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Home My WebLink About06-05-0915056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 0311 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 174-20-8296 03/07/2008 .02/24/1929 Decedent's Last Name Suffix Decedent's First Name MI Gottshall Grace A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ u 1. Original Return 2. Supplemental Return 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) _~' 6. Decedent Died Testate 7. Decedent Maintained a Living Trust . _..._,_. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Elizabeth J. Goldstein (717) 724-0266 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY Elizabeth Goldstein PC First line of address !- 355 N. 21st Street s ? ` ' - Second line of address ~ , Suite 202 ~ _ ~ ~. , ., < City or Post Office State.... ZIP Code DATE FILE , Camp Hill PA 17011 _ - - - i .. .. .- t Correspondent's a-mail address: ~- Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corcect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN TURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE 1370 Norton Road; Steelton, PA 17113 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 355 North 21st Street, Suite 202; Camp Hill, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~^ 15056052059 REV-1500 EX Decedent's Social Security Number decedent's name: Grace A Gottshall 174-20-8296 RECAPITULATION.. _.~ _ _ 1. Real estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 120,055.66 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. 61,580.65 6. Jointly Owned Property (Schedule F) ° -Separate Billing Requested ..... , . 6. 117,500.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (Schedule G) :Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 299,136.31 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 5,878.20 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 20,437.00 11. Total Deductions (total Lines 9 & 10) ................................... 11. 26,315.20 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 272,821.11 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. 272,821.11 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 45 272,821.11 16. 12,276.95 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g, 19. TAX DUE ......................................................... 19. 12,276.95 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT - 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Grace A Gottshall 174-20-8296 STREET ADDRESS 1123 Atland Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19} (1) 12,267.95 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 5,500.00 C. Discount 289.47 Total Credits (A+ B + C) (2) 5,789.47 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (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) 6,478.48 A. Enter the interest on the tax due. (5A) 6. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 6,478.48 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :........................................................................................ .. ^x ^ b, retain the right to designate who shall use the property transferced 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? ............ .. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... .. ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1j (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) percent [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-1503 EX+ (8-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER G. Aileen Gottshall 21-08-0311 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ IDARQ, Common Stock 26 Shares 128 18 2. Qwest Communications International, Inc. Common. Stock375 Shares 1,923.75 3. PPL Corporation, Common Stock 10 Shares 451.80 4. AT&T CommonStock 2, 365 Shares 82,905.08 5. AT&T Common Stock 162.668851 Shares 5,678.90 6. Comcast, Inc. Common Stock 505 Shares 9,933.35 7. LSI Corporation Common Stock 38 Shares 191.52 9. Verizon Common Stock 536 Shares 18,843.08 10. Lucent Stock 718 Shares 0.00 TOTAL (Also enter on line 2, Recapitulation) J $ 120,055.66 (If more space is needed, insert additional sheets of the same size) Qwest ~ About ~ Investor Information ~ Historical Stock Lookup: Qwest Page 1 of 1 west LOCAL PMUHE SERVICE WTEANET W{FtELESS LtSNG DISTANCE 01 G;'?i ~F`„"t .t~!-. F~.1,1.I l~hk FdEIN'~" E'~C}UFa$ ".'.: '~'4;R I~:F_:Rh7ti171;JtJ ~.~4"it.~~AT`~'3fsY C~Ll~~t_N+f:^Jt Historical Stock t.ookup: Qvuest . Symbol Investor Relatio.n..s Home Q (Common Stock) Financial Information Lookup Date C1 Stock Information ,March 07 ' 2008 __ _ _ Historical Stock I Look Up Lookup Qw.e~t Historical Stock Lookup U S__UVE...ST Re5ult5 History of Qwest Stock Date Requested 03/07/08 Dividend Info.r..rnation Shareo..w...ner Informatt.o....n.. Closing Price $5.14 Volume 11,104,080 Conferences. &.._Eyents Split Adjustment Factor 1.0000:1 Annual ReDOrts Open $5.09 Corporate Governance Day's High $5.19 Request. _Inform..ato.n Day's Low $5.07 Contact_US NOTE: The Closing Price, Day's High, Day's Low, and Day's Volume ha any stock splits and/or dividends which may have occurred for this sec above. The Actual Price is not adjusted for splits or dividends. The Spli cumulative factor which encapsulates all splits since the date shown at The closing price above is not necessarily indicative of future price per GO Copyright ~ 2007 Qwest ~ Legal Notices ~ Privacy Policy http://phx.corporate-ir.net/phoenix.zhtml?c=119535&p=irol-stockLookup&t... 6/4/2009 PPL: Historical Prices for PPL Corp -Yahoo! Finance Page 1 of 3 Yahoo! My Yahoo! Mail More Get the New, Safer IE8 Hi, amy Sign Qut ~~~G FINAhI~E % Search ~ WEB SEARCh DOW '~ 0.74~1o Nasdaq '~' 0.31% Fri, )un 5, 2009, 12:54PM ET - U.S. Markets clc GEf CtJOTES Finance Search PPL Corporation (PPL) At 12:39PM ET: 33.60 t slRllr~ ~ TRADE Try: ~V~w /~ i ~ r r Historical Prices Get Historical Prices for: GO SET DATE RANGE (?i; Daily Start Date: Mar 7 2008 Eg. Jan i, ,_~ :2003 ~~ Weekly End Date: Mar 7 2008 (~ Monthly Dividends Only Get Prices First ~ Prev ~ Next ~ Last PRICES Date Open High Low Close Volume Adj Close" 7-Mar-08 45.23 45.57 44.79 45.33 2,659,200 43.56 " Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last l Download To Spreadsheet ADVERTISEMENT http://finance.yahoo.com/q/hp?s=PPL&a=02&b=7&c=2008&d=02&e=7&f=2008&g=d 6/5/2009 ~omputershare Computershare Investor Services 250 Royall Street Canton Massachusetts 02021 www.computershare.com ELIZABETH GOLDSTEIN PC 355 NORTH 21ST STREET SUITE 202 CAMP HILL PA 17011 April 8, 2009 Company: AT&T INC. Registration: G AILEEN GOTTSHALL Holder Account Number: 00005305144 Our Reference: ATT/0002899900/8/RS/66032 Dear Ms. Goldstein: Thank you for contacting Computershare, the transfer agent for AT&T Inc. We appreciate the opportunity to be of service to you. On March 7, 2008, AT&T Inc. account number 00005305144 held 2,365 shares. On that date the closing price was $35.01 per share, giving the account a total market value of $82,798.65. On April 6, 2009, the account held 2,365 shares. The closing price on that date was $26.59 per share, giving the account a total market value of $62,885.35. The CUSIP number for this stock is 002068102. AT&T Inc. account number 00005305152 merged with account number 00005305144 on December 15, 2008. On March 7, 2008, AT&T Inc. account number 02002963909 held 162.668851 shares. On that date the closing price was $35.01 per share, giving the account a total market value of $5,695.03. On April 6, 2009, the account held 162.66851 shares. The closing price on that date was $26.59 per share, giving the account a total market value of $4,325.36. The CUSIP number for this stock is 002068102. On March 7, 2008, Comcast Corporation account number 03009185134 held 505 shares. On that date the closing price was $19.67 per share, giving the account a total market value of $9,933.35. On April 6, 2009, the account held 505 shares. The closing price on that date was $14.36 