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Home My WebLink About06-29-0915056041158 .J REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 D 8 0 919 Harrisburg, PA 1 7 1 28-060 1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 06142008 1202],919 Decedent's Last Name Suffix Decedent's First Name M I POOL MARJORIE K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (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 TO: Name Daytime Telephone Number LINDA LUNDBERG 71,7-730-2265 Firm Name (If Applicable) PNC BANK, N-A- First line of address P-O- BOX 308 Second line of address City or Post Office CAMP HILL Correspondent's a-mail address: State ZIP Code PA ],7001 REGISTER OF WILLS USE Y ~ ~ ~ ,:~. ~ `t -~ ~ CAD 'C7 ~ ~;_; ~~~ cn _. ~ C7 ~,~~ ...~ r_.+ ~ ~ ~ ~ ~ ~--~ ~ ; C ~fILED 4 ~._ a~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based ch preparer has any knowledge. SIGNATUR F-P SO RESPON LE FILING RETURN Ban , DATE BY : ~ v ~.CC-r D1--~C ~Qr.,~;- ~n 1 ~.1~1 ~Fi ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY ~,, Side 1 15056041158 6M46473.000 15056041158 J 15056042159 REV-1500 EX Decedent's Name#~ O O L M A R J R T F K RECAPITULATION 1. Real estate (Schedule A) 1. 0.OD 2. Stocks and Bonds (Schedule B) . 2. D • D D 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3. D , D D 4. Mortgages 8~ Notes Receivable (Schedule D). 4. D • D D 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 5. 3 6 0 3. 4 8 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 6 3 7 5 • D 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 701,559.60 8. Total Gross Assets (total Lines 1-7). 8. 71,15 3 8.0 8 9. Funeral Expenses & Administrative Costs (Schedule H) . s. 1, D 7 8 6.8 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I}. 1 0. 2 ],1, • 4 9 1 1. Total Deductions (total Lines 9 ~ 10) . 1 1. 10 9 9 8.2 9 12. Net Value of Estate (Line 8 minus Line 11) 12. 7 0 0 5 3 9.7 9 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) . 13. D • 0 D 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. ? 0 0 5 3 9.7 9 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 .OI~ D • 0 D 15. 0.00 16. Amount of Line 14 taxable at lineal rate x .oli5 700539.79 16. 31524.29 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17• 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18• 0. 0 0 19. TAX DUE 1s. 3],524 •29 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042159 6M46462.000 15056042159 REV-1500 EX Page 3 Decedent's Comulete Address: File Number ai, nA n9i.g DECEDENTS NAME POOL MARJORIE K STREET ADDRESS al~RLi~NU ~TI'Y CITY MECHANICSBURG STATE ZI P Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 0 • 0 0 B. Prior Payments 2 9 9 0 0. 0 0 C. Discount 14 0 0 • D 0 3. Interest/Penalty if applicable D. Interest 3 • 3 2 E. Penalty 0 • 0 0 (1> 31524.29 Total Credits (A + g + C) (2> 313 0 0.0 0 Total InteresUPenalty (D + E) (3) 3 • 3 2 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0 • 0 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) 227.61 (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 2 2 7 • 61 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; ~ ^ b. retain the right to designate who shall use the property transferred or its income; ~ ^ c. retain a reversionary interest; or . ^ 0 d. receive the promise for life of either payments, benefits or care? ^ 0 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) (1.1) (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 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)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 6 M4671 1.000 REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Marjorie K. Pool 21 080919 Include the proceeds of litigation and the date the proceeds were received by the estate. 3W46AD 1.000 (If more space is needed, insert additional sheets Of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERI'fA NCE TAX RETURN RESIDBdT DECEDf3~IT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER Mariorie K. Pool 21 080919 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVNNG JONVTTENANT(S) NAME A Pool, James H JOINTLY-0WNED PROPERTY: fTEM NUMBER LETTER FOR JOIN TENANT DATE MgDE JOII~IT DESCR~'T10N 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 DECD'S INTEREST DATE OF DEATH VALUE OF DECEDBJT'S INTEREST 1 A~ 6/8/2006 1947 Cessna Model 120 12,750.00 50.0000 6,375.00 Fixed Wing airplane Appraised By: William W. King (Copy of Appraisal attached) TOTA (acn antPrnn lino a RPr•~Fitulation) ~ $ 6, 375 00 (If more space is needed, insert addRional sheets of the same size) ADDRESS RELATIONSH~ TO DECEDENT 8932 Carlisle Road, Wellsville, PA 17365 Son 3W46AE 1.000 REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF NUMBER Marjorie K. Pool 21 08 0919 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBE DESCRIP1lON OF PROPERTY INCLIAETIf NOME OFTHETRANSFEREE, THEIR RELATIONSFpP TO DECEDENT AND rNr DOTE OF TRANSFER. ATfACHAC.OPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE 1• Marjorie K. Pool created a Revocable Trust under Agreement dated 2/5/98, as amended in its entirety under date of 2/12/02, naming PNC Bank, N.A., Trustee. The assets held in the trust have been valued as of 6/14/08 and are listed below (Items #1-#25) 300 Shares Automatic Data Processing Common New York Stock Exchange CUSIP: 053015103 12,924.76 100.0000 0.00 12,924.76 Dividend accrued on 6/14/2008 87.00 100.0000 87.00 2 200 Shares Bank Amer Corp Common New York Stock Exchange CUSIP: 060505104 5,957.50 100.0000 0.00 5,957.50 Dividend accrued