HomeMy WebLinkAbout12-29-06
REV - 1500 EX + (1.00)
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OFFICIAL USE ONL Y
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
00581
NUMBER
404-42-3141
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return
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o 2. Supplemental Return
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4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10. Spousal Poverty Credit (date of death between
1
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
4. Limited Estate
6. Decedent Died Testate (Attach copy
of Will)
9. Litigation Proceeds Received
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::! ~ IRM NAME (If applicable)
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8~ Law Offices of Debra K. Wallet
ELEPHONE NUMBER
717/737-1300
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
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DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
Osborne, Marie
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
24 North 32nd Street
Camp Hill, PA 17011
(1 ) None
(2) None
(3) None
(4) None
(5) 6,833.91
(6) 44,685.00
(7) None
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09/22/1930
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
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(8)
51,518.91
(9)
11,478.35
(11 )
11,478.35
40,040.56
(12)
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)
(13)
(14)
40,040.56
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
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19. Tax Due (19)
4,804.87
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
4,804.87
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
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Decedent's Complete Address:
STREET ADDRESS
75 Oliver Road
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CITY
I STATE PA
I ZIP 17025
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Enola
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
4,804.87
3,000.00
157.89
Total Credits (A + B + C)
(2)
3,157.89
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEDVERPAYMENT.
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 theTAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
(3) 0.00
(4) _____
(5)
(5A)
(5B)
1,646.98
1,646.98
Make Check Payable to: REGISTER OF WILLS, AGENT
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;............................................................................. ~ I
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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?................................................................................................................. D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?........................... ..n......................................................... 00..................... 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, correct and complete. Declaration
preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN AODRESS
Lu 'lie Jones
DATE
304 Prowell Drive
Camp Hill, PA 17011
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DATE
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Debra K, Wallet
ADDRESS
DATE
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24 North 32nd Street
Camp Hill, PA 17011
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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 ofthe
surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 99116 (a) (1.1) (ii)). The statutedoes not exemota 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. 99116 (a) (1.2)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116
1.2) [72 P.S. 99116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (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.
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEDENT
ESTATE OF
Osborne, Marie
I FILE NUMBER
21 - 06 - 00581
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1 M&T Bank Account #65473299
DESCRIPTION
VALUE AT DATE OF
DEATH
2,363.91
2
1997 Oldsmobile (based on Kelly Blue Book value)
4,320.00
3
Personal property in home (old furniture in poor condition, knick knacks)
150.00
TOTAL (Also enter on Line 5, Recapitulation)
6,833.91
*'
SCHEDULE F
JOINTL V-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Osborne, Marie
I FILE NUMBER
21 - 06 - 00581
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Lucille Jones
304 Prowell Drive
Camp Hill, PA 17011
Sister
JOINTLY OWNED PROPERTY:
LETTER I DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM Include name of financial institution and bank account number DATE OF DEATH
NUMBER FOR JOINT MADE or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET DE CD'S VALUE OF
TENANT JOINT estate. INTEREST DECEDENT'S INTEREST
1 A 02/05/2004 House located at 75 Oliver Rd., Enola, P A 17025 89,370.00 50% 44,685.00
(based upon assessment x common level ratio)
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TOTAL (Also enter on line 6, Recapitulation) 44,685.00
*'
SCHEDULEH
FUNERAL EXPENSES &
ADNNSTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT OECEOENT
ESTATE OF
Osborne, Marie
I FILE NUMBER
21 - 06 - 00581
Debts of decedent must be reported on Schedule I.
ITEM I
NUMBER. DESCRIPTION
A. FUNERAL EXPENSES:
Rich Funeral Home, 414 Mound St., Harlan, Kentucky 40831
AMOUNT
2 Cemetery marker - Reese Monument
3 Funeral flowers
4 Motel stay and meals for Executrix (for Kentucky funeral)
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B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Social Security Number(s) I EIN Number of Personal Representative(s):
2.
Street Address
City
Year(s) Commission paid
Attorney's Fees Debra K. Wallet, Esq.
State
Zip
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Inheritance tax return filing fee
2 Postage, photocopies
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i Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
7,236.00
895.00
240.00
218.00
1,500.00
15.00
25.00
1,349.35
11,478.35
.
ScheckE H
FlI1eI3I Expenses &
MninistraliveCosts~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Osborne, Marie
I FILE NUMBER
21 - 06 - 00581
3
Mileage for Executrix (1,270 miles @ .405/mile)
514.35
4
1/2 of real estate taxes (1/2 of$1,309.10)
655.00
5
1/2 of Nationwide Homeowner's Insurance (1/2 of360.00)
180.00
Page 2 of Schedule H
REV.1513 EX+ (9.QO)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Osborne, Marie
I FILE NUMBER
21 - 06 - 00581
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
n.. .._.
