The URL can be used to link to this page

Home My WebLink About08-05-09J REV-1500 15056041158 EX (06-05) PA Department d Revenue OFFICIAL USE ONLY Buroeu dlndMduel Tams County Code Veer File Number Po Box zeo9at INHERITANCE TAX RETURN 21 09 0394 Hemisburg, PA 17129-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Binh 204-01-9671 01272009 11121921 Decedent's Last Name DERR Suffix Decedent's First Name MARY (if Applicable) Enten Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE BOXES BELOW Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI E MI 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remelnder Retum (date or death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (tlate of ^ 5. Federal Estate Tax Return Required 6, Decedent Died Testate ~ 7. death after 12-12-62) Decedent Malntainetl a Living Trust ~ 8. Total Number of Safe Depoatt Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ 9. Litigation Proceetls Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax untler Sec. 9113(A) between 12-31-91 and 1.1-95) (Attach Sch. O) CORRESPONDENT - TNIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCEAND CONFIDENTI/LL TAx INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number LOWELL R• GATES, ESQUIRE 717-731-9600 Firm Name (If Applicable) GATES, HALBRUNER, HATCH & GUISE, P•C• First line of address 1013 MUMMA ROAD Second line of dress SUITE 100 City or Post Office State ZIP Cotle ,,'i _~ -i -'i -> LEMOYNE PA 17043 a Correspondent'se-mailaddress: L • GATESaGATESLAWFIRM • COM Under penalties o1 perjury, I declare thM I hew examined this rotum, including accompanying achetlules end etMements, end to the best of my knowledge and belief, it Is true, corroct and complete. Declaration o1 prepsror other then the peroonel ropresanfatrve Is based on all informellan of which proparor has any knowlstlga. R A E• V A R N E R /r JG~! ~~ ems-- (i (//,~.t/~L~ 15056041158 Side 1 BM1947 3.000 15056041158 Estate of MARY E. DERR Executors (Page 1) Name Kathryn A. Swope Address 2030 Old York Road Dillsburg, PA 17019- Tax ID 165-38-0870 Name Barbara E. Varner Address 5 Maple Drive Etters, PA 17319- Tax ID 167-40-2019 204-01-9671 J 15056042159 REV-1500 EX Decedent's Sodal Seadty Number 204-01-9671 Decedents Name:D E R R MAR Y RECAPITULATION 1. Real estate (Schedule A) .......... 1, O • a a 2. Stocks and Bonds (Schedule B) ......................... . 2. 0 • 0 ~ 3. Closely Held Corporation, Partn~shlp or Sde-Proprietorship (Schedule C) • ... . 3. Q . 0 0 4. Mortgages 6 Notes Receivable (Schedule D) ............. . 4. 0 • ~ ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... . 5. 6991.00 6. Jointly Owned Property (SrJradule F) ~ Separate Billing Requested .... . 6. o.ao 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (schedule G> ~ separate Bnnng Requested .... . 7. 2 9 4 8 4 8.0 0 8. total Gross Assab (total Lines 1-7) .................. 8. 3 ~ ~~ 8 39 • 0 ~ 9. FuneratExpenses&AdministrativeCosts(ScheduleH) .............. . s. 46378.00 10. Debts of Decedent, Mortgage Lladlilles, & Liens (Schedule I)..... 10. 5159.00 11. Total Deduelbns (total Lines 9 & 10) ........ 11. 51 S 37 • ~ 0 12. Nat Value of Estate (LlneBminus Line ll) ................. .. 12. 250302.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts fa which an election to tax has not been made (Schedule J) ......... 13. 0 • ~ ~ 14. Net Value SubJea to lax (Line 12 minus Llne 13) ...... 14. S ~ 02 • ~ ~ TAX COMPUTATION • SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal fax rete, or transfers unQer Sec. 9116 (a)(1.2) X .0 0, 0 0 15. O• O O 16. Amount of Line 14 taxable at lineal ratex.OL1.5 250302.00 16• 11264 •00 17. Amount of Line 14 taxable at sibling rate X .12 ~• ~ ~ 17, Q• Q O 18. Amount of Line 14 taxable at collateral rate X .15 0• ~ ~ 18. 0• ~ 0 ts. rAxDUE ................................... ts. 11264.00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042159 ernaeees.ooe 15056042159 REV-1500 EX Pepe 3 DacadenHs Complete Addrwss~ FlN Number 7l. n4 m701i DECEDENTS NAME A STREET ADDRESS GTY P STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Cretlit ~ . ~ Q B. Prior Paymems 14 0 0 0.0 0 C. Discount 563.00 3. InteresVPenalty ii applicable D. Interest E. Penalty (1) 11264.00 row creak. (A+e+c) (2) 14563.00 Total lntarsel/Penally (D+E) (3) Q. ~^ 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This le the OVERPAYMENT, FIII in box on Page 2, Lina 20 to roquut a Muntl. (4) 3299.0 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0 • 0 0 A. Enter the interest on the tax due. (5A) 0 • 0 0 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) D • 00 Make Check Payable to: REpSTEROF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1, Did decedent make a transfer and: Vas No a. retain the use or income of the property tranaferted; x^ ^ b. retain the right to designate who shall use the Droperty transferred or its income; ......... x c. retain a reversionary Interest; or ................................ X d. receive the promise for IHe of either payments, benefits or care? ................. IJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiNng adequate consideration? .............................. ^ 3. Did decedent own an "in trust for" or payable upon tleath bank account ar security et hla or her death? . ^ 0 4. Did decedent own an Indivitlual Retirement Account, annuity, or other non-probate property which contains a beneficiary deslgnation9 ................................. Q ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUS7 COMPLETE SCHEDULE 6 AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994 antl before January 1, 1995, the tax rate imposetl on the net value of transfers to or for the use of the suMving spouse is three (3) percent [72 P.S. §9118 (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. §9118 (a) (1.1) (ii)]. The statute does not exemM a transfer to a suMving spouse from tax, antl the statutory requirements for tllsGOSUre of assets and tiling a tax return are still applicable even if the suMNng spouse is the only beneflciary. For dates of death on or otter July 1, 2000: The tax rate Imposed on the net value of trensfers from a deceased child twenty-one years of ape or younger at tleath to or for use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9118(a)(1.2)]. The lax rate Imposetl on the net value of transfers to or for the use of the tlecedent's lineal benefiGertes is four and one-half (4.5) percent, except 85 noted in 72 P.S. §9116(1.2) [72 P.S. §9118(a)(1)]. The lax 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. §9118(a)(1.3)]. A siNinp is defined, untler Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. srnesn t.ooo REV-1 WZ EX+(11-W) Pennsylvania SCHEDULE A OEPARTFEMOF REVENUE INNERRANCE TAX RETURN REAL ESTATE RESIOEM OECEOEM FILE NUMBER GLARY E. DERR 21 09 0396 All real property owned wNly or r • NnaM in common muH M nporfw H fair market value. Fair market value le tleAnw r the pace at which property woultl De ezchange0 between a willing buyer antl a willing seller, neither being oompelNtl to buy or sell, both heNng IreonaWe knowtwga oithe rebvant fads. RNI pmpsrty Mat Is Jolrrtlyownetl whh rlpM of survivorship must M tllwloeetl on Sohsduls F. eweaes z.ooo If more space is needed, InseR addttipnel sheets of the same size. REV-150J EX ~ (&9e) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDEM DECEDENT SCHEDULE B STOCKS 8 BONDS I.N~_RY E. DERR 2t 09 094 All property Jointly-ownetl with rtght of aurvWonhip must be disclosed on Schedule F. 3yJ48B8 1.000 (f more space is needed, Insert additional sheets of Me same size) REV-1507 EX ~ (&99) SCHEDULE D MORTGAGES 8 NOTES ESTATE OF FILE NUMBER MARY E. DERR 21 090396 M property jWrrdyownstl wlth tlgM of survlvonhip must hs dbclossd on SeMtlule F. OW69AC 1.000 Qf moro apace la needed, insert eddhiansi sheets of pme size) REV-15ae EX t (&ae) SCHEDULE E COMMON/rE4lTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8i MISC. INHERRANCE TAX RETURN ______. _. ____-_-. 3W~8AD t.ppp (I/ moro space la neede4 insert WdNiond aheMe of the same size) REV-i50BE1(~(68a) SCHEDULE F COMMOhNVEALTH OF PB3JSVLVANW JOINTLY-OWNED PROPERTY aa.miTe urc re v orn aai ESTATE OF FILE NUMBER MARY E. DERR 21 09 0396 k an asset was made Jolntwkkln om year of tM deeedenPa dab of death, k mtut W roported on SehetluN G SURVNtJG JOM TBdAM(S) PNhE JOINTLY-0WNED PROPERTY: Ft~4TpNSFW TO OEC®BJf ~~ I'A~EFZ IETTEA Fd1 JOIN TENANT GATE M4~E JOM 06CRPfION OF PROF$iiY NUMBER d191MIWtIDBITIA'INOIIUM®I.AnMNOEED FOR JDMTLY-NEU)RPALEBTATE. ~~~~TM VALUE OFASSET ss of ~S MHt6T n4TE OF L7EATH VALI.E OF D~Bif'S M6~ST None TOTet (Also a R R I e i I 0 (N more apace ro needeQ Inasrt eddNOnal aheels of the sane she) 3W4aAE 1.000 REV-0510 E%+ (&eB) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDEM DECEDENT SCHEDULE G INTER-VIV03 TRANSFERS & MISC. NON-PROBATE PROPERTY MARY E. DERR 21 09 0396 This schedule must be completed antl filed if the answer to any of Questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBS DESCRIPTION OF PROPERTY NAILS IIENWECi11E}g46FEgEE, Tlijq gEUTlOlA~P TO pECECEM NO nEwn:ormusa. AnaalAmPr oF~oEEO FOq qE4. ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION IF APPIJCABLE TAXABLE VALUE t~ Real Property at 3501 Green Street, Camp Hill, PA held in the Mary Emma Derr Trust (Auction prise on 4/13/2009 closed on 6/26/2009) 118,000 100.0000 0 118,000 2 Janney Montgomery Scott Securities Account M1898-2690 held in the Mary Emma Derr Trust 157,525 100.0000 0 157,525 3 Janney Montgomery Scott IRA Account k2718-5710 (Payable to named beneficiaries Barbara E. Varner and Kathryn A. Swope) 19,323 100.0000 0 19,323 TOTAL (Also enter on Ilne 7, Reeapitulatbn) ~ $ (I/ moro epeoe is neetleq insert W tllllonel shaete of the same alze) ~WdeAF 1.000 REV-1511 EX~ (1608) ESTATE DF ' """""""" "'4Y E DERR 21 09 0394 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: ~ Malpezzi Ebneral Home SCHEDULE H FUNERALEXPENSE3 8 ADMINISTRATIVE COSTS DESCRIPTION AMOUNT 10,382 B. ADMINISTRATIVE COSTS: 1. Personal Reprlaentmive's Canmissions Name of Personal RepresentattNa(s) n. ~1..~ c v.~..e.- c u.tt.ryn A. Swore Street Address 5 Maple Drive City Ettera State PA Zip 17319 Year(s) Commission Paid: Pending 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation) Glaimmt 4. 5. 8. 7. 1 2 3 15,000 15,000 S}rent AAAroxx City State ZIP _ Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tex Return Preparer's Fees PPL Electric Pennsylvania American Water UGI Gas Utilities Total from continuation schedules . 605 264 115 5,012 46 ]WdeAG 1.000 more space is needed, insert atltlitional sheets of the same size) Estate of: MARY E. DERR Schedule H Part 7 (Page 2) 4 Verizon 5 Castle Clean - carpet cleaning 6 Palmer's Auto Service - Car repairs 7 Hrickera Auction - Auctioneer's Expenses on sale of household goods 8 Hrickera Auction - Avetion Fee for real property 9 Premier Appraisals - appraisal of real property 10 Hampden Township - Sewer and Water Hill 11 Hampden Township, Cumberland County - Real Estate Taxes 12 Cumberland Law Journal 13 Patriot News - Publication of Notice to Creditors 14 Settlement Charges on sale of real property Total (Carry forward to main schedule) 21 09 0394 267 106 171 1,040 1,180 300 139 372 75 169 1,193 5,012 REVd517 EX~(tP-W) ` SCHEDULE Pennsylvania OEPNRMEMOF REVENUE DEBTS OF DECEDENT, NJHERITANCE TPXRETURN MORTGAGE LIABILITIES & LIENS RESIDEM OECEDEM ESTATE OF FILE NUMBER MARY E. DERR 21 09 0394 Reoort debts Incurred 6v the decedent orlor to death that temalned unpaltl at the tlate M death, Including unnlmburaed matliesl expenses. sweanN 2.000 If more space is needed, insect atltlltional sheets of the same size. REV-1513E%+(11-09) SCHEDULE J Pennsylvania OEPMIAENTOF REVENUE BENEFICIARIES INFERRANCE TAX RETURN RESIDENT DECEDEM FILE NUMBER ~'"'RS ° • "~+'+' 21 0 9 0394 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List 7rwtee(s) OF ESTATE 1 TA%ABLE DISTRIBUTIONS [intlude outdyllt apouaY dialdbutiana, entl iranafaa antler See. 2116 (a) (1.2).] 1. Barbara E. Varner 5 Maple Drive Ettera, PA 17319 Daughter 125,151 2 Kathryn A. Swope 2030 Old York Road Dillsburq, PA 17019 Daughter 125,151 ENTER DOLLAR AMOUMS FOR OISTRIBUf10NS SHONM ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UDDER SECTION Yi 13 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARRABLE AND GOVERNMEMAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 0 ewaeAl z.ooa ~r more space Is neeaea, insert a0attlonal sNeeta of the same size. Estate of Mary Emma Derr Pennsylvania Inheritance Tax Return Form REV-1500 EXHIBIT A Copy of the Certified Death Certificate of the Decedent L^4 Em c 11f .;._i^4'3ie^Y-.., i < .,t ! .~7 ~tf ~;u ~C'. s:•.S r 'G?, ~ ~-'^i:?vS-- ~ Ci?OTDO,a I'a ~iPi. _ ., r...r.'.liinrl tnub? ?'ni< i< ID r_erhfy t17at 5Fe ir7funnatiU~~ hers .; cu tectir i{ri i d,`r~m an on eilill CuVi fii ate a( {iulY filed with me us Local Regissr'ar. The ~s _<nilic¢c Ecill ba fcr•,varded t.r the Stale j<.2CC", .~i~ ~Jl i{l C' i0f i]CI'i17011enf illlp^_. ,r ~ -, i, '~ ~'.~ r it-; c) Ir n,te'..i aua xu- uauk COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALtH • VITAL RECORDS Y~Eii.:r~iFmi" CERTIFICATE OF DEATH s.•a raN {See ins4u<tions and examples on reverse) suiF FnF,we xFn sire dGxtuml[au.cgye.hx. wroV 1. Sea ]• wSmury Nwwe, • Wu NOnm prmlM dY.na) Female 204 - O7 - 9671 January 271 2N9 sye n:aemrmn anat.+ree umlmv s. Data D:a(vum. t.n >a/Yat.t nmwmkora,fyatwr.nl aa. wttaxxaa lento wW oats a,r, u rorw. aNa. 87 i4oyember 12 1921 FlarrisbDr PA Clmw...a ^Fn roagwtw ^ec• QN+,.