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HomeMy WebLinkAbout05-12-08 o --.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17126-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year d-f O~ File Number 05)1 Date of Birth 130-20-9599 08/11/2007 11/18/1926 Decedent's Last Name Suffix Decedent's First Name MI Mowers Lillian c (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 ,a:: 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) <a) 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 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes ZIP Code (717) 221-11~ g ...... .......CS..9?.. REGISTER OJ;':'J.'lttl,LS USE dJC.y ;'~~C) ~ '-,-.._r- ":7-rT1 --::::'0 _ (J') ;." '--: ('")Q ',(..,::)-n 0':0 "0--1 ~:r> DATE FILED N Johnna J. Kopecky Esq Firm Name <If Applicable) 120 South Street -0 3: N .. The Shagin Law Group LL First line of address Second line of address City or Post Office Harrisburg State N CD PA 17101 Correspondent's e-mail address: , Under penalties of perjury, I dedare that I have examined this retum, includihg accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correet and comple . beet tion of preparer,other than the persOnal representative is based on all information of which pre parer has any knowledge. IBLE fi R Fill Co PA /7"1$ ;) DATE J ~ ~/O 8" ~bV/Lr Pfi- /7/01 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ---I ~ .....J 15056052059 REV-1500 EX Decedent's Name: Lillian C. Mow-ty~ 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). . . . . . . . . . . . . . . . . . . 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 Govemmental 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 .045 383,712.21 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedent's Social Security Number 130-20-9599 365,524.20 4. 44,219.98 40,974.18 15,847.32 10,184.65 26,031.97 383,712.21 383,712.21 17,267.05 18. 17,267.05 15056052059 -.J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Lillian C. Mowi!v'<:;" 130-20-9599 STREET ADDRESS 2128 Ritner Highway CITY I STATE I ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 17,267.05 Total Credits ( A + 8 + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 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 avalon Page 2, Line 20 to request a refund. (4) 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. 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (58) 17,267.05 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 [iJ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] 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 [iJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [iJ 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 PS. 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 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. 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 four and one-half (4.5) percent, 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 ofthe decedent's siblings is twelve (12) percent [72 PS. 99116(a)(1.3)]. Asibling 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-1502 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Mowers, Lillian C All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM NUMBER 1. DESCRIPTION 2128 Ritner Highway, South Newton Twp, Cumberland County', PA VALUE AT DATE OF DEATH 365,524.20 county assessed value: 299610.00 x. 1.22 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 365,524.20 ... ,r I' ~.. L' J~ r ,- /' ';0.5'1 J2.-~ ?::iSERT ? ZIEGLER ~~" E C;,) H DE f~ 0 F Pij-~No. { S [H Ud~ D C [) U;; T"r - i' \ ln07 f'iRR 6 PPl 3 09 THIS DEED Made the l!i- day of 8:::f/(t?11~- , 2005. Between FLOYD J. MOWERS and LILLIAN C. MOWERS, husband and wife, of Cumberland County, Pennsylvania ("Grantors"), AND FLOYD J. MOWERS and LILLIAN C. MOWERS, Trustees under THE FLOYD J. MOWERS AND LILLIAN C. MOWERS REVOCABLE TRUST AGREEMENT ("Grantees") : WITNESS, that in consideration of the sum of One Dollar ($1.00) in hand paid, the receipt whereof is hereby acknowledged, and intending to be legally bound hereby, the Grantors do grant and convey to the Grantees, ALL THAT CERTAIN tract of land situate in the Township of South Newton, County of Cumberland, State of Pennsylvania, bounded and described as follows, to-wit: BEGINNING at a point in the center of Route #11 (Ritner Highway) at common corner of lands owned by S. Fry; thence along center of said road North fifty-five (55) degrees East Eighty and Seventeen (80.17) perches to an iron pin in the center of said road at corner of lands retained by Ezra Teter, et ux; thence by lands retained by Ezra Teter, et ux South Thirty-three and One- fourth (33 1/4) degrees East Thirteen and Four Tenths (13.4) perches to a stake; thence by same, North Fifty-five (55) degrees Thirty-five (35) minutes East Forty-two and Two Tenths (42.2) perches to an iron pin at lands of A.M. Balliet; thence along the Balliet lands S,outh Two and One-half (2 12) degrees East Eighty and Twenty-six hundredths (80.26) perches to a post; thence by lands now or formerly of Harvey Str01:1.m Estate South Twenty-seven and One-half (27 ~) degrees West One hundred Three (103) perches to a post at corner oflands ofG. Jumper; thence by Jumper land and others North Thirty (30) degrees West One Hundred Thirty and Twenty-five Hundredths (130.25) perches to a point in the center of the aforesaid public road, the place of BEGINNING. CONTAINING Sixty-four (64) acres and One Hundred Fourteen (114) perches, more or less. Said draft attached for the land conveyed and for that also retained by Grantors. BEING part of the same tract oflal1d which Ezra Teter and Mary A. Teter, his wife, by their deed dated the 16th day of December, 1965 as recorded in Deed Book 21, Page 780 t.[.,,,,, ?~, ",,;' 1.4" (.;',/:1 ~/ 7J '........ ,~:J conveyed unto Grantors herein. UNDER AND SUBJECT to all other restrictions, reservations, setback lines and rights- of-way of record. AND the Grantors will warrant specially the property hereby conveyed. IN WITNESS WHEREOF, the Grantors have hereunto set their hands and seals the day and year first above written. ~ /&"~EAL) Floyd J. Mowers ) (A () ( 11. (SEAL) COMMO~TWEAL TH OF PENNSYL V M1A : SS COL~TYOFCL~ERLAND On this, the I tJ day of ~~~ t. ~efore me, the undersigned officer, personally appeared FitydJ. Mowers and Li lian C. Nlowers, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. COMMONWEALTH OF PEN"NSY'LVA......1A Notarial Seal Patrick J, Mcl..alighliri, NoUU)' PuI?I~ Upper Moreland TwJl.. MontsomeryCount\- My Commission BKpires June 21. 2008 Member. Penn~.nl' AasoeIatlon of NOUlrles I HEREBY CERTIFY, that the precise residence (address) of the Grantees is 2128 Ritner Highway, Shippensburg, Pennsylvania 17257. I Ccrtl fy this to be recorded 1;1 Cumberland County PA Agent or attorney for Grantees /J1t~,~ -;4 ~r BOOK 2.79 :,',GE 144 A;~:::JY'; -:, ;~~,!_"')o Recorder of Deeds REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Mowers, Lillian C FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. 1\11 property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 Orrstown Bank, accl. #610534 VALUE AT DATE OF DEATH 2 Proceeds from Auction (personal property) 20,739.69 23,480.29 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 44,219.98 ~ ORRSTOWN BANK A Tradition of Excellence February 7. 2008 Re: Floyd J Mowers Lillian C Mowers Revocable Living Trust Acct 610534 To Whom It May Concern: This letter is to provide the balance of the above account as of the date of Mrs. Lillian C Mowers' death, which took place on 8/11107. Our records show a balance of$20,739.69 in Mrs. Mowers' checking account on the date of 8/11107. This balance does not reflect any outstanding checks that may have been written prior to Mrs. Mowers' death. If there is any other information that I can provide to you in this matter, please do not hesitate to contact me using the information provided below. Sincerely. ~ ofjeU:tfuyu.~ Jamie L. Featherer Customer Service Representative King Street Office 717.530.3915 j featherer@orrstown.com P.O. Box 250. Shippensburg, PA 17257. 717.530.3530. 717.532.4143 fax \. '.& i'A \. '1DIiI:A'l :t. FINAL SETTLEMENT Date 3 -IS-~u Y SELLER: Est,de (iL ~ -J +- LiJl;.~^ L. Iht'wtfs Address: z) 1.t:':I !l tfll~[ /J-w,,::, 5 ~ ~Sr . Sale Location: -''PI'l- Auctioneer: G. Mark Neil Clerk:: O'.l-l.- H > Other: 112-5'7 ~ &'75-le Cashier: S)Hrr i R """'5)..;' tv ------------------------------------------------------------------------------------------------------------------ PROCEEDS OF SALE: Cash ................................. $ 9..::l '5 S ,7)' Cllt~'cks ............................. S 'll( C1 6 ~. ~ u Other ................................ -0'-? 7 '/4J()~ ~ -t7v,l-;>.t-. -.lj;-5 peL.3 .I~ Ie TOTAL PROCEEDS OF SALE S .J- 1 ,.2.L.{). z.r Less seller's expenses: (/ Auctioneer's Fee ..l.l.?v.'....... S '?J ;;t b~. L/3 Other seller's expenses: making of sale bill ....... ... ................ ....... Advertising costs: 7 j -( S't"1 "'/1':' / f/;t 6/1.(..... C'J)I:I) {&/'1 L I f(",4" I v/'Yl tt..~ r Miscellaneous expenses: $.~ $ I '3 /. bo $ 33/. I 3 $ I (;,. ~v $ I v . c;..v s S $ Total Seller's sale expense: s '3 7l:~LJ. q6 ''J- 3 I Ivl <[SO \ 2Cj , Total Net Proceeds to Seller: $ ----------------------------------------------- ------------------------------- I (we), the seller of goods, merchandise, and/or property sold at public anctiollonabove date and location, acknowledge and accept this settlement of proceeds of sale. I ( or we) agree to accept all responsibility for providing merchantable title to all goods, merchandise, and/or property sold, and for deliver of title to purchaser. (date) (Sener'ssignature) (Seller's signature) (Auctioneer's signature) REV-1511 EX+ (12099). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Mowers, Lillian C FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Cumberland Valley Memorial Garden, Carlisle Funeral Luncheon 9,700.00 647.32 2 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representatlve(s) Linda K. Mowers 5,000.00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 2128 Ritner Highway City Shippensburg Year(s) Commission Paid: 2008 19S' '3(,_5(" S-O State PA Zip 17257 2. Attorney Fees Th-e- 5ho..q I~ LD.v.J 6rovp L\..C. 500.00 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 15,847.32 REV-1512 EX+ (12-03) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mowers, Lillian Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH FILE NUMBER 1. County and Township Real estate taxes 1,835.10 Roof repair 4,744.00 Erie Insurance Premium 387.00 2007 Per capita tax 9.80 2007-2008 School Taxes 1,951.81 Embarq 25.46 PP& L 1 07.36 Landfill delivery 44.38 Auction tent rental 350.00 Tractor repair for sale 657.15 Tractor battery for sale 72.59 2 3 4 5 6 7 8 9 10 11 10,184.65 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mowers, Lillian C FILE NUMBER 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)J 1 Linda K. Mowers 2128 Ritner Highway Shippensburg PA daughter 20% 2 Dennis L. Mowers P.O. Box 43 Pleasant Hall PA son 20% 3 Robert D. Mowers 314 Newburg Road Newburg PA son 20% 4 Ricky J. Mowers 4828 E. Trindle Road Mechanicsburg PA son 20% 5 Richard V. Mowers 120 High Road Shippensburg PA son 20% 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 FLOYD J. MOWERS AND LILLIAN C. MOWERS REVOCABLE TRUST AGREEMENT DATED: /1 c;,,~'&AJ~'fik) ~S- BETWEEN: FLOYD J. MOWERS and LILLIAN C. MOWERS ASSETTLORS AND: FLOYD J. MOWERS and LILLIAN C. MOWERS AS TRUSTEES Floyd J. Mowers and Lillian C. Mowers, residents of 2128 Ritner Highway, Shippensburg, County of Cumberland, in the Commonwealth of Pennsylvania, do hereby establish a Trust (the "Trust") upon the conditions and for the purposes hereafter set forth. ARTICLE ONE Section 1.01 Trust Estate Defined This Trust is formed to hold title to real and personal property for the benefit of the Settlors of the Trust and to provide for the orderly use and transfer of these assets upon the death of the Settlors. The "Trust Estate" is defined as all property transferred or conveyed to, and received by the Trustee and held pursuant to the terms of this instrument. The Trustee is required to hold, administer, and distribute this property as provided in this Trust Agreement. The Settlors shall list the property held in the Trust on Schedule A, which is bound together with and made a part of this Trust Agreement by reference thereto, and which may be amended from time to time by the Settlors as property is added to or removed from the Trust. The Settlors acknowledge that they have transferred to the Trustee, without consideration, the sum of Fifty Dollars ($50.00), which was the original corpus of the Trust Estate. Additional property may be added to the Trust Estate at any time by the Settlors or either of them, or by any person or persons, by inter vivos or testamentary transfer. All such original and additional property constituting the Trust Estate shall be held, managed and distributed as herein provided. Section 1.02 Emplovee Benefit Plans In the event that any designation of the Trustee of this Trust as beneficiary in any employee benefit plan in which the Settlors may have an interest shall be ineffectual in whole or in part, the Trust Agreement Page 1 Settlors specifically request that the committee, or other group having authority to do so under such plan, select the Trustee of the Trust as beneficiary of such plans to the maximum extent possible. The Trustee may elect the mode of payment which, in the Trustee's discretion, appears to be the most advantageous option available to the Trust and/or its then-current income beneficiaries in terms of income, estate, and inheritance tax, and/or investment return considerations, based on the Trustee's evaluation of the facts and circumstances relevant to such considerations as they exist at the time the Trustee makes such election. Further, the Trustee may, predicated upon the foregoing considerations, elect in writing not to treat the death benefits as a lump sum distribution for income tax purposes and thus exclude the same from estate taxes. An election by the Trustee in good faith in the exercise of the discretionary power conferred upon it shall be final and binding upon all persons whomsoever and shall be a full acquittance and discharge to the Trustee, and the Trustee shall not be liable to any person by reason of its exercise of such discretionary power. 1.03 Life Insurance The Trustee may be named as beneficiary of death benefit proceeds of life insurance policies. Such death benefit proceeds will be subject to all the terms hereof. The Trustee shall not be obligated to pay any premiums, assessments, or other charges on any policies not owned by the Trust, nor to keep anyone informed with respect thereto. The Trustee shall not be responsible for any acts or omissions of the owners in connection with any policy. The owner of each policy in which the Trustee is named beneficiary but is not the owner has reserved all rights, option, and privileges, including all incidents of ownership, conferred by the terms of the policies. Such rights shall include, but not be limited to, the right to change the beneficiaries of such policies. 1.04 Retention of Property Character During the joint lives of the Settlors, any property transferred to this Trust shall retain its original character and, in the event of revocation, the Trustee shall distribute such property to the respective Settlors based on the same property rights they had prior to transfer to the Trust. Section 1.05 Other Definitions As used in this Trust Agreement 1. The term "Husband" shall mean Floyd J. Mowers. ') The term "Wife" shall mean Lillian C. Mowers. 3. The term "Settlor" shall refer individually and collectively to Husband and Wife. 4. The ten11 "descendant" shall mean the lawful issue of a deceased parent in the line of descent, but does not incl ude the issue of any parent who is a descendant of the deceased person in question and who is living at the time in question. Trust Agreement Page 2 5. The terms "child" and "descendant" include any issue born to a decedent, a child legally adopted by the decedent, and a posthumous child of a decedent. A posthumous child is to be considered as living at the time of his or her parent's death. 6. The term "survives" or "surviving", unless otherwise indicated herein, shall be construed to mean surviving the decedent for at least sixty (60) days. If the person referred to dies within sixty (60) days of the death of the decedent, the reference to him or her will be construed as ifhe or she had failed to survive the decedent; provided, however, that any such person will have, during such period, the right to the use and enjoyment as a life tenant of all property in which his or her interest will fail by reason of death during such period. 7. The term "issue" will include all natural and adopted children if applicable, and descendants and those legally adopted into the line of descent. 8. The term "per stirpes" means strict per stirpes and does not mean per capita with representation. Beneficiaries entitled to take under a "per stirpes" clause will include both natural and adopted children and their descendants. 9. The term "Trust" includes the initial Trust established hereunder as well as any separate trust established under the terms of this Trust Agreement. 1 O. The terms "Trust Assets" and "Trust Estate" include all assets of any trust created hereunder and income derived from such assets and all proceeds of any description derived from the sale, exchange, or other disposition of such assets. < 11. When required to give reasonable effect to the context in which used, pronouns in the masculine, feminine, or neuter gender include each other, and nouns and pronouns in the plural or singular number include each other. Section 1.06 Trustee Designation Husband and Wife are hereby designated as Co-Trustees. The Co-Trustees shall serve jointly and severally and either shall have full authority to act for the Trust independently. Should either Husband or Wife become unable because of death, incapacity, or other cause to serve as a Co- Trustee, or should either Husband or Wife resign as Co-Trustee before the natural termination of this Trust, the remaining Co-Trustee (Husband or Wife) shall thereafter serve as sole Trustee, except where another Co-Trustee or special trustee is provided for hereinafter with respect to a separate trust created upon the death of one of the Settlors. The term "Trustee U as used in this Trust AbYfeement shall refer collectively to Husband and Wife so long as they serve as Co- Trustees, to the spouse who serves as the sole Trustee, and/or to any Successor Trustee or Successor Trustees collectively who assume the role of Trustee. These Trustees shall serve in the Trust Agreement Page 3 order as provided in Section 9.01 of this Trust Agreement. Section 1.07 Apportionment The Trustee of the Trust is directed to apportion receipts and expenditures of the types described below between principal and income as follows: 1. \Vhenever the principal, or any part thereof, of the Trust Estate is invested in securities purchased at a premium or at a discount, any premium will be charged against principal and any discount will be credited to principal; 2. Any stock dividends and rights to purchase additional stock issued on securities held in trust will be treated as principal. All other dividends, except liquidating distributions, will be treated as income; and 3. The amount of any applicable depletion allowance for federal income tax purposes will be treated as income. Section 1.08 Administration of Trust During the Settlors' Lifetimes The Trustee shall hold, manage, invest, and reinvest the Trust Estate and shall collect the income thereof, and shall, upon demand of the Settlors, pay to the Settlors during their joint lives all net income of the joint property in