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Home My WebLink About04-04-07 (2) '\ ... ....J 15056051058 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 21 06 1152 Date of Birth 100 - 12 - 8532 09/27/2006 05/15/1924 Decedent's Last Name Suffix Decedent's First Name MI Moore Carrie M. (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C8J 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required C.f 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 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes 4. Limited Estate Andrew C. Sheely, Esquire 717-697-7050 Firm Name (If Applicable) Andrew C. Sheely, Attorney at Law l~ REGIST~F WII.I.Sl.JS!3)NLY -C-O -.J__, (~33 !O '~l_; !.:.-J...O ::u - -. ) -1>- r- . "?,11l , ~-"---'-l r- ~.'~ (I) ~ ... ~) (j -.., ._ .~)c./ > l. -1"1 ---.., .--~ ,j:O'S -o~ ~J9ATE FILED c.n -J First line of address 127 South Market Street Second line of address -0 -".. -'- P.O. Box 95 N c' CO) 'oj City or Post Office Mechanicsburg State ZIP Code 7055 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. S~RSON :~R FILING RETURN AnnRF~~ ~ ~ Susan M. Appleby,4715 Sears Run Road, Mechanicsburg, PA 17050 ~E<::!R~PRESENTATIVE Annndre~ ~. She~I~,~s~~,~~;~~t-~~.~~e~~~~iCSbUrg, PA, 17055 PLEASE USE ORIGINAL FORM ONLY ("'Il\T<= _~~8DO '/ ;~TF - m~_Y!di/ Ql Side 1 L 15056051058 15056051058 ---I -.J 15056052059 REV-1500 EX Decedent's Name: Car r i eM. 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 . . . . . .. Q. 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 unclQ, C::ec. 9116 (a)(1.2) X .0 16. Amount of Line 14 bV"Ible at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 1 ~ 100-12-8532 Decedent's Social Security Number 15. 16. 17. 18. 15056052059 4,099.51 156,092.78 160,192.29 2,770.00 3,920.16 6,690.16 153,502.13 153,502.13 6,907.59 6,907.59 -.J '\ F.(EV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Carrie M. Moore File Number 115.2... .. DECEDENT'S SOCIAL SECURITY NUMBER 100 - 12 - 8532 STREET ADDRESS 1101 Yverdon Drive Apartment A8 CITY Mechanicsburg STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 6,907.59 367.99 13.61 Total Credits ( A + B + C ) (2) 381.60 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + 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 + SA. This is the BALANCE DUE. (5) (SA) (5B) 6,525.99 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 6,525.99 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;.......................................................................................... 0 [KJ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [KJ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [KJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [KJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [KJ 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. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax 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 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 PS. 99116(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. COMMONWEALTH OF PENNSYLVANIA D~AATMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES , DEPT. 280601 HARRIS8URG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT APPLEBY SUSAN M 4715 SEARS RUN DR MECHANICSBURG, PA 17050 _--:.~_~~..-:~_t fold.. _ ..--=",_- ____.--'_ ESTATE INFORMATION: SSN: 100-12-8532 FILE NUMBER: 2106-1152 DECEDENT NAME: MOORE CARRIE M DATE OF PAYMENT: 02/20/2007 POSTMARK DATE: 02/16/2007 . COUNTY: CUMBERLAND DA TE OF DEATH: 09/27/2006 NO. CD 007819 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06156612 I $109.41 I I I . I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#1349 '. SEAL INITIALS: JA RECEIVED BY: T AXPA YER $109.41 GLENDA FARNER STRASBAUGH : REGISTER. OF.WILLS , ,~. . .~ . COMMONWEALTH OF PENNSYLVANIA bEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT APPLEBY SUSAN M 4715 SEARS RUN DR MECHANICSBURG, PA 17050 ------- fold ESTATE INFORMATION: SSN: 100-12-8532 FILE NUMBER: 2106-1152 DECEDENT NAME: MOORE CARRIE M DATE OF PAYMENT: 12/27/2006 POSTMARK DATE: 1 2/27/2006 COUNTY: CUMBERLAND DATE OF DEATH: 09/27/2006 NO. CD 007617 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $258.58 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#1348 SEAL INITIALS: JA RECEIVED BY: TAXPAYER $258.58 GLENDA FARNER STRASBAUGH . ..... REGISTER OF WILLS " , . ,~\ " >- . .' \' l . \' COMMONWEALTH OF PENNSyLVANIA DEPARTMENT OF REVENUE *' ~ JUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIIII PO ICIIC 21"11 ~'IUIS PA 17121."'1 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLoWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HILD OR TRUST ASSETS 1EV-1S4a EX AFP ("-0&) SUSAN M APPLEBY 4715 SEARS RUN DR MECHANICSBURG PA 17050 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 02-05-2007 MOORE 09-27-2006 21 06 -1152 CUMBERLAND 100-12-8532 0615"12 APPEAL DATE. 04-0'-2007 (S- mlU6tJ sUM""., ObJttedoll$) .al,bI. Mount Reantedl ~fDc),l.f1 I :cliJ:.01 HAKE CHECK PAYABLE AND REMIT PAYMENT TO. 1~9 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CARRIE M CUT ALONg THIS LINE "'RETAIN LOWER PORTION FOR YOUR RECORDS ..- ,--. ----11t~11~1-lIt l."...nki~"""''!'' -.. --""....- ---- --~~.!!l-~~_""""__:_~" ..----.:. ---.. -- _ _ "'... __ .-. ..._.-..