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Lucille Jones Sister 100% of residuary
304 Prowell Drive estate
Camp Hill, PA 17011
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Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheE t
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
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TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEr
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LAST WILL AND TE.STAMENT
OF
MARIE OSBORNE.
I, MARIE OSBORNE, of Enola, Cumberland County, Pennsylvania, being of sound
and disposing mind, memory, and understanding, do hereby make, publish, and declare this to
be my Last Will and Testament and hereby revoke all other Wills and Codicils that I have
made, including the Will dated March 16, 1998.
FIRST:
It is my wish, and I direct, that after my death my body be buried in my
cemetery plot at BROOKSIDE CEMETERY in Harlan, Kentucky.
SECOND:
I give, devise, and bequeath all of my Estate, of whatever nature and
wherever situate, to my sister, LUCILLE JONES, of Camp Hill, Pennsylvania, so long as she
shall survive me by thirty (30) days.
THIRD:
Should my sister fail to survive me by thirty (30) days, then I give,
devise, and bequeath all of my Estate, of whatever nature and wherever situate, in two equal
shares, to the children of my sister's son's daughter: ASHLEY BRAICA, of Enola,
Pennsylvania; and ANGELA CUSSON, of Enola, Pennsylvania. Should either of my two
named beneficiaries fail to survive me by thirty (30) days, but be represented by children then
living, these children shall take, per stirpes, the share to which my named beneficiary would
have been entitled if then living.
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FOURTH:
Should either of my two beneficiaries not have attained the age of
twenty-five (25) years at the time of my death, I direct that my entire Estate as given in part
THIRD of this, my Last Will and Testament, be given to my Trustee, hereinafter named, in
trust for the following uses and purposes and upon the following terms:
A. The net income of the Trust shall be paid to and be applied for my
beneficiaries' care, maintenance, education, or support at such times as my Trustee shall
determine in her absolute discretion. Should the income from this Trust be insufficient to
provide adequate maintenance, education, or support, my Trustee, in her sole discretion, may
invade the principal for this purpose.
B. In the administration of the Trust, the Trustee shall have the following
powers, deemed to be supplementary to and not exclusive of, the general powers of trustees
pursuant to law and including all powers necessary to carry the same into effect, all of which
shall be exercised in a fiduciary capacity:
1. To hold any or all of the Trust Estate in the form received.
2. To sell at public or private sale, to mortgage, pledge, or hypothecate
or to exchange or lease (including lease for a period extending beyond the term of this Trust),
any stocks, notes, securities, real estate, minerals, and other trust property, upon such terms,
cash or credit, or both, as she may deem advisable.
3. To invest and reinvest the Trust Estate in investments limited to real
or personal property, minerals, royalties, and leaseholds.
4. To construct, add to, repair, or demolish (in whole or in part) any
improvements upon any Trust property.
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5. To participate in any reorganization, consolidation, merger, or
dissolution of any corporation, the stocks, bonds, or other securities of which may be held at
any time as part of the Trust Estate and to receive and continue to hold any property which
may be allocated or distributed to it by reason of participation in any such reorganization,
merger, or dissolution.
6. To make or hold investments or any part of the Trust Estate in
common or undivided interests with other persons, corporations, or trusts.
7. To demand, receive, receipt for, sue for, and collect any and all
rights, money, properties, or claims, to which this Trust may be entitled, and to compromise,
settle, arbitrate, or abandon any claim or demand in favor of or against this Trust.
8. To borrow funds for this Trust in such amounts and for such
purposes as she shall deem for the best interest of this Trust and the beneficiary thereof, and to
purchase property on the credit of this Trust, and, in connection with such borrowing or such
purchase, to execute and deliver promissory notes or other evidences of indebtedness of this
Trust and to mortgage or pledge all or any part of the Trust Estate to secure payment of such
indebtedness, and to repay such indebtedness out of the Trust Estate.
9. To employ agents, legal counsel, brokers, and assistants, and to pay
their fees and expenses as she may deem necessary or advisable to carry out the provisions of
this Trust.
10. To vote in person or by proxy any shares of stock which may form
part of this Trust.
11. To lend money to any person or persons upon such terms, but with
adequate interest and security, as she may deem advisable for the best interests of this Trust.
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12. To elect, appoint, and remove directors of any corporation, the
stock of which shall constitute Trust property, and to act as a director and officer of any such
corporation.
13. Generally, and without limitation by any specific enumeration
herein, to manage, control, operate, reconvert, invest, reinvest, sell, exchange, lease,
mortgage, pledge, pool, or otherwise encumber and deal with the property of this Trust, for
and in behalf of this Trust and the beneficiary thereof, to the same extent and with the same
powers that any individual would have in respect to her own property and funds.
