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COMMONWEALTH OFPENNSYLVANIA ILE NUM;B~ / 5 / DEPARTMENT OF REVENUE oE.T. 28o~o, ~ RESIDENT DECEDENT 04 HARRISBURG, PA 17128-0601 I ! COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER McCullough, AMn D. 192-18-4287 DATE OF DEATH (MM-DO*YEAR) ] DATE OF BIRTH (MM-DD-YEAR) ~ 10/26/1923 11/25/2003 IF APPUCABLE) SURVIVING SPOUSE'S NAME( LAST. FIRST AND MIDDLE INITIAL) McCullough, Lois H. [] 1. Original Return [] 4. Limited Estate ] 6. Decedent Died Testate (Attach copy of Will) [] 9. Litigation Proceeds Received [] 2. Supplemental Return ] 4a. Future Interest Compromise (date of death after 12-12-82) [] 7. Decedent Maintained a Living Trust (Attach copy of Trust) [] lQ Spousal Poverty Credit (date of death between THIS RETURN MUST BE FILED IN DUPLICATE WITH THE i !~ REGISTER OF WILLS 82) 8. Total Number of Safe Deposit Boxes [] 11 .Election to tax under Sec. 9113(A) (Attach Sch O) 12-31.91 and 1-1-95) ~i~C~I~M~;~~D ;AL~C~RRE~pONDENCEA~D~0NFiDE~i~T~ INFORMATION SHOULD BE D RE~EDTOi: ~ME i co~P'LE'rE' ~AiU~G ADD'RES$ Stephen L. Bloom Stephen L. Bloom, Esquire 5tu,u. ~on,,g~s ~.,a~p,~oao -- - L. arllste, i'/-~ I/UI~ r'ELEPHONE NUMBER I · 717/249-7717 7. 8. 9. 11. 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Non~' Non~ ~ 962,908.21 11,380.50 Net Value of Estate (Line 8 minus Line 11) (8) (11) 962,908.21 11,380.50 951,527.71 951,527.71 (12) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate x .045 (16) 17. Amount of Line 14taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 794,524.96 157,002.75 0.00 7,065.12 7,065.12 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON'PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF [FILE NUMBER McCullough, Alvin D. 21 - 04 - ITEM NUMBER 10 This schedule must be completed and filed if the answer to any of quest_ions 1 through.~_o~n page 2 is yes, DESCRIPTION OF PROPERTY DATE OF DEATH % OF EXCLUSION Include the name of the transferee, their relationship to decedent and the date of transfer. NDTEECR[ ~ sSI TAXABLE VALUE Attach a copy of the deed for real estate. VALUE OF ASSET I T IF APPLICABLE) 200 Shares, Van Kampen Funds, Inc. - PA Quality Muni 3,250.00 50% 1,625.00 Trust Fund, Acct. #21303605730, ~ $16.25 per Share, held in joint trust with spouse 1,825.621 Shares, The Vanguard Group - PA LT Tax-Exempt Investor Fund, Acct. #09864176854, ~ $11.75 per Share (plus $64.32 accrued dividends), held in joint trust with spouse 545.765 Shares, Dreyfus Family of Funds - PA Intermediate Muni Bond Fund, Acct. #0000105-00220485817, ~ $13.84 per Share, held in joint trust with spouse Investment Portfolio, Pursell Associates, Inc., Accts. #5982-4493 & 5708-7833, see chart of holdings, prices and values attached, held in joint trust with spouse Investment Portfolio, A.G. Edwards & Sons, Inc., Acct. #127-185212-042, UTS-PA #215:10 Units ~ $1,073.77 per Unit; UTS-PA #216:6 Units ~ $1,059.70 per Unit; and Nuveen Multistate Trust Fund: 3,105.636 Shares ~ $10.37 per Share, held in joint trust with spouse Investment Portfolio, Edward Jones, Acct. #377-02785-1-7, Cambria Co. PA G.O. Ref: 5,000 Units ~ $1.04787 per ~r Unit; Washington Co. PA Hosp: 20,000 Units ~ $1.02253 per Unit, held in joint trust with spouse Checking Account, F&M Trust, Acct. #32-99848, held in ! joint trust with spouse Money Market Account, F&M Trust, Acct. #70-27060, held in joint trust with spouse Certificate of Deposit, F&M Trust, Acct. #015-2957613, held in joint trust with spouse 251 Shares, F&M Trust, ~ $30.77 per Share, held in joint trust with spouse Total of Continuation Schedule(s) 21,515.37 7,553.39 1,074,364.00 49,301.35 25,689.95: 5,562 36 23,871.29 7,019.23 7,723.27 5O% 5O% 5O% 5O% 50% 50% 50% 50% 5O% 10,757.69 3,776.70 537,182.00 24,650.68 12,844.98 2,781.18 11,935.65 3,509.62 3,861.64 ~ 349,983.07 TOTAL (Aisc enter on line 7, Recapitulation) 96~,¢081~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY continued ESTATE OF McCullough, Alvin D. FILE NUMBER 21 - 04 - This schedule must be com~pleted and filed if the answer to an~ of questions I thro~l~ 4 onpajie 2 !s~yes. ITEM NUMBER 11 12 13 14 DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer, Attach a copy of the deed for real estate. Various United States Savings Bonds (87), actual surrender value on 12/4/03, held in joint trust with spouse 82 Units, MetLife Trust Interests, Acct. #8062 4321 5995, held in joint trust with spouse Wachovia Securities IRA, Acct. #5708-7833, spouse is sole beneficiary ,.rica Financial Variable Annuity, Acct. #VN 417933 127-185212, spouse is sole beneficiary % OF DECD'S DATE OF DEATH VALUE OF ASSET INTEREST 16,313.55 50% 2,719.14 50% 295,737.112 100% 44,729.62 100% EXCLUSION TAXABLE VALUE (IF APPLICABLE) 8,156.78 1,359.57 295,737.10 44,729.62 Page 2 of Schedule G COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF McCullough, Alvin D. Debts of decedent must be reported on Schedule I. FILE NUMBER 21 - 04 - ITEM NUMBER A. ] 2 DESCRIPTION FUNERAL EXPENSES: Funeral Service, Egger Funeral Home, Inc. Family Travel to Funeral Service (Airfare/Transportation) ADMINISTRATIVE COSTS: Personal Representative's Commissions AMOUNT Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Stephen L. Bloom, Attorney and Counsellor at Law Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Lois H. McCullough Street Address 39 Cedar Circle City Newville Relationship of Claimant to Decedent Probate Fees State PA Zip 17241 Spouse Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Organist for Memorial Service, Helen Mowery Minister for Memorial Service, William Beck Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 1,231.50 598.00 5,500.00 3,500.00 25.00 100.00 426.00 11,380.50 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SchedubH McCullough, Alvin D. Memorial Garden, Green Ridge Village Memorial Service Luncheon, Fidelity Class Flowers for Memorial Service, Lisa's Floral Shop Postage/Mailing Costs FILE NUMBER 21 04 - 50.00 200.00 148.40 27.60 Page 2 of Schedule H RE?-1 $15 EX_+ .-00) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT . SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER McCullough, Alvin D. 21 - 04 - NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY II. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Lois H. McCullough 39 Cedar Circle Newville, PA 17241 Nancy M. Longnecker 108 Heatherhill Court Bel Air, MD 21014 James R. McCullough 148 Honeysuckle Street Casper, WY 82604 RELATIONSHIP TO DECEDENT Do Nat List Tru~te~,~) Wife Daughter Son Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: IA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE AMOUNT ORSHARE OF ESTATE Outright Distributions, Trust Residue, and Life Interest in Credit Shelter Trust 1/2 Remainder Interest in Credit Shelter Trust 1/2 Remainder Interest in Credit Shelter Trust CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET REV-1514 EX+ (9-00) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF McCullough, Alvin D. SCHEDUI F K UFE ESTATE, ANNUITY &3F_RM ~AIN (Check Box 4 on Rev-1500 Cover ~ FILE NUMBER 21 - 04 - This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. [] Will [] Intervivos Deed of Trust [] Other NAME(S) OF LIFE TENANT(S) ~DATE OF BIRTH NEARESTAGEAT[] DATE Of DEATH 81 , Life or TERM OF YEARS LIFE ESTATE IS PAYABLE Lois H. McCullough ! 06/04/1922 [] Term of Years [] Term of Years Life or Life or Life or [] Term of Years [] Term of Years $ 225,000.00 1. Value of fund from which life estate is payable 2. Actuarial factor per appropriate table Interest table rate- [] 3 1/2% [] 6% 3. Value of life estate (Line 1 multiplied by Line 2) [] 10% [] Variable Rate 4% .25163 $ 56~616.75 NAME(S) OF ANNUITANTS DATE OF BIRTH 1. Value of fund from which annuity is payable NEAREST AGE AT DATE OF DEATH 2. Check appropriate block below and enter corresponding (number) Frequency of payout - [] Weekly (52) [] Semi-annually (2) 3. Amount of payout per period 4. Aggregate annual payment. Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) TERM OF YEARS ANNUITY IS PAYABLE [] Life or [] Term of Years [] Life or [] Term of Years !l-] Life or [] Term of Years [] Life or [] Term of Years [] Bi-weekly (26) [] Annually (1) Interest table rate - [-]31/2% []6% []10% [] Variable Rat~ [] Monthly (12) [] Quarterly (4) [] Other 0.00 6. Adjustment Factor (see instructions) Value of annuity - If using 3 1/2%, 6%, 10% or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16, 17 and 18. SCl-F~ O COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER ESTATE OF McCullough, Alvin D. : 21 04 - - Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Credit Shelter Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. 2 DESCRIPTION Interests of Decedent passing directly to surviving spouse and trust residue passing directly to revocable living trust of surviving spouse Life interest of surviving spouse in "Trust A" (Credit Shelter Trust) of Decedent in total amount of $225,000.00 VALUE 737,908.21 56,616.75 Part A Total 794,524.96 Part B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION Remainder Interest of Lineal Descendents of Decedent in "Trust A" (Credit Shelter Trust) of Decedent in total amount of $225,000.00 VALUE 168,383.25 Part B Total (If more space is needed, insert additional sheets of the same size) 168,383.25 wilh\7963-h.wil 9/6/94--clm LAST WILL AND TESTAM~ I, ALVI]q' D. McCULLOUGH, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, funeral expenses, and administrative expenses be paid from my estate, as soon as practicable after my death. 2. I give such items of personalty as are itemized in a certain list attached hereto to the persons named thereon, which list is signed and dated by me at the end thereof. 3. I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal property, unto my Trustee under a certain McCullough Family Revocable Living Trust dated the 27th day of March, 1990, as may be amended, naming myself and my wife, LOIS H. McCULLOUGH, as Trustee, NANCY McCULLOUGH LONGNECKER as first successor Trustee, and JAMES RICHARD McCULLOUGH as second successor Trustee, to have and to hold, in trust, for the uses and purposes and subject to the terms and provisions thereof. In the event the aforesaid Trust is not in existence at the time of my death, then I devise the residue to my wife, LOIS H. McCULLOUGH. In the event my said wife, LOIS H. McCULLOUGH, does not survive me by thirty (30) days, then I devise said residue to my lineal descendants, per stirpes. 4. I hereby direct that all estate, inheritance, succession and other taxes imposed or payable by reason of my death, together with interest and penalties thereon, if any, with respect to all property comprising my gross estate for death tax purposes, shall be paid as provided in the Revocable Living Trust referred to above. 5. I nominate, constitute and appoint my wife, LOIS H. McCULLOUGH, as Executrix of my estate. In the event she shall be unable or unwilling to serve in such capacity, then I appoint my daughter, NANCY McCULLOUGH LONGNECKg-R, to act in such capacity. 6. I direct that my Executrix shall not be required to file a bond to secure the faithful Page 1 of 3 Pages A.D.M. performance of their duties in any jurisdiction. 7. I authorize and empower my personal representative, in her sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as she may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representatives and Trustees consider desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. IN WITNESS WHEREOF I have hereunto set my hand and seal this r'IS day of ~ , 199d. Alvin D. McCullough SIGNED, SEALED, PUBLISHED AND DECLARgD by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testator and of each other. Page 2 of 3 Pages COMMONWEALTH OF PENNSYLVANIA ) · SS. COUNTY OF CUMBERLAND ) I, Alvin D. McCullough, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Alvin D. McCullough ~ Sworn or affirmed to and acknowledged before me by Alvin D. McCullough, the Testator, this r/q% day of .~.mb4.A , 199'-/. Tdda L. Ja~'es Notary Public I- Ca~is!e Boro. c~:~ano County Notary Public ,, My Commissior~ F_xpqres Nov. 24, 997 COMMONWEALTH OF PENNSYLVANIA ) · SS. COUNTY OF CUMBERLAND ) We, ~/~ ~:,.~-/c. '~?..~'t, ,,..-,,~.'~ ., ,'C. ~,.~'~EIO~ L. ~ Iootv''-¢ the witnesses whose names are ~igned'_~ the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Alvin D. McCullough, the Testator, sign and execute the instrument as his Last Will; that the Testator signed willingly and that the Testator executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testator, signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. /' "' Address / 199~ Sworn or affirmed to and subscribed before me this ~ day of ~ Cadi.ale B~-c, C::.--.~e,,dand County Notary Public !My Comm~ss~,'.;' ~ -L,/es Nov. 24, 1997 Page 3 of 3 Pages ~ Decedent's Complete Address: ! STREET ADDRESS CITY 39 Cedar Circle Newville ST^TE PA ZIP 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 353.26 (1) 7,065.12 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 353.26 0.00 6,711.86 6,711.86 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; ........................................................................... j~ ~ b. retain the right to designate who shall use the property transferred or its income; ............................... c. retain a reversionary interest; or ........................................................................................................... d.receive the promise for life of either payments, benef ts or care? .......... . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I dec, are that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS ~Lois ~It McCullough -~'~ -Jr,}, ~h/t~ ('~. ~.,~., .... /// 39 Cedar Circle Newville, PA 17241 SIGNATURE OF P~ER'SOiq I~ESP~q'S-~H~'-E T:0"~rL"~"~iETOR~ ADDRESS DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS .... - Stephen L. DATE 2100 Lon[s Gap Road Carlisle, FA 17013 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 3% [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 0% [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 0% [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 4.5%, 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 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. MC CULLOUGH FAMILY. REVOCABLE LIVING TRUST This Trust Agreement dated 27th day of March, 1990, by and between ALVIN D. MC CULLOUGH and LOIS H. MC CULLOUGH (referred to as "Grantors") and ALVIN D. MC CULLOUGH and LOIS H. MC CULLOUGH, or their successors, as trustees (collectively referred to as ("Trustee"). ARTICLE I Original Trust Estate. ALVIN D. MC CULLOUGH transfers and delivers to Trustee the property listed in the attached Schedule A ("his separate share"). LOIS H. MC CULLOUGH transfers and delivers to Trustee the property listed in Schedule B ("her separate share"). Grantors transfer and deliver to Trustee the property owned by them as Joint tenants with right of survivorship, as tenants by the entirety, and as tenants in common (collectively referred to as "the joint property"), all as listed in Schedule C. Grantors intend that the joint property be allocated equally to each Grantor's share, so that each Grantor retains an undivided one-half interest in that property. To the extent that prior contributions by either Grantor to the acquisition of the Joint property have been unequal, each Grantor hereby makes a gift to the other of one-half of the excess contribution attributable to him or her. The receipt of this property is acknowledged by Trustee, upon the express terms and conditions and with the powers and limitations set forth in this agreement. Either Grantor may name Trustee as beneficiary to receive the proceeds of certain insurance policies or may deliver or provide for the delivery to Trustee of any insurance policies or may retain the policies in his or her own possession. Trustee agrees to hold and administer the proceeds of any policies in accordance with the terms and provisions of this Agreement. ARTICLE II Additional PropertY> Subject to acceptance by Trustee, Grantors, or any other person, may from time to time add cash, securities, insurance policies, or other property to the trust estate or any trust share by deed, gift, or will. The additional assets will be held, invested, administered and distributed according to this agreement, except to. the extent expressly provided to the contrary in the instrument of transfer. Assets assigned to the trust estate by either Grantor after the execution of this agreement are to be allocated equally to each Grantor's share. ARTICLE III Rights Reserved by Grantors. A. Alteration, Revocation, or Amendment. Except as otherwise specifically provided to the contrary in this agreement, each Grantor reserves the right and power to alter, amend, or revoke this trust agreement, with respect to his or her separate share, at any time and from time to time, without the consent of Trustee or any person, by giving written notice to Trustee to that effect. Notwithstanding the above, the duties, responsibilities, and rate of compensation of Trustee may not be altered or modified without its written consent. B. Power Over Trust Assets. Except as otherwise provided in paragraph C below, each Grantor also reserves the right to require changes in investments with respect to, and to withdraw any or all of, the assets of his or her separate share in the trust estate. C. Suspension of Grantors, Rights. If, at any time during the continuance of this trust, either or both Grantors are adjudicated incompetent by a court of'appropriate Jurisdiction, that Grantor,s (or the Grantors, , as the case may be) personal powers of alteration, amendment, revocation, and withdrawal will be suspended during that incompetency. If at any time either Trustee (or the named successor Trustee, as appropriate) has a reasonable basis to believe that either or both Grantors are suffering from any incompetency or incapacity that would ~ffect their judgment concerning the assets of the trust estate, that Grantor,s (or Grantors,. as the case may be) right to amend, modify, or revoke this trust agreement, or demand payments therfrom, will be suspended until the question of his or her incapacity is determined by a court of appropriate Jurisdiction. In reasonably determining any incapacity or incompetency, Trustee may rely conclusively upon the written opinion of two medical doctors retained by it to make such a determination. D. Personal Nature of Reserved Rights. No person (including guardian or conservator of either Grantor) other than that Grantor personally, may exercise any of the rights reserved to that Grantor by the provisions of this article. ARTICLE IV Administration During Grantors' Lifetimes. The proceeds of any policies of insurance received by Trustee as beneficiary, together with any other property which may be transferred to Trustee as provided above, are to be held by Trustee, in trust, in two separate shares, one for the benefit of each Grantor, for the purposes and under the conditions set forth in this agreement. During the lifetime of each Grantor, Trustee shall hold, manage, invest, and reinvest all assets of the trust estate and shall collect and receive the interest, income, and profits therefrom, upon the following terms and for the following purposes: A. Payment to Grantgrs. During the lifetimes of both Grantors, Trustee shall pay any of the net income of the trust estate to either or both of the Grantors or to such other persons as designated by either Grantor, as requested from time to time. Trustee also shall pay to either of the Grantors any part of the principal of his or her separate share that he or she requests in writing. B. Grantors' Incapacity or Incompetency. If either or both Grantors become incapacitated or