee may
distribute such property to the person who has custody of such beneficiary, may apply such
property for the benefit of such beneficiary, may distribute such property to a custodian for such
beneficiary, whether then serving or selected and appointed by the trustee (including the trustee),
under any applicable Uniform Transfers to Minors Act or Uniform Gifts to Minors Act, may
distribute such property to a guardian of such beneficiary's estate, or may distribute such property
directly to such beneficiary, without liability on the part of the trustee to see to the application of
such property.
99.5 Except as otherwise maybe provided in this will, during the continuance
of any of the trusts created under the provisions of this will, and thereafter until the property is
distributed to and received by any beneficiary hereunder, the principal sums thus held in trust for
any beneficiary, and the income thereof, shall not be subject to or liable for any contracts, debts,
- 12 -
engagements, liabilities or torts of such beneficiary now or hereafter made, contracted, incurred
or committed, but shall be absolutely free from the same, and such beneficiary shall have no
power to sell, assign or encumber all or any part of the principal sums or such beneficiary's
interest therein respectively, or the income thereof, or to anticipate the income.
99.6 Notwithstanding any other provision of this will, upon the expiration of
twenty-one (21) years after the death of the last survivor of my spouse and my issue living on the
date of my death, the trusts created hereunder shall forthwith terminate and the trust property
shall be distributed to the beneficiary then entitled to the income of the trust property or, ifthere
is more than one such beneficiary, to the beneficiaries then entitled to the income ofthe trust
property in proportion to their respective interests therein or, if such interests are not defined, in
equal shares to such beneficiaries.
99.7 If my husband, DANIEL E. BEREN, and I die under such circumstances
that it is impossible to determine which of us survived, it shall be conclusively presumed and this
will shall be construed as if my said husband had not survived me.
99.8 If any trust created hereunder is (or becomes) the beneficiary of any
benefits from a stock bonus, pension, profit-sharing or other retirement benefit plan or any
individual retirement account (individually, a "Plan"), then as to each such Plan account:
(i) The trustee shall withdraw from such Plan and take such other action
as is necessary to assure that the Plan distributes to the trust annually an amount which shall not
be less than the greater of (i) the amount required to be distributed by Section 401(a)(9) of the
Code or Section 408(a)(6) of the Code, as the case may be, or (ii) an amount equal to the net
income earned by the Plan during such calendar year;
- 13 -
(ii) Irrespective of whether my account in the Plan is designated as
principal for trust accounting purposes, the trustee shall allocate to income that portion of the
distributions received from the Plan during each annual period which is equal to the net income
earned by the Plan account during such period; and
(iii) If any ofthe property in my account in the Plan is non-income
producing or underproductive and the Plan benefits are payable to a trust for which a federal
estate tax marital deduction had been claimed, the trustee shall reallocate to income from
principal ofthe trust an amount which the trustee reasonably determines would have been earned
as net income on such property if it were income producing or fully productive, as the case may
be.
IN WITNESS WHEREOF I have hereunto set my hand and seal this ~ J..-\-., day of
~~~ ,2005.
't<D--~ ("'. '(b =>...l~.;"",
j JOAN C. BEREN
(SEAL)
- 14 -
Signed, sealed, published and declared by the above JOAN C. BEREN, as and for
her last will, in the presence of us and each of us, who, at her request and in her presence and in
the presence of each other, have hereunto subscribed our names as witnesses thereto the day and
year last above written.
~
~~o 5 &~~~ ~-
~~ ~~ )7)b~
~~J ~mgat
2. 20( ~~(e()~ ~DJ.-
-W.~.m:S ~ ~ \"1-lDf
- 15 -
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF DIc-VPf-i.T1J
I, JOAN C. BEREN, the testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my last will, and that I signed it willingly and as my free
and voluntary act for the purposes therein expressed.
~~ <:" -0O>Jl'r--.