the Trust Estate and shall pay to each Settlor all separate net income from his or her respective share of the Trust Estate. In the event that the Settlors do not demand payment of the net income of joint property, or, if either of the Settlors fails to demand distribution of separate property net income, then the Trustee may in its discretion accumulate such income, and such income will become the property of the Trust Estate. The Trustee shall further pay principal, up to the wnole thereof, to the Settlors upon written request. Upon the written request of the Settlor who transferred separate estate property to the Trust, the Trustee shall pay so much ofthe principal of the separate estate established by such Settlor, up to the whole thereof, as he or she shall request. Section 1.09 Discretionary Termination The Trustee may terminate the Trust when, in the opinion of the Trustee, the principal is reduced to such an extent that it is not in the best interest of the Beneficiary or Beneficiaries to continue the Trust. The judgment of the Trustee with respect to this decision to terminate will be final and not subject to judicial review. If the Trustee terminates a Trust according to this Section, the date the Trust terminates will be deemed the date fixed for termination of the Trust, and the Trustee will distribute the assets of the terminating Trust to the Beneficiary or Beneficiaries pursuant to this Af,rreement. Trust Agreement Page 4 Section 1.10 Amendment and Revocation The Settlors hereby retain the following powers, exercisable at any time during their lifetimes: 1. To withdraw any of the property included in a separate share of the Trust Estate by giving the Trustee written notice specifying the property so withdrawn, in which event, the Trustee shall promptly transfer and deliver such property to us or the respective Settlor's designee. 2. To amend the provisions of this Trust Agreement in any respect without the necessity of securing the consent of the Trustee to such changes, in which event, a copy of the amendment shall be promptly furnished to the Trustee; provided, however, that following the death of one of the Settlors, the survivor shall have no power to amend the terms of the Trust Agreement with respect to the Trust Share of the first Settlor to die. 3. To revoke this Trust by giving the Trustee written notice of such revocation, in which event the Trustee shall promptly transfer and deliver the property constituting the Trust Estate to the Settlors or their designee together with an accounting therefore; provided, however, that following the death of one Settlor, the survivor shall have no power to revoke the terms of the Trust Agreement with respect to the Trust Share of the first Settlor to die. 4. Any and all gifts of Trust Assets shall constitute a revocation by the Settlors as to Trust administration over such property, whether such gift is made by a Settlor or by the Trustee at written direction of each of the Settlors. 5. If a Settlor is incapacitated such power to revoke, alter, or amend the Trust may be exercised by the agent of such Settl~r without approval of any court, or by the Guardian or Conservator at the direction of a court of competent jurisdiction. Section 1.11 Irrevocability Except as otherwise provided, on the death of either Settlor, the designation of Beneficiaries of specific gifts in this Trust Agreement shall become irrevocable and not subject to amendment or modification. Section 1.12 Settlor Powers The surviving Settlor shall be the Trustee unless and until he or she resigns in writing or is determined incapacitated under the terms provided herein. The surviving Settlor shall retain all absolute rights to discharge or replace any Successor Trustee of any portion or share of the Trust which is revocable by the surviving Settlor so long as the Settlor is competent. Trust Agreement Page 5 ARTICLE TWO Section 2.0 I Protection of Settlor in Event of Incapacity During the joint lives of the Settlors, should either Settlor become incapacitated as defined in Section 2.02 below, the Trustee may, in the Trustee"s absolute discretion, pay income and principal for the benefit of the incapacitated Settlor. In addition, the Trustee, in his or her absolute discretion, may pay to or apply, for the benefit of that Settlor, such sums from the net income and from the principal of the Settlor's separate Trust Share as the Trustee believes is necessary or advisable for the medical care, comfortable maintenance, and welfare of the Settlor. Section 2.02 Incapacity 1. A person is determined to be incapacitated if any Trustee or Beneficiary hereunder comes into possession of any of the following: a. A jurisdictionally applicable court order holding the party to be legally incapacitated to act on his on her behalf and appointing a guardian or conservator to act for him or her; or b. Written certificates which are duly executed, witnessed, and acknowledged of two licensed physicians, each certifying that the physician has examined the person and has concluded that, by reason of accident, mental deterioration, or other cause, such person has become incapacitated and can no longer act rationally and prudently in his or her own financial best interest; or c. Evidence which such Trustee or Beneficiary deems to be credible and currently applicable that a person has disappeared, is unaccountably absent, or is being detained under duress, and that he or she is unable to effectively and prudently look after his or her own best interests. 2. In the event that a person is determined to be incapacitated as provided above, then in that event and under those circumstances: a. Such person is deemed to have become incapacitated, as that term is used in this Trust agreement; and b. Such incapacity is deemed to continue until such court order, certificates, and/or circumstances are inapplicable or have been revoked. 3. A physician' s certificate to the effect that the person is no longer incapacitated shall revoke a certificate declaring the person incapacitated. The certificate which Trust Agreement Page 6 revokes the earlier certificate may be executed by either the original certifying physician or by two other licensed, board certified physicians. No Trustee shall be under any duty to institute any inquiry into a person's possible incapacity. The reasonable expense of any such inquiry shaH be paid from the Trust Assets. Section 2.03 Principal Invasion During the joint lives of the Settlors, should the net income of assets contained in this Trust be insufficient to provide for the care, maintenance, or support of the Settlors as herein defined, the Trustee may, in the Trustee's sole and absolute discretion, pay to or apply for the benefit of the Settlors or either of them, or any of their dependents, such amounts from the principal of the Trust Estate as the Trustee deems necessary or advisable for the care, maintenance, or support of the Settlors. Section 2.04 Residence If the Settlors' residence property is part of the Trust, the Settlors shaH have possession of and full management of the residence and shall have the right to occupy it free of rent. Any expenses arising from the maintenance of the property and from all taxes, liens, assessments, and insurance premiums, are to be paid from the Trust to the extent that assets are available for payment. It is the intent of the Settlors to retain all homestead rights available to them under the applicable state law. ARTICLE THREE Section 3.01 Allocation of Assets Upon Death of One Spouse Upon the death of either of the Settlors, the assets of this Trust shaH remain in the Trust with the surviving Settlor as primary trustee and primary Beneficiary except that the surviving Settlor shall have the right to disclaim all or any part of the deceased Settlor's interest in the Trust Estate. Said assets disclaimed shall be selected by the surviving Settlor out of the Trust Assets including, but not limited to, any assets gifted, transferred or poured over into this Trust at any time. Upon said disclaimer of assets by the surviving Settlor, the disclaimed whole or portion shaH be distributed to and administered pursuant to the provisions for the Non-Marital Share as described below. Section 3.02 Non-Marital Share 1. Upon disclaimer of assets pursuant to the previous provisions, the disclaimed whole or portion shaH be distributed to a separate trust, hereinafter referred to as the Credit Shelter Trust, to be held and administered as fOHows: Trust Agreement Page 7 a. Upon the death of either Settlor, the surviving Settlor and Linda Mowers shall be co-trustees of the Credit Shelter Trust and shall be entitled to manage the assets of the Credit Shelter Trust; but the plan of distribution and all terms of this Credit Shelter Trust shall be irrevocable and unamendable upon the death of either Settlor. The surviving Settlor shall be entitled to receive all of the income therefrom for life. In addition to other payments from the Credit Shelter Trust as herein authorized, there shall be paid to the surviving Settlor during the surviving Settlor's lifetime from the principal of the Credit Shelter Trust upon the surviving Settlor's written request during the last month of each calendar year of the Credit Shelter Trust, an amount not to exceed the greater of five thousand dollars ($5,000) or five percent (5%) of the total value of the principal of the Credit Shelter Trust on the last day of the calendar year without reduction for the principal payment for such calendar year. This $5,000 or five percent (5%) right of withdrawal is non-cumulative, so if the surviving Settlor does not withdraw the full amount to which the surviving Settlor is entitled during a calendar year, the surviving Settlor's right to withdraw the $5,000 or five percent (5%) for that year shall lapse at the end of the calendar year. b. After the preceding provisions are complied with, Linda Mowers and shall act