~rwnr ~N.ripmf QaM,~£pnM1 b[w+N Ur Deu. YDii6+o. F.p pDealn W.FaiAYKmIUNrMOUta+. p.tautx vam/rcnl 9waa Meem aNy [c}yn) W dYU ,O a.tr. artnrmr vam.&>..'tMem 01 res, npngCwan IS~dn ctsnberland Hampden 'Pap. 3507 Green Street "°°^P~.a~N..~r°'r White rw4a. rnu:W a..m wa mwa.mliwak pomxwt,eare rx wu vermerv mar4 We ,J.dumvMeFas:utYWar rry lHa+'WSwmm++'w! r+wnul9uw. um~w r+t..r uxreo. rs. s~.:~:ty ywnt la~wo. y.t maoe~nm.el .t Wf di,Nn Wa&v+a.r WYxry uS wmM re:[cs: Fkmtr,UrylSxm as r,'(O f?) LuueSe ir.+m 5.1 w~"°a~<ISW~'~M Harlemaker Own Hasre O+e, L$.:: 2 Widowed .f oaaonas marg.obeu(m.a vysw.m m+.IV ~a+et u.Naas mDe«tarar anir~..an Hamalen r.P PennSYl vania mCJ3n ow , ,taw a.,w:a. n: ya: 3501 Green Street "~^'"• ,>~ ^ „, ~a„•„„.,„„„~ Cl7mberl and "° _ =,w°„„m carE•~ ` - Hill PA 77011 re ,°aT, mr u.u ....,lt ov. •w•.1 _aoaa. aa;,,,,.,.»>.. m.a. ro,.,mtl Walter Zeiders Helen Huher 3Ga xuo-.~d e l Y«, PmN xfi mranws I om9 npaeY 19.en ory: mrs'au.,p Waal BnY'bara Varner S ~/la l2 Drl VE FttaYS PA 77)24 -, xo.rw„t.' I ^ot.aaaa ^rm:am r a nr[, J xw w,tmo~x-~w,luns ms.lrs,i mPwtdaw.r+n n,.,..mamt~m. ~t.,,ovwa.,, tlr.! x,a .a.w lu,r,r/.n. rc+. ,raw.l "' O n uw.n awn $rse `Wa{Lemymm0antxon Rwrwnan 0 9 PA te Mechanicsburg h C r h i xn Oara. o, w.aw f..mko-aa.atn ^.:,Ora Fehrua 2 2 0 , ~ le an cs ur ec rasa"t,.,,.µfwN.rs,.xttpa.tt itl a"w aae•Anwnl m.:Qa.. e.,acN nr. r,,.E ar.Jam.rowsaovo- 8 MdikBt Plaza y ~~ '7055 b ~ ~ / i ` urq, FD - 054899 Mal~zzi FWeral Hang= Mec an7cs [cny~eh lu [ ~. 1Ja.WW tlmy r_h VrcmRW rw 4W'aaNe wl uw.rvxr ]M Dma 5~5nealuam 0fµ yea•I wti,.v ,... ~w a,.fw+. . aawr, 57~ ~ 5 r•M ~• _ . . u +L,mt Ream D Grwnrc IM.'+n. Wn WX %wa[as•Ibre,uy rJlep[.rE•.tme'ICa'w.t'bnMeurs u,Nr nxn GOma.m.w Cgw++x Y NeuuWgrwn Z. EEma ,.e,.. r. ... ~' ~ qu o..+r.-ar a ?x 7009. ^a m CNVSEp FaTM (See MaX sana a+ampeal - ,Po'mv't in,e•.n 1 •./a. E•,u ae yJy(yry(~{yyryulfgp{'EM x6 as 1%avu VUCtlarGhroDe+N> ~~.>„ me,na;.W wY~oa n.Wme..tlforM4atlrt-YV, bn:q,suMrM an MnUl xae ,,..i, n.r t.~rvisana. ra.JS....i Grvare Veam ~ WmriMwyn .umryag taurtgrenn Pa'af ~YU uP.tlnuY m~t~kk <....,.,,,.w.~a...a,I~N..m.,aw.a~»atr~,tN,ar,rwNw ^t~ Qa, a.~ aa~a.,~~,.art(r,.a,r...w e, ~,~,,, 5 k n -,~ s a„rt,aa .r W ^ ' - --~ , ~r_ ,-m,~N~ dl ~~m~., v.x~,w,,.• _ _._--- a.,J a r r ~,..rxrf a amtt.~,tWa.,nraa ( e. Y.u YNMP1YWLCfUSf Pwro lw axvLmrtp.eMO41. ' _. Mow aY/tx ' -'~-- rJ IUpaY~W.,^"pnl~'x.w«. rx urr r. J a ~~ .aryn~ IUSi i+'vwa r,n ,,.,~ l la,au Ll+`tr,w'ui aaV'~Y'n dw situ Va x.W^rual ,_ aeixw~u'• f US}) i YIU w[M1M.H+IiWM Sr Akrctld OeM )a 0utd'+YVII.w.n. Ur.)xr) x ]xo hss«M,Yr. F.NM1 Piw,M AkreSme9. YF4W ~PAy)fxnrfX'at aNt Pan;,n. al a,a. v„r mtuwn.w L-~/ ~rtv '«~ // eGfAUl tl Qh n ~V. uiry,rv. w lp inua ry/y 1't NYN a, WC~ JY. I11~engvawv~Yw.r lSfe.YAJ na ]x9la.u'e v, FAM1 r4.v. Ml ^. aril ^n EO,V- (]Y. ^rw ~ D.,. p,ra ^u,ato a,,.N, ^/. ,+.Or./.,. W w'.,mm,, Ocwar ps=nr ~N ... o+... o ;s'.aa,wt a,a, wx aswaa .... ~.. ~aa.:..aar/e,mrl een. .amm~ v r>+ r"s /. wuw a ~ ~~ ~ K O ~ ma ~ma+~ + . w ____________________________ ra a . . u e wpr~ m emr U1 n ao.+ w.r mr rnr m•^ s. sitar. ,/m w rn was .w.. wr rra~l . e,o,e.an..q rwtm'Mnumv..era.In,r -•~la..wr+ro~rt:a+:N..rr.,ww,at...r,wo~+.l _._Q ______ t.^e m.,,.t, .,,r.xe i n ~ _________ s r/ws:xor a,raw.lros. etnn taw,taar•.ca..wa..,a wnt.a,wa.twaatw, ~ ' mr /v +tm otm,mmra.mmt.a.'e.wou., •aa ae mrne oe,q+l xw m.aat~,uae<. ^ wa~,w /m, ,..n• na. . rwm .,` aa a.,.d«./, n/m r,l ,rw r.a ,v, ~rne : ~r P , o.,.. ~ a.e y we R ~ Jdmes F, a.lia.,rsv.v'='=,r.,arK'~aw:; 9 ~ r ~ r I J I r';ft`Olua.m.LL rta° 207 House Ave. Came Hill, PA 17071 L ~ ,~.~..„~rt...,„a n91 R573 Estate of Mary Emma Derr Pennsylvania Inheritance Tax Return Form REV-1500 EXHIBIT B Copy of the Last Will and Testament of Mary Emma Derr Dated June 12, 2006 LAST WILL & TESTAMENT OF MARY EMMA DERR 1, Mary Emma Derr, now of 3501 Green Street, Camp Hill, Pennsylvania 17011, do publish and declare this to be my Last Will and Testament, hereby revoking all other prior wills and codicils made by me" FIRST. Family Background and Appointment of Executor. (A) Family and Back around Information. I am a widow. My husband, Valentine H. Derr, predeceased me an March 5, 200b. The children of our marriage are Stanley E. Den, Kathryn A. Swope and Barbara E. Vamer. Throughout this Will, Stanley E. Derr, Kathryn A. Swope and Barbara E. Varner will be referred to as "my children." The word "issue" will include my children as well as my other descendants. (B) Appointment of Executor. 1 appoint as my Executors (all hereinafter referred to as Executor) under this Will, the following named persons to serve without bond and without being required to account to any Court: Executrix: My daughter, Barbara E. Varner Successor Executrix: My daughter, Kathryn A. Swope (C} Inter Vivos Trust. She inter vivos trusk agreement referred to in this Wili is entitled "The Mary Emma Derr Trust," by and between Mary Emma Derr, as Settlor, and Mara Emma Derr- as Tnistee. as now in effect or as may hereafter be amended. SECOND. Funeral and Last 111ness Expenses; Taxes. (A) Expenses of Funeral and Last Illness. 1 direct my Executor to pay my funeral expenses and the expenses of my last illness from my estate, In addition, my Executor may notify the Trustee of the Trust described in paragraph 0 of any such expenses and my Executor may accept reimbwsement fi-om such Trustee. (B) Taxes. 1 direct my Executor to pay any and all estate, inheritance, succession, legacy, transfer and other death taxes or duties, by whatever name cal3ed, in~litding-any-ark-- - - " all interest and penalties thereon imposed-under aws o any jurisdiction by reason of my ea upon or with respect to any and all property included in my gross estate for the purpose G~l~i LAST WILL c4z TESTAMENT OF MARY EMMA DERR P.4GE20F71 of such taxes, whether such property passes under or outside of this Will. Without any apportionment otherwise required bylaw and without being prorated or apportioned among or charged against the respective devises; legatees, beneficiaries, transferees, or other recipients of any such property or charged against any property passing or which may have passed to any of them, I direct that any taxes so paid shall be charged against my residuary estate. My Executor shall not be entitled to reimbursement for any portion of .any such [axes from any such person. The foregoing provisions of this Article 0 shall not apply to such portion or portions of said taxes, interest and penalties which may be required to be paid, or are actually paid or reimbursed, by the Trustee of the Trust described in Paragraph 0, above. THIRD. Tangible Personal Property. Except for those items excluded below and tYrose items enumerated in the Letter of Instruction, I bequeath all my tangible personal property, including but not limited to clothing, jewelry, heirlooms, furniture, household furnishings, personal effects, motor vehicles, and all other similar articles, which I own, and the insurance thereon, my children, Stanley E. Derr, Kathryn A. Swope and Barbara E. Varner, per stirpes. Tangible personal property shall not include: (]} any and all property used by me in any business, (2) cash on hand or on deposit in banks, (3) stock or securities, (4) any type of evidence of indebtedness, and 15) ary fife, health or accident insurance policies. if there is any disagreement as to distribution, I direct my Executors to make such distribution. The decision of my Executors shall be final and binding. Any items not selected or any items which my Executors considers wisuitable for rriy children may be distributed or sold in the sole discretion of my Executors and; if sold, the net proceeds therefrom shall be added to the residue of my estate. Any such article allocated to a minor may, as my Executor deems advisable, either be delivered to [he minor or to any person to safeguard on behalf of the minor. Notwithstanding any other provisions in this Article 0, I may leave a separate, dated and unsigned Letter of Instruction, which I shall place with my Will, containing directions as to the ultimate disposition of certain of the property bequeathed under this Article 0, and such Letter of Instruction shall determine the distribution of such items. FOURTH. Residuary Estate. ]devise and bequeath~_ ue an remainder of my estate, real uersnnal-and-mixed; ~liaEever nature and wherever situated to wl3ieh~-amtegal7y or equitably entitled, to the then-acting Trustee(s) of the Trust described in u~~ LAST WILL & TESTAMENT OF MARY EMMA DERR PAGE 3 of I I Paragraph 0 of this Will, to be held, administered and distributed pursuant to [he terms thereof, as the same may be amended from time to time. Sy this devise and bequest of my residuary estate I hereby exercise all Powers of Appointment I possess at the time of my death except any power of appointment which I possess under the Trust described in Paragraph 0 of this Wi11. First. Powers of Executor. In addition to the powers and duties as may have been granted elsewhere in this Wi]], but subject to any limitations stated elsewhere in this Will, the Executor shall have and exercise exclusive management and control of the Estate and sha}1 be vested with the following specific powers and discretion, in addition to the powers as may be generally conferred from time to time upon the Executor by law: (A) In the management, care and disposition of the Estate, the Executor shall have the power to do all things and to execute such instruments, deeds, or other documents as maybe deemed necessary or proper, including the following powers, al] of which may be exercised without order of or report to any Court: I. To sett, exchange or otherwise dispose of any property at any time held or acquired hereunder, at public or private sale, for cash or on terms, without advertisement, including the right to lease for any term notwithstanding the period of the Estate, and to grant options, including any option for a period beyond the duration of the Estate; except that, in lieu of any binding shareholder agreement or buyisell agreement to the contrary, the Executor shall not be permitted to sell the stock or any other ownership interest in any business owned by me, or held in trust, at my death, without first offering the same for sale to my children, or without next offering the same to the corporation or business represented by such evmership interest for redemption. 2. To invest all monies in such stocks, bonds; securities, mortgages, notes, chooses in action, real estate or improvements thereon, and any other property as the Executor may deem best; without regard to any law now or hereafter enforced limiting investments of fiduciaries, except that the Executor may not invest in any securities issued l~_~E. or, or __ --__ issued by a Harp + ~rr"s--~~ny of such Executor. ,x~L~- LAST WILL & TESTAMENT OF MARY EMMA DERR PAGE 4 0>< ll 3. To retain for investment any property deposited with the Executor- hereunder; except that the Executor may not retain for investment any stock in the corporate Executor, or in a parent or affiliate company of such Executor. 4. To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security. 5. To use attorneys, real estate brokers, accountants and other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. 6. To compromise, settle or adjust any claim or demand by or against the Estate and to agree to any rescission or modification of any contract or agreement affecting the Estate. 7. To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging, pledging or conveying any property of the Estate. 8. To retain and carry on any business in which the Estate ;nay acquire an interest, to acquire additional interest in any such business, to agree to the liquidation in kind of any corporation in which the Estate may have an interest and to carry on the business thereof, to join with other owners in adopting any form of management for any business or property in which the Estate may have an interest, to become or remain a partner, general or limited, in regard to any such business or property and to hold the stock or other securities as an investment, and to employ agents and confer on them authority to manage and operate the business, property or corporation, without liability for the acts of such agent or for any loss, liability or indebtedness of such business if the management is selected or retained with reasonable care. --- 9. 7o re ist -or-othef security in the name of a --- _ nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that ?