Loading...
HomeMy WebLinkAbout01-13-09 (2) 5056051047. REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Count Code Year File Number Bureau of Individual Taxes ~- INHERITANCE TAX RETURN y PO BOX 280601 2 1 0 `$ [) .0 5 S 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Senuity Number Date of Death Date of Birth 0 7 7 2 6 4 4 7 3 0 ~4 1 6 2 0 ~~ 8 1- 1 1 5 ~l 9 3 3 D~~~_~~~lenfs fast Name Suffix Decedents First Name MI R O Z E'N B U R G H E U G E N E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI R O Z E N B U R G H L I L L I A N Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW i 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate ® 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O 5. Federal Estate Tax Return F2equired 8. Total Number of Safe Deposit Boxes O 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 K E E N E J A B B O U R 6 1 0 2 5 3 5~ 0 8 r--~ Firm Name (If Applicable) First line of address 7 0 1 W a s h i n g t o n Second line of address City or Post Office E a s t o n Correspondent's a-mail address S t r e e t _. ~QF'~JJILLS US~NLY '~ ~ (~~ -~ ~C - _ J ~ v~ G.J - - ' ~- ~~ ~ ~ ---r {- ,,~~_~~ ` - `~ C ; _ ~ - --i ~ DATE FILED State ZIP Code L P A 1 8 0 4 2 -, i~ _7 t __ _k :"s 4__~:.t t Y.. ,_' 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 l representative is based on all information of which preparer has any knowledge. SIGNP~URE QF PERS01~,.12ESPON LE FOB FILI G RETURN DATE i Lialill L~l/Y~ K '`Xdl'_~ ltl2t k ! ~~~1 / b~ ADDRESS 110 Carpentersville Road, New Jersey 08865 SIGNA~U~R OF PRE RE THER THAN REPRESENTATIVE DATE ""~`0"f""Wash~fngton Street, Easton, PA 18042 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 15056052048 REV-1500 EX Decedent's Social Secu rity Numbe r Decedent's Name. Q 7 7 2 6 4 4 7 3 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 2 2 7 7 3 • 7 2 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... . 6 • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... 7 8. Total Gross Assets (total Lines 1-7) ................................... . g 2 2 7 7 3 7 2 9. Funeral Expenses & Administrative Costs (Schedule H) .................... . 9. 6 2 4 9 • 7 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... . 10. 2 $ J 9 Q . 2 ~ 11. Total Deductions (total Lines 9 & 10) ... .............................. . 11. 3 ~' $ 4 3 ,'9 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. - ~~ z Q 7 Q ,'2 ~ 13. Charitable and Governmental Bequests/Sec 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. - ~ 2 © 7- Q'. 2 ~ 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.O~ -'~ '2 Q. 7 Q «~ 4 15. Q Q • Q Q 16. Amount of Line 14 taxable at lineal rate X .0 _ •' 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. TAX DUE .................. ........................ ............. 19. Q Q ~ Q Q 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15056052048 15056052048 J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Eugene Rozenburgh _ - TREETADDRESS - 1550 Williams Grove. Road) #1.4.1 _ __ _ Mechanicsburg sTATEPA ZIP 1 7055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit - - ..- - B. Prior Payments C. Discount _ -- Total Credits (A + B + C ) 3. Interest/Penalty if applicable D. Interest E. Penalty _ - ----- - - - ---. $00.00 (2) 00.00 Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $ 0 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. (56) $ 0 0 . 0 0 Make Check Payable to: REGISTER OF W1LLS, 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 :................................................................................... ....... ^ b. retain the right to designate who shall use the property transferred or its income : ..................................... ....... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ X^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary tlesignation? .................................................................................................................. ...... ^ 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)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percen# [72 P.S. §9116(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-7508 EX * ItA~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RESIDENT DECEDENT RN PERSONAL PROPERTY ESTATE OF FILE NUMBER Eugene Rozenburgh 2008-00559 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. A refund from Lehigh Valley Physician Group $105.38 2. Checking account number 383002983046 located at $8,494.57 Bank of America 3. An insurance payment from State Farm Mutual Auto $4,376.94 Insurance Company for the total damage to a 1997 Subaru automobile 4. A subscription refund from the Patriot News $96.83 5. A 1972 Burlington motor home trailer with a title $5,000.00 number of 23809566304 6. A 2000 Dodge Dakota motor vehicle with a vehicle $4,700.00 identification number of 1B7GG22N2YS6O1229 TOTAL (Also enter on line 5, Recapitulation) ~ $ 2 2 , 7 7 3 . 7 2 (If more space Is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) ~h~~^Y~~'/S COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Eugene Rozenburgh 2008-00559 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Doyle-Devlin Funeral Home, Inc.. funeral expense $1,692.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)lEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees t0 Keene Jabbour 3. Family Exemption: (If decedent's address is not the same as claimant's, ariach 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 ~. egister of Wills of Cumberland County, etters Testamentary on 5/23/08 8. he Patriot-News Company, Estate Notice on 6/27/08 9. umberland Law Journal, Estate Notice on 8/26/08 $4,000.00 $110.00 $372.75 $75.00 TOTAL (Also enter on line 9, Recapitulation) I $ 6 , 2 4 9 . 7 5 (If more space is needed, insert additional sheets of the same size) REV '.51. k~•(~.~;I ~'i. r ~~ ~ SCHEDULE I w~~~«~._ c;;rnreo~,NFa~rHOFPENNSVwar~iv, DEBTS OF DECEDENT, i_~~NEai-aNCE rAx RETUR~~_ MORTGAGE LIABILITIES, & LIENS _ ___ RESIDENT DECEDENT ESTATE OF FILE NUMBER Eugene Rozenburgh 2008-00559 Include unreimbursed medical expenses. ITEM - NUP~IBER _ DESCRIPTIGN _ __ AMGUfJT ~ Value City Furniture $91 3.67 2. Lowe's $2,073.96 3. Bank of America $1,463.10 4. Bank of America $8,967.81 5. Boscov's $2,579.25 6. Sam's Club Discover $6,878.35 7. Comcast Harrisburg Equipment $79.00 8. Kohl's $207.63 9. ehigh Valley Physician Group $107.71 10. he Home Depot $117.08 11. hell Credit Card $271.06 12. unterdon Medical Center $94.01 13. 14' . 15. 1 0. i apital One Bank illiams Grove Associates Mahanoy City EMS ,Citibank Consumer $3,589.57 $1 ,,047.98 $75.95 $128.08 TCI,4L(Ah~~~~te; ,,I!qe 10 R~cae-~~,:alion; ~ 28, 594.21 If r: nrF • _ `,, ede, ~ ~~~ri ~dd~Lonal ,~.(',6fS ~t ,t n ~arri~ x:21 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES C,IAIt Vt Eugene Rozenburgh NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Lillian Rozenburgh 110 Carpentersville Road Phillipsburg, NJ 08865 FILE NUMBER 2008-00559 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Spouse AMOUNT OR SHARE OF ESTATE Total Estate 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT `- ? ~-? __ ~ (Pour-Over Will) - -;~ OF - -`~ ; ~ S -: --< EUGENE ROZENBURGH - - .v -; ~ --c~= ~__ - ~. IDENTITY "~ ~'' ~;~ -1 ~ J I, EUGENE ROZENBURGH, residing in the County of Lehigh, Commonwealtl~of Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other former Wills and Codicils to Wills heretofore made by me. My Social Security Number is 077-26- 4473. All reference made herein to "spouse or my spouse" refers to the person to whom I am currently married, namely, LILLIAN ROZENBURGH. By the ensuing provisions of this Will, it is my intention to dispose of my interest in our property; I do not intend to dispose of anything belonging to my wife or to put her to any election. I have the following children: Eugene J. Rozenburgh, III, born January 20, 1953 and currently residing in Austin, TX 78746, and Vicki Waldman, born August 9, 1954 and currently residing in Somerset, NJ 08873, and Carol DiNardo, born May 17, 1957 and currently residing in Baldwinville, MA 01436, and Stephen Roger Rozenburgh, born October 4, 1960 and currently residing in Phillipsburg, NJ 08865. DEBTS, TAXES AND ADMINISTRATION EXPENSES I have provided for the payment of all my debts, expenses of administration of property wherever situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other than any tax on ageneration-skipping transfer that is not a liability of my Estate (including interest and penalties, if any) that become due by reason of my death, under THE EUGENE ROZENBURGH AND LILLIAN ROZENBURGH REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust"), or if my spouse predeceases me, under the Survivor's Trust created by the said Revocable Trust. If the Revocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items from the residue of my Estate passing under this Will, without any apportionment or reimbursement. In the alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary to pay all or part of these items, plus claims, pecuniary legacies, and family allowances by court order. PERSONAL AND HOUSEHOLD EFFECTS It is my intent that all my personal and household effects were transferred to the Revocable Trust as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me this date in accordance with the provisions of the section titled "Residue of Estate." POUR-OVER WILLS ~'~' .°~ ,' Page 1 ~=~--:! .=;~' 1 Testator ~_ _~_ r r -, RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind. and description (including lapsed legacies and devices), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of the execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance with the provisions of the said Trust, including any amendments thereto made before my death. If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust:, as Trustee, and to their substitutes and successors under the Trust, described herein above, to be held, managed, invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to the period beginning with the date of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any, hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. EXECUTOR I hereby nominate and appoint Lillian Rozenba~rgh as my Independent Executor of this, my Last Will and Testament, to serve without bond. In the event the first named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint Stephen Roger Rozenburgh to serve without bond as my Independent Executor. In the event the second named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint [~icki Waldman to serve without bond as my Independent Executor. Whenever the word "Executor" or any modifying or substituted pronoun therefore is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally named herein. EXECUTOR POWERS By way of Illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind of partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, POUR-OVER WILLS -:> ~-, Page 2 ~_.e' ~~ f ~--, Testator and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to cant' out the purpose of this my Will, without being limited in any way by the specific grants or power made, and without the necessity of a court order. My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others. In determining the Federal Estate and Income Tax liabilities of my Estate, my Executor shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions and shall have the discretion to file a joint income tax return with my spouse. CONTESTS AND SPECIFIC OMISSIONS If any beneficiary under this will, singly or in conjunction with any other person or persons, directly or indirectly: 1. contests in any court the validity of this will or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 2. contests in any court the validity of the Testator's/Testatrix's Will or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 3. seeks to obtain an adjudication in any proceeding in any court that this trust or any of its provisions or that Testator's/Testatrix's Will or any of its provisions is void; 4. claims entitlement by way of any written or oral contract to any portion of the Testator's/Testatrix's estate, whether in probate or under this instrument; 5. unsuccessfully challenges the appointment of any person named as Executor or successor Executor of the Testator's/Testatrix's Will; 6. objects in any manner to any action taken or proposed to be taken in good faith by the Executor of the Testator's/Testatrix's Will; 7. objects to any construction or interpretation of this Will, or any provision of it, that is adopted or is proposed in good faith by the Executor; 8. unsuccessfully seeks the removal of any person acting as the Executor of the Testator's/Testatrix's Will; 9. files any creditor's claim in Testator's/Testatrix's estate (without regard to its validity), whether the claim arose before or after the date of this instrument, but excepting claims for cash advanced or paid for expenses of the Testator's/Testatrix's last illness or funeral paid by said claimant; 10. attacks or seeks to invalidate any designation of beneficiaries for any life insurance policy on Testator's/Testatrix's life; 11. attacks or seeks to invalidate any designation of beneficiaries for any pension or IRA or other form of qualified or non-qualified asset or deferred compensation account, agreement or arrangement; 12. attacks or seeks to invalidate any will which Testator/Testatrix has created or may create during Testator's/Testatrix's lifetime, or any provision thereof, as well as any gift which Testator/Testatrix has made or will made during Testator's/Testatrix's lifetime, whether before or after the date of this instrument; 13. attacks or seeks to invalidate any transaction by which Testator/Testatrix sold any assets (whether to a relative of Testator's/Testatrix's or otherwise); or POUR-OVER WILLS ,~ -'' ~_ Page 3 -. - ~' _ ~y ~ Testator 14. refuses a request of Testator's/Testatrix's, Executor or other fiduciary to assist in the defense against any of the foregoing acts or proceedings, then that person's right to take any interest given to him or her by this trust shall be determined as it would have been determined if the person had predeceased the execution of this will instrument without issue surviving. The provisions of the foregoing paragraph shall not apply to any disclaimer by any person of any benefit under this will. In the event that any of this provision is held to be invalid, void or illegal, the same shall be deemed severable from the remainder of this provision and shall in no way affect, impair or invalidate any other provision in this will; and if such provision shall be deemed invalid due to its scope or breadth, such provision shall be deemed to exist to the extent of the scope or breadth permitted by law. SIMULTANEOUS DEATH If my spouse and I should die under circumstances such that the order of our deaths cannot be determined, then it shall be conclusively presumed for the purpose of this Will that my spouse survived me. If any other Beneficiary should not survive me for sixty (60) days, then it shall be conclusively presumed for the purpose of this my Will that said Beneficiary predeceased me. "~ _,, .