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HomeMy WebLinkAbout07-17-08 --.~ REV-1500 15056041147 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 Harrisburg, PA 17128-0601 ~ RESIDENT DECEDENT 2 1 0 7 - 0 7 8 2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 132224907 08082007 02101922 Decedent's Last Name Suffix Decedent's First Name MI LINE LORNA R (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 ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® g Decedent Died Testate (Attach Copy of Will) ^ 7 Decedent Maintained a Living Trust (Attach Copy of Trust) O g. Total Number of Safe De osit Boxes P ^ 9. Litigation Proceeds Received ^ 1 p. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113 A ( ) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO Name : Daytime Telephone Number BRADLEY L GRIFFIE 7172435551 Firm Name (If Applicable) GRIFFIE & ASSOCIATES First line of address 200 NORTH HANOVER STREET Second line of address City or Post Office CARLISLE State ZIP Code PA 17013 Correspondent'se-mail address: bgriffie@griffielaw.COm r--.a~ C7 ° ' a ~ REGISTER OF'?~f S USE OnLL.Y is i ~ n L~._ _ y ~ L CT1 - -_ ~- r, ~ ~ J - - ~ _ - D ~~ _ DATE FILED ~ O _.., •` : ~ r 't C ~r _~., _.+ 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. 9lGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE 1 ;~, JANICE S. MIXELL 2160 V EY STREET, ENOLA, PA 17025 EPARER OTHER THAN REPRESENTATIVE Bradley L Griffie ADDR 00 North Hanover Street, Carlisle, PA 17013 Side 1 15056041147 15056041147 / / 0 DATE [fl J , ~`~, ~'V 15056042148 REV-1500 EX Decedent's Social Security Number oeoedent~s Name: LINE , L O R N A R 1 3 2 2 2 4 9 0 7 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. 3 3 , 8 7 9 6 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, 1 7, 5 2 2 2 4 8. Total Gross Assets (total Lines 1-7) .................................................................... ... g, 5 1, 4 0 1 8 9 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... ... 9. 6 , 3 4 7 5 3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 5 1 8 0 11. Total Deductions (total Lines 9& 10) ................................................................... ... 11. 6, 3 9 9 3 3 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... ... 12. 4 5 , 0 0 2 5 6 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... .. 13• 4 5 , 0 0 2 5 6 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... .. 14, 0 0 0 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 .00 15 16. Amount of Line 14 taxable at lineal rate X .045 16• 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. Taz Due .................................................................................................................... . 19. 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. !.- 15056042148 Side 2 15056042148 J ~ REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 07 - -0782 DECEDENT'S NAME LINE, LORNA R STREET ADDRESS #203 CORNER STONE 770 SOUTH HANOVER STREET CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + g + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.0 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request arefund - 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.0 0 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ . ~ ~ 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 :.............................. ~ a b. retain the right to designate who shall use the property transferred or its income :.................................... c. retain a reversionary interest; or ...................... . ........................................................................................... x d. receive the promise for life of either payments, benefits or care? .................. . ........................................... 2 If d . eath occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................... ........................................................................ ^ ^ x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............. ~ ^ ......................................................................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not 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 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)j. 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)j. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE E " CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF LINE, LORNA R 21 - 07 - -o7s2 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH COMMERCE BANK CHECKING ACCOUNT NO. 536 703101 SOVEREIGN BANK SAVINGS ACCOUNT NO. 2894021977 SOVEREIGN BANK CERTIFICATE OF DEPOSIT NO. 2895462550 COINS ROYAL NEIGHBORS OF AMERICA MEDICARE SUPPLEMENT CO-INSURANCE REFUND REFUND FROM PHYSICIANS SUPPORT SYSTEMS CHAPEL POINTE AT CARLISLE REFUND FOR PAYMENT OF SERVICES BLAIR LLC CHARGE CARD REFUND ROYAL NEIGHBORS OF AMERICA MEDICARE SUPPLEMENT CO-INSURANCE REFUND CASH ON HAND OIL, GAS AND MINERALS IN AND UNDER LAND RICHLAND COUNTY, MONTANA (DEED ATTACHED) BLUE MOUNTAIN ANESTHESIA ASSOCIATES, P.C. (REFUND) 4, 552.40 21, 978.46 2,264.50 51.65 237.90 7.31 217.13 25.99 16.00 13.75 4,500.00 14.56 I TOTAL (Also enter on Line 5, Recapitulation} I 33,879.65 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF LINE, LORNA R FILE NUMBER __ 21 - 07 - -0782 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A• 1 HOFFMAN-ROTH FUNERAL HOME 565.89 2 CHAPEL POINTE (BURIAL PLOT) 800.00 3 ORGANIST AND PASTOR 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees GRIFFIE AND ASSOCIATES 3,000.00 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 350.00 5. Accountant's Fees TO COHICK AND ASSOCIATES 226.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs ADVERTISING TO CUMBERLAND LAW JOURNAL 75.00 TOTAL (Also enter on line 9, Recapitulation) 6,347.53 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Schedule H Funeral Expenses & Administrative Costs continued ESTATE OF LINE, LORNA R FILE NUMBER 21 - 07 - -0782 ADVERTISING TO THE SENTINEL 2 I APPRAISAL OF COIN COLLECTION CHAPEL POINTE (GRAVE MARKER AND ENGRAVING) 4 PRESERVES 150.64 30.00 550.00 500.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF LINE, LORNA R This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM I DESCRIPTION OF PROPERTY NUMBER Include the name of the transferee, their relationship to decedent and the date of transfer. Atlach a copy of the deed for real estate. DATE OF DEATH ~ OF ' EXCLUSION VALUE OF ASSET DECD S INTEREST (IF APPLICABLE) 12,522.24 100% 0.00 TAXABLE VALUE THE CHRISTIAN AND MISSIONARY ALLIANCE P.O. BOX 3500 COLORADO SPRINGS, CO 80935-3500 (IRREVOCABLE CHARITABLE GIFT ANNUITY ESTABLISHED 12/1/93) THE ALLIANCE DEVELOPMENT FUNDS, INC (IRREVOCABLE CHARITABLE INVESTMENT CERTIFICATES ESTABLISHED 12/2/85) FILE NUMBER 21 - 07 - -0782 5,000.00 ~ 100% ~ 0.00 12, 522.24 5,000.00 TOTAL (Also enter on line 7, Recapitulation) 17,522.24 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LINE, LORNA R FILE NUMBER _ 21 - 07 - -0782 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 I EMBARQ 2 ALERT PHARMACY SERVICES, INC. (MEDICATIONS) AMOUNT 18.80 33.00 TOTAL (Also enter on Line 10, Recapitulation) I 51.80 REV-1513 EX+ (g.00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LINE, LORNA R FILE NUMBER 21 - 07 - -0782 - NAME AND ADDRESS OF PERSON(S) I RE DECOEDENIT TO SHARE OF ESTATE i AMOUNT OF ESTATE NUMBER RECEIVING PROPERTY (Words) I ($gg) Do Not List Trusteets) I. SCHEDULE J BENEFICIARIES AXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on IRev 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 1 C. L. C. MINISTRIES INTERNATIONAL P.O. BOX 1449, FT. WASHINGTON, PA 19034 13,740.16 2 THE ALLIANCE HOME OF CARLISLE OPERATING AS CHAPEL POINTE AT CARLISLE 770 SOUTH HANOVER STREET, CARLISLE, PA, 17013 13,740.16 3 THE CHRISTIAN MISSIONARY ALLIANCE P.O. BOX 3500, COLORADO SPRINGS, CO 80935-3580 (PORTION OF ANNUITY) 10,522.24 4 THE ALLIANCE HOME OF CARLISLE OPERATING AS CHAPEL POINTE AT CARLISLE (SEE ATTACHED SHEET) 2,000.00 5 THE CHRISTIAN MISSIONARY ALLIANCE (SEE ATTACHED SHEET) ~ 5,000.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 45,002.56 LAST WILL AND TE5TAMENZ' OF LORNA R. LINE I, LORNA R LINE, of 7 Alliance Drive, Apartment 203, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and ,~ making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my Executor hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. I direct my Executor to pay all inheritance, estate, succession and legacy taxes, to which my estate or the transfer of any property hereunder may be subject, and to charge such taxes as part of the expenses of the administration of my estate, being deducted and paid from the residue. of my estate and not to be deducted in any manner from any specific bequests made herein. However, my Executor need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If I do not own a burial. plot or a grave marker at the time of my death, I authorize my Executor/Executrix, in his, her or its sole discretion, to purchase a 2001V. Hanover Street Carlisle. PA 17013 GRt-FFIE & ASSOCIATES Attorneys At Law ~. Page 1 of 7 ~ `100 Lincoln Way East,-Suite D - Claambersburg, PA 17201 I i~ , burial plot and to erect a suitable grave marker at my grave, and to expend sums from my estate for this purpose. SECOND I give, devise and bequeath my entire estate of whatsoever nature and wheresoever situate, in the following shares to the following entities: (A) FIFTY (50%) PERCENT of my net estate to C.L.C. MINISTRIES INTERNATIONAL, P.O. Box 1449, Fort Washington, Pennsylvania, 19034; ~~ 'b (B) FIFTY (SO%) PERCENT of my net estate to CHAPEL POINTE AT CARLISLE, 770 South Hanover Street, Carlisle, Pennsylvania, 17013. In the event that it is impossible to provide for the distribution to either of these named beneficiaries, due to their nonexistence at the time of my death or for other reasons, the remaining beneficiary shall receive my entire estate. THIRD I grant my Executor/Executrix the following powers in addition to and not in limitation of such powers as my Executor/Executrix shall hold by law: (a) To retain