~ ~ ~~ ~-~ I, lU (/l~~ LAST WILL 8t TESTAI~4ENT OF MARY EMMA DERR PAGE 5 OF l 1 such security is a Estate asset and the Executor shall be responsible for the acts of such nominee. (B) Whenever the Executor is directed to distribute any Estate assets in fee simple to a person who is then under twenty-one (21) yeazs of age, the Executor shall be authorized to hold such property in Trust for such person until helshe becomes twenty-one (21) years of age, and in the meantime shall use such part of the income and the principal of the Estate as the Executor may deem necessary to provide for the proper support and education of such person. If such person should die before becoming twenty-one (21) years of age, the property then remaining in trust shall be distributed to the personal representative of such person's estate. (C) In making distributions from the Estate to or for the benefit of any minor or other person under a legal disability, the Executor need not require the appointment of a guardian, but shat] be authorized to pay or deliver the same to the custodian of such person, to pay or deliver the same to such person without the intervention of a guardian, to pay or deliver the same to a legal guardian of such person if one has already been appointed, or to use the same for the benefit of such person. (D) In the dis'oursernent of the Estate and any division into separate Crusts or shares, die Executor shall be authorized to make the distribution and division in money or in kind, or both, regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Executor shall be binding and conclusive on all persons taking hereunder. The Executor may in making such distribution or division allot undivided interests in the same property in several Wsts or shares. (E) The Executor shall be authorized to lend or borrow, including the right to lend to or borrow from any trusts which 1 or my spouse may have established during life or by will at an adequate rate of interest and with adequate security, and upon such terms and conditions as the Executor shaII deem fair and equitable. (F) The Executor shall be authorized to sell or purchase at the fair market value as determined by the Executor, ~n}~prep~-y-te-cr-fi-ortr-an~st created by me ,~, _i ~~` -~ ~'~/ LAST WILL & TESTAA4ENT OF MARY EMMA DERR PAGE 6 OF 11 or my spouse during life or by Will, even though the same person or corporation may be acting as Executor of my estate or as Trustee of any of my other trusts. (G) The Executor shall have discretion to determine whether items should be charged or credited to income or principal or allocated between income and principal as the Executor may deem equitable and fair under all the circumstances, including the power to amortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal, to treat any dividend or other distribution of any investment as income or principal, or apportion the same between income and principal, to charge any expense against income or principal or apportion the same, and to provide or fail to provide a reasonable reserve against depreciation or obsolescence on any assets subject to depreciation or obsolescence, all as the Executor may reasonably deem equitable and just under all the circumstances. If the Executor does not exercise the above discretionary power, the cash or accrual allocation shall be in accordance with Chapter 8l of Title 20 of the Pennsylvania Consolidated Statutes, or the corresponding provisions of subsequent state law. (H) If at any time the total fair market value of the assets of any trust established or to be established hereunder is so small that the corporate Trustee's annual fee for administering the trust would be the minimum annual fee set forth in the Trustee's regularly pubtished fee schedule then, in effect, the Trustee in its discretion shall be authorized to terminate such trust or to decide not to establish such trust, and in such event the property then held in or to be distributed to such trust shall be distributed to the persons who are then or would be entitled to the income of such trust. If the amount of income to be received by such persons is to be determined in the discretion of the Trustee, then the Trustee shall distribute the property among such of the persons to whom the Trustee is authorized to distribute income, and in such proportions, as the Trustee in its discretion shall determine. (I) Except as otherwise provided in this Will, when the authority and power under this Will is vested in two (2) or more Executors or Trustees the ~ +~ '+~----- - - ~_-_ , and owers are to _he.__held _ p y P ~ -}etrtt}y ~rthe`Executors or Trustees, res ectwel A majority of the Executors or Trustees may exercise any authority or power granted ~1~<~ Its ~r%~ LAST WILL & TESTAMENT OF MARY EMMA DERR PAGE 7 OF 11 under this Will or gamed by law, and may act under this Will. Ary attempt by one such Executor or Trustee to act under this Will on other than ministerial acts shall be void. The action of one such Executor or Trustee under this Will may be validated by a subsequent ratification of the act by a majority of the Executors or Trustees. Second. Rights and Liabilities of Executor. (A) No bond or other security shall be required of any Executor. (B) This instrument always shall be construed in favor of the validity of any act or omission by any Executor, and any Executor shall not be liable for any act or omission except in the case of gross negligence, bad faith or fraud. Specifically, in assessing the propriety of any investment, the overall performance of the entire Estate shall be taken into account. (C) Each Executor shall be entitled to receive reasonable compensation for services actually rendered to my estate, in an amount the Executor normally and customarily charges for performing similar services during the time which he,~she performs the services. (T~) Suendthrift °rovision. Na beneficiary shall have the power to anticipate, encumber or transfer his or her interest in the estate in any manner other than by the valid exercise of a power of appointment. No part of the estate shall be liable for or charged with any dehts, contracts, liabilities ar torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. Third. Tax Elections. (A) In determining the zstate, inheritance and income tax liability relating to my Estate, the Executor's decision as to ali available tax elections shall be conclusive on all coneemed. If the Executor joins with my spouse in filing income tax returns, or consenting for gift tax purposes to having gifts made by either of us during my life considered as having been made one-half by each of us, any resulting liability shall be borne by my Estate and my spouse in such proportions as they may ogee. In accordance with IRC Section 2b32(a) and without regard to whetheraF~dera)-zstate __-- - tax _return is_actually-~}ed~ -rnq~utor ~ allocate so much of the Federal l~-~~ LAST WILL & TESTAMENT OF MARY EMMA DERR PAGE 8 OF ll Generation Skipping Transfer (GSTI exemption amount as will fully exempt any generation skipping transfer which may occur under this Wi11. (B) The Executor may, in its discretion, determine the date as of which my gross estate shall be valued for the purpose of determining the applicable tax payable by reason of my death. (C) The Executor may, in its discretion, decide whether all or any part of certain deductions shall be taken as income tax deductions (even though they may equal or exceed the taxable income of my estate and whether or not claimed or of benefit on my estate's income tax return) or as estate tax deductions when a choice is available; and in the event that all or any part of such deductions are taken as income tax deductions, no ad}ustment of income and principal accounts in my estate shat] be made as a result of such decisions. Faurth. Definitions and General Provisions. (A) Survival. Any beneficiary who dies within sixty (6p) days after my death shall he considered not to have survived me. (B) Cavticns. The captions set forth in this Will at the beginning of the various articles hereof are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their constnaetion and application. (C) Children. As used in this Will, the words "child" and "children" shall include persons who are legally adopted and the issue of said persons, whether born in or nut of wedlock; so long as any person born out of wedlock is acknowledged Sn a written instrument executed by the one of their natural parents who is a descendant of mine to be the child of said descendant. The word "issue" shall include descendants of all generations including adopted persons. A posthumous child shall be considered as living at the death of his parent. The birth to me or the adoption by me of a child or children subsequent to the execution of this Will shall not operate to revoke this Will. Except for discretionary distributions which may be made unequally amon~a g_ro~of----- persons and distributions pursuan to a ~ ~,t a exereis~ofa power of appointment, in ___ _ - --------~nakirr~~dislnFiution to the children of any person, the property to be distributed shall be divided into as many shares as there are living children of the person and deceased ~'~~ LAST WILL & TESTAMENT OF MARY EMMA DERR PAGE 9 QF 11 children of the person who ]eft children who are then living. Each living child shalt take one share and the share of each deceased child shall be divided among his then- livingdescendants in the same manner. (D) Code. Unless otherwise stated, all references in my Will to section and chapter numbers are to those of the Internal Revenue Code of 1986, as amended, or the corresponding provisions of any subsequent federal tax laws applicable to my estate (E) Other terms. The use of any gender includes the other genders, and the use of either the singular or the plural includes the other. (F) Powers of Appointment are Exercised. By this Will I exercise any and al] Powers of Appointment which I possess at the time of my death except any power of appointment which I possess under the Trust described in Paragraph 0, above. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BL_?N?K v`F~I//~ 3N WITNESS WHEREOF, I, Mary Emma Derr, the Testatrix, have to this my Last Will and Testament, typewritten on eleven (l 1) pages, including the Acknowledgment and Affidavit, set my hand and seal this rz day of June, 2006. ~~-~~. Mary Emma Derr Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Wil] and Testament, in the presence of us, ~vho have hereunto subscribed our names at his request, as witnesses hereto, in the presence of the said Testatrix, and in the presence of each other. Each of us further declares that he or she believes the Testatrix to be of sound mind and memory. The preceding instrument consists of this and ten (10) other conseculively numbered typewritten pages including the Acknowledgment and Affidavit. 1_~~'~~. ~~ _~--'- residing at~'>~f..^<:; ~ , , , . t-'i~ (prier name) ~ ~~ n'^ ~~ ` residing at /~~/~~ti~G~ ~cf~_ i (print name) ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CIJMSERLAND S S: The Testatrix and the witnesses whose names are signed and subscribed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do hereby acknowledge, depose and say to the undersigned authority, that the Testatrix signed and executed the instrument as her Last Will in the presence of the witnesses; that she signed it willingly or willingly directed another to sign it for her; that she executed it as her free and voluntary act for the purposes therein expressed; that each of the witnesses were present and saw the Testatrix sign and execute the instrument as her Last Will; that each subscribing witness in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of their know}edge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ~~. On this. the ~~ day of June; 2006, before me, a Notary Public, the undersigned officer, personally zppeared MARY EMMA DERR and the witnesses, known to me er satisfactorily proven tc be ti,e persons whose names are subscribed to the within Will executed the same, and that said persons acknowledged that they executed the same for the purposed therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official Seal. Notarial Seal Victoria M. RarJrin, Notary Public Lemoyno Boro. Cumberland CouAy MY Commssiw, Expires Aug. 27.2006 Member. Pennsylvania gssodaryon O, Notaries ,vU,a,y r um,c My Commission Expires: Estate of Mary Emma Derr Pennsylvania Inheritance Tax Return Form REV-1500 EXHIBIT C Copy of the Mary Emma Derr Trust Dated June 12, 2006 THE MARY EMMA DERR TRL3ST THIS TRUST AGREEMENT is executed in triplicate on this ~°~ day of June, 2006, by and between Mary Emma Derr, now of 3501 Green Street, Camp Hill, Pennsylvania 17011 (herein called "Settlor") and Mary Emma Derr, now of 3501 Green Street, Camp Hill, Pennsylvania 17011 (herein called "Trustee"). ARTICLE I. TRUST ESTATE Section 1.01 Initial Principal. The Settlor, desiring to establish an irrevocable trust, does hereby irrevocably transfer, assign and deliver to the Trustee and her successors, and assigns the assets listed on SCHEDULE "A", attached hereto and made a part hereof. As further evidence of such assignment, the Settlor has executed or will execute or cause to be executed such other instruments as may be required for the purposes of completing the assignment or transfer of title to such property to the Trustee. The Trustee accepts such transfer and assignment to herself as Trustee, and undertake to hold, manage. invest and reinvest the assets of this Trust, and to distribute the income and principal of the Trust in accordance with the provisions of this Agreement. Section 7.02 Additional Principal. The Settlor and any other person or persons, ~a~ith the consent of the Trustee, shall have the right at any time io make additions to the corpus of this Tnrst ar any share thereof hereby established. All such additions shall be held, governed, and distributed by the Trustee in accordance with the terms and conditions of this Agreement. The Trustee, in its sole discretion, may require, as a prerequisite to accepting property, that the transferring party provide evidence satisfactory to the Trustee that (i) the property is not contaminated by any hazardous or toxic