per share, giving the account a total market value of $7,251.80. The CUSIP number for this stock is 20030N101. On March 7, 2008, Idearc Inc. account number 00000355208 held 16 shares. On that date the closing price was $4.93 per share, giving the account a total market value of $78.88. On April 6, 2009, the account held 16 shares. The closing price on that date was $.029 per share, giving the account a total market value of $.46. The CUSIP number for this stock is 451663108. On March 7, 2008, Idearc Inc. account number 00012352000 held 10 shares. On that date the closing price was $4.93 per share, giving the account a total market value of $49.30. On April 6, 2009, the account held 10 shares. The closing price on that date was $.029 per share, giving the account a total market value of $.29. The CUSIP number for this stock is 451663108. LSI: Historical Prices for LSI Corp -Yahoo! Finance Page 1 of 3 Yahoo! My Yahoa! Mail More Get the New, Safer IE$ Hi, amy Sign Out ,~~~ F' ~!""E#'r ~ ~ Search _ _ __ _ ;~ NWEB SEARCF DOW ~ 0.11% Nasdaq *~' 0.45% Fri, ]un 5, 2009, 10:21AM ET - U.S. Markets clo: GET {iE1D7ES Finance Search LSI Corporation (LSI) At 10:05AM ET: 4.25 + w~ _~~. ~~ Historical Prices Get Historical Prices for: GO SET DATE RANGE ~;! Daily Start Date: Mar 7 2008 Eg. ]an 1, ~- , Weekl __ 2003 ...J Y End Date: 'Mar ? 2008 ~ Monthly tu~Z Dividends Only Get Prices PRICES First ~ Prev ~ Next ~ Last Date Open High Low Close Volume Adj Close" 7-Mar-08 5.06 5.18 4.90 4.99 10,570,100 4.99 Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last Download To Spreadsheet ADVERTISEMENT httn://finance.vahoo.com/q/hp?s=LSI&a=02&b=7&c=2008&d=02&e=7&2008&g=d 6/5/2009 CMCSA: Historical Prices for Comcast Corporation -Yahoo! Finance Yahoo! My Yahoo! Mail More Get the New, Safer IE8 Page 1 of 3 Hi, amy Sign Out 7 E Search __ _ _ _ _ WEB SEARCh DOW ~ 0.05% Nasdaq ~ 0.44% Frl, ]un 5, 2009, 10:22AM ET - U.S. Markets clo<. GE•r GtK'7TE# Finance Search Comcast Corporation (CMCSA) At 10:07AM ET: 14.15 ~ .E ~, ~, Trade Ncrw ' ~ a~art~ ~~ t'rt>rr= rna>~E~ ~1-, La~F.ASL Sc.~r.ilet LLL `~a___. ..........-. Historical Prices Get Historical Prices for:' GO SET DATE RANGE v' Daily Start Date: .. Mar __ 7 2008 Eg. lan 1, ' 2003 ~--. Weekly End Date: Mar 7 2008 ~ Monthly (~ Dividends Only Get Prices First ~ Prev ~ Next ~ Last PRICES Date Open High Low Close Volume Adj Close* 7-Mar-08 19.65 19.82 19.51 19.67 21,505,400 19.31 Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last Download To Spreadsheet ADVERTISEMENT http://finance.yahoo.com/q/hp?s=CMCSA&a=02&b=7&c=2008&d=02&e=7&f=2008&~=d 6/5/2009 Shareholder: G AILEEN GOTTSHALL 1123 ATLAND DR MECHANICSBURG PA 17055-5365 Our Control Number: 200905210001131 ', 54946310 -LUCENT TECHNOLOGIES GOTTSHALLG---A0000 ** - ** - 8296 (REORG) YEAR TO DATE ACCOUNT SUMMARY 179 537.0000 716.0000 0.00 0.0 .0000 $0.00 CERTIFICATE HISTORY (From :1996 To: 2009) LU 00631573 I 09/30/1996 I 179 I Stock SpIiUDividend ~ 00/00/0000 BOOK ENTRY HISTORY (From :1996 To: 2009 ) PLAN TYPE : IR001 01!01/2009 Balance Forward 537.0000 .0000000 .00 .00 .00 .00' 05/14/2008 Opening Balance 537.0000 .0000000 .00 .00 .00 .00 01/01/2008 Balance Forward .0000 .0000000 .00 .00 .00 .00 PAYMENT HISTORY (From :1996 To: 2009 ) There are no Payment History to be processed. Note:- For Security reasons, we are replacing the first five digits of your Social Security number with "**"-**"(asterisks) on correspondence that we send to you. REV-1508 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER G. Aileen Gottshall 21-08-0311 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. First National Bank of Marysville Checking Acct. 56,354.00 2. First National Bank of Marysville Savings Acct. 5,226.65 TOTAL (Also enter on line 5, Recapitulation) ; 61,580.65 > (If more space is needed, insert additional sheets of the same size) May 15, 2009 MAIN OFFICE One Centre Square • PO. Box B • Marysville, PA 17053 • Phone: 717-957-2196 • Fax: 717-957-4578 Elizabeth Goldstein PC 355 North 21St Street Ste 202 Camp Hill PA 17011 RE: Estate of G Aileen Gottshall DOD: 3-7-08 Here is the information you requested per your letter of 5-12-09: Checking 911879 G Aileen Gottshall Lisa Barbush Open: 5-1-06 Int Rate: .85% DOD Bal: $56,354.00 DOD Int: 37.14 Savings 18040993 G Aileen Gottshall Lisa Barbush Open: 5-1-06 Int Rate: .65% DOD Bal: $5,226.65 DOD Int: 2.70 If you need any additional information, please feel free to contact us. Sincerely, ~~~~ ~~ Barbara Recher Manager REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER G. Aileen Gottshall 21-08-0311 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• Lisa l3arbush ' 1370 Norton Road Steelton, PA 17113 B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF OECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~ • A• 0412700 1123 Atland Drive; Mechanicsburg, PA 17055 235,000,00 50% 117,500.00 Daughter TOTAL (Also enter on line 6, Recapitulation) 13 117,500.00 (If more space is needed, insert additional sheets of the same size) Form GA1_LTR - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Vincent Minnici P.O. Box 6873 Harrisburg, PA 17112 4/15/2008 Lisa Barbush Re: Property: 1123 Atland Dr Mechanicsburg, PA 17055-5365 Borrower: Client: Lisa Barbush File No.: 0804057 In accordance with your request, we have appraised the above referenced property. The report of that appraisal is attached. The purpose of this appreisal is to estimate the market value of the property described in this appraisal report, as improved, in unencumbered fee simple title of ownership. This report is based on a physical analysis of the site and improvements, a locational analysis of the neighborhood and city, and an economic analysis of the market for properties such as the subject. The appraisal was tleveloped and the report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice. The value contusions reported are as of the effective date stated in the body of the report and contingent upon the certification and limiting conditions attached. It has been a pleasure to assist you. Please do not hesitate to contact me or any of my staff if we can be of additional service to you. Sincerely, Vincent Minnici RL 001747 L Residential Appraiser SUMMARY OF SALIENT FEATURES Subject Address 1123 Atland Dr Legal Description Referenced in Deed Book 220 Page 265 Clty Mechanicsburg COUnty Cumberland State PA Lp Code 17055-5365 Census Tract o11s.o2 Map Reference 42-30-2106-063 Sale Price $ N/A Date of Sale N/A Borrower/Client Client: Lisa Barbush Lender Lisa Barbush Size (Square Feet) t,57s Price per Square Foot $ Location Suburban/Good Age 9 Years Condition Good Total Rooms 5 Bedrooms 2 Baths 2 Appraiser Vincent Minnici Date of Appraised Value 3nrzoos Final Estimate of Value $ 235,000 form SSD - "VtrnTOTAI' appraisal software by a la mode, inc. -1-800-ALAMODE Vincem Minnici Barbush Uniform Residential Aonraisal Reuort Flle# 0804057 The u ose of this summa ap raisal re ort is to rovide the lender/client with an accurate, and ad uatel sup rted, o inion of the market value of the subect roe Pro a AddreSS 1123 Arland Dr CI Mechanicstwr State PA L Code 17055-5365 BOnOWer Client: Lisa Barbush Owner of Public Record Aileen Gottshall Lisa l3arbush COUn Cumberland Le al Descd don Referenced in Deed Book 220 Pa a 265 Assessor's Parcel # a2-3o-z1 os-0s3 Tax Year 200a R.E. Taxes $ 3 1 oa Nei hbodlood Name Ashcombe Fanns U r AI1en Townshi Ma Reference 42-30-211)6-063 Census Tract 0116.02 Occu ant Owner Tenant Vacant S ecial Assessmems $ o.oo PUD HOA $ 135 er ear er month " Pro a Ri hts A raised Fee Sim le Leasehold Other describe Assi nment T e Purchase Transaction Refinance Transaction Other describe Market Value LendedCliem Lisa Barbush AddreSS Is the subject rope Curren offered for sale or has B been offered for sale in the twelve months rior to the effective date of this a raisal? Yes No Re ort data sources used, Offerin rice s ,and date S . Central Penn Multi-List Service Owner. I ^ did ^ did not analyze the contract for sale for the subject purchase transaction. Explain the results of the analysis of the contract for sale or why the analysis was not erformed. N/A Contract Price $ N/A Date of Contract NrA Is the roe seller the owner of ublic record? Yes No Data Source s Is there any financial assistance (loan charges, sale concessions, gift or downpayment assistance, etc.) to be paid by any party on behalf of the homower? ^ Yes ^ No M Yes, re ort the total dollar amount and describe the items to be aid. N/A Note: Race and the racial Com osNion of the nei hborhood are not a raisal factors. Nei htiorhood CftaracterisUcs Ors-Unit Housip Trends Otte-Unit Houain Present Larxl Use % Location Urban Suburban Rural Pro a Values Increasin Stable Declinin PRICE AGE One-Untt 75 % Builtt-Up Over 75% 25-75% Under 25% Growth Ra id Stable Slow Nei hborhood Boundaries are Lisburn Rd to the nort DemanNSu I Shorts e M Balance Over Su I Marketin Time Under 3 mlhs 3.6 mths Over 6 mths h Williams Grove Rd to the west Ros arden Blvd to the $ 000 rs 125 Low o 350 HI h 20 2-4 Unit % Mind-Fami % Commercial % south and Rt 15 to the east. 245 Pred, 8 Other 25 % Nei hborhood Descri lion The su act is located in a residential nei hborhood. Ma'or routes of travel are located within a reasonable distance of the sub'ecl. Em to ment for the area is rated as nod. The su 'ect nei hborhood is in a stale ose of its' life c Ge with o Ries in the nei hborhood havin ave e a al and the a rants of r ular maintenance. Su and demand a ors in balance for tha sub'ect ne' hborhootl. No adverse conditions are indicated. Market Conditions includin SU ort for the above conclusions Market conditions a ar stable for this time of ear. Marketin time for reasonable rived housin is within 0 to 3 months. Sales concessions althou h evident in some transactions are not 'cal of the common sales. Pro value a ar to be stable or showin moderate increases throe hoot the area. DimenSienS See L al Area .17 Acre Sha a Rattan ular VIEW Avers e $ eCdlC Zonl CIaSSI}ICatlenR Zonin DeSCrI lion Residential Zonin Com liance Le al L al Noncordormin Grandtathered Use No Zonin III al describe IS the hi hest and best use of subject roe as im roved or as ro osed er tans and s ec'rfications the resent use? Yes No ff No, descdhe Utllides Public Other (describe) Publk Other (describe) ON-sNe Im rovemerds - PuWk Private Electdc' Water Street As halt Gas Sanity Sewer Alle None FEMA S ecial Fbod Hazard Area Yes No FEMA Flood Zone C FEMA Ma # azo364oo15B FEMA Ma Date 1z/a/1s7s Are the utilities and off-site im rovemerrts ical for the market area? Yes No ff No, describe Are there an adverse site conditions or external factors easements, encroachments, environmental conditions, land uses, etc. ? Yes No ff Yes, describe There are no noted adverse or unfavorable easements or encroachments noted. Genera~Descri Ion Fotutdatwn ExteriorDesui 11on materials/condHion Interbr meteriets/caidition Units One One wittl Accesso Unit Concrete Slab Crawl S ace Foundation Walls PourdConcrete/Good Fbors C t wood vn uGood # of Stories 1 Sto T Det. Att. S-DetJEnd Unft Full Basement Partial Basement Basement Area 1 564 s .ft. Exterior Walls Brick vn I/Good Roof Surface Com sShin le/Good Walls D all/Good Tdnt/Flnish WoodlGood Existin Pro osed Under Const. Basement Finish o % Gutters & Downs outs Aluminum/Good Bath Fbor Ca vGood Desi n S le 1 Sto TH Year Built 2ooo Effective A e rs a Years Attic None Dro Stair Stairs Outside Erd /licit Sum Pum Evidence of Infestation Dampness Settlement Headn FWA HWBB Radiant Other Fuel Gas Window T e WoodDblHun Good Storm SasfVlnsulated Therm newnd/Good Screens Screens/Good Amenities Woodstave s # Flre laces # Fence Bath Wainscot Tile/Good Car Story a None Ddvewa # of Cars 2 Drivewa Surace As halt Gara e # of Cars 2 Fbor Scuttle Finished Heated Conlin Central Air Conditionin Individual Other Patio/Deck Porch Cov. ^ Pool Other EnUPorch Car ort # of Cars Att. ^ Det. Built-in A liances Refd erator Ran e/Oven Dishwasher Dis osal ®Micro wave Washer/D er Other describe Flnishetl area above rode contains: 5 Rooms 2 Bedrooms 2 Baths 1 57s S ears Feet of Gross Livin Area Above Grade . Additional features s ecial ever effiClent Items etC.. Therm ne windows EnGOSed Porch 2 car ra Fire ace Describe the condition of the roe includin needed re airs deterioration, renovations remodelin etc.. The su act is in nod condition with no re irs noted. Are there an h sical deficiencies or adverse conditions that affect the livabil' ,soundness, or structural int ri of the roe ? Yes No if Yes, descdbe Does the roe ene211 conform to the nei hborhaod functional utili , s le, condition, use, constructicn, etc. ? Yes No h No, describe Freddie Mac Fomn 70 March 2005 Page 1 of 6 Fannie Mae Form 1004 March ZuuS Form 1004 -'WinTOTAL' appraisal software by a la mode, inc. -1-800-ALAMODE 300Wtl1tlU09-l -'~! 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Su rt for the o inion of she value summa of com arable land sales or other methods for estimatin site valve me site value is based on the a raisers knowled a of st land sales with similar site as the sub ect. ESTIMATED REPRODUCTION OR REPLACEMENT COST NEW OPINION OF SITE VALUE...._________._......_._ ....................................... _$ ao 000 . SOUfCe Of COSt data Marshall and Swift DWELLING 1 578 S .Ff. @ $ 100.00 ...... ....... _$ 157 600 Oual' rati from cost service Avera a Effective date of cost data lnrzooa 1 564 S .Ft. $ 15.00 ..._______. _$ 23 460 - Comments on Cost A roach roll livin area calculations, de reciation, etc. fiances and e~dras ______ _______ _$ 10 000 ~ See attached addendum for structure dimensions. The Marshall and Swift Gara e/Ca rt 484 $ .Ft. $ 15.00 ______ _______ _$ 7 260 Valuaeon Service was used in the determination of the Cost A roach Total Estimate of Cost-New ...... ....... _$ 198 320 to value. Less Ph slcal Functional External De reciation 13 22a =$ 13 22a De reciated Cast of I rovements ......................_.______._.....__.. ....___. _$ 1as os2 •As-is` Value of Site Im rovements ____________________________________________ _______ _$ 10 000 Estimated Remainin Economic Life UD and VA an 56 Years INDICATED VALUE BY COST APPROACH ....................__.__.__....._.. _______. =5 235,os2 INCOME APPROACH TO VALUE (npi r wired b Fannie Mae) Estimated Montld Market Rent $ X Gross Rent Mufti tier = $ Indicated Value b Income A roach Sumrla of Income A roach Includin su ort for market rent and GRM PROJECT INFORMATION FOR PUDs (if a Ilcable) Is the develo er/builder in control of the Homeowners' Association HOA ? Yes No Unit e s Detached Attached Provide the folbwin information for PUDs ONLY if the develo er/builder is in control of the HOA and tfle sub'ect roe is an attached dwegin unit. Le al Name of Pro ect Total number of hales Total number of units Total number of units sold Total number of units rented Total number of units for sale Data source s Was the ro ect created b the cornersion of existin buildin s into a PUD? Yes No If Yes, date of conversion. Does the ro'ect contain a mufti-dwellin units? Yes No Data Source Are the units, comvnon elements, and recreation facilities ca fete? Yes No If No, describe the status of com Ietion. Are the common elements leased to or b the Homeowners' Association? Yes No If Yes, describe the rental terms and o lions. Describe common elements and recreational facilities. Not a livable with this re Freddie Mac Form 70 March 2005 Page 3 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - `WinTOTAL` appraisal software by a la mode, inc. -1-800-ALAMODE Uniform Residential Appraisal Report Fllek oaoaos~ This report form is designed to report an appraisal of a one-unit property or a one-unit property with an accessory unit; including a unit in a planned unit development (PUD). This report form is not designed to report an appraisal of a manufactured home or a unit in a condominium or cooperative project. This