all property received including the stock of any corporate fiduciary acting hereunder, provided such property remains productive. (b) To join in any corporation, partnership, recapitalization, merger, reorganization. or voting trust plan; to .delegate authority with respect thereto; to deposit investments .under agreements and pay assessments; and generally GRIFFIE & ASSOCZgTES Attorneys At Law 200 N. Hanover Street - - I00 Li~xcoln Way East, Suite D Carlisle, PA I70I3 Page 2 of 7 - ; . Chambersburg, F4 ~ I720I to exercise all rights of investors, including but not limited to, the voting of shares. (c) To manage, operate, repair, improve, mortgage or lease on any terms any real estate held or owned by my estate. (d) To operate any business that I may own at my death. (e) To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, without regard to the principle of diversification S x or any other statute or general rule of law in his, her or its absolute discretion, it being my intention to give my Executor/Executrix the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate. (f) To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and on such terms and conditions as my Executor/Executrix shall see fit in his, her or its absolute discretion. {g) To borrow money for the payment of taxes or for any other proper pur-poses in the administration of my estate, and to mortgage or pledge estate assets as security. (h) To compromise claims without court approval including, but not limited to, any controversies with the United States of America or the Commonwealth of Pennsylvania concerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testament. (i) To distribute in cash or in kind upon any division or distribution of my estate. . GRIFFIE & ASSOCIATES Attorn. eys At Lain ?00 N. Hanover Street ~ ~ .100 Lincoln 'Way East,. Suite D Carlisle, PA 17013 - .Page 3 .of 7 ~ Charnbersburg, PA I720I (j) To undertake any and all acts deemed necessary and proper by my Executor/Executrix for the proper, advantageous and prompt management of the settlement of my estate. (k) In general, to exercise all powers in the management of my estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to him, her or it may seem best and to execute and deliver all instruments and to do all acts which he, she or it r .~ '~" r C ,,~ ~~ deems necessary or proper to carry out the purposes of this, my Last Will and Testament. FOURTH No interest of any beneficiary of my estate, either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have the power in any manner to charge or encumber his interest either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my Executor/Executrix for the liability of such beneficiary. FIFTH I nominate, constitute and appoint my dear and close friend, JA1vICE S. NIIXELL, as Executrix of this my Last Will and Testament. In the event my friend is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate,, constitute and appoint my dear and close friend, BETTY LOU ZARY, as Executrix. of this my Last Will and Testament. I direct .that my Executrix shall not be GRI~FIE & ASSOCIATES Attorneys At Law 200 N. Hanover Street I00 Li~xca~n T~hay East, Suite D Carlisle, PA I70I3 Page 4 of 7 Chambers~iurg, PA I720I required to give or post bond for the faithful performance of his, her or its duties in this or any other jurisdiction. SIXTH I hereby declare it to be my expressed desire that my Executor/Executrix employ the law firm of Griffie & Associates, of Carlisle, Pennsylvania, for legal advice and assistance regarding this my last Will and Testament, they having considerable lmowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and the execution of the powers herein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of seven (7) typewritten pages, the first four (4) of which bear my signature on the side margin, for purpose of identification, this ~ ~- day of 2. , 2007. WITNESS: ~ ~~ ~~~ LORNA R LINE GRIFFIE ~. ASSOCIATES Attorneys .4t Law ?OO N. Hanover Street 100 Lincoln .Way East, Suite D Carlisle, PA 17013 .Page 5 of 7 ~ Chamhersbu"rg, PA 17201 ~ ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND . I, LORNA R. LINE, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. LORNA R LINE Sworn or affirmed and acknowledged before me by the Testatrix this day of r , 2007. __ - MO~t11t ~ ~. qtr _ Noiory Fubilc IORONGH~CWN9ERIA-IVDCOIA~RY = ~1f GoratnN~ian ExPitet Apr 17, 2Q1 ~ GRIFFIE & ASSOCIATES Attorneys At Law !00 N. Hanover Street 100 Lincoln 4"ay East, Suite D Carlisle, PA I70I3 ~ Page 6 of 7 Chambersburg, PA_ 17201 AFFIDA~~IT COMMONWEALTH OF PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND ~~ ~ • and r ~' - ~i ~ , the witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Last aTill and Testament as witnesses and that to the best of our knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed and subscribed before me by ~~~,(-~, ~. j'~h,~,, -Q and + ' ~ this -~--~ day of , 2007. N . - ~At RO~I~I ,~. a~ss~tr Notary rubllc GML~LE ~ORIOUGH, CUMBERLAND COUNT My COmmitalon Expires Apr 77 2011 GRIFFIE & Au8OCIATES Attorneys At Lafv 200 hT. Hanover Street I00 Lincoln Way East, Suite D Carlisle, PA 17013 Page 7 of 7 Chcarnbersl~rcrg, PA 17201 ATTACHMENT TO "SCHEDULE E" August 22, 2007 Griffie & Associates Attorneys and Counselors at Law 200 North Hanover Street Carlisle PA 17013 RE: Estate of: Lorna R. Line (Deceased) Tax Identification Number: 132-22-4907 Date.af Death: August 8, 2007 Dear Sirs: Commerce Bank This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Account Number: 536703101 Date Opened: May 10, 2004 Primary Owner: Lorna R. Line Date of Death Balance: $4,552.40 Accrued Interest: $0.53 Principal Balance: $4,551.87 No Significant Withdrawals Please feel free to contact me at (717) 412-6134 if I may be of further assistance. Sincerely, Mindi L. Sp ut Levy Sp ialist/Deposit Services Commerce Bank Commerce Bank /Harrisburg, N.A. PO Box 4999 3801 Paxton Street Harrisburg, PA 17111-0999 commercepc.com 1 Sovereign Bank ESTATE OF Lorna R. Line SOCIAL SECURITY #: 132-22-4907 DATE OF DEATH: August 8, 2007 Account #: 2894021977 Type: Savings Open date: 5/7/2002 In the name of: Lorna R Line, Janice A Mixell POA Date of Death Balance: $21,978.46 Int.(I'TD) from 1/1/2007 to 6/29/2007 $59.90 Accrued interest to date of death: $0.00 Other Info: Account #: 2895462550 Type: In the name of: Lorna R Line Date of Death Balance: Int.(YTD) from 1/1/2007 Accrued interest to date of death: Other Info: CD Open date: 12/22/2003 $2,264.50 to 7/31/2007 $1.93 Page 1 of 1 $44.86 TABLE OF CONTENTS Table of Contents Appraisal Certificate Appraisal Summary Photograph & CD-ROM Instructions Personal Property Listing Appraisal Summary (Copy) References Privacy Notice Statement of Qualifications Assumptions and Limiting Conditions 2 3 4 5 6 10 11 12 13 14 2 APPRAISAL CERTIFICATE I hereby certify that, upon the request for the estate appraisal of the personal property of Lorna R. Line, deceased, I have personally and physically inspected the listed personal property. The personal property was appraised to determine the FAIR MARKET VALUE, AS OF d.o.d. August 8, 2007 & reported on September 10, 2007. The information and values contained in this report are based upon my experience as an appraiser and other reliable sources. The personal property was found to be in EXCELLENT condition, unless otherwise noted. Values are reported piece-by-piece, and/or as a whole. All values reported have been determined with consideration to the condition of the item, market conditions, and salability factors. pis A1~~raisa~ Lv~ssc~L.~,~nev~ C.A. hector APPRAISAL SL:Jl~IMARY It is in my opinion, that as of d.o.d August 8, 2007, the Fair Market Value of the personal property of Lorna R. Line, deceased: (Fifty One Dollars and Sixty Five Cents) ($51.65) pis Apnraisa~ Sa~vices l~ssa .lr hector The report must be read in its entirety. The Appraisal Summary ONLY is not the appraisal report 4 Photograph and CD-ROM Instructions Ibis Appraisal Services has provided you with a CD-ROM that houses all of the digital photographs of all of the items appraised. The CD-ROM also contains a saved copy of the appraisal report. This CD-ROM may be kept with the paper copy of the appraisal report or kept off=site, such as a safety deposit box. The photographs are saved in the JPEG picture format, meaning that all of the file names end with a ".JPG". The file names correspond to the written appraisal report's Corresponding Photograph File that is included at the end of each item appraised. Getting started with your CD-ROM 1. Insert the CD-ROM into your computer's CD-ROM Drive. If you do not have a computer or access to a CD-ROM Drive--a copy store, office supply store, or public library will be able to help you view and/or print your pictures. 2. Your computer may contain one or several different software programs that will allow you to view your pictures. Examples of these programs are Draw, Photo Editor, Picture It! Express, Photo Suite, My Photo Center, Photo Studio Lite, Photo Shop Pro, Picture CD, or Photo Deluxe. The program that is included with a digital camera is another way to view your pictures. • Select the program for viewing photographs and open the program. 3. Click FILE, and Click OPEN. 4. Use the Pull-Down, "Look in" Menu and select the D Drive (D:) or whichever drive is designated as your CD-ROM (sometimes this maybe the E Drive (E:) on your computer). ~ NOTE • Your CD-ROM Drive is designated with a small CD-ROM graphic Icon or a cartoon representing the drive. • The drives of your computer can be found under My Computer section of the Pull- Down "Look in" Menu. Common Drives are: A Drive (floppy disc drive), the C Drive (hard disc drive), the D Drive (CD-ROM Drive), and the E Drive (sometimes CD-ROM Drive; sometimes an external drive, like a CD-ROM Writer, Zip, or Jazz Drive). 