__ "-- NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 12-15-2187 ESTATE OF MOORE CARRIE M DATE OF DEATH 09-27-200' COUNTY CUMIERLAND FILE NO. 21 0'-1152 TAX RETURN WAS. S.S/O.C. NO. 100-12-8532 ACN 0615'612 () ACCEPTED AS FILED (X) CHANBED SEE ATTACHED NOTICE JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION. AMERICHOICE FCU ACCOUNT NO. 35109 TYPE OF ACCOUNT. <<)SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE DATE ESTABLISHED 05-21-2003 Account Balance Percent Taxable x Mo~~t Su~~.!-C?~ ,_ ~,o_ !a~ Debts and Deductions Taxable Mount Tax Rate x Tax Due 16.959.95 0.508 8.479.98 .00 8.479.98 .45 381. 60 NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE .-' - -_UPP.~!.f9~Ito~-'~f~lJi~J,.QJJ_CE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOYE ADDRESS. MAlE CHECK OR MONEY ORDER PAYABLE TO. "REGISTER OF WILLS. AgENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-27-2006 CD007617 13.'1 258.58 " , "\, .. ~ . . . PAYMENT MUST BE MADE BY 0'-28-2007*. TOTAL TAX CREDIT 272. 19 BALANCE OF TAX DUE 109.41 INTER~ST AND PEN. .00 TOTAL DUE 109.41 . IF PAID AFTIR THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIOHAL INTEREST. . fie( :1./ Jb 107 ( IF TOTAL DUE IS LESS THAN .1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl, YOU MAY IE DUE AREFUNJ). SEI REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l CU<.? 1~4~ - .. 1lIiV-147l1 EX (NIl . *' INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYlVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Bale 280801 DA 17128-alO1 DECEDENT'S NAME CARRIE M. MOORE FILE NUMBER REVIEWED BY MICHAEL KODOSKY ACN 2106-1152 06158612 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The claimed debts on this ACN are disallowed. All of the claimed expenses pertain to the decedent. estate. These .xpendltu.... should be claimed on the (REV-1500) ..tate Inheritance tax return when the ..tate attorney, .xecutor or executrix reports the decedent's _eta for tuatlon. Any money that was taken out of this account for the. claimed expen_ should be reimbursed to you from the decedent's estate. .- -.----:0..-..- . . ----~-.-.-- .---.-- --------.----- An adjustment has been made to reflect this change. " ,~\. . . , , ~ ORIGINAL PaQe 1 . " REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATEOF CARRIE MARIE MOORE 2 1- 0 6 - 115 fiLE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 1998 Chevrolet Cavalier sedan VIN 1GIJC524XW7283900 43,000 miles 3. Comcast refund $ 2,450.00 $ 18.72 $ 2.79 $ 300.00 $ 1,328.00 2. State Farm Insurance refund 4. Apartment security deposit refund 5. Decedent's 2006 Federal Income Tax refund ,"".\ TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert addnional sheets Of the same size) 4,099.51 ~ REV-1509 EX+ (6-9B. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF CARRIE MARIE MOORE FILE NUMBER 21-06-1152 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. Susan M. Appleby 4715 Sears Run Road Mechanicsburg, PA 17050 Daughter B Jackson A. Moore 8194 Davinda Court Citrus Heights, CA 95610 Son C JOINTLY.OWNED PROPERTY: 2. LETTER DATE DESCRIPTION OF PROPERTY " OF DATE OF DEATH ITEM FOR JOINT MADE INClUDE NAlAE OF FINANCIAl INSTITUTION AND BANK ACCOUNT NUMBER OR SIMLAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDamFYING NUMBER. ATTACH DEED FOR JOlNTL Y.HaD REAl. ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 06 /03 AMERICHOICE FEDERAL CREDIT UNION Savings Account #35109 Carne Marie Moore, Susan M. Appleby, Jt. Ten $16,959.95 50% $ 8,479.97 A Various Series E and EE SAVINGS BONDS Carne Marie Moore, Susan M. Appleby, Jt. Ten $152,635.31 50% $76,317.69 See Attached List 3. B Various Series Eand EE SAVINGS BONDS Canie Marie Moore, Jackson A. Moore, Jt. Ten $142,590.25 50% $71,205.12 See Attached List ., .. .' .'. ., , , ~ " . , . . TOTAL (Also enter on line 6, Recapitulation) $ 156,092.78 (If more space is needed, insert add~jonal sheets of the same size) z CD c~ !l5' CD;':!! 1~4J ::I. 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Page 1 of 4 .~.~ Calculated Value of Your Paper Savings Sondes) HOW TO SAVE YOUR INVENTORY Calculator Results for Redemption Date 09/2006 Total Price $57,562.50 Total Value $152,635.38 Bonds: 1-149 of 149 Total Interest $95,072.88 YTD Interest $4,645.34 R201970655E E R201968752E E R202296846E E R202934877E E R204096755E E R204105694E E R204902178E E R204904782E E L2063089993E E R204272734E E R206965583E E R207006348E E R207921052E E D207115770E E D207990026E E D208561073E E D208569693E E D209430019E E - D12252252EE EE D12252253EE EE D12252254EE EE D12252255EE EE D12252256EE EE D12252257EE EE D12252258EE EE D12252259EE EE D12252260EE EE D12252261EE EE 012252262EE EE D12252263EE EE D12252264EE EE D12252265EE EE .. D12252266EE EE D12252267EE EE D12252268EE EE D12252269EE EE D12252270EE EE . Issue Next Final Issue Senes Denom D t A I M t 't p' Interest a e ccrua a un y nee 01/1976 01/2006 $150.00 $928.08 03/1976 03/2006 $150.00 $928.08 04/1976 04/2006 $150.00 $928.08 06/1976 06/2006 $150.00 $940.72 07/1976 07/2006 $150.00$940.56 08/1976 08/2006 $150.00 $940.56 10/197610/200610/2006 $150.00 $919.20 4.00% 11/197611/200611/2006 $150.00 $929.60 4.00% 02/197702/200702/2007 $37.50 $233.16 4.00% 04/197710/200604/2007 $150.00 $911.44 4.00% 11/197711/200611/2007 $150.00 $815.60 4.00% 12/197712/200612/2007 $150.00 $818.32 4.00% 01/197801/200701/2008 $150.00 $818.32 4.00% 07/197801/200707/2008 $375.00 $1,601.404.00% 10/197810/200610/2008 $375.00$1,562.604.00% 12/197812/200612/2008 $375.00$1,586.204.00% 02/197902/200702/2009 $375.00 $1,586.604.00% 05/197911/2006 OS/2009 $375.00 $1,566.604.00% 06/198612/200606/2016 $250.00 $526.00 4.00% 06/198612/200606/2016 $250.00$526.00 4.00% 06/198612/200606/2016 $250.00 $526.00 4.00% 06/198612/200606/2016 $250.00 $526.00 4.00% 06/198612/200606/2016 $250.00$526.00 4.00% 06/198612/200606/2016 $250.00 $526.00 4.00% 06/198612/200606/2016 $250.00 $526.00 4.00% 06/198612/200606/2016 $250.00$526.00 4.00% 06/198612/200606/2016 $250.00$526.00 4.00% 06/198612/200606/2016 $250.00 $526.00 4.00% 06/198612/200606/2016 $250.00 $526.00 4.00% 06/198612/200606/2016 $250.00 $526.00 4.00% 06/198612/200606/2016 $250.00 $526.00 4.00% 06/198612/200606/2016$250,.00$526.00 4;00% 06/198612/2006 06/2016 '$~50.00:$526.00 - 4.0'0% 06/198612/200606/2016 $250.00'$526.00' 4.00% 06/198612/200606/2016 $250.00 $526.00 4.QO% 06/198612/200606/2016 $250.00 $526.00 4.00% 06/198612/200606/2016 $250.00 $526.00 4.00% Interest V I Rate a ue Note $1,078.08 MA $1,078.08 MA $1,078.08 MA $1,090.72MA $1,090.56 MA $1,090.56 MA $1,069.20 $1,079.60 $270.66 $1,061.44 $965.60 $968.32 $968.32 $1,976.40 $1,937.60 $1,961.20 $1,961.60 $1,941.60 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 Serial # $200 $200 $200 $200 $200 $200 $200 $200 $50 $200 $200 $200 $200 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 $500 file://C:\Documents and Settings\Administrator\My Documents\Ree\Calculated Value of Yo... 03/03/07 , ' Calculated Value of Your Paper Savings Bond(s) ~ Page 2 of 4 D12252271EE EE D12252272EE EE D12252274EE EE D12252275EE EE D12252276EE EE D12252278EE EE D12252279EE EE D12252280EE EE D12252281EE EE D12252282EE EE D12252283EE EE D12252284EE EE D12252285EE EE D12252286EE EE D12252287EE EE D12252288EE EE D12252289EE EE D12252290EE EE D12252291EE EE M16557800EE EE M24628465EE EE M24628466EE EE M24628467EE EE M24628468EE EE M24628469EE EE M24628470EE EE M24628471EE EE M24628472EE EE M24628473EE EE M24628474EE EE M24622012EE EE M24622013EE EE M24622014EE EE M24622015EE EE M24622016EE EE M24622017EE EE M24622018EE EE M24622019EE EE M24622020EE EE M24622021EE EE M26323585EE EE M26323586EE EE " M26323587EE EE M26323588EE EE M26323589EE EE M26323590EE EE M26323591EE EE M26323592EE EE M26323593EE EE M26323595EE EE M26323596EE EE $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00$526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00$526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00$526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00$526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00$526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00$526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00$526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00$526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $500 06/198612/200606/2016 $250.00 $526.00 4.00% $776.00 $1,000 06/198612/200606/2016 $500.00 $1,052.00 4.00% $1,552.00 $1,000 07/198701/200707/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 07/198701/200707/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 07/198701/200707/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 07/198701/200707/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 07/198701/200707/2017 $500.00$841.20 4.00% $1,341.20 $1,000 07/198701/200707/2017 $500.00$841.20 4.00% $1,341.20 $1,000 07/198701/200707/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 07/198701/200707/2017 $500.00$841.20 4.00% $1,341.20 $1,000 07/198701/200707/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 07/198701/200707/2017 $500.00$841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00$841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00$841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00$841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00$841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00$841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00$841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00$841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00$841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017. $.500.00$84~.204:.00~/o $1,341.20 $1,000 08/198702/2007 08/2017 $~'OO..i;>p.$841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017$500.00 $841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017$500.00 $841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00 $841.20 4.00% $1,341.20 $1,000 08/198702/200708/2017 $500.00$841.20 4.00% $1,341.20 file://C:\Documents and Settings\Administrator\My Documents\Ree\Calculated Value of Yo... 03/03/07 , ' Calculated Value of Your Paper Savings Bond(s) . M26323598EE EE M26323600EE EE M26323601EE EE M26323602EE EE M26323603EE EE M26323608EE EE M26323605EE EE M26323612EE EE M26323611EE EE M26323610EE EE M26323609EE EE D17217028EE EE M26925344EE EE M26925347EE EE D17217031EE EE D17217032EE EE M28430636EE EE M28430639EE EE M28430640EE EE M35581279EE EE M35581286EE EE D19016975EE EE D19016974EE EE M36193728EE EE M36193730EE EE M39337823EE EE M39337828EE EE M39337827EE EE M40176914EE EE M53148834EE