on 6/14/2008 128.00 100.0000 128.00 3 400 Shares Cisco Sys Inc Common NASDAQ Stocks CUSIP: 172758102 10,501.50 100.0000 0.00 10,501.50 4 200 Shares Dentsply Intl Inc New Common NASDAQ Stocks CUSIP: 249030107 7,750.50 100.0000 0.00 7,750.50 5 20,000 Par Ephrata PA Area Sch District 4.5$ Due 10/1/098 CUSIP: 294223JN3 20,125.35 100.0000 0.00 20,125.35 Interest accrued to 6/14/2008 150.00 10.0.0000 150.00 Total from continuation sched les 643,934.99 TOTAL (Also enter on line 7, Recapitulation) ~ $ 701,559.60 (If more space is needed, insert additional sheets of the same size} 3W46AF 1.000 Estate of: Marjorie K. Pool Schedule G (Page 2) Item DOD Value No. Description of Asset ~ Interest Exclusion 6 500 Shares Exxon Mobil Corp Common New York Stock Exchange CUSIP: 302316102 7 300 Shares Fpl Group Inc Common New York Stock Exchange CUSIP: 302571104 Dividend accrued on 6/14/2008 8 350 Shares General Elec Co Common New York Stock Exchange CUSIP: 369604103 9 211.745 Shares Harbor Fd Intl Fd Inst Mutual Funds, Money Market Fds CUSIP: 411511306 10 100 Shares International Business Machs Common New York Stock Exchange CUSIP: 459200101 11 500 Shares Johnson ~ Johnson Common New York Stock Exchange CUSIP: 478160104 12 300 Shares Medtronic Inc Common New York Stock Exchange CUSIP: 585055106 13 20,000 Par North Hills PA Sch Dist 4.40 Due 10/15/09 CUSIP: 659868JP9 Interest accrued to 6/14/2008 Total (Carry forward to main schedule) 43,902.50 100.0000 20,032.50 100.0000 133.50 100.0000 10,108.00 100.0000 14,457.95 100.0000 12,562.67 100.0000 32,971.75 100.0000 15,333.00 100.0000 20,126.60 100.0000 146.67 100.0000 21 08 0919 Taxable Value 0.00 43,902.50 0.00 20,032.50 133.50 0.00 10,108.00 0.00 14,457.95 0.00 12,562.67 0.00 32,971.75 0.00 15,333.00 0.00 20,126.60 146.67 169,775.14 Estate of: Marjorie K. Pool Item No. Description 14 300 Shares Ppl Corp Common New York Stock Exchange CUSIP: 693517106 Dividend accrued on 6/14/2008 15 300 Shares Pepsico Inc Common New York Stock Exchange CUSIP: 713448108 Dividend accrued on 6/14/2008 16 5,000 Par Pine County, PA 4.50 Due 10/1/09 CUSIP: 721279EQ6 Interest accrued to 6/14/2008 17 15,000 Par Pike County, PA 4.50 Due 10/1/09 CUSIP: 721279ET0 Interest accrued to 6/14/2008 18 400 Shares Procter ~ Gamble Co Common New York Stock Exchange CUSIP: 742718109 19 100 Shares ' Safeco Corp s Common NASDAQ Stocks CUSIP: 786429100 20 100 Shares 3M Co Common New York Stock Exchange CUSIP: 88579Y101 Schedule G (Page 3) DOD Value of Asset ~ Interest Exclusion Total (Carry forward to main schedule) 15,122.25 100.0000 100.50 100.0000 20,095.50 100.0000 127.50 100.0000 5,039.45 100.0000 46.25 100.0000 15,087.23 100.0000 138.75 100.0000 26,507.00 100.0000 6,737.25 100.0000 7,578.00 100.0000 21 08 0919 Taxable Value 0.00 15,122.25 100.50 0.00 20,095.50 127.50 0.00 5,039.45 46.25 0.00 15,087.23 138.75 0.00 26,507.00 0.00 6,737.25 0.00 7,578.00 96,579.68 Estate of: Marjorie K. Pool Schedule G (Page 4) Item DOD Value No. Description of Asset $ Interest Exclusion 21 400 Shares United Technologies Corp Common New York Stock Exchange CUSIP: 913017109 27,435.00 100.0000 22 200 Shares Verizon Communications Common New York Stock Exchange CUSIP: 92343V104 7,330.00 100.0000 23 100 Shares Zimmer Hldgs Inc Common New York Stock Exchange CUSIP: 98956P102 7,036.25 100.0000 24 44,984.68 Units Blackrock Liquidity Funds Tempfund Principal Cash CUSIP: 993077106 44,984.68 100.0000 Interest accrued to 6/14/2008 56.25 100.0000 25 Blackrock Liquidity Funds Tempfund Income Cash CUSIP: 999077100 6,426.99 100.0000 Interest accrued to 6/14/2008 7.64 100.0000 26 Jama Pool 12,000.00 100.0000 Transfer within one year of death 27 Cory T. Pool 12,000.00 100.0000 Transfer within one year of death 28 Rose E. Pool 12,000.00 100.0000 Transfer within one year of death 29 James H. Pool 12,000.00 100.0000 Transfer within one year of death 30 William C. Pool 12,000.00 100.0000 Transfer within one year of death 31 Lola A. Pool 12,000.00 100.0000 Transfer within one year of death 32 James W. Pool 12,000.00 100.0000 Total (Carry forward to main schedule) 21 08 0919 Taxable Value 0.00 27,435.00 0.00 7,330.00 0.00 7,036.25 0.00 44,984.68 56.25 0.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 6,426.99 7.64 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 156,276.81 Estate of: Marjorie K. Pool Schedule G (Page 5) Item DOD Value No. Description of Asset ~ Interest Exclusion Transfer within one year of death 33 Andrew C. Pool 12,000.00 100.0000 Transfer within one year of death 34 Clark Pool 12,000.00 100.0000 Transfer within one year of death 35 Elizabeth Pool 12,000.00 100.0000 Transfer within one year of death 36 Eric Pool ~ 12,000.00 100.0000 Transfer within one year of death 37 S. Holland Pool 12,000.00 100.0000 Transfer within one year of death 38 ING Amity Contract # 2722089989FE 176,303.36 100.0000 Payable to Decedent's trust Proceeds 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 0.00 21 08 0919 Taxable Value 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 176,303.36 Total (Carry forward to main schedule) 221,303.36 REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Marjorie K. Pool 2108 0919 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. William C. Pool Reimbursement for cremation expenses and funeral luncheon 1,126.80 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) pNC Bank , N . A . Street Address 4242 Carlisle Pike City Camp Hill State PA Zip 17001 Year(s) Commission Paid: To be paid 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 