5. Double-click on the photograph you wish to view. Personal Property Listing 1 2-1976 Re ublic of Liberia. One dollar. $5.00 2 1-1976 Republic of Liberia. Fifty cent. $1.20 ' 3 2-1972 Republic of Liberia. Five cent. $0.05 4 1-1937 Re ublic of Liberia. Two cent. $0.05 5 1-1941 Republic of Liberia. Two cent. $0.05 6 1-1937 Republic of Liberia. One cent. $0.10 7 1-1961 Re ublic of Liberia. One cent. $0.05 8 1-1968 Republic of Liberia. One cent. $0.05 9 4-1972 Republic of Liberia. One cent $0.20 10 1-1971 Juliana Koningin Der Nederlanden. Twenty-five cent. $0.10 11 1-1968 Juliana Koningin Der Nederlanden. Ten cent. $0.05 12 1-1977 Juliana Koningin Der Nederlanden. Ten cent. $0.05 13 1-1979 Juliana Koningin Der Nederlanden. Ten cent. $0.05 14 1-1968 Juliana Koningin Der Nederlanden. One Gulden $0.10 15 1-1939 Confederatio Helvectica. Twenty cent. $0.30 16 1-1974 Confederatio Helvectica. Ten cent. $0.10 17 1-Elizabeth II. Five dollar. $0..60 18 1-1971 Elizabeth II. 2 New ence. $0.05 19 1-1980 Elizabeth II.2 New pence. $0.05 20 1-1987 Elizabeth II-Canada. One dollar. $0.80 21 2-1978 Queen Elizabeth-Hong Kong. One dollar. $0.50 22 1-1977 Queen Elizabeth -Hong Kong. Fifty cent. $0.10 23 1-1974 Elizabeth II United Kingdom. Ten cent. $0.10 24 2-1975 Elizabeth II United Kingdom. Ten cent. $0.20 25 1-1979 Elizabeth II United Kingdom. Ten cent. $0.10 26 1-1982 Queen Elizabeth United Kingdom. Ten cent. $0.10 27 1-1975 Elizabeth II New Pence. United Kingdom. Five cent. $0.05 28 1-1979 Elizabeth II New Pence. United Kingdom. Five cent. $0.05 29 1-1980 Elizabeth II New Pence. United Kingdom. Ten cent. $0.05 30 1-1980 Elizabeth II New Pence. United Kingdom. Five cent. $0.05 31 1-1977 Queen Elizabeth-Hong Kong. Twenty cent. $0.05 32 3-Elizabeth II New Pence. United Kingdom. Twenty cent. $0.20 33 1-1977 Elizabeth II. Canada. $0.20 34 2-1971 Elizabeth II. One cent. $0.10 35 1-1980 Elizabeth II-New Penny. $0.05 36 1-1981 Elizabeth II-New Penny. $0.05 37 1-1975 Elizabeth II- New Penny. $0.05 38 1-1993 Mexican Coin. Ten cent. $0.10 39 1-1993 Mexican Coin. Twenty Cent. $0.10 40 1-Mexican Coin. Five dollar. $1.20 41 1-Mexican Coin. One dollar. $0.40 42 2-1970 Republic of America. One dollar. $1.20 43 2-1968 Republic of America. Fifty cent. $0.75 44 1-1966 Re ublic of America. Twenty five cent. $0.20 45 2-1966 Republic of America. Ten cent. $0.20 46 1-1922 Liberty. One dollar. $8.00 47 1-1978 Liberty. One dollar. $1.00 48 1-1974 Bank Indonesia. Five. $0.05 49 6-1971 Bank Indonesia Fifty. $0.30 SO 1-1971 Bank Indonesia. Ten. $0.05 51 2-1971 Bank Indonesia. Twenty five. $0.10 52 3-1973 Bank Indonesia. One hundred. $0.30 53 2-1978 Bank Indonesia. One hundred. $0.20 54 1-1964 Sierra Leone. One cent. $0.05 55 5-1967 Sierra Leone. One cent. $0.25 56 1-1964 Sierra Leone. Five cent. $0.05 57 3-1964 Sierra Leone. Ten cent. $0.15 58 1-1964 Sierra Leone. Twenty cent. $0.20 59 1-1977 Singapore. Ten cent. $0.05 60 1-1980 Singa ore. Ten cent. $0.10 61 1-1981 Singapore. Ten cent. $0.05 62 1-1989 Brasil. Fifty. $0.30 63 1-1902 Canada. Five cent. $1.20 64 1-1968 Helvetia. One Fr. $0.25 65 1-Black coin with silhouette. $0.05 66 1-Palm Tree coin. $0.05 67 2-Dragon Boat coins. Thailand. One Baht. $0.10 68 1-1985 Faith, Hope, Love - loz. Troy Silver. $7.00 69 1-1971 Mon-Dak Old-Fashioned Montana. $1.00 70 1-1972 Mon-Dak Old-Fashioned Montana-Constitutional Convention. $1.00 71 1-1973 1972 Mon-Dak Old-Fashioned Montana. $1.00 72 1957-US. One dollar bill. $1.50 73 1990-DelEcuador. One hundred sucres bill. $1.00 74 9-Deer on front. One dollar bill. $0.90 75 1-1977 Bank of Indonesia. One hundred rupiah bill. $0.25 76 1-1980 Bank of Indonesia. One thousand rupiah bill. $6.00 77 3-Bangladesh. Ten dollar bill. $0.75 78 1-Man on front, horse on back. Twenty dollar bill. $0.50 79 1-Bank of England. One ound note. $1.75 80 Rochester Clearing House Association. One dollar. $1.00 Total $51.65 APPRAISALS Y (COPY) It is in my opinion, that as of d.o.d August 8, 2007, the Fair Market Value of the personal property of Lorna R. Line, deceased: (Fifty One Dollars and Sixty Five Cents) ($51.65) pis Appvaisa~ cervices )~ C. g. ~arecto~ The report must be read in its entirety. The Appraisal Summary ONLY is not the appraisal report io Appraisal References Alderfer's Auction. 501 Fairground Rd. Hatfield, PA 19440.215-393-3003. http://www.alderferfinearts.com/ Brickers. Chuck E. Auction. 93 Texaco Rd. Mechanicsburg, PA 17050. 717-776-5785. Conestoga Auction Company, Inc. 768 Graystone Rd. Manheim, PA 17545. 717-898- 7284. http://www.conestogaauction.com/auctions/ eBay. http://www.ebay.com Gottshall, Jr.. Roy Auctions. 113 Forge Rd. Boiling Springs, PA 17007. 717-258-6222. Hershey, Dan Auctioneering Service. 3 Brown Rd. Shippensburg, PA 17257. 717-532- 4647. F. Loney, C.A.P.P., L.P.I. 2007. Personal Communication Ocker, Carl E. Auction. 4401 Philadelphia Ave. Chambersburg, PA 17201. 717-264- 6578. http://www.kennysauction.com/ Pook &Pook. 463 East Lancaster Ave. Downingtown, PA 19335. 610-296-4040. http://www.pookandpook.com York Town Auction, Inc. 1625 Haviland Rd. York, PA 17404. ll PRIVACY NOTICE Pursuant to the Gramm-Leach-Billey Act of 1999, effective July 1, 2001, appraisers, along with all providers of personal financial services are now required by federal law to inform their clients of the policies of the firm with regard to the privacy of client nonpublic personal information. As professionals, we understand that your privacy is very important to you and are pleased to provide you with this information. In the course of performing appraisals, we may collect what is known as "nonpublic personal information" about you. This information is used to facilitate the services that we provide to you and may include the information provided to us by you directly or received by us from others with your authorization. We do not disclose any nonpublic personal information obtained in the course of our engagement with our clients to nonaffiliated third parties, except as necessary or as required by law. By way of example, a necessary disclosure would be to our independent contractors, and in certain situations, to unrelated third party consultants who need to know that information to assist us in providing appraisal services to you. All of our independent contractors and any third party consultants we engage are informed that any information they see as part of an appraisal assignment is to be maintained by strict confidence within the firm. A disclosure required by law would be a disclosure by us that is ordered by a court of competent jurisdiction with regard to a legal action to which you are a party. We will retain records relating to professional services that we have provided to you for a reasonable time so that we are better able to assist you with your needs. In order to protect your nonpublic personal information from unauthorized access by third parties, we maintain physical, electronic, and procedural safeguards that comply with our professional standards to insure the security and integrity of your information. 12 Statement of Qualifications Alyssa L. Loney, C.A.P.P. Professional Designations and Certifications C.A.P.P. -Certified Appraiser of Personal Property designation earned through course work and classes provided by the Institute of Appraisal of Personal Properly. Archaeological Resources Protection Act -Certified to conduct investigations and damage assessment that pertains to violations of the United States federal, state, and local laws pertaining to archaeological sites and cultural properties. Including by not limited to the Archaeological Resources Protection Act of 1979, National Historic Preservation Act of 1966, the Native American Graves Protection and Repatriation Act and the American Antiquities Act of 1906. Professional Accomplishments ~ State Historical and Underwater Archaeologist for the State of Louisiana. ~ Attended the Conservation of Indian Artifacts Symposium sponsored by the Smithsonian Ilistitution and the Tunica-Biloxi Indian Reservation, Marksville, Louisiana. ~ Director of the West Virginia University Historical Costume Museum. ~ Research Archaeologist/ Artifact Instructor for CADW (Welsh Historic Monuments)/ University of York, England. ~ Research and Preservation Specialist for the Maryland Historical Trust. ~ Presented and published works for national and international organizations including the Society for Historical Archaeology, Middle-Atlantic Archaeology Conference, Southeasteni Archaeological Conference, Louisiana Archaeological Society, and the Maryland Historical Trust. Education B.Sc. Historical Textiles and Clothing, 1992, West Virginia University, Morgantown, West Virginia, United States. M.A. Medieval Archaeology, 1995, University of York, York, England. C.A.P.P. Certified Appraiser of Personal Property, 2001, Institute of Appraisal of Personal Property, York, Pennsylvania, United States. A.R.P.A. Certified to conduct investigations and damage assessment that pertains to violations of the United States federal, state, and local laws pertaining to archaeological sites and cultural properties. S.B.D.C. First Step Entrepreneurial Series, 2001, Kutztown University of Pennsylvania, Small Business Development Center. Presently Director and Founder of Ibis Appraisal Services. Member of Institute of Appraisal of Personal Property, American Society of Appraisers, Appraisers Association of America, International Society of Appraisers, and Professional Coin Grading Service. 13 Conducts extensive on-site appraisals, assessments, analyses, and authentication of personal and cultural property. Operates on local, national, and international levels. Conducts research on all objects considered personal and cultural properly. Assumptions and Limiting Conditions The term "Fair Market Value", as used in this report, is defined as follows: The highest price an item would bring if the sale occurred under normal market conditions providing 1. neither the buyer or seller is acting under duress, Z. the property has been exposed on the open market for a reasonable length of time,. 3. both the buyer and the seller are aware of the potential assets and defects, 4. no unusual circumstances are present. This appraisal was based upon the following assumptions, limitations, and conditions: 1. The information contained in this report was gathered from sources considered reliable, personal examination, research of authenticit~~ and comparable sales and/or auction prices. 