. . OAN C. BEREN \
Sworn to or affIrmed and acknowledged before me by JOAN C. BEREN, the
testator, this
lh ~ J
5. day of LA2C011tJey, 2005.
(SEAL)
NOTARIAL SEAL
TROY ROHRBAUG~ NOTARY PUBLIC
em OF HARRISBURl:i, DAUPHIN COUNTY
MY COMMISSION EXPIRES JUNE 3D, 2007
- 16 -
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF D;tu'?t\r~
We,
and 1Q~ J. l..'u ( Jt,
, the
witnesses whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw the testator sign and execute
the instrument as her last will; that the testator signed willingly and executed it as her free and
voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and
sight of the testator signed the will as a witness; and that to the best of our knowledge the testator
was at the time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Witness
Sworn to or affirmed and subscribed to before me by Mo.f~ U""-tloo..h L~...Y~t+
and -\o\A" 7. l~t"~ ~ ~ ~~. , witnesses, this S-l-t, day of .n-ef'fl''\~ef."" , 2005.
I
(SEAL)
~~
- 17 -
October 17,2006
Joan Beren
59 S Terrace Dr
Wormleysburg PA 17043-
Dear SirIMadam:
We are responding to your request for information about Joan Beren's account(s) with
Fidelity. The table(s) below list(s) the account holdings and values as of 02/08/2006.
Fidelity account 677-015148: JOAN C BEREN -INDIVIDUAL
Security Description CUSIP Quantity Unit Value Market Value
Fidelity Mum Money Market 316114107 25252.580 $1.00 $25,252.58
Total Value $25,252.58
The table below shows the accrued unpaid dividends from 2/1/2006 through 2/812006
Dividends
$14.55
We hope this information is helpful. For questions concerning account holdings or
instructions on how to transfer the ownership ofthe accounts, please call our Inheritor
Services Group at 800-544-0003 between 8:00 A.M. and 6:30 P.M. Eastern time Monday
through Friday or visit our website at www.fidelity.com.
Sincerely,
Fidelity Investments
Our file: W006405-130CT06
Estate Valuation
Date of Death: 02/08/2006
Valuation Date: 02/08/2006
Processing Date: 10/19/2006
Report Type: Date of Death
Number of Securities: 1
File ID: 12551.002
Shares
or Par
Security
Description
High/Ask
Low/Bid
Mean and/or Div and Int Security
Adjustments Accruals Value
1)
116.172 SENSIENT TECHNOLOGIES CORP (81725T100)
COM
New York Stock Exchange
02/08/2006 19.18000
18.66000 H/L
Div: 0.150000 Ex: 02/07/2006 Rec: 02/09/2006 Pay: 03/01/2006
18.920000
+ 0.150000
19.070000
2,215.40
Total Value
Total Accrual
Total $2,215.40
$2,215.40
$0.00
Page 1
This report was produced with EstateVa1, a product of Estate Valuations & Pricing systems, Inc. If you have questions,
please contact EVP systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.3)
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Report Dale:
Time Prepared:
Requested By:
Includes:
October 12.2006 ABUNDANCE WEALTH COUNSELORS
05:31:58 PM
Jennifer Andersoll
Account: 49009155402 JOAN C. BEREN. IRA ACCOUNT
Account Holdings as of 2/8/2006
Cusip No. Security Name Shares / Par Investment Unit Price Market Value Price Date
02507M600 AM CENT EO GROWfH 558.5380 13,215.00 23,73 13,254.11 0210812006