7,115.00 2,000.00 City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Auer Memorial Home Fees for death certificates 30.00 2 Wildman ~ Obrock Income tax services 500.00 Total from continuation schedules 15.00 TOTAL (Also enter on line 9, Recapitulation) $ 10 786.80 7W46AG 1.DD0 (If more space is needed, insert additional sheets of the same size) Estate of: Marjorie K. Pool Schedule H Part 7 (Page 2} 3 Register of Wills of Carberl~and Coiarty Fee for filing Inheritance tax return Total (Carry forward to main schedule) 21 08 0919 15.00 15.00 REV-1512 EX+(12-08) SCHEDULE pennsylvania DEPARTMENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LtABILtTIES & LIENS ESTATE OF FILE NUMBER Marjorie K. Pool 21 OS 0919 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. swasAH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mar~orie K. Pool 21 08 0919 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal disVibutions, and transfers under Sec. 2116 (a) (1.2).] 1. Jama Pool 8932 Carlisle Road Wellesville, PA 17365 ' Gift within 1 year of death Daughter-in-law 9,000.00 2 Eric Pool 701 Dunkirk Drive Baltimore, NID 21212 Gift within 1 year of death Grandson 9,000.00 3 Corey T. Pool 8932 Carlisle Road Wellesville, PA 17365 Gift within 1 year of death Grandchild 9,000.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. ( NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 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. a 0.00 SCHEDULE J BENEFICIARIES swasAi 2.00o it more space is neeoea, insert aooitional sheets of the same size. Estate of: Marjorie K. Pool Schedule J Part 1 (Page 2) Item No. Description 4 Rose E. Pool 8932 Carlisle Road Wellesville, PA 17365 Gift within 1 year of death 5 Lola A. Pool 207 N. 38th St Harrisburg, PA 17109 Gift within 1 year of death 6 James W. Pool 207 N. 38th Street Harrisburg, PA 17109 Gift within 1 year of death 7 Andrew C. Pool 207 N. 38th Street Harrisburg, PA 17109 Gift within 1 year of death 8 Elizabeth Pool 701 Dunkirk Road Baltimore, MD 21212 Gift within 1 year of death 9 William C. Pool 207 N. 38th St Harrisburg, PA 17109 Gift w/i one year of death 9,000.00 1/3 share of residue 195,366.26 10 Susan H. Pool 701 Dunkirk Road Baltimore, MD 21212 Gift within 1 year of death Relation Grandchild Daughter-in-law Grandchild Grandchild Grandchild Son Daughter-in-law 21 08 0919 Amount 9,000.00 9,000.00 9,000.00 9,000.00 9,000.00 204,388.26 9,000.00 Estate of: Marjorie K. Pool Schedule J Part 1 (Page 3) Item No. Description 11 Clark R. Pool 701 Dunkirk Road Baltimore, MD 21212 Gift w/i one year of death 9,000.00 1/3 share of residue 195,388.26 12 James H. Pool 8932 Carlisle Road Wellsville, PA 17365 Gift w/i one year of death 9,000.00 1947 Cessna per Sch F 6,375.00 1/3 share of residue 195,388.27 Son Son Relation 21 08 0919 Amount 204,388.26 210,763.27 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 Telephone March 24, 2009 Robert A Laughead 1600 Market Street Philadelphia, Pa 19103 717 783-6893 Fax 717 772-0412 Re: Estate of Marjorie K Pool File Number 2108-0919 Dear Robert Laughead: This is in response to your letter of March 11, 2009 concerning the inheritance tax return due in the above referenced estate. Since it is apparent that you will be unable to file a tax return in the near future, the estate record will be placed in an informal hold status for an additional period of six (6) months so that the department will initiate no enforcement activity. At the end of that period we would ask that you contact us to provide an updated status for our file. The return may be filed at any time during the informal hold period. Kindly note that this action will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. Thank you for your cooperation, and, if I may be of any further assistance, please feel free to contact my office. incerely, Laurel Fulmer Supervisor Inheritance Tax Division Ifulmer@state. pa.us Amended AgYeement of Trust 2Z-2.4-00~- 312.'1 ~~6 THIS AMENDED AGREEMENT OF TRUST, made and entered into this ~? day of ~~~-v--t- , 2002, by and between R~IARJORIE K. POOL, as Grantor, hereinafter referred to as "Grantor",and PNC BANK., N.A., as Trustee. WITNESSETH: WHEREAS, Grantor and Trustee entered into an Agreement of Trust dated February 5, 1998; and WHEREAS, Paragraph 7 of said Agreement of Trust provides it may be amended by the Grantor; and WHEREAS, Grantor desires to restate the terms of said Agreement of Trust in its entirety; NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained, it is agreed by and between the parties hereto as follows: ARTICLE I: The assets presently held by the Trustee under the Agreement of Trust dated February 5, 1998, shall continue to be held IN TRUST and are hereinafter referred to as the "Trust", and Trustee, in consideration thereof, agrees to hold and administer said assets and any additions thereto, as Trustee, IN TRUST NEVERTHELESS, for the following uses and purposes: (a) Trustee shall have, hold, manage, invest and reinvest the same, collect the income and pay over the net income in quarterly installments to Grantor during the Grantor's lifetime. (b) During the lifetime of Grantor, Trustee shall pay to Grantor such portion or all of the principal of the Trust as such income beneficiary may from time to time request in writing. (c) Trustee may also expend so much of the principal of the Trust as, in its discretion, may be necessary and/or advisable to supplement alI income of Grantor in order to provide support and maintenance, including