~ J~ EUG~ E ROZEN$U}~GH Test for ' - r POUR-OVER WILLS Page 4 This instrument consists of 6 typewritten pages, including the Attestation Clause, Self-Proving Clause, signature of Witnesses, and aclrnowledgment of officer. I have signed my name at the bottorn of each of the preceding pages. This instrument is being signed by me on this ~~,j` day of ATTESTATION CLAUSE The Testator whose name appears above declared to us, the undersigned, that the foregoing instrument was his Last Will and Testament, and he requested us to act as wifiesses to such instrument and to his signature thereon. The Testator thereupon signed such instrument in our presence. At the Testator's request, the undersigned then subscribed our names to the instrument in our own handwriting in the presence of the Testator. The undersigned hereby declare, in the presence of each of us, that we believe the Testator to be of sound and disposing mind and memory. Signed by us on the same day and year as this Last Will and Testament was signed by the Testator. WITNESSES: ADDRESSES: 4 ! ~ (Printed Name of Wifiess) (Printed Name of Witness) City, State, Zip T ` -"; - x a C. - j. City, State, Zip ~T POUR-OVER WILLS ~ : '" Page 5 ~'~,,. ;... Testator COMMONWEALTH OF PENNSYLVANIA COUNTY OF LEHIGH SELF-PROVING CLAUSE BEFORE ME, the undersigned authority, on _,this day + personally appeared EUGENE ROZENBURGH, ~ ,~ :^- ;`: ~.~.: _ and ~- ~ { ,, ;~ i~. '~ r-r :~ ~ ,known to me to be the Testator and the witnesses, respectively, -whose names are subscribe8 to the foregoing instrument in their respective capacities, and all of them being by me duly sworn, EUGENE ROZENBURGH, Testator, declared to me and to the witnesses, in my presence, that the instrument is his Will and that he had willingly made and executed it as his free act and deed for the purposes therein expressed; and the Witnesses, each on his or her oath, stated to me in the presence and hearing of the Testator, that the Testator had declared to them that the instrument is his Will and that he executed the same as such and wanted each of them to sign it as a witness; and upon their oaths, each witness stated further that he did the same as a witness in the presence of the Testator, and at his request and that he was at that time eighteen (] 8) years of age or over and was of sound mind, and that each of the witnesses was then at least fourteen (14) years of age. . _ -~ l-. .~ ,~ /,: EUGENE ROZEN$URGH Testator ' j ~ , , ,,,, i a ~ , ~~;1 Witness ` (Printed Name of Witness) - ry t ~ . 4, ,, -'Witness ~ !.'~~`,' ' .,.--f sal r~l l._.''.. ''/ (Printed Name of Witness) ='- SUBSCRIBED AND ACKNOWLEDGED before me by EU~NE ROZENBURGH, Testator, and subscribed and sworn to before me by = ~" • ; ?~ ~ ~~;_-,~ and iC .1~'~ ~ G~I ~G ' witn ses, thi• the ~.;,,~;~"" da of Y c / Notary Public, o monwealth of Pennsylvania COMMQNWEALTH pF PEPJNSYLVANIA NoGaria! Seal Henry L. Cohen, Notary Public Upper Mt. Bethel Twp., Northampton County POUR-OVER WILLS My Commission expires pct. 6, 2007 Page 6 Member, Pennsylvania Association Of Notaries REVOCABLE LIVING TRUST AGREEMENT t IS ~GREEMENT AND DECLARATION OF TRUST, made effective the ~~ day of _~j.~>~71~-> , 20 C~~~, between EUGENE ROZENBURGH AND LILLIAN ROZENBURGH, husband and wife, residents of the County of Lehigh, Commonwealth of Pennsylvania, as Grantors, EUGENE ROZENBURGH AND LILLIAN ROZENBURGH, as Settlors, and EUGENE ROZENBURGH AND LILLIAN ROZENBURGH, as Co-Trustees; WITNESSETH; WHEREAS, in order to provide the future comfort and security of themselves and the other beneficiaries hereafter mentioned, Grantors desire to create a revocable trust for the purposes hereinafter set forth; ARTICLE ONE Terms of the Trust Section 1.01 -Trust Estate Defined NOW, THEREFORE, in consideration of the premises and of the mutual covenants herein contained, this Revocable Trust is formed to hold title to real and personal property for the benefit of the Settlors of this 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 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 name of this Trust Agreement shall be: THE EUGENE ROZENBURGH AND LILLIAN ROZENBURGH REVOCABLE LIVING TRUST AGREEMENT i DATED >.. ~- :~ Pr ,~1 ~ ~ ~ 20 ~~ Section 1.02 -Definitions of Terms In the interpretation or construction of the provisions of this Trust Agreement, the following words and phrases shall have the meanings set forth below: The term "Husband" shall mean EUGENE ROZENBURGH. 2. The term "Wife" shall mean LILLIAN ROZENBURGH. The term "Settlor" shall refer individually and collectively to Husband and Wife. 4. The term "Descendant" shall mean the lawful issue of a deceased parent in the line of descent, but does not include the issue of any parent who is a descendant of the deceased person in question and who is living at the time in question. REVOCABLE LIVING TRUST AGREEMENT Page 1 The terms "Child" and "Descendant" include any issue born to 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 if he or she had failed to survived 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. The term "Issue" will include all natural and adopted children, if applicable, and descendants and those legally adopted into the line of descent. 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 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. 10. 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 1.03 -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 resign as Co-Trustee before the natural termination of this Trust, the remaining Co-Trustee, husband or wife, shall thereafter serve as sole Trustee. The term "Trustee" as used in this Trust Agreement 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 who assumes the role of Trustee. These Trustees shall serve in the order as provided in Section 9.01 of this Trust Agreement. Section 1.04 -Additions to Trust Properties The Trustee, at any time during the continuance of this Trust in his or her sole discretion after consideration of the possible tax consequences to all concerned, is authorized to receive into the Trust additions of cash and other properties from any source whatsoever, whether by gift, will, or otherwise. However, the Trustee shall accept all assets which any person or persons may give, devise, or bequeath by Last Will and Testament to this Trust, and shall accept all assets transferred to this Trust pursuant to the provisions of any other Trust document or documents. 2. In addition, any person or persons may designate this Trust as the Beneficiary, Primary or Contingent, of any death benefits to include insurance benefits, pension benefits, or other benefits. Until such benefits mature, the Trustee shall have no responsibility with respect to those benefits. REVOCABLE LIVING TRUST AGREEMENT Page 2 Section 1.05 -Apportionment The Trustee of the Trust is directed to apportion receipts and expenditures of the types described below between principal and income as follows: Whenever the principal, or any part thereof, of the Trust property 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; 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 The amount of any applicable depletion allowance for federal income tax purposes will be treated as income. Section 1.06 -Administration of Trust During Our Lifetime During our lifetime, the trust shall be held and administered as follows: All property and other assets transferred to this trust shall be allocated to and held in separate shares, the first such share being designated the "Eugene Rozenburgh Trust Share" and the second share being designated the "Lillian Rozenburgh Trust Share". 2. Each Grantor's separate Trust Share shall be composed of the assets as follows: a. The Grantor's one-half interest in jointly held property transferred to the Trust; and b. The Grantor's individually owned property which is transferred to the Trust. While each share shall be held and administered separate from the other, for tax and accounting purposes, the Trustee is authorized to hold or invest the separate shares in common investments and co-ownership of assets. The Trustee shall pay to or apply for the benefit of EUGENE ROZENBURGH all of the net income of the EUGENE ROZENBURGH Trust Share, in convenient installments, not less often than quarter-annually, and in addition thereto, shall pay so much of the income and principal of such Trust Share to or for the benefit of EUGENE ROZENBURGH as he may direct from time to time, or in the absence of a direction, as the Trustee may determine to be advisable for his medical care, support, maintenance, and general welfare. 4. The Trustee shall pay to or apply for the benefit of LILLIAN ROZENBURGH all of the net income of the I:ILLIAN ROZENBURGH Trust Share in convenient installments, not less often than quarter-annually, and in addition thereto, shall pay so much of the income and principal of such Trust Share to or for the benefit of LILLIAN ROZENBURGH as she may direct from time to time, or in the absence of a direction, as the Trustee inay determine to be advisable for her medical care, support, maintenance, and general welfare. REVOCABLE LIVING TRUST AGREEMENT Page 3 All property that a Settlor transfers to the Trustee pursuant to this instrument which was community property, quasi-community property, or separate property at the time of the transfer shall remain respectively community property, quasi-community property, or the separate property of the Settlor transferring such property to the Trust. Community and quasi-community property transferred to the Trustee by the Settlors shall be their community property and treated as such. This property, as invested and reinvested, together with the rents, issues, and profits therefrom (hereinafter referred to as the "Community Estate" or the "Community Property") shall retain its character as community property during the joint lifetimes of the Settlors in spite of any change in the situs of the Trust, subject, however, to the provisions of this Agreement. Section 1.07 -Discretionary Termination The Trustee may terminate any 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 Agreement. Section 1.08 -Amendment and Revocation We hereby retain the following powers, exercisable at any time during our lifetimes: To withdraw any of the property included in our 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 our designee. To amend the provisions of this Trust declaration 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 us, the survivor shall have no power to amend the terms of the Trust declaration with respect to the Trust Share of the first of us to die. 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 us or our designee together with an accounting therefore; provided, however, that following the death of one of us, the survivor shall have no power to revoke the terms of the Trust declaration with respect to the Trust Share of the first of us to die. Section 1.09 -Revocation or Alteration by Settlor Alone The rights of revocation, withdrawal, alteration, and amendment reserved in this Article may only be exercised by the Settlor and may not be exercised by any other person, including an agent, a guardian, or a conservator. Section 1.10 -Irrevocability Except as otherwise provided, on the death of either Settlor, the designation of Beneficiaries of specific gifts in this Trust shall become irrevocable and not subject to amendment or modification. REVOCABLE LIVING TRUST AGREEMENT Page 4 Section l.ll -Settlor Powers The surviving Settlor shall be the Trustee unless and until he or she resigns in writing or is determined incompetent 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. ARTICLE TWO Trust Administration Section 2.01 -Trust Income During the joint lives of the Settlors, the Trustee shall at least annually, unless otherwise directed by both Settlors in writing, pay to or apply for the benefit of husband and wife, all of the net income from the Trust Estate in the same proportions as each of the spouse's respective interests in the Trust Estate. Section 2.02 -Protection of Settlor in Event of Incapacity During the joint lives of the Settlors, should either Settlor become incapacitated as defined in Section 2.03 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 Estate as the Trustee believes is necessary or advisable for the medical care, comfortable maintenance, and welfare of the Settlor. Section 2.03 -Incapacity 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 or 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 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, then in that event and under those circumstances: 1) Such person is deemed to have become incapacitated, as that term is used in this Trust agreement; and 2) Such incapacity is deemed to continue until such court order, certificates, and i or circumstances are inapplicable or have been revoked. REVOCABLE LIVING TRUST AGREEMENT Page 5 2. 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 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 shall be paid from the 'Trust Assets. Section 2.04 -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 2.05 -Residence If the Settlor's residence property is a part of the Trust, the Settlors shall 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 Administration upon Death of First Settlor Section 3.01 -Provisions After The First Death On the death of either Settlor leaving the other Settlor surviving him or her, the Trustee shall collect all insurance proceeds payable to the Trustee by reason of such death and all bequests and devises distributable to the Trust Estate. Section 3.02 -Control of Assets The surviving spouse may, at any time by written notice, require the Trustee either to make any nonproductive properly of this Trust productive or to convert productive property to nonproductive property, each within a reasonable time. The surviving spouse may further require the Trustee to invest part or all of this share of Trust Assets for the purpose of maximizing income rather than growth or growth rather than income. Section 3.03 -Division into Shares Upon the death of either Settlor, if the deceased Settlor is survived by the other Settlor, the deceased's individual Trust Share, including any additions made by reason of the deceased Settlor's death, shall be divided into two shares. 