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HomeMy WebLinkAbout01-19-10 (3) 1505607121 06 05 REV-1500 EX ( - ) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes Coun Code Year ~ File Number INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 4 0 7 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 2 6 5 8 0 3 0 9 0 4 1 8 2 0 0 9 0 3 1 8 1 9 4 5 Decedent's Last Name Suffix Decedent's First Name MI W E A K L E Y J U D I T H L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82} 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election bo tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST 8E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number H E A T H E R D R O Y E R E S Q 7 1 7 2 3 4 2 4 0 1 Firm Name (If Applicable) REGISTER OF WILLS USE }!1?~, LY S M I G E L A N D E R S O N & S A C K S ~ ~; ~~: ~ ~, ;_ First line of address ~ ~ _ ~ ~ 4 4 3 1 N O R T H F R O N T S T T' ~' ~ -- I r ' 1 .~7 l.0 - Second line of address ~' CIS - t 3 R D F L O O R ~C7"r' ~ -~ ~~- ; City or Post Office State ZIP Code ~ L.. _ __ DATE~ED W ~ ,~ r.~ H A R R I S B U R G P A 1 7 1 1 0 a' Correspondent's a-mail address: HROYERna.SASLLP.COM Under penalties of pery'ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best ofmy knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. TURE OF ESPONSIBLE FOR FI ING RE N ~ DATE ~/~s 2 DRESS 128, 0L_D FORp~~ CAMP HIL 4431 N FRONT ST, 3~ FLOOR HARRISBURG 1'LCAJC UJC VKWIIVAL FVKM UNLT 'A 17011 DATEI 17110 Side 1 1505607121 15D5607121 J ~ 1505607221 REV-1500 EX Decedent's Social Security Number ~ecedenYs Name: JUDITH L• W E A K L E Y 2 2 6 5 8 0 3 0 9 RECAPITULATION 1. Real estate (Schedule A) 1. 1 1 0 0 0 0• 0 0 ........................................ 2. Stocks and Bonds (Schedule B) .................................. 2• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 5 0 8. 0 3 0. 0 0 6 1 0 2 2 5. 2 8 5 4 8 5 3. 2 9 2 4 4 8 4 5. 8 4 1 0 2 0 4 3 2. 4 4 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9• 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 11. Total Deductions (total Lines 9 ~ 10) ........................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12• 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. 14. 8 1 1 1 3. 3 3 7 9 0. 3 6 8 9 1 0 3. 6 9 9 3 1 3 2 8. 7 5 9 3 1 3 2 8. 7 5 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable ~ ~ ~ at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable Q ~ 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable 9 3 1 3 2 8 7 5 at collateral rate X .15 . 1 g_ 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O. o 0 O. o o 0. 0 0 1 3 9 6 9 9. 3 1 1 3 9 6 9 9. 3 1 Side 2 1505607221 1505607221 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0407 DECEDENTS JUDITH L. WEAKLEY STREET ADDRESS _ _ _ ___ __. __.._ ___..___ ___ _.____ ___. 174 WILLOW MILL PARK ROAD CITY STATE I ZIP MECHANICSBURG PA ~ 17050 Tax Payments and Credits: 1~ Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 126,000.00 C. Discount 6,631.38 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 139,699.31 Total Credits (A + B + C) (2) 132,631.38 (3) Total InteresUPenalty (D + E ) 4. If lane 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 7,067.93 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ X^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^ c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ X^ 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ ^X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. X^ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (O) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. (4) 0.00 (5) 7,067.93 0.00 REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT --- ESTATE OF FILE NUMBER JUDITH L. WEAKLEY 21 09 0407 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real roe which is 'oint -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 174 WILLOW MILL PARK ROAD, MECHANICSBURG, SILVER SPRING TOWNSHIP, 110,000.00 PENNSYLVANIA 17050; COPY OF APPRAISAL ATTACHED. TOTAL (Also enter online 1 Recapitulation) ~ $ 1 I 0 000 00 (If more space is needed, insert additional sheets of the same size) REV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS ~ BONDS ESTATE OF FILE NUMBER JUDITH L. WEAKLEY 21 09 0407 All propeRy jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SCOTTRADE, INC. -BROKERAGE ACCOUNT #84138XXX 508.03 TOTAL (Also enter on line 2, Recapitulation) ~ S 508.03 (If more space is needed, insert additional sheets of the same size) REV-1507 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER JUDITH L. WEAKLEY 21 09 0407 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ASSET PURCHASE AGREEMENT WITH KRISTEN ZELLNER FOR SALE OF ABRAMS 0.00 & WEAKLEY, WHICH IS ATTACHED. ZERO VALUE PER THE TERMS OF THE AGREEMENT. TOTAL (Also enter on line 4, Recapitulation) ~ $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN R SI DENTED ~ DENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER JUDITH L. WEAKLEY 21 09 0407 Include the proceeds of litigation and the date the proceeds were received by the estate. All propeRy jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2001 P. T. CRUISER AUTOMOBILE- KELLY BLUE BOOK TRADE IN VALUE 1,550.00 2. 1987 VOLKSWAGON VANAGON AUTOMOBILE-KELLY BLUE BOOK TRADE IN 3,800.00 VALUE 3. 2005 SUBARU BAJA AUTOMOBILE-KELLY BLUE BOOK TRADE IN VALUE 10,450.00 4. FISHING BOAT AND MOTOR -SEE ESTIMATE OF MICHAEL NAILOR ATTACHED 350.00 HERETO. 5. US TREASURY - 2008 FEDERAL INCOME TAX RETURN REFUND 1,516.00 6. COMMERCE BANK CHECKING ACCOUNT #53603XXXX 9,021.17 7. COMMERCE BANK CHECKING ACCOUNT #53715XXXX 39,267.61 8. COMMERCE BANK CHECKING ACCOUNT #538301XXXX 101,304.89 9. COMMERCE BANK CERTIFICATE OF DEPOSIT # 12000XXXX 82,321.49 10. COMMUNITY BANK C.D. #100080XXXX 45,829.73 11. COMMUNITY BANK C.D. #10080XXXX 10],593.15 12. DUPONT COMMUNITY CREDIT UNION SAVINGS #28XXXX 30.25 13. DUPONT COMMUNITY CREDIT UNION MONEY MARKET 43,182.49 ACCT. #28XXX 14. DUPONT COMMUNITY CREDIT UNION C.D. #28XXX 40,000.00 I5. DUPONT COMMUNITY CREDIT UNION SAVINGS #557XXX 92.53 16. DUPONT COMMUNITY CREDIT UNION MONEY MARKET 42,658.90 ACCT. #557XXX - TOTAL (Also enter on line 5, Recapitulation) $ 61022528 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent JUDITH L. WEAKLEY 21 09 0407 Decedent's Name Page 1 File Number Schedule E -Cash, Bank Deposits, 8~ Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. COMMERCE BANK SAFE DEPOSIT BOX -INVENTORIED 05!26/09 - ENOLA BRANCH 0.00 18. CITIZENS BANK CHECKING ACCOUNT #610078XXXX 8,243.18 19. SUN TRUST C.D. XXXX6686 - I 15,001.35 20. SUN TRUST C.D. XXXX6686-2 60,046.37 21. HOUSEHOLD ITEMS -SOLD AT AUCTION 3,180.79 22. ALLSTATE -HOMEOWNERS' INSURANCE REFUND OF UNUSED PREMIUMS 10.76 23. AUTOMOBILE INSURANCE -REFUND OF UNUSED PREMIUM 759.00 24. COMCAST -REFUND 15.62 SUBTOTAL SCHEDULE E 87,257.07 GRAND TOTAL SCHEDULE E $ 610,225.28 REV-1509 EX + (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER JUDITH L. WEAKLEY 21 09 0407 A. LUCINDA S. STONE B BRAD STEVENS C 128 OLD FORD DR FRIEND CAMP HILL, PA 17011 313 SEYBERT STREET STEP-BROTHER WAYNESBORO VA 22980 JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 09/05/06 COMMERCE BANK CHECKING ACCOUNT #53751XXXX 108,314.88 50. 54,157.44 2. B. CIGNA STOCK 60 SHARES X $21.41 DOD VALUE 1,284.60 50. 642.30 (STOCK IN DECEDENT'S MOTHER'S ESTATE TO WHICH BRAD WAS 1/2 BENEFICIARY) 3. B. RAYONIER, INC. STOCK 3 SHARES X 35.70 DOD 107.10 50. 53.55 (STOCK IN DECEDENT'S MOTHER'S ESTATE TO WHICH BRAD WAS 1/2 BENEFICIARY) If an asset was made joint within one year of the decedent's date of death, it must be reported on Schediule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT TOTAL (Also enter on line 6, Recapitulation) I $ 54 853 29 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE JUDITH L. WEAKLEY 21 09 0407 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes, ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIRRELATIDNSHIPTODECEDENTAND THE DATE OF TRANSFERATTACHACDPYOFTHEDEEDFDRREALESTATE. DATE OF DEATH VALUE OF ASSET °k OFDECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1. TRANSAMERICA ANNUITY #02PPOOIXXXX 29,069.06 100. 29,069.06 BENEFICIARY: ESTATE 2. MONY LIFE INSURANCE COMPANY ANNUITY 3,661.04 100. 3,661.04 #2VAOOIXXXX; BENEFICIARY: ALEX JONES, COUSIN 3. MONY LIFE INSURANCE COMPANY ANNUITY 18,958.88 100. 18,958.88 #2VAOOIXXXX; BENEFICIARY: ALEX JONES, 2ND COUSIN 4. COMMERCE BANK C.D. #XXXX1686 87,466.57 100. 87,466.57 BENEFICIARY: KIZ SMITH, FRIEND 5. COMMERCE BANK C.D.#XXXX1687 87,466.57 100. 87,466.57 BENEFICIARY: LUCINDA STONE, FRIEND 6. TD WEALTH MANAGEMENT - SEP IRA #XXX-344613 18,223.72 100. 18,223.72 BENEFICIARY: ESTATE OF JUDITH L. WEAKLEY TOTAL (Also enter on line 7 Recapitulation) 13 244,845.84 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8a IN HERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER JUDITH L . WEAKLEY 21 09 0407 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. AUER CREMATION SERVICES OF PENNSYLVANIA, INC. 1,931.28 2. STOCK'S ON 2ND, INC. -CATERING 6,468.00 3. WINE & SPIRITS STORE 536.00 4. THE BEER KING 734.93 5. OBITUARY NOTICE 359.00 6. BAND FOR FUNERAL LUNCHEON (FUNKTION) 700.00 7. VA MEMORIAL SERVICE, LLC -PLAQUE AT GRAVE SITE 817.40 8. CAPT'N SAM'S LANDING-VA MEMORIAL LUNCHEON 1,000.00 9. CINDY BALDWIN - VA OBITUARY 121.40 B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) KIZ SMITH AND LUCI STONE 45,000.00 Street Address 128 OLD FORD DRIVE Chy CAMP HILL State PA Zip 17011 Year(s) Commission Paid: 2. Attorney Fees SMIGEL, ANDERSON & SACKS, LLP 20,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 760.00 5 Accountant's Fees 6. Tax Return Preparers Fees ALAN CEPERICH, CPA 1,200.00 FINAL PERSONAL RETURNS AND 1041 ESTATE RETURN 7. PP&L ELECTRIC 284.56 8. UNITED WATER 11.58 9. VA PROPERTY INSURANCE ASSN. 250.00 10. UNITED WATER 36.66 11. CUMBERLAND LAW JOURNAL -LEGAL ADVERTISEMENT 75.00 12. THE SENTINEL -LEGAL ADVERTISEMENT 237.79 13. COMCAST -CABLE TV 32.77 14. VERIZON -PHONE BILL 160.69 15. WALMART-STORAGE SUPPLIES 12.00 16. GIANT -CLEANING SUPPLIES 45.74 17. JASON SHOAFF -REPLACE LOCKS, MOW GRASS 173.50 18. PENN WASTE -TRASH 88.70 TOTAL (Also enter on line 9, Recapitulation) E 81,113.33 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent JUDITH L. WEAKLEY 21 09 0407 Decedent's Name Page 2 File Number Schedule H -Funeral Expenses 8~ Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 19. SCOTTRADE, INC. -BROKERAGE FEES 27.33 20. RECORDER OF DEEDS, CUMBERLAND COUNTY -TRANSFER PROPERTY 49.00 SUBTOTAL SCHEDULE H-B7 I 76.33 REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBEt~ JUDITH L. WEAKLEY 21 09 0407 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CENTRAL MEDICAL EQUIPMENT COMPANY 4.58 2. CRITICAL CARE SYSTEMS 955.31 3. ELDERS-CHOICE 1,050.00 4. HERITAGE MEDICAL GROUP, LLC 1,499.52 5. SMIGEL, ANDERSON & SACKS -BALANCE FOR LEGAL FEES PRIOR TO DEATH 500.00 6. LL BEAN CREDIT CARD ACCOUNT #XXXX5916 264.63 7. DAVID ABDU-GYAMI -PERSONAL CARE TAKER 840.00 8. ~ WILLIAM RICHWINE, D.O. -MEDICAL EXPENSE ~ 13.40 9. ASSOCIATED PRODUCTS -CHECK CLEARED AFTER DATE OF DEATH 225.00 CLEAN SEPTIC TANK ]0. PA DEPARTMENT OF REVENUE -TAX, PENALTY AND INTEREST ON OVERDUE 756.92 INCOME TAX ON ABRAMS & WEAKLEY BUSINESS 11. X2007 FEDERAL TAXES DUE -SEE ATTACHED IRS NOTICE. ~ 1,881.00 TOTAL (Also enter on line 10, Recapitul8tion) I S 7,990.36 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER JUDITH L. WEAKLEY 21 09 0407 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1. KIZ SMITH Collateral 262,224.13 128 OLD FORD ROAD CAMP HILL PA 17011 2. LUCI STONE (A/K/A LUCINDA STONE) Collateral 312,581.61 128 OLD FORD ROAD CAMP HILL PA 17011 3. JAMES PONDER Collateral 93,338.27 94 PEPPER AVENUE ENOLA PA 17025 4. KAY PONDER Collateral 82,888.28 94 PEPPER AVENUE ENOLA PA 17025 5. JAY SHOAFF Collateral 17,477.65 170 WILLOW MILL PARK ROAD MECHANICSBURG PA 17050 6. SHAWN SHOAFF Collateral 15,577.65 170 WILLOW MILL PARK ROAD MECHANICSBURG PA 17050 7. LINDA KRUGER Collateral 31,155.31 400 SUMMIT ROAD NEW CUMBERLAND PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent JUDITH L. VVEAKLEY 21 09 0407 Decedent's Name Page 3 File Number Schedule J -Beneficiaries -1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. SUSAN CASTRO Collateral 31,155.31 2710 GREENWOOD STREET HARRISBURG PA 17111 9. DOUG DEFFENBAUGH Collateral 3 I ,155.31 121 PAIGE STREET WAYNESBORO VA 22980 11. ALEX JONES Collateral 22,619.92 3068 TEXAS AVENUE PITTSBURGH, PA 17216 12. ELIZABETHMcQUAID Collateral 31,155.31 7508 WERTZVILLE ROAD CARLISLE PA 17015 REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 126,000.00 Discount: 6,631.38 Interest Table Year Vpya Vii 1111y Y~il ll Vp1Y 11bG VYG III~GI ~i~7L _ _ _ _ ~ this time period this year this period Before 1981 1 1982 ~ ~ 1983 _ _ _ j 1984 1985 1986 - 1987 ~ ~ __ _ --- 1988 through 1991_ _ I _ _ _ __ _~ A ~S9 '. .. __-_-_._.__..-__.._... _. ._--.._. .f_-_._____-_-_____. __--_-_-_r _. ___.-_._.._.___._..-. _._____. .__-___...______.__- 1993 through_1994 i ___ __ _ _ _ I '" ~aa~ u~rvu~n_i~~~-- ---- 1,999 - - --..._..- -- ---- r- -- - - - 2000 ~ -- ---------- 1 I-- - ----- -F -- I 2001 ~ - 1 - ~002_ i 2003 2004 ---- 2005 --------------- -- - - -- 1 --- -- , ~~~~ --_ _. __ - --- -- _ - ;.2007_ _.__ _ __ 2008. - --- -- ._ ~ _ _ _ __..