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Home My WebLink About01-16-07 (2) ~ ....J 15056051058 REV-1500 EX (otHlS) PA 0epar1ment or Revenue '* Bureau of Individual Taxes PO BOX 280601 Ha~,PA171~1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 21 06 File Number INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth 234-22-5886 10/1612006 03/31/1920 Decedent's Last Name Suffix Decedent's First Name Nottingham Mr. DOlby (If Applicable) Enter Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE RlED IN DUPUCA TE WITH THE REGISTER OF WillS FILL IN APPROPRIATE OVALS BELOW '. 1. Original Return 2. Supplemental Retum 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 48. Future Interest Coinpromise (date of deall1 alter 12-12-lS:l) 7. DecedEint Maintained a Living Trust (Attach Copy ofTrust) 10. Spousal Poverty Credit (dale of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPlETED. All CORRESPONDENCE AND CONADENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Uaytlme telephone Number 4. limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. litigation Proceeds Received -(). 8. Total Number of Safe Deposit Boxes Shaun E. O'Toole (717) 213-6653 Firm Name (If Applicable) First line of address REGISTER OF WIllS USE ONLN (,';....~ = --.J <- :r::-- :;E: 2813 North Second Street Second line of address City or Post Office \--:~s DATE FJLEIt,; . :.'::; Slale ZIP Code 17110 Harrisburg PA 0925 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including aa:ooJparJying sc:heduIes and statemenls, and to the best of my knowledge and belief, It IS true. correct and complete. Declaration of preparer oIher Ihan !he personaIl8pt8Sen/ati\oe is based on all informalion of which preparer has any knowledge. :;D:~:ERS~ilE~i&~=_;I~:~bv . _~~~__m____.. L;&l~;u.- 517 Mountain Road, Boiling Springs, Pennsylvania 17007 SIG~1~E~::'~~~~~~REse:~~ _______ AooRESS 2813 North Second Street, Harrisburg, Pennsylvania 17110 PLEASE USE ORIGINAL FORM ONLY """-- --- DATE L 15056051058 Side 1 15056051058 ...J MI M MI cr> -a ::;:: ~-) ':'::"':':'-1 ---1 ,~~~ I I. '::-? ;;:- (..) ( /) Cj --.J 15056052059 REV-1500 EX Decedent's Name: Dolby M Nottingham RECAPITULATION 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10)................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X .045 68,798.81 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 234-22-5886 Decedent's Social Security Number 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 15056052059 0.00 0.00 0.00 0.00 0.00 0.00 85,581.69 85,581.69 6,010.30 10,772.58 16,782.88 68,798.81 0.00 68,798.81 3,095.95 3,095.95 --.J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Dolby STREET ADDRESS 100 Mt. Allen Drive c---__________ 21 06 0925 M Nottingham DECEDENTS SOCIAL SECURITY NUMBER 234-22-5886 ---------_..~-------------~~---- CITY Mechanicsburg ---------------l STATT-------T~------ PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3,095.95 0.00 0.00 ~_._- 162.94 Total Credits (A + B + C ) (2) 162.94 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 -.-----....-- 0.00 - ---------- Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 0.00 0.00 2,933.01 0.00 2,933.01 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 tax due. 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] 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ [i] 0 c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [i] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [i] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [i] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [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 of transfers to or for the use of the surviving spouse is zero (0) percent [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 retum 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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [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-1510 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Nottingham, Dolby M. FILE NUMBER 21-06-0925 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 INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEOENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE OATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. The Dolby M. Nottingham Living Trust 85,581.69 100 0.00 85,581.69 Trust created by Decedent on July 22,2005. The trust is a revocable trust which provides that upon Decedent's death, the principal and accumulated income is to be distributed to Decedent's heirs, per stirpes, which, in this case, are Decedent's three children. A copy of the trust is attached. Attached immediately after this Schedule is a copy of the Belco Community Credit Union statement for the month of October, 2006. The only assets of the trust are the Belco Community Credit Union savings account and checking account. TOTAL (Also enter on line 7 Recapitulation) $ 85,581.69 (If more space is needed, insert additional sheets of the same size) 01/18/2807 97:4B 71723414aa MARSH BELCO CcmunniI1 en.tit ~ L ~)'OU"... II STATEMENT OF ACCOUNT PAGE as/as '. 