2. The Trustee, in his or her sole discretion, may defer the division or distribution of the deceased's individual Trust Share until six months after the deceased Trustoe's death. If the division or distribution of the deceased's individual Trust Share is so deferred, the deferred division or distribution shall be made as if it had taken place at the time prescribed above. In addition, all REVOCABLE LIVING TRUST AGREEMENT Page 6 rights given to the Beneficiaries under the provisions of this Trust Agreement which follow shall be considered to have accrued and vested as of that prescribed time. Upon the death of the first Settlor to die ("Predeceased Spouse"), the Trustee shall divide the deceased's individual Trust Share (which shall include any property which may be added from the Predeceased Spouse's general estate) as follows: a. The Trustee shall divide the balance of the deceased Trustor's individual Trust Share into two (2) separate shares (hereinafter designated as "Share A" and "Share B"). Share B shall be composed of cash, securities, and/or other property of the deceased's individual Trust Share (undiminished by any estate, inheritance, succession, death, or similar taxes) having a value equal to the maximum marital deduction as finally determined in the Predeceased Spouse's federal estate tax proceedings, less the aggregate amount of marital deductions, if any, allowed for such estate tax purposes by reason of property or interest in property passing or which have passed to the Surviving Spouse otherwise than pursuant to the provisions of this paragraph; provided, however, that the amount of Share B hereunder shall be reduced by the amount, if any, needed to increase the Predeceased Spouse's taxable estate (for federal estate tax purposes) to the largest amount that, after allowing for the unified credit against federal estate tax and the state death tax credit against such tax (but only to the extent that the use of such state death tax credit does not increase the death tax payable to any state), will result in the smallest (if any) federal estate tax being imposed on the Predeceased Spouse's estate. The term "Maximum Marital Deduction" shall not be construed as a direction by the Predeceased Spouse to exercise any election respecting the deduction of estate administration expenses, the determination of the 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. The Trustee shall have the sole discretion to select the assets which shall constitute Share B. Iri no event, however, shall there be included in Share B any assets or the proceeds of any asset which will not qualify for the federal estate tax marital deduction. Share B shall be reduced to the extent that it cannot be created with such qualifying assets. The Trustee shall value any asset selected by the Trustee for distribution in kind as a part of Share B at the value of such asset at the date of distribution of such asset. The balance of the deceased's individual Trust Share, after the assets have been selected for Share B, shall be allocated to Share A. Share A and Share B shall be administered and distributed as hereinafter set forth. Section 3.04 -Credit Shelter Trust If either of the Settlors survives the other, the Trustee shall set apart and hold as a separate trust (the "Credit Shelter Trust") the assets referred to as Share A in Section 3.03 above. The Trustee shall hold, manage, invest, and reinvest the assets of this Credit Shelter Trust, shall collect the income therefrom, and shall pay the net income to or for the benefit of the surviving Settlor in convenient installments at least quarter-annually; provided, however, that the surviving Grantor may elect to pass any portion of said income to the remainder Beneficiaries of the Trust. In addition, the Trustee may pay to or for the benefit of the surviving Settlor for the health, education, maintenance, or support of the surviving Settlor, any part or all of the principal of this Trust, as the Trustee may determine in its sole discretion, without considering other resources available to the surviving Settlor. The surviving Settlor shall have the right to demand and receive, from the principal of this Trust in each of its fiscal years, the greater of five thousand dollars ($5,000.00) or five percent (5%) REVOCABLE LIVING TRUST AGREEMENT Page 7 of the fair market value of such principal determined as of the last day of such fiscal year. Such right shall lapse to the extent it is not exercised in any year. Any commission payable with respect to principal so withdrawn shall be charged against such principal. No person, who at any time is acting as Trustee hereunder, shall have any power or obligation to participate in any discretionary authority which the Settlor has given to the Trustee to pay principal or income to such person, or for his or her benefit or in relief of his or her legal obligations; provided, however, that if an individual Trustee has discretion to invade principal for himself or herself and such discretionary authority is limited by an ascertainable standard, then such Trustee may invade principal (if limited by such standard) for himself or herself, but not in relief of his or her legal obligations. The plan of distribution and all terms of this Credit Shelter Trust shall be irrevocable and unamenable at any time after said Credit Shelter Trust comes into being. The Credit Shelter Trustee(s) shall invest the assets of the Credit Shelter Trust to produce a reasonable income for the benefit of the surviving Grantor without subjecting the principal to unreasonable risk of loss. The Credit Shelter Trustee(s) shall be authorized and empowered to invest, reinvest, manage, transfer, and convey any and all property held in this Credit Shelter Trust, including all powers now or hereafter conferred upon Trustees by applicable state law, and also those power appropriate to the orderly and effective administration of the Trust. The Credit Shelter Trustee(s) shall make a written accounting to all income and remainder Beneficiaries or to their guardians at least annually and at the time that all assets of this Credit Shelter Trust are distributed. Said accounting shall consist of a record showing assets on hand at the time of the last accounting, plus additions, minus expenses and distributions, which shall equal current assets on hand. The Credit Shelter Trustee(s) shall not be required to obtain authority or approval of any court in the exercise of any power confen-ed upon the Trustee(s), nor shall said Trustee(s) be required to make accountings or reports to any court. Upon the death of the surviving Settlor, any accrued income shall be paid to the estate of the surviving Settlor and the remaining principal of this Credit Shelter Trust shall be held, administered, and disposed of in accordance. with the dispositive provisions of this agreement. Section 3.05 -Qualified Terminable Interest Trust If either of the Grantors survives the other and there are assets allocated to Share B described in Section 3.03 above, then the Trustee shall set apart said assets and hold them as a separate trust (the "Qualified Terminable Interest Trust"). The Trustee shall hold, manage, invest, and reinvest the assets of this Qualified Terminable Interest Trust, shall collect the income therefrom, and shall pay the set income to or for the benefit of the surviving Grantor in convenient installments at least quarter-annually. Upon the surviving Grantor's death, any accrued, undistributed income shall be distributed to said surviving Grantor's estate. The remaining principal shall be added to and become part of the Credit Shelter Trust and shall be held and administered and disposed of in accordance with the plan of distribution for the Credit Shelter Trust as provided in Sections 3.04 and 4.03, after provision has first been made for the payment of any estate, inheritance, transfer, succession, or other death taxes, payable by reason of the inclusion of the value of the Trust property in said surviving Grantor's estate. The Trustee(s) of the Qualified Terminable Interest Trust are hereby authorized, in the Trustee(s) sole discretion, to determine whether to elect (under Section 2056(b)(7) of the Internal Revenue Code) to qualify all or a specific portion of the Qualified Terminable Interest Trust created herein for the federal estate tax marital deduction. The Trustee(s) of the Qualified Terminable Interest Trust, in exercising such REVOCABLE LIVING TRUST AGREEMENT Page 8 discretion, shall attempt to minimize, or eliminate if possible, the federal estate tax payable by the estate of the decedent spouse's estate. However, if the Trustee(s) of the Qualified Terminable Interest Trust determine that it is in the best interest of the persons who may receive any assets after the decedent spouse's death and after the surviving Grantor's death to pay some federal estate tax in the decedent spouse's estate, taking into consideration any other tax that is to be paid because of the decedent spouse's death and the surviving Grantor's death, and any income tax liability that may be affected by the election, the Trustee(s) of the Qualified Terminable Interest Trust may elect to take a marital deduction that does not reduce the tax to zero if the payment of the tax will not jeopardize the ability of the Qualified Terminable Interest Trust to provide the surviving spouse with the level of support and maintenance contemplated by this Declaration of Trust. The decision of the Qualified Terminable Interest Trustee(s) to make this election shall be final and binding on all persons. The Trustee(s) of the Qualified Terminable Interest Trust is (are) authorized and empowered to invest, reinvest, transfer, and convey any and all property held in this Qualified Terminable Interest Trust. This includes all power now or hereafter conferred upon Trustees by applicable state law, and also those powers appropriate to the orderly and effective administration of the Trust. The Trustee(s) shall make a written accounting to the surviving Grantor at least annually and shall make a written accounting to all remainder Beneficiaries at the time that all assets of this Qualified Terminable Interest Trust are distributed. Section 3.06 -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 3.07 -Maximum Marital Deduction Except as otherwise expressly stated herein, the term "Maximum Marital Deduction" shall not be construed as a direction by the deceased Settlor to exercise any election respecting the deduction of Estate administration expenses, the determination of the 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 3.08 -Trust Income After The First Death Following the death of either Settlor and until the death of the 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 3.09 -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 Eugene Rozenburgh 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. REVOCABLE LIVING TRUST AGREEMENT Page 9 Section 3.10 -Last Expenses Upon the death of each of the Settlors, the Trustee of this Trust may, in its discretion, pay any part of or all of the funeral and burial expenses, probate claims, administration expenses, and any estate, inheritance, succession, 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 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 Administration distribution of Survivor's Trust 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 that follow. Section 4.02 -Second Death On the death of the last Settlor to die (the "Surviving Settlor"), the Trustee shall distribute the principal of the Trust and any accrued or undistributed income from the principal of the Trust in such a manner and to such persons, including the Estate or the Creditors, as directed in this Trust Agreement. Section 4.03 -Payment of The Second Death Expenses On the death of the Surviving Settlor, the Trustee shall pay from that portion of the Trust Estate constituting the deceased Settlor's separate Trust Share 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 determines that other adequate provisions have been made for the payment of such expenses and taxes. Section 4.04 -Trust Income and Principal Distribution Upon The Death of The Surviving Trustor The Trustee shall apply and distribute the net income and principal of each of the shares of the resulting Trust Estate, after giving effect to the section of this Trust Agreement entitled "Special Directives" to the following Beneficiaries in the indicated fractional shares: Eugene J. Rozenburgh, III 9/40 Vicki Waldman 9/40 Carol DiNardo 9/40 Stephen Roger Rozenburg/T 9/40 Bethlehem Seventh Day Adventist Church 4/40 If any of the above Beneficiaries, or any other Beneficiary, is under the age of 21 years when the distribution is to be made, the Trustee shall have authority to distribute the same, in whole or in part, to a custodian for the minor appointed under a Uniform Gifts or Transfers to Minors Act, or the Trustee may retain any such property and administer and distribute the same for the benefit of the minor, paying to or for the benefit of such minor so much of the income and principal of the REVOCABLE LIVING TRUST AGREEMENT Page 10 retained property from time to time as the Trustee deems advisable for the health, education, support, and maintenance of the minor. When the person for whom the property is held attains the age of 21 years, the property shall thereupon be distributed to him or her free of trust unless otherwise stated in this Agreement. If the minor should die before attaining the age of majority, the property shall then be paid and distributed to the estate of the minor. If all of the Settlor's Beneficiaries and their children should fail to survive the final distribution of the Trust Estate, all of the Trust Estate not disposed of as hereinabove provided shall be distributed as provided for in this Trust Agreement. Section 4.05 -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 that 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, that share shall pass to the surviving issue of that deceased Beneficiary per stirpes and with right of representation. ARTICLE FIVE Trustee Powers & Provisions Section 5.01 -Non-Income Producing Property During the joint lives of the Settlors, the Trustee is authorized to retain in the Trust, for so long as the Trustee may deem advisable, any property received by the Trustee from the Settlors, whether or not such property is of the character permitted by law for the investment of Trust funds. Section 5.02 -Trustee Powers The Trustee shall have all powers conferred upon a Trustee 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 ("PAUTMA"). The Trustee is further authorized to sign, deliver, and/or receive any documents necessary to carry out the powers contained within this Section. The Trustee of any trust created under this Trust Agreement (including any substitute or successor Trustee) 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 of this Agreement. Section 5.03 -Specific Powers of Trustee In addition, the Trustee will have the following specific powers: Trust Estate: The Trustee may leave invested any property coming into its hands hereunder in any form of investment even though the investment may not be of the character