materials or substances; and (ii) the property is not being used and has never been used for any activities directly or indirectly involving the generation, use, treatment, storage, disposal, release or discharge of any hazardous or toxic materials or substances. Section 3.03 Disclaimer. The Trustee shall have the right to disclaim, in whole or in part, prior to its acceptance by the Trustee, any interests in property for_any r~acnn~"-----_ not limited to a concern that su sperE}~rl-ramie pot'enffal liability under any federal, state, ---- ----- enviiomnental law. ARTICLE II. IRREVOCABILITY OR TRUST Section 2.01 Irrevocability. The Settlor has been advised of the consequences of an irrevocable trust and hereby declare that this Trust shall be irrevocable and shall not be altered, amended, revoked, or terminated by Settlor or any other person or persons. ARTICLE III. LIFE INSURANCE POLICIES Section 3.01 General Provisions. If any insurance policies are transferred into this Trust, the Trustee shall be vested with all right, title, and interest in and to the transferred policies of insurance, and are authorized and empowered to exercise and enjoy, for the purposes of the Trust herein created and as absolute owner of such policies of insurance, all the options, benefits, rights and privileges under such policies, including the right to borrow upon and to pledge them for a loan or loans. The Trustee takes all rights, title, and interest in and to the above stated insurance policies subject to any prior split-dollar life insurance agreement and assignments, which may be in effect at the time of transfer. The insurance companies which have issued policies are hereby authorized and directed to recognize the Trustee as absolute owners of such policies of insurance and as fully entitled to al] options, rights, privileges, and interests under such policies, and any receipts, releases, and other instruments executed by the Trustee in connection with such policies shall be binding upon all persons interested in this Trust, The Settlor hereby relinquishes all rights, title, interest and powers in such policies of insurance which Settlor may own and which rights, title, interest and powers are not assignable, and will, at the request of the Trustee, execute all other instruments reasonably required to effectuate this relinquishment. Section 3.02 Payment of Premiums. The Trustee shall be under no obligation to pay the premiums which may become due and payable under the provisions of any policy of inswance which may be transferred or assigned to this Trust, or to make eer'ain that such premiums are paid by the transferor of such policy, or to notify any persons of the nonpayment of such premiums, and the Trustee shall be under no responsibility or liability of any kind in case such premiums are not paid, except the Trustee shat] apply any dividends received on such policies to the payment of premiums thereon. Upon notice at any time during the continuance of this Trust that the uremiums due upon such policies are in default, or that premiums which will become due will not be paid; either by the transferor or by any other person, the Trustee, within their sole discretion, may apply any cash values attributable to such policy to the purchase of paid-up insurance or of extended insurance, or may borrow upon such policy for the pa}nnent of premiums due thereon, or may accept the cash values of such policy upon the policy's forfeiture. In the event that the Trustee receives the cash value of such policy upon its forfeiture for nonpayment of premiums, the amount received shall be added to the corpus of this Trust and_ ___ - shall be administered according to the terms_of this t--}f- insured ender such THE MARY EMMA DERR TRUST PnGE 2OF 14 policies of insurance, becomes totally and permanently disabled within the meaning of any policies and because thereof the payment of premiums, or any of them, shall during the pendency of such disability, be waived, the Trustee, upon receipt of such knowledge, shall promptly notify the insurance company which has issued such policies, and shall take any and all steps necessary to make such waiver of premium provision effective. Section 3.03 Duties of Trustee With Regard to Life Insurance Policies. The Trustee shall be under no obligation or duty whatever except with respect to the safekeeping of such policies of insurance and the duty to receive such sums as may be paid to them, in accordance with the requirements of this Trust, by the companies issuing such policies, and to hold, manage and disburse such proceeds subject to the terms of this Agreement. Upon the death of the insured, the Trustee shall make reasonable efforts to carry out the provisions of this Agreement. including the maintenance or defense of any suit, provided, however, the Trustee shall be under no duty to maintain or enter into any litigation unless its expenses, including counsel fees and costs, have been advanced or guaranteed in an amount and in a manner reasonably satisfactory to the Trustee The Trustee may repay any advances made by them or reimburse themselves for any such fees and costs from any corpus or income of this Trust. ARTICLE IV. TRDST DISTRIBUTIONS Section 4.O1 Trust Principal. The entire carpus of this Trust, including the assets initially transferred to this Trust, subsequent additions to this Trust, and the proceeds of any sale, exchange or investment of such Trust assets, shall be used for the purposes herein contained. Section 4.D2 Income Distribution. During the Settlor's lifetime, the Trustee shall distribute all of the net income of the trust to, or for the beneftt of, Mary Emma Derr, for and during the remainder of her life, provided that if Mary Emma Derr should be admitted into a long-term care facility for a period of time greater than ninety (90) days, then the Trustee shall discontinue distribution of al{ income, and shall accumulate any and all of the net income of the trust, and shall add such nci income to the principal of the trust. The Trustee shall make no distribution of principal to, or for the benefit af, the Settlor. Section 4.03 Principal Distributions. Upon the death of the Settlor, the Trust shall terminate. Upon termination, all the rest, residue and remainder of the Trust estate shall be distributed in the following manner: (a) Fifty Percent (50%) of the rest, residue and remainder of the Tnst estate shall be distributed to the Settlar's daughter, Kathryn A. Swope. (b) Fifty Percent (50%) of the rest, residue and remainder of the Tiust_,estate--- - shall be distributed to the Setth'c rta>,.g#'~>-$arbar~~rner. THE MARY EMMA DERR TRUST PAGE ~ OF ]4 (c) The Settlor acknowledges her son, Stanley E. Derr. However, the Trustee shall not make any distributions of income or principal from the Trust estate to Settlor's son, Stanley E. Derr. If either of Kathryn A. Swope or Barbara E. Varner predeceases the termination of this Trust, the predeceased daughter's share shall be distributed to the predeceased daughter's issue, per stirpes. If either of Kathryn A. Swope or Barbara E. Varner predeceases the termination of this Trust without leaving issue, then such predeceased daughter's share shall be distributed to the then-living Kathryn A. Swope or Barbara E. Varner, per stirpes. Section 4.04 General Power of Appointment. Kathryn A. Swope and Barbara E. Varner are hereby granted the genera] power to appoint some or a31 of the principal of this Trust to themselves and their estates, in such proportions and upon such terms (in trust, outright gifts, or in any other manner) as they jointly deem advisable. This power shall not be exercisable under their Wills. If Kathryn A. Swope and Barbara E. Varner fail, either in whole or in part, to exercise this general power of appointment herein granted, the unappointed principal shall continue in trust and shall be administered according to the terms of this Trust. Upon the death, resignation, removal or incapacity of Kathryn A. Swope or Barbara E. Varner, the survivor of them shall exercise the general power of appointment under this provision. Prior to the exercise of the General Power of Appointment by Kathryn A. Swope and Barbara E. Varner, they must provide a written notice of the intent to exercise this power to the then-current Trustee. The Trustee shall inform the Settlor of the intent to exercise this Genera] Power of Appointment. For a period of ten (10) days, the Settlor may veto the proposed exercise of the General Power of Appointment. After the ten (10) day period expires, the proposed exercise of the Genera] Power of Appointment shall take effect unless the Trustee has received written veto from the Settlor, 4.05. Broad Special Power of Appointment. Mary Emma Derr is hereby granted the special power to appoint, at any time and from time to time, the principal of this Trust, in whole or in part, and in any manner and in such proportions as she deems advisable to whomever she desires. This power shall be exercisable by her Will, specifically referring to this special power of apnointmen± ir. this paragraph 4.U5 cf this Trust. This special power of appointment does not grant to her the power to appoint the principal of this trust to herself, her estate, her creditor, or the creditors of her estate. If she fails, either in whole or in part, to exercise this special power of appointment herein granted, the unappointed principal shall continue in trust and shall be administered according to the terrvs of this trust_ ART]CLE V. POWERS OF TRUSTEES Section S.OI General Powers. In addition to such other powers and duties as may have been granted elsewhere in this Trust, but subject to any limitations contained elsewhere in this Trust, the Trustee shall have the following powers and_duties;__ ~--~~-~- t THE MARY EMMA DEAR TRUST PAar4oF 14 (a) In the management, care and disposition of this Trust, the Trustee shall have the power to do all things and to execute such deeds, instruments, and other documents as may be deemed necessary and proper, including the following powers, all of which may be exercised without order of or report to ary court: (i) To sell, exchange, or otherwise dispose of any property, real, personal or mixed, wheresoever located, at any time held or acquired hereunder, at public or private sale, for cash or on terns as may be determined by the Trustee, without advertisement, including the right to lease for any term notwithstanding the period of the Trust, and to grant options, including an option for a period beyond the duration of the Trust. (ii) To invest all monies in such stocks, bonds, securities, investment companies or trust shares, mortgages, notes, chooses in action, real estate, improvements thereon, and other property as the Trustee may deem best, without regard to any law now or hereafter in force limiting investments of fiduciaries; except that the Trustee may not invest in any stock or securities issued by the corporate Trustee or issued by a parent or affiliate company of such Trustee. (iii) To retain for investment any property deposited with the Trustee hereunder; except that the Trustee may not retain for investment any stock or securities in the corporate Trustee or in a pazent or affiliate company of such Trustee. (iv) To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security held by this Trust, (v) To use lawyers, real estate brokers, accomrtants and any other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. (vi) To compromise, settle or adjust any claim or demand by or against the Trust and to agree to any rescission or modification of any contact or agreement affecting the Trust. (vii) To renew any indebtedness, as well as to borrow money, _ and to secure the same by mortgaging, pledging or_ cotA~ -- - -axy__-. -_- Txi= MARY EMMA DERR TRUST PAGE 5 OF 14 property of the Trust, including the power to borrow from the Trustee (in the Trustee's individual capacity) at a reasonable rate of interest. (viii) To retain any business interest transferred to the trustee, as shareholder, security holder, creditor, partner ar otherwise, for any period of time whatsoever, even though the interest may constitute all or a large portion of the trust principal; to comply with the provisions of any agreement restricting transfer of the interest; to participate in the ccnduct of the related business or rely upon others to do so, and to take or delegate to others discretionary power to take any action with respect to its management and affairs which an individual could take as outright owner of the business or the business interest, including the voting of stock (by separate trust or otherwise regazdless of whether that separate trust will extend fora term within or beyond the term of the trust) and the determination of all questions of policy; to execute and amend partnership agreements; to participate in any incorporation, reorganization, merger, consolidation, sale of assets, recapitalization, liquidation or dissolution of the business, or any change in its nature, or in any buy-sell, stock restriction, or stock redemption agreements; to invest in additional stock or securities of, or make secured, unsecured, or subordinated loans to, the business with trust funds; to take all appropriate actions to prevent identify, or respond to actual or threatened violations of any environmental law or regulation thereunder; to elect or employ with compensation, as