- _ -- - + ~_- ____ TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: ...._. _ Penalty: 980cs-i-5/Will/HDR,~tmc ti23/08 1:46 Pti~ LAST WILL AND TESTAMENT OF JUDITH LOUISE WEAKLEY ~O, 00~ '~' GO I, JUDITH LOUISE WEAKLEY, presently of Cumberland County, Pennsylvania, declare this to be my Last Will and Testament hereby revoking all Wills and Codicils previously made by me. MARITAL STATUS I declare that I am a single woman. CHILDREN I declare I have no children born to or adopted by me. DISPOSITION OF BODY ARTICLE I I direct that my body be cremated and my ashes placed in my mother's vault located at Augusta Memorial Park, 1775 Goose Creek Road, Waynesboro, Virginia 22980. I direct that any and all decisions regarding the disposition of my body, including cremation decisions be made by my friends, LUCI STONE and KIZ CAROLINE SMITH, presently of Camp Hill, Pennsylvania, or by the survivor of them. PET ARTICLE II I give my dog, JOLLY MOONBEAM, to my friends, JAMES and. KAY FONDER, presently of Enola, Pennsylvania, together with the sum of Ten Thousand ($10,000) Dollars which shall be expended for the care of my dog, JOLLY MOONBEAM, during its remaining lifetime; provided, however, that this gift shall lapse if my dog, JOLLY MOONBEAM, is not living at the time of distribution according to this provision or if my friends, JAMES and KAY FONDER, do not undertake to use the funds gifted herein for the care of my dog, JOLLY MOONBEAM. SPECIFIC BEQUESTS ARTICLE III A. I give my friend, KRISTEN L. ZELLNER, presently of Harrisburg, Pennsylvania, all of my interest in my pet food and pet supply business known as Abrams & Weakley General Store for Animals, the principal office of which is located at 3963 North 6`t' Street, Harrisburg, Dauphin County, Pennsylvania 17110. This gift includes all of the property, tangible or intangible, used in connection with the business, including, without limitation the goodwill, accounts receivable, inventory, machinery, furniture and fixtures, contracts and all kinds of property used as part of that business and the enterprises connected with it. It also includes all insurance on the business assets and the proceeds, if any, from all insurance if there is a claim against that insurance at the time of Page 2 of 12 Pages my death. This gift does not include any property of any kind or nature that is not used in connection with the business. If my friend, KRISTEN L. ZELLER, does not survive me, then I direct my Co-Executrixes to liquidate this business, and all net proceeds of sale, after paying all claims and obligations allowed against my estate on account of the business, shall become part of my residuary estate. B. I give my fishing boat and its motor to my friend, JAY SHOAFF, presently of Mechanicsburg, Pennsylvania. If I do not own my fishing boat and its motor at the time of my death, then this gift shall lapse. C. I give my 1987 Volkswagon Vanagon to my friend, KIZ CAROLINE SMITH. If I do not own my 1987 Volkswagon Vanagon at the time of my death, then this gift shall lapse. D. I give my 2005 Subaru Baja to my friend, JAMES PONDER. If I do not own my 2005 Subaru Baja at the time of my death, then this gift shall lapse. E. I give my 2001 PT Cruiser to my friend, JAY SHOAFF. If I do not own my 2001 PT Cruiser at the time of my death, then this gift shall lapse, F. I give the cash balances of any and all bank accounts that I may own at Commerce Bank at the time of my death to my friends, LUCI STONE and KIZ CAROLINE SMITH in equal shares. If either LUCI STONE or KIZ CAROLINE SMITH fails to survive me, then the survivor shall receive the balances of any and all said bank accounts. Page 3 of 12 Pages REAL ESTATE ARTICLE IV I give my real property located at 174 Willow Mill Park Road, Mechanicsburg, Cumberland County, Pennsylvania (the "Property"), to my friends, LUCI STONE and KIZ CAROLINE SMITH, as joint tenants with the right of survivorship. If the Property is subject to a mortgage or other encumbrance at the time of my death, any remaining obligation secured by the mortgage or encumbrance shall be discharged by the use of funds from my residuary estate so that the beneficiary shall receive the Property free from the mortgage or encumbrance. If neither LUCI STONE nor KIZ CAROLINE SMITH survives me, then my Property shall be sold and the proceeds added to my residuary estate. PERSONAL PROPERTY ARTICLE V I direct that the remainder of my household furnishings and tangible personal property not otherwise disposed of in the preceding portions of this Will, be sold and the proceeds added to my residuary estate. Page 4 of 12 Pages RESIDUE ARTICLE VI I direct that the rest, residue and reminder of my estate be divided and distributed as follows: A. Fifty (50%) percent to JAMES PONDER and KAY PONDER, or to the survivor of them. If both JAMES PONDER and KAY PONDER fail to survive me, then I direct that this fifty (50%) percent share of my residuary estate be divided and distributed pro rata among the other beneficiaries listed in this Article VI. B. Ten (10%) percent to ELIZABETH McQUAID, presently of Carlisle, Pennsylvania. If ELIZABETH McQUAID fails to survive me, then I direct that this ten (10%) percent share of my residuary estate be divided and distributed pro rata among the other beneficiaries listed in this Article VI. C. Ten (10%) percent to JAY SHOAFF and SHAWN SHOAFF, or to the survivor of them. If both JAY SHOAFF and SHAWN SHOAFF fail to survive me, then I direct that this ten (10%) percent share of my residuary estate be divided and distributed pro rata among the other beneficiaries listed in this Article VI. D. Ten (10%) percent to LINDA KRUGER, presently of New Cumberland, Pennsylvania. If LINDA KRUGER fails to survive me, then I direct that this ten (10%) percent share of my residuary estate be divided and distributed pro rata among the other beneficiaries listed in this Article VI. Page 5 of 12 Pages E. Ten (10%) percent to SUSAN CASTRO. If SUSAN CASTRO fails to survive me, then I direct that this ten (10%) percent share of my residuary estate be divided and distributed pro rata among the other beneficiaries listed in this Article VI. F. Ten (10%) percent to DOUGLAS DEFFENBAUGH, presently of Waynesboro, Virginia. If DOUGLAS DEFFENBAUGH fails to survive me, then I direct that this ten (10%} percent share of my residuary estate be divided and distributed pro rata among the other beneficiaries listed in this Article VI. EXECUTRIX ARTICLE VII A. Appointment. I appoint my friends, LUCI STONF, and KIZ CAROLINE SMITH, to act jointly as the Co-Executrixes of this Will. If either LUCI STONE or KIZ CAROLINE SMITH is unwilling or unable to serve, then the remaining Executrix shall serve alone. B. Bond. No bond or other security shall.be required of any Executrix appointed in this Will. C. Compensation. The Executrix shall receive reasonable compensation for her services performed as determined by the Court in which this Will is admitted to probate. Page 6 of 12 Pages CO-EXECUTRIX POWERS ARTICLE VIII I give my Co-Executrixes in addition to and not in limitation of the powers given by law or by other provisions of this Will, the following powers with respect to settlement of my estate, to be exercised from time to time in the discretion of my Co-Executrixes without further order or license of the Register of Wills or of any court; A. Investments. To retain any property, pending distribution hereunder, to invest in or purchase any property without restriction to legal investments for fiduciaries, to compromise claims, and to sell any property at public or private sale; B. Securities. To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; C. Litigation. To engage in litigation and compromise, arbitrate or abandon claims; D. Distributions. To make distributions in cash or in kind at current values, or partly in each, allocating specific assets to particular distributees on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; E. Tax Returns. To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of incame or principal of any person affected thereby; Page 7 of 12 Pages F. Loans. To pay off any loans I may have taken against any life insurance policies owned by me that remain unpaid at the time of my death; G. Borrowing and Encumbering. To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; H. Property Management. To manage, control, repair and improve all real and personal property; I. Insurance. To procure and carry at the expense of the estate, insurance of the kinds, forms and amounts deemed advisable by the Co-Executrixes to protect the estate and the Co-Executrixes against any hazard; J. Employment of Attorneys, Advisors and Other Agents. To employ any attorney, investment adviser, accountant, broker, tax specialist or any other agent deemed necessary in the discretion of the Co-Executrixes; and to pay from the estate reasonable compensation for all services performed by any of them; K. Business Operation. If I have an interest in a business at the time of my death, whether the same is a sole proprietorship, apartnership, or a corporation in which I own all or a substantial interest or portion of stock, I authorize my Co-Executrixes, subject to the terms of any agreement I may have made for the sale of my interest, to continue such business, without order of court, until such time as they deem it advisable to sell, liquidate or distribute the same in kind. My Co-Executrixes shall have all rights and powers in connection with such business as I had when living, including by way of Page 8 of 12 Pages example and not limitation the powers to operate or join in the operation thereof as a going concern, to form or re-form a general or limited partnership, to incorporate or re- incorporate and to liquidate or sell the same or any part thereof, all as they deem advisable for the best interests of my estate and of the beneficiaries thereof, without any liability for loss resulting from the operation of such business except where such loss is the result of gross negligence or fraud on the part of my Co-Executrixes. I'vly Co- Executrixes shall be entitled to receive, for their services in connection with such business, such additional compensation as may be commensurate therewith. L. General. To do all the acts, to take all the proceedings, and to exercise all the rights, powers and privileges which an absolute owner of the property would have, subject always to the discharge of their fiduciary obligations. The enumeration of certain powers in this Will shall not limit the general or implied powers of the Co-Executrixes. The Co-Executrixes shall have all additional powers that may now or hereafter be conferred on the Co-Executrixes by law or that may be necessary to enable the Co-Executrixes to administer the provisions of this Will, subject to any limitations specified in this Will. NO ALIENATION ARTICLE IX No interest of any beneficiary under this Will or any codicil hereto shall be subject to anticipation or voluntary or involuntary alienation. Page 9 of 12 Pages NO CONTEST ARTICLE X If any beneficiary or remainderman under this Will in any manner, directly or indirectly, contests or attacks this Will or any of its provisions, any share or interest in my estate given to that contesting beneficiary or remainderman under this Will is revoked and shall be disposed of in the same manner provided herein as if that contesting beneficiary or remainderman had predeceased me without issue. LEGALITY OF ARTICLES ARTICLE XI If any provision of this Will or of any codicil thereto is held to be inoperative, invalid or illegal, it is my intention that all of the remaining provisions thereof shall continue to be fully operative and effective so far as it is possible and reasonable. TAXES ARTICLE XII All estate, inheritance and succession taxes, together with any interest and penalties thereon, payable as a result of my death and imposed with respect to any property, whether or not disposed of by this Will, shall be paid out of the residue of my estate. Page 10 of 12 Pages IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last Will and Testament, consisting of twelve (12) typewritten pages, including this attestation clause, to be executed, declared and published this ~~ day of ~ ~~~'~~~ , 2008, at River Chase Office Center, 4431 North Front Street, Harrisburg, Pennsylvania. ~`.7~ ~ ~+Gt`1 C?~t~.~G .fC~..k'_~ (SEAL) JUDIT LOUISE WEAKLEY Signed, sealed, published and declared by the above named JUDITH LOUISE WEAKLEY, Testatrix, as and for her Last Will, in the presence of us and each of us, who, at her request and in her presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year last above written. I ~1 ~ ~..~ .i.~tlr>> ~ , ~~C~~ ~ -1 Residing at Residing at 1-110 1~1 ~ r~~ ~ , C~,~~..~ ~^, _ L., Residing at ~ .~ ~ ~~~1~~?~~_j`L~~_]~~~• ~,~,'1 -~l Page 11 of 12 Pages COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN . SS. We, JUDITH LOUISE WEAKLEY, the Testatrix, and ~> l =~ 'C~~~- r . ~ 1~~ ' l ~~~~J'~L~- ~~1. C~~d ~ ~ ~ 1_ . ~'~~It'U,ryhe witnesses, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the V~%ill as a witness and that to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint. or undue influence. __--- JUDIT LOUISE WEAKLEY Witness _~ ~ ~~'~ _ Witness ~ Witness Subscribed, sworn to and acknowledged before me by JUDITH LOUISE WEAKLEY, r ~~~ the Testatrix, and subscribed and sworn to before me by ~:~ - Qc~~.~' ! .) Q;L, I 1 ~f ~~ - ~~C ~ and ~ ~ ( ~ L L • ~-~1 , lJ)'1~~ witnesses this .. _~ day of ! ~--~;,;'~~ , 2008. Notary Public My Commission Expires: Page 12 of 12 Pages FIRST CODICIL TO THE WILL QF JUDITH LUUISE WEAKLEY 1. JUDITH LOL?ISE ~VEAKLEY ,presently of Cumberland County, Pennsylvania, { -- - _ ~_ . ,° t~~: tt"ill and Testament dated Tune 23, ?008. da hereb~° make. publish and :a;1 _ _ x': i Substitution. of Provision ~~icle 1\' an Page ~t of the aforesaid V~'ill is hereb~° revoked and the following is { substituted in its place: j REAL ESTATE j ARTICLE IV A. I give my real property° located at 171 Willov~~ Mill Park Road, { Mechanicsburg, Cumberland County, Pennsylvania (the '`Mechanicsburg Propem~"), to my iri~nd~, Lt CI STOKE and KIZ CAROLINE S?