2. No responsibility is assumed for matters that are legal in nature, including, but not limited to: the representation of others concerning the value, authenticity, condition, origin, or provenance of an item appraised. 3. The appraiser assumed that a normal and careful examination of the property was sufficient to determine its quality and condition and that no extraordinary examination procedures were to be utilized, unless these were specially requested and the expenditure of funds therefore authorized. 4. The appraiser's court attendance and expert testimony report, if required, are not included as part of this report. The appraiser does have the right to refuse testimony. THE UNDERSIGNED HEREBY CERTIFIES; 1. That I have no interest now, nor have I had an interest in the past, nor shall I contemplate an interest in the future, in the property covered by this appraisal. 2. That to the best of my knowledge and belief, all statements and information included in this appraisal are true and based upon objective fmdings and that no pertinent information has been knowingly withheld or deleted in this report. 3. That neither the employment to make this appraisal or compensation for doing so is contingent upon the value of the property. It is the firm belief of the appraiser that the information furnished in this appraisal report and the conclusions drawn from this information are true and correct, but they are not guaranteed. is Aj~~raisa Se~ices 14 a ti RETURN TO: McCartney Petroleum, Inc, P.O. Box 1438 Sidney, MT 59270 MINERAL DEED State: Montana County: Richland Grantor: Janice S, Mixell, Executrix and Personal Representative of the Estate of Lorna R. Line, aka Lorna Line, deceased c/o Bradley L. Griffie 200 North hanover Street Carlisle, PA 17013 Grantee: Gary D. McCartney and Helen S. McCartney as Co-Trustees of The McCartney Family Mineral Trust P.O. Box 1438 Sidney,NlT 59270 Effective Date: December 1, 2007 For adequate consideration, Grantor, named above, grants, bargains, sells, conveys and transfers, with warranty, to Grantee, named above, an undivided ALL RIGHT TITLE AND INTEREST in all of the oil, gas, and other minerals in and under and that may be produced from the following lands (the "Lands") in the county and state named above: TOWNSHIP 22 NORTH. RANGE 58 EAST MPM Section 12: A 73.76 acre tract in the N'/SE'/a as more completely described as Tract 2 of Minor Subdivision 30 in Doc. No. 479740 Also described as follows: A 73.338 acre tract in N2SE of Section 12, also known as Tract 2 of Minor Subdivision 30 (Certificate of Survey filed January 9, 1996 as Document No. 479740). Together with a tract described as follows: Section 12: A 0.25 acre tract in the SE'/.NE'/4 being a portion of that certain tract described in book A120, page 375, more completely described as follows: Beginning at the East Quarter Corner of said Section 12, thence S88°40'26"W along the East-West Mid Section Line a distance of 198.10 feet, thence North parallel to the East Section Line 55 feet, thence East parallel to the South Section Line 198.10 feet to the Section Line, thence South along the Section Line 55.00 feet to the Quarter corner and point of beginning. Also described as follows: A 0.25 acre tract in the NE of Section 12 (Metes and Bounds description in Quit Claim Deed recorded November9, 1982 in Book A120, page 375 and included in Certificate of Survey 27-335filed November 9, 1982 as Document No. 396589) Together with a tract described as follows: Section 12: Lot 1 of Schilling Homesitesl st Pfat Also described as follows: A 1.101 acre tract comprised of Lot 1 of Schilling Homesites First Plot (Certificate of Surveyfiled July 21, 1959 as Document No. 263274) It is the intention of the Grantor herein to convey ALL RIGHT TITLE AND INTEREST in above premises to grantee. By this Deed, Grantee is also conveyed the right of ingress and egress, at all times, for the purposes of mining, drilling, exploring, operating and developing the Lands for oil, gas' and other minerals and storing, handling, transporting and marketing the same from the Lands, with the right to remove from the Lands all of Grantee's property and improvements. .~' This sale is made subject to any right now existing in favor of any Lessee or its assigns under any valid and subsisting oil and gas lease covering the Lands now appearing of record in the county where the Lands are located.. It is understood that the Grantee shall have, receive and enjoy the stated undivided interest in all bonus, rents and royalties and other benefits which may accrue from and after the Effective Date, as if Grantee had been, at the date of making any current valid and subsisting lease, the owner of a similar undivided interest in the Lands. Grantor agrees to execute such further assurances as may be reasonably requested or required to allow Grantee full use and enjoyment of the interest conveyed by this Mineral Deed. L,1 I T ~ E-SS e anice S. Mixell, xecutrix and Personal Representativ of the Estate of Lorna R. Line, aka Lorna Line, deceas STATE OF - (s/ ACKNOWLEDGMENT, INDIVIDUAL' ss COUNTY OF ~ ct,. On this ~~ day of _, in the year 200 before me personally appeared Janice S. Mixel Executrix an Personal Renresentative of the Estate of Lorna R Line aka Lorna Line, deceased known to me to be the person(s) described in and who executed the foregoing instrument, and who acknowledged to me that he (she, they) executed the same. (Notary Seal) Notary Signature~s~.~,~s~~' ~t.s~.~'•~ . ..11>Q~RIAl. SE~1l RWIN J. BASSETT Notary Public C,1;I~i1,~lE IOROUGH, CUMBERLAND COUNN ~lti ,t~!~_~gRlmifsion Expires Apr 1 7. 201 1 Printed Name of Notary j~o-(~ cks , ~ 55r"f'~' Notary Public for the State of ~~ Residing at My commission expires ~/-17-I1 ATTACHMENT TO "SCHEDULE G~~ ;; ~ff~~r/ F.O. Box 35660 Colorado Springs, CO 80935-3566 August 28, 2007 Bradley L. Griffie, Esquire 200 N. Hanover Street Carlisle, PA 17013 RE: Lorna R. Line (Deceased) Annuity Agreement #1821 Dear Mr. Griffie: Till Frec: (EaE) 6E~-6300 Office: (719} 268-7200 Fax: (719) 268-7256 E-mail: steward@theorchard.org www.theorchar-d.org Thank you for your letter dated August 20, 2007 concerning Loma R. Line. On December 1, 1993, Ms. Line established a charitable gift annuity with The Christian ~; Missionary Alliance for $12,000. This is the only annuity she had with our organization. Since the charitable gift annuity is an irrevocable gift, Ms. Line was only entitled to the quarterly payments until her death. V~'hen we receive a copy of the death certificate, we will terminate this gift annuity and distribute the residuum of the annuity to the charity specified in the annuity contract. The undistributed investment in the contract that Ms. Line is entitled to is $522.24 and u<.-+-Y Liv LVU v 11 1 IiLl1Li1 L(111 iVLlLlll. If you have any questions or I can be of further assistance, please feel free to contact me at the toll-free number above. Sincerely, r ~ ~~.~ ~~ Darlene Lanzi Annuity Administrator A Ministry of The Glristian and Missianar-~~ Allio;~ce The Christian and Missionary Alliance .~ _ Stewardship Ministries ,; P.O. Box 35000, Colorado Springs, CO 80935-3500 Application for Gift Annuity Agreement I hereby apply for a Charitable Gift Annuity in the amount of $ =(Minimum $1,000.00) The contract is to be ~ Single Life ^ Survivorship ^ Joint Life Payments to be made ^ Annually ^ Semiannually ,~!~Quarterly ~--•- ' Applicants Name Dr, Mr. Mrs. Mies. ~ Rev. ~, ~/ ~ .~' .~ ~'. L l /~~ Street ~ D. i3f1 X y ~ ~ 9' Date of Birth ~. iG ~ City ~ 7; +,V /`} ~ ~,' >/u~' ~ T©/1~ State ~ Zip Code 19 ~ 3 ~ - i Li` ~ ~/ Telephone # (,~. l ~) ~ ~ ~- ~ I ~ '7 Social Security No. ~ ~ ~ - ~ ~ - ~f 90'7 Type of Security (Stocks, Bonds, Cash, etc.) Cost Basis Please attach schedule if other than cash If'a sun~ivo:ship or joint. contract iedes~red; ~t~~~ti~llow~ing inforn~aiion is required: 'Fame of Second Person nr. ~tr~- hin. ~.~i~u. t~~~. R~•. Street Date of Birth - -- Cit}- _ _ St~te_ 7_ip Code Telephone #} fem. ~ ~, Social security I~' ..._ , _ ,, if you wish your aflnuiry paymea'tts to : maclc t~ Vc~ur checlcin~~ or sa~~in~s account, please c~m~lYte t~~e. follow=in;r: (Provide Deposit Slit) Bark Accnunt Number _ ~~ ~1_L_- ~~~~ _~, '7 _ l__ -~ `~, Name 'ref Bank i,( ,~~~" l ~ .~f-~' ;Lr.,.:}~' ~ f ~ ,L' .~~' ~ ~~ . ~1 a' ~~ z x~StrEet" ~`, ~ r~~ ! ~-.~ ~-, q .x .1.~~_ ~~ ~ t l .~ ~ ~~ l~, C~ Cin' 'i'i ~~1,° 7' ~ ~..~:.~;~ may' ~,' 1 tr ~,~'- State` Zip Cock ~~~~-^ ~ ,. Applications received by the 15th of the month dated as of the first of the month. Applications received after the 15th dated as of the first day of the fallowing month: Signature ~~"-'`~~ !~i' `~ i~.rz. Date 1 ~ ~i 9/ ~' ~3 Signature Date '~' TH E ALLIANCE THE CHRISTIAN AND MISSIONARY ALLIANCE P.o. Box 35000 • Colorado Springs, Co 80935-3500 Phone 866-443-8262 • E-Mail receipt@cmalliance.org • Web www.cmalliance.org ~.; Ci.%i~~ k~,e C~~~ k~~ek~ew 28:.8-ZO'n' - i- k kl~e ~~~"+d. ~ c~,V,~k. -r~~-~~.5rn~~. 1 t Gory. N,~,~.~,~( `v,a ~~.~...~.,,.,,,`~k,eS ~ ~ ~v'U i'^r^v-.^ (~C'Uf~IC'. ~i`^.~rJ w(rv-C'~ l~~l U`^ Cx~~'v.dv~~i~^U. v'.^ + ~~ j Lorna Line Estate Griffie & Associates 200 North Hanover Street Carlisle PA 17013 9900001 OTHER ORGANIZATIONS EC~®FA ~~~~;:.