256219106 DODGE & COX STOCK 82,5940 9,681,83 141.22 11,663.92 02108/2006
298706409 EUROPAC GROWTH FD F 255.9140 7,598.32 42.39 10,848,19 02/08/2006
315809400 FIDELITY INT SRT GOV 1,691.1660 16,265.87 9.47 16,015.34 02/0812006
315910802 FIDELITY DIV INTL fD 317.7990 8,028.42 34.03 10,814.70 02/0812006
315911107 FIDELITY US SD INDEX 2,127.5560 23,261.19 10.84 23,062,71 02/0812006
315911206 SPARTAN US EQ INDEX 314.4870 12,375.48 44.86 14,107.89 02/08/2006
316067107 FID CASH RESERVS 6.933A800 6.933.48 6,933.48 01/31/2006
399874403 GROWTH FD OF AMER F 392.0170 9,650.00 31.50 12,348.54 02108/2006
464287655 ISHARES RUSS 2000 100.0000 6.223.50 71.70 7,170.00 02108/2006
518550838 LAUDUS RSNBRG DISCOV 504.5150 8,940.00 18.10 9,131,72 02/08/2006
€-93390726 PIMCO TOTAL RET ADMN 2,370.3030 25,224.33 10.45 24,769.67 02/08/2006
722005550 PIMCO CMDTTY RR CL D 365.3790 5,541.43 14.35 5.243.19 02/08/2006
741479208 T ROWE PRCE GR STK 431.4300 10.958,90 28.78 12,416.56 02lOS/2006
Total Securities 16,445.1780 163.897.75 177.780.02
Income Cash -5.320.96 -5,320.96
Principal Cash 5.320.96 5.320.96
Account Total 163.897.75 1n.780.02
Page 1
1145683_l.DOC
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
INRE:
ESTATE OF
JOAN C. BEREN, DECEASED
NO. 21-06-390
DISCLAIMER
WHEREAS, JOAN C. BEREN (the "Decedent") died on February 8, 2006, a resident of
Cumberland County, Pennsylvania;
WHEREAS, Decedent's Last Will and Testament dated December 5, 2005 (the "Will")
was admitted to probate and filed of record by the Register of Wills of Cumberland County,
Pennsylvania on May 2, 2006;
WHEREAS, pursuant to Article THREE of her Will, Decedent bequeathed the residue of
the estate to be held in trust for the benefit of her husband, DANIEL E. BEREN;
WHEREAS, the undersigned, DANIEL E. BEREN, the Disclaimant herein, is now
desirous of disclaiming his entire beneficial interest in the residuary estate passing and remainder
trust created for his benefit under the aforementioned Article THREE of the Decedent's Will;
NOW, THEREFORE, the undersigned Disclaimant, DANIEL E. BEREN, hereby
declares as follows:
1. The foregoing Preambles are hereby incorporated herein by reference.
2. This instrument is a disclaimer within the meaning of and under and in
accordance with sections 6103 and 6205 of the Pennsylvania Probate, Estates and
Fiduciaries Code (Title 20 of the Pennsylvania Consolidated Statutes).
3. Daniel E. Beren hereby disclaims all right, title and interest that he has in the
residuary estate passing and the remainder trust created for his benefit under
Article Three of Joan C. Beren's Will.
4. The Disclaimant has not accepted any interest in or benefits of the Disclaimed
Interest.
5. This Disclaimer is irrevocable.
6. The Disclaimant is not insolvent and this Disclaimer is not made to prejudice the
rights of any creditor of the Disclaimant.
1145683_1 DOC
7. The Disclaimant intends that the within disclaimer shall constitute a "qualified
disclaimer" as defined in Section 2518 of the Internal Revenue Code of 1986, as
amended
IN WITNESS WHEREOF, the undersigned hereby executes this Disclaimer this
C; j::J.. day of November, 2006.