1 MAIN ama: '03 N. ZIllIhMt P.o. .. IZ /iInI..... PA 171 01 Own YOUI'!. ho... soon.sir wn~ a . No-Fite JO-VlJar Speed. "~;.t9~~! . YOIJ -cou old s~.~.. t.ttousandp;. in. i ",terut.. .. .. .:A~ ::iti.ou.~~ it. t'od.y! . ..... . _ J u .lIIu.lllmllllll. 1.IJ.I",','ml.IIJ.III11I11...I...111 ...-r _ THE DOLBYM. NOTTINGHAM EVELYN G. OHARA TRUSTEE LIVING TRUST 517 MOUNTAIN RD BOILING SPRINGS PA 17007-9SZ0 :~~~T~~. ~~ :',:'2:(.:;~1~!~~~~.:~:~:~F;~:~~~:' ::.:~~::~ '~'~~f~.~:~~\f~~~'.,:..' ~~.~!~ '_. ..: 1001 r~~VIDU$ BAlANCE II ~ I!YlI SAVINGS 1101. DIRECT DEPOSIT 30~l036004 180 IF_~ an !lET 1031 DIVID~ND 1 8 THE ANNUAL PERCENTA8E RATE IS 1.00 THE ANNUAL PERCENTAGE YIELD IS 1.00 THE ANNUAL PERCENTAGE YIELD EARNED IS 1. D 1031 NEW BALANCE 1001 1011 IOU 1020 1023 1021!\ 1031 PREVIDU~ ~~NCE ~ = ~ ~N~~KIN~ PAY"ENT VIA DFFICE/HAll DRAFT PAID :lOtf7 DRAFT PAID 10~8 DRAFT PAID 1050 DRAFT PAID 104' DIVIDEND THE ANNUAL PERCENTAGE RATE IS 0.25 THE ANNUAL PERCENTAGE VIELO ts 0.$0 THE ANNUAL PERCENTASE YIELD EARNED IS NEW BALANCE 5 321 -11 -70S -150 -17 1 1031 SUMMA ------------------------ CLEAReD ORA 1047 lO~8 1049 1050 ------------------------------------ ------ - LtrT~ 111'"-11 YfM- TO-IAl'! .... ...... ftllIIpt IIlIl ~~I~~~ f8I' ..~,.... "IJ8I:ATB 9F8:TJWf MIl 354.70 mAL -- CIfMCE YEAIl- TD-DAtE far II Rw. IIlR: 111...... ... __......... XXXX&7 II 0.00 06'''326 REV-1511 EX+ (12-99* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Nottingham, Dolby M. FILE NUMBER 21-06-0925 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Ewing Brothers Funeral Home 1,033.30 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. Attorney Fees 4,800.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State . Zip Relationship of Claimant to Decedent 4. Probate Fees 177.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6,010.30 REV-1512 EX+ (12-D3) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Nottingham, Dolby M. FILE NUMBER 21-06-0925 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Messiah Village -- Nursing home care 10,655.87 116.71 2. Alert Pharmacy Services -- medication TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 10,772.58 REV-1513 EX+ (9-00) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES FILE NUMBER 21-06-0925 ESTATE OF Nottingham, Dolby M. 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 [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. A. Elaine Hardy -- 2547 Gilbert Avenue, Missoula, Montana 59802 Daughter 1/3 2. Lowell M. Nottingham --166 South Street, New Haven, Vermont 05472 Son 1/3 3. Evely O'Hara -- 517 Mountain Road, Boiling Springs, Pennsylvania 17007 Daughter 1/3 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 $ (If more space is needed, insert additional sheets of the same size) THE DOLBY M. N01TlNGHAM LIVING TRUST TIllS AGREEMENT is executed this 'Z1- day of July, 2005, by and between DOLBY M. NOTTINGHAM, now of Messiah Village, 100 Mt. Allen Drive, Mechanicsburg, Pennsylvania, 17055, by and through EVEL YN O'HARA, his agent to a Power of Attorney executed July Z' , 2005, as settlor (hereinafter, "Settlor") and EVELYN O'HARA as trustee (hereinafter, "Trustee"). ARTICLE I. TRUST ESTATE 1.01. Transfer to Trnst. Settlor does hereby assign, transfer and deliver to Trustee the property described in Schedule "A," attached hereto and made a part hereof: or as Schedule ... A" may be amended. As further evidence of such assignment, Settlor bas executed or will execute or cause to be executed such other instruments as may be required for the purposes of completing assignment or transfer of title of such property to Trustee. Trustee accepts such transfer and assignment and undertakes to hold, manage, invest and reinvest the assets of the Trust, and distribute the income and principal of the Trust in accordance with the provisions of this Agreement. 