directors, officers, employees, or agents of the business, any persons, including a trustee of any trust held under this instrument, or any director, officer, employee, or agent of a corporate trustee of any trust held under this instrument, without adversely affecting the compensation to which that trustee would otherwise be entitled; to rely upon reports of certified public accountants as to the operations and financial condition of the business, without independent investigation; to deal with and act for the business in any capacity (including in the case of a corporate trustee any banking or trust capacity and the loaning of money out of the trustee's own funds) and to be compensated therefor; and to sell or liquidate the business or any interest in the business. (ix) To register any stock, bond or other security in the name of a nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that the stock; bond or other security is a trust asset and the Trustee shall be responsible for the acts of the nominee. THE MARY EMMA DERR TRUST PAGE 6 OE 14 (x) To merge this Trust with any other trust created in my Will or otherwise, with similar provisions and purposes and the same beneficiary or beneficiaries, but only to the extent that the merger of the trusts will not cause the imposition of gift tax or generation-skipping tax, federal or otherwise. (xi) To set aside as a separate trust, to beheld and administered upon the same terms as those governing the remaining trust property, any interests in property, for any reason, including but not limited to a concern that such property could cause potential liability under any federal, state, or local environmental law. Section 5.02 Whenever the Trustee is directed to distribute any trust principal in fee simple to a person who is then under twenty-one (21) yeazs of age, the Trustee shall be authorized to hold such property in trust for such person until he becomes twenty-one (21 }years of age, and in the meantime shall use such part of the income and the principal of the trust as the Trustee may deem necessary to provide for the proper support and education of such person in the standard of living to which he has become accustomed. If such person should die before becoming twenty-one (21) years of age, the property then remaining in trust shall be distributed to the personal representative of such person's estate. Section 5.03 In making distributions from the Trust to or for the benefit of any minor or other person under a Iega1 disability, the Trustee need not require the appointment of a guardian, but shall be authorized to pay or deliver the distribution to the custodian of such person, to pay or deliver the distribution to such person withoui the intervention of a guazdian, to pay or deliver the distribution to the legal guardian of such person if a guardian has already been appointed, or to use the distribution for the benefit of such person. Section 5.04 In the distribution of the Trust and any division into separate ousts and shares, the Trustee shall be author-;zed to make the distribution and division in money or in kind or in both, regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Trustee shall be binding and conclusive on all persons taking hereunder. The Trustee may in making such distribution or division allot undivided interests in the same property to several trusts or shares. Section 5.05 If at any time after Senior's death the total fair market value of the assets of any trust established or to be established hereunder is so small that the corporate Trustee's annual fee for administering the trust would be equal to or less that the minimum annual fee set forth in the Trustee's regularly published fee schedule, then the Trustee in its discretion shall be authorized to terminate such trust or to decide not to establish such trust, and in such event the ro ert then held in or to be distributed to such trust shall be distrib~fn ch: THE MARY EMMA DERR TRUST PAGE 7 QF 14 then or would be entitled to the income of such trust. if the amount of income to be received by such persans is to be determined in the discretion of the Trustee, then the Trustee shall distribute the property among such of the persons to whom the Trustee is authorized to distribute income, and in such proportions, as the Trustee in its discretion shall determine. Section 5.06 The Trustee shall be authorized to ]end or borrow, including the right to lend to or borrow from the Seitlor's estate, at an adequate rate of interest and with adequate security and upon such terms and conditions as the Trustee shall deem fair and equitable. Section 5.07 The Trustee shall be authorized to sell or purchase, at the fair market value as determined by the Trustee, any property to or from Settlor's estate; the estate of Settlor's spouse, or any trust created by Settlor or Settior's spouse during life or by will, even though the same person or corporation maybe acting as executor of Settlor's estate or the estate of Settlor's spouse or as trustee of any other such trusts and as the Trustee of this Trust. Section 5.08 The Trustee shall have discretion to determine whether items should be chazged or credited to income or principal or allocated between income and principal as the Trustee may deem equitable and fair under all the circumstances, including the power to amortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal, to treat any dividend or other distribution on any investment as income or principal or to apportion the same between income or principal, to charge any expense against income or principal or apportion the same, and to provide or fail to provide a reasonable reserve against depreciation or obsolescence on any asset subject to depreciation or obsolescence, all as the Trustee may reasonably deem equitable and just under all of the circumstances. Section 5.09 The Trustee is hereby authorized and empowered to purchase such insurance policies as they deem appropriate. Section 5.10 Actions and Voting by Trustees. When the authority and power under this Trust is vested in two (2) or more Trustees or Co-Trustees, the authority and power under this Trust or granted by law shall be vested in, and exercised by; each of the Trustees jointly, such that each Trustee ma_y only act jointly, ir, the administration or under the terms of the Tract agreement. Section 5.11 Trustee's Power to Deal with Environmental Haaards. The Trustee shall have the power to use and expend the trust income and principal to (i) conduct environmental assessments, audits, and site monitoring to determine compliance with any environmental law or regulation thereunder: (ii) take all appropriate remedial actiea-te~eerrtairr;' clean up or remove_ any ~nvirearrterrta}-traz~rd- r`nc1uding a spill, release, discharge or TxE MARY EMMA DERR TRUST Pacr 8 or 14 contamination, either on its own accord or in response to an actual or threatened violation of any environmental law or regulation thereunder; (iii) institute legal proceedings concerning environmental hazards or contest or settle legal proceedings brought by any local, state, or federal agency concerned with environmental compliance, or by a private litigant; (iv) comply with any local, state or federal agency order or court order directing an assessment, abatement or cleanup of any environmental hazards; and {v) employ agents, consultants and legal counsel to assist or perform the above undertakings or actions. Any expenses incun-ed by the trustee under this paragraph maybe charged against income or principal as the trustee shall determine. ARTICLE VI. SPENDTI3RIFT PROVISION Section b.01 General Provision. No beneficiary shall have the power to anticipate, encumber or transfer his interest in the Trust Estate in any manner other than by the valid exercise of a Power of Appointment. No part of the Trust Estate shall be liable for or charged with any debts, contacts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. ARTICLE VII. CONSTRUCTION OF TRUST Section 7.01 Choice of Law. This Trust shall be administered and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. Section 7.02 Code. Unless otherwise stated, al] references in this Trust to section and chapter numbers are to those of the Internal Revenue Code of 1986, as amended, or corresponding provisions of any subsequent federal tax laws applicable to this Trust. Section 7.03 Other Terms. Unless the context otherwise requires, the use of one or more genders in the text includes all other genders, and the use of either the singular or the plural in the text includes both the singular and the plural. Section 7.04 Captions. The captions set forth in this Agreement at the beginning of the various divisions hereof are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their construction and application. Section 7.05 Situs of Trust. The Trust shall have its legal situs in Cumberland County, Pennsylvania. THE MARY EMMA DERR TRUST PAGE 9 OF 14 ARTICLE VIII. COMPENSATION OF TRUSTEES AND APPOINTMENT OF SUCCESSOR TRUSTEES Section 8.01 Compensation. The Trustee shall receive as her compensation for the services performed hereunder that sum of money, based on an hourly charge or percentage rate, which the Trustee normally and customarily charge for performing similar services during the time which they perform these services. Section 8.02 Removal of Trustee. Settlor, may remove the Trustee, or any of them, at any time or times, with or without cause, upon thirty (30) days' written notice given to the curcent Trustee. Upon the death of the Settlor, a majority of the current income beneficiaries may remove the Trustee, or any of them, at any time or times, with or without cause, upon thirty (30) days' written notice given to the Trustee. Upon the removal of the Trustee, a successor Trustee shall be appointed in accordance with the terms set forth in Section 8.03. Section 8.03 Appointment of Successor Trustee. The Trustee may resign at any time upon thirty (30) days' written notice given to the Settlor or upon the death of the Settlor, upon thirky (30) days' written notice given to the current income beneficiary or beneficiaries (including a beneficiary's natural or legal guardian or legal representative), hereunder. Upon the death, resignation; removal or incapacity of the Trustee, Kathryn A. Swope and Barbara E. Varner shall become the successor co-trustees. Upon the death, resignation, removal or incapacity of Kathryn A. Swope and Barbara E. Varner, then additional successor trustees maybe appointed by the Settlor during her lifetime, or, after Settlors death, by a majority of the current income beneficiaries. Rny successor trustee shall be a financially sound and competent corporate trustee. Any successor trustee thus appointed, or, if the Trustees shall merge with or be consolidated with another corporate fiduciary, then such corporate fiduciary; shall succeed to all the duties and to al] the powers, including discretionary powers, herein granted to the Tmstees. Section 8.04 Exoneration of Trustee. No Trustee shat] be liable for any loss or depreciation in value sustained by the Trust as a result of the Trustee retaining any property upon which there is later discovered to by hazardous materials or substances requiring remedial action pursuant to anY federal; state; or local environmental law, unless the Trustee contributed to the loss or depreciation in value through willful default, willful misconduct, or gross negligence. Section 8.05 Indemnification of Trustee Upon Distribution. Notwithstanding any contrary provision in this Trust Agreement, the Trustee may withhold a distribution to a beneficiary until receiving from the beneficiary an indemnification an agreement in which the beneticiary agrees to indemnify the Trustee against any claims filed against the Trustee as an Tx>: MARY EMMA DERR TRUST PAGE 10 or ]4 "owner" or "operator" under the Comprehensive Envirottmental Response, Compensation and Liability Act of 1980, as from time to time amended, or any regulation thereunder. ARTICLE IX. PERPETUITIES CLAUSE Section 9.01 General Provision. Notwithstanding anything to the contrary in this Trust, each disposition I have made here, legal or equitable, to the extent it can be referred in its postponement of becoming a vested interest to a duration measured by some life or lives in being at the time of my death is definitely to vest in interest, although not necessarily in possession, not later that twenty-one (21) years after such lives (and ary period of gestation involved); or, to the extent it cannot be referred in any such postponement to such lives, is to so vest not later than twenty-one (21) years from the time of my death. ARTICLE X. ACQUISITION OF UNITED STATES TREASURY BONDS ELIGIBLE FOR TAX PAYMENT; PAYMENT OF TAXES, FUNERAL EXPENSES, AND EXPENSES OF ADMINISTRATION Section 10.01 Acquisition of Bonds. The Trustee may, at any time, without the prior approval or direction of the Settlor and whether or not the Settlor are able to manage their own affairs, acquire United States Treasury Bonds selling at a discount, which bonds are redeemable at their par value plus accrued interest thereon for the purposes of applying the proceeds to the payment of the United States estate tax on the Settlor's estate; and the Trustee may borrow from any lender, including itself, with or without security, to so acquire these bonds. Section 10.02 Pavment of United States Estate Tax by Bond Redemption. The Settlor direct that any United States Treasury Bonds which may be redeemed at their par value plus accrued interest thereon for the purpose o£ applying the proceeds to the payment of the United States estate tax imposed on the Settlor's estate, and which are held by the Trustee, shall, to the extent of the amount determined to be required for payment of the estate tax, be distributed to the legal representative of the Settlor's estate to be used by the legal representative ahead of any other assets and to the fullest extent possible to pay the estate tax. Section 10.03 Pavment of Death Taxes and Other Estate Settlement Costs. Afrer the Trustee has complied with Section 10.02; above, acd ascertained from the legal representative that all such bonds have been redeemed in payment of the United States estate tax, the Trustee shall also ascertain from the legal representative whether the legal representative has sufficient assets to pay the remaining legacy, succession, inheritance, transfer, estate and other death taxes or duties (except the additional estate tax imposed by Section 2032(c), or corresponding provisions of the internal Revenue Code of 1986 applicable to the Settlor's estate and imposing - - t etax _levied_or_.asseased.. against--ihe-,Se~tilor'~-estate--(h~a}t-rnt r~~t-ate-pe--dies THE MARY EMMA DERR Tlzus7 Pace I t Or ]4 thereon}, all of which taxes, interest and penalties are hereafter referred to as the death taxes, interest and penalties. 