EE M53148835EE EE C397853500EE EE C397853501EE EE M54103645EE EE M54103644EE EE M57040650EE EE M61324279EE EE M61324278EE EE M61455470EE EE M61455469EE EE M65536569EE EE M65536570EE EE . M65680614EE EE M65680613EE EE M65680612EE EE M66890223EE EE , M66890225EE EE M66890224EE EE M67794527EE EE M69699755EE EE M69699756EE EE $1,000 08/198702/200708/2017 $500.00 $841.20 $1,000 08/198702/200708/2017 $500.00 $841.20 $1,000 08/198702/200708/2017 $500.00$841.20 $1,000 08/198702/200708/2017 $500.00 $841.20 $1,000 08/198702/200708/2017 $500.00 $841.20 $1,000 01/198801/200701/2018 $500.00 $815.20 $1,000 01/198801/200701/2018 $500.00 $815.20 $1,000 01/198801/200701/2018 $500.00 $815.20 $1,000 01/198801/200701/2018 $500.00 $815.20 $1,000 01/198801/200701/2018 $500.00 $815.20 $1,000 01/198801/200701/2018 $500.00 $815.20 $500 02/198802/200702/2018 $250.00$407.60 $1,000 02/198802/200702/2018 $500.00 $815.20 $1,000 03/198803/200703/2018 $500.00 $815.20 $500 04/198810/200604/2018 $250.00$394.60 $500 04/198810/200604/2018 $250.00$394.60 $1,000 09/198803/200709/2018 $500.00 $789.20 $1,000 02/198902/200702/2019 $500.00 $764.00 $1,000 03/198903/200703/2019 $500.00 $764.00 $1,000 05/198911/200605/2019 $500.00$739.20 $1,000 07/198901/200707/2019 $500.00$739.20 $500 08/198902/200708/2019 $250.00 $369.60 $500 08/198902/200708/2019 $250.00$369.60 $1,000 01/199001/200701/2020 $500.00 $714.80 $1,000 05/199011/200605/2020 $500.00$691.20 $1,000 08/199002/200708/2020 $500.00 $691.20 $1,000 12/199012/200612/2020 $500.00 $667.60 $1,000 12/199012/200612/2020 $500.00 $667.60 $1,000 02/199102/200702/2021 $500.00$667.60 $1,000 02/199302/200702/2023 $500.00 $578.80 $1,000 02/199302/200702/2023 $500.00 $578.80 $100 02/199302/200702/2023 $50.00 $57.88 $100 02/199302/200702/2023 $50.00 $57.88 $1,000 06/199312/200606/2023 $500.00 $375.20 $1,000 06/199312/200606/2023 $500.00$375.20 $1,000 07/199301/200707/2023 $500.00 $375.20 $1,000 05/199411/200605/2024 $500.00$337.20 $1,000 05/199411/2006 OS/2024 $500.00 $337.20 $1,000 07/199401/200707/2024 $500.00$337.20 $1,000 07/199401/200707/2024 $500.00$337.20 $1,000 05/199511/200605/2025 $500.00$271.20 $1,000 05/199511/200605/2025 $500.00 $271.20 $1,000 07/199501/200707/2025 $500.00$271.20 $1,000 07/199501/200707/2025 $500.00 $271.20 $1,000 07/199501/200707 /2025 $500~00 $271.20 $1,000 02/199602/200702/2026 .$~PO.00$251.20. $1,000 02/199602/200702/2026 $506.00.$25L20 $1,000 02/199602/200702/2026 $500.0'0$251.20' $1,000 10/199610/200610/2026 $500.00 $221.60 $1,000 07/199710/200607/2027 $500.00 $232.80 $1,000 07/199710/200607/2027 $500.00$232.80 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 3.81% 3.81% 3.81% 3.84% 3.84% 3.84% 3.84% 3.88% 3.88% 3.88% 3.88% 3.88% 3~880f0 3.88% 3.88% 3,41% 4.11% 4.11% Page 3 of 4 $1,341.20 $1,341.20 $1,341.20 $1,341.20 $1,341.20 $1,315.20 $1,315.20 $1,315.20 $1,315.20 $1,315.20 $1,315.20 $657.60 $1,315.20 $1,315.20 $644.60 $644.60 $1,289.20 $1,264.00 $1,264.00 $1,239.20 $1,239.20 $619.60 $619.60 $1,214.80 $1,191.20 $1,191.20 $1,167.60 $1,167.60 $1,167.60 $1,078.80 $1,078.80 $107.88 $107.88 $875.20 $875.20 $875.20 $837.20 $837.20 $837.20 $837.20 $771.20 $771.20 $771.20 $771.20 $771.20 $751.20 $751.20 $751.20 $721.60 $732.80 $732.80 file://C:\Documents and Settings\Administrator\My Documents\Ree\Calculated Value of Yo... 03/03/07 Calculated Value of Your Paper Savings Bond(s) . , ' M69773904EE EE M69773903EE EE M70078179EE EE M70078178EE EE M70078177EE EE M70078176EE EE M70078175EE EE M70078174EE EE M75660513EE EE M75660514EE EE $1,000 08/199710/200608/2027 $500.00 $230.40 $1,000 08/199710/200608/2027 $500.00 $230.40 $1,000 03/199810/200603/2028 $500.00$207.20 $1,000 03/199810/200603/2028 $500.00$207.20 $1,000 03/199810/200603/2028 $500.00$207.20 $1,000 03/199810/200603/2028 $500.00$207.20 $1,000 03/199810/200603/2028 $500.00 $207.20 $1,000 03/199810/200603/2028 $500.00 $207.20 $1,000 07/200110/200607/2031 $500.00$96.40 $1,000 07/200110/200607/2031 $500.00$96.40 , ,.>, . . '~ ; 4.11% 4.11% 4.11% 4.11% 4.11% 4.11% 4.11% 4.11% 4.11% 4.11% Page 4 of 4 $730.40 $730.40 $707.20 $707.20 $707.20 $707.20 $707.20 $707.20 $596.40 $596.40 file://C:\Documents and Settings\Administrator\My Documents\Ree\Calculated Value of Yo... 03/03/07 . ' REV-1511 EX+ (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF CARRIE MARIE MOORE FILE NUMBER 21-06-1152 Debts of decedent must be reported on Schedule L ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. COCKLIN FUNERAL HOME $1,585.00 B. ADMINISTRATIVE COSTS: 1 . Personal Representative's Commissions Name of Parsonal Representative(s) SUSAN M. APPLEBY, EXECUTRIX Social Security Numbar(s)/EIN Number of Personal Representative(s) City 4715 SEARS RUN ROAD MECHANICSBURG, PA 17055 State _Zip $ 0.00 Street Address Year(s) Commission Paid: 2. Attorney Fees ANDREW C. SHEELY, ESQUIRE, PER AGREEMENT $ 500.00 3. Family Exemption: (If decedenrs address is notlhe same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decadent 4. Probate Fees 5. Accountanrs Fees 6. Tax Return Preparer's Fees 7. DECEDENT'S 2006 INCOME TAX-BOREMAN . BABB, CPA FILING FEES FOR INHERITANCE TAX RETURNS 170.00 15.00 , <~. , Reserves to conclude administration of ~.t:.t~, .inci.