1.02. Additional Transfers to Trust. Settlor, and any other person with the consent of the Trustee, shall have the right at any time to make additions to the coIpus of the Trust or any shares thereof hereby established. All such additions shall be held, controlled, and distributed by the Trustee in accordance with the terms and conditions of this Agreement. ARTICLE D. DISTRIBUTIONS FROM TRUST 2.01. Provisioas durin!! Settlor's Li(etiJne. During Settlor's lifetime, the Trustee shall pay the net income of the Trust to Settlor, or as Settlor may direct in writing, and ftom time to time 1 shall pay to Settlor, or as Settlor may direct. as much (even if all) of the principal of the Trust as Settlor may so direct Trustee may, even after Settlor's incapacity, apply the income and such portions of the principal as the Trustee deems advisable for Settlor's benefit dwing such incapacity and may pay to or apply for Settlor's benefit such income and such portions of the principal as the Trustee deems advisable for the maintenance, health or support of Settlor, after taking into consideration other funds available to her from other sources. Any income not distributed or applied as provided herein shall be accumulated and invested. 2.02. Pavment of Certaia Euaues at Settlor's Death. After SettIors death, Trustee may make such payments from income and/or principal of the Trust as Trustee deems desirable to tacilitate the settlement of Settlor's estate, including but not limited to the payment of any or all of Settlor's debts, funeral and burial expenses, and any administration expenses of Settlor's estate even though they are unrelated to property subject to this Trust. Neither the Executor nor any beneficiary of Settlor's estate shall be required to reimburse the Trustee for any such expenditures. The balance of funds not so distributed shall be held and distributed as hereinafter provided. 2.03. DisDOsition at Deatlt .fSettlor. Upon Settlor's death, the principal and undistributed income of the Trust shall, after the payment of any expenses at Settlor's death as provided in Article 2.02, be distributed to Settlor's then-living issue, per stirpes. ARTICLE m. POWERS OF TRUSTEE 3.01. Powers of Trustee. In addition to such other powers and duties as may have been granted elsewhere in the Trust, the Trustee sbaI1 have and exercise exclusive management and 2 control of the Trust. and shall be vested with the fonowing specific powers and discretion, in addition to the powers as may be generally conferred from time to time upon Trustee by law: A. To invest, reinvest and keep the Trust assets invested in such real and personal estate as a prudent man of intelligence and discretion would do for himself, for investment and not for speculation, giving due regard to the safety of the principal and the adequacy of the income, without being limited to the so-called "legal investment" limitations in the Commonwealth of Pennsylvania .8. To sell or otherwise dispose of any property, real or personal, at any time held hereunder, for cash or upon credit, in such manner and on such terms and conditions as the Trustee may deem best, and no person dealing with Trustee shall be bound to see to the application of any moneys paid. C. To borrow or loan money for any purpose in connection with the administration of the Trust upon such terms and with such security as the Trustee may determine. kind. D. To make any distribution hereunder in cash, in kind, or partly in cash and partly in E. To maintain all property held in trust hereunder in a single fund, except as specifically instructed otherwise herein, and to maintain such records as may be necessary to properly administer said fund and the trust created herein. F. To make any distribution hereunder for the benefit of minor beneficiaries directly to the beneficiary thereof, to the natural guardian of such beneficiary, to his legal guardian, or to the person who has custody of such beneficiary, or to apply any such distribution directly for the benefit of any such beneficiary. The Trustee shall not, in any way, be liable to see to the proper use or application of any such amount paid whether directly to a benefici8.1y or otherwise. G. To receive such other property, including policies of insurance, or the proceeds thereof, upon the life of Settlor or any other person and to administer such property or policies and the proceeds thereof in accordance with the terms of the Trust. H. To dispose of aU income producing property upon whatever terms or conditions the Trustee deems advisable. . .. I. In general. ~o ~xereise all powers in the management of the Trust which any IndIVIdual could exercJse.