~IITH, as joint tenants iti-ith the right of If the Mechanicsburg Property is subject to a mortgage or other I enc~unbrance at the time of my death, any remaining obligation secured by the mortgage or encumbrance shall be discharged by the use of bands from my residuary estate sa that the beneficiar;• shall receive the >Vlechanicsbtu•gPropcrty iYee from the mortgage or encumbrance. tthe "~'ir~Tinia Property'' f. to AMY GOODE. _ =- - - - -. ""^: -- - ,cam. ~~..''3'*~~:~ ~~ ~~~ ."~ :, .,. ~ ~, ._. ~:~ ^." ii;'~ lL~~ 4t L2TIt`l~ from m~~ r~sldtiai'~ e5tat~ ~o that the t~Ti~'FIC1aFy:" Sliaii r.cei~"e the ~-'ir~inia Propem- free from the mortgage or encumbrance. ... i If AMY GOODE fails to survive me, then my Virginia Property' shalt be sold and the proceeds added to my residuary estate. Republication of Will In every other respect, I hereby confirm and republish my Last Will and Testament dated June 23, ?008. Page 2 of 4 5 ~ s`k,..~' w t i7ti" . ~. 5 fir- ~~" _: _ _„ s _. ___ ..'.. _-~ i ._ = - _ - -_ x ` ~ - .~.ai :..-.zi _`r~. a.. ~3C'~~,~~ ~r`33S .a~estataon clause. ~Et my Last _ , • -~~~ to be er-ecuted, declared and ublished this ~''" day- of 4 '~~~~~ ~ ~ ~ ~~ '0t~9. at ~ ~ r s ~" ~1 n,~ r ,~ ~~r ~. ublisl}ed :pfd ~.eclar~d icy- tlEe abo~.-; named .IL~FTN LUL`IS£ - «-E aKLEI", Testatrix. as and for her First Codicil for her Last tit ill, in the presence of us and ~ac~ of us, who, at her request and in her presence and in the presence of each other, have -._.~ nta subscribed our names as witnesses thereto the day and year last above written. t' r ~---d.,.,._ ~- - -r :> _ `~ Residing at ..~ {.~~-~ ~=~ [ a ~- r-•~ ., ~ ~ ~, Residing at ~s <;~.~ ~~,r~~;~'-.~i:-z~~~. ~ ~~ I i i -~ -- --=' _. ~. ~ --. ~.;, i y,~ '.~: ,,t'a- Page 3 of =~ `a` ` ~~ `'~ PF VVe, JUDITH LOUISE WEAKLEY, the Testatrix, and~~a~ i:;-`t~, ;,; ,:, ~ z. ~ ~: ~.. _ a~.. ~ ; ,. `; ~ l :? and ~ r .. ~ ,`"., , i ~ ' ~-•' ?~ ,the witnesses, ~~$ose names are signed to the attached or foregoing instrument. being tint c`?ul~~ , -~,~;. u~, z`r ;~•. ~y~ _ , • - ti~ T _ ~, unaerst~rne~ auth._ rf . • that he t eStatrl stgr:eo and ex~:ura ink - her Last ~t'iII; that the Testatrix signed willingly and executed it as her fr ~-~ . . ee and ~ ~~I;,:;..,3r• 'a~.t fE~r ~ r{' the purposes therein expressed; that each. subscribing witness in the hearin e g and stght of the ; Testatrix signed the First Codicil as a ~~~itness and that to the best of his or her knowledge t i he Testatrix was at that time eighteen 18 ? ( }years of age or older, of sound mind and under no I i, - _ _ Wjt~ss /~ : ~ f~,J r r~ ^^~ ! ..4. %. Fitness Subscribed, s~~,orn to and ackno~~~ledged before me by JL I3ITH LQL'ISE fit- - - 1:1a. l.~t~rr... ._ _ ~~~ ~'r -L_r~~ L - C, c `~.. . ti3tn~S~2~, t1]:~ t~ _ day- of I~ ~,~ L~ br. ~ ~, z' .2009. _ 'otary Publi~~- ' ~ ` :``~~ "~ ~ (SEAL) COMMQNWEAtTN vF ~E1VN5YZVAN[A ~~ Sad _ Page ~ of 4 ~--~ler}T ~~~°~'!~'ubiic j' ~C,c~it,'I'tiss~en E.a;jrx q~ 30 ~~ i ~~ Notartes carlCtralni nr a„~.,d.,~ :__r, D..A.. _POTTS ~..a~p p r• a i s a t 4.FT~.P I. ~~C.~,._. JUNE 21, 2009 ESTATE OF JUDITH L. VVEAKLEY File Number: Psos Klz to accordance with your request, I have appraised the real property at: 174 WILLOW MILL PARK ROAD MECHANICSBURG, PA 17050-1760 Fde No. P509 KIZ The purpose of this appraisal is to develop an opinion of the market value of the subject property, as improved. The property rights appraised are [he fee simple interest in the site and improvements. In my opinion, the market value of the property as of Aprll 1s, Zoos is: s1lo,o00 One Hundred Ten Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final opinion of value, descriptive photographs, limiting conditions and appropriate certifications. RESPECTFULLY SUBMITTED, ~~ a. ~ DAVID A. POTTS, PA STATE CERTIFIED GENERAL RE APPRAISER 4301 Woodaest Lane, Camp Hill, PA 17011 (717) 763-1060 !Fax: (/17) 763-1062 ©~A. ROTTS ~r~~~rczisrrl .c€i rice APPRAISAL OF LOCATED AT: 174 WILLOW MILL PARK ROAD MECHANICSBURG, PA 17050-1760 FOR: ESTATE OF JUDITH L. WEAKLEY BORROWER: N/A AS OF: April 18, 2009 BY: DAVID A. POTTS, PA STATE CERTIFIED GENERAL RE APPRAISER 4301 Woodcrest Lane, Camp Hill, PA 17011 (717) 763-1060 /Fax: (717) 763-1062 D.A POTTS APPRAISAL SERVICE Uniform Residential Appraisal Report File NO. P509KIZ The urpose of this summa! a sisal re ort is to rovide the lenderlclient with an accurate, and ade uatel su orted, o inion of the market value of the subject propert . Pr Address 174 WILLOW MILL PARK ROAD Cit MECHANICSBURG State PA Zi Code 17050-1760 bortowa NIA Owner of Public Record WEAKLEY JUDITH L Coum CUMBERLAND L al Desai lion DEED BOOK 0036A PAGE 01137 SILVER SPRING TOWNSHIP Assessor's Parcel ~ 36161070006 Tax Year 2009 R.E. Taxes f 743.76 Nei hbortaod Name NONE KNOWN Ma Reference ADC 3004 9C Cenws Tract 0116.01 Ot or Owner Tenant Vatam 5 wl Assessments f NONE KNWN PUD HOA f ear er month Pro Ri is A aised Fee Si a Leasefald Other describe Assi meet T e Purchase Trareatlion Refinance Trerrsaction X Other describe ESTATE PURPOSE Lender/Client ESTATE OF JUDITH L. WEAKLEY Address Is the w ~ect rt ctxreml offered fa sale or has R been ofered fa sale in the twelve months rior to the effective date of this a sisal? Ves No Report data source(s) used, offering price(s), and dale(s). CENTRAL PENN MULTI-LIST SERVICE I did did rat analyze the coniraa for sale fa the wgect purchase transaction. Explain the results of the analysis of the contract for sale a why the anaysis ~Mas rat performed. Contras Prke f Dale of Contract Is the o seller the owner of ublk record? Yes No Data Soorce s Is these any financial assistance (loan charges, sale concessions, gih or downpaymem assistance, etc.) to be paid by any party on behad of the bonowa? Yes Na If Yes, report the total dolWr amount and describe llte items ro be paid. f Note: Race and the racial com sition of the nei hborh ood are not a sisal !actors. Nchghborlnod Characteristics One-Unit Fbusing Trends i}ne-Unn Heuslrg R?sertt land Use% Locatgn Urban Suburban Rural Pro Values Increasi X Stable Dec6ni PRICE AGE One- nil 70 % Buik-U Over 75% 25-75% Under 25% DemanMSu Shorty In balance Ova Su S 000 furs) 2.4 U~tit % Gri>wth Ra id Stable Sbw MarketM Time Under 3 mlhs 3.6 mths Over 6 mths 100 Low 30 Multi- anvil % Neighborhood boundaries RTE 114 TO THE EAST 1-81 TO THE NORTH US RTE 11 TO THE SOUTH AND 175 H' h 85 Co ercial % RICH VALLEY ROAD TO THE WEST. 125 Pred 70 Other VAC 30 % Neighborhood Description PROPERTIES ALONG WILLOW MILL PARK ROAD THAT BACKUP TO THE CONODOGUINET CREEK. EAS`~ACCESS TO EMPLOYMENT AND SHOPPING AREAS VIA RTE 114 US RTE 11 AND 1-81. REGIONAL SHOPPING CENTERS WITH NATfONAL C IAINS ALONG RTE 11 WITHIN 1-3 MILES OF THE SUBJECT. Market Conditbns (including wppon fa the above conclusions) THE AREA REAL ESTATE MARKET IS CONSIDERED TO BE ACTIVE WITH TYPIICAL MARKETING TIME OF 90-180 DAYS. LOAN DISCOUNTS INTEREST BUY OOWNS AND OTHER FINANCING CONCESSIONS ARE MODERATE. INTEREST RATES ARE REGARDED AS FAVORABLE. Dimensions 50/129+/- Area .14 ACRES Sha RECTANGULAR View GOOD S ecific Zortin Classifx;adon Rt Zoni Descri tan RESIDENTIAL Zoni Co fiance X Le al L al Nonconfarmi GraMfatnered Use No Zonin II al desaibe K the taghesl and best use of the subject property as improved (or as proposed per plans and specifications) the present use? Yes No If No, describe. Utilities Public Otner describe) Public Other describe Off•site lm rovements-T a Public Private Electrki X Water WELL Sveet MACADAM Gas X BOTTLED Sanity Sewa SEPTIC Alle NONE FEMA S ial Flood Hazard Area Yes No FEMA Fbad Zone AE FEMA Ma 1 420370 0093E FEMA k1a Dale 03/1612009 Are the utilities and off-site i vemems ical fa the market area? Yes No H No, describe. Are there arty adverse site tonditions a eztanal factors (easements, encroachments, ernkonmental conditions, land uses, eaJ? Yes X No d Yes, describes. PROPERTY APPEARS TO BE IN FLOOD HAZARD ZONE A. GENERAL OE IPT F DATION EftIOROESCRIPTkkI m~erialskondi@on INTERIOR materialsltondnon, Units X One One with Acces Unit Concrete Slab Crawl S ace Foundatan Walls CONC BLK/AV Floors HW CORK/AC i d Stories 1 Full Basement Partial Basement Exterior Walls MAS BRDlGO Walls DRYWALUAVER T e Det. Att. S-Del./End UnR Basemem Area 0 . ft. Roof Surface ASPHALT/GD TrimlFinish MOOD/AVERAGE Exisd Pro sed Under Const. Basemem Finish NIA % Gutters & Downs outs ALUNVAV Bath Fbor VINYUAVER Des n St le RANCH Outside Ent! (Exit Sum Pum Wirxlow T e DBLHUNG/AV Bath Wainscot BGUAVER Year Buik 1950 Evidence of mlestation Storm Sashllnsulated DBLPANE/AV Car Story i None Effective rs 12 Dam ness Seakmenl Saeens Y ES/AVER Drivewa of Cars 3 AUK None Heati FWA HWBb Radiant Amenities WoedStove s) a Orivewa Sudac MACADAM Dro Stair Stairs X OIhaBB Fuel ELECTRIC Fire ace s t X fence Gara a of Cars Floor Scuttle Coolie Cemral Air CixWNionin PatiolDeck Porch Car rt of Cars Firyshed Heated Individual Other Pool Other Att. Det. Built-in A fiances Refd aorta Ra IOven Dishwasher Dis sal Microwave Washer! r Other describe Finished area above lade contains: 4 Rooms 1 Bedrooms 1 Bath s 1200 5 are Fea of Gross L vi Area Abwe Grade Additional features (special energy elfKienl items, etc.). LOFT, SPIRAL STAIRCASE, FENCE, SKY LITES, BOAT DOCK, FRONT PATIO REAR PORCH Desaibe the condition of the property (including needed repairs, deterioration, renovations, remodeling, etc.). PROPERTY IS IN AVERAGE CONDITION FQR IT'S AGE AND HAS BEEN WELL MAINTAINED. KITCHEN IS MODERN. Are (here any physical deficiencies a adverse conditions that affect the livability, soundness, a structoral integrity of the property? Yes X No ll Yes, describe. UE TO MAINTENANCE AND UPGRADES THE ACTUAL AGE EXCEEDS THE EFFECTIVE AGE BY MORE THAN 25 YEARS. THE SUBJEC WAS BUILT PR10R TO 1978 AND MAY CONTAIN LEAD BASED PAINT A KNOWN HAZARD. Does the property generally conform a the neghborhtad (functbnal utility, style, condition, use, construction, etc.)? Yes No If No, describe. ~ sac ram N wcn nua RoaurM aing,ltl shwa am 171 ern wwxarata.[an Fame Abe Form 1001 aartn zoos verge t d 6 ~oo._os a6asoe D.A. POTTS APPRAISAL SERVICE Uniform Residential Appraisal Report File NO. P509KIZ There are 2 com table ernes currend ortered fa sale in the wb'ect nei hbodtood ra in in ice from S 119,900 to f 139 900 There are 4 com table sales in the wh' t n ei ahtad within the ast twelve months ra i in sale rice from f 105 000 to f 134 000 FEATURE SUflIECT COMPARABLE SALE N0.1 COMPARABLE SALE N0.2 COMPARABLE SALE N0.3 174 WILLOW MILL PARK ROAD Address MECHANICSBURG PA 1082 OYSTER MILL ROAD CAMP HILL PA 4430 SEARS RUN ROAD MECHANICSBURG PA 5505 CREEKVIEW ROAD MECHANICSBURG PA Proam to Su 'ect 5.62 MILES E 4.33 MILES E 3.36 MILES E Sale Rice f REFI f 127 000 S 114 400 S 105,000 Sale PricelGross Liv. Area f 0.00 ft. S 120.95 s . fl. S 157.79 . ft. S 61.08 . ft. Dau Space s WSPECTION . DATABANK DATABANK DATABANK Verificatan Sarc s CPMLSlPUBLIC RE C CPMLS/PUBLIC RE C CPMLSIPUBLIC REC VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION d- s mea DESCRIPTION .t S ~ustmem DESCRIPTION .41s ustmem Sale a Financing Concessions FHA $7000 PO COSTS -7 000 CONV. $6500 PD COSTS ~ 500 CONV. $2100 PD CO TS -2 100 Dale of SaleRime 02/102009 04/102009 D2/122009 Laation SUBURBAN SUBURBAN SUBURBAN SUBURBAN LeasehatYFee Si ro FEE SIMPLE FEE SIMPLE FEE SIMPLE FEE SIMPLE Site .14 ACRES 1 ACRE -5000 .15 ACRES 33 ACRES -1 000 View GOOD GOOD GOOD GOOD Des' n St le RANCH RANCH RANCH RANCH Dual' a Constnation AVERAGE AVERAGE AVERAGE AVERAGE Actual a 59 YEARS 69 YEARS 109 YEARS 4000 79 YEARS Condition AVERAGE AVERAGE AVERAGE AVERAGE Above Gratle raa cams erns Tar ea aaas Taal germs. eaaa row BAan aa~ Room Courn 4 1 1 5 3 1 5 3 1 6 3 1 Grass L' ' Area20.00 1 Z00 . ft. 1050 . ft. 3000 725 . ft. 9500 1 295 s . fl. -1 900 Basement d finished RoomsBerowGrade SLAB N!A FULL UNFINISHED -3,000 FULL UNFINISHED -3,000 SLAB N/A FtaatbnalUtili AVERAGE AVERAGE AVERAGE AVERAGE Heati Cooli EBB/NONE GFHAlCA 3000 HP/CA -3,000 OFHA/CA -3 000 Ener Efficient Items THERMO PANE THERMO PANE THERMO PANE THERMO PANE Gar Ca on NONE 1 CARPORT -1 000 1 CAR DET -1 000 NONE PachlPaDolDeck PAT POR PAT POR PAT POR DK POR Net ustment Taal « X - f 16,000 X + f 0 S 8,000 Adjusted Sale Prke a Com ambles Net Adj. -12.6% Gross 17.3% S 111 000 Nel Adj. 0.0% Gross 23.6% S 114 400 Net Adj. -7.6% Gross '. 7.6% S 97 000 I ditl did not research the sale a transfer history a the wDject property and comparable sales. II not, explain research did did rat reveal a rot sales a transfers of the sir ' fa the tlxee ors 'or to the eBective date a this a sisal. Data space s CPMLS,PUBLIC RECORD, REDS research did X did not reveal a ar sales a transfers of the com table sales fa the ar tort to the date or sale a the com arable sale. Data space s CPMLS PUBLIC RECORD REDS Re the rewfts of the research a ITEM nd ana is a the 'or sale a transfer h SUBJECT iss a the wb'ect ro en and com COMPARABLE SALE N0. 1 arable sales re additional ria sa COMPARABLE SALE N0.2 les on a e COMPARABLE SALE N0. 