~u~illg preparation of decedent's first and finai acc'ouDting, costs, $ 500.00 ostage TOTAL (Also enter on line 9, Recapitulation) $ 2,770.00 (If more space is needed, insert addilional sheets of the same size) . . Coeklin Funeral Home, IDe. 30 N. Chestnut Street Dillsburg, P A 17019 (717)432-5312 October 17,2006 Mrs. Susan M. Appleby 4715 Sears Run Drive Mechanicsburg, P A 17050- The Funeral Service for Mrs. Carrie Marie Moore We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. 1lIE FOUOWlNG IS AN ITEMIZED STATEMENT OF 1lIE SERVICES. FACILI1lES. AUTOMOTIVE EQUIPMENT. AND MERCHANDISE mAT YOU SELECTED WHEN MAKING 1lIE FUNERAL ARRANGEMENTS. (A) OUR SERVICE: BASIC SERVICES OF FUNERAL DIRECTOR & STAFF . . . . . . . . . ,- - - -- 1l'I'Nlr.It~J.IIOME-SE8YlCE~GU~. . . . . . .. . . THE COST OF OUR SERVICES, EQUIPMENT, AND MERClfANDISE TBATYOUBAVESJ:U:CTED . . . . . . . . . . . . . . . Calla Advuces $1530.00 51530.00 Death Ccrti1ic8tcs. . . . . . . . . . . . . . . . . . . . . . . . Cumberland Co. Coroacr Authorization. . . . . . . . . . . . . . . . . TOTAL CASH ADVANCES AND SPECIAL CHARGES . ....... Total Total Cost. . . . . . . . . . . . . . . . . . . . . . . . . . SUB-TOTAL INITIAL PAYMENT I DISCOUNT I CREDITS TOTAL AMOUNT DUE Ibc unpaid balance over 0 days is subjected to a 0.50 % service cbarp per month _ 6.0000 % per annum. \ .... Mrs. Carrie Marie Moore Page 1 51530.00 $30.00 $25.00 S55.8O 51585.00 $1585.00 0.00 51!85.00 CftL I j)/Ol/p/~ (Jf<:# /33/ I'~ L--~ Boreman & Babb CERTIFIED PUBLIC ACCOUNTANTS , ' BILL TO Susan Appleby 4715 Sears Run Drive Mechanicsburg, P A 17050-5553 DESCRIPTION 2006 FEDERAL INCOME TAX RETURN-- CARRIE MOORE Statement of Person Claiming Refund Due PA 40 - PENNSYLVANIA STATE RETURN P A Schedule SP - Special Tax Forgiveness QTY Check I Amount Date '. , ,~\. , . l 710 Bridge Street New Cumberland, PA 17070 Phone: (717) 774-8129 INVOICE DAlE INVOICE j 3/27/2007 701138 RATE 125.00 10.00 25.00 10.00 Total TERMS AMOUNT 125.00 10.00 25.00 10.00 $170.00 \ \ REV-1512 EX+ (6-98) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABIUTlES, & UENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF CARRIE MARIE MOORE 2 1- 0 6 - 11 SP.l-E NUMBER Include unrelmburl8d medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, PPL Electric utilities - final bill 70.42 2. Verizon - final bill 17.33 3. Bunker Associates - final rent 470.00 4. John's Carpet - carpet cleaning 90.10 5. Holy Spirit Hospital - final medical services 1,817.00 6. MEDCa-prescription drugs 36.16 7. Quantum Imaging & Therapeutic - final medical bill 64.63 8. Schein Ernst Eye Associates -final medical bill 65.32 9. Internists of Central PA 61.83 10. West Shore Anesthesia 47.07 11. PA Gastroenterology consultant 62.95 12. American Home Patient 133.20 13. Heritage Cardiology Associates 94.59 14. Hershey Kidney Specialists 53.59 15. Central PA pulmonary Associates 835.97 " ,". ,~\ - , TOTAL (Also enter on line 10, Recapitulation) $ $ 3 , 920 . 16 (If more space is needed, insert additional sheets of the' same size) . -~"~...'''' '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN lENT OECE EN SCHEDULE J BENEFICIARIES ESTATE OF NUMBER 1. CARRIE MARIE MOORE NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (indude outright spousal distributions) 1. Susan M. Appleby 4715 Sears Run Drive Mechanicsburg, P A 17050 FILE NUMBER 21-06-1152 RELA TIONSHJP TO DECEDENT Do Not Ust Trultee(l) Daughter Son AMOUNT OR SHARE OF ESTATE 50 % Rest, ResiduE and Remainder of of Estate per Will 50 % Rest, ResiduE and Remainder of of Estate per Will ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17. AS APPROPRIA TE, 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 Jackson A. Moore 8194 Davinda Court Citrus Heights, CA 95610 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. " "\, , \ ~ " , .... " , " TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed. insert additiona~sheets of the same size) LAST WILL AND TESTAMENT OF CARRIE MARIE MOORE I, CARRIE MARIE MOORE, of the County of Cameron, State of Texas, being of sound mind and disposing memory, do make, publish and declare this to be my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. et (}V ITEM ONE: Let it ~e known that under date of July 9, 1992, prior to the execution of this Will, I have entered into a Trust Agreement which will be known as "The Carrie Marie Moore Revocable Trust Agreement", hereinafter referred to as the Moore Family Trust. My intention is simply to identify said Trust Agreement and not to incorporate it by reference into this Will or to create a testamentary trust hereby. 