~ THANK YOU FOR YOUR GIFT.f 324742 DATE RECEIPT NUMBER 12/3/07 018GP ,, - . - "The Word became flesh and made his dwelling among us" (John 1:14); Thank you for bringing the Living Word to people who otherwise might never meet God's Son. Your faithful support enables your Alliance team of missionaries to reach countless people with the message. of His. love. 9 19~ A story from Cambodia is one of hundreds illustrating the power of Jesus to bring life to the lost. When a man ~' was paralyzed after a stroke, nothing could be done for him. C&MA medical missionaries prayed for him, and he was healed. His whole family and the village leader came to faith. +~ Thank you for helping to bring the good news of peace on earth to a hurting world. May the Lord pour out the ` abundance of His Spirit in your life as you serve Him through your prayers and giving. ~~ ®® wp f~`` Vic. /~'-'~ ~`'~ Gary M. Benedict U.S. C&MA President ~ ~ • " Tax Deductible Great Commission Fund 5,109.05 Please keep this receipt for your tax records. • 5,109.05 Contributions to the C&MA are administered and disbursed under the supervision of the Board of Directors. In the event that a ministry is overfunded, gifts maybe used in another ministry activity as Gosety in keeping with • •• ~ ~ • 5,109.05 your intent as possible. No goods or services were provided by the C&MA in consideration for this contribution. ~ Non Tax Deductible ®~ ~~ Please detach and return with your next gift. j Please detach and return with your next giR. j ATTACHMENT TO "SCHEDULE J" ATTACHMENT TO SCHEDULE "J" 4. 770 SOUTH HANOVER STREET, CARLISE, PA, 17013 (PORTION OF ANNUITY HELD WITH THE CHRISTIAN MISSIONARY ALLIANCE). 5~ P.O. BOX 3500, COLORADO SPRINGS, COLORADO, 80935- 3500, (BENEFICIARY UNDER IRREVOCABLE INVESTMENT CERTIFICATE). t s 4 01/07/2008 ltON B: 59 FAX 7172494551 • .; - . .". ~ :J . - ,'- :` ~e) rAM* S 1CC'r to OSl'!f fb 1905 tRrv t) J2) i1Ft~ (tll: SIO (l.itll' far numberingl - ~ttt-tt ~~ g t~ Jlrtitles of .COMMONWEALTH OF PENNSYLVANIA ~s,~tch_ , f>f;l'ART:t'IENT OF STATE otneenieNa~nldCgaatinn (;URI'OR;lTiON fil}liEAti ®004/005 Filed thlt~_ • _ eri^:a,~ ref ...: i`;. ` Commnnwealth of Pcnrtrvlvanist Department of State ~ r' . ' :~~. ~ ' , Secretary of the Catnmonwr.:tlth (Box for Cenftll:ation) 1n compliance with the requirements of 15 Pa. S. f+7flf}5 (relating to articles of amendment). tltr under signed nonprofit corporation• desiring to amend its Articles, does hereby certify that: • 1 Tha name oC the corporation is: Alliance ijome of Carlisle; Cumberland County Pennsylvania 2. T'hr address of its registered olficr in this Commonwealth is (the Department of Stair is hereby authorixctif to corrc•rt the• following statement to conform to the records of the Department): ' 770 Soittl~°-Hanover Street~'.`r~ :.: :HVV8ER7 ' ... .. .. ~ - - ~ ~ ~ -- ~- ~ '(ST EfTi Carlisle ~ 1713 • . Pennsylvania :atr~ tz~-zooe) :~. The ,tatute ~by or under which`ir was incorporated isc '=. ' Non-Profit Corpo a~i.o-n Law ~ ~ _ .,. 4. Th•' date of its incorporation is• June 27, 1944 5. ~Cl)crk. and if appropriate, complete ane of the fallowing): ~ ~ - - ` ~ , The amendment shall be effective upon llling these Articles of Atnendment in the Dcpai-trrient. `. of State. ~ _, ^ The amendment Ahall be cffectivl• on: - •• . at ~ .. (GATE), IM6Ufl) - t,. (ChQCk one of the following): ~ . ~ ,. . '. - ~ - .. . [] The amendment was adopted by the meiilhers puc~uant.to l5.Pa.~S,, fiZ904(a). .: ,.. - The,amendment was adopted by the l~oard,o[-direetQrs.pttrsugnt to 1~.Pa:~S. ~79O9(b).. , , ., .- , . ~. l'i)n :tm~ndment adopted by the corporation. set fot•th in full, is as.follows: ~ .. - - :a~ num ~ers.'~ir•ers.. sh:.t~ti~c~~m .. • ~~ ~ ~ ~ , _i ~~~~g~:~,~;~ttit,~1~"~~~`°i m5~";~°"'~~~r~.~~.°e't~X+1Gt 01/07/2008 ltON 8:59 FAX 7172494551 REVIC,283 {01.Oq REVODIdS BUNFJIU OF BUBINPbS TAU6T FUU~ TAXeS DEPT. la~09 lUINI~ISBURa, R417f7ad90- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE CHAPEL POINTE AT CARLISLE 770 S HANOVER ST CARLISLE ~PA 17013-4105 SALES AND USE TAX CERTIFICATE OF EXEMPTION Entity tD: 23-1A45fi58Kf00 Notice Number: 735-265.400-122-9 Notice Date: January 3, 2001 Account Number. 75,'t22-726 Exemption Type: CHARITABLE Void Aftsr: July 31, 2005 1003/005_ ~t~~ ~" USE OF THIS CERTIFICATE FOR PERSONAL OR NONEXEMPT PURCHASES WILL RESULT iN CANCELLATION OF EXEMPT STATUS. Always refer to your Aoaourtt Number in oorrespondenoe. ti your organization changes its name, address or ceases operation, complete the appropriate sections below and return this form to: PA Department of Revenue, Bureau of Business Tn~t Fund Taxes, Exemption Unit, .Dept. 260909, Harrisbur8, PA 17128-0909. Any questions may be addressed to the above address, or caH {717) 783-5473; TT # Only 1-800-447020 {Service for Taxpayers With Special Hearing and/or Speaidng Needs). Name and/or Address Change Cancellation of Exemption Name Address ~ -- . Date organization ceased operation C~ State Zip Code Signature and Title of Authorized Representative Date Print Name Telephone No:{ ~) 01/07/2008 LION 8:59 FAX 7172494551 1 - .+.~"'~~ ~.. '? i Internal Revenue Service District Director ~ The Alliance Home of South Middleton Township Cumberland 770 South Sanover Street . Carlisle, Pa. 17013 . Dear Gentlemen: --.-_-....., ._.__.-.. _._.._._.. _..__...._. X005/005 Department of the Treasury P.O. Baa 12070 Phila., Pa. 29105 Person to Contact: K. Smith Telephone Number. C215) 597-41b8 Refer Reply to: E0:7201:KS Gate: ~~ $ We are supplying the following information in reply to your letter of April 1, 1985. The Alliance Home of South Middleton Township Cumberland is exempt from Federal income taz under section 501(c)(3) of the Internal 8evenue Code as of August, 1952. According to our records your Employer Identification Number is 23-1445658. We have also determined that you are not a private foundation within the meaning of section 509 (a) of the Code because you are an organization de- scribed in section 509(a)(2). Sincerely yours, ' --~~~ •:~ Exempt O~ga za~~~ns Group Manager Employee Plans and Exempt Organization . Division CLG ~~~ November 27, 2007 CLC Ministries International Impacting the World with Christian Literature Bradley L. Griffie Griffie and Associates 200 North Hanover Street Carlisle PA 17013 Dear Mr. Griffie, Please find the following for CLC Ministries International: 1. Amended Articles of Incorporation in the District of Columbia. 2. IRS determination letter dated SeYtember 13, 2001. 3. Original IRS determination letter dated May 3, 1960. I hope these are sufficient to show that we are a charitable and tax exempt organization. Sincerely, GC.~~~-~-fi~ Debra J Almack Treasurer, CLC Ministries International (Formerly Christian Literature Crusade) P.O. Box 1449 701 Pennsylvania Avenue Fort Washington, PA 19034 Tel: (215) 542-1242 Fax: (215) 542-7580 E-Mail: clcmail@clcusa.org Web: www.clcusa.org _ - GOVERNMENT OF THE DISTRICT OF COLUMBIA - , • DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS . ~® C7ERTIFICA.T~1E THIS IS TO CERTIFY that all applicable provisions of the District of Columbia Nonprofit Corporation Act have been complied with and accordingly, this CERTIFICATE OFAMENDMFNT is hereby issued to: CLC MINISTRIES INTERNATIONAL LN WITNESS WHEREOF I have hereunto set my hand and caused the seat of this office to be affixed as of the 12th day of May,2003 . David Clark DIRECTOR Elizabeth O. Kim Administrator B siness,~Rec~ul~tion Administration ,~ - - '' - i _-- r... ~~t~f ~ ~.: -lam atricia E. Grays(?~<?~ (' Superintendent of Corporations ~J Corporations Division Anthony A. Williams Mayor .. , CERTIFICATE OF AMENDMENT OF INCORPORATION OF CLC MINISTRIES INTERNATIONAL We, William Almack, President, and Irene Cagle, Secretary, certify. that the written consent oftwo-thirds of the Board of Directors, being first had and obtained, file . the following amendment to the Certificate of Incorporation, heretofore filed on June 7, 1957: The following new Articles FIFTH, SIXTH, and SEVENTH are added: FIFTH. No part of the net earnings of CLC Ministries International shall be used for the personal benefit of its members, officers, or other private persons, other than to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of the purposes set forth above. CLC Ministries International shall not carry on any activities not permitted to be carried on by an organization exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code. SIX'T'H. In the event of a sale or dissolution of CLC Ministries International, it is prohibited to use any surplus funds for private inurement of any person. SEVENTH. Upon the dissolution of CLC Ministries International, any assets remaining afrer the satisfaction of all of its liabilities, or provision therefor, shall be distributed to CLC (IO), if such organization is then exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code, or the corresponding section of any future federal tax code. Should the aforementioned organization not, at that time, be in existence or not be exempt as aforestated, then alI such assets shall be distributed for one or more exempt purposes within the meaning of Sectiori 501(c)(3) of the Internal Revenue Code, or the corresponding MAY 12 2003 section of any future federal tax code, or shall be distributed to the federal government, or to a state or local government, for a public purpose. ~.c.-,----~~~ William M. Almack President ~~ i Irene Cagle Secretary I, mc,y2 ~ ~.(,n~,• ~~ a notary public in and for ,the Commonwealth of Pennsylvania, do hereby certify that William M. Almack, President and Irene Cagle, Secretary personally appeared before me and acknowledged the above Certificate of Amendment to be their act and deed. Subscribed and sworn to before me this ~~day of April, 2003. O Not ublic (Notary Seal) ~ F. Herd 6ttiCotvrsH, iVotary pu~#c; - _. Whftemateh Twp. k4cntgomaty Camty - • My CDrTUfifsdiol'- ~4res OcL 26~ 2003 Marrter, A86ocl~SanotN~artes 2 5EP-13-2001 11 55 Internal Revenue Service Date: September 13, 2001 CLC Ministries international PO Box 1449 Fort Washington, PA 190348449 Dear Sir. Department of the Treasury P, O. Box 2508 Cincinnati, OH 45201 Person to Contact: Ms. Dalton 31-07425 Customer Service Representative Toll Face Telephone Number: 8:00 a.m. ro 9:so p.n~ EST 877-829-5500 Fax Number. 513-263-3756 ' Federal identification Number: 23-6393292 r . ~~i ~ This letter is in response to your request for a copy of your organization's determination letter. This letter will take the place of the copy you requested. Our records indicate that a determination letter issued in May 1960 granted your organization exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect Based on information subsequently submitted, we classified your organization as one that is not a private foundation within the meaning of section 509(a) of the Code because ii is an organization described in section 509{a){2). This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required io file Form 990, Return of Organization Exempt from Income Tax, only if its gross receipts each year are normalcy more than $25,000. If a teturn is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10,000, when a return is filed late, unless there is reasonable cause for the decay. Al) exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each employee during a calendar year. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, these organizations are not automaticaNy exempt from other federal excise taxes. Donors may deduct Contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your organization orfor its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2'106, and 2522 of the Code. ./U iJ LVV1 1 1 • JJ -G~ CLC Ministries International 23-6393292 Your organization is not required to frle federal income tax returns unless it is subject to the tax on unrelated business income under section 511 of the Cod®. If your organization is subject to this tax, it must file an income tax return on the Form 990-T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code. The law requires you to make your organization's annual return available for public inspection without charge for three years after the due dace of the return. If your organization had a copy of its application for recognition of exemption on July 15, 1987, it is also required to make available for public inspection a copy of the exemption application, any supporting documents and the exemption latter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liable for a penalty of 520 a day for each day you do not make these documents available for public inspection (up to a maximum of $10,000 in the case of an annual return). Because this letter could help resolve any questions about your organization's exempt status and foundation status, you should keep it with the organization's permanent records. If you have any questions, please call us at the telephone number shown in the heading of this letter. This letter affirms your organization's exempt status. Sincerely, ~~ John E. Ricketts, Director, TElGE Customer Account Services TOTAL P.03 U e..~a e. CONt1lS,lONEA OF INTERNAL REYEIiUE wooww wot,Y to puarta~~ o~ rrrrw.aw n[vw~[ wa~wr.rro.r ~ s. c quo wva to T: R :1~E0 : 2 AC Christian Literature Crusade Box A, Fort Washjngton, Pennsylvania Gentlemen: MAY 3 - 1gSO It is the opinion of this office, based upon the evidence ' _ presented, .that you are exempt from 2~deral income tax -as an organs- zat3on described in section 501(c)(3) of the Internal Revenue Code of 195, as it is alwWn that you are organized and operated exclu- sively for religious purposes. ' Accordingly, you are not required to f`Ll.e income tax returns unless you change the character of youx organization, the purposes for which you were organized, or your method of operation. Arty' such changes should be r©ported immediately to the District Director of ' Internal. Revenue for your district in order that their effect upon your examp t status mfr be determined. It xi]1 not be necessary for you to file t<'~e annual return of information, Form 990A generally required of organi2ations exempt under section 501(c) (3 j of the Internal Revenue Code of 1951, as you come within the specif`le exceptions contained in section 6033{a) of the Code Contributions made to you are deductible by the donors in com- puting their taxable inceene in the manner and to the extent provided by sect3.on 170 of the 195 Code. Bequests legacies, devises or transfers to or for your use aro deductible in computing the value of the ta:cable estate of a decedent for B~daral estate tax purposes in the manner and to the extent provided by sections 2055 and 2106 of the 1951 Code. Gifte of property to or for pour use are deductible in canputing taxable gifts for Federal gist tax purooses in the manner and to the extant provided by section 2522 of the 195It Code. u. S. l-KtASU(-~Y DEPAI-~TMENT WASHINGTON 25 Form 5992 (P,ev. 2-5~) 2 - Christian Literature Crusade Na liabilitty is incurred by you for the tares imposed under the Fbderal Insurance ContriaZ,ttions Aet (social security tames) unless you have filed a.xaiver of exemption certificate in accordance with tho applicable provisions of such Act. In the event yt~u desire social securi-tsy coverage Sor your employees or have a~ questions relating to the filing of a Naiver of exemption certificate you should take the matter up wi th your District Direc for o f In ternal Revenue. Your attention i3 called to the provisions of section 501(c)(3) of the Internal. Revenue Code of 1951 under which your exemption xi.ll be revoked if ar~* substantial .part of your activities consists of carrying on propaganda, or otherwise attempting, to ..influence legisla_ tion, or if you part3.cipate in, or intervene in (including the publishing or distributing of stat~menta), ar{y political campaign on behalf of ~ar~r candidate for public office. R~r the purpose of aPP~ng this ruling to ar~y Period xl.th respect to which the Z_ ternal Revenue Code o f 195t~ is not appZic able, arty reference herein to a provision of tt'ie 19511 Code shall be deemed a reference to the corrQSnonding provision of the 1939 Code. one D~.strict Director o£ Internal Revenue, ?hiladelphia, Pennsylvania ~s being advised of 1i.h~.s action. Very {~•Lt~r Yours, ,J ~' .. '.. ~ Fom G9~2-t (RQy. 2-5c) ; /I Chiefs Rern.s~ //~~ ~:emPt ~•Canizat{ons Branch ~,i '' I ~'~ THE "I __ _ ALLIANCE DEVELOPMENT FUND, INC. November 29, 2007 Griffie & Associates Attorneys and Counselors at Law Attention: Bradley L. Griffie, Esquire 200 North Hanover Street Carlisle, PA 17013 RE: Estate of Lorna Line Dear Mr. Griffie: Thank you for your recent letter regarding the distribution of Lorna Line's investments with The Alliance Development Fund, Inc. As you suggested, I have distributed the funds to The Christian and Missionary Alliance for The Great Commission Fund. Enclosed, you will fmd the documentation that you had requested: 1. Copy of the Tax Exempt Status for The Christian and Missionary Alliance Development Fund 2. Copy of the check that was sent to them 3. Statements of the final payment of each Certificate of Deposit 4. Copy of the Application requesting the CD's final distribution upon death If you have any questions or need further assistance regarding these funds, please do not hesitate to contact me at our office. Sincerely, / ~/ ~ Maxine Dale-Jackson Investment Services Representative The Alliance Development Fund, Inc. Toll-Free Number: 1-888-878-3060 Direct Number: 1-719-268-2232 E-Mail: jacksonm@adf-inc.com A S U P P O R T I N G O R G A N I 'L A T I O N O F T H E C H R I S T I A N A N D M I S S I O N A R Y A L L I A N C E P. O. Box 63419, Colorado Springs, CO 80962-3419_ Web Site N~7v11~.adf-nic.com a~„~» ~~o MFR ~~sn FAX 719 2FR 2259 Toll Free 888.878.3060 E-moil ndf@ndf-inc.com .: INTERNAL RSVEHiTB SEKVICE DISTRICT DIREC"1'OR 1100 COHHKRCE STR&BT DALLAS, T% 75242-0000 Date: JAN l u -~gg2. TH$ CHRISTIAN AND MISSIONARY ALLIANCE OF COLORADO C/0 JOHN, R WYLIE 90 SOUTH CASCADE AVE STE 1300 COLORADO SPRINGS, CO 80903 D EP ARTMP..HT O F. THE 2'REAS UR 7C ~~(~~ ~aN ~ 4 ~ssz Employer Identification Numb ROBERTS &~01r~ 84-11'75729 Contact Person: SHARI FLOWERS Contact Telephone Number: . (214) 767-3526 Accounting Period Ending: . December 31 Foxm 990 Required: - No •• Addendum Applies:: ~ . No .~ ,Dear Applicant: ~ ~ - • Based, on .information supplied, and assuming your operations will be as ~ • stated in your application for recognition of exemption; we have determined ' -you are exempt-from Federal income tax under section 501 (a) of the Internal Revenue. Code as an organization described in section 501'(c)(3-). ~ ' - We hav®'further determined that:you are not a-private foundation within '1 - the meaning.~of section 509~(~) of the Code, .because .you are an.organization ~. .described in sections 509{a)(1} and 170(b)(1)(A)(i). • •.If• your sources of .support-, or your purposes; character, or _ method of • --operation change, please let us know so 'we can consider •the effect of the . .change on your exempt status and foundation status; In the case of an amend- - went to your organi•zational~document or bylaws, please send us a copy of -the' ' amended document or. bylaws. Also, you should inform us- of all changes•.in your ' name sir address. •. - . ~ ~ As' of January 1, 1984, you are liable foretaxes under 'the.Fe~eral - ~I-nsurance Contributions Act .(social security taxes) on remuneration of $100 -or more you pay to each of your employees during~a calendar year:. This does • not apply, however, if you. make or have made a timely else-tion under section 312.1 (w) of trhe Code to he exempt from such tax. You' are not liable for the tax imposed under the Federal'Unemployment Tax Act (FUTA).. Since yoo~ are not a private foundation, you ar.e ~ not subject to the excise - . taxes under Chapter 42 of the Cade: However, you are not automatically exempt from other Federal excise taxes. If you .have any questions about excise,. ~- employment, or other Federal taxes, please let us know.. - . -.-Donors may deduct contributions to you 'as provided in section 170 of the. Cade. Bequests, legacies, devises, transfers, or gifts to you or for your use _ are deductible for F'ede'ral estate and gift tax purposes if they meet the applicable provisions of Code sections 2055, 2106, and 2522. Contribution deductions are allowable to donors only 'to .the extent thaE .' their contributions .are gifts, with no consideration received; Ticket.pur- chases and similar payments in conjunction with. fundraising events may not. . -z- THE CHRISTIAN AND MISSIONARY necessarily qualify as deductible contributions, depending on the ci•rcum- stances. See Revenue Ruling 67-246, published. in Cumulative Bulletin 1967-2, on page 104, which sets forth guidelines regarding•the deductibility, as chari- table contributions, of payments .made by taxpayers for admission to or other participation in fundraising activities for charity., ~~In the•heading~of this, letter we have indicated whether you must•file Form 990, Return of Organization Exempt From-Income Tax. If Yes is indicated, you are required to. file Form 990 only if your gross•receipts each -y ear are normally more than $25,000. However, if, you receive a Form 990 package in the mail, please file the return even if you do not. exceed the gross receipts test. If you are. not required to file, simply attach thelabel provided,.. check the. box in the heading to indicate that your annual gross receipts are.normally• $25,000 or less,. and sign the return. _• If a return is required, it .must be filed by~ the 15th day of the fifth month after the end, of your annual accounting period. A penalty of ~510_a day is charged when a return is~filed late, unless there is reasonable cause for . the. delay. However, the maximum penalty, charged cannot exceed..