incompetent to the extent that his or her personal powers of alteration, amendment, revocation, and withdrawal are suspended under the conditions set forth in Article III above, Trustee may, in its absolute discretion, rather than make payment as provided in paragraph A above to the incapacitated or incompetent Grantor (or Grantors as the case may be), pay to or on behalf of that Grantor (or those Grantors) such of the net income or principal of his or her separate share, in such amounts and at such times, as Trustee considers necessary or advisable in order to provide for the medical care, for the comfortable maintenance and welfare, and for any other purposes that Trustee considers necessary in order to fully provide for and manage the everyday needs and requirements of an incompetent or incapacitated Grantor or his or her dependents. Such payments are to include, but are not limited to, direct payments: to any landlord, hotelkeeper, or hospital; for services rendered in connection with any medical nursing, or dental care; for any and all bills for services rendered in furnishing food, clothing, transportation, legal services or any other services needed or required, upon proper substantiation by those performing the services; and for preparation of returns and payment of any and all taxes which an incompetent or incapacitated Grantor may be obligated to pay under the provisions of any applicable state or federal law. Payment or use of any portion of the income or principal of the trust shares for any of the purposes expressed in this agreement will not be subject to question by any person or by any court. c. Accumulation. Any unexpended net income is to be accumulated into the principal of this trust as an integral part of it, to be held, administered, and distributed in accordance with all of its terms, conditions, and limitations. This accumulated income is to be added equally to each Grantor,s separate share. ARTICLE V After the first Grantor,s death the principal and accumulated income the deceased Grantor,s share shall be held and administered as follows: A. The Trustee of the deceased Grantor,s share and Trust A created out of it hereafter shall be appointed as set forth in Article XIII hereafter. The Trustee serving at the first grantors death shall continue as Trustee of any other Trusts herein. B. Transactions with Estates of Grantor. Trustee may, in its absolute discretion and without regard to whether it may also be serving as personal representative of the estate of either or both Grantors, purchase on behalf of the Trust any property personal representatives of the estate to.provide liquidity for payment of any other claim or indebtedness of a deceased Grantor,s estate not specifically described in this article. Any purchases or loans will be made on the terms and conditions that Trustee, in its absolute discretion, deems appropriate, provided that any purchase of assets must be for adequate consideration in money or money's worth, and any 10an must be made only with adequate interest and security. Trustee will not be liable for any loss to the trust estate caused by its acting in accordance with this article, except for losses occasioned by its own gross neglect or willful misconduct. C. Payment of Expenses and Taxes. To the extent that, in Trustee's absolute discretion, it is inadvisable to use some or all of the residuary assets of a deceased Grantor,s estate to pay all administration expenses of that Grantor's estate, the expenses of that Grantor,s last illness and burial, and all state and federal estate, inheritance or transfer taxes payable by reason of that Grantor,s death, including any related interest and penalties but excluding any taxes assessed or imposed under Chapter 13, Subtitle B of the Internal Revenue Code of 1986, as amended (referred to in this agreement as "The Code"), or to the extent that the deceased Grantor,s residuary estate is insufficient to pay those amounts, Trustee may rely on a written statement signed by the personal representative of a deceased Grantor as to the adequacy or inadequacy of the assets of the estate to pay those expenses, costs, and taxes. Non liquid assets are not to bear any portion of those expenses, costs and taxes and need not be disposed of in order to pay any of these amounts. Notwithstanding any other provision of this trust agreement to the contrary, Trustee is specifically directed to use in payment of all applicable federal estate taxes any United States Treasury Bonds that are redeemable at par in Payment of federal estate tax. D. Administration and Disposition of Income and Principal. After making the Payments provided for in paragraph C, if any, Trustee shall administer and distribute %he deceased Grantor,s share as provided below. ARTICLE VI Division of Trust Estate Into Two Trusts. On the death of the first of the Grantor,s to die, the trust estate shall be divided into two separate trust, hereinafter referred to as Trust A and Trust B (also known as the surviving grantor's share). Trust A shall consist of the sum of $225,000.00 which shall be funded only by assets in which the surviving ~rantor had no interest at the time they were contributed to the MC CULLOUGH FAMILY TRUST and to the greatest extent possible from assets which do not qualify for the marital deduction. Trust B shall consist of the remainder of the trust estate. ARTICLE VII Trust A. Trustee shall hold, manage and invest Trust A in accordance with the powers granted by this agreement, for the following purposes: A. Payments to Surviving Grantor. Trustee shall pay to or apply for the benefit of the surviving Grantor any of the net income and principal that Trustee, in its absolute discretion, deems necessary or advisable for the health, education, support, and maintenance of the surviving Grantor, taking into consideration the standard of living to which he or she is accustomed at the deceased Grantors,s death, and also considering all other income and resources known to Trustee to be reasonably available to the surviving Grantor for those purposes. Except as otherwise provided in this trust, Trustee shall periodically incorporate any accumulated income as an integral part of the principal of this'trust, to be held, administered, and distributed according to all of its terms, conditions, and limitation. B. DistributiOn after Death of Surviving Grantor. Upon the death of the surviving Grantor, the Trustee shall administer and distribute the entire remaining trust estate outright and fee of trust to Grantor,s lineal descendants, per stirpes. ARTICLE VIII A. After the death