1f the legal representative advises the Trustee that insufficient funds exist to pay all the death taxes, interest and penalties, the Trustee shall then pay to the legal representative from the trust property, an amount equal to al] the death taxes, interest and penalties in excess of the funds available to the legal representative for this purposes, which payments are to be made without apportionment. In making the payments, the Trustee shall use only those assets or their proceeds which are includable in the Settlor's gross estate for purposes of the United States estate tax and shall not impair the marital portion without first exhausting the entire non-marital portion. Section 10.04 If the Executor of the Settlor's Estate, in such Executor's sole discretion, shall determine that appropriate assets of Settlor's estates are not available in sufficient amount to pay (1) the Settlor's funeral expenses, and (2) expenses of administering the Settlor's estates, the Trustee shall, upon the request of the Executor of the Settlor's estate, contribute from the principal of the trust estate the amount of such deficiency; and in connection with any such action the Trustee shall rely upon the written statement of the Executor of the Settlor's estate as to the validity and correctness of the amounts of any such expenses, and shall furnish funds to such Executor so as to enable such Executor to dischazge the same, or to discharge any part of all thereof itself by making payment directly to the person entitled or claiming to be entitled to receive payment thereof. No consideration need be required by the Trustee from the Executor of Settlor's estate for any disbursement made by the Trustee pursuant hereto, nor shall there be any obligation upon such Executor to repay to the Trustee any of the funds disbursed by it hereunder, and all amounts disbursed by the Trustee pursuant to the authority hereby conferred upon it shall be disbursed without any right in or duty upon the Trustee to seek or obtain contribution or reimbursement from any person or property on account of such payment. The Trustee shall not be responsible for the application of any funds delivered by it to the Executor of the Settlor's estate pursuant to the authority herein granted, nor shall the Trustee be subject to liability to any beneficiary herew5der on account of any payment made by it pursuant to the provisions hereof. IN WITNES WHEREOF, the Settler and Trustee Lave hereunto set their hands and seals as of the day and year first above written. Witness ~V ~ `. Settler 1Vlary Emma Derr TxE MARY EMMA DERR TRUST' PAGE 12 Or 14 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 5S: On this, the l,- r day of June, 2006, before me, a Notary Public, the undersigned officer, personally appeared Mary Emma Derr, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Trust Agreement, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official Seal. -~ i ~~ i otary Public My Commission Expires: rdotartat Seat Victoria M. Flartfcfn, tJOtary Public Lemoyne 6oro. Cumberland County MY Cnnrtwssion Ei~irea Aug. 27, 2006 Member. Pennsylvania Association Of Nobries ACCEPTANCE The foregoing Trust Agreement was delivered, and is hereby accepted, at t'°~- p F4, t1 _, Pennsylvania, on June f~ r, 2006. Witness L t I ''.~( d Trustee Mary Emma Kerr TxE MARY EMMA DERR TRUST PAGE ] 3 OF l4 SCHEDL3LE "A" SCHEDULE REFERRED TO IN THE TRUST AGREEMENT DATED: JUNE ~, ZOO6 FROM: MARY EMMA DERR, SETTLOR T6: 1'rZARY EMMA DERR, TRUSTEE PROPERTY DESCRIPTION: Residence and all personal property contained within located at: THE MARY EMMA DERR TRUST PAGE 140E IA SCHEDULE"A" SCHEDULE REFERRED TO iN THE TRUST AGREEMENT DATED: JUNE , 2006 FROM: MARY EMMA DERR, SETTLOR TO: MARY EMMA DERR, TRUSTEE PROPERTY DESCRIPTION: Residence and all personal property contained within located at: THE MARY EMMA DERR TRUST PAGE Id OF IT Estate of Mary Emma Derr Pennsylvania Inheritance Tax Return Form REV-1500 EXHIBIT D Copy of Department of Revenue Receipt for Prepayment of Inheritance Tax No. CD 011148 Dated 04/23/2009 wcaa OF MpNtbunl rqk ES OEPL PBO60t NnRGSFURG. ca 1 >t?6.O6C' PENNSYLVANIA RECEIVED FR6M: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT VARNER BARBARA E 5 MAPLE Dft ETTERS,PA 17319 -- ~o,~ ESTATE INFORMATION: ssN: 2oa-o~-ss7i FILE NUMBER: 2109-0394 DECEDENT NAME: DERR MARY E DATE OF PAYMENT- D4J23/2009 POSTMARK DATE: 04/23/2009 CauNTV: CUMBERLAND DATE OF DEATH: 01;27/2009 -~~ REV-1167 Ekn 1-96~ N0. CD 01 1 148 ACN ASSESSMENT AMOUNT CONTROL NUMBER ?01 ~ 514,000.00 , i TOTAL AMOUNT PAlD: REMARKS: X14,000.00 CHECK~153 INITIALS: JN seas RECEIVED BY: GLENDA EARNER STRASBAUGH RE~t~TEf~ O~ WILLS TAXP0.VER Estate of Mary Emma Derr Pennsylvania Inheritance Tax Return Form REV-1500 EXHIBIT E Documentation of Assets _ _ __.__.,~.:r, ,~ ~,_.N, s r~ CjF TITLE Fi7R ~ `~EF#tCLE _..~ ,, ~ _ "- ; ;iw~ `1,651 ~~.~( %r_{lii ^6L^3C7^~4^^15c'8-Ll^1 i,FAFP34P41ui1:'t•i~7L8 ~ r ^^1 ~ ~ FSRD 554865967^c L'E i I a.y i ~.E~~~~~,F~~,~. ,nr,~~a ,,.,,~,~ ,.T,, ~~,R~~a ~I7t8 ~ ^ ~ i I 4/21l06~ CJ28541 ^ 1~7~'~ lvl~E [rll~ ~F4t L,J ~ f '1 Y lr ti 1'N1 ~;, 1 r I iilh~ I (vi '~~,~il ~'. I 12/06/iI^ ~ 'ii2LlD6 i ' ~ ~ i ~,. .-. r;. r„yen I _. ~., _.~,_ I ss, ~.,_.. i ...,,~, ~, ,.. I -r~~ ern,we ~ :.,~,r~.:,.r, ,~ ,,,~E ~„E ,., ~: r,,.ro,W.~2, E` ~ e rm icr es,ws~He v~eais~ce _r ow. eiavv ~~ co u u e aver PilxRY Ef1f1A DERR ~ ~'r:Fi9Ef'`„',r nNr nr nn m 'P.C C'n,~ 'CYf ~i R i i .. + CAMP NIL't RA 1X711 " .r ~ ear e or.~ne , e rcicsrtc en. r c r,mc, , r,,+wvon o~. ~ ~,ao uc« : r.wn nr ~ ~ = 1 ._ e~.~,~ of ~ i n ~IliJl ll[N PEL EnSEO___ -lan ~ ;',t rr^l` ~I,II'IJHLfC~ ftCf'hf;iltl\i`.1~)C I..,li i„fit i~. ,U!]FEtiV 1' a~9s1~ . - ti~,.„~~,z~,~,,.e~,~r,~.~~,~E - MA.R';' EMMA I%ERR 35'31 uREEN ~T CAfiP HILL GA :L?iJ11 ~~u .~. ,. ~~~ , ,.,. ~: ,. .. '"il L. IL .:WO,ln1 kLLEN D BIEHLER ~ ~ ~ .~ i i i- , i i5i aY romc i0e io ~~ ~ h~ L @,1 a J T~n.ipl_ ,J I H I ~ p' IOn tlC Li OI ofB ,~~' ~ ____ - .V 'r I E I11 ~~ II IJ '.u if I i{ I I 1 f-(: w,i~ C F.0~ ~i( f/. I nl~ ,1~_I If J ~ ~~, ~ f5, T~ ' .,~:E I i --D L'I 'Nf ~ k I E+ir„l c I- ~_ s+,E -.... - - ~~ IF `.'! R `~ ~ < ~~ p L 5 N[,=F ( el r k I r.p F"i _ ar u. P , ~Fr ~. - i_ ~_ .. n ,.~. BRICKERS AUCTION - Buy & Sefi on Gominession - Complete Saie Service 93 Texaco Rd., -Mectiariicsbur8, PA 17055 766-5785 Personal Property of ;;°~/~~ ~~ ~ ~~` Address Sofd At Public sale ;'~ }~ ~ ~ L ~ ~a ~' ~ a~.tatandi.~s Total sale 3 ~ 3 ~ , ~. Tata6Checks f y zt ~. L S~ Total Cash ~ ` ~Z; ,j' ~~ z L Cash After Payout Ems AtlCfiOfl9er ac Clerks K - i ,-_. I 1 l l.' rf Cl ~: \ t~~ ib C. Adv. Cost ~" y / C' U;~ t-x!`ri Property Fare - i ~: ~ ~ - ___. Sc^rls Setup or Nelp ~ '~ .~%~ G ~ 0 ~? ~=xdstis~ ¢ Total E~enses ,`~ , ~ 2 ~ _ ~' , ~`, ~~. ~ ~,~ ~ ~~ l~%1 ~ ~~ rXc~'P ~ ~ , ~' ~ ~-E~- ~1~ `` r E- ` - fl ---,~-- _. __ ~/ _ _ _ ~ 1t ~U,c,J ~ ~lb~ ~~U~ `ice>' ~I~xf~ -. ~_ C O ~~ ~~ - ~~ ~ t , ~ 04~- - ,~ ~t_ ,~:~ ,~.:~._~,~: yl' - t ~. y. MBTBank a99 ~Ntdiell Road, Millsboro. DE 19966 Mail Code DE~MB-R Law Offices of Gates, Halbruner, Hatch & Guise, P.C. 1073 Mumma Road, Suite 700 Lemoyne, Pennsylvania 17043 Re' Estate o1 n;an~ 6nrnrn Derr Socia! Sactrrity: ?0?-DI-?671 Date of Death: January 27, 2009 Phone 1886!502-4,49 Fax r:(I')91a~?9» Hine i0. 2009 Dear Sir or Madam: Per your inquiry dated June 18, ?009. please be advised [hat a[ the time of death, the above-named decedent had on deposit with this bank the following.- I. Type ofAccoaun Accozuv Number eTnmership (Hanes n~ Opening Drne Balnnce nn Dare oJDeath Accared Interea Tara! Claecking.Account 61210137 D'ralentine H Der'r* A4an' Emma Den-* /0/2884 Closed 3/79/09 S (,010.09 S 0.01 S 1.070.11 ~ Tune ri(Appn,~ftl Account Nroarber Otvnerslvp (Names oj) Opening Dnre tsalance on Date of Death Acovred Interest Total ~;,9a;a~s ACS vi,n,' 15004213563932 d4an~ Ermna Derr" 5//6/06 Closed 2/24/09 S 0.00 S 0.00 5 D.00 Please he advised, there was no safe depose box found for the above. dgce~[ _~._H_tipoti.reviewing.[he_+ntevmation- --- above, yoii-belie3e /here are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Mechanicsburg Office k 717-255-2031. Sincerely, ^ ~. Trade Hare Ad;ucnnent Services canT~IT~or~1~ aF ~,~~,~ PRC?PERTY: 301 GREEN STREET, C:1;~'i€' H{L%,, H.A119PDEN TCiI~~NSH{P, CUNfBERLAND COUNTY, FE1~NS1'L~%,aN{A; [;E?iNC, T,tX PAP.CEL NU114BER 7Q-27- 027~-347. The conditions of the sale ofreal estate owned by THE MARY EMRhA DERR TRUST tlgte~[I !1 Ilx?F 1 ~ ?p06, ill'1(l? Oneih~ by }~i~hl IC S le Ur 3uCt~~~i1 on thie 1 21 n ~Iw n{ p1_pl tl, ?(If)Q arC 1° fpl~tlWS': TRRST: The real estate to be sot d is locared at 3501 Green Street, Camp Hill, Hampden Township. Cumberland County, Pennsylvania, as set lorth in the Property Description attached herato a5 Exhibit "A". Any additional survey of the pmpeiiy desired by the Buyer shall he at rite E?uyer's exliense. SECOND: The Seller reserves the ri~~ht to reject any and all bids. THIRD: The hiehest bidder shall he declared in he the Buyer subject to the light of the Seller u~ reject anti rmci all bids. FOURTH: CnuntylTp~~~nshih real estare r.,~~s hn~r'n~cn ~~,iid Ihrongh I)cc~'n~ix~; i 1. _'0(~2 School real estate taxes have been paid duou~;L>rn~~?'i _rn~~l :ail fares will be prorated between the Seller and the Buyer at the time of settlement on a fise~ii andlor calendar year as designated by the tasine authority. FIFTH: The Seller shall convey the tide in Fee sin~plc by deed bearing a special ~*~arrnnh~_ l he property is lip he conveyed free and clear of all liens. encumbrances and easements: excepting, h~i~,x~~ever. the fo{lowima existing building restrictions. i~rdioiu~ecs_ easements of roads. privileges. __ __ _ _ _ _ __ nr ri phis of any public service companies providing service to t'nc premises or agreements or like nulllers trh record_ and eascmeNS or restrictions visible uprm the ^__round~. otherwise. title to the described ~~cal estate sha{f he good and markeuihle ('nnciitinnc of Cale ~ilC h~~ar~~ Emma iierr Trust dal eci .6une ]'z, 2tliro 3~6i Green Sireet, Camp Hill, Pa rAoc -j- h S1\TH: Buver shall pay Ten'hhousand anc9 noll OD Dollars (Sl it_t)r1U.U0) of the prn~chase price to the Sellerat the timethe property is struck down. Payment shall be eitherin cash orceitit3ed Bieck. SE~'El\TH: Settlement shall beheld on orhefore forty-tlve (.451 days atier the signing of ~hesc C'onilitions of Sale. At final settlement, the remainder of the purchase price shall be due and ,., EiGFITH: Possession of the prenuses will he delivered to the Buver upon the date of the ~citlement_ NINTB: Seller and Buyer shalleaehpayone-halft'~~)ofanyappiicabiereallynansfertaxes. TGNTH~ The decd is to be p cp:n~ed ~ rl e~:ecute:' „ t~,; ~ i arse ~,;~th~c Seller- 'the costs ~iF rca~rding the deed and searching the title try (he prnpeiwshall he paid h~ lii vec rill ~uher c~lsls z,f >~at{ement shall he paid by the party who incurs such cosis- ELEVENT}I: Seller ceriities therehas been no work done. or notice received that work is in he rime- by the numie.ipality or at its direction. in a~nnection veiti~ the ~~nstallation i,f sewer or woicr r,r lin~ improvements such as pavine nr re-pavim~ of streets or nlleys_ or the installations Of curbs r~r,idewalks. " "`f\~EI~F fH~:-"Tile pi~pctitybeim; sold is suhje~t to a{I .