of investments REVOCABLE LIVING TRUST AGREEMENT Page 11 permitted by law to trustees, without liability for loss or depreciation in value. The Trustee may sell, mortgage, exchange, or otherwise dispose of and reinvest property which may at any time be apart of the Trust Estate upon such terms and conditions as the Trustee may deem advisable. The Trustee 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 or 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 Trustee may hold property in the Trustee's name, as trustee, or in the name of a nominee without disclosing the Trust. Release of Power: If the Trustee deems it to be in the best interest of the Trust and its Beneficiaries, the Trustee, by written instrument signed by such Trustee, 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 Trustee may employ one or more agents to perform any act of administration, whether or not discretionary, including attorneys, auditors, investment managers, or others, as the Trustee shall deem necessary or advisable. The Trustee may compensate agents and other employees and may delegate to them any and all discretions and powers. Leases: The Trustee 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 Trustee 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 Trustee 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. Securities: With respect to securities held in the Trust Estate, the Trustee may exercise all the rights, powers, and privileges of an owner, including but not limited to, the power to vote, give proxies, and to pay assessments and other sums deemed by the Trustee necessary for the protection of the Trust Estate. In addition, the Trustee may participate in voting trusts, foreclosures, reorganizations, consolidations, mergers, and liquidations, and in connection therewith, to deposit securities with and transfer title to any protective or other committee under such terms as the Trustee may deem advisable. In addition, the Trustee 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 any limitations elsewhere in this instrument relative to investments by the Trustee. In addition, The Trustee may Buy, sell exchange, assign, convey, settle and exercise commodities future contracts and call and put options on stocks and stock indices traded on a regulated options exchange and collect and receipt for all proceeds of any such transactions. Establish or continue option accounts for the principal with any securities of a futures broker. In general, exercise all powers with respect to commodity and option transactions that the principal could if present. REVOCABLE LIVING TRUST AGREEMENT Page 12 8. Purchases from Estate: The Trustee may purchase property of any kind from the Executor or Administrator of our Estates. Lending: The Trustee may make loans, secured or unsecured, to the Executor or Administrator of our Estates, to any Beneficiary of the Trust, or to the Trustee. Further, the Trustee may use Trust Assets to guarantee obligations of any income Beneficiary of the Trust (unless such Beneficiary is serving as Trustee). 10. Distributions to or for Beneficiaries: The Trustee 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 Trustee 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 trustee 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 Trustee, under the Pennsylvania Uniform Transfer to Minors Act. Alternatively, the Trustee 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 Trustee with respect thereto. On any partial or final distribution of the Trust Assets, the Trustee 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 Trustee and to sell any property deemed necessary by the Trustee to make the distribution. The Trustee may distribute gifts of up to the maximum allowable per year per donee out of principal and/or interest. 11. Insurance: The Trustee 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, forms, and amounts deemed advisable by the Trustee to protect the Trustee and the Trust Estate. 12. Borrowing: The Trustee may borrow money from the Trust Estate and others. To secure the repayment thereof, the Trustee may mortgage, pledge, or otherwise encumber part or all of the Trust Assets, and in connection with the acquisition of any property, the Trustee may assume a liability or may acquire property subject to a liability. 13. Repairs: The Trustee may make ordinary and extraordinary repairs and alterations to buildings or other Trust Assets. 14. Reserves: The Trustee may establish such reserves out of income for taxes, assessments, repair, and maintenance as the Trustee considers appropriate. 15. Continuation of Business: The Trustee may continue any business or businesses in which the Trust has an interest at the time of the Settlors' death for so long as the Trustee 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 Trustee may, in its sole discretion, consider necessary or desirable. 16. Retain Property for Personal Use: The Trustee 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. REVOCABLE LIVING TRUST AGREEMENT Page 13 17. Dealings with Third Parties: The Trustee may deal with any person or entity regardless of relationship or identity of any Trustee to or with that person or entity. The Trustee 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 Trustee will have the power to make all partitions, divisions, and distributions contemplated by this Trust Agreement. Any partitions, divisians, or other distributions may be made in cash, in kind, or partly in cash and partly in kind, in any manner that the Trustee deems appropriate (including composing shares differently). The Trustee 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 Trustee may maintain and defend any claim or controversy by or against the Trust without the joinder or consent of any Beneficiary. The Trustee 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 Trustee may deem advisable. The Trustee may employ, for reasonable compensation, such counsel as the Trustee shall deem advisable for that purpose. 20. Merger of Trusts: If at any time the Trustee of any trust created hereunder shall also be acting as trustee 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 Trustee is authorized and empowered, if in the Trustee's 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 Trustee is 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. 21. 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 Share 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. 22. Power to Determine Income and Principal: 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 Trustee 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 Trustee has the power to determine what will constitute principal or income and may withhold from income such reserves for depreciation or depletion as the Trustee may deem fair and equitable. In determining such matters, the Trustee may give 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. REVOCABLE LIVING TRUST AGREEMENT Page 14 23. Generation-Skipping Taxes and Payment: If the Trustee considers any distribution or termination of an interest or power hereunder as a distribution or termination subject to a generation-skipping tax, the Trustee is authorized: 24. a. To augment any taxable distribution by an amount which the Trustee estimates 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 of the Trust Assets, the Trustee 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 Trustee deems advisable; and c. To postpone final termination of any particular trust and to withhold any portion or all of the Trust Estate until the Trustee is satisfied that the Trustee no longer has 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)(1) of the Internal Revenue Code (or any corresponding successor statute), such stock will be segregated from the other assets of such and treated as a separate trust. The Trustee 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 Trustee will distribute all of the income from each separate trust to its Beneficiary in convenient installments at least annually. It is the Settlors' intent that each separate trust will be recognized as a "Qualified Subchapter S Trust" ("ASST") 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 Trustee'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 ASST as above described. ARTICLE SIX Trustee Powers with a Probate Estate Section 6.01- Coordination with Settlor's Probate Estate 1. At any time during the continuance of this Trust, including subsequent to the death of either Settlor, the Trustees 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: (i) distributed to or for the benefit of the Settlor's Executors or the Settlor's Probate Estate; or (ii) used to pay any other obligations of the Settlor's Estate. The term "Restricted Proceeds" means: REVOCABLE LIVING TRUST AGREEMENT Page 15 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 a 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 determined solely by the Trustee, according to the Trustee's best judgment and without recourse to any court. Each determination by the Trustee is binding on the Beneficiaries and prospective Beneficiaries hereunder, both in 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 determination. 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 Resolution of Conflict 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 disagreeing 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) REVOCABLE LIVING TRUST AGREEMENT Page 16 shall decide. Such arbitration shall comply with the commercial arbitration rules of the American Arbitration Association, 140 West 51st 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 whatsoever 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: Such Beneficiary shall thereby absolutely forfeit any and all beneficial interests of whatsoever kind and nature which such Beneficiary or his or her heirs might otherwise have under this T rust Agreement and the interests of the other Beneficiaries hereunder shall thereupon be appropriately and proportionately increased; and 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 Beneficiary, shall thereupon become absolutely void; and 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 -Trust Contests and Specific Omissions If any beneficiary under this trust, singly or in conjunction with any other person or persons, directly or indirectly: 1. contests in any court the validity of this trust or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 2. contests in any court the validity of the Settlor's Trust or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 3. seeks to obtain an adjudication in any proceeding in any court that this trust or any of its provisions or that Settlor's Trust or any of its provisions is void; 4. claims entitlement by way of any written or oral contract to any portion of the Settlor's estate, whether in probate or under this instrument; 5. unsuccessfully challenges the appointment of any person named as Trustee or successor Trustee of this Trust, 6. objects in any manner to any action taken or proposed to be taken in good faith by the Trustee Settlor's Trust; 7. objects to any construction or interpretation of this Trust, or any provision of it, that is adopted or is proposed in good faith by the Trustee; 8. unsuccessfully seeks the removal of any person acting as Trustee of any Trust created under this instrument; 9. files any creditor's claim in Settlor's estate (without regard to its validity), whether the claim arose before or after the date of this instrument, but excepting claims for cash advanced or paid for expenses of the Settlor's last illness or funeral paid by said claimant; REVOCABLE LIVING TRUST AGREEMENT Page 17 10. attacks or seeks to invalidate any designation of beneficiaries for any life insurance policy on Settlor's life; 11. attacks or seeks to invalidate any designation of beneficiaries for any pension or IRA or other form of qualified or non-qualified asset or deferred compensation account, agreement or arrangement; 12. attacks or seeks to invalidate any trust which Settlor has created or may create during Settlor's lifetime, or any provision thereof, as well as any gift which Settlor has made or will made during Settlor's lifetime, whether before or after the date of this instrument; 13. attacks or seeks to invalidate any transaction by which Settlor sold any assets (whether to a relative of Settlor's or otherwise}; or 14. refuses a request of Settlor's Trustee, Executor or other fiduciary to assist in the defense against any of the foregoing acts or proceedings, then that person's right to take any interest given to him or her by this trust shall be determined as it would have been determined if the person had predeceased the execution of this trust instrument without issue surviving. The provisions of the foregoing paragraph shall not apply to any disclaimer by any person of any benefit under this trust or under the Settlor's Trust. In the event that any provision of this Article is held to be invalid, void or illegal, the same shall be deemed severable from the remainder of the provisions ol~ this Article and shall in no way affect, impair or invalidate any other provision in this Article; and if such provision shall be deemed invalid due to its scope or breadth, such provision shall be deemed to exist to the extent of the scope or breadth permitted by law. 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 General Provisions Section 8.01 -Distribution in Kind or in Cash On any division of the assets of the Trust Estate into shares or partial 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 rata 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. REVOCABLE LIVING TRUST AGREEMENT Page 18 Section 8.02 -Spendthrift Provision Neither the principal nor the income of the trust 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 his or her interest in the principal or income of this Trust in any manner, nor shall the interests of any Beneficiary be subject to the claims of his or her creditors or liable to attachment, 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 incompetent 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 incompetent 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 not competent or as being disabled, and who shall be entitled to governmental support and benefits by reason of such incompetency 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 incompetent 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 incompetency 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 Trust 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 Successor Trustee AppoinUnents 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: First: The undersigned, Eugene RoZenburgh and /or Lillian Rozenburglt. Second: The Surviving Spouse. REVOCABLE LIVING TRUST AGREEMENT Page 19 Third: At the death or incapacity of the Surviving Spouse, Stephen: Roger Rozenburgh shall serve as First Successor Trustee. Fourth: Vicki Waldman shall serve as Second Successor Trustee. 