of the first Grantor to die, the Trustee shall add to the surviving Grantor,s share, (Trust B), the residue directed in Article VI. Said amounts are to be incorporated into said share and administered under its terms~and conditions, except that any suspension of the powers reserved by the surviving Grantor in Article III of this Trust will not apply to this gift. B. Distribution after Death of Surviving Grantor. Upon the death of the surviving Grantor, Trustee shall make provision out of that Grantor,s separate share for the payments described in paragraph C of Article V, if any. Trustee shall administer and distribute the entire remaining trust estate outright and free of trust to Grantor's lineal descendants, per stirpes. ARTICLE IX Survivorship. If there is insufficient evidence to determine that the Grantors have died other than simultaneously ALVIN D. MC CULLOUGH is to be deemed to have predeceased LOIS H. MC CULLOUGH for purposes of this agreement. ARTICLE X Equalization of Estates. If LOIS H. MC CULLOUGH survives ALVIN D. MC CULLOUGH but dies within six months after ALVIN D. MC CULLOUGH,s death, the gift provided in Article VIII will be void and, instead of that gift Trustee shall distribute to the separate share of LOIS H. MC CULLOUGH that amount, if any, required to obtain for his/her estate an estate tax marital deduction resulting in the lowest combined estate taxes his/her estate and his/her estate, on the assumption that he/she died after him/her on the date of his/her death, that his/her estate is valued on the same date and in the same manner as his/her estate is valued for federal estate tax purposes, and that elections in his/her estate were made that would be consistent with minimizing taxes. The purpose of this provision is to equalize, insofar as possible, the estates for federal estate tax purposes, based on the above assumptions. The remaining assets of his/her estate not distributed under this article will be distributed as provided for Trust A in Article VII as though she/he had predeceased him/her. ARTICLE XI Generation-Skipping Tax Apportionment. If any tax is imposed against the assets of any of the trusts created by the agreement because of taxable termination, taxable distribution, or direct skip as defined in Chapter 13, Subtitle B of the Internal Revenue Code of 1986, as amended (referred to in this agreement as "the Code',), the tax imposed is to be charged to the property constituting the transfer pursuant to SectiOn 2603 (b) of the Code. ARTICLE XII Spendthrift Provisions. No beneficial interest under any trust created by this agreement, whether income or principal, is to be subject to anticipation, assignment, pledge, sale, or transfer in any manner, and no beneficiary may anticipate, encumber, or charge such interest. A beneficiary,s interest, which in the possession of Trustee, and to the extent allowable by law, which in the possession of a beneficiary, will not be liable for or subject to the debts, contracts, obligations, liabilities, or accounts of any beneficiary. Inasmuch as any trust created by this agreement is for the express purpose of protecting the beneficiaries from want and inconvenience by reason of the vicissitudes of life, so far as reasonable foresight can prevent, the portion of the net income, rents, and profits of the trust property paid to any beneficiary shall be payable only upon his personal receipt or, in the absolute discretion of Trustee, specifically on behalf of that beneficiary. The income from the amounts receivable by each beneficiary or payable on his behalf will not be subject to any legal process for the payment of that beneficiary,s debts. ARTICLE XIII Trustee. The following provisions apply to all Trustees appointed herein unless the context requires otherwise: (1) The Trustees of the Trust Estate shall be as follows: ALVIN D. MC CULLOUGH and LOIS H. MC CULLOUGH, except that upon the creation .of Trust A the Trustees for the purpose of that Trust shall be the surviving Grantor and NANCY MC CULLOUGH LONGNECKER. In the event the surviving Grantor is unable to serve then JAMES RICHARD MC CULLOUGH will serve as 'Co-Trustee. In no event shall the surviving Grantor serve as sole Trustee of the Trust A and should a successor Co-Trustee be needed Article XVI shall control the selection. It shall be permissible for NANCY MC CULLOUGH LONGNECKER, (first successor), or JAMES RICHARD MC CULLOUGH, (second successor), to serve as sole Trustee of the Trust A if no other named Trustee is available and Article XVI need not be used to name a successor Co-Trustee unless the surviving named Trustee so elects. (2) As compensation for services hereunder, the Trustee shall receive a reasonable fee. Such commission may be charged currently or deferred in the discretion of the Trustee. (3) The Trustee shall have the right to make a reasonable charge each year for services in preparing income and other tax returns for the trust estate. The charge may be made to the principal of the trust estate or to the income thereof or partly to one and partly to the other in the discretion of the Trustee. ARTICLE XIV Waiver of Bond. No Trustee or succe.ssor Trustee appointed hereunder shall be required to furnish any bond or other security in any jurisdiction for the faithful performance of their duties as such, the same being expressly waived hereby. ARTICLE XV Succession of Trustee. The following procedures shall apply to transfers of the trust estate between successive Trustees: (1) Any successor Trustee shall accept the office by written instrument and shall assume the duties thereof immediately upon the delivery of the instrument to the other Trustee then serving, or, if no Trustee is then serving, to any adult beneficiary, without the necessity of any act, conveyance of transfer. (2) The title to the trust estate shall vest forthwith in any successor Trustee acting pursuant to the foregoing provisions hereof, but any resigning or removed Trustee shall execute all instruments and d° all acts necessary to vest such title in any successor Trustee without Court accounting. A successor Trustee shall have no duty to examine the accounts, records and acts of the previous Trustee or Trustees and shall in no way or manner be responsible for any act or omission to act on the part of any previous Trustee. Any claim or action against any previous Trustee must in any event be asserted or filed by any beneficiary within one year after such Trustee ceases to serve. (3) Each Successor Trustee, including any Successor to a corporate trustee by consolidation, merger, transfer of trust