~pplrcable i~ecieral. state ,m<i local la~:~c statutes. ordinances- Hiles and reeulations. Seller certifies that nn rotice has been served by I 4. ~ . - I Oil ~ i*u~-ern nl c'lliai alJ ihC)rit]~ t0~i the ieirirwai fir al ;~icillun U ftny it ulSFi~Ce, tC~ [uc ~iuicu Ifni vt an;p zunin_ rc~_ulation_ or concealing the coiutemnntiun of any potion oflhe said prnpenv. Cmsditions of Sale The iE1ar~' Gn}nsa .)err "i rust dated .inne .Z, ZUU(} 101 Green Street_ Canzp Hilh Pa Pater -3- THIRTLEN~TFi: kirk of loss ur danrtge to the property shall pass to Buyer when the pmpctty is struck dog>~n by the auctioneer. Subsequent loss or damage to the proper!y shall eat relieve the Buyer tiom his obligation to purchase the property. FOURTEENTH: The property is being sold "as is". Seller makes no representations or warranties concerning the property to be sold. It is understood that Buycs' had the right to inspect the property prior to sale and either has iiapected the property or waives the right to do so- Buyer agrees to purchase the propem~ as a result of such inspection or the waiver of the right ofsame and not because of or in reliance uprni any representation or ~m~an ante made by Seller, and Buyer agrees to purchase the propert}~ in its present condition. FIFTEENTH: In the Brent that Seller is unable to give ,t good and marketable t~,„?e ;uch as rr-ill he insured bU a licensed title innrrance cr~mpony et rep=ular tales. Buyer shrill have the npti~n ni takinu such title ris theSeller can give without abatement ofthe purchase price orirfbeing rel;aid all moneys paid by Buyer to Seller on account of the purchase price, togetherwith costs for searchin title as 6'LIVeI n~av have incun~ed: and in the latter event, there shall be nn further liability or obli~~ation on either cif the panics hereto and these Conditions of Sale shall become null and ~roirl. SIXTEENTH: if the Buyer tails to comply with the above teens, Buyer shall forfeit the _. _:nuauru_paici orr the-E}ap of thessle as sseesced mTd irgtirdaietttiamaeci. ant] the Sellei may proceed to make a rosaie of the premises. either et public or pri~~ate sale. Cundifions of Sale 'i'{li~ I~-i H1'~' cnurut f3err Trusi daieci Jtute IZ, Ziiiin tti(i[ Green Street, C';inip Fiii{, P>t Fade -4- SEV`ER'TEENTH: Bttver iterehv ,icl;ninaVed~~r; receipt ~~f these Cnndihons of Save, the acceptance attached hereto and the Prope:~y Description attached hercto- ;i'iTNGSS: %~'Z- ~y~' ~/,~~~---__ TIyE ivi:E[i~ F~)tii4'fiE BF.RR'~'RE!ST B,~tTE6 JUNE t2, ZOQh: "i i f is ATF192~'N .A. SW(}pF, C'(~-TRIICT£'F p a.aRB.aa,~ ~. ~~,~RrvE€z, ~o-T~E~sT~.~ Conditions of Sale Tile i~4arv Emma E7err Trust dated Sane i=, 2iriin 5~U1 lrccn Street, Canrp Fl ill, Ya E'a'se -~- SUP'ER'S ~CCGPTwPJC'i 1 (~>t~ e) hereb~r ackno~n~ledge, that L (' Wej have this ;l~rJ purcl~rase~{ zit publi;; auction the aLove- nanlcii Onii dC52rii?id ICai eStale IGCated ai ~~O~ VreCn ~trcCl- Qlnip [ii{{. }j.lT~l~({81 TtYWtiShl{), Cumberl,mii Couniv. Pennsyhrania- owned by The lvtar~~ Emnw Derr Tru.,t dated lone 12, ?U(In, Kathryn A. Swope and Barbara ~. Vm~er, Successm~ C'rr-Trustees. at the price of ~ r (~ L''C'~„'''" 1 (We) ~~eree to he suhjecs in and a~~ree to comt>ly with the foreaoine Conditions of Sale. \~~itncss my Eour) hand(s) this 13`" day ni ApriL 2009. \~'ET~ESS: ~ r '~ 2~ - ,_i/ Buvis Ai1tk~„. __~ i,..i i=aria--r_I~._,-~_ .,1~'_r_y- ~: _.. c ~ ~ Z Buyer Aitnrnev __-SIZcL^_}2w",-J•"'•"`~-~~~- f !`~~~~~'-~_'-_~ ~- - ~- ~ -- Conditions of Sale T im iJisrv Emma irerr Trust dated .Tune I=, Ziiii6 X5111 Cat-een Sn ecr, Camp Hili, Pa Pale -f.- N:~hltBC"I' "4" PROPERTY [DESCRTPi'iON ALL THAT CERT.41N pieceor pareel otlandsihiatein HampdcnTotnntsltil.?. CumbcrlandCounty. Penn~yl vemiu. nu~te particularl}~ hounded and described in accordance with a stnvey of Gen i t f .Betz, Re~zistcred SurvcYOr. dated Match 1 5. 1970. as i~ollows, to ~~uit: BEGINNING at a hub at the southwest airner of the intectectirtn ~~f Careen , nd ;S'' Rheetc; thence a{i~nu ~}ie wesletly {ine of ,j°i StteeS, South f I de::rees, 12 minutes E.asi a disi2nce n1 1 ZL 4l1 feet to a hub: thence along the dividing fine 6eiv,~een the herein dcscnbed lot and prouerry now of tormerlvofAu~~ustusand MaijrnieLucisano_South 70 degrees OSminures Westadisianeeof55.16 feet to a huh. thence ;Tong the cfiviilin, line between the herein described log and lot Nip 1 ? on the herrinoficr meniinncd plan of lots, Nprth l~) derces SS mntu[es West a distance ~~f 1?U 00 feet to ,nt inn pin ,Ilona the southerly line ni Green SueeC thence ;+lone said line North (1 de~rters U~ n°~uxite, E,~~i .i tfi~i.ince of 7 ~ >(~ feet in huh. the place o± heeinning. BEING: I_~~~ Nn I : _ Bnul: "M" Plan Nn. ; "Hnmpdcn Gardens" rcenrdcii ut Pl;;i°, 6o,d. ~. i;:~~~ (~3- ii;1~~iNG TIleRE'HN rRrCTE~:IiI, c . ~il< I : lwu of , v ±~.~~~ cilvJ~iil7lC J<1~il,itiiduici~i~li71i1eSc hl<~el: _nraue known ,ts ~5f11 Green Sheet. C vLTE is brm i5lumuAep lp give ypv Halakmenl p/actual «IlkTenl FO5l5 4mpunls P<~p lp antl0y l]le selrlem<nl ag<nl ere sown nams ma»<a TPOC]'w< e Pa p p~raia< me nw;ng. mre art mown n¢ra m•;nwrmarmnal wmpsea ene are _pr mn ^eee iKmr for:e . . cNAI.E aND AUUrrEaa t'. nvN.~wcr. rrATYr`f.WR R066W5 :O VJHEATI 4NO DFIVF Mf CHFNIF$6UFfi. PA 1]055 rnmt ..ro .~,,,.e.,a... .,~..r.. ........ ...... _..~.~_... ..,..,... MAFYEMMP DERR TRUST COMMERLE 6PNxwaRRSeUFC n'P 3561 GR££N $1flEEl T/D161A METRp DANK LAMP HILL, PJ. 1]Drr 3801 o0.%iON STF£ET HPPRI$DURFi, PP r]rrl G PFppERTY LpLAtION :SO+GRE4N Si REEY CAnnP MLL PA ITOn CUMfiERLANp COUnry vennsVlvan~a H. SEITLEMEIJT PGENT iRI.LOUNtt A95TRgCT pLALE pF SEtTLEMENT n6 CENTRAL 6LV0. CAMP MILL. PP 1)011 . 25~',fi19Et\ I SFTTL FMENT Da TE SERVICE June 26 :OC9 ` J SUMMPRY Of BORROWER'S TRANSACTION KSVMMPRY pF SELLER'$TPANSA[TJN t00. GRO55 AMOUNT pUE GgOM 6pgROWER: <OO. GROS6 AMOUNT DUE TO SELLER. rot Lpnvad bares Price 10: PPrspnbl Pm a ttf;Op06D sOL Contract galas Fri[e ~ a02. Personal Pro e1P. rr6000.OD T 035elUemem Cner e51p 8pslpper Line la00 46339) 509. rCe -.L°_ 50e 505. AO Utlmenls Fpr hems Paie9 $e4er Jr ae.'an ¢a Atl uBlmenli FO/Ikma PaieH $ellerm aeven[e r 06. Ci Rpwn Taxes 0613fi/09 to Ot/Otllp 192.88 aD6. CI /Town Tares OEr]EID9 Ip MIC'.nn "e6 :9r Cpun Taxes to Pm can Taea m IDE ScFrooL TAx O6J1mae m 0]ronw n ~. +D6. scHOpL TAJI D6rz6Ja9 Ip otm+lnE n n \09 $EWER/iRP5M p6/26N91a 0TNtN9 ]fi] 509. SEWERRRASM p626/09m U1/61109 I Pfi3 ne +m ni n2 nz Ii0 GROSS AMOUPoT DUE FRpM BORROWER 11:051$$ 830 GROSS AMOUNT DUF TO SELLER ~ rr621t 61 }OU. AMOUNTS PAID BY OR LN BEHALF Oi BORROWER' 500. REDUCTIONS IN AMOUNT pUE TO SELLER 201 De osn pr eamesl mpne A;Ofi0A0 50T. Excess De psil See matrpnipns I 3D1 Prrno alPmounl pl New loans 9a <00.00 502. Senl¢manl Lllar ea lp Bellel L'-ne +a00 r r9]-0 101. brsbn Ipan s taken a d W 50]. Ex¢lin Ipan s b4en su0 n Ip 20a p15BUR5EMENY OF GIFT FUN05 16,65155 56A. PaypX of Lrsl Mortgage I 105 505. Pa Mp eeeontl p e 206 506. Oe pall relainepp ¢Oer 10.000-0 20] 50> 20E SOB. 209 509. Peusrmenrs Fw hems ue aieB Server Aeuslmems Pornems un a;e6 gene 210 GI down )saes 1p 510. Ci Rpwn Taxe¢ 1 CpunT Teas Ip 511. Cpun Yaxea P12 SCHppI TA% 1p 51]. SCHOOL TAX n' S1] 515. n5 515 216 11t }r6 E+6 St) St6. _ L9 _ _____ .Fp t_,+F:IG 3VFOF BORROWEfl \ 123-5i55 90 TpT0.L RFOVCYION AMOUM pt'E SELLEF ~ '~r5_00I >Dp CASH Ai 6E TTLEMENT FROMRO BORROWER'. 600. CA6H AT SETTLEMENT iO1GROM $FLLFR. ]C1 Gip<s Ampum Ou<Grpm Barpwer Cme syO 4305155 601 Gmss Ampvnl Due iv Seller Line a20) - -~5 >61 ]D2 Lesa Amm~m PaieO if pi Bprrn rlLina 220) ,I t23-Sr551 602. Less ReUUCevns DUe Selln lL~ne 52Ur c50G _0i Cf Ertl FROM)1 TOJ BORROWER Op0 60] CASHIX i0)r .RpM,)SELLFF `L%O:e E` 1 i ur.eera~pnp4' 1'¢rcey acMnpwl¢pg¢ r Leipl pl a CpmObleC copy pl Ca9¢a 132 pl Ipis slaleml!rvl L any alla¢nmems re tee Ip .rPVE LPREFULLY RE VIEWED 1HE HUO~t SETTLEMENT 6TALEMENI PND TO THE 6E51 OF MY NNdNLEDGEepNO fiEnLIE Fn IT IEL TREE /.NC ALC'R4Tf$TPTEMEN10f ALL RFC£IPTS ANppJ$HUPSEMENI$MPOE ON UY ACCOV JT OR~MEI 11151PF /~C 1 1'.l. 1~A /.pVf RECE VEDA/C~p~Py D,~FppTHE//HUD-r SETTLEMENT SI4FEMENi - - -~ 6prpwe ~~~.d~-A~(~ See ~J4 L c yvU MATTHEW R. RD6B N$ MAP V f MMA pEFR TF U$' C TGS VJMC OWER`N ~yfp Np~EBEE~LF]J~5~0.5E06V THE UNOERSF~NE0 ~5 PPFT OF irvg SECTLE/£NCvGG 9',6„ ~x TRANSACTION LL~J // SelpemeM EANTO FILER gem W APNING NI$pCRIME iO NNCININGLY MPNE FpL$E$TpiEMf-NT$TO THE UNITEp 51PTE50N JH15 pF PNV 51Ml\AR 10HI4 Ff NAI TEE t'F[iN CONVICiIGN CAN INCL UDE PFINE PNp IMPR15ONMENi FOP DFTgIL$$ff. TITLE 16 V.$ CODE SECTION 1Cp1 S $E CTION rCrG D) s ~ n. >D] commras~rn va.fi ar $emem¢m ]Da ippNSACTION FEE n HOD. ITEMS PAYPBLE IN CONNECTION WITN LOAN IB01 Loan Ongi .fion [e= A BO' LOan Oracc 00i P00•a0 In MARK VY HELKMAN POC a000060RROWER )5.00 BDa. CgOil Remn c WUIFAX MORTGA ESERVICE$ POC t].tH LENDER BOS LenOe/s msgeOmn Fes O MpgK HECNMAN BS OG 806 MOnOage my Rp4 Fee 00). Assumpllon F ¢ BOB. VNpE RV+q Ii ING FEE COMM RL BANKIHPRRISSURG. NP.TN/B/A A96I859AMENCER g09 ADMINISiq AiION FEf n COMMERC BPNI(/HARRISSURG,NA. i.Nl61A METR06pNK S%500 610. OVERNIGHT MaG FEES UNISHIPPER$ POC 16.00 LENDER Bt1 FLOOC CERTIFrUTION PEE W LTERS KLUWIfR FI POC 60p LENDER 900. ITEMS REOl11REp BV LENLEP TO BE PPIG IN PDV PNLE 9011n esl From OEIZ6105 c GLOLOS E Ia.22pp0/tlay ) SOays T) h.12 902 Mon a elnzwance vrtmbmlo• gnlnz lq I 90J Hazsrtl insurance PremWm lcr 10me oALLSTATE W3URPNCE PCL a9].a080RROWER 90e ZDO65CMOOL 1P%F5 10 a MICNAEI LANGAN TA%COLLECTOR iOC 11a9.]] 905 2005 COUrvYVROWNSNIP TFTr MICHAEL LANCWN. TA%COLLECTOR POC ]65.p1 1000 RESERVES BEPOSITEC WITN LENDER 1001 Ma:aro lnsu•:nce _ iODp mon0s ~ f lay a Onln tN.JS 10021JOngace - onlll3 ((TS E gnln 100]. Cnv/10w= ~ E onlll 100< COU Tav 6.60p momma D ]f.pa on111 IBfi.1< 1005. $LHOOI TFM 1) 000 monlnc f t0a.11 per manln t,]Sia3 1006. ?DOB SCHOOL !NYE` mgnllls S monln 10m. mina 1m S mpmn t 000. AGGREG:.TE ESCFGW ALJUSIVIE monlna f mMlp -2)8.10 1100. TIYLE CXPRGES 1101 Serllemenr or ClOS Fee 1101 CLOSING PROTECTIOm IETTEF l0 FIRST AMERICAN TITLE IN$URPNLE COMPANY 110] LiIIe EHaminalion Ic )S.pO tlC< inletr e6rne x n05 Docu mP 1IDf NOIxry Fae _ e CASH 15.00 800 110T a ys Res a GAiE5 HaL0RUNER. HATCH8GW5E P.L. POC s aewe ae~. nr,mm.•• 11DE t - c TRbCOUNiV ABSTRACT SERVICEIAGENT FpP 15i AMERICA W e 9v5]5 s e0 vmLne tl[s 1.05 Lenom's COVeraae _ 9a a000p t06B99000PA1 1lp Owners Ce~e•age ~ f nH.00000 9n0]51069p6916PA0 1 ENCORSENEN_rOF_)'OD E' __ VCCOUNTV ASS~GT SERVICE 15000 1200. GOVERNMENT pECOROINL oNp iRPNSFER CNPRGES t 20'~ Rem•Oinp Fees peen b <6 SG. Mongage b ]6 Sp: Releases b 40Z Cny~CCUnry ia43amps G¢eo T100.OpN00a 1PW 6rare Tavl6lamps ue 5lemps 110060: MOggage 12S.p0 1]6000 1,10000 12pa ELECTRONIC pOCUME^+T 6f TR1EVRL rc CRbLOUNTV ABSTRACT SERVICE ZS00 '~2H5 OVERNIGHTIC(NR1ER [EFS O TRSCOUNTY PBSTRALI SERVILE 1a 50 t]OO. PpOIiIONPL $FTFLf MErv1 LNPPGES t 101 Surve 1]O? iA3 CERlIF1CFilON FEE [ TR1~C0'JNTY PB$TRPLT SEPVILE RE-IMDURSEMENT 5.00 1i0: $EWEGnpaSr.!Ul'r.SEGIPS3E=c HhMPCErv TOWNSNIP SEWER AUTHORITY 1iB6S tIOS 1 <p0. iOIAL SETTLEMENT CHAPGE$ IEnfer on Llnas 101, $acllon J anE 501. SaGlion K) a N]i 9al 1.19] 00 EETTtEMENI OFFICER Cen.Oec o ov. ",x 1c.r Senkmem Apen L% C m a m w A p~~~o gg ~~ ~D ~A c Oy ic X m W oo~ Z .°n C7 ~' ~ ~ C N N y y A A A A I I{ y0'VN~W ~ ~ O N ~ W e ~ 9 ~ ~ ~ N ~ W ~t V A O1 to N ~ ~~~+ ~ t~0 O N ~ A t ~ ~~ O N °° O V w d - O 3 m J 0 3 m p ~ m A toN vpJ ~ N ~N "3 V T A y o 0 N W • [P `J.n W. ~ rll _~. p~ m N Q J ++ o wn a°U m~ 'Q O n O 2' . W 4 N Sb N ~~~ a ~ m ~ ~ ~ ~ ~ !J Q ~ P a= ~ yCod OwN '-n a' o~~ -~cm~~~w C ~Gi yy W ~ j YN C"~ j'6f n <O .~ Z o m~m to m.a ~~ ~_.3C a~_ mn3°wK `< O ~rocroo.o_no z N^~. ~'~.OI ~Y~ Q N3~ ~ ~ .CsN~'nN m ~j0~7» N ~m= O ~~ BOO ~c~~Q d K 3c~-%UO ~ N D~~ ~.~0 ~~ ~,o_3.A.N y3Qrniyoo m ~m»yw ~ 4»O d ~, Q ~ O tD ~ ~ 3 j C ' ry i - ~~~y~o~ ~~~e°K°~ mr~ Yw~ vd~~~_ ~ ICJ a°ig8 f+ btl GS o° y "A o w of a w H H ~ 4 c~S ~ N W ~ H H w ~q vrr.~n -< m "'~mD C ~1 ~ 3W.~~r' -ry ~m~N m p'p0~ ~ m y A n. 8 a Z ~' 3 bop c7 Wc~ N -i C m m W N ~k g 6 .~ W n y ra Q ~MH i.v~ i .~ O r r ~ "~~ d ~4 e w ~ C J m a `a ~ r O ~ 'C c 0 account vvorKnook }~ ~•rt Page: 1 Pnsitinns ~ T~° t _ ACrnunt Name: DERR MARY FMMA Afrnunt M.imber: 27tft-571!1 Username: CharVes Pass Account Information Details Balances 271 B-5710 H832 C51 _ _ _ 4C-Street PJame~HOld/Hold All Funds Total Acc[ Val _ _ _ 19494.45 MARY EMMA DERR (1RA) investment ObjeCbve _ W Trading & Speculation Total Market Val 19,377.69 ]MS LLC CUST FBO Risk Tolerance A Funds Available-.- _ __ 122.26 5 MAPLE DR Cash Bal 122 26 ETFERS PA 17319-9473 Home Phone 717(Ti7-D E-Mail Address ___ 2uantitr~, Name __ - i Account T e , 5 mbol Mkt Price ---Y~!~- J_ Value -_--.~ Mgn. i Loc Ot-,,2-i-di ~~- 19,377.73 197.0370 AIM EQUTY CHRTER FD CL A I CHTRX 11.1600 2,198.93 Yes SKF / Z 1 ~ ;: ~ `i 333.3310 A1M EQUITY FDS CONSTELLA 1 CSTGX 16.5800 5,526.63 Ves SKF t v ~ c = _ - _, _ , ~~~ 6fl9.5770 HANC OCK 1NbTTR REG BK A 1 FRBAX 9.8200 6,771.65 Yes SKF ~t' `~!ti ? _.. .-_ .. ' tl t' 167.8320 MFS SER II GRWTH FD CL A 1 MFEGX 26.0400 4,370.35 Yes SKF P " ~ I -. ~- - ~ e 35.7510 MUTUAL SER FD SHS CL C 1 _ _ _ TEMiX 14.2700 510.17 Yes SKF 14 ~ ~ c? - `~' " ""This information is not the official record of your account and is subject to changes, errors and omissions and cannot be guaranteed as to its accuracy or completeness- Your panted confirmations and periodic account statements constitute your official account record. This information is not a substitute for other important information that Janney sends to you. Tne above may not oe used for iax reposing purposes. Janney will provide oninc+ai iax documeniaiion regarding your account to you by mail Estate of Mary Emma Derr Pennsylvania Inheritance Tax Return Form REV-1500 EXHIBIT F Documentation of Expenses ~ _ Michael J. Mn7yeZZi.Owrrer Jeremy J. Shartzer, Funeral DireUOr FUNERAL HOME -- 8 Nlnrket Plaza W'ny Mechanicsburg, PA 17055 • Phone: (7I7) 697-4696 February 10, ?009 Barbara Varner 5 Maple Drive Etters. PA 17319 The l uneral Service for b^,aty Emma Derr We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING 1S AN ITEMIZED STATEMENT OF THE SERVICES FACILST]ES. AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FLT~ERAL .ARR,ANGEMENTS. I. PROFESSIONAL SERVICES Services of Funeral DicectorlStaff $4275.00 FUNERAL HOME SERVICE CHARGES $4275.00 SELECTED MERCHANDISE: Sotid Oak Casket $2795.00 AZ Ga. Regular $1425.00 Register Package $90.