3 Date a Rio SaaRransfer 1221/1992 01282008 10/10/2007 05/02!1996 Price a Rat SaleRransfer $47 000 $100000 SBO 000 $20 000 Data Souce s PUBLIC RECORD PUBLIC RECORD PUBLIC RECORD PUBLIC ECORD Effective Date a Data Souce s 06212009 O6/212009 06212009 06!21/2009 Analysis a prat sale a tansfa history of the subject property and comparable sak:s HOME IS NOT KNOWN TO BE CURRENTLY LISTED FOR SA E. COMPARABLES HAVE NOT SOLD IN LAST YEAR EXCEPT AS NOTED IN THE SALES COMPARISON APPROACH. Summary of Sales Compadson Approach. ALL COMPARABLES HAVE SOLD WITHIN THE PAST 6 MONTHS. SUBJECT ANO ALL COMP RABLES ARE LOCATED ALONG THE CONODOGUINET CREEK AND OFFER SIMILAR AMENITIES AND LIFE STYLE. ALL COMPARABLES ARE 3 BEDROOM HOMES SUBJECT OFFERS A 1 BEDROOM AREA WITH LOFT AREA FOR GUESTS. COMPARABLES CHOSEN APPEAR TO BE THE BEST AVAILABLE AT THIS TIME AND ARE DEEMED TO BE ACCEPTABLE TO DEVELOP THIS REPORT. Indaated Value D Sales Com rison A ch f 110000 ONE HUNDRED THOUSAND TEN DOLLARS Indicated Value D Sales Com rison roach f 110000 Cost A oath Ir level f 0 Income roach it level f M/A THE SALES COMPARISON APPROACH WITH A WEIGHTED ANALYSIS IS THE MOST RELIABLE INDICATOR OF VALUE. THE COST APPROACH IS LESS RELIABLE FOR AN OLDER PROPERTY. THE INCOME APPROACH LACKS ADEQUATE NUMBER OF RENTAL SALES TO BQ APPLICABLE. TNs appraisal's made 'as is,' wbject to completlan per plans and specifications on the basis of a hypolhe[aal cpndition Thal the improvements have been completed, ^ wDject td the folkwnng relWlrf a afteradons an the basis of a hypahelaal contHDon tltel the repass or alteratbns have been completed, a ^ wtyect to the following required inspeaan based on the exvaoMaary aswmplan that the candflan a defaiency does rat requke alteretipn a repair: INSPECTION WAS MADE 05272 DATE OF APPRAISAL IS DATE OF DEATH 04 /1 812 0 0 9. Basetl on a complete visual inspection of the in[erlor antl ezteriar areas of the subject property, tleflned scope of work. statement of essumptionsand limiting conditions, and appraiser's certification, my (our) opinion of the market value. as defined, of [he real property that is the subject pt [his report is f 110,000 as of 04f 182009 DATE OF DEATH , which Is the date or ins aion and the eRecuve date of this a sisal. .._.. _.......o,........ .,~ e.,y m, n,.....,<»..,.,....,~~.®.w„ .ar..a Ma..ora ws w.a~ nw Pegs Z d 6 trod os ebi9o6 D.A. Potts Appraisal Service D.A. POTTS APPRAISAL SERVICE Uniform Residential Appraisal Report File NO. P509KIZ THE CLARIFICATION OF INTENDED USE AND INTENDED USER: THE INTENDED USER OF THIS APPRAISAL REPORT IS THE LENDER/CLIENT. THE INTENDED USE IS TO EVALUATE THE PROPERTY THAT IS THE SUBJECT OF THIS APPRAISAL FOR ESTATE PURPOSES SUBJECT TO THE STATED SCOPE OF WORK PURPOSE OFT E APPRAISAL REPORTING REQUIREMENTS OF THIS APPRAISAL REPORT FORM AND DEFINITION OF MARKET VALUE. NO ADDITIONAL INTENDED USERS ARE IDENTIFIED BY THE APPRAISER. THIS APPRAISAL REPORT HAS BEEN PERFORMED FOR THE CLIENT INDICATED IN THE PRECEDING WITH WHOM PROFES ZONAL STANDARDS REQUIRE ME TO MAINTAIN A STRICT REQUIREMENT OF CONFIDENTIALITY. THIS APPRAISER IS NOT A HOME INSPECTOR. THE APPRAISER ONLY PERFORMED A VISUAL INSPECTION OF THE ACCESSIBLE AREAS AND THE APPRAISAL CANNOT BE RELIED UPON TO DISCLOSE CONDITIONS ANDlOR DEFECTS IN THE PROPERTY THE USE OF THIS REPORT IS SUBJECT TO THE REQUIREMENTS OF THE APPRAISAL INSTITUTE RELATING TO REVIEW BY ITS DULY AUTHORIZED REPRESENTATIVES. THE REPORTED ANALYSES OPINIONS AND CONCLUSIONS WERE DEVELOPED AND THIS REPORT HAS BEEN PREPARED I CONFORMITY WITH THE REQUIREMENTS OF THE CODE OF PROFESSIONAL ETHICS AND STANDARDS OF PROFESSIONAL APPRAISAL PR CTICE OF THE APPRAISAL INSTITUTE. PURPOSE THE PURPOSE OF THIS APPRAISAL IS TO ESTIMATE THE MARKET VALUE OF THE FEE SIMPLE INTEREST IN THE TITLE OF THE PROPERTY. THE VALUE IS OF THE DATE OF THE APPRAISAL WHICH IS THE DAY THE PROPERTY WAS LAST VIEWED IN ITS ENTIRETY A'ND PHOTOGRAPHED. SIGNATURE THE ELECTRONIC SIGNATURE USED IN THIS REPORT IS PROTECTED BY THE APPRAISER. ONLY THE APPRAISER HAS COMPLETE CONTROL OF THIS SIGNATURE. COST APPROACH TO VALUE{not re ulred b Fannie Mee) , Provide a to information fa the lenderlclient to r licale the bebw cost fi es and calcuWtiore. Support fa the opinion of site value (wmmary of comparable land sales or other methods for estimating site value) ESTMAATED REPRODUCTION OR REPLACEMENT COST NEW OPINION OF SRE VALUE ........................................ = f Source of cost data Dwelli S . Ft. ~ f ....... ... = f 0 Quash ratio from cost service Effective date of cost data S . Ft. ®f ............ = f Comrtiems on Cost A oath oss livin area calculadons, de eciation, etc. Gar Ca art S . Ft. ~ f = f 0 Total Estimate dCost-New ............ = S 0 Less Ph kal Functional External De eciation = f 0 Oe eciated Cost of Im ovemems ................................ < f 0 'AS•is' Value of Sile Im vements ................................: f Estimated Remain Economic Life UD and VA o 38 Years INDICATED VALUE BY COST APPROACH ........ ..... f 0 WCOME APPROACH TO VALUE (not r uked b" Fannie Maa) Estkttated Month Market Rent f % Gross Rent Muki lien = f IMicatetl Value Income A oath Summary of Income Approach (inclutling support fa market rent and GRM) PROJECT INFORMATION FOR PU05 (If IicablE) Is the Bevel albuider in comrd of the Homeowners' ASSOCiation HOA ? Yas NO Unk s Detached Attached Reside the (Bawl infomtation fa PUDs ONLY if the deveb Mulder is in wnbol of the HOA and the sub' t is an attached dwellin unit. L I name of [ Taal number of hales Total number a oohs Taal numtter of units sold Taal number of units rented Taal numbs of units fa sale Data source s Was the o' t creased b [he conversion d an exis[i buildi s imo a PUD? Yes No H Yes, date of conversion. Does the t comain an multi-dvRlk units? Yes No Da[a source s Are the units, common elements, and recreation facilities complete? Yes No d No, describe the status of completion. Are the common elements leased to a by the Homeowners' Associa[an? Yes No If Yes, describe the rental tams am) options. Describe Common elements and recrearanal facilities. ^~ •Mm ~~..a~ut cwa Na0[M arg xCl sollwe.lW IN 8121 wwrx~weD.can rams Mae ram taN Mzrcn rows Page3d6 1Wt OS 061906 D.A POTTS APPRAISAL SERVICE Uniform Residential Appraisal Report File NO. P509KIZ This report form is designed to report an appraisal of a one-unit property or a one-unit property with an accessory unit; including a unit in a planned unit development (PUD). This report form is not designed to report an appraisal of a manufactured home or a unit in a condominium or cooperative project. This appraisal report is subject to the following scope of work, intended use, intended user, definition of market value, statement of assumptions and limiting conditions, and certifications. Modifications, additions, or deletions to the intended use, intended user, definition of market value, or assumptions and limiting conditions are not permitted. The appraiser may expand the scope of work to include any additional research or analysis necessary based on the complexity of this appraisal assignment. Modifications or deletions to the cert~cetions are also not permitted. However, additional certifications that do not constitute material alterations to this appraisal report, such as those required by law or those related to the appraiser's continuing education or membership in an appraisal organization, are permitted. SCOPE OF WORK: The scope of work for this appraisal is defined by the complexity of this appraisal assignment and the reporting requirements of this appraisal report form, including the following definition of market value, statement oP assumptions and limiting conditions, and certifications. The appraiser must, at a minimum: (1) perform a complete visual inspecction of the interior and exterior areas of the subject property, (2) inspect the neighborhood, (3) inspect each of the comparable sales from at least the street, (4) research, verity, and analyze data from reliable public and/or private sources, and (5) report his or her analysis, opinions, and conclusions in this appraisal report. INTENDED USE: The intended use of this appraisal report is for the lender/client to evaluate the property that is the subject of this appraisal for a mortgage finance transaction. INTENDED USER: The intended user of this appraisal report is the lendedclient DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competftive and open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well informed or well advised, and each acting in what he or she considers his or her own best interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment is made in terms of cash in U. S. dollars or in terms of financial arrangements comparable thereto; and (5) the price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions` granted by anyone associated with the sale. 'Adjustments to the comparables must be made for special or creative financing or sales concessions. No adjustments are necessary for those costs which are normally paid by sellers as a result of tradition or law in a market area; these costs are readily ident~able since the seller pays these costs in virtualty all sales transactions. Special or creative financing adjustments can be made to the comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in the property or transaction. Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession but the dollar amount of any adjustment should approximate the market's reaction to the financing or concessions based on the appraiser's judgment. STATEMENT OF ASSUMPTIONS AND LIMITING CONDITIONS: The appraiser's certification in this report is subject to the following assumptions and limiting conditions: 1. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised or the title to it, except for information that he or she became aware of during the research involved in performing this appraisal. The appraiser assumes that the title is good and marketable and will not render any opinions about the title. 2. The appraiser has provided a sketch in this appraisal report to show the approximate dimensions of the improvements. The sketch is included only to assist the reader in visualizing the properly and understanding the appraiser's determination of its size. 3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted in this appraisal report whether any portion of the subject site is located in an identified Special Flood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantees, express or implied, regarding this determination. 4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do so have been made beforehand, or as otherwise required by law. 5. The appraiser has noted in this appraisal report any adverse conditions (such as needed repairs, deterioration, the presence of hazardous wastes, toxic substances, etc.} observed during the inspection of the subject property or that he or she became aware of during the research involved in performing this appraisal. Unless otherwise stated in this appraisal report, the appraiser has no knowledge of any hidden or unapparent physical deficiencies or adverse conditions of the properly (such as, but not limited to, needed repairs, deterioration, the presence of hazardous wastes, toxic substances, adverse environmental conditions, etc.) that would make the property less valuable, and has assumed that there are no such conditions and makes no guarantees or warcanties, express or implied. The appraiser will not be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, this appraisal report must not be considered as an environmental assessment of the property. 6. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory completion, repairs, or alterations on the assumption that the completion, repairs, or alterations of the subject property will be performed in a professional manner. _r D.A. POTTS APPRAISAL SERVICE Uniform Residential Appraisal Report file No. P509KIZ APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that: 1. I have, at a minimum, developed and reported this appraisal in accordance with the scope of work requirements stated in this appraisal report. 2. I performed a complete visual inspection of the interior and exterior areas of the subject property. I reported the condition of the improvements in factual, specific terms. I identified and reported the physical deficiencies that could affect the livability, soundness, or structural integrity of the property. 3. I performed this appraisal in accordance with the requirements of the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place at the time this appraisal report was prepared. 4. I developed my opinion of the market value of the real property that is the subject of this report based on the saes comparison approach to value. I have adequate wmpareble market data to develop a reliable sales comparison approach for tPois appraisal assignment. I further certify that I considered the cost and income approaches to value but did not develop them, unless otherwise indicated in this report. 5. I researched, verified, analyzed, and reported on any curcent agreement for sale for the subject property, any offering for sale of the subject property in the twelve months prior to the effective date of this appraisal, and the prior sales of the subject property for a minimum of three years prior to the effective date of this appraisal, unless otherwise indicated in this report. 6. I researched, verified, analyzed, and reported on the prior sales of the comparable sales for a minimum of one year prior to the date of sale of the comparable sale, unless otherwise indicated in this report. 7. I selected and used comparable sales that are locationally, physically, and functionally the most similar to the subject property. 8. I have not used comparable sales that were the result of combining a land sale with the contract purchase price of a home that has been built or will be built on the land. 9. 1 have reported adjustments to the comparable sales that reflect the market's reaction to the differences between the subject property and the comparable sales. 10. I verified, from a disinterested source, all information in this report that was provided by parties who have a financial interest in the sale or financing of the subject property. 11. I have knowledge and experience in appraising this type of property in this market area. 12. I am aware of, and have access to, the necessary and appropriate public and private data sources, such as multiple listing services, tax assessment records, public land records and other such data sources for the area in which the property is located. 13. I obtained the information, estimates, and opinions furnished by other parties and expressed in this appraisal report from reliable sources that I believe to be true and correct. 