as special trustees of the Credit Shelter Trust, with sole right and power to distribute principal over and above the distributions authorized in the preceding provisions to the surviving Settlor. The special trustees, in the special trustees' sole discretion, may distribute all or any part of the principal of the Credit Shelter Trust remaining after the preceding provisions are complied with, to or for the benefit of the surviving Settlor in such proportions and in slfch amounts as the special trustees deem appropriate. c. Notwithstanding any other provisions of this Trust Agreement, under no circumstances shall the surviving Settlor act as sole trustee of the Credit Shelter Trust. This paragraph shall take precedence over any other provisions of this Trust Agreement. d. If the surviving Settlor is unable or unwilling to act as co-trustee of the Credit Shelter Trust, then Linda Mowers shall act as trustees of the Credit Shelter Trust with all the rights and responsibilities given to the original trustees of the Credi t Shelter Trust. e. If Linda Mowers is unable or unwilling to act as trustee, then Dennis Mowers shall serve as co-trustee or sole trustee of the Credit Shelter Trust, as the case may be, with all rights and responsibilities given to the original trustee of the Credit Shelter Trust. Trust Agreement Page 8 f. The trustees of the Credit Shelter Trust shall have the same administrative powers given to the Trustees under Section 5.02 below. g. The Credit Shelter Trust trustees shall act without bond and shall make such accounting to the Beneficiaries as the trustees, in the trustees sole discretion deem advisable. Said Credit Shelter Trust trustees shall not be required to make any current reports or accountings to any court nor to any Benefi ciaries. h. The Credit Shelter Trust trustees shall serve without compensation. 2. Upon the death of the surviving Settlor, the assets then remaining in the Credit Shelter Trust shall be distributed after giving effect to the section of this Trust Agreement entitled "Special Directives", to the following Beneficiaries in the indicated shares: Linda K.Mowers corner cupboard, jewelry, plus one-fifth of the residue of the estate Dennis L. Mowers choice of gun, plus one-fifth of the residue of the estate Robert D. Mowers choice of gun, plus one-fifth of the residue of the estate Ricky J. Mowers choice of gun, plus one-fifth of the residue of the estate Richard V. Mowers choice of gun, plus one-fifth of the residue of the estate Any child shall have the option to purchase the family farm from the other beneficiaries, at a price that is agreed upon by the rest. If any of the Beneficiaries named immediately above who are natural persons do not survive the surviving Settlor, then the share that would otherwise have passed to that deceased Beneficiary shall be distributed to that deceased Beneficiary's issue then living per stirpes. In the event said issue have not attained the age of twenty-one (21) then said share shall be held, in trust. If the deceased Beneficiary has no issue which survive the surviving Settlor, then the share that would otherwise have been distributed to the deceased Beneficiary named above shall be distributed to the other Beneficiary(ies) named above on a pro-rata basis. Section 3.03 Plan of Distribution Upon Death of Surviving Settlor 1. Upon the death of the surviving Settlor, the successor Trustee(s) shall take charge of the Trust Assets, pay all of the legally enforceable debts of the surviving Settlor, including the expenses of the last illness and funeral expenses of the Trust Agreement Page 9 surviving Settlor, current bills, and any and all other expenses incurred in closing out this Trust and making distributions of assets thereof. The Successor Trustee(s) shall divide personal effects, including automobiles, boats, sporting equipment, jewelry, furniture, furnishings, china, glassware, silver and household equipment (except those items which are specifically given to a Beneficiary elsewhere in this Trust Agreement, in which case said specific gift shall take precedence over this paragraph), among Linda K.Mowers, Dennis L. Mowers, Robert D. Mowers, Ricky J. Mowers, and Richard V. Mowers (or, if any of them are deceased, their issue by representation) as they may agree or, failing such agreement, in such manner as the Successor Trustee(s) may deem equitable. If Linda K.Mowers, Dennis L. Mowers, Robert D. Mowers, Ricky J. Mowers, and Richard V. Mowers (or their issue by representation) do not agree, the Successor Trustee(s) shall have full discretion to determine the division and distribution of the articles above referred to between Linda K.Mowers, Dennis L. Mowers, Robert D. Mowers, Ricky J. Mowers, and Richard V. Mowers (or their issue by representation) and such determination shall be binding on all persons. If any Beneficiary is a minor at the time of such division, distribution shall be made to the person having custody of him or her for purposes of this provision, and the receipt of such person for the distributable share of such minor shall fully and completely release the Successor Trustee(s) from responsibility for such personal property. 2. The assets then remaining in the Trust shall be distributed after giving effect to the section of this Trust Agreement entitled "Special Directives", in the manner as described in Section 3.02, above. Section 3.04 If All Beneficiaries Predecease Upon the death of the surviving Settlor, if neither Beneficiaries nor alternate Beneficiaries named herein survive, then the Trust Assets shall be distributed fifty percent (50%) to the heirs at law of Husband and fifty percent (50%) to the heirs at law of Wife. Section 3.05 Power to Appoint Agents The surviving spouse shall have the right to retain an accountant and/or an attorney at law for professional services on behalf of the Trust Estate or Estates herein. The surviving spouse shall not be responsible for the acts of such agents beyond his or her obligation to use reasonable care in the selection of such agents. Section 3.06 Maximum Marital Deduction Except as otherwise expressly stated herein. the tern1 "maximum marital deduction U shall not be construed as a direction by the deceased Settlor to exercise any election respecting the deduction Trust Agreement Page 10 of estate administration expenses, the determination ofthe estate tax valuation date, or any other tax election which may be available under any tax laws, only in such manner as will result in a larger allowable estate tax marital deduction than if the contrary election had been made. Section 3.07 Trust Income After the First Death Following the death of either Settlor and until the death ofthe surviving Settlor, the Trustee shall, at least annually, pay to or apply for the benefit of the surviving Settlor all of the net income from the Trust Estate. Section 3.08 Simultaneous Death If the Settlors should die under circumstances which would render it doubtful as to which Settlor died first, it shall be conclusively presumed for the purposes of this Trust that husband died first. If any other Beneficiary and a Settlor should die under such circumstances, it shall be conclusively presumed that the Beneficiary predeceased such Settlor. Section 3.09 Last Expenses Upon the death of each of the Settlors, the Trustee(s) of this Trust may, in their discretion, pay any part of or all of the funeral and burial expenses, probate claims, administration expenses, and any estate inheritance, successions, or other death taxes, which are payable as a result of the death of each of the Settlors, out of that portion of the Trust Estate constituting the deceased Settlor's separate Trust Share. The Trustee(s) may make any such payments directly to the creditors or taxing authority in question, or may remit funds to the personal representative of the Estate of the deceased spouse for such payments. ARTICLE FOUR Section 4.01 Common Pot Trust At the death of the Surviving Settlor, the Trustee shall not create a Common Pot Trust. All of the Trust Estate that has not been distributed under prior Articles of the Trust Agreement shall be held, administered, divided, and distributed according to the provisions set forth above. Section 4.02 Payment of the Second Death Expenses On the death of the Surviving Settlor, the Trustee shall pay the expenses of the surviving Settlor's last illness, funeraL buriaL and any inheritance, estate. or death taxes that may be due by reason of the Surviving Settlor's death unless the Trustee in his or her absolute discretion detennines that other adequate provisions have been made for the payment of such expenses and Trust Agreement Page 11 taxes. Section 4.03 Principle of Representation Unless indicated differently in this Trust Agreement or in the "Special Directives" section that follows, in the event any of the named Beneficiaries should predecease both Settlors, all of that person's share of the Trust Estate is to be divided equally among the deceased Beneficiary's children or issue per stirpes. In the event the predeceased Beneficiary leaves no surviving children or issue, then all of the person's share of the Trust Estate shall be divided equally among the remaining Beneficiaries per stirpes. If a Beneficiary of the Settlors survives both Settlors, but should fail to survive to collect his or her share at distribution, the share shall pass to the surviving issue of that deceased Beneficiary per stirpes and with right of representation. ARTICLE FIVE Section 5.01 Non-Income Producing Property During the joint lives of the Settlors, the Trustees are authorized to retain in the Trust, for so long as the Trustees may deem advisable, any property received by the Trustees from the Settlors, whether or not such property is of the character permitted by law for the investment of Trust funds. Section 5.02 Trustees Powers The Trustees shall have all powers conferred upon< a Trustees by law