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $8585.00 ,aT THE TIME FUNERAL ARRANGEMENTS WERE MADE. WE ADVANCED CERTAIN RaYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS .aN ACCOLIAITING PGR THOSE CHARGES. CASH ADVANCES Opening Grave $725.00 Cemetery Equipment $160.00 Certified Death Certificates $30.00 Newspaper Notices - Paviot $520.42 Flowers $212.00 Monument Engraving $ I SU.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $1797.42 SUII-TOTAL $10382.4? INi"FIAL PAYMENT (DISCOUNT /CREDITS _ _ TOTAL AMOUNT DUE $16382.42 1 JI ~r1 ~~~~~~D ~~ ~~~,~i ~ 1 ~i~ iru-n:ni~dp~'_:.i(imrrulhn~nr.~vm v .~. rrrar nct Jt. Harrisburg, PA 17101 Inquiries - 717-255-8213 GATES, HALBRUNER & HATCH, P.C. ATTN ACCTS PAYABLE 1013 MUMMA ROAD SUITE 100 LEMOYNE PA 17043 \ ~ r, ~; . ~. 1 h `~ THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin) ss Joseph A. Dennison, being duly sworn according to law, deposes and says: That he is the Assistant Controller of The Patriot News Co., a corporation organized and existing under the laws of the ~ommonweal[h of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of larrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of genera4 circulation, printed and published at 812 to 818 Market Street, in the City, County and State aforesaid; that fhe Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and 3N have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular icily and/or Sunday/ Metro editions which appeared on the date(s) indicated below. That neither he nor said Company is nterested in the subject matter of said printed notice or advertising, and that all of the afiegations of this statement as to the time, >lace and character of publication are true; and That he has personal knowledge of the facts aforesaid and is duly authorized and empowered io verity this statement on lehalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds T and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. 'UBLICATION COPY ESTATE NOTICE NOTICE is hereby 9ivenihat MARY EMMA DERR late of Homvden TownshlR, CUmbe(tontl COOnty, PennSYl VantR, hvs tlied, fhatdvring her h/ettme shp,estVEltstied The Marv EmITO Derr TYVS}..entl tM1pl VII pe(SVnS mdebte0 to her are reauesied to mpke Immetllate pov moot and those bovinR The MOry EmmR Detr Trvsf c/o Bdrb¢rRE. Varner and KatEixu-A Swoae,CmTrus}ees This ad # 0001954923 ran on the dates shown below: March 11, 2009 March 18, 2009 I / ~ March 25, 2009 ........... d ~ < ~_-.~ i /` Swortfto and subscribed before, the thls26,day of March, 2009 A D t_' - , I / ' ~ ' .. / ~ ___- __ ,. ~. ~~ii!~( _ t ,~ Y ~i Notary Public temovne, PA noga ,y M1llflfi(>NVUFALrH CAF °FNNSVLVANii ~~~~ ,tau tu~~,lVCtu~ Now you know Nt~tana~ eal ~ ShBnie L Hsner, Notary Public ( GY Of Hartist>t+r9, Dauphin Gartty '' M'/ Cnnrttiesion E+cpi2a Nov. 26, 201 t Mgrnp¢e, PennavWania Aseoclatfon o/ NDtarVP.s CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET - _~ CARL{SLE, PA 17013 _~r,,, Tele: (717) 249166 Fax: (717) 249-2663 it ~ ~ ~ Vic`' March 27, 2009 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of iegal notices. TO; Lowell R. Gates, Esquire Mary Emma Derr Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payab4e to: Cumberland Law Journal. Advertisement inserted on following dates: March 13, March Z0, and March 27, 2009 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May I6, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Joumal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid; was established .lamtary 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, ] 952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: March 13, March 20, and March 27 2009 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law 3ournal, a legal periodical of general circulation, and that he is not interested In the subject matter of the aforesaid notice or advenisement, and that a)] allegations in the foregoing statements as to time, place and character of publication are nzie. / rv`~' - - ~ ®~_ L' a Marie Coyne, Ediltor SWORN TO AND SUBSCRIBED before me this 27 day of March 2009 /% -- -. ~ 6~ ~~'~ Notary- ?~- r~ Derr, Mary Emma, decd. [,ate of Hampden Township. Co-Trustees: Barbara E. Varner and Kathryn A. Swope. 5 Maple r.-_..~.,-s.:...,,_.~..__,-..-E-~_.,~...r.„,~.,•:,,..~.>:,-.. Drive, Etters, PA 17319. ~ ~ ":, -; _a Attorneys: Lowell R. Ga[cs, Es- ~ p@t ~ ~, ,EI,,._ quire, Gates, Halbruner & Hatch, ~ No'oy Fz~:;c P P. C., 1013 Mumma Road, Suite ~ CRrt"i> 5C> ~ rtl +yE;~ ~.~~,~;.;;"y ,q l OQ (,emoFme, PA 170A3. p NM1 e r r d; n E ~rnes < ^r;l G h t.,»... m.q,.... o. ..,---~~.. .r--.,,. .... I~RtCKERS AUC~iC)N Buy & Selt on Commission - Carrlptete Sale Service 93 Texaco Rd., .Mechanicsburg, PR i 7055 766,5785 Peaxonal P.operty of ,%'~1~~~~ l~ ~: i`~. ~~ som at PaaDtlc Saaiie ,%~- h j< ~ ~ ~ --z~, zo t~ ~j Oaststanding Total Sale j ~ `3 I , ~ .~ TotatChecks ~ y ~~ 7 ~~' Total Cash iZ; `j ~`~ C L Cash 1ltter Payout Expa><~sss ~extlaaroa: ~ Clams r, - Ativ. Cost ?~ ~ - , f ! C.` L~ 1 - ~ ce rya, Pro~se-ty Fee ~ ,°:` ~ . {,, ,~ ~'~ ~'~'"~ ~ Z~ / Sate So trap or Fietp Total Expa~sa.®s ~- ;~ .~ ) '` C.` ; ~~ ~~~% ICi,~[ '. c - r117 ~1~f_ ' . ~1-~.. .. .- '~~ i ;. I ~. ~ , ~ ~ ~- /~ ~ ~. - ~ ~ jy, F f. _~ cC. ,,~~ ~/ ~ / ~i /~% J ~' %: ;, ~~ ~I I, ~~ ~ r ~~ I ~ ~~ ~. ~ ~ ~~ -a c F '. E "' ~~ ~~ CIS -- ; ~, j ~~ ~ Cil r ;_ ~ ~ ~ l ~ (~ .U ~ °' >_ _ ~, ~~ v, - ~p 0 6 U `s 10 0 •~~ 1 1 ~ ~~~ ~ ~ '~ _ ~ d -~ rl-' !,~~~ ~ I I ~~ x ~ _t it ~~= j _~ ' - ~--; ~ d. ~. _ 6 ` E 2I ~ ` C N N ~~T'~ 1j 1 ~~ ~ m c ~? 1 ~ ~~~ ~ '-' 0 0 ~ r 1 `~-~ ~~~ ~ ' ' I ~ ~ o0 `. m i ~ ~~~ ~ ~ ~~ ~ ~ ~ ~~, , ,~ ,-~, ~ ~, ~~~ ~_ _ ~ ~, . ~N ~"' . ~ ., - _; ~,. , Z ,.-. ,~~. ~ + ~ ~. C y ` d - ~ ~ ¢ O 0. o ~ w °m a < r ~:' w' ~ ~~` s ° s . ~ o , _" : ~ p t °' ti ~ ~n_...,. ~ _ c ~ ° ~ m m m pt a ' ~ ~ ~ ~~ ° i m ~ - -. ~ -.,,. 1 _ m cv_m 3 - HJ m' c `' v rom~4 ~ w ,~ _ E ~ 3 m ~ 6 W "R, 4 WO S Y m0 ~'C ~ Wm ~ Y _ ~ ~ ¢ aU n " s 3o~nty o ~ z 4' ro zz ~ S o E°m-_ a x a 3 -~~~- ~ 3 uN ~ ~ ~ _ ~moL~d o $Y N 4 Ql \ .J.. O d D you o ~ N ~ o9 n~o o a O ..~ ~ i ° m a u. K,_ _ < r ° 'V ~.. y _ ro `& _, \ w ~. ~ ' c ~fl ~ ~ tE®'~DN m \ - ` ~ r o~ r , o o m~ ~ y J N 4 6 _ L a ' ~ O _ O ~ ~ ' 1 5 ~ N < a = m ~ p Y 6 Q ~ 1 ....' 1 ~ ¢ 6 Q G ~ 6 \ ~t +V O 0 U `' `1 - Y \ `~ _ - ~ R T' ~, ~ ~ , Y J O_ ~, Z a ~; ~ O l1~ '6~ , j. - -- ~ - ~q v o o o 7 L ~ Q r ~, C r ry CL o w ~ ~ c e ` ym~ o c - : La Q lJ- ~ a V 2 4 ~ ~~ r z' Q ~ a a N W Q O- N 6 -[ ~ _ _ p ~ (Il ~ ~~ ° r , ~"' g~ z ~ o ~ ~ ~ ~ ~ m ~ W `" ~ ~ G-- i 1 ~ PLEASE REMIT PAYMENT T0. HAMPDEN TOWNSHIP 230 S. Spotting Hill Road Mechanicsburg, PA 17050-1097 PHONE 717-909-7145 hampden n hampdeniou•nship. us www. hampdenm~~~nsh ip. us Maste~CardNisa Accepted PROPERTY ADDRESS 3501 GREEN ST MARY EMMA DERR 3501 GREEN ST CAMP HILL PA 17011-4319 DUE DATE 041302009 CN: 006464-000 LC'. 102I02?5347 AMOUNT DUE $138.65 AFTER DUE DATE 8182.52 __ RETURN TOP PORTION N17H PA\TiENT BILL INCLUDES APRt L-.ii1NE?604 Q7 SE}}'ER AND/OR TRASH CHARGES. PA}TiENT ISbUE BY APRIL 30, 20091N ORDER TO :}VOID LATE CHARGES. DATF, CONSUMPTION BALANCE FORWARD PAYMENT SEWER TRASH AD)US7MENT PENALTY {NTEREST MARY EMMA DERR 7501 GREEN ST CAMP HILL PA 1 701 1-43 19 O1/Oi/2D04 olnzn6D9 04!01(2009 D4101/2009 ~~ ~\a~~°~ \' Gi:GSS BALANCE PAYABLE AFTF P. ;C CATS DIRECT W17HDRAWAL AVAILABLE AMOLMT 138.65 { 38.65 94.40 44 25 D oD 0.00 0.00 PROPERTY ADDRESS 3804 GREEN ST CA 0 0 69 6 4-006 LC 10210275347 DGE DATE 04!30/09 .4MOUN"f DUE $138.65 AFTER DUE DATE $152.52 RESIDENTIAL & COMhiERCIAI. PROPERIIF:S ARE 12E~IIN UED lF THEY if:U'F. n SANITAR}' SEWER BLOCKAGE OR BACK UP TO NOTIFY THE TOWNSHIP BF,FORE CALLIN'GA PLUM1iBER. CALL THE 70}1'NSHIP'S ROTFl LANE TREATMENT PLANT AT 7(i-7963- MICHAEL LANGAN, TREASURER COUNTY OF CUMBERLAND _ ~ ~ _ Discount I - Face I Penalty 230 SOUTH SPORTING HILL ROAD Race 5. oonoo ! _ z % 1 j 10 MECHANCSBURG. PA 17050 cNTY P/c _. __. I a.sc I 5.00 ~ 5-so TOWNSHIP OF HAMPDEN I Rate 5.00000 2~~ ~ 10~ MUN Pii - .°0 :.00 5.50 __ _- ° I TAX AMOUNT DUE --> ~I $ssD j sTa.DD ~ Sn.oD I rf Paia on or Afeai '~~ ;im/zoo9 ! 5lo112009 ~ 7/ol/zoos If Paid On or Hefo>•a I 4/90/2009 ~ 6/30/2009 DERR, MARY EMMA 3501 GREEN 5T. ~~~ )~ ~ ,~ ~~ L CAMP HILL PA 17011 ~ ~ ~~~~ Ij ~~ MARCH-JUNE MON 8 TUES 9-4:30. G~l ~ G ~ /~ ~l ~~ THURS 9-m30 ANC 6-B PM GLOS ED \NED. FR1, AND HOLIDAYS PHONE: 7t 7737-4822 Return Bill with Payment. For a Receipt ,Enclose Self Adtlressed Stamped Envelope. ?SE SEND BOTH COPIES CF BILL N7/SASE FOR RECEIPT TAX COLLECTOR COPY Bill No: 3725 AID TAXES SUBMITTED 70 UELINOUE NT COLL 12/15/09 Control No: 010.007478 2009 Statement of Personal Taxes Bill Date: 3/01/2009 ,~e Assessed Value 0 MICHAEL LANGAN TREASURER COUNTY OF CUMBERLAND Discount i Face Penalty 230 SOUTH SPORTING HILL ROAD Rate 5.00000 2 ~ i 10 % MECHANICSEURG. PA t70S0 cNrv P/c e.4D ~ s. oo I s.sD TOWNSHIP OF HAMPDEN '~ 'I Rate 5.00000 ~ 2 % j ~~ 10 % MUN P C 4.5C 5.00 ~ 5.50 TAX AMOUNT DUE ---> j s9sD % $10.00 ~ StT.oa I If Paid on or After i- 31c-,/zoos ~, 5/ol/zoo9 i/OS/zoos DERR. MARY EMMA 3501 GREEN SL CAMP HILL PA 17011 MARCH-JUNE MOIJ &TUES 9-4 a0', THURS 93:30 AND 6~8 PM CLOSED WED. FRL AND HOLIDHYS PHONE: 717-737-0822 AXES ARE IN ESCROW. FORWARD TO MORTGAGE GO- RSE SEfJD BOTH CGFIES OF BILL WfSASE FOP REC£1PT }~E MICHAEL LANGAN TREASURER 230 SOU I H SPORTING HILL ROAD MECHANICSBURG. PA +7050 A 5 S ESS. NO - t 0007382 MAP NO' 10-21-0275347 3501 GREEN STREET RCRES .180 DEED 00275/01504 HAMPDEN GARDENS tOT 11 BLK M PL3 PB 5 PG 63 Residential Building RESIDENTIAL DERR, MARY EMMA TR 5 MAPLE DRIVE ETTERS PA 17319-9473 MARCH~JUNE tJiON 8 TUES 3-4.30 THUR59~4:30 AND 6-8 PM CLOSED VJED, FRI. AND HOLIDAYS PHONE: 717-737-48[2 Return Bill with Payment. For a Receipt, Enclose Self P,ddre55eo Stampetl Envelope. TAXPAYER COPY Bill No: 2269 Control No: 010 ~ 007382 2009 Statement of Real Estate Taxes Bill Daie 3/0V200<, .0.55e55ed Lanp ImGrOVer.en[ Mineiail _ ~ Total Values I 29 210j 704 800 01 ~' .75 O3D I COUNTY OF CUMBERLAND I i Discount ' __ Face Penalty Rates - i .v0.39500 ' .0039900 2 5 '~. ~ SO @ COONTY R/H fi0.9Bj 263.x11 j 317.51 i ]2J .09 35b. d0 Rates _ .000380001 DDU1B0001 i ~ ~ I, lOS COUNTY LIB _ i9.76 '. S. E1 ?9.30 '.6.73 _ TOWNSHIP OF HAMPDEN i Race6 .00016000' .OOC 18000 _ `~I , 10 '< MUNLC F(E 4. _i i 19.9E - 23 y+ 29-?0 1 26. )l TAX AMOUNT DUE ---> j s3ss.D3 ', s372.as j $aos.7a If Paid On oz Af [er ~-7/pl (DCOE ~ J91 /2069 1)01/2005 If Paid On or Before 4/]0/2005 ~' 6/]0/2609 IF NOT PAID BY 12/25(2009 TH15 BILL WILL BE RETURNE D TO TAX CLAIM BUREAU FOR COLLECTION AND FlLING OF A LIE N AGAIN57 VOUR PROPERTY. "SEE REVERSE SIDE OF BILL FOR A BREAKDOWN OF YOUR COUNTY TAX DOLLARS "' R?ti rrn Rill wleh P~:,m am a.,. ~ o,.,-,..... o-_:_-_ ~... , Darren Barbacci DPM 1 ~G ~~ ~j'~- ~ 2 n ,~j~ 1~ 996 E ORANGE STREET ~` ~ ~~ _ _ _ ~_ _ ._,_ LANCASTER, PA 17602 /~' 4/22/2009 I I (717)393-4503 1, ~ c~ ~~~LI _ MARY E. DERR 3501 GREEN STREET , / ~„ /\~~C~ DERMA001 CAMP HILL, PA 17011 ~ / Last Payment Received 4/16!2009 Amoun?: -39.22 Previous Balance: 46.00 Patient: MARY E. DERR Chart # DERMA001 Case Description: i/ i6/09 1/16/2009 011609A NEW HOME VISIT 37899 75.00 3/11/2009 0116098 MEDICARE PAYMENT 37899 0.00 3/11(2009 0116098 PATIENT DEDUCTIBLE 37899 0.00 3/11/2009 011609B ADJUSTMENT OF MEDICARE PAYMENT 37899 fi.78 4/6/2009 011609E INSURANCE PAYMENT 37899 0.00 4/16/2009 0116098 CHECK PAYMENT 37899 -39.22 4122/2009 011609A MEDICARE PAYMENT 37899 0.00 4/22/2009 011609A PATIENT DEDUCTIBLE 37899 0.00 4/22/2009 011609A ADJUSTMENT OF MEDICARE PAYMENT 37899 -21.94 warren 8arbacci DPM 996 E ORANGE STREET LANCASTER, PA 17602 (717)393-4503 MARY E.DERR 3501 GREEN STREET CAMP HILL, PA 17011 Statement Date Chart Number Page 04!0612009 DERMA001 ~ Make Checks Payable To: Darren Barbacci DPM 996 E ORANGE STREET LANCASTER, PA 17602 (717)393-4503 Date of Last Payment: 3/11/2009 Amount: 0.00 Previous Balance: 0.00 Parient: MARY E. DERR Chart Number DERMA001 Case: 1116109 Paid by Dates Procedure Charge Primary Paid By Guarantor Remainder 01(16/09 11721 46.00 0.00 ~\l~ ~~`~~~ -6.78 39.22 Amount Due 39.22 ______ ___~~4...~ n rirvHNCE CHARGE OF 1.50 % PER MONTH 2645 NORTH THIRD STREET iAN ANNUAL PERCENTAGE RATE OF 18.0°s) OFE -Ii HARRISBURG, PA 17110 MINIMUM SERVICE CHARGE OF $ 1.00 WILL BE CYIARGED ON ALL AMOUNTS 30 DAYS OR MORE PAST DUE STATEMENT OF ACCOt}NT PHONE: 717-232-0400 ' _..,,,,.._-r?;~^:?:_ 02/03/2009 PMT DUE..02J14j09 MARY DERR HCPA 3501 GREEN ST CAMP HILL PA 17011 '~I'."L..DIIE_--_- l 7_..12 .=.".3t u~G,C:i N[FL-RT?E~14= r ~'18TIf ~.'J ~. Ypiif' ~+l'1hErv5 i k* ACTIVITY FOR DEP,R, MARY- -- 01/05/09 ! 6256927 25 I NITROGLYCERIN 0.4 01/07/09 ', Payment-Thank You CK 1361 Ol/26j09 ~, 6256927 25 '', NITROGLYCERIN 0.4 i -~ O1 i 01 I Q ~1,`~~ ~~~ >ERRM1 - 8.56 '' 96.71-~ 8.56 i - ;_ . _.--- - _ --17.12 LEGEND ' '~ b`~ ~~` ~~+~ ~~^-f 1 1' ~1Llx ~~'~.~i~.at'lat ~ ~'i+~ ~`~~ ~~' . f +..4-.`d Fh .vl. .5~tv.,ar f.> . '+ , . . f[ . .. + 96.71 17.12 .00 113.83 96.71 DERRMl /~J-~-1~ PAGE 1 OO I 8.56 0 0 '. 9 6.71-. 00 ! 8.56 - __ ' .oo ~~ KR s e 17.12 Caregiver Expenses for Mary Emma Derr 2009 (INC = In Home Care) A enc /Care ber Pa went Date Amount Month! Total IHC 1!2/09 $1043.50 IHC I/9/09 $973 IHC 1/17/09 $973 IHC I/24/09 $973 IHC I/3l/09 $973 Janua $4935.5 2009 Total $4935.50. _ i