business, or otherwise, shall have, exercise and enjoy all of the rights, privileges and powers, both discretionary and ministerial, as are herein given to the original Trustee and shall incur all the duties and obligations imposed upon said original Trustee. ARTICLE XVI Trustee's Resignation. Each Trustee hereunder, whether originally designated herein or appointed as successor, shall have the right to resign at any time by giving 30 days' written notice to that effect to the current income beneficiary or beneficiaries of the Trust. Thereafter, such beneficiary (or a majority in interest of the beneficiaries) shall have the right within such 30 day period to appoint a successor Trustee, if no successor Trustee be designated herein, and shall notify the resigning Trustee of such appointment; provided however, that the successor Trustee must be a trust company, bank or savings and loan association organized under the laws of the United State of America or one of the stated thereof. In the event the current income beneficiary or beneficiaries shall fail to designate a successor Trustee within the time specified, then the acting Trustee may apply to a court of competent jurisdiction for leave to resign, for the appointment of a successor and the judicial settlement of such Trustee's accounts. The term "income beneficiary', as used in this paragraph shall include any beneficiary who is then entitled to any distributions under the terms of this Trust Agreement and who is eighteen (18) year of age or older. Powers of TrUstee. ARTICLE XVII In administering the trust estates, all Trustees serving under this agreement shall'have all of the powers and authority which are presently granted to a trustee under the laws of the State of Florida as they are now written or amended in the future (except as would disqualify any marital trust or would disallow the application of tl.~ unified estate tax credit to Trust A and in addition thereto, the following: A. ~ale and Investment. The Trustee shall invest, reinvest and maintain invested the principal of the trust estate in such stocks, bonds and other securities and assets as it may determine, including units in a discretionary common trust fund. Except as may otherwise be provided herein, the Trustee shall have full and complete independent power and authority t° sell, assign, transfer and convey any security or property held in any Trust at such time and price and upon such terms and conditions as it may determine. B. UnderDroductive Property. The Trustee is not to be bound by the provisions of Florida Statues, Section 738.07, dealing with bond premium and discount and Section 738.12, dealing with underproductive property, as they are now written or amended in the future. The provisions of this paragraph shall not apply to any trust fund created herein which qualifies or is intended to qualify for the federal estate tax marital deduction. C. Retention of Assets. The Trustee may retain any investment received from Grantor,s.estate whether or not I be of the character permissible for investments by fiduciaries and without regard to any effect the retention may have upon the diversification of the investments. Notwithstanding the foregoing provision, the Trustee shall not retain any underproductive property in any trust fund created herein which qualifies or is intended to qualify for the federal estate tax marital deduction. The Trustee shall not retain any stock in an "electing small business corporation,, as that term is defined in Section 1371 (B) of the Internal Revenue Code if such retention would cause the termination of that particular corporation,s election. IN WITNESS WHEREOF, ALVIN D. MC CULLOUGH and LOIS H. MC CULLOUGH, as Co-Grantors of the foregoing Joint Trust Agreement, have hereunto set their hands and seals this 27th day of March, 1990. -- -- ALVIN D. MC CULLOUGH Signed, sealed, p~lished and declared by the above named Co- Grantors, ALVIN D. MC ~LLOUGH and LOIS H. MC ~LLOUGH, as and for their Trust Agreement, and we, after they have signed their names thereto, in our presence and at their re~est and in their presence and in the presence of each other, have hereunto affixed our names as witnesses on this 27th day of March, 1990. , STATE OF FLORIDA COUNTY OF PASCO The foregoing TRUST Agreement was acknowledged before me this 27th day of March, 1990, by ALVIN D. MC CULLOUGH and LOIS H. MC CULLOUGH. Notary Public - State of Florida My Commission Expires: MC CULLOUGH FAMILY TRUST SCHEDULE A IRA WITH A.6. EDWARDS ACCOUNT NO. 127 I8i306 042 ACCDUNT EXEUTIVE - RONALO J. HAY (813)-848-3599 02/23/90 185,847.64 02/23/90 2,165.78 188,013.42 A.G.E. W.H. NEWBOLD'S TRANSFERRED IN HARCH '90 BANK IRA'S CHENICAL BANK NEW JERSEY NA NADISON BRANCH 2 WAVERLY PLACE, NADISON, NJ 07940 TEL. NO. ]-(20l)-377-360! ACC'T VALUE 12/31/89 NATURES 01/18/91 18 NDNTHS ADH LHH 21-006-190-0677575 21-006-190-0677583 3,527.87 1,007.98 PEOPLES BANK OF 6LEN R0CK PA P.O. BOX 67 6LEN ROCK, ~ I7327 TEL. NO. 1-(717)-235-6871 OR !-(717)-846-I970 ACC'T 300566660 CERT. 27765 VALUE I2/22/89 2,801.85 NATURES 06/22/9! I8 NONTHS 7.75% ACC'T 300565860 CERT. 27766 800.52 CERT, 28640 VALUE 01/19/90 NATURES 07/19/9J 30 flONTHS 8.25~ 2,911.31 CERT. 28639 831.75 5,713.16 !,632.27 MC CULLOUGH FAMILY TRUST SCHEDULE B MC: CULLOUGH FAMILY TRUST SCHEDULE B AT&T BELL ATLANTIC BELL SOUTH SHARES 6~. 1263. 340 248. i 14. 993 751. CERTIFICATE NO. DATED ZQ 5009 8219 02-16-90 DIV. REINVESTMENT PLAN ZQ 0046 2085 02-16-90 DIV. RE!NVESTMENT PLAN ZQ 0050 702'? 02-16-90 NYNEX ~-)~. ZQ 0040 4~o6 02-16-90 PSEG 376. ZQ XY00068331 02-13-90 THE FIRST TRUST OF INSURED MUNICIPAL BONDS SERIES 5 4 UNITS 005 0001533 PA QUALITY INVESTORS QUALITY TAX EXEMPT TRUST SERIES 9 5 UNITS 009 0003487 VAN KAMPEN MERRITT PA INSURED MUNIC:IPALS INCOME TRUST SERIES 16 3 UNITS 016 0003~08 PA INSURED MUNICIPALS INCOME TRUST SERIES 20 5 UNITS 020 0007601 PA INSURED MUNICIPALS INCOME TRUST SERIES 28 4 UNITS 028 0003116 PA INSURED MUNICIPALS INCOME TRUST SERIES 41 5 UNITS 041 0003231 PA INSURED MUNICIPALS INCOME TRUST SERIES 7'9 5 UNITS 079 A000553 PA SERIES 02-12-90 02-12-90 02-12-90 02-12-90 02-12-90 02-12-90 02-12-90 MC CULLOUGH FAMILY TRUST SCHEDULE C COHPANY CERT. ALLEGHENY POWER II4 ~P INCORPORATED 60 BORDEN INC. 20 CCNB CORPORATION lO0 CURTICE-DURN$ FOODS INC 45 DAUPHIN DEPOSIT CORP· 150 DOE. 50 GTE 30 GENERAL ELECTRIC CO. 40 GENERAL MILLS INC. 40 GIANT FOOD INC. 100 6LATFELTER, P.H. 300 HEINZ, H.$. 