medical, hospital, nursing and nursing home care for such beneficiary. (d) Upon the death of Grantor, Trustee shall pay over to the Executor of Grantor's estate, to the extent that probate assets of Granter's estate are not available, as much of the principal as shall be required to pay all specific bequests provided in Grantor's will and inheritance and estate taxes, funeral and administration costs which may be incurred with respect to Grantor's estate. Thereafter, Trustee shall, if Grantor predeceases Grantor's husband, CHAMPS C. POOL, divide the remaining assets, proceeds from or on account of insurance policies received by reason of the death of Grantor, and any other assets and funds (hereinafter referred to as the "principal") into two (2) parts, each of which shall beheld in trust and constitute a separate Trust Fund, to be known as "Trust A" and "Trust B": -2- "Trust A": _ There shall be placed in "Trust A" that fraction of the total principal of which the numerator shall be a sum equal to the largest amount that can pass free of Federal estate tax by reason of the applicable credit amount and the state death tax credit (provided that the use of this credit does not require an increase in state death taxes) allowable to the Grantor's estate but no other credit and after taking account of property passing outside of this Agreement of Trust which does not qualify for the marital charitable deduction and after taking account of charges to principal that are not allowed as deductions in computing Grantor's Federal estate tax, and of which the denominator shall be the value of the total principal. For purposes of establishing such fraction, the values finally fixed in the Federal estate tax proceeding relating to Grantor's estate shall be used. Grantor recognizes that the numerator of such fraction may be zero (0}, in which case no property shall pay under "Trust A" and that said numerator may be affected by the action of the Executor of Grantor's estate in exercising certain tax elections. "Trust B": The balance of the principal not placed in "Trust A" shall be placed in "Trust B". ARTICLE II: The following provisions shall apply to "Trust A": (a) The Trustee shall pay the net income in quarterly installments to Grantor's spouse, CHAMPE C. POOL (the "Beneficiary"), during his lifetime, commencing from the date of Grantor's death. The Trustee shall also, from to time, pay -3- to the Beneficiary such amounts of the principal of this Trust as is necessary for the proper support, maintenance and medical care of the Beneficiary. (b) Upon the death of the Beneficiary, or if said Benef ciary predeceases Grantor, then upon Grantor's death, the Trustee shall distribute the remaining principal and any accretions thereto and any accumulations of income in equal shares to the B eneficiary's children. If any of the Grantor's children is not then living, his share shall be paid to his then living issue, per stirpes. If there is no such living issue, his share shall be paid to the survivors of them, or to the then living issue of the survivors of them, per stirpes, if none of them is then living. ARTICLE III: The following provisions shall apply to "Trust B": (a} The Trustee shall pay the net in come in quarterly installments to Grantor's spouse, CHAMPE C. POOL (the "Beneficiary"}, during his lifetime, commencing from the date of the Grantor's death. (b) During the: lifetime of the Benef ciary, the Trustee shall pay to the Beneficiary such amounts of principal of this Trust as the Trustee, in the sole discretion of the Trustee, deems necessary for the proper support, maintenance and medical care of the Beneficiary. (c) Upon the death of the Beneficiary, the Trustee shall pay over all of -4- the accrued or undistributed income to the estate of the Benef ci . ary All of the remaining principal shall be added to "Trust A", to be held, administered and dis tnbuted according to the provisions of ARTICLE II. (d) The Executor of Grantor's estate or the Trustee (hereinafter referred to as the "Executor" in this subparagraph d shall be ( }) authorized in the Executor's sole, exclusive and unrestricted discretion to determine whether to elect (under Section 2056(b){7) of the Internal Revenue Code of 1986 as amended, or any corresponding provision of the Federal estate law), to qualify all, none or a frac tion of "Trust B" for the Federal estate tax marital deduction. The decision o f the Executor with respect to the exercise of the election shall be final and conclusive u on all e P p rsons whose interests in Grantor's estate or "Trust B" are directl or indirec Y tly affected by the election. Only property which is fuI1y eligible for the marital deduc tion under Federal estate tax law shall be assigned to this Trust. I`lotwithstanding an hin to t Yt g he contrary contained herein, the Trustee of this Trust shall not retain be and a re Y asonable time any property which may at any time be or become unproductive, nor shall the y invest in unproductive property. Notwithstanding the provisions of sub ara a .P gr ph (c) of this Article, the Trustee shall pay to the Executor of Grantor's s Ouse's e P state, out of the principal of this Trust upon the death of Grantor's s Ouse an P amount equal to the estate, inheritance, transfer, succession and other death taxes "death t ( axes"), Federal, state and other, payable by reason of the inclusion of the value of Trust ro e . P P rty in Grantor's spouse's estate. Such payment shall be equal to the amoun t by which (1) the total of such -5- death taxes paid by Grantor's spouse's estate exc - - - eeds the total of such death taxes which would have been payable if the value of the Trust property had not been included in such spouse's estate. The determination by Grantor's s ous ' P e s Executor of the amount payable hereunder shall be final. Grantor directs the Trustee to pay such amount promptly upon written request of Grantor's s Ouse's . P Executor. The final determination of the amount due hereunder shall be base d upon the v~Ue as finally determined for Federal estate tax purposes in Grantor's s ous ' p e s estate. After payment of the amount fnaIly determined to be due hereunder the T rustee shall be discharged from any further Iiability with respect to such payment. Grant or's spouse may waive the right of payment under this subparagraph by Will, in which such spouse specifically refers to the right to payment hereunder given to the estate of Grantor's spouse. ARTICLE IV: Grantor or an o y Cher party or person, from time to time with the consent of Trustee, ma ' y made additional assets, by Will or other-wise sub' terms of this Agreement of Trust. ~ ,lect to the ARTICLE V: Whenever and as often as any beneficiary hereunder, to whom payments of income or principal are here' in directed to be made, shall be unable to act shall lack abili ~ , or ty, or in the sole judgment of the Trustee, shall o therwise be unable to apply such payments to the beneficiary's own best interest and adv antage, the Trustee shall make any portion of such payments in any one or more of the following ways: ~a) DirectIy to such benef ciary; -6- (b) To the Legal_ Guardian of su:,h beneficiary; (c) To a relative of such beneficiary, to be expended by such relative for the benefit of such beneficiary; or {d) By Trustee expending the .same for the beneft of said benef ciary. Provided that this ARTICLE shall not apply to "Trust B". ARTICLE VI: No part of the income or principal of the property held under this Trust shall be subject to attachment, levy or seizure by any creditor, spouse, assignee or trustee or receiver in .bankruptcy of any beneficiary prior to his or her actual receipt thereof. The Trustee shall pay over the net income and the principal to the parties herein designated, as their interests may appear, without regard to any attempted anticipation, pledging or assi ent by any beneficiary under the Trust, and without regard to any claim thereto or attempted lev Y~ attachment, seizure or other process against said beneficiary. ARTICLE VII: The Trustee shall possess, among others, the following powers: (a) To vary or to retain investments, when deemed desirable by the Trustee, and to invest in such bonds, stocks, notes, real estate mortgages or securities or in such other property, real or personal as the Trustee shall deem wise, without bein g restricted to so-called "legal investments" -7- ('v) In order to effect a division of the principal of a Trust or for any other purpose, including any final distribution of a Trust, the Trustee is authorized ~to make said divisions or distributions of the personalty and realty, partly or wholly in kind; and to allocate specific assets among beneficiaries and Trusts created hereunder so lon g as the total market value of any share is not affected by such allocation, division or distribution. Should it appear desirable to partition any real estate, the Trustee is authorized to make, join in and consummate partitions of Lands, voiuntaril or Y involuntarily, including giving mutual deeds, recognizances, or other obli ations with as g wide powers as can be exercised by an individual owner in fee simple. (c) To sell either at public or private sale and upon such terms and conditions as the Trustee may deem advantageous to the Trust, any or all real sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title free and clear of all trust and without obligation or liability of the purchaser or purchasers to see the application of the purchase money, or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds; assignments, options or other writings which may be necessary or desirable in c in QTY g out any of the powers conferred upon the Trustee in this paragraph or elsewhere in this instrument. (d) To mortgage real estate, and to make leases of real estate, extending beyond the term of the Trusts hereunder. -8- . _ ~~: {e) To borxow money from any party, including the Trustee, to pay indebtedness of a Trust and taxes, and to assign and pledge assets of a Trust therefor. Provided, however, that this paragraph shall not authorize borrowing from "Trust B". (fl To pay alI costs, taxes, expenses and charges in connection with the administration of a Trust, including a reasonable compensation to agents. If any estate or inheritance taxes are payable from the assets received by Trustee, such taxes shall be paid from. "Trust A". (g) In the discretion of the Trustee, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of a Trust. (h} To vote any shares of stock which form a part of a Trust. (i) To assign to and hold in trust an undivided portion of any asset. (j) To place and carry any asset of the Trust in the name of a nominee. (k) To do all other acts in the judgment of Trustee deemed necessary or desirable for the proper and advantageous management, investment and distribution of the Trust. ARTICLE VIII: No rule of law against self-dealing, divided Loyalty, or conflict of interest shall be applied to render any transaction effected by the