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: 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. Upon the death of the Surviving Spouse, the Trustee shall hold, administer, and distribute the Trust Assets in the manner hereinafter 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, 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 -Liability 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 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 exempt 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, question, 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 REVOCABLE LIVING TRUST AGREEMENT Page 20 neglected to be done by any predecessor Trustee. A Successor Trustee shall be liable only for his or her own acts and defaults. ARTICLE TEN Rule Against Perpetuities 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 General Provisions 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. The validity of the Trust hereunder, as well as the validity of the particular provisions of~ that Trust, shall be governed by the laws of the state which has sufficient connection with the Trust to support such validity. The meaning and effect of the terms of this Trust Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. The administration of this Trust shall be governed by the laws of the state in which the principle office of the Trustee then having custody of the Trust's principal assets and records is located. The foregoing shall apply even though the situs of some Trust Assets or the home of the Settlor, 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. REVOCABLE LIVING TRUST AGREEMENT Page 21 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 shall 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. REVOCABLE LIVING TRUST AGREEMENT Page 22 SPECIAL DIRECTIVES OF EUGENE ROZENBURGH I, EUGENE ROZENBURGH a resident of the County of Lehigh, Commonwealth of Pennsylvania, being of lawful age, and of sound and disposing mind and memory, and not acting under duress, fraud, or undue influence, hereby make, publish and declare this to be my Special Directive, and I incorporate THE EUGENE ROZENBURGH AND LILLIAN ROZENBURGH REVOCABLE LNING TRUST AGREEMENT. FIRST The natural objects of my affection are: My Wife - Lillian Rozenburgh My Children - Eugene J. Rozenburgh, III Vicki Waldman Carol DiNardo Stephen Roger Rozenburgh SECOND I direct that all estate and inheritance taxes payable as a result of my death, not limited to taxes assessed on property, shall be paid out of the residue of my Estate, and shall not be deducted or collected from any Legatee, Devisee, or Beneficiary hereunder. THIRD In the event any of my named Beneficiaries should predecease me, all of that person's share of the Trust Estate is to be divided equally among that person's issue per stirpes. In the event any such predeceased beneficiary leaves no surviving children or issue, then all of that person's share shall be distributed to the remaining Beneficiaries. FOURTH In the event all of my named beneficiaries and their children and issue predecease me, all of the trust estate is to be distributed to my heirs at law. FIFTH I direct that all outstanding debts and/or loans owed by any beneficiary shall be forgiven and deemed as having not existed. REVOCABLE LIVING TRUST AGREEMENT Page 23 SIXTH I direct that, before any distribution of the assets of the Trust Estate to the named Beneficiaries, certain specific distributions, if any, shall be made from the assets as set forth on the list attached hereto and marked "Exhibit A." SEVENTH I hereby acknowledge and accept the "Special Directives," if any, of my spouse. REVOCABLE LIVING TRUST AGREEMENT Page 24 SPECIAL DIRECTIVES OF LILLIAN ROZENBURGH I, LILLIAN ROZENBURGH, a resident of the County of Lehigh, Commonwealth of Pennsylvania, being of lawful age, and of sound and disposing mind and memory, and not acting under duress, fraud, or undue influence, hereby make, publish and declare this to be my Special Directive, and I incorporate THE EUGENE ROZENBURGH AND LILLIAN ROZENBURGH REVOCABLE LIVING TRUST AGREEMENT- FIRST The natural objects of my affection are: 1. My Husband - Eugene Rozenburgh 2. My Children - Eugene J. Rozenburgh, III Vicki Waldman Carol DiNardo Stephen Roger Rozenburgh SECOND I direct that all estate and inheritance taxes payable as a result of my death, not limited to taxes assessed on property, shall be paid out of the residue of my Estate, and shall not be deducted or collected from any Legatee, Devisee, or Beneficiary hereunder. THIRD In the event any of my named Beneficiaries should predecease me, all of that person's share ol~ the Trust Estate is to be divided equally among that person's issue per stirpes. In the event any such predeceased beneficiary leaves no surviving children or issue, then all of that person's share shall be distributed to the remaining Beneficiaries. FOURTH In the event all of my named beneficiaries and their children and issue predecease me, all of the trust estate is to be distributed to my heirs at law. FIFTH I direct that all outstanding debts and/or loans owed by any beneficiary shall be forgiven and deemed as having not existed. REVOCABLE LIVING TRUST AGREEMENT Page 25 SIXTH I direct that, before any distribution of the assets of the Trust Estate to the named Beneficiaries, certain specific distributions, if any, shall be made from the assets as set forth on the list attached hereto and marked "Exhibit A." SEVENTH I hereby acknowledge and accept the "Special Directives," if any, of my spouse. REVOCABLE LIVING TRUST AGREEMENT Page 26 ~; DATED to be effective this ~~ day of ~7 ? ,"-b~j2~z`y ,~ ~,~Cl~. SETTLORS: ~ , <.., r ~ EUGE~y ROZEN~3URGH ' ~`" .1 ~: ~/ f LILLIAN ROZENBUR >'H ~- ACCEPTED BY CO-TRUSTEES: JG$NE ROZE~B[T12GH LILLIAN ROZENBURGH COMMONWEALTH OF PENNSYLVANIA COUNTY OF LEHIGH This instrument was acknowledged before me on the date herein set forth by EUGENE ROZENBURGH as Settlor and Co-Trustee to certify which witness my hand and seal of office. Notary Publi ommonwealth of Pennsylvania COMMONWEALTH OF PENNSYLVANIA Notarial Seal COMMONWEALTH OF PENNSYLVANIA U ~~~' L. Cohen, Notary Public pper Mt. Bethel Twp., Northampton County My Commission Expires Oct. 6, 2007 COUNTY OF LEHIGH Member, Pennsylvania Association Of Notaries This instrument was acknowledged before me on the date herein set forth by LILLIAN ROZENBURGH as Settlor and Co-Trustee to certify which witness my hand and seal of office. ~_, Notary Public ommonwealth of Pennsylvania COMMONWEALTH OF PENNSYLVANIA Notarial Seal Henry L. Cohen. Notary Public Upper Mt. Bethel Twp.. Northampton County My Commission Expires Oct. 6, 2007 Member, Pennsylvania Association Of Notaries REVOCABLE LIVING TRUST AGREEMENT Page 27 VENDOR NUMBER DATE CHECK NUMBER 999107862 11/26/08 1030023904 VENDOT2 NAME ESTATE OF EUGENE ROZENBURGH INVOICE NUMBER 'DATE.' ' ?PURCHASE ORDER _.. GROSS DISCOUNT NET PR 7583974 ROZENBURGH 11/25/08 105.38 0.00 105.38 CHECK TOTAL 105.38 0.00 105.38 Lehigh Valley Physician Group P.o. sox 1so7, Allentown, PA 18105-1807 ~ 38-14-3774B 06-2005 ~o OO~o b o' ~ a~ ~ ~ p' ev z a ~« ~< a rAs ~~ k ).Y :8i .. + ,::a ~.as 5 _5 'Y~ hs5 f+7 0' S C Q K~R9 d ~a7 :w ~] e- x Cs .7 ~iy y rarer ~: rr+ ix! <. , ~7 C .C .. ~ C 4) .C dr;4 s ~.5 '.T :ll xa° ~ oy ~~ o~s e~ro •~i °'a.~ ao ~ `~~ } o ~+ o ~~ °= w 5 a, F~a ` ~wA ,- ,Ar ~8e '~ 5n -' m ~ ~ ,n GO a ~ ~. o'~? w s~ .~ 6 'B $ * ^o ar mP r ~w ~~ :['' :ar a•-K ~ r{ ~ LSS 2 ~ t.+3 ~ f f r r ,°,? ^.8 } ~ Gj .:a ; s ~ a , G1 ~,,,..- ~ ~ ~ ~• ~ o y ~_q~ .~ "Y ~ C k w C ~ ~ n ~'O ~' ~ n ``' .._.~_.. 0 0 rn .A 0 0 rn V (D ww .-~•. z ~ I 0 ~~ a d^ ~~ I ylY i_ /~ l 1 A C.,3 OQ A m ~ 3 n ! r D O < a '~ r _ ' ~ r f9 3 N .. N ~ < _ < Z '~ ~' ; O O ~ .~ Z d o W "~ ,~ r ,~ ~ ~ 3 ~ r O < N ~, v ' V! N ~ J~ O ~ » -.• O ~ fp 7 ~ ~D 7 M 0 r n z 0 w r pp ~ w a a ~ -~ ~ r ~ ~ N W r ° ~ w O ~ O m W n a C ~ r O N -i O i ~~ ZI D --1 m N = v m +•?,. 2 O ~ O z w '~ ~ m -< t ~ ..a W ~ ~ Z ~ ~ 0 ~ ~ z .~ ~D ~~ si D ~ ~ 3 ~ C D Z -I Z ~ g .:v,6 Z -i m Z p m#m iF~ ~ 0 ~ S ~A cJ~ '°"° ~e~, r i ~ Created Payment S3539F85 Clm: 38-L450-411 Ins: ROZENBURGH, EUGENE Pol: 8414-48 2-38M 003 DOL: 04-15-08 Payment no: 113326490) Total: 4,376.94 Issued: 05-14-08 Payment status: PAID 06-12-08 Chgd by: BMAP: Authorized by: Benson, Kanita Consol pymt: N Entered by: Benson, Kanita Repl no: EFT pymt: N Billing ref: Bill amt: Begin bill: - - Adj code: End bill: - - Remarks: total loss settlement Payee: LILLIAN ROZENBURGH 110 CARPENTERSVILLE RD PHILLIPSBURG NJ 08865-3507 St & TIN: - COL 1 to 1 of 1 COL Amount Pay Cd Reporting Party Rsn Cd 403 COLL 4,376.94 2 Named Insureds) THE PATRIOT-NEWS PO Box 2265 Harrisburg, PA 17105 Check Date: 05/08/2008 Vendor Number: 9999999999 Check No. 0900024107 Invoice Number Invoice Date Voucher m c~.,~~ e....,....r n:~......... T,.~,.... -- 010276079 ,2008-OS-06 05/06/2008 00073386 96.83 0.00 ra~u Hwuum 96.83 SUBSCRIBER REFUND Receive your payments faster! Ask how! Call us (866J 2I1-2620 opt 3 Questions regarding this check contact the AP Dept 717/255-8260 Check Number Date 'total Total Total Gross Amount Discounts Paid Amount 0900024107 _- _ 05/08/2008 ^~_^ _ $96.83 $0.00 X96.83 No 3~C~~~~~~. a mi.E NuMeeR (AS SHt>Mm oN AT7ACiED E) GwaE of VEHICLE MouEL YEAR O W ....- ~~ ~ VEHICLE IDENTIFlCATION NUMBER ~.~. -~. ~~ C` I Gi, C ~ - ,. - DITION - SSTRADEaN !~ ...~ ~ -D: GOOD CIFAiR Q POOR $, ~ ` ' ~ ,IQR~EOLL ~~55 NAME.) , ._ . ~ p ~ ~ MIDL)LE-NAME ARABLE AMOUNT .t,~^ f,~ (~`. T NAME (OR FULL BUSINESS NAME) FB2ST NAME MIDDLE NAME SALES TAX DIIE : Pa o1~-roro IDe DATe of BrctiH '~ tqe) ort x rx ('o>) r , (~ ~ ,(,'`~ oR Bus. Ion {ax ~ ~, Rerenel .. W R LAST NAA1E FIRST NAME MKK)LE PA OUPF.{OTO IDk TE BIR / °,- ~-.. j / tiq si ryigObir 9Chi t, b ~}~;-- ...~ ~~ u 1 .:. _. ! ~'utsr GTY STATE ~ Z!P CODE DATE 2 TITLE FEE ~l` ` f_` J (j ~~t p ( `f~^ ~ f REFER TO COUNTY CODES Vj F ~„, l f Y: ~~ :. ~~r ('~_i N' ~~ 14~?~ ~ ~ -~ % f f ~~~ LISTING ON REVERSE SIDE ~'~' ~ YEU_OW COPY 1 L~11/ FEE ~ _ LAST NAME (OR FULL BUSINESS NAME).... FIRST NAME MIDOCE NAME PA' DUDS-IOTO IDlF DATE OF BIRTH OR BUS. IDA 4, REGIS'TRATKIN OR. ' ~~, ~ -: RLASTNAME FIRST NAME MIDDLE E PADLIPI10T0IDB ..DATE BN2Tli-.. PROCESSWGFEE z FEE ExEMPT NUMBER - ° V _ STREET AS ASSIGNED BY 7NE - ~° ~ '' 000NTY CODE D~PARTLIEMT - O~ ? ~""'~ 5. DUPLICATE RECa. .. .. n FEE NO..OF ,. CITY ,STATE .ZIP CODE DATE ACQUIREW .. CARRS,_;_ _ PURCHASED REFER TO CDLINTYCODES LISTING ON REVERSE SIDE TRAiVST~ ~... OF YELLOW COPY ,. ~~ MAKE OF VEHK7 E VEHK:LE bEN'IiFK;dU1bN NUMBER . .INCREASE FEE... w., ~ °o ~,. ~ ~ MOOELYEAR BODYTYPE(CP, TK ETC.) CONDITK)N. _ .REPLACEMENT FEE O GQOD OFAIR dPOOR s. - F ,.. a PLATE TO ~"ISSUED 8Y: .:TRANSFER OF PREVKxISLV iSSUEU PLATE ADD 11 ~ $) ~ l _ ~~ t0 PEPARTMENT(PiLOOF OF TRANSFER a RENEWAL OF PLnrE+ /' INSGRANCE MUST BE TW WSFER 8 REPLACEMENT OF PLATE 11. GRAND TOTAL SEND ONE CHECK lµ /! ATTAC~O.) TRANSFER OF PL4TE8F:FPLArEMENT Of STICKER (AD09810j Tipp AMOUNT '~ ,~/` -~ d' ExcruNOE ru+Te To eE ISSUED BYO@PAFLTMENT. %' '.,. _.. .."~ ~.; REASONFORR£PLACMENT D TEMPORARY PLATE ISSUEtI CT COST O = ~ ~ 3 ~ .;:~ - ~ t~ ~ ~ - 0 D£fACEO O ST~ CI NEVER RECENEIJ (Lpsi in MapJ ¢ BY FVLI,AGEN7 NOTE: N'NEVER RECENED' plods is deedced, mustpompl~ Fam MV~4. ., ~ ~Q TRANSFERRED FROM TITLE NO. -- ~ - s ~N y _ i= R` ' ~, ~~ ~SIGNHERE $.9~ F',C.AI~ ~ - "! PLATE LS BEING TRANSFERRED (IF .. - RELATIONSHIP t0 APPLICANT _ ' -- ". ."~' .f ' ~-. OTHER THAN APPUCANTj VEiHC:L& OWEIC3HI- UNLAD REG. _ . I COMPANY'NAME POLICY NO. (I~t.. - ATTACH POLICY EFFECTIVE POLICY - I CERTIFYTHAT ON MONTH DAY- .DATE DATE YEAa;,~ ISSUING AGENT (PRINT NAME) AO£NI' ND. ~. TSSUINfi I HAVE CHECKED TO DETERMINE TINT THE VEHK:LE IS INSI>RED AND . . AGF_NT. ISSUED TEMPORARY REGISTRATION TO TH£A80VEAPPIJCANT, W INFORMATIQN COMPUANCEWITHnLVil'PLH'JIBLEPROVIS1oNSOFTNEVEttICLE ISSUINCAGENTS[GNATURE iELEP110NENO. CODE AND DEPARTMENT REGlriATiONS. ~ ~ ) .. ` -. ,.. uWE CERTIFY THAT uWE HAV!_ ExAAgNED AND S+GNED THIS FORM AFTER ITS CONa'LETIOMI MK1:Tr1AT 7NE INFORMATION GIVEN IS ~, ~ WRTHER CERTIFIES THAT tiEJSktE-IS AUTHORIZED TO CiAIM THIS EXEMPTION. NNf: ACKNOWLEDGE THAT WJE MATy LE~E.MYfOUR ppERATING PRi ~~ ~ ~MED.:THE REGiSTRATKXJ(S) FOR FAILURE. TO MAINTAIN FINANCIAL RESPONSIBILITY ON THE CURRENTLY REGISTERED VEHN:LE. FOR TIC PERIOD OF REGISTRATI~1. -IIWE ACICNOYYL~ ED~OESTHAT UWE~MAy - 9E SUB.IEC'T TO A F,utE N07 £XGEEDMIG 55,000 AND I~SOMIMENT OF NOT MORE THAN TWO YEAR$ FOR ANY FALSESTATEMENT THAT UWE MAKE ON THIS FORM. <... 1ST:: Y ~ ~~ orAvUio~d . - Tebgq„s No. EMIR 5+8+~eafifieeabPmd~3seewAledSigher •a ~`~ `''~+..i ASSKit!- Tekpp«~e Fb_ M9lT ( ) ~ Qzz f~TE iF A C.O-PIA~NSER OTHER THAN YOUR SPOUSE IS LISTED AND YOU WANT THE TRLE TO BE LISTED AS',IOINT TENANTS WRH (2IGHT OF SURW1/ORSWIp` (ON DEATH QF Or1E OWNER, F TITLE GOES TO SURVIVIPJG OWNER) CHECK HERE O. OTHERYVfsE;~ THE TITLE WILL BE ISSUED AS 'TENANTS tta COMMON' (aN DEATH of ON£ OWNER INTEREST OF D£cEAS£D oWNiR ~ ~ GOES 70 HISAiEft HEIRS OR EST74TE.) - ~ ~ ~ I~TE:. iF THE VEHICLE 1S TO BE USED AS A DAILY RENTAL OR LEASED VEHICLE; CHECK THIS:BLACK rJ; -IF SOCK IS Ct~CKED, COMPLETE AND ATTACH FORM MV-tl MESSENGER Ni1M8ER: S: APPiJCANTS CORY f TEMRORAI3Y REGtStRATtt7N (VALID` FOR 90 t')A1-S) L`JUU llodge llakota - Ynvate Party Yrlcmg Keport - UirECial Kelley t31ue book rte i ~ ~ I(el~y Blue Book _. THE TRUSTED RESOURCE advertisement . ~~~ `- Home New Cars Used Cars Research & Explore News & Reviews keady To Buy Classifieds Loans & Insurance KBBy Green Used Car Prices { Search Used Car Listings I Certified Pre-Ownetl I Compare Vehities I Perfect Car Flnder i Most Researched Vehitles 1 CARFAX Vehkk RisMry Welcome Beek Recently Viewed You Mlgh[ Alsa like Free Dealer Price quote Trade-In Value Private Party Value BIllE BOOK'' PRIVATE PARTY YAlUE :: _. Suggested Re[ail Value Photo Gallery COtICElYlO11 -....~ ValuE! Compare Vehicles •~w~ ,~. ~' ;~~ -- Review Excellent $5,575 Consumer Ratings Good $5,175 Find Your Next Car Fair X4,700 $peClflCdtlODS More Poo[os ~% Shopping Tools ` Free CARFAX record check ~ EXT ST ~ S • Search Used Cars E Free CARFAX Record Check FREE Gedit Score & Report Compare Insurance Rates Average Consumer Rating (SIII Rariews) Read Reviews Payment Calculator Extended Warranty Quote Print For Sale sign ~3:.:~~i'~~%`:: 4.4 Out of S Review this Vehicle Similar New Vehicles BUY A USED (AR ~ en Blus Book ClasaifledsTM 2D09 Dodge Dakota Ertentletl i Cab I I D°tlge ; I ` Pho[os ~ 1 Dakota PrlCing ' ~ '~ I ~ i 30 Miles or less ' j ~" ~ More Results ZIP Code 08865 To Viaw Ads, Click ~ ~: VehideNighlighb LIST YOUR tAR fOR SAIE Special Package OKer! Mileaea: 120,000 Fo n l a Engine: VB 4.7 Liter r o e ow p ce you ~'-' un reach mllllons of Transmissbn: Autamatlc used car shoppers. Drlvetraln: 4WD Learn more now ' ' _ ' - .Selected Equipment Change Equipment _.. Sbndard FINL' THE R16NT CAR Compan Used vs. Naw Air Cnntlitlonlrg AM/FM stereo Power Steerin 9 Dual Fron[ Air Bags Under SS,000e - Optlonal Both New arM Used Single Compact Dix Bed Lkrer Pickup SNdinq Rear Window Alloy Wheek To waw List, Clidc YIEW AROTNER YENICLE Blue Book Private Party Vatue Select Vear... ; ~`::; . Private Party Value Is what a buyer can expect to pay when buying a used car from a Drlva[e party. The PrWate Parry Vahre assumes the vehicle a sold 'AS is' antl carries no warranty (oMer Man the contlnuinq factory warranty). _ ~ The flnai sale price may vary depending on the vMkk's actual wntlition antl local market condi[tons. This value may also be usetl [o Derive Fair Market Value for insurance and vehicle tlonation purposes. 