WITNESSES:
9d!j M-,"<nV;f-
COMMONWEAL TH OF PENNSYLVANIA )
/J ) SS:
COlJNTY OF ~kl.(f~?~ )
On this theb ~ day of November, 2006, before me, a Notary Public,
personally appeared DANIEL E. BEREN, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument, who, having been duly qualified
according to law, acknowledged that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
COMMON
NOta aI
Christine Brody, Notary Public
City Of Hanisburg, Dauphin County
My commlssion Expires July 29, 2010
Member. Pennsylllllnia Association of Notaries
2
1145627 _1.DOC
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
INRE:
ESTATE OF
JOAN C. BEREN, DECEASED
NO. 21-06-390
DISCLAIMER
WHEREAS, JOAN C. BEREN (the "Decedent") died on February 8, 2006, a resident of
Cumberland County, Pennsylvania;
WHEREAS, Decedent JOAN C. BEREN was owner of Aetna Life Insurance Policy
#G 1390939 insuring the life of DANIEL E. BEREN, such policy having a surrender value of
$23,363.78;
WHEREAS, pursuant to the terms of the life insurance contract, upon the death of the
Decedent ownership of the policy reverts to the insured, DANIEL E. BEREN;
WHEREAS, the undersigned, DANIEL E. BEREN (the "Disclaimant"), is the surviving
spouse of the Decedent.
NOW, THEREFORE, the undersigned Disclaimant, DANIEL E. BEREN, hereby
declares as follows:
1. The foregoing Preambles are hereby incorporated herein by reference.
2. This instrument is intended to be a disclaimer within the meaning of and under
and in accordance with sections 6103 and 6205 ofthe Pennsylvania Probate,
Estates and Fiduciaries Code (Title 20 of the Pennsylvania Consolidated Statutes).
3. Daniel E. Beren hereby disclaims all right, title and interest that he has by virtue
of the death of Joan C. Beren, in and to Aetna Life Insurance Policy #G1390939.
4. The Disclaimant has not accepted any interest in or benefits of the Disclaimed
Interest.
5. This Disclaimer is irrevocable.
6. The Disclaimant is not insolvent and this Disclaimer is not made to prejudice the
rights of any creditor of the Disclaimant.
1145627_1 DOC
7. The Disclaimant intends that the within disclaimer shall constitute a "qualified
disclaimer" as defined in Section 2518 of the Internal Revenue Code of 1986, as
amended
IN WITNESS WHEREOF, the undersigned hereby executes this Disclaimer this
/:'--1---4 day of November, 2006,
WITNESSES:
/;;jn!2i M'L->>J
r
AI ANT: .l~
f tDiflfA
IE E. BEREN
COMMONWEALTH OF PENNSYLVANIA )
) SS:
COUNTYOF4~A )
On this the h v6/~ day of November, 2006, before me, a Notary Public,
personally appeared DANIEL E. BEREN, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument, who, having been duly qualified
according to law, acknowledged that she executed the same for the purposes therein contained,
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary P
COMMONWEALT OF ENNSYLVANIA
[N all
Christine . Notary Public
City Of Harrisburg, Dauphin County
My Commission Expires Juty 29. 2010
Member, Pennsylvania Association of Notaries
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Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of Joan C. Beren
No 21-06-390
Date of Death 02/08/2006
Social Security No. 056-28-9224
also known as
, Deceased
Daniel E. Beren
The Personal Representatlve{s) of the above Estate, deceased, verify that the Items appearing In the following Inventory
Include all of the personal assets wherever situate and all of the real estate located In the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each Item of said Inventory represents its fair value as of the date of
the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except
that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made In this Inventory
are true and correct. I/We understand that false statements herein are made subject to the penalties of 16 Pa. C. S.
Section 4904 relating to unsworn falsification to authorities.'
p~rsonal Re r~.s:;;;+uve J ( id
Signature: ~/ k~ II 1.1U1.
diel E. Beren -
Signature:
Attorney:
Daniel E. Beren
10 No:
08529
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Signature:
Firm:
Address:
Address: 59 S. Terrace
Wormleysburg, PA 17043
Telephone: 717-763-0991
Dated: 'I 1(" to Ip
Telephone:
213 Market Street, 3rd Floor
Harrisburg, PA 17101-2121
(717) 2374801
Personal Property
Cas h... .......... .................... ...... ............ ............ ... ......... ... ..... ... .........