Trustee void, -9- voidable, or otherwise subject to attack solely for violation of such rule, nor shall the Trustee incur any liability, nor shall any Trustee commissions for acting hereunder be reduced, solely for violation of such rule. Any transaction which involves self-dealing, divided loyalty, or conflict of interest by the Trustee shall be judged by the rules of law which would apply to the same transaction at arm's length between strangers free of any element of self dealing, divided loyalty, or conflict of interest. Thus, by way of illustration and not~of limitation, the Trustee is authorized, without giving any notice required by statute, to: (1) Employ and compensate the Trustee or any affiliate as broker, agent, or professional advisor for any purpose. (Z) Borrow from the commercial department of its Trustee or any affiliate at current interest rates. (3) Buy, retain, and sell any debt or equity security issued or underwritten by the Trustee or any affiliate and any debt security secured, supported, and/or otherwise enhanced by a letter of credit issued by the Trustee or any affiliate. (4) Buy, retain, and sell any security of any investment company or trust registered under the Investment Company Act of 1940 to which the Trustee or any affiliate renders services for compensation. (5) Buy propeity from or sell property to any beneficiary or Trustee acting hereunder ar otherwise on arm's Length terms. -10- An "affiliate" means any entity which owns, directly or indirectly, an interest in the Trustee, any entity in which the Trustee owns an interest, directly or indirectly, and any entity in common control with the Trustee. ARTICLE IX: It is agreed that the Grantor during- the Grantor's lifetime may, by inshzunent in writing delivered to the Trustee, modify, alter or revoke this Agreement in whole or in part. ARTICLE X: Trustee is authorized and directed to pay from the assets of "Trust A" all state and Federal estate, inheritance or succession taxes, together with all interest and penalties arising from said taxes, to the extent that the principal of this Trust is subject to any such taxes upon Grantor's death. ARTICLE XI: Any person who shall have died at the same time as Grantor, ar under such circumstances that the order of deaths cannot be established by proof, or within thirty (30) days of Grantor's death, shall be deemed to have predeceased Grantor. Any person (other than Grantor) who shall have died at the same time as any then recipient of income or under such circumstances that the order of deaths cannot be established by proof, shall be deemed to have predeceased such beneficiary. ARTICLE XII: The Trustee shall be compensated for its services hereunder in accordance with its published fee schedule as in effect from time to time. Without the permission of any court the corporate trustee acting hereunder may resign by a writing lodged with the permanent records hereunder, effective (1) after thirty days' written notice to each adult -11- income beneficiary and (2} a successor Corporate Trustee's execution of acceptance of appointment to act hereunder following the resignation. Such a successor corporate trustee may be located in or out of Pennsylvania and shall be appointed by the then acting trustees, including the corporate trustee who wishes to resign, even if such corporate fiduciary is then acting alone. IN WITNESS WHERE0~,11~IARJORIE K.. POOL, has hereunto set her hand and seal, and.PNC BANK, N.A. has caused this Agreement of Trust to be signed by its (Vice} President and its seal affixed, attested by its Assistant Secretary, and all on the day and year first above written. f.) ~~~~~ fitness GRANTOR: '~-~ ~~ `~~ (SEAL) RIE K. POOL TRUSTEE: ATTEST: .. ~ ~ /' (Assistant) Secretary By: {Vice) President (SEAL) -12- SC]EIEDULE "A" All assets now held in the Marjorie K. Pool Revocable Trust U/A 02/05/98, at PNC BANK, N.A. -13- April 14, 2009 Jim Pool 8932 Carlisle Rd Wellsville, PA 17365 ~~~ ~ ~ 200 "~~~ Dear Mr Pool: I apologize for the delay in getting this letter out to you. Once I began the research on the recent value history. of your Cessna 120, I found that there were more sources for this information than I had ~r~,iaaall anticipated. . , uj ~ 4'' ;';" r ry ~a w~,t we spoke on the phone about how rough this estimate will be but I want to mention it .f f. .. b?~.,~'p~tr, YF; ;~- ~~ ~ ~: praisal such as the one I prepared' for N2714N last month is an evaluation of the air ti nt in time which includes a physical examination of both the aircraft and the _ ` ' '~ records. Using the extensive database at the NAAA we are able to place a value on the ;Y ~ ` ~ ~ `;~°x ~ ~ ed point in time that is very dependable. Those appraisal reports have an excellent s ?~,. 4; _~:. ~ - , ;~47 ~ ; ess and accuracy. w , s ~'' ^,~' - - J ~ ~ `~ ~r to produce an estimate of the value of your airplane as of Mid June of 2008, this is what I ~t ~_ dY~` i~~'ewed the three issues of Trade-A-Plane from June of 2008. I reviewed two other aviation i ~~s~Y~ ublications from that time period. I spoke to several sellers and interviewed them on the general ..'