for the orderly administration of the Trust Estate. If any property is distributed outright under the provision of this Trust Agreement to a person who is a minor, distribution may be made under the Pennsylvania Uniform Transfer to Minors Act ("P AUTMA"). The Trustees are further authorized to sign, deliver, and/or receive any documents necessary to carry out the powers contained within this Section. The Trustees of any trust under this Trust Af,rreement (including any substitute or successor Trustees) will have and be subject to all of the powers, duties, and responsibilities granted or imposed by the Pennsylvania Consolidated Statutes (20 Pa. C.S. Section 101 et seq.) as such Statute may provide at the time of administration of the Trust, except to the extent that the same are inconsistent with the provisions ofthis Agreement. Section 5.03 Specific Powers of Trustees In addition, the Trustees will have the following specific powers: Trust Agreement Page 12 1. Trust Estate: The Trustees may leave invested any property coming into its hands hereunder in any form of investment even thought the investment may not be of the character of investments permitted by law to trustees, without liability for loss or depreciation in value. The Trustees may sell, exchange, or otherwise dispose of an reinvest property which may at any time be a part of the Trust Estate upon such terms and conditions as the Trustees may deem advisable. The Trustees may invest and reinvest the Trust Assets from time to time in any property real, personal, or mixed, including without limitation, securities of domestic and foreign corporations and investment trusts of companies, bonds, debentures, preferred stocks, common stocks, mortgages, mortgage participation, and interests in common trust funds, all with complete discretion to convert realty into personalty or personalty into realty or otherwise change the character of the Trust Estate, even though such investment (by reason of its character, amount, proportion to the total Trust Estate, or otherwise) would not be considered appropriate for a fiduciary apart from this provision and even though such investment caused part or all of the total trust Estate to be invested in investments of one type or of one business or company. 2. Holding Property: The Trustees may hold property in the Trustees' name, as Trustees, or in the name of a nominee without disclosing this Trust. 3. Release of Power: If the Trustees deem it to be in the best interest of the Trust and its Beneficiaries, the Trustees, by written instrument signed by such Trustees, will have the power and authority to release, disclaim, or restrict the scope of any power or discretion granted in this Trust Agreement or implied by law. 4. Agents, Employees: The Trustees may employ one or more agents to perform any act of administration, whether or not discretionary, including attorneys, auditors, investment managers, or albers, as the Trustees shall deem necessary at advisable. The Trustees may compensate agents and other employees and may delegate to them any and all discretions and powers. 5. Leases: The Trustees may lease any Trust Assets generally or for oil, gas, and mineral development, even though the lease term may extend beyond the term of the Trust of which the property is a part. The Trustees may enter into any covenants, and agreements relating to the property so leased or concerning any improvements which may then or thereafter be erected on such property. 6. Common Funds: The Trustees may hold any of the Trust Assets in a common fund with property from other trust estates and may make investments jointly with any other trust, the property of which is included in the common fund. 7. Securities: With respect to securities held in the Trust Estate, the Trustees may exercise all the rights, powers, and privileges of an owner, including but not Trust Agreement Page 13 limited to, the power to vote, give proxies, and to pay assessments and other sums deemed by the Trustees necessary for the protection of the Trust Estate. In addition, the Trustees may participate in voting trusts, foreclosures, reorganizations, consolidations, mergers, liquidations, and in connection therewith, to deposit securities with and transfer title to any protective or other committee under such terms as the Trustees may deem advisable. In addition, the Trustees may exercise or sell stock subscription or conversion rights and may accept and retain as an investment any securities or other property received through the exercise of any of the foregoing powers, regardless of nay limitations elsewhere in this instrument relative to investments by Trustees. 8. Purchases from Estate: The Trustees may purchase property of any kind from the executor or administrator of our estates. 9. Lending: The Trustees may make loans, secured or unsecured, to the executor or administrator of our estates, to any Beneficiary of this Trust, or to the Trustees. Further, the Trustees may use Trust Assets to guarantee obligations of any income Beneficiary of this Trust (unless such Beneficiary is serving as Trustees). 10. Distributions to or for Beneficiaries: The Trustees may make any distribution contemplated by this Trust Agreement (1) to the Beneficiary: (2) if the Beneficiary is under a legal disability or if the Trustees determines that the Beneficiary is unable to properly manage his or her affairs, to a person furnishing support, maintenance, or education for the Beneficiary or with whom the Beneficiary is residing for expenditures on the Beneficiary's behalf; or (3) if the Beneficiary is a minor, to a Trustees of an existing trust established exclusively for the benefit of such minor, whether created by this Trust Agreement or otherwise, or to a custodian for the Beneficiary, as selected by the Trustees, under the Pennsylvania Uniform Transfer to Minors Act. Alternatively, the Trustees may apply all or a part of the distribution for the Beneficiary's benefit. Any distribution under this paragraph will be a full discharge of the Trustees with respect thereto. On any partial or final distribution of the Trust Assets, the Trustees may apportion and allocate the assets of the Trust Estate in cash or in kind, or partly in cash and partly in kind, or in undivided interests in the manner deemed advisable at the discretion of the Trustees and to sell any property deemed necessary by the Trustees to make the distribution. The Trustees may distribute gifts of up to $10,000.00 per year per donee out of principal and/or interest. 11. Insurance: The Trustees may purchase new life insurance, pay the premiums on existing life insurance on the life of any Trust Beneficiary, purchase annuities (either commercial or private) from any corporation, trust, or individual, and may procure and pay the premiums on other insurance of the kinds, fonus, and amounts deemed advisable by the Trustees to protect the Trustees and the Trust Estate. Trust Agreement Page 14 12. Borrowing: The Trustees may borrow money from the Trust Estate and others. To secure the repayment thereof, the Trustees may mortgage, pledge, or otherwise encumber part or all of the Trust Assets, and in connection with the acquisition of any property, the Trustees may assume a liability or may acquire property subject to a liability. 13. Repairs: The Trustees may make ordinary and extraordinary repairs and alterations to buildings or other Trust Assets. 14. Re~erves: The Trustees may establish such reserves out of income for taxes, assessments, repair, and maintenance as the Trustees consider appropriate. 15. Continuation of Business: The Trustees may continue any business or businesses in which the Trust has an interest at the time of the Settlor's death for so long as the Trustees may, in its sole discretion, consider necessary or desirable, whether or not the business is conducted by the Settlors at the time of their death individually, as a partnership, or as a corporation wholly owned or controlled by them, with full authority to sell, settle, and discontinue any of them when and upon such terms and conditions as the Trustees may, in their sole discretion, consider necessary or desirable. 16. Retain Property for Personal Use: The Trustees may retain a residence or other property for the personal use of a Beneficiary and allow a Beneficiary to use or occupy the retained property free of rent and maintenance expenses. 17. Dealing with Third Parties: The Trustees may deal with any person or entity regardless of relationship or identity of any Trustees to or with that person or entity. The Trustees may hold or invest any part of or all of the Trust Estate in common or undivided interests with' that person or entity. 18. Partitions, Divisions, Distributions: The Trustees will have the power to make all partitions, divisions, and distributions contemplated by this Trust Agreement. Any partitions, divisions, or other distributions may be made in cash, in kind, or partly in cash and partly in kind, in a manner that the Trustees deems appropriate (including composing shares differently). The Trustees may determine the value of any property, which valuation will be binding on all Beneficiaries. No adjustments are required to compensate for any partitions, divisions, or distributions having unequal consequences to the Beneficiaries. 19. Claims Controversies: The Trustees may maintain and defend any claim or controversy by or against the Trust without the joinder or consent of any Beneficiary. The Trustees may commence or defend at the expense of the Trust any litigation with respect to the Trust or any property of the Trust Estate as the Trustees may deem advisable. The Trustees may employ, for reasonable Trust Agreement Page 15 20. 21. 