appraisal report is subject to the following scope of work, intended use, intended user, definition of market value, statement of assumptions and limiting conditions, and Certifications. Modifications, additions, or deletions to the intended use, intended user, definition of market value, or assumptions and limiting conditions are not permitted. The appraiser may expand the scope of work to include any additional research or analysis necessary based on the complexity of this appraisal assignment. Modifications or deletions to the certifications are also not permitted. However, additional certifications that do not constitute material alterations to this appraisal report, such as those required by law or those related to the appraiser's continuing education or membership in an appraisal organization, are permitted. SCOPE OF WORK: The scope of work for this appraisal is defined by the complexity of this appraisal assignment and the reporting requirements of this appraisal report farm, including the following definition of market value, statement of assumptions and limiting conditions, and certifications. The appraiser must, at a minimum: (1) perform a complete visual inspection of the interior and exterior areas of the subject property, (2) inspect the neighborhood, (3) inspect each of the comparable sales from at least the street, (4) research, verify, and analyze data from reliable public and/or private sources, and (5) report his or her analysis, opinions, and conclusions in this appraisal report. INTENDED USE: The intended use of this appraisal report Is for the lender/client to evaluate the property that is the subject of this appraisal for a mortgage finance transaction. INTENDED USER: The intended user of this appraisal report is the lender/client DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and open market under alt conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well informed or well advised, and each acting in what he or she considers his or her own best interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment is made in terms of cash in U. S. dollars or in terms of financial arrangements comparable thereto; and (5) the price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions* granted by anyone associated with the sale. Adjustments to the comparables must be made for special or creative financing or sales concessions. No adjustments are necessary for those costs which are normally paid by sellers as a result of tradition or law in a market area; these costs are readily identifiable since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in the property or transaction. Any adjustment should not be calculated on a mechanical doNar for dollar cost of the financing or concession but the dollar amount of any adjustment should approximate the market's reaction to the financing or concessions based on the appraiser's judgment. STATEMENT OF ASSUMPTIONS AND LIMITING CONDITIONS: The appraiser's certification in this report is subject to the following assumptions and limiting conditions: 1. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised or the title to it, except for information that he or she became aware of during the research involved in performing this appraisal. The appraiser assumes that the title is good and marketable and will not render any opinions about the title. 2. The appraiser has provided a sketch in this appraisal report to show the approximate dimensions of the improvements. The sketch is included only to assist the reader in visualizing the property and understanding the appraiser's determination of its size. 3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted in this appraisal report whether any portion of the subject site is located in an identified Special Flood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantees, express or implied, regarding this determination. 4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do so have been made beforehand, or as otherwise required by law. 5. The appraiser has noted in this appraisal report any adverse conditions (such as needed repairs, deterioration, the presence of hazardous wastes, toxic substances, etc.) observed during the inspection of the subject property or that he or she became aware of during the research involved in performing the appraisal. Unless otherwise stated in this appraisal report, the appraiser has no knowledge of any hidden or unapparent physical deficiencies or adverse conditions of the property (such as, but not limited to, needed repairs, deterioration, the presence of hazardous wastes, toxic substances, adverse environmental conditions, etc.) that would make the property less valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, express or implied. The appraiser will not be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, this appraisal report must not be considered as an environmental assessment of the property. 6. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory completion, repairs, or aherations on the assumption that the completion, repairs, or alterations of the subject property will be pertormed in a professional manner. Freddie Mac Form 70 March 2005 Page 4 of 6 Fannie Mae Form tuua nnarcn zuub Fonn t00d -'WinTOTAL' appraisal software by a la mode, inc. -1.800-ALAMODE Uniform Residential Appraisal Report Fllea 0804057 APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that: 1. I have, at a minimum, developed and reported this appraisal in accordance with the scope of work requirements stated in this appraisal report. 2. I performed a complete visual inspection of the interior and exterior areas of the subject property. I reported the condition of the improvements in factual, specific terms. I identified and reported the physical deficiencies that could affect the livability, soundness, or structural integrity of the property. 3. I performed this appraisal in accordance with the requirements of the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place at the time this appraisal report was prepared. 4. I developed my opinion of the market value of the real property that is the subject of this report based on the sales comparison approach to value. I have adequate comparable market data to develop a reliable sales comparison approach for this appraisal assignment. I further certify that I considered the cost and income approaches to value but did not develop them, unless otherwise indicated in this report. 5. I researched, verified, analyzed, and reported on any current agreement for sale for the subject property, any offering for sale of the subject property in the twelve months prior to the effective date of this appraisal, and the prior sales of the subject property for a minimum of three years prior to the effective date of this appraisal, unless otherwise indicated in this report. 6. I researched, verified, analyzed, and reported on the prior sales of the comparable sales for a minimum of one year prior to the date of sale of the comparable sale, unless otherwise indicated in this report. 7. I selected and used comparable sales that are locationally, physically, and functionally the most similar to the subject property. 8. I have not used comparable sales that were the result of combining a land sale with the contract purchase price of a home that has been built or will be built on the land. 9. I have reported adjustments to the comparable sales that reflect the market's reaction to the differences between the subject property and the comparable sales. 10. I verified, from a disinterested source, all information in this report that was provided by parties who have a financial interest in the sale or financing of the subject property. 11. I have knowledge and experience in appraising this type of property in this market area. 12. I am aware of, and have access to, the necessary and appropriate public and private data sources, such as multiple listing services, tax assessment records, public land records and other such data sources for the area in which the property is located. 