'L F~ L/J-~l.A- V However, if for any reason said living trust shall not be in existence at the time of my death, or, if for any reason a court or courts of competent juriSdiction shall validly and definitively declare the bequests and devises set forth therein to be ineffective and invalid, then I give, devise and bequeath all of the said property passing under this Will to the Trustee provided for in such Moore Family Trust, to serve without bond, to be held, managed and distributed in exactly the same manner described in said Moore Family Trust which, under said circumstances, I do hereby incorporate by reference into this Will to be administered as a testamentary trust. ITEM TWO: I direct my executor to pay all lawful debts, funeral and burial expenses, costs of "delivering bequests, estate, -. ,".,\ inheritance taxes payable by reasc;>i{)o~".lllY d,eath, 'including, but not limited to, those taxes paya}jle because of joint property passing to the survivors, because of insurance' on my life, and ... (/ ) }(., k\. (!i (;it/(/ I' those taxes due because of any gifts I have made or any trusts I have created during my lifetime, or from the residue of my estate. ITEM THREE: Should the estate available to my executor be insufficient, after considering Items Two above, said executor may call upon the Trustee of the Trust to provide such additional funds from the Trust, if there are funds in the Trust after providing for said previous Items. ITEM FOUR: Any remaining rights which I may have to the Residuary Section of any Moore Family Trust, I hereby devise and bequeath to the Residuary Section of the Moore Family Trust. All the rest, residue and remainder of my estate and property of whatsoever kind and character and wheresoever situated, whether now owned or hereafter acquired by me, I give to the Trustee of the Trust to be held and disposed of under the Trust and as provided in said Trust Agreement entered into between me and said Trustee prior to the execution of this Will and previously mentioned herein under Item One. ITEM FIVE: I nominate and appoint my Daughter, Susan Appleby, to be the Executrix to serve without bond. I give my Executrix full power to retain any of my real or personal property, without liability for any loss or depreciation by reason of such retention; to sell or lease any of my real or personal property for such prices (whether more or less than their appraised value), and upon such terms as she deems advisable; to vote all stocks by proxy or in person; to invest or reinvest any money in such investments as she .... s,~a11 . d.eem . advisable without . " ~\ being limited by any statute or ru1e,'of'. law,' regardi,ng investments by Executors now or hereafter in ~ffe~t';'to' file a joint' federal income tax return with my husband, if any; to continue, ~ incorporate or liquidate any business in which I may be engaged without liability for any losses; to exercise the option created by Section 642 (g) of the Internal Revenue Code (relating to the deduction of administration expenses) in her absolute and uncontrolled discretion, without any reimbursement or adjustment of the shares of the beneficiaries herein as a result of exercising such option; to settle any and all claims in favor of or against my estate as she deems advisable; to complete any contracts I may have entered into before my death; to make distributions in cash or in kind; to employ such attorneys, agents and consultants as she may deem necessary in the administration of my estate, and to pay them from my estate reasonable compensation for services rendered by them; and to make such funeral and burial arrangements as she sees fit. ct 1)0 Should my daughter, Susan Appleby, for any reason at all be unable or unwilling to be appointed Executrix of this Will, or if after having been appointed should she cease to act for any reason, then I appoint my son, Jackson Arthur Moore of Citrus Heights, california, as such Executor without bond, and he shall have all the powers, rights, obligations and duties as in this Will provided for my Executrix. IN WITNESS WHEREOF, I, CARRIE MARIE MOORE, have to this my last will and testament, consisting of five typewritten sheets of paper (including attestations), subscribe my name this ~ t~ day of July, 1992, at Pawhuska, Oklahoma. t~ . 1~ '\~ - \.:....~ ... '-. -'- \.: __ u) n. "t..CL- ,./}) t.l.'<! ,\..\L CARRIE MARIE MOORE " , .\ . Subscribed by CARRIE MARI~~,~~_ in the 'presence of each of us, the undersigned, and at the same time declared to us by her to be her LAST WILL AND TESTAMENT, and we thereupon at her request , and in her presence and in the pres(fce names hereto as witnesses this - -fh Pawhuska, Oklahoma. of each other, sign our day of JUly, 1992, at &'L--<---e; ;rl-'-- t!~L-L_ , ADDRESS: Pawhuska, OK ( L \\"L ~ >--_ l~ \~) \,,/'-,,-- ,-" ADDRESS: Pawhuska, OK STATE OF OKLAHOMA, COUNTY OF OSAGE, ss: Before me, the undersigned authority, on this day personally appeared CARRIE MARIE MOORE, and Carolyn Kane and Anice Conner, known to me to be the testatrix and the witnesses, respectively, whose names are subscribed to the annexed or foregoing instrument in their respective capacities, and all of said persons being by me first duly sworn, said CARRIE MARIE MOORE, testatrix, declared to me and to the said witnesses in my presence that said instrument was her last will and testament and that she had willingly made and executed it as her free and voluntary act and deed for the purposes therein expressed; and the said witnesses, each on his oath, stated to me, in the presence and hearing of the said testatrix, that the said testatrix had declared to them that said instrument is her last will and testament and that she executed the same as such and wanted each of them to sign it as a witness; and upon their oaths each witness stated further that they did sign the same as witnesses in the presence of the said testatrix and at her request and that said testatrix was at that time eighteen years of age or over and was of sound mind. /! 