22. compensation, such counsel as the Trustees shall deem advisable for that purpose. Merger of Trusts: If at any time the Trustees of any trust created hereunder shall also be acting as Trustees of any other trust created by trust instrument or by trust declaration for the benefit of the same Beneficiary or Beneficiaries and upon substantially the same terms and conditions, the Trustees are authorized and empowered, if in the Trustees' discretion such action is in the best interest of the Beneficiary or Beneficiaries, to transfer and merge all of the assets then held under such trust created pursuant to this Trust Agreement to and with such other trust and thereupon to terminate the trust created pursuant to this Trust Agreement. The Trustees are further authorized to accept the assets of any other trust which may be transferred to any trust created hereunder and to administer and distribute such assets and properties so transferred in accordance with the provisions of this Agreement. Termination of Small Trust: Any corporate Trustee which is serving as the sole Trustee of any Trust or any Share thereof may at any time terminate such Trust or Share if, in the Trustee's sole judgment, the continued management of such Trust or Shares is no longer economical because of the small size of such Trust or Share and if such action will be deemed to be in the best interests of the Beneficiary or Beneficiaries. In case of such termination, the Trustee will distribute forthwith the share of the Trust Estate so terminated to the income Beneficiary, per stirpes. Upon such distribution, such Trust or Share will terminate and the Trustee will not be liable or responsible to any person or persons whomsoever for its action. The Trustee will not be liable for failing or refusing at any time to terminate any Trust or a Share thereof as authorized by this paragraph. Power to Determine Income and Pripcipal: Dividends payable in stock of the issuing corporation, stock splits, and capital gains will be treated as principal. Except as herein otherwise specifically provided, the Trustees will have full power and authority to determine the manner in which expenses are to be borne and in which receipts are to be credited as between principal and income. The Trustees have the power to determine what will constitute principal or income and may withhold from income and reserves for depreciation or depletion as the Trustees may deem fair and equitable. In determining such matters, the Trustees may given consideration to the provisions of the Pennsylvania Statutes (or its successor statutes) relating to such matters, but it will not be bound by such prOVISIOns. ').., _.J . Generation-Skipping Taxes and Payment: If the Trustees consider any distribution or termination of an interest or power hereunder as a distribution or tennination subject to a generation-skipping tax, the Trustees are authorized a. To augment any taxable distribution by an amount which the Trustees Trust Agreement Page 16 estimate to be sufficient to pay such tax and charge the same to the particular trust to which the tax related without adjustment of the relative interests of the Beneficiaries; b. To pay such tax, in the case of a taxable termination, from the particular trust to which the tax relates without adjustment of the relative interests of the Beneficiaries. If such tax is imposed in part by reason for the Trust Assets, the Trustees will pay only the portion of such tax attributable to the taxable termination hereunder taking into consideration deductions, exemptions, credits, and other factors which the Trustees deem advisable; and c. To postpone final termination of any particular trust and to withhold any portion or all of the Trust Estate until the Trustees are satisfied that the Trustees no longer have any liability to pay any generation-skipping tax with reference to such trust or its termination. Section 5.04 Special Provision for S Corporation Stock Notwithstanding what is otherwise provided in this Trust Agreement, if at any time the Trust contains any stock of a corporation which elects or has elected treatment as an "S Corporation" as defined by Section 1361(a)(l) of the Internal Revenue Cod (or any corresponding successor statute), such stock will be segregated from the other assets of such and treated as a separate trust. The Trustees will further divide the separate trust into shares for each Beneficiary and such shares will be distributed outright or held in trust as herein provided. In addition, all other provisions of this Trust Agreement will apply to each share held in trust (and constituting a separate trust) except that the Trustees will distribute all of the income from each separate trust to its Beneficiary in convenient installments at least a~ually. It is the Settlor's intent that each separate trust will be recognized as a "Qualified Subchapter S Trust" ("QSST") under Section 1361 (d)(2) of the Internal Revenue Code (or any corresponding successor statute). Notwithstanding any provisions of this Trust Agreement to the contrary, the Trustees's powers and discretions with respect to the administration of each separate trust (including methods of accounting, bookkeeping, making distributions, and characterizing receipts and expenses) will not be exercised or exercisable except in a manner consistent with allowing each separate trust to be treated as a QSST as above described. ARTICLE SIX Section 6.01 Coordination with Settlors' Probate Estates I. At any time during the continuance of this Trust, including subsequent to the Trust Agreement Page 17 death of either Settlor, the Trustee(s) may, in their sole and uncontrolled discretion, distribute to the deceased Settlor's probate estate cash and/or other property as a Beneficiary of the Trust. 2. All other provisions to the contrary notwithstanding, under no circumstances shall any restricted proceeds, as hereinafter defined, be either directly or indirectly (1) distributed to or for the benefit of the deceased Settlor's executors or the deceased Settlor's probate estate; or (ii) used to pay any other obligations of the deceased Settlor's estate. The term "restricted proceeds" means: a. All qualified plans, individual retirement accounts, or similar benefits which are received or receivable by any Trustee hereunder, and which are paid solely to a Beneficiary other than the executor of the Settlor's gross estate for Federal estate tax purposes; and b. All proceeds of insurance on the Settlor's life which, if paid to a Beneficiary other than the Settlor's estate, would be exempt from inheritance or similar death taxes under applicable state death laws. Section 6.02 Direction to Minimize Taxes In the administration of the Trust hereunder, its fiduciaries shall exercise all available tax related elections, options, and choices in such manner as they, in their sole but reasonable judgment (where appropriate, receiving advice of tax counsel), believe will achieve the overall minimum in total combined present and reasonably anticipated future administrative expenses and taxes of all kinds. This applies not only to said Trust, but also to its Beneficiaries, to the other Trusts hereunder and their Beneficiaries, and to the Settlor's probate estate. Without limitation on the generality of the foregoIng direction (which shall to that extent supercede the usual fiduciary duty of impartiality), such fiduciaries shall not be accountable to any person interested in this Trust or to Settlor's estate for the manner in which they shall carry out this direction to minimize overall taxes and expenses (including any decision they may make not to incur the expense of a detailed analysis of alternative choices). Even though their decisions in this regard may result in increased taxes or decreased distributions to the Trust, to the estate, or to one or more Beneficiaries, the fiduciaries shall not be obligated for compensation readjustments or reimbursements which arise by reason of the manner in which the fiduciaries carry out this direction. Section 6.03 Judgment and Discretion of Trustee In the absence of proof of bad faith, all questions of construction or interpretation of any trusts created by this Trust Agreement will be finally and conclusively detennined solely by the Trustee. according to the Trustee's best judgment and without recourse to any court. Each detennination by the Trustee is binding on the Beneficiaries and prospective Beneficiaries Trust Agreement Page 18 hereunder, both ii being and unborn, as well as all other persons, firms, or corporations. The Trustee, when exercising any discretionary power relating to the distribution or accumulation of principal or income or to the termination of any trust, will be responsible only for lack of good faith in the exercise of such power. Each determination may be relied upon to the same extent as if it were a final and binding judicial detennination. In the event of a conflict between the provisions of this Trust Agreement and those of the Pennsylvania Statutes, the provisions of this Agreement will control. ARTICLE SEVEN Section 7.01 Resolution of Conflict Any controversy between the Trustee or Trustees and any other Trustee or Trustees, or between any other parties to this Trust, including Beneficiaries, involving the construction or application of any of the terms, provisions, or conditions of this Trust shall, on the written request of either or any disagreement party served on the other or others, shall be submitted to arbitration. The parties to such arbitration shall each appoint one person to hear and determine the dispute and, if they are unable to agree, then the two persons so chosen shall select a third impartial arbitrator whose decision shall be final and conclusive upon both parties. The cost of arbitration shall be borne by the losing party or in such proportion as the arbitrator(s) shall decide. Such arbitration shall comply with the commercial arbitration rules of the American Arbitration Association, 140 West 5pt Street, New York, NY 10200 Section 7.02 Incontestability The beneficial provisions of this Trust Agreement are intended to be in lieu of