14. To act freely under all or any of the powers by this agreement given
to the Trustee in all matters concerning this Trust, after forming her judgment based upon all
the circumstances of any particular situation as to the interest of this Trust and the beneficiary
hereunder, without the necessity of obtaining the consent or permission of any person
interested therein, or the consent or approval of any court, and notwithstanding that she may
also be acting individually, or as trustee of other trusts, or as agent for other persons or
corporations interested in the same matters, or may be interested in connection with the same
matters as stockholder, director, or otherwise, provided, however, that she shall exercise such
powers at all times in a fiduciary capacity primarily in the interest of the beneficiary
hereunder.
15. To invest trust funds in interests in any common trust fund or funds
now or hereafter established and being administered by the Trustee solely for the investment of
trust funds.
C. Should the Trust, in the sole opinion of my Trustee, be or become too
small to warrant continuing such fund in trust, or should its administration be or become
impractical for any other reason, my Trustee, in her sole discretion, may deposit the trust
monies in a savings account in a savings institution of the Trustee's choosing, payable to the
beneficiaries at majority.
D. If any beneficiary of this trust is the beneficiary of any life insurance
policies, any pension plans, or other contracts, the proceeds of such policy, plan, or contract
may be added to such trust at the sole discretion of my Trustee. Should any of my
beneficiaries be a minor at the time of my death, I direct that the proceeds of such policy, plan,
or contract shall be added to such trust and administered in accordance with the terms of the
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E.
This Trust shall terminate, and the Trustee shall pay the accumulated and
undistributed principal and income then remaining in her hands at termination to my
beneficiaries when the younger beneficiary has attained the age of twenty-five (25) years. If
my younger beneficiary dies prior to attaining the age of twenty-five (25) years, but the other
beneficiary is older than twenty-five (25) years of age, then the Trust shall terminate upon that
beneficiary's death and shall be distributed in accordance with Paragraph THIRD, as if no trust
had been created.
FIFTH:
All interests of any beneficiary in the income or principal of this Estate,
while undistributed and in the possession of my Executrix and Trustee, even though vested and
distributable, shall not be subject to attachment, execution or sequestration for any debt,
contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to
pledge, assignment, conveyance, or anticipation.
SIXTH:
All inheritance, estate, and succession taxes (including interest and any
penalties thereon) payable by reason of my death shall be paid out of and be charged generally
V.9nciPaI of my residuary estate, without apportionment or right reimbursement
om anyiperson. In the event that a substantial portion, as determined in the sole and absolute
judgment and discretion of my Executrix, of the non-probate assets such as an annuity or
mutual funds are directed to be paid to a beneficiary or beneficiaries, so that the taxes referred
to herein would be paid out of the probate residue passing to the beneficiary or beneficiaries of
this will (whether or not the same as the beneficiary or beneficiaries under the non-probate
assets), my Executrix, in the Executrix's sole and absolute judgment and discretion, shall have
the right to allocate the full or partial payment of the taxes to the beneficiary or beneficiaries of
the non-probate assets.
SEVENTH: In addition to all rights and powers conferred by law, I authorize and
empower my Executrix and Trustee and their successors, in their absolute discretion and
without necessity of obtaining court approval:
...
A.
To retain any of the investments composing the principal of this trust in
the form in which the same shall have been delivered to the Trustee whether or not the same be
in the nature and type legal for the investment of trust funds under the laws of the
Commonwealth of Pennsylvania, including the stock of any corporate fiduciary acting
hereunder.
B. To invest in all forms of property (including, but not by way of
limitation, real estate, all types of stocks and bonds, and participations in common trust funds),
without being confined to investments prescribed by statute.
C. To buy investments at a premium or discount.
D. To hold property unregistered or in the name of a nominee.
E. To give proxies, both ministerial and discretionary.
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F. To compromise claims.
G. To join any merger, consolidation, reorganization, voting trust
plan, or any other concerted action of security holders and to delegate discretionary duties with
respect thereto.
H. To lend,to, and buy from, my estate.
I. To borrow and to pledge real and personal property as security therefor.
J. To sell at public or private sale for cash or credit or partly for each, to
exchange, or to lease for any period of time, any real or personal property, and to give options
for sales, exchanges, or leases.
K.
To allocate any property received or charge incurred to principal or
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income or partly to each, without being obliged to apply the usual rules of trust accounting.
L. To exercise any option permitted by law which they believe to be
advantageous from the viewpoint of overall tax reductions, including, without limitation of the
foregoing, power and authority to claim administration or other expenses either as income tax
deductions or inheritance or estate tax deductions, without regard to whether they were paid
from principal or income and without requiring adjustments between principal and income for
any resulting effect on income or estate taxes, and a deduction of such expenses for income tax
purposes shall be given effect in computing the respective shares of all persons interested in
my estate or the trusts set forth herein, even though the effect is to increase the share of one
beneficiary or class of beneficiaries hereunder at the expense of another; and to make such
adjustments, if any, between beneficiaries with respect thereto as they deem appropriate in
view of the nature of the transaction and the amounts involved.