14. I have taken into consideration the factors that have an impact on value with respect to the subject neighborhodd, subject property, and the proximity of the subject property to adverse influences in the development of my opinion of market value. I have noted in this appraisal report any adverse conditions (such as, but not limfted to, needed repairs, deterioration, the presence of hazardous wastes, toxic substances, adverse environmental condtions, etc.) observed during the inspection of the subject property or that I became aware of during the research involved in performing this appraisal. I have considered these adverse conditions in my analysis of the property value, and have reported on the effect of the conditions on the value and marketability of the subject property. 15. I have not knowingy withheld any significant information from this appraisal report and, to the best of my knowledge, all statements and information in this appraisal report are true and corcect. 16. 1 stated in this appraisal report my own personal, unbiased, and professional analysis, opinions, and conclusions, which are subject only to the assumptions and limiting conditions in this appraisal report. 17. I have no present or prospective interest in the property that is the subject of this report, and I have no present pr prospective personal interest or bias with respect to the participants in the transaction. I did not base, either partially or complefey, my anaysis and/or opinion of market value in this appraisal report on the race, color, religion, sex, age, marital status, handicap, familial status, or national origin of either the prospective owners or occupants of the subject property or of the pres@nt owners or occupants of the properties in the vicinity of the subject properly or on any other basis prohibited by law. 1 t3. MY employment and/or compensation for performing this appraisal or any future or anticipated appraisals was rhot conditioned on any agreement or understanding, written or otherwise, that I would report (or present anaysis supporting) a predeetermined specific value, a predetermined minimum value, a range or direction in value, a value that favors the cause of any party, or the attainment of a specific resuR or occurrence of a specific subsequent event (such as approval of a pending mortgagle loan application). 19. I personally prepared all conclusions and opinions about the real estate that were set forth in this appraisal report. If I relied on significant real property appraisal assistance from any individual or individuals in the performance of this appraisal pr the preparation of this appraisal report, I have named such individual(s) and disclosed the specific tasks performed in thhis aippraisal report. I certify that any individual so named is qualfied to perform the tasks. I have not authorized anyone to make a Change to any item in this appraisal report; therefore, any change made to this appraisal is unauthorized and 1 will take no responsibility for it. 20. I identified the lender/Glen/ in this appraisal report who is the individual, organization, or agent for the organization that ordered and will receive this appraisal report. Yec am vroa,oa vaq ~ci.e~~sedoofiaaem w.w.. cw.n.em ~~oo._os aaxeos D.A. POTTS APPRAISAL SERVICE uniform Keslaentlai Hppralsal Kepori File NO. PSOSKIZ 21. The lendedtient may disclose or distribute this appraisal report to: the borrower; another lender at the request oif the borrower; the mortgagee or its successors and assigns; mortgage insurers; government sponsored enterprises; other secondary market participants; data collection or reporting services; professional appraisal organizations; any department, agency, or instrumentality of the United States; and any state, the District of Columbia, or other jurisdictions; without having to obtain the appraiser's or supervisory appraiser's (if applicable) consent. Such consent must be obtained before this appraisal report may be discbsed or distributed to any other party (including, but not limited to, the public through advertising, public relations, news, sales, or other media). 22. I am aware that any disclosure or distribution of this appraisal report by me or the lendedclient may be subject tp certain laws and regulations. Further, I am also subject to the provisions of the Uniform Standards of Professional Appraisal Practice that pertain to disclosure or disVibution by me. 23. The borrower, another lender at the request of the borrower, the mortgagee or its successors and assigns, mortgage insurers, government sponsored enterprises, and other secondary market participants may rely on this appraisal report as part of any mortgage finance transaction that involves any one or more of these parties. 24. If this appraisal report was transmitted as an "electronic record" containing my'electronic signature," as those t#rms are defined inapplicable federal and/or state laws (excluding audio and video recordings), or a facsimile transmission of this appraisal report containing a copy or representation of my signature, the appraisal report shall be as effective, enforceable and valid as if a paper version of this appraisal report were delivered containing my original hand written signature. 25. Any intentional or negligent misrepresentation(s) contained in this appraisal report may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Cade, Section 1001, et seq., or similar state laws. SUPERVISORY APPRAISER'S CERTIFICATION: The Supervisory Appraiser certifies and agrees that: 1. I diretty supervised the appraiser for this appraisal assignment, have read the appraisal report, and agree with the appraiser's analysis, opinions, statements, conclusions, and the appraiser's certification. 2. I accept full responsibility for the contents of this appraisal report including, but not limited to, the appraiser's anaysis, opinions, statements, contusions, and the appraiser's certification. 3. The appraiser identified in this appraisal report is either asub-contrator or an employee of the supervisory appraiser (or the appraisal firm), is qualified to perform this appraisal, and is acceptable to perform this appraisal under the applicablrz state law. 4. This appraisal report complies with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place at the time this appraisal report was prepared. 5. If this appraisal report was transmitted as an 'electronic record" containing my "electronic signature,° as those t#rms are defined in applicable federal and/or state laws (excuding audio and video recordings), or a facsimile transmission of this appraisal report containing a copy or representation of my signature, the appraisal report shall be as effetive, enforceable and valid as if a paper version of this appraisal report were delivered containing my original hand written signature. APPRAISER SUPERVISORY APPRAISER (ONLY IF REQUIRED) Signature~_~ ('~ _ Name DAVID A. POTTS. PA STATE CERTIFIED GENERAL RE APPRAISER Company Name D.A. POTTS APPRAISAL SERVICE COmpany Address 4301 VJOODCREST LANE CAMP HILL, PA 17071 Telephone Number 7nas3-toso Email Address dave~dapappraisal.com Date of Signature and Report 06/21/2009 Elfetive Date Of Appraisal 04/1812009, DATE OF DEATH State Certification # GA000479L or State License # or Other (describe) State # State PA Expiration Date of Certification or License O6/3oV2011 Signature Name Company Name Company Address Telephone Number Email Address Date of Signature State Certification # or State License # State Expiration Date of Certification or license ADDRESS OF PROPERTY APPRAISED 174 WILLOW MILL PARK ROAD MECHANICSBURG, PA 17050-1760 APPRAISED VALUE OF SUBJECT PROPERTY $ t 10,000 LENDER/CLIENT Name COmpany Ndme ESTATE OF JUDITH L. WEAKLEY Company Address Email Address SUBJECT PROPERTY Q Did not inspet subjet property ^ Did inspect exterior of subjet property from street Date of Inspection ^ Did inspect interior and exterior of subject property Date of Inspection COMPARABLE SALES ^ Did not inspet exterior of comparable saleslfrom street ^ Did inspect exterior of comparable sales from sVeet Date of Inspetion ..in..,..e?o.za+m~.w.... ciw.e..om D.A. Potts Appraisal Service sl IR IFCT PROPERTY PHOTO ADDENDUM BOffOWef: N/A Flle NO.: P509 KIZ PfOperty AddfeSS' 174 WILLOW MILL PARK ROAD Case No.: Clty' MECHANICSBURG $ta[e: PA Zlp: 17050-1760 Lefldef: ESTATE OF JUDITH L. WEAKLEY FRONT VIEW OF SUBJECT PROPERTY REAR VIEW OF SUBJECT PROPERTY STREET SCENE D.A. POTTS cnMPARA6LE PROPERTY PHOTO ADDENDUM Borrower: wA File No.: Psos Klz PfOpertY Addfe55' 174 WILLOW MILL PARK ROAD Case No.: City' MECHANICSBURG State: PA ZIP: 17050-1760 Lendef: ESTATE OF JUDITH L. WEAKLEY COMPARABLE SALE #1 '~ k ~, - ,._ :~„A ., , ~~•~ ~ ~y~~ :" 1082 OYSTER MILL ROAD CAMP HILL, PA MLS PHOTO Sale Date: oznonoos Sale Price: S 127,000 COMPARABLE SALE.#2 4430 SEARS RUN ROAD MECHANICSBURG, PA ML$ PHOTO Sale Date: oa~lonoos Sale Price: S 11a,aoo COMPARABLE SALE#3 5505 CREEKVIEW ROAD MECHANICSBURG, PA ML$ PHOTO Sale Date: oz/12noos Sale Price: S 105,000 O.A.POTTS Borrower: WA File No.: Psos Klz PrOpertV Addre55' 174 WILLOW MILL PARK ROAD Case No.: Clb/' MECHANICSBURG $[a[e: PA ZID: 17050-1760 Lendef: ESTATE OF JUDITH L. WEAKLEY KITCHEN LNING ROOM HALL fl.A.POTTS BDffOWe~: N/A File Na.: P509 KIZ PfOpertY AddIeSS' 174 WILLOW MILL PARK ROAD Case No.: Clty' MECHANICSBURG $ta[e: PA ZID: 17050-1760 Lendef: ESTATE OF JUDRH L. WEAKLEY r ~_. ;_,, °>'~ i SPIRAL STAIRCASE TO LOFT LOFT BEDROOM D..A. ROTTS Borrower: WA Fife No.: Psos Klz PfOpe~ AddreSS' 174 WILLOW MILL PARK ROAD Case No.: Clty' MECHANICSBURG State: PA Zlp: 17050-1760 Lendef: ESTATE OF JUDITH 1. WEAKLEY CREEK AT REAR LIVING ROOM BOAT LAUNCH .. O. A_ POTTS FLOORPLAN Borrower wA File No.: Psos Kiz FfOperty Addfe55' 174 WILLOW MILL PARK ROAD Case No.: Clty' MECHANICSBURG $(BIe: PA Zlp: 1705p-1760 Lefldef: ESTATE OF JUDITH L. WEAKLEY :o.o a PORCR ]e.e' eEOROOM ]e.e' 4 toPr Rug uuKORr a ~ uwKO Roo e~rR KITQIEN OINN6 ]e.e' § P~rio ]a.0' sx~M/s~K~ t.~01It11e1~S: I I L D.A. POTTS cm .AREA CALCLlLAT10NS $V1YxYe'1f~1 t4a Net Tor+r oui rl:.c riROr iooo.oo looo.ao OL11T eeou,a Tlaer 200.00 200.00 pip ypy~ 210.00 eeaci~ 200.00 uo.oa TOTAL ENABLE (rounded) 1200 LMNG AREA BREAKDOWN tAadefoen 9~boouls ncxe 22eer zo.o : so.o iooo.oo semd eaoer 10.0 x 20.0 200.00 2 Calculations Total (rounded) 1200 4301 WOOdOreet Lane, Genlp Hill, PA 7 /071 (rv) rti3-~wur rax: (nr) roe-loco FI nOD MAP Borrower: NrA File No.: Psos Klz PfOpertY Addre$5' 174 WILLOW MILL PARK ROAD ~2Se No.: ' cRy' MECHANICSBURG ,x0-1780 State: PA Zlp: 170' Lender: ESTATE OF JUDITH L. 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POTTS sa? :a.. .e. >.......... 4301 Woodcrest Lane, Lamp r1nl, rn i iun ~nr/ roo-~w~r rax: 1r irk ~w-iw~ BDrrOWBf: NIA F118 ND.: P509 KIZ PfOpBf[Y Ad(1f8SS' 174 WILLOW MILL PARK ROAD 0258 NO_ CIt4: MECHANICSBURG $t2t8: PA _ ZIP: 17080-1760 L8fld8f: ESTATE OF JUDITH L. WEAKLEY ~- ('ommonweattti of Fennsytvan3a Q$ Q 63 5 9 8 9 Deparfmisnt of State :Bureau oi` Proftb8iwtal~and fJCCupat~nal ~-ffairs PO faux 26~t91farriefrur~ PA x7IQ5-2trt9 C'ernfzcalte Tipe Certificate titatus Certified General Appraiser Active f~citiat f'~rfif-c24ion I)atc I , 11/2fi/t 991 f DAYiD AtiDREW PDTTS C;ertifiratC 131st WOOACRfST IN NumLer CAMPMILI.PA ti(Ett GAOOO479L I~:xpirat+un Date tl6l30l2041 If '~ y~ ~~ I f _.___..,_.~.sm_.. . fR~.~~,,,~~ ~ l-- __ 1 .Lmrn>.NNH,.ttli ti1nYY~4:sI 111~()ctlhjlL•~IY~. ~/-5~.i~ ~. ~~ kr~~}r i~ _~Y-~ D.A. P~TT$ ~.. :o. ,...... . ~.. 4301 Woodcresl Lane, Camp Hill, PA 17011 (n/) /tie-uxwi rax: (n~) /tis-1UOZ 4301 1lVoodcrest Lane, Camp Hill, PA 17011 (717) 763-1060 !Fax: (717) 763-1062 ASSETS SALE AND PURCHASE AGREEMENT THIS AGREEMENT dated the 30`h day of December, 2008, by and between Judith Weakley, d/b/a Abrams &Weakley General Store for Animals (hereinafter "Weakley" or "Seller"), an adult individual, of Cumberland County, Pennsylvania; AND Kristen L. Zellner, an adult individual, of Dauphin County, Pennsylvania, or her nominees or assigns ("Buyer"). BACKGROUND A. Weakley is an adult individual who operates, under an oral lease, a general store for animals located at 3963 North Sixth Street, Harrisburg, Susquehanna Township,Dauphin County, Pennsylvania (the "Premises"), which does trades and does business under the registered fictitious name known as "Abrams &Weakley General Store for Animals" (and beirng the Business as hereinafter defined). B. Seller has determined that it would be in her best interests to sell to Buyer the Business and certain Assets of Seller free and clear of all liabilities and debts of the feller and to assign her possessory rights to the Premises. C. Seller and Buyer have agreed to the sale and purchase of certain Assets of Seller and desire to formalize the agreement setting forth the respective liabilities, obligations and covenants. AGREEMENT NOW, THEREFORE, in consideration of the mutual covenants, agreements, representations and warranties hereinafter stated, and intending to be legally bound hereby, the Seller agrees to sell to the Buyer, and the Buyer agrees to purchase, the Assets of Serer and the leasehold rights utilized in the Business, as set forth herein and upon the following tetms and conditions: I. DEFINITIONS. As used herein, the following terms/words shall have the meanings indicated, unless the context requires otherwise: a. Assets: shall include the following: i. All equipment, furniture, fixtures and leasehold improvements that are owned by the Seller and utilized in the Business (as defined hereinafter), as mote fully set forth on Exhibit "A" attached hereto and made a part hereof ("Equipment"); ii. The name "Abrams & Weakley General Store for Arbimals" ("Name") or any variation thereof. In connection therewith, an appropriate form shall be executed by Weakley and filed with the Department of State, transferring said name at Buyer's cost; iii. The inventory and supplies ("Inventory"); iv. All of Seller's right, title and interest as tenant in and concerning the Premises; and b. Business: shall mean the retail business known as "Abrams cBc Weakley General Store for Animals", which is operated and located at 3963 North Sixth Street, Harrisburg, Susquehanna Township, Harrisburg, Dauphin County, Pennsylvania. c. Premises: shall mean 3963 North Sixth Street, Harrisburg, Susquehanna Township, Harrisburg, Dauphin County, Pennsylvania on which the business is situated, together with all relevant space within the buildings and improvements situated thereon, together with all easements, privileges, interests and other rights that are appurtenant to the land and property. 