Pers ona I Property........ ....... ... ...................... ..... .., .............. ..... ......
Stocks/Listed.. ..... ........ .......... ..... .... ................. .... ......... ...... ..... ......
Stoc ks/Closely Held............ ....... ................. .... ........... ........ '" ........
Bon ds... ............ .... .............. ....... ............... ... .... ........... ........... .... .....
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable...............................................
All Other Property......................... ............... .................. ..... ..........
97,363.78
27,482.53
Tota I Personal Property.........................................
124,846.31
Total Real Property.................. ...... .............. ..........
Total Personal and Real Property.........................
[
124,846.31 I
Total Out-of-State Real Property..........................
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Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of
Joan C. Seren
No.
21-06-390
also known as
, Deceased
Date of Death 02/08/2006
Social Security No. 056-28-9224
Personal Property
2002 Audi
21.000.00
Aetna Life Insurance Policy #G-1390939 insuring life of spouse, Daniel E.
Seren
23.363.78
Miscellaneous Jewelry and Furs
53.000.00
Total Personal Property
97.363.78
Stock I Listed
Fidelity Account #677-015148
25.267.13
116.1720 shares Sensient Technologies Corporation
2.215.40
Total Stock / Listed
27.482.53
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
124.846.31
COMMONWEAL TC' Oc PE,",NSYlVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDlJAl TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BEREN DANIEL E
59 S TERRACE
WORMLEYSBURG, PA 17043
---~---- fold
ESTATE INFORMATION: SSN: 056-28-9224
FILE NUMBER: 2106-0390
DECEDENT NAME: BEREN JOAN C
DA TE OF PAYMENT: 11/08/2006
POSTMARK DATE: 11/08/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 02/08/2006
NO. CD 007407
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,813.50
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TOTAL AMOUNT PAID:
$3,813.50
REMARKS:
CHECK# 995
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
, .
1145683_l.DOC
2006 NOV -8 PM 12: SO
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION CLERI< OF
ORPH~~I'c' "('" IRT
I H,~' 'd\J Vi \".I)v 1
Ci HACr-';'l'!'T': n., ,-'A
,,, ,~ . ",' , , ru,
INRE:
ESTATE OF
JOAN C. BEREN, DECEASED
NO. 21-06-390
DISCLAIMER
WHEREAS, JOAN C. BEREN (the "Decedent") died on February 8, 2006, a resident of
Cumberland County, Pennsylvania;
WHEREAS, Decedent's Last Will and Testament dated December 5, 2005 (the "Will")
was admitted to probate and filed of record by the Register of Wills of Cumberland County,
Pennsylvania on May 2, 2006;
WHEREAS, pursuant to Article THREE of her Will, Decedent bequeathed the residue of
the estate to be held in trust for the benefit of her husband, DANIEL E. BEREN;
WHEREAS, the undersigned, DANIEL E. BEREN, the Disclaimant herein, is now
desirous of disclaiming his entire beneficial interest in the residuary estate passing and remainder
trust created for his benefit under the aforementioned Article THREE of the Decedent's Will;
NOW, THEREFORE, the undersigned Disclaimant, DANIEL E. BEREN, hereby
declares as follows:
1. The foregoing Preambles are hereby incorporated herein by reference.
2. This instrument is a disclaimer within the meaning of and under and in
accordance with sections 6103 and 6205 of the Pennsylvania Probate, Estates and
Fiduciaries Code (Title 20 of the Pennsylvania Consolidated Statutes).
3. Daniel E. Beren hereby disclaims all right, title and interest that he has in the
residuary estate passing and the remainder trust created for his benefit under
Article Three of Joan C. Beren's Will.
4. The Disclaimant has not accepted any interest in or benefits of the Disclaimed
Interest.
5. This Disclaimer is irrevocable.
6. The Disclaimant is not insolvent and this Disclaimer is not made to prejudice the
rights of any creditor of the Disclaimant.
~
r
. .