8; sLn~fi`~'e°Yt6~€58ry Vehicle Condition Ratings Check Vehicle Title History 3s. Estimated Payments Get aPre-Ownetl Loan from 6.34% APR FREE Gedit Score & Report Get a Free Insurance Quote aCVeriisemeiit----- Page 1 oil http a/www.kbb. com/KBB/UsedCars/PricingReport.aspx?WebCategoryId=44&Yearld=20... 12/2/2008 LVVV .."_o 85,575 gxcellent ~. L? ~: L±o'vks nPw, i5 in P.vicehent mCChaR'.cbl 0andttion and needs no nndidon;:'9- ark and .s free o('LSns e[tion. tint or UndY ss a smog and safer{' P frze of any • Wever had a story and wdt Pa ~ n~id teak= an4 is ::IP.an titfemP.'rt1Rent is clean, with no • EnOinp rn OrdS. 'NCa, br vi Stole defef[S. • "mtlpletc and veflftaUle Service (e mis cate9^rY' Less clan 5.,; of an used vemats tau !n n §5,175 Good ~ ~~~,"'< v minor (If • Kee of any malt, defects. UodY~ °^d interror have oN. the paints, cal Problems. • fleen title- hlstO1Y' a no major mecnani any) Ulemishv"s, a^ahse cltic:e. ~ ncA r loft • tilde al ho rust ^ [R U2 ial$ qt rztgil. '~•~~ a It ,ad 0512 f.Ondfl'nir~g • ~vg~d^'val td ' ktll Into t .5 caY g0!V. Ma;t consuma~ nv,'1<d :en .f >rt4r700 p~yr xst~ Y Bhme tit_~ehan ~a ~antnn~faQlart~wnEr ehd h~od~ aRrvf~fne but s walk t~ ry.l'~W~;y th8 oa r boeY ahdi6r tptat(bi• rrdck+ s ~oYlp~PrfN~E~ h d (afe5.ibngi ~ {ti~~BAffiai 4~twf~N?p~l@aali tttP€ d5kf4~e' pti~r N(~ ' * even i rh3nical a a r n5riteG." t facts And ~ I+ poor Nnnillg w MaY na p e n= th l' [a '~i%t La d f f'. ed trdme r Sett-th uh , dy. 4.Wn. t. l t ;aua • 4t": +ir•ditl IvnH H n ke ) y i!ir"12 k ley Bli t?r. f. [ •e atf pt t recta e ti I h vet Irlrou. pobr " G2CaULP. the value f (nPtiCrYavtra,.n•,~e roPn ulnwl ~e aaten d ~' - tenNft'Mi1 M • rcgyl.e a„ i,,y, ~F~•r s~r~; ralsal change Condition pecurate CondttloR MP Accurately approfsln9 the condfUOn of a vehicle is an important aspect in Oe[ermming Its Blue Book value. Taking our 16 questlon colMltlon quiz will ensure you know the correct mndrtwn rating. N EST Si' E P S • Free CARFAI( record check Search Used Lars ' b IBBB KelkY Blue Book Cp., Inc. AR riphcs reserved. Sep-OeG 2008 Edkbn. Tae specific inhrmaovn required m determine the vah,e for tnk partNxdar vehK/a was 5upplkd Dy tee Perto^ perleradr'P this report. Veaick vslWtbrts art opinions and may vary Irom veh.'cb m .enrGb. gc[ual valwtbns will vary cased upon market ~~ n, spacltk'atiorrs, vahklt mndl[km or other part ,tier re th! t V ~ ~ Is 2~rt 5 partiwkr veaicb Or tat [ronSaGion or tae Pa nera[In9 tats report only and saap rcpt lnrerided are the Mdividval use or tae 1><' Kelk BNb Bank assumes no ,esponslDllity roe tx 5okl or [ransmiCed to another party. Y errors o/omdssbM. (v. 08[20) Home I New Cars I Used Cars i ReseaKh a Evplore I News & kevlews ~ Ready To Buy I Classifieds ~ Loans & Insurance i KBB®dreen About Us Careen FAQ Contact Us Site Map Media Center Advartismg KBB`• Mabde Auto Show LA Auto Shaw De:rolt Auto Show Linking ?olicy Privacy PPlky Copyright & Trademarks Terms of Bervlce ®1895-20t1B Kalkry 01Na aoek Ca., IM. http://www.kbb.com/KBB/UsedCars/PricingReport.aspx?WebCategoryId=44&YeazId=20... 12/2/2008 Doyle-Devlin Funeral Home, Inc. G. JOSEPH DEVLIN, JR. -MANAGER, NJ License 3895 G. JOSEPH DEVLIN, SR. -DIRECTOR, NJ License 2451 695 Corliss Avenue Phillipsburg, New Jersey 08865 Tel: (908) 454-1361 Fax: (908) 454-5200 Name of Deceased ~ --~ 'ter "~~ Date of Death ~ `~ G6 i< ~ Total Funeral Home Charges and Cash Expenditures Payment Balance Due I hereby acknowledge that I have the legal right to arrange the final services for the deceased, and I authorize this funeral estab- lishment to perform services, furnish goods, and incur outside charges specified on the Statement of Funeral Goods and Services selected. TERMS OF PAYMENT The Balance Due is payable upon receipt of Statement. After 30 days, a FINANCE CHARGE of 1.5% monthly (ANNUAL PER- CENTAGE RATE OF 18%) will be added to the unpaid portion of the Balance Due, which is the AMOUNT FINANCED. I agree to pay and/or guarantee payment of the charges. In the event of default of payment, I agree to pay reasonable attorney's fees and court costs. I agree that the liability is being personally assumed by me and is in addition to the liability imposed by law upon the estate, and this agreement does not constitute a release of liability. By my signature below, acknowledgement and agreement of the above is hereby made. r~ - f~Il ~ a k.,'r i.~ I ti' ~ ~ a' (--y~,. Signed ~X~ Co-Signed 7yy ~. $ ~~ ~ L.- ~ S~ ~ 4 . Social Security # Social Security # ~=1~-~~ Dated Dated ACCEPTANCE: This funeral establishment agrees to provide all services, merchandise and cash advances indicated on the statement of funeral goods and services selected. /r' ~ , BY: uneral Director ACKNOWLEDGEMENT AND AGREEMENT RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 ROZENBURGH LILLIAN Receipt Date: 5/23/2008 Receipt Time: 14:09:18 Receipt No.: 1052800 Estate File No.: 2008-00559 Paid By Remarks: LILLIAN ROZENBURGH CJ ------------------------ Receipt Distribution ----- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST SHORT CERTIFICATE 60.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 20.00 CUMBERLAND COUNTY GENERAL FUN AUTOMATION FEE 10.00 5.00 BUREAU OF RECEIPTS CUMBERLAND COUNTY & CNTR GENERAL M.D FUN WILL --- 15.00 - CUMBERLAND COUNTY GENERAL FUN Check# 284 ------------ $110.00 Total Received......... $110.00 ~'be Patriot-News Co. 812 Market St. Harrisburg, PA 17101 Inquiries - 717-255-8292 KEENEJABBOUR 701 WASHINGTON STREET EASTON c~e~latriot News NOw you know PA 18042 THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss Joseph A. Dennison, being duly sworn according to law, deposes and says: That he is the Assistant Controller of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/ Metro editions which appeared on the date(s) indicated below. That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. PUBLICATION COPY ESTATE NOTICE Estate of Eugene Rozenburoh, late. of e Borough of fVlechanlcsburo, County f Cumberland and Stgte of Pennsrlva- la. WMEREAS, Letters Testamentary In the above-named Estate have been granted to the undersl9ned, all persons ~ Indebted to the sold Estate are request- ~. ed to make Immediate garment and `:~ Those havlnfa claims or demands to fires-•~ ~~~ ent the same without delay to: Lillian Rozenbur9h 110 Carpentersvllle Road - Phllllpsburo, NJ 08865 or Keene Jabbour, Attorney 701 Washlnfaton Street Easton, PA 18042 This ad # 0001868739 ran on the dates shown below: July 11, 2008 July 18, 2008 July 25, 2008 bscribed before lne Notary Public ~d~y~of July, 2008 A.D. ~~~l 1...~---~ OMMONWEALTN OF PENNSYLVANIA Notarial Seal Shenil~ L Kisser, Notary Public City (~ M~It7isburg; Dauph~l County My Ccxnmission Expires Nov. 26, 2011 M~Tttber, pennisyNenla Association of Notaries • ~~e Patriot-News Co. 812 Market St. Harrisburg, PA 17101 Inquiries - 717-255-8292 KEENEJABBOUR 701 WASHINGTON STREET EASTON PA 18042 c~he ~latriot News NoW you know INVOICE ALL CHARGES ARE NEl ACCT # NAME AD ORDER # DATE EDITION ADDTL. INFO. TYPE OF CHARGE AMOUNT 186665 KEENE JABBOUR 0001868739 07/11/08 REGULAR BOLD TEXT CHARGE $4.00 186665 KEENE JABBOUR 0001868739 07/11/08 REGULAR BASIC AD CHARGE $121.25 186665 KEENE JABBOUR 0001868739 07/18/08 REGULAR BASIC AD CHARGE $121.25 186665 KEENE JABBOUR 0001868739 07/25/08 REGULAR BASIC AD CHARGE $121.25 AFFIDAVIT CHARGE $5.00 TOTAL: REMITTANCE ADDRESS The Patriot-News Co. 23794 Network PL Chicago, IL 60673-1237 $372.75 Please include the Account # or Ad Order # (above) with your remittance--Thank You NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law 3ournal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: __ July 11 July 18 and July 25 2008 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Coyne, Rozenburgh, Eugene, deed. Late of the Borough of Mechanics- burg. Executrix: Lillian Rozenburgh, 110 Carpentersville Road, Phil- lipsburg, NJ 08865. Attorney: Keene Jabbour, Esquire, 701 Washington Street, Easton, PA 18042. SWOkN TO AND SUBSCRIBED before me this 25 day of July, 2008 Notary ~ ,,,,._.,.~...~~..w~<n'H,RIAL SEAL DEDORAH A COLLINS ~ Nctory Public CARLISLE 80±d0, CUMBERLAND COUNTY My Commission Expires Apr 28, 2010 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249166 Fax: (717) 249-2663 July 25, 2008 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Keene Jabbour, Esquire Eugene Rozenburgh Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: July 11, July 18, and July 25, 2008 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by serv~ees 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS MINNESOTA 55422-4811 TELEPHONE 763-852-8640 Hours (CST); 7:00 am - 9:00 pm M - TH FAX 877-326-8784 7:0o am - 5:0o pm F TOLL-FREE 877-326-1534 s:oo am - 12:0o pm s October 31, 2008 KEENEJABBOUR 701 WASHINGTON ST EASTON PA 18042 Re: In the Estate of EUGENE ROZENBURGH Probate Case No. 2008-00559 Date of Death: 4/16/2008 Last known residence: 110 CARPENTERSVILLE, PHILLIPSBURG NJ 08865 Our Client: WORLD FINANCIAL NETWORK NATIONAL BANK VALUE CITY FURNITURE Account Number: ************0302 Unpaid Balance Due: $913.67 Reference No.: 4706839 Dear KEENE JABBOUR: Enclosed herewith is a copy of the Creditor's Claim for the above-referenced Estate. If you have any questions or if this is a duplicate claim, please call our company toll free at (877) 326-5681. Cordially, DCM Services, LLC Enclosures This company is a debt collector. We are attempting to collect a debt and any information obtained wilt be used for that purpose. Calls may be monitored or recorded for quality assurance purposes. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION -Side 1 of 2 - COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NOTICE OF CLAIM In Re: The Estate of: Court File No: 2008-00559 EUGENE ROZENBURGH Deceased TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). 1) Claimant's name: WORLD FINANCIAL NETWORK NATIONAL BANK VALUE CITY FURNITURE 2) Claimant's address: C/O DCM SERVICES LLC, 4150 OLSON MEM HWY #200, MINNEAPOLIS MN 55422 3) Creditor listed below is the owner and holder of a claim in the amount of $913.67. 4) The facts upon which this claim is based is an account for credit evidenced by the attached Affidavit of Account Stated. 5) Decedent's address: 110 CARPENTERSVILLE, PHILLIPSBURG NJ 08865 6) Date of Death: 4/16/2008 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, I do solemnly declare and affir der the penalties of perjury that they Information and representations made erei are true and correct to the best of my knowledge, information a belief. Melanie A. Euston Dated : I1 • '~v• O"g orized Representative Claimant Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: KEENEJABBOUR Name 701 WASHINGTON ST Address EASTON, PA 18042 City/State/Zip l 1• ~ a~ Date notice mailed This "Backer" must be used in Montgomery, Luzerne & Allegheny Counties _ =D zC~ O ~p ~~ z ~p D ~* N Dz ~ ~ 3 OS o r-1 ~ Z \ ~ D ~ z ~ ~ N z rn ~ z ~ 3 ~ D 3 rn a ~- cn O ~ ~ D r ~ m ~. ~ ~ ~ m ~ ~ 3 < z C~ rn ~ ~ ~ ~ u, cn ~ „ z ~' ~ C D ^' n zn c D µ ~ mrn o O O ~ z ~ 3 rn 3 n _~ 3 rn D rn O rn c G7 m z rn O N m z W c G) 2 m n m D m O a v~ n 0 c z 0 N 0 0 O 0 0 IN RE ESTATE OF: EUGENE ROZENBURGH AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Authorized Representative to make this Affidavit. 2. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of his/her duties. 3. The Decedent purchased merchandise in the amount of $913.67 evidenced by account number ************0302 Further your affiant sayeth not WORLD FINANCIAL NETWORK NATIONAL BANK VALUE CITY F ITURE '~y. ,/ One of its Authorized ep sentatives: Printed Name: Melanie A. Euston .Authorized Representative WORLD FINANCIAL NETWORK NATIONAL BANK VALUE CITY FURNITURE C/O DCM SERVICES LLC, 4150 OLSON MEM HWY #200 MINNEAPOLIS MN 55422 Subscribed and sworn before me This o~ day of 6 v , 2000 .~ JOSHUA T. PATRICK NOTARY PUBLIC - STATE OF MINNESOTA i MY COMM. EXP. 1-31-12 Paul W. Zwicker dfA Bur Robert W. Thuotte AfA Bar William H. Harris AfA & NH Bars Mireillc H. Vartanian AfA Bar Raymond ,I. Lee CA Bar Ingrid Causey CA Bar File ID: 2822545 Barbara A. Harvey AfA Bar Personal and Conrdential Zwicker & Associates, P.C. Attorneys at Law ~ Probate Department ~.:K..e,,,:e,,,..:.,~ PO Box 9013 Andover, Massachusetts 01810 Tel. (877) 346-9983 Fax (978) 686-3538 probate@zwick~~rpe.com 06/07/2008 Acct # :7981923390067975 Original Creditor. Lowe's Consumer Zwicker Notice Number : GE0001 Trevor Clement Re: Estate of EUGENE ROZENBURGH mfA B°, GE Money Bank Jennifer L. Acct No. # : 7981923390067975 I?3 Bockstahler ,yt 8~,,. Balance : $ 2073.96 Eleanore Hargreaves AfA ~ NHBars Dear Sir/Madam: Erin M. Reczek MA Bar Andrew J. Dick On behalf of our client, GE Money Bank, we wish to extend our sympathy for your recent loss. Our client has advised us NY ~ F~ Ba,-, that the decedent, EUGENE ROZENBURGH, had an account with our client. We would like to discuss this account with Steven V. Sorg the legal representative of the estate. KY & OH Barr Robert A. Fierman If you are not the legal representative of the estate, we request that your forward this letter to the legal representative or c~i aa, provide us with the name, address and telephone member of the legal representative so that we can contact him or her Dwignt Baylor ' directly. The following notice is directed to the legal representative: AZ, NG & VA Bas Debra Dawn Ft„ Nc, NY ~ rx Unless ou not{ this o rce within thir ~ fy p f y p Y f}' ff ty (30) da ~s o o:1r recei t o this letter that ou des ute the validity of this debt Bars or any portion thereof, this ofjce shall assume the validity of this debt. Upon your written notif cation within such Brian Szilvasy thirty-day period that this debt, or any portion thereof, is disputed, this office shall obtain verification oj~the debt or a Fz Bar copy of a judgment, if ar?r, and mail you a copy of'such verification or judgment. Furthermore, upon your written Randall Pratt* Mfi & N1rB req:eest within said thirty-day period, this office shall provide you with the name and address of the original creditor if °rs , dcffererrt, frurn the current creditor. This firrrr is attempting i0 coiled a debt and any information obtained will be used Robert G. Markoff* for that purpose. 