4 - ct.- L "'-.~~(' . rlA...-/ WITNESS ./ ,'O...::::::...L-'~/ L'; /)6' IL~ n ' r;,) \ ')-") \.A..Jt... UL--- !\~~ v\ iX.....-'\...u (' /).& <{-1'"\."~-- . CARRIE MARIE MOORE ('\ { , ..:' ,\It,' , . '\' ~,"~\~ r:: ( \. \ ,1\. '(,-l !\,-/ . WITNESS ~ Subscribed and acknowledged before me by the said CARRIE MARIE MOORE, testatrix, and subscribed and sworn before me by the said Carolyn Kane and Anice Conner, witnesses, this 9th day of July, 1992. C!JJ~f.fer ~~~rf#~d~~')~BLIC (SEAL) My comm. exp.: 1/19/96 " " ,~\ . . '. . .. THE CARRIE MARIE MOORE REVOCABLE TRUST This trust agreement made this q i~"!:- day of JUly, 1992, by Carrie Marie Moore, a single person, hereinafter called settlor, and Carrie Marie Moore, hereinafter called Trustee; WITNESSETH: WHEREAS, Settlor desires to create a revocable inter vivos trust for the benefit of herself and for such other beneficiaries as are hereinafter designated; and WHEREAS, Trustee is willing to accept and does by execution of acceptance at the end of this trust agreement, does hereby agree to administer under and in accordance with the terms of this trust agreement. NOW, THEREFORE, in consideration of the premises and the benefits that will be derived by Settlor and in consideration of the acceptance of Trustee responsibilities and duties by Trustee, Settlor does by these presents, give, grant, bargain, sell and convey and set over unto Trustee all of the property listed in Exhibit A attached hereto and made a part hereof IN TRUST'during the time and for the purpose and subject to the terms and conditions hereinafter set forth: FIRST It is specifically understood and agreed that the Settlor reserves unto herself the right and power during the period of time that she is alive, and she specifically reserves unto herself without being joined by any other person and without the consent of the Trustee the following rights: 1. To add cash, securities, personal property or real prop- erty of any kind and description to said trust estate by delivery to the trustee or by execution of proper instruments of conveyance. 2. To amend this revocable trust agreement by written amend- ment executed by the Settlor and delivered to the Trustee hereunder in any manner whatsQ~ver;\ .provided; 'however, that the duties, powers and 1iabi1itieso~ the Trustee shall not be changed without the Trustee's written consent.. . 3. To revoke this trust in whole or in part or to withdraw trust property from the operation of said trust during the lifetime of said Settlor by giving written notice to Trustee and if said Trustee should receive written notice of the withdrawal of trust property from the operation of this trust, said Trustee shall, upon receipt of said notice, make, execute and deliver to Settlor, or the survivor of said Settlor, such instruments in writing as may be necessary to withdraw said property from the trust agreement. However said property shall remain subj ect to the terms of this revocable trust agreement until the actual transfer thereof is completed. SECOND All trustee assets shall be held for theuse and benefit of Settlor during her lifetime and all income of the trust herein created shall be distributed during the lifetime of the Settlor to the Settlor for the period of her natural life. If the net income of the trust estate is not sufficient to pay for all of the support, care, maintenance and other needs of the Settlor the Trustee is authorized to use and extend such sums from the corpus of said trust as may be necessary to meet such needs. THIRD The Trustee shall have such powers, immunities and duties as are granted to trustees by virtue of 60 Oklahoma Statutes ~175.l and following, in force and existence at the time of the execution of this revocable trust agreement and the provisions of the Prudent Man Rule for Investments, 60 Oklahoma Statute ~16l except as other- wise modified by this trust agreement. No amendment or appeal of said statute shall be effective to change the powers and duties of the Trustee hereunder. In addition thereto, the Trustee shall have the following specific powers, to-wit: 1. To borrow money for payment of taxes, improvements or operation of property or to perform other legitimate duties of the Trustee. 2. For the purpose of making periodic distribution and to estimate or anticipate the net,iiwome without l~ability for such error in such estimate. ,', ., '\ . , ' .,; '. ", 3. The Trustee shall be permitted to deal with itself in that it shall be permitted to invest money iriitsown institution, '. l. provided that said investment does not exceed the $100,000.00 limit of FDIC insurance. 4. To determine who is entitled to distribution and to deter- mine heirship without court intervention, including all inherit powers in connection therewith. 5. To sell, mortgage, exchange, lease or otherwise deal with all of said property in the trust and to exercise the judgment and care in the circumstances then prevailing, which men of discretion, prudence and intelligence exercise in the manage- ment of their own affairs. 6. To make distribution to minor beneficiaries or to third parties for the benefit of minor beneficiaries as said Trustee shall deem in its discretion to be proper without the inter- vention of a legal guardianship. 