1145683_1 DOC
7, The Disclaimant intends that the within disclaimer shall constitute a "qualified
disclaimer" as defined in Section 2518 of the Internal Revenue Code of 1986, as
amended
IN WITNESS WHEREOF, the undersigned hereby executes this Disclaimer this
(.. _cl day of November, 2006.
/1
WITNESSES:
(7J/}, av1A--uuj--
:~\
COMMONWEAL TH OF PENNSYLVANIA )
/J ) SS:
COUNTY OF "-.Jftli'fflCA.. )
On this thet(7~ day of November, 2006, before me, a Notary Public,
personally appeared DANIEL E BEREN, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument, who, having been duly qualified
according to law, acknowledged that she executed the same for the purposes therein contained,
IN WITNESS WHEREOF, J have hereunto set my hand and official seal.
/"
/./
/'
COMMON
n I
Christine Brody, Notary Public
City Of Harrisburg, Dauphin County
My commission Expires July 29, 2010
Member, Pennsylvania Association of Notaries
2
"
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1145627 _l.DGe
Z006 NOV - 8 Pr\ 12: 50
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION CLERK OF
ORPH/NS COURT
Cl,J~ .r, ~-"'" '" n~, r!
IV': "..( '. . '; 'j '- I i, _I . ~...,:..l.
INRE:
ESTATE OF
JOAN C. BEREN, DECEASED
NO. 21-06-390
DISCLAIMER
WHEREAS, JOAN C. BEREN (the "Decedent") died on February 8, 2006, a resident of
Cumberland County, Pennsylvania;
WHEREAS, Decedent JOAN C. BEREN was owner of Aetna Life Insurance Policy
#01390939 insuring the life of DANIEL E. BEREN, such policy having a surrender value of
$23,363.78;
WHEREAS, pursuant to the terms of the life insurance contract, upon the death of the
Decedent ownership of the policy reverts to the insured, DANIEL E. BEREN;
WHEREAS, the undersigned, DANIEL E. BEREN (the "Disclaimant"), is the surviving
spouse of the Decedent.
NOW, THEREFORE, the undersigned Disclaimant, DANIEL E. BEREN, hereby
declares as follows:
1. The foregoing Preambles are hereby incorporated herein by reference.
2. This instrument is intended to be a disclaimer within the meaning of and under
and in accordance with sections 6103 and 6205 of the Pennsylvania Probate,
Estates and Fiduciaries Code (Title 20 of the Pennsylvania Consolidated Statutes).
3. Daniel E. Beren hereby disclaims all right, title and interest that he has by virtue
of the death of Joan C. Beren, in and to Aetna Life Insurance Policy #01390939.
4. The Disclaimant has not accepted any interest in or benefits of the Disclaimed
Interest.
5. This Disclaimer is irrevocable.
6. The Disclaimant is not insolvent and this Disclaimer is not made to prejudice the
rights of any creditor of the Disclaimant.
~~
/
I
i
.
1145627_1 DOC
7, The Disclaimant intends that the within disclaimer shall constitute a "qualified
disclaimer" as defined in Section 2518 of the Internal Revenue Code of 1986, as
amended
IN WITNESS WHEREOF, the undersigned hereby executes this Disclaimer this
0_-t-..J; day of November, 2006,
WITNESSES:
. -4,/jJ, M,<-~J
(/1
COMMONWEAL TH OF PENNSYLVANIA
COUNTY OF 4/~(t..
On this the b ~/~ day of November, 2006, before me, a Notary Public,
)
)
)
SS:
personally appeared DANIEL E, BEREN, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument, who, having been duly qualified
according to law, acknowledged that she executed the same for the purposes therein contained,
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
/'"
Notary P
COMMONWEALT OF ENNSYLVANIA
[N all
Christine , Notary Public
City Of Harrisburg, Dauphin County
My Commission Expires July 29. 2010
Member, Pennsylvania Association of Notaries
2