2. BACKGROUND. The Background set forth above is incorporated herein by reference as if more fully set forth. 3. SALE AND PURCHASE OF ASSETS. Subject to the terms and conditions of this Agreement, at the Closing the Seller shall sell, assign, convey, transfer and deliver to Buyer, and Buyer shall purchase and acquire from Seller, all of the Assets and a Restrictive Covenant (such as term is defined below). 4. PURCHASE PRICE. a. In consideration for the purchase of the Assets and the Restrictive Covenant, Buyer shall pay the Purchase Price of Fifty Thousand Dollars ($50,000.00). Such purchase price shall be paid as set forth in Paragraph 5 below. b. The allocation of the Purchase Price is as follows: i. Equipment- $ 400.00 ii. Inventory- $ 9,500.00 iii. Name- $ 100.00 v. Restrictive Covenant-$ 40,000.00 TOTAL $ 50,000.00 5. PAYMENT TERMS. The Purchase Price shall be payable as follows: a. The sum of Ten Thousand Dollars ($10,000.00), in cash, by vv~ire transfer, or by certified or cashier's check, or by other cash equivalent, at Closing hereunder. Cr;W-N-QhC~N pebrva.y I, aDpq ~ ,~~ ~,Z b. Fifty-three ~53) equal monthly installments of Eight Hundred dollars ($800.00) and a final installment of $362.73 but said payments shall cease upon Weakley's death upon which the Buyer shall have fully performed under this Agreement. 6. CONDITIONS PRECEDENT TO CLOSING. Buyer's duty to purchase the Assets is conditioned upon satisfaction of the following items and within the timeframes stated: a. All Assets being free and clear of all liens, claims or encumbbrances. Seller shall retain responsibility for all taxes relating to the business through the date of Closing. To the extent that the Pennsylvania Department of Revenue imposes liability upon Buyer for Seller's tax liability, Buyer may offset any such liability with a credit to the payments due the Seller under Paragraph 5(b). b. Buyer's successful negotiation of a lease, by and between the Landlord of the Premises, and Seller, upon terms satisfactory to Buyer in his sole discretion. In the event that Buyer can not successfully negotiate said lease, this Agreement shall be null and void and Buyer shall have no responsibilities to proceed to Closing. 7. CLOSING. a. Closing under this Agreement shall on occur on December 30, 2008 at 11:00 A.M., with an effective date of January 1, 2009 (the "Effective Date"). b. Closing shall be conducted at the Premises or such other place as the Seller and Buyer mutually agree upon, at a time and date to be mutually determined. DOCUMENTS TO BE DELIVERED BY SELLER AT CLOSINCz At Closing, Seller shall deliver to Buyer: a. Such duly executed and acknowledged Bill(s) of Sale with Affidavit(s) of Title, together with any and all other bills of sale, endorsements, assignments, and other instruments of transfer and conveyance as shall be reasonably satisfactory in form arnd substance to Buyer and its counsel, necessary and sufficient to convey and vest in Buyer good and marketable title to the Assets, free and clear of any mortgages, liabilities, payables, security interests, pledges, liens, encumbrances, title retentions, or other security arrangements. Seller shall also provide to Buyer at Closing, an Amendment to fictitious name, duly executed by all necessary parties to transfer the Name to Buyer. 9. REPRESENTATIONS OF SELLER In order to induce Buyer to purchase the Assets, and acknowledging Buyer's reliance hereon, Seller warrants and represents as follows: a. Seller has the full right, power and authority to execute, deliver and carry out the terms of this Agreement and all documents and agreements necessary to give effect to the provisions of this Agreement. The Bill of Sale to be delivered at Closing will transfer all of the Assets enumerated in Paragraph 1 above, free of all liens, claims and encumbrances. b. Seller is the owner of, and has good and marketable title to, a-11 of the Assets being sold, which Assets are subject to no pledges, trusts, equities, security interests, liens, encumbrances, or other claims and charges of any kind that will not be disposed by the sale set forth in this Agreement, except: i. such minor encumbrances or imperfections, if any, that are not substantial in nature or amount and that do not substantially detract from the value of such property as presently used by, and do not otherwise impair the Assets of, Seller; and ii. liens of current state and local property taxes that are not delinquent or subject to penalty. c. Seller has received no notice that the Premises are in violation of any zoning, building, elevator, fire, plumbing, subdivision or health laws, rules, orders or regulations. d. There aze no actions, suits, proceedings, investigations or litigation pending or, to either Seller's knowledge, threatened against Seller or any basis theref©r that arises out of the ownership of the Assets or the occupancy of the Premises or that might affect the Seller's ability to fully perform its obligations under this Agreement. e Seller has no employment agreements, either written or oral, with any person that would require Buyer to employ any such person after Closing. f. The books and records of the Business aze true and correct to the best of Seller's knowledge. 10. REPRESENTATIONS OF BUYER. In order to induce Seller to sell the Assets, and acknowledging Seller's reliance herein, Buyer warrants and represents as follows: a. Buyer is not relying upon any oral statements made by Seller. b. Buyer is purchasing all of the Assets and taking possession of tl~e Premises "AS IS", without any warranties, either express or implied, including but not limited to, warranties of merchantability or fitness for purpose, and that Buyer has conducted its own investigation and is not relying upon any representations of Seller except as expressly stated in this Agreement. c. Buyer has the full right, power and authority to execute, deliver and carry out the terms of this Agreement and the transaction contemplated herein. This Agreement constitutes the legal, valid and binding obligation of Buyer, enforceable in accordance with its terms. 11. NATURE AND SURVIVAL OF REPRESENTATIONS. All statements contained in any certificate or other instrument delivered to either party on behalf of the other party pursuant hereto, or in connection with the transactions contemplated hereby, shall be deemed representations and warranties hereunder. All representations, warranties and agreements made by either party in this Agreement nor pursuant hereto, including specifically, but not limited to, Paragraphs 6, 9, 10, 11, 12, 13, 14 15, 19 and 21 of this Agreement, shall survive the execution and delivery of this Agreement and Closing hereunder, notwithstanding any investigation, if any, at any time made by or on behalf of the recipient party. 12. INDEMNIFICATION BY SELLER Seller shall indemnify Buyer, its successors and assigns, and hold them harmless, in respect of a. All liabilities of, or claims against, the Assets arising out of the conduct of Seller's business, prior to the Effective Date; b. All liabilities and claims, including any penalty and interest„ arising out of Seller's unfiled tax returns and reports or unpaid taxes; any damage or deficiency rQSUlting from any misrepresentation, breach of warranty, or nonfulfillment of any agreement on the part of Seller under this Agreement or from any misrepresentations in or omissions from any certificate or other instrument furnished or to be furnished to Buyer hereunder; and c. All actions, suits, proceedings, demands, assessments, judgnnents, costs and expenses (including reasonable legal expenses and costs, original and appellate) incident to any of the foregoing. 13. INDEMNIFICATION BYBUYER Buyer shall indemnify Seller, its successors and assigns, and hold them harmless, in respect of a. All liabilities of, or claims against, Seller arising solely out of Buyer's ownership or use of the Assets and/or occupancy of the Premises after the Effective Date; b. All liabilities of or claims against Seller or any guarantor of ain Equipment Lease arising, after the Effective Date, out of Buyer's assumption of any Equipment Lease, as set forth above; and c. All actions, suits, proceedings, demands, assessments, judgments, costs and expenses (including reasonable legal expenses and costs, original and appellate) incident to any of the foregoing. 14. CLOSING ADJUSTMENTS. At Closing, Seller shall deliver to Buyer possession of the Premises and keys to all portions of the Premises. At Closing, Buyer shall deliver to Seller the Purchase Price. Each party shall deliver such documents as may be required to be delivered under the terms of this Agreement. 15. INSURANCE AND RISK OF LOSS. Seller shall maintain fire and extended coverage insurance on the Assts until the Effective Date, in an amount not less than the existing policies. 16. DEFAULT. a. In the event of failure by Buyer to perform and comply with the terms and provisions of this Agreement to be performed and complied with by Buyer within the time or times provided herein, Seller shall have as its sole remedy the right to receive One Hundred Dollars ($100.00) as liquidated damages and not as a penalty, whereupon all rights and remedies of the parties hereunder shall terminate and Seller shall have no other remedy against Buyer. b. In the event of failure by Seller to perform and comply with any of the terms and provisions of this Agreement to be performed and complied with by Seller within the time or times provided herein, Buyer shall have, as its sole remedy, the right to specific performance, and all damages including but not limited to attorney fees. 17. PAYMENT OF EXPENSES. Except as otherwise provided herein, Seller and Buyer each shall pay their own expenses, including without limitation, the disbursements and fees of all their respective attorneys, accountants, appraisers, advisors, agents and other representatives, incidental to the prepazation and carrying out of this Agreement, whether or not the transactions contemplated hereby aze consummated. The parties shall pay (share) equally all documentary stamp taxes, transfer taxes, and filing/recording fees, if any. 18. ASSIGNMENT. Except as otherwise provided herein, this Agreement and all rights and obligations hereunder (except Seller's right to payment hereunder) shall not be assignable without the written consent of the parties hereto, except that Buyer shall be permitted to assign his rights hereunder to an entity of which she is the majority owner. 19. BROKER'S FEE. Seller represents and warrants that there are no claims for broker's commissions or finder's fees in connection with the transaction contemplated by this Agreement. To the extent that any such broker's fees are due and owing, Seller shall be responsible therefor and Seller agrees to indemnify Buyer and hold her harmless from, all liabilities arising from any claim against Buyer for any brokerage or finder's fee (including, without limitation) cost of counsel fees, in connection therewith. 20. NOTICES. All notices, requests, demands and other communications hereunder shall be in writing and shall be hand delivered or mailed first-class mail, certified, with postage prepaid as follows: If to Seller: Judith Weakley 174 Willow Mill Park Rd. Mechanicsburg, PA 17050 If to Buyer: Kristen L. Zellner 234 Lewis Street Harrisburg, PA 17110 With a copy to: Bruce J. Warshawsky, Esquire CUNNINGHAM & CHERNICOFF, P.C. 2320 North Second Street Harrisburg, PA 17106-0457 21. OTHER DOCUMENTS. At the request of Buyer, Seller shall execute and deliver to Buyer all such further assignments, endorsements or other documents as Buyer may reasonably request in order to perfect the transaction. 22. WAIVER. The failure of any party to insist, in any one or more instances, on performance of any of the terms and conditions of this Agreement, shall not be construed as a waiver or relinquishment of any rights granted hereunder or of the future performance of any such term, covenant or condition, but the obligation of the parties with respect thereto shall continue in full force and effect. 23 CONSTRUCTION. This Agreement has been executed and delivered within Pennsylvania and shall be governed and construed in accordance with the laws of the Commonwealth of Pennsylvania, disregarding any rules relating to the choice or conflict of laws. The headings contained in this Agreement have been inserted for the convenience of reference only and shall in no wvay restrict or modify any of the terms or provisions hereof. 24 MERGER. This Agreement (including any Exhibits hereto), and all other agreements and documents executed in connection herewith, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all negotiations, representations, warranties, commitments, offers, contracts and writings prior to the date hereof. 