13. I obtained the information, estimates, and opinions furnished by other parties and expressed in this appraisal report from reliable sources that I believe to be true and correct. 14. I have taken into consideration the factors that have an impact on value with respect to the subject neighborhood, subject property, and the proximity of the subject property to adverse influences in the development of my opinion of market value. I have noted in this appraisal report any adverse conditions (such as, but not limited to, needed repairs, deterioration, the presence of hazardous wastes, toxic substances, adverse environmental conditions, etc.) observed during the inspection of the subject property or that I became aware of during the research involved in pertorming this appraisal. I have considered these adverse conditions in my analysis of the property value, and have reported on the effect of the conditions on the value and marketability of the subject property. 15. I have not knowingly withheld any significant information from this appraisal report and, to the best of my knowledge, all statements and information in this appraisal report are true and correct. 16. 1 stated in this appraisal report my own personal, unbiased, and professional analysis, opinions, and conclusions, which are subject only to the assumptions and limiting conditions in this appraisal report. 17. I have no present or prospective interest in the property that is the subject of this report, and I have no present or prospective personal interest or bias with respect to the participants in the transaction. I did not base, either partially or completely, my analysis and/or opinion of market value in this appraisal report on the race, color, religion, sex, age, marital status, handicap, familial status, or national origin of either the prospective owners or occupants of the subject property or of the present owners or occupants of the properties in the vicinity of the subject property or on any other basis prohibited by law. 18. My employment and/or compensation for pertorming this appraisal or any future or anticipated appraisals was not conditioned on any agreement or understanding, written or otherwise, that I would report (or present analysis supporting) a predetermined specific value, a predetermined minimum value, a range or direction in value, a value that favors the cause of any party, or the attainment of a specific result or occurrence of a specific subsequent event (such as approval of a pending mortgage loan application). 19. I personally prepared all conclusions and opinions about the real estate that were set forth in this appraisal report. If I relied on significant real property appraisal assistance from any individual or individuals in the performance of this appraisal or the preparation of this appraisal report, I have named such individual(s) and disclosed the specific tasks performed in this appraisal report. I certify that any individual so named is qualified to perform the tasks. I have not authorized anyone to make a change to any item in this appraisal report; therefore, any change made to this appraisal is unauthorized and I will take no responsibility for it. I 20. I identified the lender/client in this appraisal report who is the individual, organization, or agent for the organization that ordered and will receive this appraisal report. Freddie Mac Form 70 March 2005 Page 5 of 6 Fannie Mae Form 1004 March 2005 Form 1004 -'WinTOTAL' appraisal software by a la mode, inc. -1-800-ALAMODE unnorm Hestaentiai Aaardisal Report Hies nanens- 21. The lender/client may disclose or distribute this appraisal report to: the borrower; another lender at the request of the borrower; the mortgagee or its successors and assigns; mortgage insurers; government sponsored enterprises; other secondary market participants; data collection or reporting services; professional appraisal organizations; any department, agency, or instrumentality of the United States; and any state, the District of Columbia, or other jurisdictions; without having to obtain the appraiser's or supervisory appraiser's (if applicable) consent. Such consent must be obtained before this appraisal report may be disclosed or distributed to any other party (including, but not limited to, the public through advertising, public relations, news, sales, or other media). 22. I am aware that any disclosure or distribution of this appraisal report by me or the tender/client may be subject to certain laws and regulations. Further, I am also subject tc the provisions of the Uniform Standards of Professional Appraisal Practice that pertain to disclosure or distribution by me. 23. The borrower, another lender at the request of the borrower, the mortgagee or its successors and assigns, mortgage insurers, government sponsored enterprises, and other secondary market participants may rely on this appraisal report as part of any mortgage finance transaction that involves any one or more of these parties. 24. If this appraisal report was transmitted as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal andfor state laws (excluding audio and video recordings), or a facsimile transmission of this appraisal report containing a copy or representation of my signature, the appraisal report shall be as effective, enforceable and valid as if a paper version of this appraisal report were delivered containing my original hand written signature. 25. Any intentional or negligent misrepresentation(s) contained in this appraisal report may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq., or similar state laws. SUPERVISORY APPRAISER'S CERTIFICATION: The Supervisory Appraiser certifies and agrees that: 1. I directly supervised the appraiser for this appraisal assignment, have read the appraisal report, and agree with the appraiser's analysis, opinions, statements, conclusions, and the appraiser's certification. 2. I accept full responsibility for the contents of this appraisal report including, but not limited to, the appraiser's analysis, opinions, statements, conclusions, and the appraiser's certification. 3. The appraiser identified in this appraisal report is either asub-contractor or an employee of the supervisory appraiser (or the appraisal firm), is qualified to pertorm this appraisal, and is acceptable to pertorm this appraisal under the applicable state law. 4. This appraisal report complies with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place at the time this appraisal report was prepared. 5. If this appraisal report was transmitted as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal andfor state laws (excluding audio and video recordings), or a facsimile transmission of this appraisal report containing a copy or representation of my signature, the appraisal report shall be as effective, enforceable and valid as if a paper version of this appraisal report were delivered containing my original hand written signature. APPRAISER Vincent Minnici Signature !