- ,.._.h ~r... ~ discussed the rice that they got for their . . ;. -~ dondition of their airplane and, when they were willing, P aircraft. I don't want to give the impression that I spoke to dozens of sellers. I did not I was able to speak to a few. My objective was to give you as close an estimate to the value of your airplane in June of last year.. . I think if you had been selling N2714N is mid 2008, you could have expected about $12,750. I hope that this will give you what you need. Call i_f you have any questions. AIRCRAFT APPRAISAL REPORT Client: James H. and Marjorie K. Poole Attention: Jim Poole Company: Phone: Address: 8932 Carlisle Rd. Wellsville, PA 17365-973 This appraisal report is intended to be used by: This appraisal report is to be held strictly confidential and should not be disseminated to anyone other than the intended users without the client's permission. It is intended that this appraisal report be used to estimate the Market Value of the subject aircraft in U.S. dollars for Estate Settlement purposes. For the purposes of this aircraft appraisal report the aircraft is considered to be free and clear of all liens and encumbrances, unless noted within the report. This aircraft appraisal report is intended to be used by the client for the purpose(s) noted. It should not be used for any other purpose, nor should it be considered valid after the expiration date expressed in the report. The entire appraisal is based on this appraiser's visual inspection of the aircraft and its records on the effective date of this report. This report is not intended to be an evaluation of the mechanical condition of the aircraft, nor is any of the data herein intended to be used for evaluating the mechanical condition of the aircraft. Aircraft Identification Make: CESSNA AIRCRAFT COMPANY Model: 120 Serial No: 12972 Reg. No.: N2714N Yr. Mfg.: 1947 Page 1 of 8 Appraisal Worksheet: 20090312N2714N Type of Aircraft: Single Engine Piston Airframe Total Time: 1751 Hrs. No. Landings: N/A Cycles: N/A Airframe Condition: Very Good Log Books in Aircraft Appear: Original Comments: The Maintenance Logs for N2714N are contained in 5 logbooks. The records show the 60+ year history with a time line that is generally easy to follow. Together the multiple logbooks create a picture of an aircraft that has been well cared for while being lightly used. Maintenance Status Maintenance Inspection Date: 05/01/2007 On Progressive Inspection: No Comments: The aircraft has had at least two "rebuilds" over the years. One of those rebuild projects involved changing out part of the airframe. The aircraft has the forward section of a Cessna C-140, which includes the cockpit and firewall forward. The wings are C-120 wings (No Flaps). Time Life Limited Systems: No Cycle Life Limited Systems: No Comments: Service Bulletin Status: AD's Complied With: Yes Estimated Cost for AD's Compliance: SN/A Tires Condition: Average Type Brakes: Anti-Skid: No Exterior Pain# Condition: Good Repaint Date: N/A Repainted By: N/A Comments: This aircraft has been owned and maintained in the Poole family for several .years. Mr. Poole is an A&P with IA privileges. The aircraft is hangered at his home on Kampbell Airport in Wellsville, PA. Interior Condition: Extra Fine . Cockpit Condition: Extra Fine Cabin Configuration: Passenger Panel Layout: Average Pressurized Cabin: No Window Condition: Average Comments: It is the opinion of this appraiser, that the interior of N2714N is the real show case of this aircraft. At some point in the life of this airplane (maybe during one of the rebuilds) the standard C 120 bench seats were replaced with the seats of a C 150 (or 152). The seats and door Page 2 of 8 Appraisal Worksheet: 20090312N2714N panels are done in a gray and white leather that extends back into the baggage area. The carpet is in very nice shape. Three point shoulder harnesses have been installed for both seats. An ,interior like this on a 62 year old airplane is very rare. Airframe Modifications None Known or Reported. Damage History Current Damage: None Listed Historical Damage: None Listed En ' nes & Props Engine Manufacturer: Continental Engine Type: Piston Engine Fire Detection: No Model: C85-12F Engine Fire Bottles: No Engine #1 Serial No.: 26910-7-12 Hrs. Time Since Major Overhaul: 1064 Hrs. Recommended TBO: 1800 Hrs. Comments: Propeller #1 Propeller Type: Fixed Pitch Make: Mc Cauley Model: 1 A190 TSO/New: 0 Date O/H: Comments: Engine Total Time: 1751 Engine Overhauled By: N/A Serial No.: 17255 No. Blades: 2 Page 3 of 8 Appraisal Worksheet: 20090312N2714N i 3/01/2009 13:2 FAX 7177748327 None mown or Reported. HARRISBURG FSDO En 'ne Modi~catioms Known MaYatenance Problems with ~agine(9): None lmown or reported EstYmated Cost to RepaiY: N/A Greaeral ~ag~ne Comments: None known or reported Full Psner: Yes ~'anel Conf guratioa: Average MFR Equipped: No Instramentation Duai Panel: No Panel Coaditio~n: Average Comments: 'phis panel is standard for this gear and model. I want to note here that the panel mounted .A.pollo Nav Com is listed in the aircraft documents as being a lvtodel 702 Com Avionics Type of AvioniC: ALTIlVIE'I"ERS, ENCODING Mfg: NARCO Model: NOT LISTED Quaatity: 1 hype of Avionics LORAN Mfg: APOLLO Page 4 of S Appraisal Worksheet: 20090312N2? 