~ the Il\anagement of similar property owned in his own righ~ upon such terms and conditions as the Trustee may deem best, and to execute and deliver all 3 instruments and to do all acts which the Trustee may deem necessary or proper to carry out the purposes of the Trust. ARTICLE IV. SPENDTHRIFr PROVISION 4.01. SoeDdthrift ProvisiolL No beneficiary shall have the power to anticipate, encumber or transfer his interest in any trust established under this Agreement in any manner other than by the valid exercise of a power of appointment. No part of this Trust shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. ARTICLE v. D~ COMPENSATION OF TRUSTEE 5.01. Suretv and ComDellSatioD of Trustee. The Trustee shall serve without the duty or obligation of filing any bond or other security and sball be entitled to compensation for services in accordance with the standard schedule of fees in effect when the services are rendered. 5.02. Resitm..tion ofTnstee ud S~rTntStee. The Trustee may resign at any time upon thirty (30) days' written notice given to Settlor, if Settlor is living, or in the event of Settlor's death, upon written notice 10 the cum:nt income beoe6ciary or beneficiaries (including a beneficiary's natural or legal guardian or legal representative) hereunder. 5.03. Dutv to Pay Ex- - File Tax Ildara. All income and property taxes. assessments, fees, charges, and other expenses incurred by the Trustee in the administration or protedjon of the Trost sbaU be a charge on the Trost and sbaU be paid by the Trustee prior 10 fioaJ distribution of the Trost lISSels in full out of the principal or in full out of the income of the Trust, or partially out of the principaJ and J>IIrtiaIIy out of the income of the Trust, in such IDlI11Der and 4 proportions as the Trustee may deem to be advisable. The Trustee shall prepare and file any necessary tax returns for the purpose of paying such taxes or retain a certified public accountant to pertorm such services. ARTICLE VI. REVOCATION AND AMENDMENTS 6.01. Reservation of Powen. Settlor expressly reserves the powers to: (i) revoke this Agreement by an instrument in writing delivered to the Trustee while Settlor is alive; (ii) alter, amend or modifY this Agreement at any time or from time to time by an instrument or instruments in writing delivered to the Trustee while Settlor is alive; and (iii) withdraw from the Trust any property forming a part of the T~ or the proceeds therefrom. Any such withdrawal by Settlor shall be considered a revocation of the Trust solely with respect to the property withdrawn. 6.02. Effect of Settlor's IncaDaeitv. (A) If Settlor Ineaoaeitated. Ifatthetimeofanyattemptedexerciseof(a) the powers reserved to Settlor or (b) any other powers to demand and receive the principal of the Trust, Settlor is incapacitated as defined below in subparagraph (B), through illness, age or other cause, then the Trustee shall disregard any instructions from Settlor which have the effect of remaking, altering, amending or modifYing this Agreement in whole or in part or enabling Settlor to withdraw from the Trust any property forming a part of the Trust (B) Definition oflneaoacitt. For purposes of the Trust, Settlor shall be deemed to have become incapacitated upon the happening of either one of the following events: (1) AdJnissioa ofincaDaeitv. Delivery, by hand or by mail to the Trustee, of a written instrument from Settlor declaring that Settlor no longer 5 considers that he should possess the power to exercise any of the powers reserved by Settlor in this Article VI or any other powers to demand and receive the principal of the Trust; or (2) Medical eertifieation of laek of C8oaCitv. Delivery, by hand or by mail to the Trustee, of written instruments by two physicians licensed to practice medicine, one of whom must be a board certified psychiatrist and the other of whom must be a board certified internist, that Settlor no longer has the capacity, as a result of illness, age or other cause to exercise any of the powers reserved by Settlor over the Trust under the terms of this Article VI or any other powers to demand and receive the principal of the Trust. (C) Powers oersonal to Settlor. The powers reserved by and to Settlor in this Article VI shall be personal to Settlor and shaD not be exercisable by any conservator, committee, guardian or like fiduciary, nor shall they be assignable to, nor extend to, the executor or administrator of Settlor's estate, nor to any beneficiary named herein. ARTICLE VII. CONSTRUCTION OF TRUST 7.01. Trust Irrevocable UDOD Datil of Settlor. Upon the death of Settlor, the Trust shall be deemed irrevocable. 