M. To distribute in cash or in kind or partly in each.
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The powers granted hereunder shall be exercisable with respect to all real and personal
property, including, but not limited to, income and principal held for minors or disabled
beneficiaries at any time held by the Trustee and shall continue in full force, even after the
termination of any trust hereunder, until the actual distribution of all property. All powers,
authorities and discretion granted here shall be in addition to those granted by law and shall be
exercisable without leave of court. However, nothing herein shall be interpreted or construed
to encourage, authorize, empower, or permit the Trustee or Executrix to act or cause anyone
to act in a manner contrary to or inconsistent with accepted standards of portfolio
diversification and risk management.
EIGHTH:
I nominate, constitute, and appoint the following persons:
A.
My sister, LUCILLE JONES, as Executrix of this, my Last Will and
Testament. In the event of the renunciation, death, resignation, or inability of my sister to act
for whatever reason in this capacity, then I nominate, constitute, and appoint my friend,
SHARON BRANDT, of Harrisburg, Pennsylvania, as Executrix of this, my Last Will and
Testament.
B.
My friend, SHARON BRANDT, as Trustee of the Trust described
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'\' herein. In the event of the renunciation, death, resignation or inability of my friend to act for
whatever reason in this capacity, then I nominate, constitute, and appoint my niece, BOBBIE
JO VIA, of Enola, Pennsylvania as Trustee.
I direct that no representative named above shall be required to post security for the
faithful performance of her duties in any jurisdiction insofar as I am able by law to relieve
her of such obligation. Any of my representatives shall be entitled to reasonable compensation
for the performance of the duties set forth here.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this J1Sr- day of
~AY , 2004, on this, the ninth of nine typewritten pages. I have also signed the
left-hand margin of the first eight of these pages for purposes of identification only.
/'1/)1(A-'~ L~{~V;~
MARIE OSBORNE
SIGNED, PUBLISHED, and DECLARED by the Testatrix, MARIE OSBORNE, as
her Last Will and Testament, in the presence of us, who at her request, in her presence, and in
the presence of each other, have hereunto subscribed our names as witnesses.
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ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of Cumberland
I, MARIE OSBORNE, Testatrix, whose name is signed to the attached 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.
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MARIE OSBORNE
Sworn or affirmed to and subscribed before me by MARIE OSBORNE, the Testatrix,
this :;\ I ':it day of
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,2004.
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Notary Public) ,
COMMONWEALTH OF PENNSYLVANIA
NoIarial Seal
Mary M. Loper. Notary Public
Camp Hill 8010. Cumber1and County
My CommiSSiOn Expires 0cl27. 2007
Member. Pennsylvania Association Of Notaries
AFFIDAVIT
Commonwealth of Pennsylvania
County of Cumberland
We, Debra K. Wallet and KOUQIt I="' \ (\c\.\ I tJ
, the witnesses whose names
are signed to the attached instrument, being duly qualified according to law, depose and say
that we were present and saw the Testatrix, MARIE OSBORNE, sign and execute the
instrument as her Last Will and Testament; that she executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix
signed the Will as witnesses; and that, to the best of our knowledge, the Testatrix was at that
time 18 years of age or older, of sound mind, and under no constraint or undue influence.
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Sworn or affIrmed to and subscribed to before me bYJ=:A.b-n.. k:. l ()C1l ( Q t and
'"l<0}jQ.\"~ r-: l\jo ILet , witnesses, this ~ l')~ day of
J ] k., 7
,2004.
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Notary Publi
COMMONWEALTH OF PENNSYLVANIA
NoIarial Seal
Mary M. Loper. NoIary Public
Camp HiI 8010. Cumberland Comly
My Coovnission Expires Oct. 27, 2007
Member. Pennsylvania Association Of Notaries
PHONE: (717) 737-1300
~aw Dffiaei of
DEBRA K. WALLET
24 N. 32nd SlREET
CAMP HILL, PA 17011-2917
Email: Walletdeb@ao1.com
FAX: (717) 761-5319
December 28, 2006
Glenda F. Strasbaugh, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of Marie Osborne
D.O.D.04/03/06
No. 21-06-00581
Dear Ms. Strasbaugh:
Enclosed are an original and one copy of the Pennsylvania Inheritance Tax Return, a
check in the amount of $1,646.98 representing the remainder of the inheritance tax due, and a
check in the amount of $15.00 representing the filing fees for the tax return. I have also
enclosed two copies of the first page to be stamped in and returned to me in the pre-addressed
envelope provided.
As I indicated in my June 30, 2006 letter, there is no need to open an Estate, but a tax
return is being filed.
Should you need any additional information, please contact me.
Sincerely yours,
~". ~....r
Debra K. Wallet
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