14N 05/01/2009 13:52 FAX 7177748327 1Vlodel: 618 HARRISBURG FSDO Quantity: 1 Type of ,A-.vionic: NAV/C~MM Mfg: APOLLO Model: 702 Com 'T`ype of A~vlonic: TRANSFC~NbFRS Mfg: NARCO Model: AT l50 Quantity: 1 Quantity: 1 The Avionics O~ This Aircrat~t A-re Considered To Be: Average bual Controls: No Stall Warning Systeu~: No rotating Bencoa: No Taxi Lights: No Long ~iia~nge Fuel: No Single point Refuel: No Toilet: No Galley: No Other Equipment: Comments: N/L Adt~itioaal Eauxpment 'T'ype: Stick Shaker: No Strobe Light: No Navigation Lights: No 'total Fuel Capacity: 0 Lavatory: No Cabinetry: No f~ 002/002 .D~-Ycin~ Systems Known Ice System: No Ice Lights: No Prop De-Ice: No De-Ice Type: Wing Tsil Boots: No Boot9 Condition: N/A Windshield D~Ice: No Windshield Wipers: No Jet Intake De-Ice: No Pitot Ileat: No Comments: Page 5 of S Appraisal Worksfieet: 20090312N2714N Aircraft At~nraise_r's Comments The information contained in this report is private, confidential, and may be protected by attorney/clientlwork-product privilege. It is intended only for the use of the individual named above and the privileges are not waived by virtue of this having been sent by mail. If the person actually receiving this report or any other reader of the report is not the named recipient or the employee or agent responsible to deliver it to the named recipient, any use, dissemination, distribution, ,or copying of the communication is strictly prohibited. If you have received this communication in error, please immediately notify us by return a-mail andlor telephone and then destroy this original report. This aircraft is a well kept and cared for aircraft that shows remarkably well for its age. It is clean and properly maintained. It is just short of a show quality airplane due particularity to the excellent i„+°,~^.- This aircraft, N2714N, was personally inspected on 03/04/2009 by William King, member of the National Aircraft Appraisers Association, at Kampel Airport (2N5) Airport, located at Wellsville, York County, PA. Page 6 of 8 Appraisal Worksheet: `LUVyU:i 1 "Elul / 141V A, pp,raisai Computation Average Green Aircraft Value $2,950 Additions Add for Airframe Condition $354 Add for Airframe Low Total Time $354 Add far Annual and Mandatory Inspection $0 Add for Ezterior Paint Value $2,550 Add for Interior Value $1,800 Add for Airframe & Engine Modifications $0 Add for Engine(s) Residual Value $3,987 Add for Propeller(s) Residual Value ~ $0 Adc~ for Time-Limited Components $0 Add for Avionics Value $2,077 Add for De-Ice Systems Value $0 Add for Additional Equipment $0 Total Additions $11,122 Deductions Deduct for Airframe Condition $0 Deduct for Airframe High Total Time $0 Deduct for Damage History $0 Deduct for AirframelEngine Maintenance Items $0 Deduct for Ezterior Paint Value $0 Deduct for Interior Value $0 Deduct for AD's Estimated Cost for AD Compliance $0 Deduct for Estimated Cost to Repair Avionics $0 Total Deductions $0 Based on the above, the Market Value of N2714N is: $14,072 Page 7 of 8 Appraisal Worksheet: 20090312N2714N The information herein has been prepared from many sources and believed to be correct. does not warrant the accuracy of the source material. An inspection and inventory was conducted by a physical examination of the external surfaces o f the aircraft, cockpit and passenger cabin. It includes an inventory and assessment of condition o avionics, instrumentation and aircraft systems. No inspection plates were removed for internal inspection. Further, the logbooks and other aircraft records were carefully examined for compliance with FAA regulations relating to Airworthiness Directives, damage and maintenance history, along with other required inspections. The appraiser hereby certifies that he has no personal interest in the aircraft identified in this appraisal or any bias toward any of the parties who may be involved in the resulting transaction coincident to this report. The appraiser's fee is not contingent upon a predetermined value being reported or a percentage of the value being reported. All values expressed in this report are in U. S. Dollars unless otherwise stated. The effective date of this report is 03/12/2009 and the expiration date of this report is 06/10/2009. This report was written on 03/12/2009. This appraisal report may be used for the stated purpose exclusively and only in its entirety. Appraisal procedures, research methodology, market selection, and the resulting value conclusions can vary with the various purposes and functions of appraisal assignments. Therefore, this report, the markets selected, and the value conclusions are intended solely for the stated purpose and function. They are invalid for any other purpose or function. In the event of error or omission, the liability of, if any, is limited and may not, in any event, exceed the amount paid for the appraisal. Further, accepts no responsibility for usage of this form unless signed by an officer of the company. William King Page 8 of 8 Appraisal Worksheet: 20090312N2714N ING August 15, 2008 Marjorie K Pool Tntst ICO PNC Bank, ttee PO Box 308 Camp Hill, PA 17001 RE: Decedent: Marjorie K Pool PolicyNumber: 00027220899$9FE Explanation of Benefits Ap~~SO AUG, r ~s ~ ZQ08 Under separate cover, you will receive a check in the amount detailed below represen#ing the death benefi# payable to you under the above contract. The check consists of the death benefit due to you as of August 14, 2008. Basic Value $ 177,317.11 Interest on Claim $N/A Other Additions $N/A Loan Balance Due $N/A State Tax Withheld $0.00 • State Premium Tax Withheld $0,(}0 Federal Tax Withheld . $0,00 Other Deductions $0.00 Net Death Benefi# . $177,31.7.11 1'~~ ~ t`~~ ~~ t~l~, 3C~3 ~ ~ ~ ~1~.~ +~~ ~d~ ~ ~ ~ If you have any questions please call our Customer Sexvice Center at 1-800-366-0Obb. Sincerely, Claims Department Annuity Services Annuities are issued.and/or administered by ING Life Insurance and Annuity Company (Windsor, CT) and distributed by ING Financial Advisors, LLC (Enember SIPC) or other broker-dealers that maintain a selling agreement ER 11i `G USr1,~nnuiry mrd Life Irisztrruice Comprurn 909 Locust Street