25. AMENDMENT. Neither this Agreement nor any term or provision hereof, including this Paragraph 25, may be changed, waived, discharged or terminated orally, or in any manner, other than by an instrument in writing signed by the party against which the enforcement of the change, waiver, discharge or termination is sought. 26. WEAKLEY'S CONTINUING SERVICE TO BUYER AND RESTRICTIVE COVENANT (a) Weakley agrees that for a period of fifty-four (54) months following the Closing, she will continue to provide consulting services to Buyer for the purposes. of assisting Buyer in the transition of the Business on a as requested basis to be set by Buyer in her sole discretion, but Weakley shall not be obligated to provide such services if it would be detrimental to her health, to be determined in her sole discretion. (b) Weakley agrees that for a period of fifty-four (54) months after the Closing Date, that Weakley will not, within a radius of fifteen (15) miles from the Premises (the "Geographic Area") directly or indirectly establish or engage in the an animal related business (the "Business") which competes in any way, or otherwise own, operate, control, pap-ticipate in, be employed by, an agent of, or be connected in any manner with such business (patagraphs (a) and (b) above shall be collectively referred to as the "Restrictive Covenant"). (c) Weakley agrees that the "time", "Geographic Area", and "Scope of Business" provisions of this Restrictive Covenant are reasonable and proper and have been negotiated in connection with the purchase of the Assets by the Buyer. (d) Weakley agrees that the remedy at law for any breach of any of the above covenants would be difficult to ascertain and, therefore, in the event of breach or threatened breach of any such covenant, Buyer (or its successors), in addition to any other remedy, shall have the right to temporarily, preliminarily and permanently enjoin Weakley from any threatened or actual activities in violation thereof, and Weakley hereby consents and agrees that temporary, preliminary and permanent injunctive relief may be granted in any proceeding which may be brought to enforce any such covenant without the necessity of proof of actual damages. (e) Weakley agrees, that if any court of competent jurisdiction shall, for any reason, conclude that any portion of this covenant shall be too restrictive, the court shall determine and apply lesser restrictions, it being the intent of the parties that some such restrictions shall be applicable for the protection of Buyer (or its successors) and its shareholders. (f) The provisions of this Paragraph shall survive the termination of this Agreement. 27. BINDING EFFECT. This Agreement shall be binding upon and inure to the benefit of the respective parties, and their successors and proper assigns, except as otherwise expressly provided herein. 28. COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original. 29. ADVICE OF COUNSEL. Buyer is represented by Bruce J. Warshawsky, Esq. Seller has been afforded the opportunity to seek counsel in connection with this proposed transaction and has opted to proceed without counsel. SIGNATURE PAGE FOLLOWS IN WITNESS WHEREOF, the parties have executed this Assets Sale and Purchase Agreement as of the date first above written. Witness SELLER: By: Jw~~ ~ Judith Weakley /a Abrams & Weakley Gen ral Store for Animals G BUYER: i fitness Kristen L' llner EXHIBIT "A" Air conditioners (3) Cash register Credit card machine Dolly/cart File cabinet (tall) Fire extinguishers (3) Freezers (2) Kennels in grooming room Scales (2) Shelves Telephones (3) F:1Home1BJW1DOCSIZELLNER.KRISTEN1Purchase of BusinesslAsset Sale and Purchase Agreement.doc BNY Mellon Shareowner Services P.O. Box 358333 Pittsburgh, PA 15252-8333 May 11, 2009 ESTATE OF LAURA L STEVENS C/O JUDITH WEAKLEY 4431 NORTH FRONT STREET HARRISBURG PA 17110 Dear Investor: przl 9 goy-~5~ 13NY Ml~bLON SMAREQWHER SHR'VICS5 'Company CIONA Name CCDRPORATION~ Account Key ST'EVENS-- LA,.U1L00_0_0 ~ Control 204905070009013 Number Telephone 800-522-6645 Number Thank you for your recent inquiry requesting information for the above referenced account(s). You will find included an account transcript containing the requested information. This report will show: • Account Profile-general account status • Account Certificate Listing-debit/credit of certificates • Account Payment List-details cumulative dividend payments • Dividend Reinvestment Account Summary-details shares purchased with reinvestment Listed below is the account balance as of 04/18/2009. Date: 04/18/2009 Certificated/DRS Balance: 0.0000 Div. Reinv. Balance: 60.0000 Total Shares: 60.0000 Closing Price Per share value: $21.41 Total value: $1,284.60 Thank you for the opportunity to assist you. As a reminder, you may access our Investor ServiceDirect Web site at www.bnyrnellon.com/shareowner/isd or call our automated voice response system at the above number for account information and to initiate certain transactions. You may also choose to speak with one of our Customer Service Representatives who are available from 9 a.m. until ? p.m. on Monday through Friday. Sincerely, Shareholder; LAURA L STEVENS CIO JUDITH WEAKLEY 174 WILLOW MILL PARK RD MECHANICSBURG PA 17050 Our Control Number: 200905070009013 12550810 - CIGNA CORPORATION STEVENS-LAU1L0000 YEAR TO DATE ACCOUNT SUMMARY :.. ; ~ ,~ .. 0 60.0000 80.0000 2.40 2.4 There are no certificates for this account. PLAN TYPE : IR001 CERTIFICATE HISTORY (10 Most Recent Transactions) BOOK ENTRY HISTORY (10 Most Recent Transactions } »» - "' .5004 8800 ~ $1,420.80 01/01/2009 Balance Fonrward 80.0000 .0000000 .00 .00 .00 .00 01/01/2008 Balance Forward 60.0000 .0000000 .00 .00 .00 .00 06/04/2007 Stock Dividend/Spiit 40.0000 .0000000 .00 .00 .00 .00 01/01/2007 Balance Forward 20.0000 .0000000 .00 .00 .00 .00 01/01/2006 Balance Forward 20.0000 .0000000 .00 .00 .00 .00 01!01/2005 Balance Forvvard 20.0000 .0000000 .00 .00 .00 .00 09/13!2004 Transfer 20.0000 .0000000 .00 .00 .00 .00 01!01/2004 Balance Forward .0000 .0000000 .00 .00 .00 .00 PAYMENT HISTORY 1 From :2003 To: 2009 1 Dividend • s. 04/10/2009 78035460 PAID on 05/07/2009 2.40 ~~•- 0000000938175 -~.. 0000000000 Dividend 04/10/2008 78029044 PAID on 05/05/2008 2.40 0000000936175 0000000000 Dividend 01/10!2008 78023502 PAID on 01/22!2008 0.60 0000000938175 0000000000 Dividend 10/10!2007 76017906 PAID on 05/05/2008 0.60 0000000938175 0000000000 Dividend 07/10/2007 78012167 PAID on 08!02/2007 0.60 0000000936175 0000000000 Dividend 04/10/2007 76006148 PAID on 04120/2007 0.50 0000000938175 0000000000 Dividend 01/08/2007 76000318 PAID on 01/29/2007 0.50 0000000936175 0000000000 Dividend 10/10/2006 64100290 PAID on 10/18/2006 0.50 0000000938175 0000000000 Dividend 07/10/2008 63000284 PAID on 08/29/2006 0.50 0000000936175 0000000000 Dividend 04/10!2008 82000291 NCSH 0.50 0000000936175 0000000000 Dividend 01/09/2006 61000193 PAID on 01/17/2006 0.50 0000000936175 0000000000 Dividend 10/11/2005 54000194 PAID on 10/17/2005 0.50 0000000938175 0000000000 Dividend 07/11/2005 53000212 PAID on 07!21/2005 0.50 0000000936175 0000000000 Dividend 04111!2005 52000198 PAID on 04/27/2005 0.50 0000000936175 0000000000 Dividend 01/10/2005 51000197 PAID on 01!20!2005 0.50 0000000938175 0000000000 Dividend 10108!2004 44000198 PAID on 10/20!2004 0.50 0000000936175 0000000000 Note:- For Security reasons, we are replacing the first five digits of your Social Security number with "" =""(asterisks) on correspondence that we send to you. Please note that this duplicate statement only contains the 10 most recent Certificates , 10 most Recent Book Entries transactions. Page: 1 `~~`ra~~ A~ors broker !or your mommy. JUDITH L WEAKLEY 174 WILLOW MILL PARK RD MECHANICSBURG PA 17055-1760 Brunch Office SCOTTRADE, INC 500 N THIRD ST #100 HARRISBURG, PA 17101-1111 (717)234-4040 Account Number Office 84138684 37D PaNod Beplnninp PeNod Ending 04 ! 01 / 2009 04 / 30 / 2009 INFORMATION UPDATE Earn FREE Online Trades For each person you refer that opens an eligible account, both you and your friend will receive FREE onlint~ trades. For program rules and more information, log in to your Scottrade account and click the °Refer Someone You Know" buttion in the ReferALL box. ACCOUNT 8UMI~WRY TRANSAGT1oN 8UMMARY VALUE THIS PERIOD OPENING BALANCE 198,gp VALUE SECURITIES IN POSITION ~ 309.12 CREDITS: DIVIDEND/INTEREST INCOME 0.01 MONEY BALANCES : TOTAL CREDITS 0.01 BROKERAGE ACCOUNT BALANCE 198 91 DEBITS: . TOTAL MONEY BALANCE 198 91 CLOSING BALANCE 198.91 TOTAL ACCOUNT VALUE 508.03 SECURnY POSITIONS Symbol / Estimated Market Estimated Annual Type Cusip Quantity Description PHce Value % Income Cur. Yld CASH CSCO 16 CISCO SYSTEMS 19.32 309.12 100.00 CASH NCIS# 100 NETCURRENTS INFORMATION SVCS 0.00 0.00 0.00 TOTAL 309.12 100% CASH ACCOUNT AGTINII'Y' Data Transaction Quantity Dsscrlotbn Price Amount Balance OPENING BALANCE 198.90 04/30/09 INTEREST EARNED CR INT 30 DAYS ®.05% 0.01 198.91 APY EARNED .O6% CLOSING BALANCE 188.91 May 1, 2009 Smigel, Anderson & Sacks, LLP. Attn: Heather D. Royer 4431 N. Front St. 3~d Floor Harrisburg, PA 17110 RE: Estate of: Judith L. Weakley Tax Identification Number: 226-58-0309 Date of Death: April 18, 2009 To Whom It May Concern: Commerce CBank o a ~fi~ c/~p~Z SCI This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 536033483 Date Opened: 03/11/2005 Primary Owner: Judith Weakley D/B/A Abrams and Weakley General Store for Animals Authorized Signer: Judith Weakley Date of Death Balance: $9021.17..X Accrued Interest: $0.00 Principal Balance: $9021.17 Account Type: Checking Account Number: 537153744 Date Opened: 11/14/2005 Primary Owner: Judith Weakley Date of Death Balance: $39267.61 X Accrued Interest: $4.37 Principal Balance: $39263.24 Commerce Bank /Harrisburg PO Box 4999 3801 Paxton Street Harrisburg, PA 17111-0999 commercepc.com Commerce Bank Account Type: Checking Account Number: 537519670 Date Opened: 09/05/2006 Primary Owner: Judith Weakley Secondary Owner: Lucinda S. Stone '~ Date of Death Balance: $108314.88 ~ Accrued Interest: $35.25 Principal Balance: $108279.63 Account Type: Checking Account Number: 538301128 Date Opened: 10/14/2008 Primary Owner: Judith Weakley Date of Death Balance: $101304.89 x: Accrued Interest: $32.97 Principal Balance: $101271.92 Account Type: Time Deposit Account Number: 120001686 Date Opened: 08/12/2008 Primary Owner: Judith Weakley Date of Death Balance: $87466.57 Accrued Interest: $79.71 Principal Balance: $87386.86 Primary Beneficiary: Kiz C. Smith Account Type: Time Deposit Account Number: 120001687 Date Opened: 08/12/2008 Primary Owner: Judith Weakley Primary Beneficiary: Lucinda S. Ston Date of Death Balance: $87466.57 Accrued Interest: $79.71 Principal Balance: $87386.86 Account Type: Time Deposit Account Number: 120001688 Date Opened: 08/12/2008 Primary Owner: Judith Weakley Date of Death Balance: $82321.49 Accrued Interest: $75.02 Principal Balance: $82246.47 Commerce Bank /Harrisburg PO Box 4999 3801 Paxton Street Harrisburg, PA 17111-0999 commercepc.com Commerce Bank The above named decedent also holds a safe deposit box at our branch located at 742 Wertzville Road, Enola, PA 17025. Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely, Diana Reynolds Commerce Bank Research Associate/Deposit Services Commerce Bank /Harrisburg PO Box 4999 3801 Paxton Street Harrisburg, PA 1 71 1 1-0999 commercepc.com ._-~ 00l Chrysler PT Cruiser -Trade In Value, blue book vahie - Otlicial Kelley Blue Book Site Page 1 oF. ~„~ `„'=~>~} ~~ Kelley Blue Boob . TiiE TRUSTi:!) 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'G 4 .. a.. 4~ 4. 03-13-200903-14-2009:03-13-2009: Credit Interest 270.43: 45,797.95 Completed ~~,.ir.l _ .? ,„$e late tl v:' CAMP ] D '~.: 16Q86 r Thursday, May 07, 2009 01:46 PM COMMUNITY BANK 38 NORTH CENTRAL AVENUE P. O. BOX 1209 STAUNTON, VA. 24402.1209 ~Op~ ~@~!f`Cal ~C~f@ii'I8 - _ ~x Account`~ , ' ~ 1UU1=1~Oi4=~41 ' '~~umtier`~ -- Frorn Cate: , O 1-01 'Oi~'_==+ ~ °._. '- _ a Solt ilyde~ :. _ ... 1~. .-~hru Qate 0~~-14-?UU-{ I ~ < Clear ~ ~ Ascending ~~Descanding a- . , . ~ _ '~ 1~ Poste EfFectiue ; ~ Activity j Current Date ~ ..Data ~ `Date ~- Description Amount i Balance j Status ( ~' 03-13-2009;03-14-2009;03-13-2009 Credit Interest 599.48: 101,522.70 ~ Compl ted ;i .CAMP I ~ 16086 Thursday, May 07, 2009 01:50 PM ~ DuPont Communit ~ ~- Y ~~ CREDIT UNION May 12, 2009 Heather D. Royer SMIGEL, ANDERSON & SACKS LLP 4431 North Front Street, 3~d floor Harrisburg, Pennsylvania 17110-1778 Re: Estate of Judith Louise Weakley Letter dated on 4/29/09 Dear Ms. Royer: 5-i ~~-z s?ry Based on our records, Judith Louise Weakley has two accounts, 28886 and 557439. 1. On account 28886, she is the only registered owner. The exact title of the account is JUDITH L WEAKLEY. In this account, there is a savings, a money market, and a certificate number 30 (which mature in 8/7/09) 2. The date that the account was established was 5/23/03. 3. Prior to the date of death, there is no change of ownership or registration. 4. As of 4/18/09, the balance in savings was $30.25, in money market was $43,182.49, and in Certificate number 30 was $40,000. These accounts will still accruing interest until they are closed. 5. This account does not have any safety deposit box. Concerning account 557439: 1. She is the only registered owner. The exact title of the account is JUDITH L WEAKLEY. In this account, there is a savings and a money markex. 2. The date that the account was established was 5/23/09. 3. Prior to the date of death, there is no change of ownership or. registration. 4. As of 4/18/09, the balance in savings was $92.53 and in money marlket was $42,658.90. These. accounts will still accruing interest until they are closed. 