~- A Name Vincent~~~ Company Name Minnici Appraisal Services Company Address P.O. Box 6873 Harristwrg, PA 17112 Telephone Number 7n s71-lass Email Address Minnici.appraisalst~comcast.net Date of Signature and Report April 17.2008 Effective Date of Appraisal 3nioa State Certification # RL-001747-L or State License # or Other (describe) State # State PA Expiration Date of Certification or License si3oi2oos ADDRESS OF PROPERTY APPRAISED 1123 Atland Dr Mechanicsburg, PA 17055-5365 APPRAISED VALUE OF SUBJECT PROPERTY $ 235,000 LENDER/CLIENT Name Company Name Lisa Barbush Company Address Email Address SUPERVISORY APPRAISER (ONLY IF REQUIRED) Signature Name Company Name Company Address Telephone Number Email Address Date of Signature State Certification # or State License # State Expiration Date of Certification or License SUBJECT PROPERTY ^ Did not inspect subject property ^ Did inspect exterior of subject property from street Date of Inspection ^ Did inspect interior and exterior of subject property Date of Inspection COMPARABLE SALES ^ Did not inspect exterior of comparable sales from street ^ Did inspect exterior of comparable sales from street Date of Inspection Freddie Mac Form 70 March 2005 Page 6 of 6 Form t OOA -'WinTOTAL' appraisal software by a la mode, inc. -1.800-ALAMODE Fannie Mae Form 1004 March 2005 Vincent Minnici Lender aA Zo Code APPRAISAL AND REPORT IDENTIFICATION This Appraisal Report is 4IIe of the following types: ^ Sell Cordalned (A written report prepared under Standards Rule 2-2(a) , persuant to the Scope of Work, as disclosed elsewhere in this report.) ®Summary (A written report prepared under Standards Rule 2-2(b) , persuant to the Scope of Work, as disclosed elsewhere in this report.) ^ Restricted Use (A written report prepared under Standards Rule 2-2(c) , persuant to the Scope of Work, as disclosed elsewhere in this report, restricted to the stated intended use by the specified client or intended user.) Comments on Standards Rule 2-3 1 certrfy that, to the best of my knowledge and belief: • The statements of fact contained in this report are true and correct. • The reported analyses, opinions, and conclusions are limited ony by the reported assumptions and limiting conditions and are my personal, impartial, and unbiased professional analyses, opinions, and conclusions. • I have rro (or the specified) present or prospective interest in the property that is the subject of this report and no (or the specrfied) personal interest with respect to the parties involved. • I have ra bias with respect to the property that is the subject of this report or the parties involved with this assignment. • My engagement in this assignment was not contingent upon developing or reporting predetermined resuhs. • My compensation far completing this assignment is not contngent upon the development or reporting of a predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurence of a subsequent event direcity related to the intended use of this appraisal. • My analyses, opinions and conclusions were developed and this report has been prepared, inconformity with the Untiorm Standards of Professional Appraisal Practice. • I have (or have not) made a personal inspection of the property that is the subject of this report. • No one provided signficant real property appraisal assistance to fhe person signing this certification. (K there are exceptions, the name of each individual providing significant real property appraisal assistance is stated elsewhere in this report.) Comments on Appraisal and Report Identification Note any USPAP related issues requiring disclosure and any State mandated requirements: APPRAISER: Signature: ~~~~ ~~~ Name: Vincent Minnici Date Signed: April n zoos StateCertificarion#: R~-oo~~a~-~ or State License #: State: Pn Expiration Date of Certification or License: sr3o/200s Effective Date of Appraisal: SUPERVISORY APPRAISER (only if required: Signature: Name: Date Signed: State Certificaton #: or State License #: State: Expiration Date of Certification or License: Supervisory Appraiser inspection of Subject Property: ^ Did Not ^ Exterior-ony from street ^ Interior and Exterior Form ID06 - "WinTOTAL" appraisal software by a la mode, Inc. -1-800-ALAMODE Sunnlemental Addendum F;IeNa.osoao57 BorreWef/CIieM Client: Lisa Barbush Pro AddfeSS 1123 Atland Dr ~I Mechanicstwr COU Cumberland State pA ~ Code 17055-5365 Lender Lisa Barbush SCOPE OF WORK ADDENDUM The intended users of this report are the Lender/Client only and not for any others. The Scope of Work to complete this report used the Sales Comparison to determine an opinion of Fair Market Value. The Replacement Cost is used only on new consVuction or properties that are less than 10 years old and the Income Approach is used when the subject is to be a single family rental property. REPORT REFERENCE COMMENTS Every effort has been made to conform to U.S.P.A.P. and in most cases even stricter interpretations found common to most investors in the secondary market. Exact "R" value insulation factors could not be determined. Any information stated on the appraisal was provided by the inspection where the insulation was visible, or by the owner or agent of the owner where the insulation was concealed. Heating systems abbreviations used in this report are as follows: The first letter denotes the fuel used - O = Oil, G = Gas, E = Electric, C = Coal, W =Wood, and D =Duel Fuel. The next series indicated the type of heat: BB =Baseboard, FWA =Forced Warm Air, HWBB =Hot Water Baseboard, CIB =Cast Iron Baseboard, STM =Steam (radiator or convector), HW =Hot Water (Radiator or Convector), RAD =Radiant (heating elements concealed in the ceiling or floors). Air Condition: CENT =Central Air, Wall =Built in wall units. Occasionally, the subject or comparable have special, higher efficiency heating systems: HEAT PUMP = a forced warm air heating system with a conventional backup heating system (usually electric, could be oil or gas) and central air conditioning. Comparable photos may show listing signs or weather cond'Aans different then the subject photos. Photos may be taken from the appraisers data base. All of the sales have been viewed by the appraiser as generally requested by the appraisers clients. Subject photographs are original photos taken at the time of the property inspection and have not been altered. The digital signature is an original signature that is password protected and is an accepted form of signing an appraisal. SUBJECT PROPERTY NOTATIONS There has not been a title search or survey completed on the subject property that would confirm or deny any encroachment, easements or deed restrictions on or against the subject property. At the time of the inspection of the subject unless noted in the appraisal report, none of the items mentbned in this paragraph were visibly noticed or apparent. The appraisal is made considering the items not present or having no effect on the overall typical use of the subject as valued in this report. If any of these items are present, the Fair Market Value as determined by this report may be adversely affected. When applicable wfthin the appraisal report, it is assumed, unless noted in the report, that the roof, plumbing, heating, electrical and air conditioning system, wells, septic tanks or cesspool are in satisfactory operating condition, that the building is structurally sound and free of termite infestatan and free of termite damage. The appraiser suggests that buyers, lenders and other interested parties obtain certifications from properly qualified professionals for their protection. The presence of UREA-FORMALDEHYDE FOAM INSULATION or RADON GAS has not been determined. If UFFI or RADON GAS is present, the appraised market value may be adversely affected. COST APPROACH COMMENTS The Cost Approach to Value for homes with an age greater than 10 years is considered inappropriate. This is due to the fact that a cost analysis for subject property is generally subjective, based on the appraisers estimate of depreciation, cost manuals general analysis for an area, and subjective statements from area contractors. Generalities in the cost analysis leads to the inaccuracy of the Cost Approach to Value and leads the client to improper conclusions. With the above information considered, lenders/clients generally desire to see the Cost Approach provided. It has been provided in this report, but the appraiser states that any reliance on the value established should be considered misleading. For that reason, although considered, the Cost Approach to Value is inappropriate. INCOME APPROACH COMMENTS The Income Approach to Value is considered inappropriate for use in this appraisal report. This is based on the fact that a typical purchaser for the subject property has an interest in the purchase for their primary residence opposed