$5,0.00 or 5.pe.r-~. cent of your gross receipts for the year, whichever is less.. Thi-s.penalty,may •~ also-be charged if a return is not complete,'so please be sure your"return-is complete before you file it-. '- You'are• not required to file Federal income tax returns unless you are subject to. the tax 'on unrelated- business income• under section 51 1 of the Code. ~f you are subject to this tax, you must file an income .tax return an.•Form 990-T,~Exempt Organization Business Income Tax:Ret-irri. In this letter we are riot determining whether any of your present'or proposed activities aze unre- . lated trade. or business asdefined in section 5~1 3 'of. the Gode. ' You need an employer identification number even.if•you have no,employees. ~• If•'an employer identification number was not entered on your appLicatibn, a •• number will be assigned to you and you will be advised of it. Please use that. - number on 'all returns you file and in 'all correspondence wi•th.the Internal ~ - Revenue Service. - If we have indicated in the. heading of. this letter that'an addendum applies, the enclosed addendum is.an integral-part of;this letter. - • Because this letter could help resolve any questions about• your exempt status and foundation status, you should keep it in your. permanent records. • We have sent a copy. of this letter_ to your representative as indicated in -.your power of attorney. - - -3- • THS CHRISTIAN AND MISSIONARY - - - - If you have any"questions, please contact the person whose name and - telephone number are shown in the heading of this. letter. - ~ Sincerely yours, - ~ Gary O. Booth - ~ District Director - - ~_ I2ITERNAL gEYENIIE SERVICE ' DISTRICT DIRECTt)R 1100 COHliERCE STREET DALLAS, T7C 75242-0000 Date: SAN 1 ~ 1992 THE CHRISTIAN AND MISSIONARY ALLIANCE OF COLORADO C/0 JOHN R WYLIE . 90 SOUTH CASCADE AVE STE 1300 COLORADO SPRINGS, CO 80903 Dear Applicant: DEPARTMENT OP THE TREASURY Employer Identification Number: 84-1175729 Contact Person: SHARI FLOWERS Contact Telephone Number: (214) 767-3526 Addendum Applies: No RECf IVf D JAN 14 1992 HO LME RO B~•RTS ~ OV~ET - We have considered your application for a group exemption letter recog- nizing your subordinates as .exempt from Federal income tax under section 501(a) of the Internal Revenue Code as organizations of the type described in section 501(c)(3). Our records show that you were recognized as exempt .from Federal income tax under section 501ic)(3) of the Code. Your exemption letter remains in effect. Based on information you supplied, we recognize ,your subordinates whose names .appear on the list you submitted as exempt from federal income-tax under section 501(c)(3} of the Code.' Additionally, we have classified the organizations that you operate, supervise,.or control, and that are ¢avered by your notification to us, as organizations that are not private foundations because they are organizations of the type described in sections 509(a)(1) and 170(b}(1)(A)(i) of the Code. Donors may deduct contributions to your subordinates as provided in section 170 of the Code. Eequests, legacies, devises, transfers, or gifts to your subordinates or for their•use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of section 2055, 2106, and 2522 of the Code. Your subordinates are not required to f ile Form 990, Return of Organiza- tion Exempt From Income Tax, if they qualify as churches or integrated auxil- iaries of churches or otherwise meet the exceptions in section 1.6033-2(g) of the Income Tax Regulations. Your subordinates are .not required to f ile federal-income tax returns unless subject to the tax on unrelated business income under section 511 of -the Code. Each organization subject to this tax must file Form 990-T, Exempt Organization Business Income Tax Return. In this letter we are not determining whether any of your subordinates' present or groposed activities are unrelated trade or business as defined in section 513 of the Code. As of January 1, 1984, each of your subordinates is liable for social security (FICA) taxes for each employee to whom the subordinate paid $100 or more during a calendar year.. This does not apply, however, to any subordinate -2- THE CHRISTIAN AND MISSIONARY that makes or has made a timely election under be exempt from such tax.. Your subordinates are under the Federal Unemployment Tax Act (FUTA). section 3121(w) of the Code to not liable for tax imposed Each year, at least 90 days before the end of your annual accounting period, please send.the items listed below to the Internal Revenue Service Center at the address shown below. 1. A statement describing any changes during the year in the purposes, character, or method of operation of your subordinates; 2. A list showing the names, mailing addresses (including Postal ZIP codes), actual addresses if different, and employer identification numbers of subordinates thatr since your previous report: a. Changed names or address; b. Were deleted from your roster; or c. Were added to your roster. 3. For subordinates to be added, attach: a. A statement that the information on which your present group exemption letter is-based applies to the new subordinates; b. A statement that each has given you written authorization to add its name to the roster; . c. A list of those to which the Service previously issued exemption rulings or determination letters] - d, A statement-that none of tY-e subordinates is a private. foundation as defined in section 509(a) of the Code if -the group exemption letter covers organizations described in section 501(c)(3); e. The street address of each subordinate whose mailing .address is a P.O. Box; and f. The"information required by Revenue Proce$ure 75-50, 1975-2 C.B. 587, for each subordinate that is a school claiming exemption under section 501(c~(3). Also include any other information necessary to establish that the school is complying with the requirements of ,Revenue Ruling 71-447, 1971-2 C.B. 230. This is the same information required, by Schedule A, Form 1023, Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code. 4. If applicable, a statement that your group exemption roster did not change since your previous report. The above information should be sent, "Attention: Entity Control Unit," to~. the following address: . Internal Revenue Service Center '. 3651 S. Interregional Highway Stop 6181 AUSC Austin, Texas 78740 . -3- THE CHRISTIAN AND MISSIONARY The service center that processes your returns. will send you a Group Exemption Number. Your subordinates are required to include this number on each Form 990, Return of Organization Exempt From Income Tax, and Form 990-T, Exempt Organization Business Income Tax Return, that they file. Please advise your subordinates of this requirement and provide them with the Group Exemption Number. If the heading of this letter indicates that an addendum applies, the enclosed addendum is an integral part of this letter. Because this letter could help resolve any questions about the exempt status and foundation status of your subordinates, you should keep it for your records. We have sent a copy of this letter to your representative as indicated in your power .of attorney. If, you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter. Sincerely yours, ``. .. .. ~ ~.~ Gary Oi.. Bnoth • District Director Interrtai Revenue Services Department of the Treasury Washington, DC 20224 Person to Contact: Mr. Gaines Holme Roberts & Owen Theodore Bozovich Telephone Number: Suite 1300 Refer Re~l2~o:622-8106 90 South Cascade Ave. pY Colorado Springs, Colorado 80903 E:SDA Hate: APR 2 7 1993 Re: mhe Christian and Missionary Alliance Merger Dear Mr. Gaines: This confirms ourJprevious conversation concerning the subject organization merger and the Service's confirmation of the following matters: (1) the transfer of EIN and GEN exemption numbers from The Christian and Missionary Alliance, a New York religious corporation ("Old CMA"), to The Christian and Missionary Alliance of Colorado, a Colorado nonprofit corporation("New CMA"), and (2)-the change in New CMA'~s name from "The Christian and Missionary Alliance of Colorado" to "The Christian and Missionary Alliance." Our computer records have been updated to reflect the employer identification number (EIN) 13-1623940 and group exemption number :(GEN) 2284 for. Old CMA has now been transferred to New CMA as a result of the completion of the merger. EIN 84-11755729 and GEN 7153 previously assigned to New CMA has been cancelled per your request. Accordingly, New CMA should continue to use the tax identification numbers previously assigned to Old CMA. In addition, based on Amended and Restated Articles of Incorporation, we have changed our computer'records reflecting changing its name from The Christian and Missionary Alliance of Colorado to "The Christian and Missionary Alliance." This confirms that N.ew CMA's individual and group tax exemptions continua after the official name change, We hope this information will be helpful to you. If you ha~~e~any questions regarding this matter, pleases refer them to the person whose name appears in the heading of this letter. Sincerely yours, ~.