any other rights, claims, or interests of whatever nature, whether statutory or otherwise, except bona fide pre-death debts, which any Beneficiary hereunder may have in Settlor's estate or in the properties in trust hereunder. Accordingly, if any Beneficiary hereunder asserts any claim (except a legally enforceable debt), statutory election or other right or interest against or in Settlor's estate, or any properties of this Trust, other than pursuant to the express terms hereof, or directly or indirectly contests, disputes, or calls into question, before any court, the validity of this Trust Agreement then: 1. Such Beneficiary shall thereby absolutely forfeit any and all beneficial interests of whatever kind and nature while such Beneficiary or his or her heirs might otherwise have under this Trust Agreement and the interests of the other Beneficiaries hereunder shall thereupon be appropriately and proportionately increased; and 2. All of the provisions of this Trust Agreement, to the extent that they confer any benefits, powers, or rights whatsoever upon such claiming, electing, or contesting Trust Agreement Page 19 Beneficiary, shall thereupon become absolutely void; and 3. Such claiming electing, or contesting Beneficiary, if then acting as a Trustee hereunder, shall automatically cease to be a Trustee and shall thereafter be ineligible either to select, remove, or become a Trustee hereunder. Section 7.03 Specific Omissions Any and all persons and entities, except those persons and entities specifically named herein, have been intentionally omitted from this Trust Agreement. If any person or entity shall successfully challenge any term or condition of this Trust Agreement, then, to that person or entity shall be given the sum of one dollar ($1.00) in lieu and in place of any other benefit, grant, or interest which that person or interest may have in the Trust Estate. Section 7.04 Benefits Confidential The Settlors further declare that it is their desire and intent that the provisions of this Trust Agreement are to remain confidential as to all parties. The Settlors direct that only the information concerning the benefits paid to any particular Beneficiary shall be revealed to such individual and that no individual shall have a right to information concerning the benefits being paid to any other Beneficiary. ARTICLE EIGHT Section 8.01 Distribution in Kind or in Cash On any division of the assets of the Trust Estate into shares, and on any final or partial distribution of the assets of the Trust Estate, the Trustee, at his or her absolute discretion, may divide and distribute undivided interests of such assets on a pro rate or non-pro rata basis, or may sell any part of or all of such assets and may make divisions or distributions in cash or partly in cash and partly in kind. The decision of the Trustee, either prior to or on any division or distribution of such assets, as to what constitutes a proper division of such assets of the Trust Estate, shall be binding on all persons interested in any trust provided for in this Trust Agreement. Section 8.02 Spendthrift Provisions Neither the principal nor the income of this Trust Agreement shall be liable for the debts of a Beneficiary. Except as otherwise expressly provided in this Agreement, no Beneficiary of any trust shall have any right, power, or authority to alienate, encumber, or hypothecate this or her interest in the principal or income of this Trust Agreement in any manner, nor shall the interests of any Beneficiary be subject to the claims of his or her creditors or liable to attachment, Trust Agreement Page 20 execution, or other process of law. The limitations herein shall not restrict the exercise of any power of appointment or the right to disclaim. Section 8.03 Definition of Children The terms "child" and "children" as used in this Agreement mean the lawful issue of a Settlor or of the Settlors together. This definition also includes children legally adopted by a Settlor or by the Settlors together. Section 8.04 Handicapped Beneficiaries Any Beneficiary who is determined by a court of competent jurisdiction to be incapacitated shall not have any discretionary rights of a Beneficiary with respect to this Trust, or to their share or portion thereof. The Trustee shall hold and maintain such incapacitated Beneficiary's share of the Trust estate and shall, in the Trustee's sole discretion, provide for such Beneficiary as that Trustee would provide for a minor. Notwithstanding the foregoing, any Beneficiary who is diagnosed for the purposes of governmental benefits (as hereinafter delineated) as being incapacitated or as being disabled, and who shall be entitled to governmental support and benefits by reason of such incapacity or disability, shall cease to be a Beneficiary of this Trust. Likewise, they shall cease to be a Beneficiary if any share or portion of the principal or income of the Trust shall become subject to the claims of any governmental agency for costs or benefits, fees, or charges. The portion of the Trust Estate which, absent the provisions of this section, would have been the share of such incapacitated or handicapped person shall be retained in trust for as long as that individual lives. The Trustee, at his or her sole discretion, shall utilize such funds for the maintenance of that individual. If such individual recovers from his or her incapacity or disability and is no longer eligible for aid from any governmental agency, including costs or benefits, fees, or charges, such individual shall be reinstated as a Beneficiary after 60 days from such recovery and the allocation and distribution provisions as stated herein shall apply to that portion of the Trues Estate which is held by the Trustee subject to the foregoing provisions of this section. If said handicapped Beneficiary is no longer living and shall leave children then living, the deceased child's share shall pass to those children per stirpes. If there are no children, the share shall be allocated proportionately among the remaining Beneficiaries. ARTICLE NINE Section 9.01 Trustees All Trustees are to serve without bond. The following will act as Trustees of any Trusts created by this Trust Agreement, in the following order of succession: Trust Agreement Page 21 First: The undersigned, Floyd J. Mowers and Lillian C. Mowers. Second: The Surviving Spouse Third: Upon the end of the terms of the original Trustees, Linda Mowers is hereby designated Successor Trustee as well as special trustee of any QTIP trust or credit-shelter trust created hereunder. Fourth: If Linda Mowers is unable or unwilling to act as Successor Trustee and/or special trustee, then Dennis Mowers shall serve as Successor Trustee and/or special trustee, as the case may be. Last: A Trustee chosen by the majority of Beneficiaries with a parent or legal guardian voting for minor Beneficiaries; provided, however, that the children of any deceased Beneficiary shall collectively have only one vote. Section 9.02 Allocation and Distribution of the Trust Assets The Trustees shall allocate, hold, administer, and distribute the Trust Assets as hereinafter provided: 1. Upon the death of the first Settlor, the Trustee shall make any separate distributions that have been specified by the deceased Settlor. The Trustee shall also take into consideration the appropriate provisions of this Article. 2. Upon the death ofthe Surviving Spouse, the Trustee shall hold, administer, and distribute the Trust Assets in the manner herein prescribed. Section 9.03 Personal Property Distribution Notwithstanding any provision of this Trust Agreement to the contrary, the Trustee must abide by any memorandum by the Settlors, particularly that contained in the section entitled "Special Directives" incorporated into this Trust Instrument and any exhibits attached to this Trust Agreement containing Special Directives of the Settlors, directing the disposition of Trust Assets of every kind including, but not limited to, furniture, appliances, furnishings, pictures, china, silverware, glass, books, jewelry, wearing apparel, and all policies of fire, burglary, property damage, and other insurance on or in connection with the use of property. Otherwise, any personal and household effects of the Settlors shall be distributed with the remaining assets of the Trust Estate. Section 9.04 Liabilitv of Trustee The Trustee will not be responsible or liable for any loss which may occur by reason of depreciation in value of the properties at any time belonging to the Trust Estate nor for any other Trust Agreement Page 22 loss which may occur, except that the Trustee will be liable for each Trustee"s own negligence, neglect, default, or willful wrong. The Trustee will not be liable or responsible for the acts, omissions, or defaults of any agent or other person to whom duties may be properly delegated hereunder (except officers or regular employees of the Trustee if such agent or person was appointed with due care). The Trustee may receive reimbursement from the Trust Estate for any liability, whether in contract or in tort, incurred in the administration of the Trust Estate in accordance with the provisions hereof, and the Trustee may contract in such form that such Trustee will be except from such personal liability and that such liability will be limited to the Trust Assets. Section 9.05 Successor Trustees Any Successor Trustee shall have all the power, rights, discretion, and obligations conferred on a Trustee by this Trust Agreement. All rights, titles, and interest in the property of the Trust shall immediately vest in the successor Trustee at the time of appointment. The prior Trustee shall, without warranty, transfer to the Successor Trustee the existing Trust property. No successor Trustee shall be under any duty to examine, verifY, questions, or audit the books, records, accounts, or transaction of any preceding Trustee; and no Successor Trustee shall be liable for any loss or expense from or occasioned by anything done or neglected to be done by a predecessor Trustee. A Successor Trustee shall be liable only for his or her own acts and defaults. ARTICLE TEN Section 10.01 Perpetuities Savings Clause Notwithstanding any other provision of this instrument, the Trusts created hereunder shall terminate not later than twenty-one (21) years after the death of the last survivor of all Settlors and any other Beneficiary or Beneficiaries named or defined in this Trust living on the date of the death of the first Settlor to die. The Trustee shall distribute remaining Trust principal and all accrued or undistributed net income hereunder to the Beneficiary or Beneficiaries. If there is more than one Beneficiary, the distribution shall be in the proportion in which they are Beneficiaries; if no proportion is designated, then the distribution shall be in equal shares to such Beneficiaries. ARTICLE ELEVEN Section 11.01 Governing Law It is not intended that the laws of only one particular state shall necessarily govern all questions pertaining to all of the Trust hereunder. Trust Agreement Page 23 1. The validity of the Trust hereunder, as well as the validity of the particular provisions of the Trust, shall be governed by the laws of the state which has sufficient connection with the Trust to support such validity. 