7.02. Minor Beneficiarv. Should the trust created herein provide for a distribution to a beneficill1y who is under the age of twenty-one (2 I), or, in the opinion of the Trustee, is mentally or physically incapacitated, the Trustee may pay such beneficia.ys distnDutable share to the varont or guardian of the distribun:e, or 10 any person Iaking care of the disttibutee, or, in the case of a minor, 6 may deposit the share in a savings account, made payable to the minor upon attaining majority, which, for purposes herein, shall be twenty-one (21) years of age. 7.03. Pennsvlvania LaWs. This Agreement sball be administered and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. 7.04. Other Terms. The use of any gender includes the other ~ and the use of either the singular or the plural includes the other. 7.05. Captions. The underlined captions set forth in this Agreement at the beginning of the various divisions hereof as well as the title accompanying the Article number which precedes each Article, are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their construction and application. IN WITNESS WHEREOF, Settlor and the Trustee have hereunto set their hands and seals as of the day and year first above written. Witness: Settlor: ~t.~~ ./ ~~ 2J. o'f~. (Po ..6--) (SEAL) DO M. NOTTINGHAM, by and through EVEL YN O'HARA, his agent Trustee: --'~ ~.~ ?;~~LD~ EVE O'HARA (SEAL) 7 cOMMONWEALrn OF PENNSYLVANIA ) ) 88.: ) COUNTY OF CUMBERLAND On this~"'y of July, 2005, before me, the undersigned officer, personally appeared EVEL YN O'HARA, who acknowledged that she is the agent for her father, DOLBY M. NOTTINGHAM, and that she executed the foregoing Living Trust for the purposes therein contained by signing the same on behalf of DOLBY M. NOTTINGHAM. WITNESS my hand and Notarial Seal the day and year aforesaid. No Public in and for the Commo of Pennsylvania CQMMONWEALTH Of PENNSYLVANIA Notarial Seal .Rhonda L; Lang. Notal)' Public CIty ofH~sbll!,g. Dauphin County My CommIssIon Expires Aug. 9. 2008 H SCHEDULE "A" REFERRED TO IN TIIE ANNEXED TRUST AGREEMENT Dated July 22, 2005 From DOLBY M. NOTTINGHAM, Settlor To EVELYN O'HARA, Trustee Prouertv Description: Bank TV{le of Account Account Number PNCBank Sovereign Bank Checking Checking 51-4018-9143 Glenbrook Life & Annuity Company Annuity GA0838932 * Settlor will retain $75,000 in this account. 9 Estimated Value $ 83,372 $ 151,325* $ 69,500 LAST WILL AND TESTAMENT ::.0 :y l' r-r, a :71 C) l..-:- e':'; C) ~: ,'"c, ::D N r-I~ c:. ,-::1 "' -, '. ) (-:-" -;:~:~ ~ ~ -F1 , l :J,: ,'- -n .:, :0; ,- 23 ,:,:-.:,~,.~ :.:::J --I . , .:--:.. ---- ,-,,-) s~ I, DOLBY M. NOTTINGHAM, declare this to be my Last Will and Testament and11ereby " OF o Co .- ;:-: "5 :.:-(") :;,~~ t--..> = = 0-. DOLBY M. NOTTINGHAM revoke all prior wills and codicils made by me. FIRST: My Executor shall pay from the residue of my estate all my debts, funeral and administration expenses and aU estate, inheritance, succession and transfer taxes imposed by the United States or any state, territory or possession which shall become payable by reason of my death. It shall not be necessary to file any claims therefore, nor to have them allowed by any court. SECOND: I give all tangible personal property which I own as follows: (A) My automobile to my daughter, EVELYN O'HARA; (B) I bequeath the rest of my tangible personal property as is set forth in a separate, dated and unsigned Letter of Instruction, which I shall place with my Will, to the persons therein designated. If I have not left a Letter of Instruction or for those articles not distributed under this Letter of Instruction, I direct that such items be distributed among my children in as nearly equal shares as is practical. If there is any disagreement as to distribution, I direct my Executor to make such distribution. The decision of my Executor shall be final and binding. Any items not selected may be distributed in the sole discretion of my Executor and, if sold, the net proceeds therefrom shall be added to the residue of my estate. .<;'~ /" THIRD: : I give to my wife, VIRGINIA A. NOTTINGHAM, all tangible personal property which I own and insurance thereon, if she survives me by sixty (60) days. If my wife is not living on the sixty-first (61 st) day after my death, I bequeath such tangible personal property as is set forth in a separate, dated and unsigned Letter of Instruction, which I shall place with my Will, to the persons therein designated. If I have not left a Letter of Instruction or for those articles not distributed under this Letter of Instruction, I direct that such items be distributed among my children in as nearly equal shares as is practical. If there is any disagreement as to distribution, I direct my Executor to make such distribution. The decision of my Executor shall be final and binding. Any items not selected may be distributed in the sole discretion of my Executor and, if sold, the net proceeds therefrom shall be added to