5. This account does not have any safety deposit box. If I could further assist you, my number is 540-946-3200 ext. 3352. Sincerely, Khen Quach Loan Officer P.O. Box 1365, 140 Lucy Lane Waynesboro,VA 22980 p: 540.946.3200 f 540.946.3212 ~ ~ Citizens Bank June 2, 2009 HEATHER D ROPER 4431 NORTH FRONT STREET, 3RD FLR HARRISBURG PA 17110-1778 Estate of JUDITH L WEAKLE Date of Death: Apr 18, 2009 SSN: 226-58-0309 Dear Sir/Madam: 525 William Penn Place Suite 153-2618 Pittsburgh, PA 15219 ~:• '~` q-~ In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884 Sincerely, JB Operations Services ,,, ..~ ~ .. t - _.. SunTrust Banks ,~,; ,~ ~, ._~ Mail Code GA-ATL-5134 G Post Office Box 4418 Atlanta, GA 30304418 ~(~-Z~~ SUI1fI~tUST- Verification of Deposit/Loans SMIGEL, ANDERSON & SACKS LLP ATTORNEYS AT LAW 4431 NORTH FRONT STREET San FLOOR HARRISBURG, PA 17110 Applicant Estate of Judith Louise Weakley Judith Louise Weakley 171 Willow Mill Park RD Mechanicsburg, PA 17050 Our records indicate Judith L Weakley held an account with SunTrust. CD - xxxxxxxxx6686 investment (0001) Date of Death Balance $15,001.35 accrued interest $2.30 and interest rate 2.81% CD - xxxxxxxxx6686 investment (0002) Date of Death Balance $60,046.37 accrued interest $9.41 and interest rate 2.86% Account Opened- 05/16/2005 No changes made with the name. Account Titled - Judith L Weakley Account interest is included above. No safe deposit box. No other accounts found. Signature of D itory Official Title Date O erations Su ervisor OS/~8/2009 G K. Davis Please direct inquires: SU11fIY2UST Cr Credit Verification Department GA-ATLANTA-5134 /Post Office Box 44 l 8 Atlanta, GA 30302-4418 Request Number Contact Number: 1-877-841-8443 This letter is confidential and written without prejudice as a matter of business courtesy with the undersl:anding that ~~its souaral contents will not be divulged and that no responsibility is to attach to this Bank or any of its officers or agents for information herein. It'contains information solely as to transactions or experience between the designated customer and this Bank. C.V. Rep #3 JUN-23-2009 14:01 TD WEALTH MGMT 8564705660 P.002 ~ O u° g ~~a = , ~~~.. A.~~ ~ ~~~ a ~ o N q~ a .U iY WJ! M + O ~ v y 5 ~, . o m ~ ~~ ~ ,~ o ~ uo « 4 G p ~ ~.+ cw H w Q (~ ~ ~ it a y..Q~ .r ° ao .I~.Ak o ~ ~ a o a~~ ~na e^ O . . ~. 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Iitrj.wT~j , 4~. p.1 o~ ~~~ N w N ~? ~ N ,. ~4 !ig ~, S 8 ~ F ~ ~ ~ '~ ers ~ "'' r~i, M uj '' ipl~ ~iifs 0 ri N N :I i,,, ~ ;~~a s kc e! :i 8$ ~M M tIy M Oi a14Tii ~~~i ~ ~Ck~Nee ..:.k.r, '. ~~~ i7 i.~.~ai~ II;S~~I'Y p X:IyS915 ':ti:t~'i ~ ~iwE~wik °1~i!i+• r : sr~ "'i :i;~ M u b~~~]'.7 ~ i7:.w1r ~i .~ t•: ~L^ r ~ryI..~ C.bMl+.l AISrr~ O ?:I ,.~ ~ i:: .Sao .,. .~ ••~ a+ ~ ~~t:u ~ ~ O C y:l < ~ ','i, A ,~+ iK :~kek ~ ~' y (~1 ;w ~ ii ~i3Sa?I 0 aF ~.~ ~~ ~ ~~~~ ~~ ~~ ~~ A ~ ~cc r7v~J! 0. 4?i gyp ~Y 'S ~~ ~ ~, o PO w ~[ t 0 f a0 a~ v ~s~~ .~ W ~ ,~ Pi x ~ m y~ O fn ,~ d`tj' F '~ ~ ~z~ m ~o~x ~~5~ q H FWdl4 ~q~ o 1~-O`^~ .~' ~ ~ ~~~~~ .z ~,~o~ ~ ~ o H ~~~ ~~sy. ~~z~ ~~~~ W~~<~ u ~ ~~~~ pg $A ~~ a TRANSA-MERICA • LIFE INSURANCE COMPANY May 6, 2009 ~ ,-~, ~' a, ~~, .~. . Estate of Judith Louise Weakley ~,;`~~~,;~ a'E, c/o Smigel, Anderson & Sacks ~ U Ej~~~ Attn Heather D Royer 4431 N Front St 3rd Flr ~~~"Z~ Harrisburg PA 17110-1778 RE: Annuity Nwnber(s) OaPP0016480 Dear Personal Representative(s): Transamerica Life Insurance Company 43133 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 We have received notification, Judith Louise Weakley, Beneficial Owner of the above listed non-qualified tax deferred annuity is deceased. Our office wishes to extend sincere condolences for your loss. The following is the current information on this annuity: Annuitant: Beneficial Owner: Primary Beneficiary: Contingent Beneficiary: Annuity Policy Date: Full Value as of 05/06/2009: Taxable Portion: Full Value as of 04/18/2009: Laura L Stevens (deceased) Judith Louise Weakley None Listed None Listed March 04, 2003 $29,069.06 $ 4,069.06 $29,021.86 The attached document outlines the option available to the estate. The full value as of the date of death is for tax purposes only and is not a guaranteed death benefit amount. Operations performed on an automatic basis when applicable have been terminated, such as; Systematic Payouts or Automatic Billing. The attached document contains general tax information bused on Transamerica Life Insurance Company's interpretation and should not be relied upon for your personal tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Member of the ~;EGOW. Group a:~... bs'a.„ ' ~' ~t~aw_`~,+t OhYri1"~ "~jf jF r; i~E~IAAY ~=x S ~ ..c"A,vzRn- • C~%~~ c--~,_T°' M .4XA Financial Company May 7, 2009 Smigel Anderson & Sacks LLP 4431 North Front Street 3`~ Floor Harrisburg, PA 17110 Re: Judith Weakley 2VA0011062 & 2VA0015609 Dear Mrs. Royer: t.~ Ors ,,"~~ ~".-~ 4~o6-z-~ On behalf of MONY Life Insurance Company of America, please accept my heartfelt condolences on the loss of Judith. The beneficiary listed for all policies/contracts listed is: Mother, Laura Louise Stevens, if living, if not, Cousin, Alex Jones. The approximate death benefit amount payable is as follows: 2VA0015609 - $3,661.04 all of which is taxable. 2VA0011062 - $18,958.88 none of which is taxable. Listed below are the payment options available; the beneficiary may want to consult with a tax advisor to determine which option is best for them: 1. Electing an Installment or Life Option can spread the taxable amount out. If a Settlement Option is elected, it must be elected within 30 days of when the proceeds become payable. For further information on this option, please call toll free at (800) 326-6744. 2. The beneficiary may be eligible for a Beneficiary IRA to defer taxes on 2VA0015609. For more information, a Financial Professional should be contacted. If assistance is needed in contacting a Financial Professional, please let me know. 3. Immediate payment option: a) An interest-bearing checking account called a MONY Access account can be set up in the beneficiary's name. This account earns a competitive rate of interest, and provides the ability to settle immediate needs, without making major decisions about future investment options. To process a claim, please submit the following forms and documents to my attention at MONY, PO BOX 4830, Mail Drop 40-50, Syracuse, NY 13221: • The enclosed Request for Payment of Benefits Claim form #03582. • Certified copy of the Annuitant's Death Certificate. MONY Life Insurance Company of America P.O. Box 4720 Syracuse, New York 13221 (315) 477-3000 35424 (9/2004) Cat. #134228 (9/04) Apri122, 2009 Dear Luci and Kiz, .., ~^ '~ ~ ~ F ~.. ~, Enclosed are the Elderschoice invoices that total $1050.00. Per the agreement, Elderschoice, Inc. invoices every two weeks. Judy owed frorn March 14"'through March 27`h and March 28`h through April 10`x'. These two invoices were unpaid along with the final balance for 7 days of service until her passing. Please feel free to call if you have any questions or concerns. The agency understands that it will take time to be reimbursed. It was a pleasure working with both of you. See you May 3`d for the celebration of Judy's life. Best regards, /- 4 ~ F 1 Paula Levitas ~, i I '~-ii, ,^i ~-~ 1. Tili_,\.~ ~.., _ ~ ..I' i'. ~~I: i~:I,\~ ~ :~ `ice `I~Tr Y`12 6i~lton \otci~ Place, Harri.hurg, Penn>}Icania 1110 TeI: 71'.99I.2'~Z ~~r~~.,r.elders-c~o~cr..com n ._--~ ~ Heritage Medical Group, LLP HERITAGE CARDIOLOGY DIAGNOSTIC CENTI 425 North 21st Street Camp Hill, PA 17011 = FORWARDING SERVICE REQUESTED ~_ p ~ - ~ Please check if address or insurance information ~ _ ~ is incorrect and complete form on back. I~~~III~~~III~~~~I~1~11~~~~~~111~~~1~11~~11~~~1~~~1~1~~1~~1~11 o'o`o`3io' """""`5-DIGIT 17050 JUDY WEAKLEY 174 WILLOW MILL PARK RD MECHANICSBURG PA 17050-1760 Check Card Used and Fill in Below to Pay by Credit Card ~~J--^ ^ MasterCard I - ~ ^ Visa ~-==-~~ ^ Discover artl Number mount Signature xp. Date tatement ate ay Is mount ccount 03/23/09 51499.52 355898 ayment ue ate SHOW AMO NT 04/13/09 PAID HERE HERITAGE MEDICAL Gt'tOUP, LLP PO Box 70850 Philaia;~7~~9 ,f _ _._ ~ ~ eR f , ~'° ~ ...~'~ ~i OD3345610000355898000014995~2 0 PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT Account #: 355898 Please Pav: $1499.5'1 Due (bate: 4113/09 .Insurance 'Patiear~ Date Desctiptian Charges Balance Balance JUDY WEAKLEY ID# 355898/STANLEY B LEWIN MD 02/06/2009 MYOCARDIAL PERFUSION IMAGING; TOMOGRAPHIC CSPECT), MULT 1117.00 1117.00 0.00 02/06/2009 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, 688.00 688.00 0.00 02/06/2009 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUHMAXIMAL 310.00 310.00 0.00 02/06/2009 MYOCARDIAL PERFUSION STUDY WITH WALL MOTION, QUALITATIV 199.00 199.00 0.00 02/06/2009 MYOCARDIAL PERFUSION STUDY WITH EJECTION FRACTION CLIST 199.00 199.00 0:00 02/18/2009 CONTRACTUAL ADJUSTMENT FROM BLUE SHIELD -1541.88 0.00 02/18/2009 PAYMENT FROM BLUE SHIELD 0.00 0.00 02/18/2009 PATIENT RESPONSIBILITY - THE BALANCE IS YOUR DEDUCTIBLE WHICH IS NOT -971.12 971.12 --> COVERED BY YDUR INSURANCE. HOWEVER, IF YOU ARE ENROLLED IN AN HRA --> OR HSA PLEASE CONTACT YOUR PLAN ADMINISTRATOR PRIOR TO MAKING --> PAYMENT. THIS WILL AVOID AN OVERPAYMENT ON YOUR ACCOUNT. BALANCE TICKET #HCDC020930 .00 971.12 JUDY WEAKLEY ID# 355898/STANLEY B LEWIN MD 02/06/2009 INJECTION, REGADENOSON, 0.1 MG ,263.00 263.00 0.00 02/06/2009 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, 62.00 62.00 0.00 02/18/2009 CONTRACTUAL ADJUSTMENT FROM BLUE SHIELD -56.60 0.00 02/18/2009 PAYMENT FROM BLUE SHIELD 0.00 0.00 02/18/2009 PATIENT RESPONSIBILITY - THE BALANCE IS YOUR DEDUCTIBLE WHICH IS NOT -268.40 268.40 --> COVERED BY YOUR INSURANCE. HOWEVER, IF YOU ARE ENROLLED IN AN HRA --> OR HSA PLEASE CONTACT YOUR PLAN ADMINISTRATOR PRIOR TO MAKING --> PAYMENT. THIS WILL AVOID AN OVERPAYMENT ON YOUR ACCOUNT. BALANCE TICKET #HCDC020936 .00 268.40 JUDY WEAKLEY ID# 355898/STANLEY B LEWIN MD 02/06/2009 ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE D 349.00 349.00 0.00 02/18/2009 PATIENT RESPONSIBILITY - THE BALANCE IS YOUR DEDUCTIBLE WHICH LS NOT -260.00 260.00 --> COVERED BY YOUR INSURANCE. HOWEVER, IF YOU ARE ENROLLED IN AN HRA --> OR HSA PLEASE CONTACT YOUR PLAN ADMINISTRATOR PRIOR TO MAKING --> PAYMENT. THIS WILL AVOID AN OVERPAYMENT ON YOUR ACCOUNT. 02/18/2009 CONTRACTUAL ADJUSTMENT FROM BLUE SHIELD -89.00 0.00 I1~IPORTAJliT ilfiESSAGE ABOI~ YCU~3 AC!OOUR9T Prompt payment is greatly appreciated! To2~l r3alanc~ 1499.52 -lraslurar~ce ~~rs>iia~g .00 ;~d898~1iAJ5t ~~e 1499.52 ~s~r ~99i~~~ ~~a:~s4ic~s ~~91 e M N O a a fll F~~F nn ~nT s~aur~ cash THROUGH THL UfAIL Critical Case Systems 6380 FLANK DR. SUITE 600 '.~ ~ ~r HARRISBURG, PA 17112 ~s 717-540-6800 °!~/ 03!04/2009 ~/ JUDITH WEAKLEY 174 WILLOW MILL PRRK RD MECHANICSHURG PA 17055 A recent review of your account has indicated there is a balance that is your financial responsibility based or. the co-insurance or co-pay oer the Explanation of Benefits from your Insurance Company. Details OE Balance. First Date Invoice Invoice Patient of Service Date Number Therapy Responsihility 01/30/2009 01/30/2009 65124 Antibiotic 950.28 02/17/2009 65580 Nursing (Only) 11.10 Total Patient Balance:5 961.38 Please remit payment to: CRITICAL CARE SYSTEMS 6380 FLANK DR. SUITE 600 HARRISBURG, PA 17112 Enclosed is a self addressed return envelope for your convenience. If you should have any questions, please contac[ our office at 717-540-6800 Sincerely, Critical Care Systems Billing Department -----------------Detach here and return this portion with payment------------------- Critical Care Systems accepts personal checks, Debit Cards (with MasterCard or Visa logo) as well as MasterCard and Visa credit cards for payment of patient balances. Zf paying with MasterCard or visa, Please provide the information below. MasterCard Visa (Circle One): Card Number: Card Code(3 digits on back of Credit Card) Complete name or. credit card: Expiration Dateiinciude month a.^.d year) Sigr.acure of Card Holder: Addresa of Card Holder: City, Stae a~9 Z-_a Co'= ro_a1 z~..,_.._ a..tco,._z.. ;.., _..4 _ .._~~i= cacd:5 AUR Control: 50050-5676 Department of Treasury Intemai Revenue Service PO BOX 16336 PHILADELPHIA, PA 19114-0436 024315.619056.0208.005 2 AT 0.482 1885 I,~JII,..IIL.,.,~II~~~III~~I~~JI~~IJ~~,LLJ,II,J,~~I~II Notice: CP200i) Notice Date: June 22, 2009 Social Security Number: 226-58-0308 Form: 1040 Tax Year: 20b7 To call for assistance: 1-800-829-8310 TOLL FREE bet-veen 8: b0 AM - 8:00 PM 024315 JUDITH L WEAKLEY 128 OLD FORD DR To FAX infprmation: CAMP HILL PA 17D11-8352282 215-516-2335 LOCAL FAX Contact: Offiee of t. Fulmer • ~ • ~ • • - • • July 22, 2009 1 ~ Why are you getting this notice? The income and payment information (e.g., wages, miscellaneous income, interest, income tax withheld, earned income credit, etc.) that we have on file does ndt match entries on your 2007 Form 1040. If this information is correct, you will dwe ~ 1, 881. The proposed changes to your tax are listed below. • ~ • i • • ~ - 2007 Tax Increase S 1,763' Payment Increase 9 0 Penalties -may not include all applicable penalties ! 0 Interest - if paid by July 22, 2009 3 118 Proposed Balance Due 0 1, 881 2 ~ What steps should you take? Following these steps can help you understand this notice. 1. Review your 2007 tax return. 2. Compare your return to the information in the Explanation Section -- page 7 . 3. Decide if the information in the Explanation Section is correct. 4. Check the answers to freguentlyAsked Questions -- page 2. 5. Complete and return the A~esponse Form in the enclosed envelope -- page 3. 6. Complete and return the Installment Agreement Request (enclosed) if' you need to set up a payment plan. 7. Review your rights in The Examination Process Boofclet (enclosed). 3 ~ What happens If you don't respond by July 22, 2009? We will send you a final notice, followed by a bill. During this time, interest will increase and certain penalties may apply. {SP1A} CP2000 (Rev. 11/2!004)