2. The meaning and effect of the tenns of this Trust Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. 3. The administration of this Trust shall be governed by the laws of the state in which the principal office of the Trustee then having custody of the Trusfs principal assets and records is located. The foregoing shall apply even though the situs of some Trust Assets or the home of the Settlors, a Trustee, or a Beneficiary may at some time or times be elsewhere. Section 11.02 Invalidity of Any Provision If a court finds that any provision of this Trust Agreement is void, invalid, or unenforceable, the remaining provisions of this Agreement will continue to be fully effective. Section 11.03 Headings The use of headings in connection with the various articles and sections of this Trust Agreement is solely for convenience and the headings are to be given no meaning or significance whatsoever in construing the terms and provisions of this Agreement. Section 11.04 Internal Revenue Code Terminology As used herein, the words "gross estate," "adjusted gross estate," "taxable estate," "unified credit," "state death tax credit," "maximum marital" deduction," "marital deduction," and any other word or words which from the context in which it or they are used refer to the Internal Revenue Code shan be assigned the same meaning as words have for the purposes of applying the Internal Revenue Code to a deceased Settlor's estate. Reference to sections of the Internal Revenue Code and to the Internal Revenue Code shall refer to the Internal Revenue Code amended to the date of such Settlor's death. ARTICLE 12 Section 12.01 Special Directives of Floyd J. Mowers. ] . Floyd J. Mowers hereby directs that any specific distribution of assets from the Trust Estate provided for on the list attached hereto and marked "Exhibit A- Special Directives of Floyd J. Mowers" (if any) be made before the distributions Trust Agreement Page 24 to the named Beneficiaries as set forth above. 2. Floyd J. Mowers hereby acknowledges and accepts the "Special Directives," if any, of Lillian C. Mowers. Section 12.02 Special Directives of Lillian C. Mowers. 1. Lillian C. Mowers hereby directs that any specific distribution of assets from the Trust Estate provided for on the list attached hereto and marked "Exhibit A-Special Directives of Lillian C. Mowers" (if any) be made before the distributions to the named Beneficiaries as set forth above. 2. Lillian C. Mowers hereby acknowledges and accepts the "Special Directives," ifany, of Floyd J. Mowers. SETTLORS: " -f~ C/%/7 ..'Jf. .,,' #;?;ZA,,,'4L..---- ~ ,..-./ ~ f?(j.11 ./ Floyd J. Mowers Lillian C. Mowers, by her attorney-in-fact, Linda Mowers CO- TRUSTEES: Floyd J. Mowers // / ( \ ,. '~ r?dJI) .~J: tCl-n .~. "~( /t. /' / /'87:-c)-eA./J.-- Lillian C. M attorney-in-fact, Linda Mowers COMMONWEAL TH OF PENNSYL V ANlA COUNTY OF CUMBERLAND The undersigned certifies that on the I q: day of St.::Jp Tt:?'l(/3l7/i_ , j.jI&' ~ Floyd J. Mowers, known to me or satisfactorily proven t6 me to be the person whose name is subscribed to the foregoing document, personally appeared before me and acknowledged that he executed the same as Settlor and Co-Trustee for the purposes therein contained. -- " f ~. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Patrick J. McLaughlin, Notary Public Upper Moreland Twp., Montgomery County My Commission Expires June 21, 2008 Member, Pennsylvania Assoclatlon of Notaries COMMONWEAL TH OF PENNSYL V ANlA COMMONWEALTH OF PENNSYLVANIA Notarial Seal Patrick J. McLaughlin, Notary Public Upper Moreland Twp., Montgomery County My Commission Expires June 21, 2008 Member, Pennsylvania Associatlon of Notaries )\ ,;..) 1I1l):'ixll:, REV ((ll/Oi) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate. $6.00 P 13774532 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for perma t filing. Hl05-143 REV 1112006 TYPE 1 PRINT IN PERMANENT BlACK INK COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) STATE FILE NUMBER l.Name~~(First,_."'._) Lillian C. Mowers 5. Age ILaslllirlMay) 80 Highway 1 a Decedent> EdlJcation (Sl>ecifY omy hlg!lesl grade CXlllI!>IeIed) EJeman1aJy 1 Secoodary (0-12) ~Jege (1-4 or~) 12 years 6. Dale of Blr1h IMonlh. day. v... 11-18-26 Shippensburg, PA 8d. FdIy Name (U noIlnalilution, g;....... and numbar) 6b. County of Dealh 2128 Ritner ~t Cumberland North Newton Twp. 11. Decedent's Usual ion most 01 life. Do noIstate retired KI1d~_ KInd~Busi1assI_ Cook Ditty's Drive Inn . 16. Decedent's Mailing Address (Street, city I town, stale, ~ code) 2128 Ritner Highway Shippensburg, PA 17257 16. Fa...... Nama IF""', _..... ~ David F. Rolar 2<la. _'. Name (Typa 1 Print) Linda K. Mowers 17b. County 12. Was Decedent ever in the U.S. Armed Forces? OVas IXlNo Oacedant's Actual Residence 178. &ate PA Cumberland 9599 4. Date of Death (Month, day, year) August 11, 2007 Other: 14. Marital Status: Married, Never Married, Widowed. DNo<cad (_ widowed Did Decedenl Uve in a Township? OOlher. Sl>ecifY; 10. Race:An\erica.n Indian, Black, White, etc. (- White 15. Surviving Spouse (If wife, give maideo name) Hc.K] Yas,_Uwld" North Newton Twp. 17d.O No,_Uwldwilhln AcIua1 Umits 01 Top. City/BOlO 19. Mother's Name (Firs~ middle, maiden surname) Laura J. Woods 201>. _'.MaiingAddress 1_, cIIy 1_. _. z~ coda) 2128 Ritner Highway, Shippensburg, PA 17257 21d. Location (City ftown, stale, zip code) 21c. Place of Disposition (Name of cemetery, crem8lory or other place) Shippensburg, PA 17257 Spring Hill Cemetery 22c. Name and Address ol Facirrty Fogelsanger-Bricker be~ of my knowledge, _ occunad alllla liIIa. da~ "'" pIIIca slated. (Signalura "'" mo) ~ vtfIi""~ Funeral Home Inc., Shippensburg, PA 17257 23b. License Number 23c. Dale Signed (Month, day, year) Ie./V '> t!J7. %0 ~ / II I ZoC 7 26. Was Case Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation? o Yes g1<<i fiJ ; ~ :;;1 hems 24.26 _ be completed by paISOll :' who pronounces death. 24. Tme ol Death 3:"251 25. Dale _ Dead (Month. day, year) /"/.-1 M. ;'1/11 / 'Z r:.;c7 CAUSE OF DEATH (See Instructions .00 exlUnples) Item 'D. Part I: Enter the ~.- dseases, iljuries, or complications -that dinlctIy caused !he death. DO NOT enterlerminal events such as cartiiac arrest, respiratory arrest, or ventricUar flbrillalion wilhout showing the etiology. LIsl only <<Ie cause 00 each Ine. =~d~~)<fi~ a. ,&~ I Approximate interval: : Onset to Death , , iyeRM I I , , , , , , , I Due to (or as a conseqoence 01): Sequen~:~,~~ a. ~ UNDERlvtNG CAUSE =~~ryM1u:'a\'t'LA1t~ b, Due to (or as a consequence oij: Due to (or as a consequence 01): 308. Was an Autopsy Performed? d. n. Were Autopsy Finlings Ava~ablePriorlo~ of Cause of Dealh? 31. 01 Death Nalural 0 Homicide o Accidenl 0 Pendin9'nvesl\)8IOO o Suk:ide OCouldNol beOetermioed M. o Yes [il""No OVes ONo 32d. Ttme of lr1ury 33a. Certifier (check only one) Cer1lfying phy&il;ian (Physician certifying cause of death when another physician has pronounced death and completed IIem 23) To the besl of my knowtedge, death oceurred due to lhe cawse(s) and manner as s\alecL _ _ _ _ _ - -.. - - - - - - - - - - - - - - - - - - - - - - -- ~~=:es~f~~J:m~~ :h~and~~:~O~:C:~= manneru staled.. ____ __ __ _ _ __ _.. __.. 0 IIedicaI Examiner I Coroner On the blals of examln and I 35. Registrar's Signature ~ Part U: Enter other sianificanl conciIions conIributina to death, 001 nolresullinginthe under1ying cause given in Part 1. 28. DId Tobacco Use CooIribuleto Death? o Vas OProbably o No 0""Unknown ~~~~ .~ ~Vl- 29. "Female: c;;rNotpregnanlwkhinpaslyear o Pregnant at time 01 death o Nolptegnant,bolptegnanlwilhln42days 01 death o Notpregnanl,butpregnant43dayst01year before death o Unknowrlitpregnanlwilhinthepaslyear 32c. Place oll.~ury: Home, Farm, Street, Factory, otfICeBuilding,elc.(Specify) 32g.localionollnjury(StreeI,city/lown,stale) (MonIh,day,year) DJ'M'171/- L /3 1P7 ~. Name and Address 01 Person Who ~ed Causefl Dealh H1tlI~P) Type I Prin1 Nl ,(.It It;v;:j A. O~JI'/A~" 1/ ' V&- tJ~;6I'~1U Af\Ai. ""'" /'..1 Iltr~ " \ ~.::l 0:> ~ leg ~c> ;c> - ',- CC\Cr Ck " 'Jl \' ~ \r::N';HCt~ \. , t:,.\.Jv ~T.' , ".' ~ ~'r..\(~ \ r' t~ Q.b,),.,;..... I, pt\ \2: 26 1.U\\~ ~~ '{ \ 2- l"'f"V rr T C' n",,\, ~~,r~\J'R \ ...- .e(: ; ..,J" 0" 0<-.1" ^ hi, ",.' ,- ,-\ ,1'\ ORr rv::~ "\\. C\,.,e'c.'", " J\'}\ - .:::- -:- ~ -- ::::::: --: -::: :::::- :::::- =f ..::- :::::- =-t - -- - - :::.- ~ -::::- - ~ -- - ::::::- -::: -::: --- ~ ~~ ~~ ~- ~ ~ ~ '" c> ~~ ~ \~ 0 0-' "'~ ''i'a ".. UI -- --- - 3 ~ t- m rO v cO !.- l <0 rO ~ - ~ rflJ- Q) Q)~ r/J. ~ >L- :3 ()o-~ t ~~ J - l-l .-->- --t;--u; <0 ~j J y ,- 0 >--- -- '- I \ \ \ \ \ \