the residue of my estate. FOURTH: I give and devise the residue of my estate, real, personal and mixed, of whatever kind and nature, and wherever situate at the time of my death, including any property over which I now have or hereafter acquire a power of appointment, unto my wife, VIRGINIA A. NOTTINGHAM, provided that she survives me and is living sixty (60) days after the date of my death. Ifmy wife, VIRGINIA A. NOlTING HAM, predeceases me or is not living on the sixty-first (61 st) day after my death, I devise and bequeath the residue of my estate to my then-living issue, per stirpes. FIFTH: I nominate, constitute and appoint my daughter, EVELYN O'HARA, Executrix of this my Last Will and Testament, to serve without bond or security, and to make distribution of my estate in cash or in kind, or partly in cash and partly in kind, and in such manner as she may determine. I authorize, empower and direct her to sell and convey, by good and sufficient deed, in tee simple estate, any and all of my real estate, at public or private sale, for such price or prices, upon 2 LAST Wll.,L AND TESTAMENT OF DOLBY M. NOTTINGHAM such terms and conditions, as in her judgment is best for my estate, and to that end to sign, seal, execute, acknowledge and deliver all deeds or other instruments necessary therefor, as effectively as I could do if I were personally present. In the event my daughter, EVELYN O'HARA, does not survive me, or refuses to act as Executrix or does not complete the duties of Executrix, then I nominate, constitute and appoint my son, LOWELL M. NOITINGHAM, as the alternate Ex~utor, to serve without bond or security. My alternate Executor shall have all of the powers, privileges, duties and immunities granted to my Executrix as provided herein. SIXTH: No beneficiary shall have the power to anticipate, encumber or transfer his or her interest in my estate or any trust created herein in any manner other than by the valid exercise of a power of appointment. No part of my estate or any trust created herein, shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. SEVENTH: My Executor may make any distribution hereunder for the benefit of minor beneficiaries directly to the beneficiary, to the natural guardian of such beneficiary, to his legal guardian, or to the person who has custody of such beneficiary, or apply any such distribution directly for the benefit of any such beneficiary. The Executor shall not in any way be liable to see to the proper use or application of any such amount paid whether directly to a beneficiary or otherwise. 3 LAST WILL AND TESTAMENT OF DOLBY M. NOTTINGHAM IN WITNESS WHEREOF, I, DOLBY M. NOTTINGHAM, the Testator, have to this my Last Will and Testament, set my hand and seal this ,<f' day of ~ . 2005. /~4 .L DOL ~GJIAlif' (SEAL) Signed, sealed, published and declared by the above named Testator, as and for his Last Will and Testament, in the presence of us, who have hereunto subscribed our names at his request, as witnesses hereto, in the presence of the said Testator, and of each other. The preceding document consists of this and three (3) other consecutively numbered typewritten pages. L{d~ ;~~~ residing~ V,' !~ residingat ~~ \M~ ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA) ) SS.: COUNTY OF CUMBERLAND ) 1, DOLBY M. NO'ITINGBAM, the Testator whose name is signed to the attached or f?regoing instrument, h~ving been duly qualified according to law, do hereby acknowledge that I SIgned and executed the mstrument as my Last Will; and that I signed it willingly and as my free and voluntary act fOT the purposes therein expressed. 4 LAST Wll.,L AND TEST AMENT OF DOLBY M. NOTTINGHAM Sworn to or affirmed and acknowledged before me by DOLBY M. NOTTINGHAM, the Testator, this ~ day of ~.~~ta? .2005. ~:YLVAH~ /~ Wf1L /, Carl Eugene Ginder. Nocary Pubfie Testator Ml Joy Twp.. LanI:uIer County My Commission Expires Ocl 12.2007 ._ Member. PemsyIv8nia AssocIation of Nolaries M ~ ..~ NO~lic (SEAL) AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ) SS.: COUNTY OF CUMBERLAND ) We, ~P../'f' Ci 0 h.,y h/!"S and ~Cf't-1 ~f"~h , 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 his Last Will; that the Testator signed willingly and executed it as his 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 that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by ftecc.4! j l yJ-fe5 and r; f~ y Jt?4Hfj"/~ , witnesses, this 1</ day of 'lz.., --7- I I ~~ ,2005. COMM EALTH OF PENNSYLVANIA Notarial Seal Carl Eupnc Ginder. NclC8ry Public Ml Joy Twp.. Lancaster County My COIl1mission Expires Oct. 12. 2007 Member, PIlI'IIlSyIvania Aasoclafion of Nolaries (SEAL) 5