1L Bar MyXuan McClure Koski 1~ Bar This letter is not intend to state or imply that the person reading it is personally liable for the above-referenced debt. Christopher D. Osborn T,Y Bnr Very truly yours, Irvin Borenstein CO & NY Barr Sanford J. Pollack ZWICKER & ASSOCIATES, P.C. NE & MO Bnrs Shannon M. Pawley Ml Bar Jessica Ellicatt* VT Bar ' otCounse~ 'This Linn is a debt collector. z This firm is attempting to collect a debt and any information obtained will be used for that purpose. s Important notices appear on the back of this letter. Please read them as they may affect your rights. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF EUGENEJROZENBURGH Deceased No. 21-2008-0559 of 20~ To the Clerk of the Orphans' Court: Enter the claim of BANK OF AMERICA, N.A. Acct. 74993997684169 In the amount of $1,463.10 ,against the above entitled estate. The decedent, who resided at 110 CARPENTERSVILLE RD C/O LILLIAN ROZENBURGH PHILLIPSBURG NJ 8865 died on .Written notice of said claim was given to LILIAN ROZENBURGH ,if known to claimant, at (Personal Representative or counsel) 110 CARPENTERVILLE RD, PHILLIPSBURG, NJ 8865 on September 30, 2008 (Date) (Claimant) Address: 2323 Lake Club Drive, Suite 300 Columbus Ohio 43232 Claimant's Counsel Address ~~~ J 4 STATE OF PENNSYLVANIA IN RE: ESTATE OF IN THE PROBATE COURT: EUGENE ROZENBURGH CUMBERLAND COUNTY ESTATE NO# 21-08-0559 STATEMENT OF CLAIM 1. Bank of America hereby presents for filing against the above estate this statement of claim in the amount of $8967.81. The basis for the claim is account number 4313070213324202 which was opened on 06/14/1995. 2. The tax identification number of the claimant is 510331454. 3. The name and address of the claimant is Bank of America, PO BOX 15409, Wilinin ton, DE 19885-5409. 4. This claim IS NOT contingent. 5. This claim IS NOT secured. 6. The last payment made on the account was $64.33 on 07/14/2004. 7. Please send payments to Bank of America, DES-014-02-03, ESTATE DEPT., 1000 Samoset Drive Wilmington, DE 19884. Please write the above account number on your check. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Executed this 24 day of OCTOBER, 2008 SUZANNE BURNS Bank of America Claimant State Of Delaware, C my of NEW CASTLE IN W TNESS WHE ~, F, ve set my hand and notarial seal this ~~ day of , 2008 My Commission Expires: ~~ fG; i :, ,.,,. /, Customer Service {Servicio al Cliente): 1-800-755-7872 ~/~ Jr~n/' ~/~ Payment Address: Boscovs, PO Box 17642, Baltimore MD 21297-1642 77N i(,/' Mail Billing Inquiries to: Retail Services, PO Box 15521, Wilmington DE 19850-5521 Days in Billing Cycle: 31 Statement Date: 08/04/2008 ~ _~ ~,i~: ~~ NEW! CHARMINGLY DELICIOUS Two new limited edition fragrances ripe for summer from DKNY ee DeliL7ol.s arxj Red Deliaous 4.2-oz. Charmingly Delicious Green 4.2 oz. Charmingly Delicious Red $55 Stop by [he Fragrance Counter at Boscov's to experience these new scents. YOtl~r@ $ memb@r ofi Bti$GOV'~5 Ch$imnan"S Clubl See tfte Oval ~ a# yc~~lr stalttemef~l for a summary of your remm~ds accour}t. PAYMENT TOTAL MINIMUM NEW PAST DUE AVAILABLE DUE DATE PAYMENT DUE BALANCE AMOUNT CREDIT 08/27/2008 $126.00 $2,579.25 $0.00 $0.00 Please see reverse for important disclosures, including grass period information. fransacCwn Date Transaction Detail Promo. Type/Credit Plan Amount 07/05/2008 Previous Balance ..................................... $2,528.51 08/04/2008 Billed Finance Charges ................................ $50.74 08/04/2008 New Balance. X2,579.25 B Smart. Visit Boscov's for all of your Back tb School Essentials! From famous brands in kid's apparel to dorm room decoratlng, we have it all in one place. • Promotion Variable FINANE:E Type! Promotion Average Daily Correa- %' ANI~At Deferred Minimum Credit Purchase Expiration Previous Daily Periodic ~ PERC&tl` at PerbdiG FINANCE New Payment Plan Date Date Balance Balance Rate APR' RATE:. Race ' CfiARGES Balance Due Regular Purchase WA WA $2,351.07 $2,373.82 D.06410% 23.40% 23.40% $47.18 N/A $2,398.25 $120.79 oaom-0t Regular Purchase N!A N/A $177,44 $179.16 OA6410% 23.40% 23:40% $3.56 WA $181.00 $5.21 calla-a¢ Page 1 of 2 08040029316 126 Please return coupon below with your payment. ~~,pr~- Customer Service (Servicio al Cliente):1-800-75x7872 AC OC UNT NUMBER NEW BALANCE PAYMENT DUE DATE RECOMMENDED MAIL DATE TOTAL MINIMUM PAYMENT DUE 3006-0101-0017-9149 $2,579.25 08/27/2008 08/18/2008 $126,00 AMOUNT ENCLOSED ~ , AV 01 031545 630008145 C* *5DGT Please complete using black or blue ink only. E U G E N E J R O Z E N B U R G H J R 00300 Make checks payable to Retail Services. Include your 110 CARPENTERSVILLE RD aocountnumberonyourcheckormoneyorder. PHILLIPSBURG NJ 08865-3507 BOSCOVS III I I I I II I I II I III I I IIII I II Po Box 17sa2 ~~~ ~~ r r~ r~ rrr ~ ~~~ ~r r r l~r rrr r~~ rrr rrr BALTIMORE MD 21297-1642 Inlrlu~ll~~l~llrlrrlrnirullrllrululrrlrlrlrrlrrl~lllurl 00257925000Z26DOOOD3DD6D10100179149D030DD Pt) Box 153 B0 [3sltitnore, Maryland ? 1220 .~dJ~ esr Senicr lteyuc+tcd ~uurc tear cults iwt. U~'iice Haurs (Eastern 'lime) [~f - i n 9~m - 9paZ -- Fri: gam . Spm F~c. ~:;•~?51-7702 fhc Estate ui' Eugene Roienbur~gh, ,Ir. G`~(1 Keene Jabbc-ur, ESQ. 7(il t1'ashiugtoa Street L''ast~>:n, P.~ 18042 ~~:r trlr Jabbour, 10/28/08 14'c are pleased to advise you that the settlement oi~'er wr have discussed hfls been approved. The terms of this ;tl~reetnent are as f~~ltows: Settlement nmoupt: $~t,12i,01 Due Date: 10!30/OS ~, !~ner confirming that the acw~tnt has been settled Lt full will be forwarded to yeu once the Settlement a,~wunt is received. P1es,e :Hake check (s) payable to Estate Rrcavcries, Inc at7d forward in the enve.ope encltxscd with the n;,~::it*ance ::lip found at the bottom ~f this lcttrr. 'i'o ens~.tre proper posting, please ~n~rite the. ER.I File number ~~~: y o u check or money order. If' w~~u hwe any questinns, or require assistance w;th this matter, please contact us at fi66.794-1321 Ext, ;94SR}, ~t'~e~iever $600.00 or more of a debt is for[liven as a resu:t of settling a debt for less titan the balance awinQf tt ;; ~r: ditor i.~ repaired n, report the amount of the debt forgiven to the lntcrnal Revenue Service on a 1 U94C fc,r^;. s cop;' of which wi i! he mailed to y~~u by the creditor. S~naa 41y, A1r (.;i3tide ['altersot? F;t;it~ FitX.UVer1eS, IP,C, NOTtCF: S>EE REV.F.RSE SIDE FQR tMP()it'1'ANT INFt)RMATIUN Tits t:;state of Y'ugcne Rozenburgh, .Ir, ~ ,.IT)FNTlFYING LNFaRMArION __ _ (.'/O Keene Jabbour ESQ. (ERI Fife Number: 'i GECS0000039554 _~ Crcd~tar Account Number ~ 601136112+5~07~>55_~ 701 Waxhin ton Street ~' ~ ~' -' ~ l Creditor: _ I GF, C:apitat Cor~ura.iim~! Ettsttzn, YA 18042 SETTLEMENT AMQUNT: i 54,127,01 Make Check Payable '1'0 ~:sts-tc Recoveries, lne. P.4. Box 15380 Baltintorc, MD 21220 'i; ~ ~..~ ,,' .. , ~~~ Xn~;NTIFYlNG LYFURViATlUrr ~ ~ ~ _ __ ~ Greditor~ GE Ca ital Co rna:ion -{ Client: Sams Club I _ Pri imu.~~ Account H~~1cic~r: Eugene Rozenhur~h !r.~ ERI File Number: t GECS000003~554 Account Number: ACCOUNT BALANCE: 601 136;12680?96s 56,878.35 .~ _~-- -~ ltemitta>ace Rn P.O. Box 837 Newtown, CT 06470 Change Service Requested June 30, 2008 PERSONAL & CONFIDENTIAL #BWNLPGJ #0654 2700 0818 9936# I~~JII~~~II~I~~~I~~II~J~~J~IL~L~~I~I~~IJ~~II~~I~LIJ~~I s Rozenburgh, Eugene 23291186 a 635 E Pine St Mahanoy City, PA 17948-2822 P.O. Box 837 Newtown, CT 06470 (800)750-6343 Fax (203) 426-9630 ACCOUNT IDENTIFICATION EAS Account Number: 23291186 Creditor #: 239464- 4 Creditor: Comcast Harrisburg Equipment Notice Date: June 30, 2008 Service Balance Due: $ 0.00 Equipment Balance (if not returned): $ 79.00 Total Balance Due: $ 79.00 * * * FIRST NOTICE * * ~ Your account has been placed with this office for collection. To avoid further collection activity, pay it in full. If you can not pay it in full or have a problem, contact our office. * * IMPORTANT * Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days from receiving this notice, this office will: obtain verification of the debt or obtain a copy of a judgment and mail you a copy of such judgment or verification. If you request this office in writing within 30 days after receiving this notice, this office will provide you with the name and address of the original creditor, if different from the current creditor. To be sure of proper credit and to stop further procedure make your payment in full. This is an attempt to collect a debt. Any information obtained from you or anyone else will be used for that purpose. This communication has been sent by a debt collector. Office hours are gam to Spm EST, Monday -Friday. ------ ----------------------------------- ------Detach and Return with Payment-------------_ ---------------------------------------- Enter the requested information in the spaces provided below: Change of Address: For: Eugene Rozenburgh Street Address: City, State, Zip: Creditor #: 239464- 4 Creditor: Comcast Harrisburg Equipment Notice Date: June 30, 2008 EAS Account Number: 23291186 Service Balance Due: $ 0.00 Equipment Balance (if not returned): $ 79.00 Total Balance Due: $ 79.00 Telephone: Eastern Account System of Connecticut, Inc. P.O. Box 837 Newtown, CT 06470-0837 III~~~JI~~~I~JI~~~IIL~~II~~J~~I~~~II~L~~I~~II~I~~JJ~I~I FIRSTCBL 001486P 1 078 000641 182 065427 S-CRE EASTERN ACCOUNT SYSTEM OF CONNECTICUT, INC. New York License #1244261 Amount Enclosed: $ Please charge to my []Visa []MasterCard []American Express []Discover Card Number Expiration Date Name of Cardholder Signature Enclosing t is notice wtt your payment wt expe rte cre rt to your account. ESTATE CLAIMS SERVICE 9441 LBJ FREEWAY LOCK BOX 30 DALLAS, TEXAS 75243 972-644-6360 Mrs. Lillian Rozenburgh c/o Keene Jabbour, Esq. 701 Washington St. Easton, PA 18042 Re: Deceased:Eugene Rozenburgh Case #21-08-0559 PC #117664 Dear Mrs. Rozenburgh: Enclosed please find your copy of the creditor's claim filed on behalf of Kohl's/Chase Bank USA,N.A. in the above referenced case. Payment and any further notices should be directed to: KOHL'S/CHASE BANK USA,N.A. PC #117664 P.O. Box 741026 DALLAS, TX 75374 Thank you for your cooperation. If 2 can be of further assistance, I can be reached at 800-648-1519. Yours very truly, /~`~w ~jC~~ri~~i~ Mark E. Bennett Date: 9/18/08 Estate No: 21-08-0559 Date of Death: ~~ i ~ ~ ~ ~ deceased, in accordance with the attached statement of account the sum of $ 2 0 7.6 3 together with interest at the rate of from until paid. CLAIM AGAINST DECEDENT'S ESTATE The Claimant certifies that there is due and owing by the EUGENE ROZENBURGH On behalf of the claimant I do solemnly declare and affirm under the penalties of perjury that the information and representations made herein are true and correct of the best of my knowledge, information and belief. In the estate of: EUGENE ROZENBURGH CHASE BANK USA, N.A. Name of Claimant Re: Kohl's Dept. Store Address of Claimant Phone Number FILED: Mark E. Bennett, Agent ~~~ Signature of Claimant or person authorized to make verification on behalf of creditor 9441 LBJ Freeway Lock Box 30 Dallas, TX 75243 Address 972-644-6360 Phone Number THIS FORM MAY BE FILED WITH THE ORPHANS COURT UPON PAYMENT OF A FILING FEE OF $10.00. A COPY MUST ALSO BE SENT TO THE PERSONAL REPRESENTATIVE. t PROBATE COURT Cumberland County, State of Pennsylvania Eugene Rozenburgh, Deceased Case #21-08-0559 Proof of Mailing I mailed the creditors claim to the fiduciary (and attorney, if applicable) as follows: I deposited a copy/copies of the claim with the United States Postal Service in a sealed envelope with the postage fully pre-paid. I used first-class mail. I am employed in the county where the mailing occurred. The envelope(s) was/were addressed and mailed as follows: Mrs. Lillian Rozenburgh c/o Keene Jabbour, Esq. 701 Washington St. Easton, PA 18042 Date of Mailing: ~ Z f ~~ County of Mailing: Dallas, Texas I declare under penalty of perjury that the foregoing is true and correct. Date: Z f` a~'' ~~e~ Mark E. Bennett, Agent for Kohl's/Chase Bank USA,N.A. P.O. Box 741026 Dallas, TX 75374 SC8820/1 06/27/2008 KOHL'S ACCOUNT STATUS DISPLAY 06/27/2008 12:46 ID: PAS2 cct": 0446184228 52 Cycle: 22 Bi : 06/22/2008 Due: 07/17/2008 MVC: N VIP: N t/Lc: 90 601 CBS - DECEASED Op: 04/11/2006 Closed: 06/24/2008 Ins: N 'amel: EUGENE ROZENBURGH Home: 717 691 - 3501 Pull: 'ame2: Busl: - AScr: 433 04/08 .ddr 635 E PINE S~ Srce: I 00000001 Emp: NScr: 786 04/06 R N C/S Rstr: 33 05/08 MAHANOY CITY PA 179482822 AdChg: 06/12/2008 :nstr: PRMENT RECEIVED DC DOD IS 4-16-08 , ~CTEAS: N Pymnt H: 32NM2NLNMZN ---FNF------- Dun H: 321021010210000100000000 MKC: Y Last Stmnt Curr Stmnt Auths Last Reage: >rv Bal: 228.46 257.63 Avl Credit: 92.37 cur/Adv: Disputes teturns: Last Pymnt: 50.00 03/18/2008 ?ee/Int: 29.17 Cr Lmt E 300 06/23/2008 :r/Dr -50.00 Limit Ext ?ymnts MVC Pur Dbt Cde: N as,. Bal : __ 257.63 _ ____ __ 207.63__ _ ,207_63 Issued Cards Cnt Sts Issue date ~ Post Office Box 1754 Allentown, PA 18105-1754 610-798-4500 or Toll Free 877-345-8989 LEHI~H VALLEY PHYSICIAN GROUP Affiliated with Lehigh Valley Hospital & Health Network Patient Name: C~~O~,'1'~A_ ~~'a`'l Service Date: l ~~~o~., account #: C~c~tS~~ \a~~~ Payment due by: Physician Billing at this time, your account is considered past due and is currently being considered for further collection activity. We are willing to work with our patients and their families by setting up an affordable payment plan which fits into your budget. Currently your account has an outstanding balance of ~ \b'~~~~ We are able to establish a payment plan over the period of twelve(12) months. as long as payments are received consistently each month, you account will remain in current standing without possibility of further action. If you would like to take this opportunity to reduce your balance, you may do so by contacting customer service at: 610-798-4500 or toll free: 1-877-345-8989. You may also complete the bottom portion and return it with the enclosed envelope. If you do not prefer a budget plan and would like to pay your account in full, we accept: personal checks, money orders, Mastercard, Visa, American Express and Discover. You may also make payment at any of our Lehigh Valley Physician Group practices. Always include you account number on all correspondence. Thank You for your prompt attention to this matter. Sincerely, Lehigh Valley Physicians Group Collection Department I agree to pay g per month (up to 12 months). My first payment is enclosed. I agree to pay by credit card. Credit Card Holder's N Type of Card Exp Date Credit Card # servit~s 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-8640 Hours (CST): 7:00 am - 9:00 pm M - TH Fax 877-326-8784 7:00 am - 5:00 pm F TOLL-FREE 877-326-1534 $:00 am - 12:00 pm S October 31, 2008 KEENE JABBOUR 701 WASHINGTON ST EASTON PA 18042 Re: In the Estate of Probate Case No. Date of Death: Last known residence: Our Client: Account Number: Unpaid Balance Due: Reference No.: Dear KEENE JABBOUR: EUGENE ROZENBURGH 2008-00559 4/16/2008 110 CARPENTERSVILLE, PHILLIPSBURG NJ 08865 CITIBANK (SOUTH DAKOTA), N.A. THD CONSUMER ************1057 $117.08 4504429 Enclosed herewith is a copy of the Creditor's Claim for the above-referenced Estate. If you have any questions or if this is a duplicate claim, please call our company toll free at (877) 326-5168. Cordially, DCM Services, LLC Enclosures This company is a debt collector. We are attempting to collect a debt and any information obtained will be used for that purpose. Calls may be monitored or recorded for quality assurance purposes. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION -Side 1 of 2 - COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NOTICE OF CLAIM In Re: The Estate of: Court File No: 2008-00559 EUGENE ROZENBURGH Deceased TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). 1) Claimant's name: CITIBANK (SOUTH DAKOTA), N.A. THD CONSUMER 2) Claimant's address: C/O DCM SERVICES LLC, 4150 OLSON MEMORIAL HWY #200, MINNEAPOLIS MN 55422 3) Creditor listed below is the owner and holder of a claim in the amount of $117.08. 4) The facts upon which this claim is based is an account for credit evidenced by the attached Affidavit of Account Stated. 5) Decedent's address: 110 CARPENTERSVILLE, PHILLIPSBURG NJ 08865 6) Date of Death: 4/16/2008 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, I do solemnly declare and affirm er the penalties of perjury that they Information and representations made h 'n re true and correct to the best of my knowledge, information belief. Melanie A. Euston ,,~,~~ ~ Authorized Representative Dated: ~l•. aimant Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: KEENEJABBOUR Name 701 WASHINGTON ST Address EASTON, PA 18042 Cit /St t Z~ y a e/ ip ~~'7.0~ Date notice mailed This "Backer" must be used in Montgomery, Luzerne & Allegheny Counties = m~ 2n ~ m z 3 O O~ p ~ v ~ D ~ ~ ~ ~ .-. ~ 3 ._,; ~ ~ v ~ z _ ~ p c cn 3 z ~ m n o G7 a °' p N 3 m Z o a- cn '-` ~ o ~ ° ~ m ~, m N ~ ~ D ~ 000 z cn f7 m z ~ rn z ' ° o ~ ~ r n ! ~ C can N (~ ~ 3 +~ ~ ~ = 2 ° D n ~ ~ rn D ~ ~ D z ~ z D IN RE ESTATE OF: EUGENE ROZENBURGH AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Authorized Representative to make this Affidavit. 2. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of his/her duties. 3. The Decedent purchased merchandise in the amount of $117.08 evidenced by account number ************1057 Further your affiant sayeth not CITIBANK (S~'fJT~AKOTA), N.A. THD CONSUMER One of its Melanie A. Ellston Printed Name: Authorized Representative CITIBANK (SOUTH DAKOTA), N.A. THD CONSUMER C/O DCM SERVICES LLC, 4150 OLSON MEMORIAL HWY #200 MINNEAPOLIS MN 55422 Subscribed and sworn before me This ~ day of ~(1 ~y , 200 No Publi j JOSHUA PATRICK NOTARY PUBLIC STATE OF MINNESOTA MY COMM. EXP. 1-31-12 s ~ ~i~lc! ! 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-8640 Hours (CST): Fax 877-326-8784 TOLL-FREE 877-326-1534 October 31, 2008 KEENE JABBOUR 701 WASHINGTON ST EASTON PA 18042 Re: In the Estate of Probate Case No. Date of Death: Last known residence: Our Client: Account Number: Unpaid Balance Due: Reference No.: Dear KEENE JABBOUR: 7:OOam-9:OOpmM-TH 7:00 am-5:00pmF S:OO am - 12:00 pm S EUGENE ROZENBURGH 2008-00559 4/16/2008 110 CARPENTERSVILLE, PHILLIPSBURG NJ 08865 CITIBANK (SOUTH DAKOTA), N.A. M-SHELL CONSUMER **********5419 $271.06 4504472 Enclosed herewith is a copy of the Creditor's Claim for the above-referenced Estate. If you have any questions or if this is a duplicate claim, please call our company toll free at (877) 326-5168. Cordially, DCM Services, LLC Enclosures This company is a debt collector. We are attempting to collect a debt and any information obtained will be used for that purpose. Calls may be monitored or recorded for quality assurance purposes. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION -Side 1 of 2 - COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NOTICE OF CLAIM In Re: The Estate of: EUGENE ROZENBURGH Deceased Court File No: 2008-00559 TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). 1) Claimant's name: CITIBANK (SOUTH DAKOTA), N.A. M-SHELL CONSUMER 2) Claimant's address: C/O DCM SERVICES LLC, 4150 OLSON MEMORIAL HWY #200, MINNEAPOLIS MN 55422 3) Creditor listed below is the owner and holder of a claim in the amount of .$271.06. 4) The facts upon which this claim is based is an account for credit evidenced by the attached Affidavit of Account Stated. 5) Decedent's address: 110 CARPENTERSVILLE, PHILLIPSBURG NJ 08865 6) Date of Death: 4/16/2008 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, I do solemnly declare and affirm under the penalties of perjury that they Information and representations made rein are true and correct to the best of my knowledge, informatiq~r-and belief. ( ~ 11+Ic1ar~ie A. ~l[ston Dated: (f.'~.o $ .Authorized Representative Claimant Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: KEENE JABBOUR Name 701 WASHINGTON ST Address EASTON, PA 18042 City/State/Zip II.~ o~ Date notice mailed This "Backer" must be used in Montgomery, Luzerne & Allegheny Counties ~ m 0 n ~ c '-' O m ~ ~~ ~D ~ 3 ~ n r z C7 -i ~ v z ~ O ~ z ~ v D ~ ° ~3 ~ r rn n N 3 rn m O v 01 (n ~, w 3 ~ W z n z ~ rn ~ ~ ~ .A r cn N (~ ~ C -P ~ _ ~ to o p D 0 0 D O z ;' z D n _~ 3 rn D m O m C c~ rn z m O N m z c 2 rn n rn D m O s v~ C7 0 c z 0 N O O 0 0 ~o IN RE ESTATE OF: EUGENE ROZENBURGH AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Authorized Representative to make this Affidavit. 2. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of his/her duties. 3. The Decedent purchased merchandise in the amount of $271.06 evidenced by account number **********5419 Further your affiant sayeth not CITIBANK (SOUT AKOTA), N.A. M-SHELL CONSUME ~l One of rts Authorized Representatives: Printed Name: Melanie A. E1lston Authorized Representative CITIBANK (SOUTH DAKOTA), N.A. M-SHELL CONSUMER C/O DCM SERVICES LLC, 4150 OLSON MEMORIAL HWY #200 MINNEAPOLIS MN 55422 Subscribed and sworn before me This _~ day of r ~OV , 206 ~y ~' Notary Pub 'c JOSHUA T. PATRICK NOTARY PUBLIC STATE OF MINNESOTA MY COMM. EXP. 1-31-12 it I I ~{ ni OI mi of ~i ;I 0 zl ~I xl I of ~I al ~I I ZI ~I I I I I I I I I O IV ITl Z W C Gl S O O O O O O O O O O O O O O O 0 0 ru 0 0 0 w 0 W o- Ln r 0 0 0 0 r O t-' HUNT 080304-02433-0001 II I I I IIII~ II I II I ~II 6 STD BRE v-+700 = r~ON . rnm~ 'oDWW -_ ~~C~ Cm~~ 7oZn' w c~-~?A ~m0 Z<GC~~ DprZO . aDmmW ~~ A ~ ~ V O O 0 0 ao z~== mOC- z. °°~- ~x~= Zoo= ~~z= orn~- ~ m= -~ v o ~__ ~ n= `~ z ~~ ~ ~ Z ~ ~ ^~ fD T ~ O N ~ W ~ N ~ .p ~-~ O A W ~ n ~ A S F m mo D~ ~ N~(TI v o ~I,y d=*°-~ o ~ ~ CM o_~ Z m G ~ D ~ as Z ~ ~ ~ ^ r 1 mH m0 o d ,~~ ny ~~ N (CD ~ \~ ~ ~ D = a~ m~ Z.~.~ ~~ ~O N ~ D a~ ~, M ?a ~ ~~ <y Z ~ ~ `° _ ~ z N N T ~~ N 7 ~ d ~ N ~ ~ O fD ~ N N m a v 0 e a 0 a a c IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF EUGENE ROZENBURGH ,Deceased of 2008 No. 21-2008-0559 To the Clerk of the Orphans' Court: Enter the claim of CAPITAL ONE BANK (USA) NA Acct. 5178052465638993 In the amount of $3,589.57 ,against the above entitled estate. The decedent, who resided at PO BOX 551 DILLSBURG, PA 17019 died on 4/16/2008 .Written notice of said claim was given to LILIAN ROZENBURGH ,if known to claimant, at (Personal Representative or counsel) 110 CARPENTERVILLE RD PHILLIPSBURG, NJ 8865 June 25, 2008 (Date) on (Claimant) Address: 2323 Lake Club Drive, Suite 300 Columbus Ohio 43232 Claimant's Counsel Address b. D 0 v .a ~_ n a' (D z O D r_ n D r m 2 Z m V v A W W c~ D v m N W N W r v m n 0 <~ m c m w 0 0 0 a 0 W N W N n _~ Z z D m n D r z m W D Z C D Z D n _D m D m O m C m Z m O m z C 2 m n m D m 0 O 2 Z n -~ Z O N N 0 0 0 co Commonwealth of Virginia ) ss: County of Henrico ) LIMITED POWER OF ATTORNEY Now comes ~ Lh"li'~ fi'~t L rN- , a representative of Capital One, and hereby appoints Estate Information Services, LLC as its limited attorney-in-fact for the limited purposes of executing, filing, amending, negotiatins, settling andJor withdrawing estate claims with probate courts andlor executors throughout the United States on behalf of Capital One, as further provided in the contractual agreement between Estate Inforn~ation Services, LLC and Capital One. Be it known that this Limited Power of Attorney will be abolished upon the ternlination of the contractual agreement between Estate Inforn~ation Services, LLC and Capital One. Dated this ~ day of fcl'Tb~'t~c,~ ?007. Capital One By `~5~ Title: DlREe •rv,e Printed name: ¢~rt-st SNt~Ttr Swdrn and subscribed before me this' ]7*~ day of ~l l~~ , X007. a notary public in and for the Commonwealth of Virginia. x tary Public My commission ex ' es: _~:,~, MICHELLE RUTHERFORD NOTARY PUBLIC COMMONWEALTH OF VIRGINIA MY COMMISSION EXPIRES AUGUST 31, 2010 ~•?~' ~. C ~' ....~ .,,,~~ N ~ ~'M, ~' bt: o •! +~ No. ~~~~ _ _ 20 p ~' Received from _~ ~~li~i.-~=-,-.-. For z~ ' ° f~ofl~rs 1 u:!. ~ Dye 9~`_~~~'''~., ~~; (?_ WILLIAMS GROVE ASSOCIATES C/O D.L. FAGAN P.O. BOX 718 MECHANICSBURG, PA 17055 Voice: (717) 791-1201 Fax: (717) 791-1218 Tod- ~r~ ~ _ _ - _ -- - LILLIAN ROZENBURGH i 110 CARPENTERSVILLE ROAD PHILLIPSBURG, NJ 08865 Statement Date: Apr 28, 2008 Customer Account I D: 141 ROZ, E ~.': Date~~ ------ ,; Due Date -_. _ r` .Reference J _ _ _ _ _ Paid I J ~ ,Description WATER FEES SEWER/TRASH FEES PET FEES 3/25/08 3/25/08 LF0333 Full LATE FEES 4/10/08 4/10/08 0409980 Part LOT RENT WATER FEES SEWER/TRASH FEES 4/15/08 ~ 678 Payment on INV# CF02 Payment on INV# 0309980 Payment on INV# LF0333 Payment on INV# 0409980 4/22108 4/22/08 RETCK678 Part RETURNED CHECK RETURNED CK FEE 4/22!08 678RD Payment on INV# RETCK678 4/28/08 4/28/08 RETCK678(2) RETURNED CK (2ND ~~~ ~~.~ _ TIME) RETURNED CK FEE Amount Enclosed Amount ~ Balance ;- 14.75 284.75 42.00 326.75 10.00 336.75 32.08 368.83 254.00 622.83 16.14 638.97 42.00 680.97 -1.6.00 664.97 -320.75 ~ 344.22 -32.08 ~ 312.14 -0.17 ~ 311.97 369.00 680.97 25.00 705.97 -369.00 336.97 - 369.00 ~ 705.97 25.00 ~ 730.97 TOTAL _ ~ ~ j I I:' ~ 730.97 1 _- _ _ - -_ - ,. -~~ , ~ -- ~~ -~~ g. ' 0-30 ~. " 31-60 - - - - - - - _ __- 61-90~ *_1 Over 90 days,, ... 730.97 0.00 _ _ _ - - - { 0.00 ~ 0.00 o You may have forgotten this bill. Thanks for your attention. ~ `~ MAKE CHECKS PAYA8LE TO: Mahanoy City EMS Billing Office P.O. Box 726 New Cumberland, PA 17070 Patient Name: Patient SSN: Date. of Service: From: To: Primary Payor: Secondary Payor: TIN: 23-25111 19 ROZENBURGH, EUGENE J. Jr. XXX-XX-4473 4/15/2008 12:10 635 EAST PINE <Landing Zone> Highmark Medicare Services Continental Life MASTERCARD ~ ~ DISCOVER ~ VISA ~P.RD NUhABER EXP. DATE INVOICE DATE RUN NUMBER PAYTHlSAMO 11/17/2008 08-20314 $75.95 Local Telephone: 1-717-214-6018 Para Espanol !lame 1 _866-724-4114 Toll Free : 1-877-214-6018 FAX: 1-717-214-6020 email: info@ambulancebillingoffice.com EUGENE J. ROZENBURGH Jr. 110 CARPENTERSVILLE RD PHILLIPSBURG, NJ 08865-3507 6IIIIIIIIIIIIIIIINIIIIIII 611111011 PLEASE MAKE ANY CORRECTIO^IS TO ADDRESS ABGVE. Date Description 4/15/08 ALS Emergency Level 1 4/15/08 Mileage 4/15/08 Adjustment -Insurance 7/11/08 Adjustment -Insurance 7/11/08 Payment 7/11/08 Payment Total DETACH AND RETURN TOP PORrION WITH YOUR PAYMENT-. ___T - - - -- rocedure Total Discounts / ___Code___Qty Unit Price Charge Adjustments Payments __- --- _- A0427 1 - -- - - - 775.00 ~ ~ - A0425 2 9.50 19.00 -420.39 6.16 -288.62 -15.20 794.00 -414.23 -303.82 Medicare has paid their portion of these charges. The balance due is your responsibility. P/ease remit payment for the remaining balance. Thank you. Mahanoy City EMS, 877 214-6018 ROZENBURGH, EUGENE J. Jr. 08-20314 aa.,~~saMa~~.,~,~C IIYI~ffiMBBdNtlI _. AMBULANCE BILLING OFFICE PO. P,nx 77ft NFIA( CI LLr1RF 41 ~: nl Cl o~ ~~„~~. ,~~~, ~,~ serv~c~s 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-8640 Hours (CST): 7:00 am - 9:00 pm M - TH Fax 877-326-8784 7:00 am - 5:00 pm F TOLL-FREE 877-326-1534 s:oo am - 12:0o pm s KEENE JABBOUR 701 WASHINGTON ST EASTON PA 18042 Re: In the Estate of Probate Case No. Date of Death: Last known residence Our Client: Account Number: Unpaid Balance Due: Reference No.: Dear KEENE JABBOUR: October 31, 2008 EUGENE ROZENBURGH 2008-00559 4/16/2008 110 CARPENTERSVILLE, PHILLIPSBURG NJ 08865 CITIBANK (SOUTH DAKOTA), N.A. CITG CONSUMER *********9220 $128.08 4463103 Enclosed herewith is a copy of the Creditor's Claim for the above-referenced Estate. If you have any questions or if this is a duplicate claim, please call our company toll free at (877) 326-5168. Cordially, DCM Services, LLC Enclosures This company is a debt collector. We are attempting to collect a debt and any information obtained will be used for that purpose. Calls may be monitored or recorded for quality assurance purposes. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION -Side 1 of 2 - COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION NOTICE OF CLAIM In Re: The Estate of: Court File No: 2008-00559 EUGENE ROZENBURGH Deceased TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). 1) Claimant's name: CITIBANK (SOUTH DAKOTA), N.A. CITG CONSUMER 2) Claimant's address: C/O DCM SERVICES LLC, 4150 OLSON MEMORIAL HWY #200, MINNEAPOLIS MN 55422 3) Creditor listed below is the owner and holder of a claim in the amount of $128.08. 4) The facts upon which this claim is based is an account for credit evidenced by the attached Affidavit of Account Stated. 5) Decedent's address: 110 CARPENTERSVILLE, PHILLIPSBiJRG NJ 08865 6) Date of Death: 4/16/2008 7) That the claim arose prior to the death of the decedent on or about 8) On behalf of the claimant, I do solemnly declare and of 'rm under the penalties of perjury that they Information and representations de rein are true and correct to the best of my knowledge, informatigrfand beli f. iL[eianie A. Ellston Dated : ~ ~~~• O$ ( c R.uthorized Representative Claimant Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: KEENEJABBOUR Name 701 WASHINGTON ST Address EASTON, PA 18042 City/State/Zip 11.7•og Date notice mailed That the claim is secured by This "Backer" must be used in Montgomery, Luzerne & Allegheny Counties ~ O 3 D 3p C~ C~ ~~ ~ rn O ~ C7 D O ~ ~ 3 ~ ~ z ~ -i ~ ~ z O ~ 3 z ~ N D n ~ 3 n~i °i O N 3 m v µ r o° ~ ao < W 3 z n z ~ ~ ~ ~ r .-. ~ N N f~ ~ C ~ ~ _ ~ cn o p D O ~ D O z :' z D C) _~ 3 rn D rn O -n rn C G~ m z rn O N rn z W C 2 G m C7 rn D m v O v ~, v~ n 0 z 0 N O O O 0 l0 IN RE ESTATE OF: EUGENE ROZENBURGH AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Authorized Representative to make this Affidavit. 2. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of his/her duties. 3. The Decedent purchased merchandise in the amount of $128.08 evidenced by account number *********9220 Further your affiant sayeth not CITIBANK (SOU AKOTA), N.A. CITG CO SUMER / One of its Authorized Melanie A. F.llston Printed Name: authorized Representative CITIBANK (SOUTH DAKOTA), N.A. CITG CONSUMER C/O DCM SERVICES LLC, 4150 OLSON MEMORIAL HWY #200 MINNEAPOLIS MN 55422 Subscribed and sworn before me This ~ day of ~.~j V , 20 0 ~