~~~ Theodore Bozovich Senior Program Analyst Office of Systems Development and Administration - Employee Plans and Exempt Organizations THE ALLIANCE DEVELOPMENT FUND, INC. PO Boc63419, Colorado Syrings, C080962-3419 DATE (719) 264-?250 • Fi1X (7/9) 268-2259 • Tol! Free (88818784060 &mail: a~adJinc rom • WeG sire: HaneadJ-incrom 11 / 2 9 / 0 7 FIVE THOUSAND ONE HUNDRED NINE DOLLARS & 05/100 WELLS FARGO WEST, N.A. O O [' O [ C 90 SOUTH CASCADE AVENUE J o J J COLORADO SPRINGS, CO 80903 $****5,109.05 L- J 5«~~n Feaiurea } oeuiir „r. xs~ PAY TO CHRISTIAN & MISSIONARY ALLIANCE THE THE GREAT COMMISSION FUND _ ORDER p0 BOX 35000 OF COLORADO SPRINGS CO 80935-3500 r ~i'00 58 5 5~~' ~: 10 20000 76~: 50 5804 7 50 1~-' __ THE ALLIANCE DEVELOPNffiVT FUND, INC. P.O. Bax 63419, Calmndo dprmgs. C080962-3419 (719) 264-2350 • FiLY(719J 268-2259'• Tot/Fife (888) 878-3tM0 Email: ndfriy¢1(-us. com • fl~ebsite: iw+nuadf-inccom CHECK NUMBER: 005855 DATE: 11/29/07 13:09:32 CHECK AMOUNT: $5,109.05 ACCT 4869 CHRISTIAN & MISSIONARY ALLIANCE RDM CDS/GFT GCF-L LINE EST iur %' 1 1 TI1E ALLIANCE DEVELOPMENT FUN U, INC ~ !~ P. O. Uua 63A14. Colorado Sprinb.r, CO ~1'09Fi1-3414 (?l>l ='6~~'--''S0 • Fill' 1719/ 36.1'-??54 • 7n11 Free (Rb'8) d'7n~-31160 I 1 ~E-mail: ud/'(urud/-inc.cnm IVeb .c ire: rrn~rr.udJ-inc.com LORNA R LINE 7 ALLIANCE DRIVE APT 203 CARLISLE PA 17013-4198 STATEMENT PERIOD: 11/20/2007 - 11/30/2007 - -------------- INVEST. CERTIFICATES 4869 300 /00 12 DC ------------------------------------------------------------------------------------- C/D NUMBER: 4869 DESCRIPTION DEBIT CREDIT DATE BALANCE BALANCE LAST STATEMENT 11/19/2007 1,013.12 INT PAID (ADDON) 8.72 11/29/2007 1,021.84 C/D PAYOFF 1,021.84 11/29/2007 .00 CURRENT INTEREST RATE 5.25 CURRENT MATURITY DATE 12/01/2010 SUMMARY: ACCOUNT PREVIOUS TOTAL TOTAL SERVICE ENDING .....NUMBER:.... ..BALANCE.. .......DEBITS..... ....CREDITS.... .CHARGE. ..BALANCE.. C/D 4869 1,013.12 1 1,021.84 1 8.72 .00 .00 1 ECFA tg. ;.,,,,r.,.., I '~ TIIE ALLIANCE DE\'GLOPA4LNT ~L,'ND, INC. ~ P. O. Ua,~ 63411. Colorado Sprin.c, CO J'096?-3A/4 '1 /7 /9/ ?h.1'-??50 • Fill" (7/JJ 2GA'-3359 • 7n11 Free In8~7 ,1'78-3b6/I 1 ~G-utuil od%(iaod~-inc cum N~eh .ci~e mw~u~.ndJ-/~ic_t~om LORNA R LINE 7 ALLIANCE DRIVE APT 203 CARLISLE PA 17013-4198 STATEMENT PERIOD: 11/20/2007 - 11/30/2007 INVEST. CERTIFICATES 4870 300 /00 12 DC ------------------------------------------------------------------------------------- C/D NUMBER: 4870 DESCRIPTION DEBIT CREDIT DATE BALANCE BALANCE LAST STATEMENT 11/19/2007 1,013.12 INT PAID (ADDON) 8.72 11/29/2007 1,021.84 C/D PAYOFF 1,021.84 11/29/2007 .00 CURRENT INTEREST RATE 5.25 ~ CURRENT MATURITY DP.TE 12/01/2010 SUMMARY: ACCOUNT PREVIOUS TOTAL TOTAL SERVICE ENDING .....NUMBER..... ..BALANCE.. .......DEBITS..... ....CREDITS.... .CHARGE. ..BALANCE.. C/D 4870 1,013.12 1 1,021.84 1' 6.72 .00 .00 1 r' I ECFA j~ i ~ i I ~ THE ALLIANCE DEVC-LOPMENT PUN D. INC. jl ~~ P.U. Bui~ 63419. Colorado S'pring.c. CO ~)'lI961-341J (71 J) ?6X-?'Sll • FiU," (719) ?6X-J?59 • Tall Free pYBd'/ b'7b' _i0611 ~E-mail: adl(iuadJ-inc.cuu~ I4'eb sire: u~w~u~.atlJ-inc.cnn~ LORNA R LINE 7 ALLIANCE DRIVE APT 203 CARLISLE PA 17013-4198 STATEMENT PERIOD: 11/20/2007 - 11/30/2007 ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- INVEST. CERTIFICATES 4871 3D0 /00 12 DC ------------------------------------------------------------------------------------- C/D NUMBER: 4871 DESCRIPTION DEBIT CREDIT DATE BALANCE BALANCE LAST STATEMENT 11/19/2007 1,013.12 INT PAID (ADDON) 8.57 11/29/2007 1,021.69 C/D PAYOFF 1,021.69 11/29/2007 .00 CURRENT INTEREST RATE 5.25 ~ CURRENT MATURITY DATE 12/01/2010 ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- SUMMARY: ACCOUNT PREVIOUS TOTAL TOTAL SERVICE ENDING .....NUMBER..... ..BALANCE.. .......DEBITS..... ....CREDITS.... .CHARGE. ..BALANCE.. C/D 4871 1,013.12 1 1,021.69 1 8.57 .00 .00 1 i ECFA 11 ~ THE ALL,IANCB DEVELOPMENT FUND, INC. P.0 dos bi419, Colorado Spring.e, CO ~1'(14G'-3419 (7 L) 16,5'-??SU • Fi! 1" (7/91 ?6F.- "S~i • Tirll Free /b'b'A') K7b'-3060 ~ ~( G-nwil: udJ'(io.ad/-inc.com VVeh sire: u~u~m.ud/-iuc'.cnm LORNA R LINE 7 ALLIANCE DRIVE APT 203 CARLISLE PA 17013-4198 STATEMENT PERIOD: 11/20/2007 - 11/30/2007 ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- INVEST. CERTIFICATES 4872 300 /00 12 DC ------------------------------------------------------------------------------------- C/D NUMBER: 4872 DESCRIPTION DEBIT CREDIT DATE BALANCE BALANCE LAST STATEMENT 11/19/2007 1,013.12 INT PAID (ADDON) 8.72 11/29/2007 1,021.84 . C/D PAYOFF 1,021.84 11/29/2007 .00 CURRENT INTEREST RATE 5.25 CURRENT MATURITY DATE 12/01/2010 ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- SUMMARY: ACCOUNT PREVIOUS TOTAL TOTAL SERVICE ENDING .....NUMBER..... ..BALANCE.. .......DEBITS..... ....CREDITS.... .CHARGE. ..BP.LANCE.. C/D 4672 1,013.12 1 1,021.84 1 8.72 .00 .00 ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- 1 r ~' ECFA 1 ~, THE ALLIANCE DE\'ELOPMENT FUND, INC. PD. Hu.r 63419, Colorado Spr(nge~, CO ,S II%(?-3419 (719) ?6.Y-]?50 • FiIA" (7/9/ 36A'-2?54 • Tnl1 Free /RA.1y A'7X-9060 ~Galai/: adl~~!;urlJ-inc.cum 17'eh.eiie: H~H~v.udJ'-ine.cuur LORNA R LINE 7 ALLIANCE DRIVE APT 203 CARLISLE PA 17013-4198 STATEMENT PERIOD: 11/20/2007 - 11/30/2007 ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- INVEST. CERTIFICATES 4873 300 /00 12 DC ------------------------------------------------------------------------------------- C/D NUMBER: 4873 DESCRIPTION DEBIT CREDIT DATE BALANCE BALANCE LAST STATEMENT 11/19/2007 1,013.12 INT PAID {ADDON) 8.72 11/29/2007 1,021.84 C/D PAYOFF 1,021.84 11/29/2007 .00 CURRENT INTEREST-RATE 5.25 CURRENT MATURITY DATE 12/01/2010 ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- SUMMARY: ACCOUNT PREVIOUS TOTAL TOTAL SERVICE ENDING .....NUMBER..... ..BALANCE.. .......DEBITS..... ....CREDITS.... .CHARGE. ..BALANCE.. C/D 4873 1,013.12 1 1,021.84 1 8.72 .00 .00 ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- 1 i ECFA r~rY PURCHASE APPLICATION AMID AGREEMENT ~N '~S ~~ 5' T ~76' ~f 1 / for c~ ~?~, ~~73 ALLIANCE DEVELOPMENT FUND INL'ESTMEh'T CERTIFICATES 1. I hereby apply for and agree to purchase from. The Christian and Missionary Alliance ("Alliance"), the Alliance Development Fund Investment Certificate(s) ("Certificate(s)") specified below. TOTAL PRINCIPAL AMOUNT REQUESTED INTEREST (In Even Hundreds - Minimum TERM OF CERTIFICATE RATE* Purchase Amount is $500.00 One Year Maturity ~•5% $ Two Year Maturity 8.0% $ Three Year Maturity 8.5% $ Four. Year Maturity 9. O % $ Five Year Maturity , ~!~ *Rates Offered Subject to Change TOTAL AMOUNT $,~ e O D, 2. I elect to have interest payments on the Certificate(s) paid as follows (check one): a. ( ) Monthly (on the last day of each month after date of issue if principal amount is $5,000 or more). b. ( x) Quarterly (on the last day of each March, June, September and December after (First) (Middle Initial) (Last) (Number nd Street) , ~ ~I ~o . ~c ~, CP ~) 7 ~ O (City) (State) (Zip) (If to Bank, Account Name and Number) 3. With respect to the ultimate disposition of the account balance of my Certificate(s) (check one): a. (~) At my death, the account balance of my Certificate(s) becomes the sole property of the Alliance for the furtherance of its general purposes. My desire is that said funds be used in behalf of the following ministry of the Alliance: b. ( ) At my death, the Alliance Shall pay the account balance, at maturity, to the person(s) legally entitled to the proceeds of the Certificate(s). date of issue). c. ( ) Semi-annually (on the last day of each June and December after date of issue). d. ( ) Annually (on the last day of each December after date of issue). Please send all interest payments to the following person at the address indicated below: ` Please COMPLETE and SIGN the back of this Purchase Application and Agreement. 4. I hereby acknowledge receipt of the Alliance's Offering Circular dated ~~c~c~ a~ /9 ~',~ 5. Registration instructions are as follows: a . OL~TN ER ~, First) (Middle Initial) (Last) (Number and Street) (City) b. ADD IF JOINT OWNERSHIP: (Social Security Number) ~ ~e~~~ ~ o y~ ~ (State) (Zip) (First) (Middle Initial) (Last) (Social Security Number) (Number and Stree*_) City) (State) (Zip) Unless otherwise instructed, joint ownership of Certificate(s) will be indicated by use of the conjunction "or" between the names, thus creating a joint tenancy with right of survivorship, rather than ownership as tenants in common. 6. In accordance with the terms set forth in items l through 5 above, and as set forth in the Alliance's Offering Circular, I hereby execute this Purchase Application and Agreement. Executed at ~~~i~~~~- (City) on this {yi~,t~~ (State) day of ;7~,1.L~-y~ir~c~etc/ , 19_~. ~vo--~ - .~ ~ ~ - 8' 9 ,~ - 000 ~5 (Telephone) (Signature) Please mail this Purchase Application and Agreement together with check payable to "The Christian and Missionary Alliance Development Fund" to: The Alliance Development Fund The Christian and Missionary Alliance Box C Nyack, New York 10960 ~~ DEC ~ 1985 r~F~TMENT OFFICE SASH tttt/t1t' I VUU~htK THE CHRISTIAN AND M1S510NARY ALLIANCE DSO NORiH HIGHLAND AVE., NYACK, N.T. 10960 DA'I'G .°.cCEIVED FROM: 12/3/85 LORNA LINE GENERAL FUND BUDGET -SUPPORT SPECIALS ACCOMMODATION OTHER TOTAL ~``C°_IPT DISPOSIT_IOi. Send to Donor ~ r",, ICIFTI AN.OG'ti'T File X Send to ACCOUtiT DESCRIPTIO": 22002 N $1,000.00 ADF 132-22-4907 9.5% 12/1/90 -1,000.00 1,000.00 1,000.00 1,000.n0 22002 N ~ 1,988.32 ADF RETURN EXCESS INVESTMENT RECEIVED ~ - $6,988.32 Metropolitan life Metropolitan Insurance and Annuity Company AND AFFILIATED COMPANIES 500 SCHOOLHOUSE ROAD TypeolPayment ANNUITY WITHDRAWAL JOHNSTOWNi PA`. 15915 282 OFFICE 030035405 MA 1 K95 Pay to the Order ot: T02 ALLIANCE DEVELOPMENT-FUND INVESTMENT CERTIFICATE C/0 LORNA R LINE 422 LACKAWANA AVENUE SCRANTON PA 18503 To The Chase Manhattan Bank, N.A. 33 East 23rd Street, New York, N.Y. .,. ~ nnn i C,rl ~4u' t:0 2 L0000 2 L~: 00 211 311100 6 5 L 3ti' INDIV FLD CODE CODE 04869 04870 04871 04872 04873 04873 -z 651 Z'° Gheck Number 100016054 Not Vaud newre 10/18/85 Amount Dollars - Cents $***6988~~32 C~~~ ~~ Vice-President and Treasurer