to the concern of the value generated, through investment, from the possible income produced. In additan, the verifiable information available is not a matter of public record and accuracy is, at best, considered limited in nature. For this reason, although considered, the Income Approach to Value is considered inappropriate for use in this appraisal report. Form TADD -'WinTOTAL"appraisal software by a la mode, inc. -1-800-ALAMODE Subject Photo Page Borrower/Client Client: Lisa Barbush Pro a AddreSS 1123 Atland Dr Ci Mechanicsbur COUn Cumberland State PA Z Code 17055-5365 Lender Lisa Barbush Subject Front 1123 Atland Dr Sales Price N/A Gross Living Area 1,57s Total Rooms 5 Total Bedrooms 2 Total Bathrooms 2 Location SuburbaNGood View Average Site .nacre Duality Brick,ViNGood Age a Years Subject Rear Subject Street Form PICPIX.SR - "Win70TAL" appraisal software by a la mode, inc. -1-800-ALAMODE Comparable 1 1133 Atland Dr PrOX, t0 SUbject 0.01 miles NE Sale Price 235,000 Gross Living Area 1,soo Total Rooms 5 Total Bedrooms z Total Bathrooms z Location Suburban/Goad View Average Site 16 Acre Duality Brick,Vin/Good Age 6 Years Comparable ; 1106 Atland Dr Prox. to Subject 0.02 miles SW Sale Price 235,000 Gross Living Area 1,654 Total Rooms 5 Total Bedrooms 2 Total Bathrooms 2 Location Suburban/Good YIBW Average Site 10 Acre Duality Brick,Vn/Good Age 5 Years Comparable 3 1101 Atland Dr Prox to Subject 0.02 miles SW Sale Price 2a5,ooo Gross Living Area 1,814 Total Rooms 5 Total Bedrooms 3 Total Bathrooms 2 Location Suburban/Good View Average Site .18 Acre Duality Brick,Vin/Good Age s Years Form PICPIX.CR - •WinTOTAL' appraisal software by a la mode, inc. -1.800-ALAMODE Comparable Photo Paae Aaaraisers 2009 Certification Borrower/Client Client; Lisa Barbush Pro a AddfeSS 1123 Atland Dr Ci Mechanicstwr Cou Cumt~erland State PA L Cnde 17055-5365 Lender Lisa Barbush t Camme~nr~~ealth of Pennsylvania Department of State ' ~' ~ ~ ~ ~ ~ ~ bureau of Prnfessionai and ~rcz;pational affairs PA 13ox ?64~ ttarrishur~ I'~ 171U5-2b49 Certiiliratc Type Certificate Status Certified Residential Appraiser Active Initial E:ertification Date 03/Q811994' VINCENT MINNICI 58i8 BARNSLEY DRIVE HARRISBURG PA 17iii Certif"state 'umber RLQ01747~ £xpiratio';r date 0613412t3Q9 ~': ! ,1 ~~di!S a ~ .-~ ,, ,y~r , ~,,., Form MAP.Trattic -'WinTOTAL' appraisal software by a la mode, inc. -1-800-ALAMDDE Building Sketch BOrrOWer/Client Client: Lisa 8arbush Pro AddfeSS 1123 Atland Dr CI Mechanicsbur COUn Cumberland State PA ZI COde 17055-5365 Lender Lisa 8arbush iz.v SMC~MM ~^" Comments: AREA CALCULATIONS SUMMARY Coda Owcrfptlon Nat 81za Nat Tohb GLA1 Sirat Floor 1576.0 1576.0 pjP porch 120.0 120.0 GAR Garage d84.0 484.0 Net LIVABLE Area (Rounded) 1576 LIVING AREA BREAKDOWN B»akdown 3ub0ohb Sirst Floor 16.0 z 4a.0 768.0 l.o : 4.0 4.0 6.0 z 50.0 300.0 14.0 z 36.0 504.0 4ltems (Rounded) 1576 Forth SKT.BIdSkI - "WinTOTAL' appraisal software by a la mode, inc. -1-800-ALAMODE Location Mao BOffOwef/Client Client: Lisa Barbush Pro a AddfeSS 1123 Atland Dr CI Mechanicsbur COUn Cumberland State PA Z Code 17055-5365 lender Lisa Barbush a la mode, tnc: ~ ~,s +~-~~x s~,__,~,. ~ ~,,~,o '~ Rey ~anry~rq 4a T''`~ n 1'BtttN~'. 'Y "'sss 94a ~tl" t 7 gU att 8 F; c^ r : 4'~' T~ ~ ~rbYSitire Ave 6 ?~•@~ m' ^~Syi Aua -- - N8 ~,,~~ - n~~xot k e::iald Ave FmAy Dr_ I O ~~r Shor~ton ~ I v O C~~ G~+nii~ '+~ R~ ,.... ~ NRiaseSa'Ue"awo a m~ o- Granada h. ¢° iu 15 ~ yfiite 4avm Ln ka 250 yd> M~erosolt' y Virtual Earth t, Form MAP.LOC -'WinTOTAL' appraisal software by a la mode, inc. -1-800-ALAMODE RECORDATION REQUESTED BY: WHE/N~ RECORDED/ MAIL TO: I ~ b/'~ ~ !~-% r.'d~'/L'~ ~~i~%~G'Cp d i Tax Parcel No.: L>~~ .~ t^ -~.y7,ic'~' .. ELF; ~ SEND TAX NOTICES TO: T ... _ -., .:;~~ JJi~I C~~t' ~... 7 fJ ~'~~1~ ~ tl f_i ~D (~~~`r ~ ~'(r3 3 'i? SPACE ABOVE THIS LINE IS FOR RECORDER'S USE ONLY DEED ~ ~~I~~1 This Deed is made the ,,~ . 'day of April, 2000, BETWEEN HAUBERT HOMES, INC., a Pennsylvania corporation, ("Grantor"), AND G. AILEEN GOTTSHALL, a single woman, and LISA R. BARBUSH, a married woman, as joint tenants with right of survivorship ("Grantees"). WITNESSETH That the Grantor, in consideration of One Hundred Sixty-Eight Thousand Two Hundred Eighty-Five Dollars and 00/100 Cents ($168,285.00), paid by the Grantees to the Grantor, the receipt whereof is hereby acknowledged, does hereby grant and convey to the Grantees: iUJI~ f~;r,~ PAGF ti~~ z ~:_~ ALL THAT CERTAIN tract or parcel of land known as Lot No. 124, Ashcombe Farms P.R.D., Phase 2A, situate in Upper Allen Township, Cumberland County, Pennsylvania, as shown on that certain Subdivision Plan for Ashcombe Farms P.R.D. prepared by Melham Associates, Inc., recorded in Plan Book 78, Page 37, being more particularly bounded and described as follows, to wit: BEGINNING at a point on the northwestern corner of Lot No. 125, said point being on the eastern right-of--way line of Atland Drive, a 50 foot wide street; THENCE along said right-of--way line along a curve to the left having a radius of 190.00 feet and an arc length of 40.18 feet, said arc being subtended by a chord of North 23 degrees 35 minutes 04 seconds West, a distance of 40.10 feet to a point, said point being on the southwestern corner of Lot No. 123; THENCE along the southern line of said lot, North 46 degrees 15 minutes 28 seconds East, a distance of 117.81 feet to a point, said point being on the western line of Lot No. 179; THENCE along the western line of said lot, South 43 degrees 44 minutes 32 seconds East, a distance of 8.00 feet to a point; THENCE continuing along said line, South 21 degrees 07 minutes 58 seconds East, a distance of $4.91 feet to a point, said point being on the northeastern corner of Lot No. 125; THENCE along the northern line of said lot, South 72 degrees 28 minutes 24 seconds West, a distance of 110.33 feet to the point and PLACE OF BEGINNING. CONTAINING: 7390.75 square feet or 0.1697 acres. BEING a part of the same premises which Country Square Partnership, a Pennsylvania general partnership, by its Deed dated March 13, 1999 and recorded in the Office of the Recorder of Deeds in and for Cumberland County in Deed Book 198, Page 252, granted and conveyed unto Haubert Homes, Inc., Grantor herein. UNDER AND SUBJECT to half of a 25 foot wide Controlled Facility Drainage Easement following the southern boundary as being shown in greater detail on Final Plat Sheet 1 of 1 of the aforementioned Subdivision Plan. ALSO UNDER AND SUBJECT to restrictions and covenants of record, including, but not limited to, Declaration for Ashcombe Farms P.R.D., a Flexible Residential Planned Community, dated April 6, 1998, recorded in the Office of the Recorder of Deeds of Cumberland County, in Miscellaneous Book 573, Page 407, First Amendment to Declaration of Ashcombe Farms P.R.D., a Flexible Residential Planned Community, -2- ~OC~K ~~~ PAGE ~~~ dated March 13, 1999, recorded in the Office of the Recorder of Deeds of Cumberland County in Miscellaneous Book 607, Page 440. ALSO UNDER AND SUBJECT to easements and rights-of--way of record and visible by inspection. Grantor hereby covenants and agrees that Grantor will warrant SPECIALLY the property hereby conveyed. IN WITNESS WHEREOF, the Grantor has hereunto set its hand and seal, the day and year first written above. ATTEST: M, ~' ~ "~ ,~ .,,_ t~~,~,~ ~~ a ~\: . ,, s r~ Title• ~- HAUBERT HOMES, INC. ~` _ f Name: Don E. Haubert, Sr. Title: President (Corporate Seal) -3- 8001( ~;Z~D FAGE 2~~ COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND On this, the ~-~ ` day of April, 2000, before me, a Notary Public in and for the above-named Commonwealth and County, the undersigned officer, personally appeared DON E. HAUBERT, who acknowledged himself to be the President of HAUBERT HOMES, INC., a corporation, and that as such officer, being authorized to do so, executed the foregoing instrument for the purpose therein contained by signing the name of the corporation by himself as President. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. ~~ `b' ~ `~: ~ ~ o. ' ~ ``' ~1C Yi n :. _~ ~ rze~ ~~ ~ . //~~~.~~~~w-1wr1 ~~f~'nn{n11Ri -4- aGGK 2~0 PAGE X68 CERTIFICATION OF ADDRESS I, hereby certify that thev~precise address of the Grantees herein is as follows: R j _~ -~ 11 _, ~4 i _ ~ ~ 31 1., i 1 C' ~ i ,~ ~,,- ~' ~, ~ ~~ Attorney or Agerit for Grantees . ~~ ~ ~ ~~~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. RECORDED in the Office for the Recorder of Deeds in and for said County in _~~~j Book ~ ,Page WITNESS my hand and official seal this ~ .~ day of _ 'fY1v~ , 2000. RETURN ORIGINAL TO: to °w- :-s° ..~ r~''i c::. r*i -• i n'~ '-Y rd ri? tC+ fit C":~ 1"~`! ^t^~ C"] :p: ~ :7J:: F-ti °r-1 1 :~ t 1-, h.-. i--` r:.N :.{.? .G, ". fM- tJ3 -N :d7 rn u... t,,.J f,,.t 4'.:`• IT9 S t^r7 ~ --•i ~-•a "~ ~ ~ ~° 1 i ~ ~ s ~ 221855 BO~K ~ P~~~ .~ ~ fiJ i Z] fSJ C7"^ tF~ t7ra ~"1? CJ^- '•.iJ W:'- n~• 4:+ I'sl y...+. ..i.`~ ..~'• iwrril F..+ I..A1 r4w1 -~ Y.w. M'. 1-..n. y..t Y ~ ~`r~ C.y is 7 1`:.} {,..J f fS +-.:~ CJ ~:":. ++.. 1'.»I X....1 f..J•1 ~] r"..~ ~' ~ {AY .. r~',~ .'~:JI G ~~ ~ 1~-'~:~~ ~ C r_ T~ C"? ~.+ r._n -.. w ;~s9 .~ n r=• e.A".1 r.~ -f:• ~r ro p~ ~..+ ~'Y >~ r•a ~, r-~ tJT w 4k. a -i- "'9 .t ?y ~'f1 -n -~•A ~_~. >.i ~»-~ i G ~. •~; ~ ~~ ~-• ru rn COMMONWEALTH OF PENNSYLVANIA STATE EMPLOYEES' RETIREMENT SYSTEM HARRISBURG REGIONAL COUNSELING CENTER 30 NORTH THIRD STREET, ROOM 319 HARRISBURG. PA 17101 TELEPHONE: (717) 783-9065 FAX: (717)783-9599 TOLLFREE: 1-800-633-5461 www.sers.state.pa. us March 24, 2008 AILEEN GOTTSHALL ESTATE C/O LISA BARBUSH 1370 NORTON ROAD STEELTON PA 17113 Re: G A GOTTSHALL SSN; 174-24-8296 This is in regard to the death benefit payable for the above referenced account. We will need a certified copy of the Death Certificate for G A GOTfSHALL. SE In the event there is an Estate, we will also need a Short Certificate naming the Administrator of the Estate. Include Employer Identification Number (EIN) [also known as Federal Tax Identification Number] for the Estate, the name of the payee exactly as it should appear on the payment and the address to where payment should be mailed. In the event there is no Estate, it will be necessary for the enclosed Next-of-Kin Affidavit to be completed, notarized and returned to this office. We ask that only one Next-of-Kin Affidavit be submitted to this office for processing. Upon receipt of the above-mentioned documents, we will proceed with the processing of this account for payment. If you have any questions, please call me at this office at (717) 783-9065. Sincerely, ~~ ~~, Linda Dolan Administrative Assistant In the event there is an Estate, please list the required information on the lines provided and return it to SERS: Employer Identification Number: 3 '3 [AKA Federal Tax Identification Number] Name of Payee to appear on payment: _~~S"~--__~ _ A~Bu.~`N Address to where the payment should be mailed: /~ 7d 710,e -fin- /` o ~c~ BEN62A REV•1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER G. Aileen Gottshall 21-08-0311 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 2,484.20 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City .State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Appraisal for House s. Short Certificates 9. Death Certificates Zip Zip 3,000.00 144.00 200.00 24.00 26.00 TOTAL (Also enter on line 9, Recapitulation) I $ 5,878.20 (If more space is needed, insert additional sheets of the same size) REV-1512 Ex+ (12-08j ~~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERRANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER G. Aileen Gottshall 21-08-0311 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. :Hospice of Central Pennsylvania 1,000.00 2. Insurance Group 161.75 3. '.;Upper Allen Twp. Sewer Billing 112.00 4. ' PPL Electric Utilities 23.25 5. United Water 8.63 6. UGI Gas Service 54.32 7. Cumberland Cty 4.90 8. 'Local Taxes 702.19 9. M&T Bank 521.02 10. 'M&T Bank Mortgage 17,848.94 TOTAL (Also enter on Line 10, Recapitulation) $ 20,437.00 If more space is needed, insert additional sheets of the same size. ~ M&T Banlc 1200 Market Street, Lemoyne, PA 17043 717 731 1730 F~ 717 761 6497 cst .~ ~-~..~ - ~ csv~n ~t~ February 23, 2009 The Estate of G Aileen Gottshall C/O Lisa Barbush To Whom It May Concern: ~c~ c~.nc~ a ~a ~o ~ (~ 8 X35, L~~7~~g ~c~au~. e.p 3 ~ - ~ ~ ~~ ~35,a4y.~ca The balance on the Home Equity Loan (100 001 9244853 0001) on March 7~' 2008 was approximately $35,697.88. Please call me if you have additional questions. Sincerely, ~ ~-~-~-- Leigh~ affer Assistant Branch Manager 1200 Market Street Lemoyne, PA 17043 717.731.1730 REV-113 EX+ (11-08; Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER G. Aileen Gottshall 21-08-0311 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. ~ Lisa Barbush ~ Daughter ~ 100% 1370 Norton Road; Steelton, PA 17113 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS; A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 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. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280607 HARRISBURG, PA 17128-0601 DECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-96) NO. CD OC9820 BARBUSH LISA R 1370 NORTON RD STEELTON, PA 17113 ACN ASSESSMENT AMOUNT CONTROL NUMBER ------ falA ESTATE INFORMATION: ssN: i 74-20-8296 FILE NUMBER: 2108-031 1 DECEDENT NAME: GOTTSHALL G AILEEN DATE OF PAYMENT: 06/02/2008 NOS~ilvlARK L7A1-E: C16/UL/1ul?~3 COUNTY: CUMBERLAND DATE OF DEATH: 03/07/2008 REMARKS: LISA R BARBUSH SEAL CHECK# 809 101 ~ 55,500.00 f TOTAL AMOUNT PAID: INITIALS: AKK RECEIVED BY; $ 5, 500.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER ,. ,~, . < ?>-,, i I, G. Aileen Gottshall of 128 Park Drive, Marysville, Perry County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. ITEM I. I direct that all my just debts and funeral expenses, including my cemetery lot, grave marker, and all expenses of my last illness, shall be fully paid and satisfied as soon as conveniently may be after my decease. ITEM II. I give my entire estate, of whatever nature and wherever situate, to my daughter, Lisa R. Barbush, of Steelton, Pennsylvania, provided she survives me by thirty days. In the event my said daughter, Lisa R. Barbush, should fail to survive me by said period of thirty days, I then give my entire estate, of whatever nature and wherever situate, in equal shares unto my surviving grandchildren I realize that I have a daughter, Jody Seig, and it is my intent that she not receive a share of my estate. ITEM III. In the event any beneficiary entitled to a share of my estate is a minor at the time of my death, said share or shares shall be held by my cousin, Barbara Holley, of Marysville, as guardian of the property for said minor beneficiary or beneficiaries until he/she/they attain the age of eighteen (18). ITEM IV. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. ITEM V. I nominate, constitute and appoint my daughter, Lisa R. Barbush, of Steelton, Pennsylvania, to be and act as my sole Executrix of this, my Last Will and Testament. In the event of her renunciation, death, resignation, or inability to act for any reason whatsoever, I then nominate, constitute and appoint my cousin, Barbara Holley, of Marysville, Pennsylvania, to be and act as my sole Executrix of this, my Last Will and Testament. I direct that my Executrix shall not be required to give bond for the faithful performance of her duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will. and Testament this _~__ day of January, 2000. ,-~~ 11 ,, ~r ; ~~ J ~ .Aileen Gottshall The preceding instrument was on the day thereof signed, published and declared by G. Aileen Gottshall, the testatrix named therein, as and for her Last Will and Testament, in the presence of us who, at her request and in the presence of her and each other, have subscribed our names as witnesses hereto. WITNESS: ADDRESS: %/~Ar~ >;l/P~~~~ /753 v~ ti~ccYti.~- ~ ~~~