7 . The Trustee may, for the purpose of management and invest- ment treat all trust property or some portion thereof as a whole with each beneficiary having an undivided beneficial interest. 8. Upon distribution of the assets to make distribution, either in kind or in part, with the Trustee using its best judgment as to the value of assets, which judgment shall be conclusive as long as the Trustee acts fairly and in good faith to the interest of all concerned. 9. To determine what is income and what is principal of said trust in accordance with normal customary and accepted ac- counting practices. FOURTH After the death of the Settlor, all assets then existing within the trust estate, whether same be principal or accumulated interest, shall be held, handled, managed, divided and distributed as follows, to-wit: 1. Trustee is hereby authorized to pay all expenses of Settlor IS last illness, funeral, burial, and all related expenses. 2. Should the estate of the deceased Settlor incur any estate, inheritance, transfer or other deatb,:'taxes because of the death ~ - , \ of the Settlor, the Trustee shall be atithQ~izedto file necessary tax returns and shall be authorized to pay such taxes out of the trust estate as a first charge thereon, such paYment of taxes to . . . be without the right to seek recoupment or contribution from the Settlor's estate or any other person. 3. After the items listed in paragraphs 1 and 2 immediately above have been totally completed and the Trustee has received approval of the federal estate tax return and the state inher- itance tax return and has received acknowledgment for the payment of all taxes due because of the death of the Settlor. The Trus- tee shall distribute all the remaining assets of this trustee and all undistributed income thereof in the fOllowing manner, to-wit: a) An undivided 1/2 to Susan Appleby, daughter of Settlor; b) An undivided 1/2 to Jackson Arthur Moore, son of Settlor; 4. In the event that any of the children above named should predecease the settlor and leave heirs of his or her body surviving them, the share of said deceased child in and to the trust estate shall pass in equal shares to the heirs of his or her body; provided, that it is expressly understood and intended that for the purposes of this Trust, "heirs of the body" is not intended to include adopted children or step-children. In the event any of the children above named should predecease the Settlor, and leave no heirs of his or her body surviving, then and in such event, the share of such deceased child in and to the trust estate as above defined shall go to the survivors of said Settlor's children as above named. After distribution of all assets have been made under this paragraph of this trust agreement, this trust shall terminate and cease. FIFTH " ,'..' The principal of the trust estate here,iraJ;)ev~ created 'and the in- come resulting therefrom while in thehahds of the Trustee shall not be subject to any conveyance, transfer orassiqnment or to be . . ... ~ pledge for security for any debt of any beneficiary and the same shall not be subject to any claim by any creditor or any benefi- ciary through any legal process or otherwise. SIXTH None of the beneficiaries of this trust except the Settlor or the ,survivor of the Settlor as the case may be, shall have the right to sell, transfer or otherwise encumber or in any manner anticipate or dispose of his or her interest in the trust estate or the income therefrom and neither the principal or income shall be sUbject to seizure under any writ or other proceedings at law or equity for the debt of any such beneficiary. SEVENTH The Trustee shall keep accurate books of account of all matters pertaining to the trust estate Showing all receipts of prinicpal and income and investments and changes of investments. These accounts shall be open at all reasonable times for inspection by the Settlor and beneficiaries hereunder and the Trustee shall upon request but not more frequently than quarter-annually render to the Settlor, as the case may be, itemized statements reflecting the condition of the trust and the Trustee is hereby specifically exempted from making an annual or any other report to any court of jurisdiction. EIGHTH This trust is hereby declared to be revocable at any time by the Settlor and may be revoked, amended, altered or modified in any manner at any time, in writing, by the Settlor. \l~'L.LQ. fl'11 il_/~~L(:J). '\ \\u'.~' CARRIE MARIE MOORE " , ,_\, . , ! , ... .. , The terms, conditions, duties and obligations of the above and foregoing trust are hereby accepted this ~ day of July, 1992. (>>, '''-~ 11 ~~,~LQ._. "J) '\ CL."u.-1.) _ \./ // (;) Ci.))>~- CARRIE MARIE MOORE, TRUSTEE STATE OF OKLAHOMA, OSAGE COUNTY, ss: The foregoing instrument was acknowledged before me this ~~l) day of July, 1992 by Carrie Marie Moore, a single person. Ql~ ~IM~t \, Q t<5 ()(,:j (;> '\ r' \( OFFICIAL SEAL: I\IL1 Q CIl,i") \ ~X~ \/\C~6 , ,.\, .. 1t . .. . EXHIBIT "A" Lot 1, and the SE/4 NE/4 of Section 4, T-22-N, R-6-E, Pawnee County, Oklahoma, and Lot 5, Section 33, T-23-N, R-6-E, Pawnee County, Oklahoma, and Lot 87, Section No.2, Municipal Cemetary, City of Pawhuska, Osage County, Oklahoma " ", ,~\