240 HERSHEY FOODS CORP. ]§0 ITT CORPORATION 39 McCULLOUGH FAMILY TRUST SCHEDULE C DIV. REIN TOTAL SHARES 0.0000 114.0000 25.2413 85.2413 166.5J35 18G.5135 8.7455 108.7455 18.2880 63.2880 3/26/90 VALUE 39.375 52.875 32.625 20.000 22.500 TOTAL VALUE 4488.75 4507.13 6085.00 2174.91 1423.98 35.2844 185.2844 31.250 5790.14 199.6000 249.6000 20.875 5210.40 51.0900 81.0900 63.750 5169.49 98.5561 138.5561 64.000 8867.59 13,1674 53.1674 71.375 3794.82 0.0000 100.0000 26.125 2612.50 0.0000 300.0000 42.750 12825.00 135.0336 375.0336 30.750 11532.28 149.7668 299.7668 30.875 9255.30 0.0000 39.0000 52.625 2052.38 IBN CORPORATION 10 4.9860 14.9860 [SOMEDII INC. 100 0.0000 I00.0000 K-MART CORP. 60 0.0000 60.0000 KROGER CO. 48 50,2670 98.2670 KROGER 15 1/2% DEBENT. ~ARRIOTT CORP. JO0 McDONALD'S CORP. NCI COMNUNICATIONS CORP I00 MOBIL CORP. 30 PAN AM CORP. lO0 PARAHOUNT COIINUNICATIONS 100 PENNEY, J.C. COHPANY 40 P.P.& L. 30 SEARS ROEBUCK & CO. 20 TEXACO INCORPORATED 20 WEIS MARKETS INC. 82 YORK FINANCIAL CORP. 347 FIDELITY PA TA% FREE MM T. PRICE ROWE TAX FREE VANGUARD PA INS TAX FREE VAN KAHPEN HERRITT HUN, 104.125 11.375 34.125 13.125 1560.42 1137.~0 2047.50 1289.75 0.0000 IO0, O000 26.500 2650.00 134.5350 134.5350 31.375 4221.04 .0~:0000 100.0000 35.875 3587.50 I5.8436 45.8436 61,375 2813.65 0.0000 100.0000 2.875 287.50 53.4486 153.4486 44.500 6828.46 25.9342 65.9342 69.250 4565.94 133.1160 163.1160 41,500 6769.31 31.6910 51.6910 38.500 1990.10 29.6760 49·6760 58.750 2918.47 114.7339 196.7339 29.500 48.3515 395.3515 15.000 2O0 2773.3200 1045.8060 767.4240 20.0900 220.0900 1.000 8.620 10.020 9.125 ~UN INVEST TRUST FUND SERIES IE HANOVER PA 80RO 60 9.6Z READING PA SCHOOL 60 8.5% 5 UNITS 5 UNITS 5 UNITS 5803.65 , 5930.27 140190.74 2773.32 9014.85 7689.59 2008.32 161676.82 5000 5000 5000 176676.82 Financial Consultants December 15, 2003 Mrs. Lois H. McCullough 39 Cedar Circle Newville, PA 17241 Dear Mrs. McCullough: Per your request, I am including a list of all assets that were held in the McCullough Trust Account, as well as their values as of November 25th, 2003. If you need any additional information, please feel free to contact me at 243-0619. Sincerely, Pursell Assoicuates, Inc 205 York Road · Carlisle, PA 17013 · (717) 243-0619 · 1-866-443-0619 · Fax (717) 243-3216 Securities art, offered through Wachovia Securities Financial Network, LLC, Member NASD/S1PC McCullough Family Rev Trust Dated 03/2 7/1990 Values as of November 25, 2003 *** Quantity Description Price Accrued Value (11/25/03) Interest (11/25/03) 19 Agere Systems Inc C1A 3.38 64.22 483 Agere Systems Inc C1B 3.19 1,540.77 100 AT & T Corp New 19.80 1,980.00 132 Atmos Energy Corp 24.77 3,269.64 235 Avaya Inc 13.44 3,158.40 228 Allegheny Energy Inc 10.70 2,439.60 108 Allstate Corp 40.37 4,359.96 732 AT & T Wireless Services 7.31 5,350.92 429 Bank of America Corp 74.90 32,132.10 67 Bank One Corp 42.93 2,876.31 3,004 Bellsouth Corp 25.81 77,533.24 400 Campbell Soup Company 25.57 107228.00 140 ChevronTexaco Corp 74.02 10,362.80 400 Coca Cola Coi~qJany 46.42 18.568.00 736 Comcast Corp New CL A 32.19 23,691.84 205 Del Monte Foods Co 9.47 1,941.35 300 Disney Walt Company 22.83 6,849.00 1,000 Duff&Phelps Util Corp Tr 14.50 14,500.00 654 Duquesne Light Holdings 17.01 11,124.54 300 Equity Office Properties 27.72 8,316.00 236 Exxon Mobil Corp 35.56 8,392.16 2,427 General Electric Company 28.75 66,776.25 366 Genl Mills Inc 44.91 16,437.06 600 Glatfelter 12.05 7,230.00 461 Heinz H J Co Common 35.67 16,443.87 150 Hershey Foods Corp 78.06 11,709.00 478.17400 Lord Abbett Resh Fd Inc 24.10 11,523.99 700 McDonalds Corp 25.64 17,948.00 200 PPL Corporation 40.68 8,136.00 251 PNC Financial Services 53.82 13,508.82 38 Progress Energy Inc CVO 0.17 6.46 500 PUB SVC Enterprise 40.22 20,110.00 35 Starwood Hotels & 33.39 1,168.65 390 Tyco Intl Ltd New 21.87 8,529.30 3,004 Verizon Communications 32.50 97,630.00 184 Viacom Inc CL B 38.33 7,052.72 450 Wal-Mart Stores Inc 56.08 25,236.00 1,050 Waypoint Financial 21.63 22,711.50 244 Weis Market Inc 36.55 8,918.20 12 World¢om Inc MCI Grp 0.076 0.91 1,000 FT Technology Set 13-5YR 2.54 2,540.00 3,276 FT UT 618 Key 3 G/T Ser2 9.95 32,596.20 50 NUV T/E PA INSD 170 QTR 36.45 1,822.50 McCullough Family Rev Trust - continued Dated 03/2 7/1990 Values as of November 25, 2003 *** Quantity Description Price ** Accrued Value** (11/25/03) Interest (11/25/03) 1,403.57200 NUV AERO&DEFENSE SA REIN 9.6630 13,562.72 100 NUV PA INSD 226 S 102.84 10,284.00 10,000 Allegheny County PA Higher Education 6% 5/1/28 110.727 39.36 11,112.06 6,000 Boston Scientific Notes 6.625% 03/15/05 104 76.68 6,316.68 10,000 Chesapeake &Potomac Tel MD 7.15% 05/01/23 107 46.80 10,746.80 7,000 Computer Associates Int'l 6.5% 04/15/08 106 50.84 7,470.84 10,000 Consolidated Edison 7.125% 02/15/29 104 198.90 10,598.90 10,000 Cumberland Cty Presbyterian Homes 6% 2/15/29 99.869 291.92 10,278.82 15,000 Cumberland Cty Presbyterian Homes 6% 12/1/26 105.259 437.88 16,226.73 10,000 Duke Capital Corp 8% 10/01/19 114 122.64 11,522.64 10,000 Entergy New Orleans 6.75% 10/15/17 102 18.40 10,218.40 21,000 Firstbank Puerto Rico 5.625% 09/05/18 99 64.60 20,854.60 15,000 Ford Motor Company 6.5% 08/01/18 93 312.39 14,262.39 10,000 Fox Chapel Waterworks 4.75% 05/15/24 100.217 13.00 10,034.70 10,000 GTE California 8.07% 04/15/24 105 90.61 10,590.61 20,000 General Electric Capital 5% 05/15/28 97 27.30 19,427.30 5,000 GMAC Smart Notes7.15% 01/15/16 99 9.70 4,959.70 17,000 GMAC Smart Notes7.375% 11/15/16 99.50 34.30 16,949.30 15,000 GMAC Smart Notes 7.125% 08/15/12 100 29.20 15,029.20 15,000 GTE North 5.65% 11/15/08 107.50 23.20 16,148.20 25,000 Hilton Hotel Corp. 7% 07/15/04 101.50 637.07 26,012.07 15,000 Household Finance Corp 7.5% 06/15/22 104 30.80 15,630.80 15,000 J C Penney Corp 6.875% 10/15/15 101 115.62 15,265.62 25,000 Montgomery Cty Industrial 5.25% 11/15/28 90.182 35.90 22,581.40 20,000 Montgomery Ct), Hospital 5.125% 06/01/32 95.321 498.40 19,562.60 15,000 Moon Industrial Dev Authority PA 5.65% 20 111.219 194.88 16,877.73 5,000 Northampton Kirkland Village IDA 5.5% 14 100 122.25 5,122.25 5,000 Pennsylvania State Turnpike 5% 12/01/23 103.937 121.04 5,317.89 15,000 Pennsylvania State Turnpike 5% 12/01/23 105.544 364.90 16,196.50 5,000 Pennsylvania State Turnpike 5% 12/01/2023 105.544 121.07 5,398.27 5,000 Philadelphia Temple Univ 6.625% 11/15/2023 102.513 9.00 5,134.65 5,000 Pittsburgh PA Water & Sewer 5.1% 9/01/2022 104.311 57.96 5,273.51 7,000 Sprint Capital 6.875% 11/15/2028 95 13.10 6,663.10 15,000 Washington REIT 7.25%281 104.97 273.24 16,018.74 Total Account Value as of November 25, 2003 ................................................ $ i, *** The information that is contained in the above listing of holdings, values, and accrued interest, has been obtained from sources that are believed to be reliable however, there is no guarantee with respect to accuracy. P.O. Box 1469 11031 U.S. tlighwc(v 19 Port Richey. Florida 34673 (727) 697-0400 /hx (727) 697-0300 December 16, 2003 Lois H. McCullough 39 Cedar Circle Newville, PA 17241 Dear Lois, Here are the prices that you request: UTS PA # 215 $1073.77 per UT UTS PA #216 $1059.70 per UT Nuveen Multistate Trust $10.37 Hope this will help you, Sherri Hughes Edward Jones 21 West High Street Carlisle, PA 17013 (717) 258-4688 Art Amundsen Investment Representative Edward Jones DECEMBER 9, 2003 LOIS H MC CULLOUGH 39 CEDAR CIRCLE NEWVILLE, PA. 17241 RE: DOD VALUES FOR ALVIN D MC CULLOUGH NOVEMBER 25, 2003 DEAR LOIS, PER LETTER DATED DECEMBER 5,2003 THE VALUES FOR DOD ARE ATTACHED. SINCERELY, ART AMUNDSEN ARA/ama ,ART AMUNDSEN EdwardJones December 09, 2003 Historical Quote Symbol Description/Type Date Value 938592FCl WASHINGTON CNTY PA HOSP AUTH R HOSP REV Best Adjusted Price 11/25/2003 $102.2530 132033EB3 CAMBRIA CNTY PA Best Adjusted Price G.O. REF 11/25/2003 $104.7870 Page I This information is for tax and estate purposes only and while believed accurate, is not guaranteed. There is no warranty that any trades were or would have been executed at these prices on the dates given. .Demanql Deposits Display History Page 1 of 1 * SAFEDEPOSIT PAYMENT BOXNO 15-36 * 11/17/fl3 CHECK * 11/1~03 DAILY BALANCE * ~1/1&~03 CHECK * 11/18/03 CHECK * 11/18/B3 DAILY BALANCE * 11/19/03 CHECK * 11/1~/03, CHECK * 11/~9:/03 DAIkY BALANCE * 11/20!/03 CHECK * 11~:~070~ INTEREST CREDIT '* ~i/~0~3 DAILY BALANCE 00D779BDDDO 1427 D0101603606 (2,989.DD) 6,188.16 1426 OO300200S05 ($O.,OO) 1428 00301404004 (48.82) 6,089.34 1429 00100701826 (106.17) 1430 00100200185 (91.85) 5,891.32 1425 00200400959 (29.95) DOODDDO00DO 0.99 5,862.36 Demand Deposits Display History Page 1 of 1 ATfl'CASH' W/D 004399 [LLE PA 11/Bk/03 CHECK 11/~h/03 11/B8703 12/01/03 12/0t/03 12/01/03 DAILY BALANCE DEPOSIT DAILY BALANCE AT&T MANAGEMENT PPD EFTS 031201 192184287 CHECK DAILY BALANCE 1431 1432 81100000000 00100601308 00400501814 00077900000 00100400202 (11.67> 5,550.69 61.2fl 5,611.89 2,407~75 (146.18) 7,873.46 ,Deman4 Deposits Display History Page 1 of I * 11 ~A'~LY BXLANCE * 10/20/03 INTEREST CREDIT * lO/ED/03 DAILY BALANCE * 10/24/09 CHECK * 10~2~/03: DA~LY BALANCE * ~1~I?~03' THE~NARTFORD SB1900106871 * 11/17/09 DAILY BALANCE * 11/20/09 INTEREST CREDIT * 11/20/03 DAILY BALANCE 184 O0000OOO000 O0100701545 OO0779DOOOD O000OOOOOOO 24,~.98 9.45 24,8~9o49 529.67 29,867.60 9.69 Time D~posits Display Main Page 1 of 1 7,019i23 00015 7,019.23 015 11/24/2004 11/24/1997 1'1/24/2003 0,5/24/2004 07/01/2003 0010010000 11/2~1./2003 1.2500% 3.36 o.oo ~ A~uti\e~:.~~ 0.00 TIME ACCOUNT 0.00 December 9, 2003 Lois McCuliough 39 Ceader Circle Newville, PA 17241 Egger Funeral Home, Inc. 15 Big Spring Ave. Newville, PA 17241- (717)776-3414 The Funeral Service for Mr. Alvin D. McCullough We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. Professional Services Funeral Director & Staff $745.00 FUNERAL HOME SERVICE CHARGES $745.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $745.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES Newspaper Notice $166.50 Certified Copies $120.00 Coroner $25.00 Crematory $175.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $486.50 SUB-TOTAL INITIAL PAYMENT / DISCOUNT / CREDITS TOTAL AMOUNT DUE $1231.50 $1231.50 Il/ Page E-Ticket Receipt & Itinerary Page 1 of 3 From: United Airlines Date: Tuesday, November 25, 2003 8:08:36 AM To: JIMMC 17(.(3~BRESNAN.N ET Subject: Your E-mail Confirmation from United Please do not respond to this e-mail! If you have questions about your reservation, please contact United reservations at 1- 800-UNITED-1 within the United States, or your local international reservations office listed below. E-Ticket Receipt & Travel Itinerary :Thank you for choosing United! Your electronic airline ticket is stored in our computer system. As with all airline tickets, your E-Ticket is not transferable to others. At check-in, you must present a copy of this receipt with a valid photo ID and the credit card used for purchase, Minimum check-in requirements for flights based on scheduled departure times: -60 minutes for customers traveling without checked baggage within the U.S. -90 minutes for customers traveling with checked baggage within the U.S. -120 minutes for customers traveling on flights with International itineraries. Reservations are subject to bancellation if you ara not checked in and available for boarding at the gate at least 20 minutes pdor to scheduled departure for flights between U.S. cities, to/from Canada, Mexico or the Caribbean; 30 minutes to/from Hawaii; and 30 minutes to/from International points. Ticket validity is based on fare and point of odgin. Refundable tickets are valid for one year from date of issue. Nonrefundable tickets are valid as issued. For travel originating in the U.S., any changes and/or exchanges to a nonrefundable ticket must occur prior to midnight of your current ticketed travel dates o,' ticket ~vill lose all remaining value. Certain penalties and/or fees may also apply. To make changes to your reservation within the United States, call 1-.800-UNITED-1 (1-800,864-8331). For up-to-date flight information within the US, call 1-800-824-6200. Check on united.com. E-Ticket ReceiptE-Ticket Receipt Reservation No: T4QOQM Issued: 25 NOV03 Number in Party: 1 Name: MCCULLOUGH/JAMES R MR Ticket No: 0162102715713-14 Mileage Plus® No: 03082 526 900 Per Passenger 471.62 USD Base Fare: " E-Ticket Receipt & Itinerary Tax/Fee/Charge: Total: Fare Details: 35.38 US 40.00 XT C 7.00 USD. Fare Basis QRCARE FC 25NOV CPR UA X/DEN UA X/VVAS UA HAR Q9.30 226.51QRCARE UA X/CHI UA X/DEN UA CPR Q9.30 226.51QRCARE USD 471.62 END ZPCPRODENIADMDTORDDEN0 XT 12.00ZP 10.00AY 18.00XFCPR4.5DEN4.5ORD4.5DEN4.5 C~UA ONLY/BEREAVEMENT F~ DSXX~ 1738 EXP0905/25400 . Travel ItineraryTravel Itinerary CASPER to DENVER Flight . Depalts An ~ves ~ Lt # I T E D CASPER DENVER 6329 * TUE 25 NOV TUE 25 NOV ~ 1:30P 2:35P · OPERATED BY UNITED EXPRESS/SKYWEST TUE 25 NOV Class .. UNITED ECONOMY® Mp Miles Meals Served Equip * .... EM2 DENVER to WASH/DULLES Flight Departs Arrives -,, · ' U N I · I D DENVER WASH/DULLES 1240 TUE 25' NOV TUE 25 NOV '. 3:25P 8:30P .. ,~ MP Miles Meals Served Equip ~ ' ..... ..757 WASH/DULLES to H~RRISBURG Flight Departs Arrives Baggage Inflight Allowance Services 2PC NONE TUE 25 NOV Class Seat UNITED 33C ECONOMY® Baggage Inflight Allowance Services 2PC MOVIE TUE 25 NOV m u # ~ ? E (~ WASH/DULLES HARRISBURG 7890 * TUE 25 NOV TUE 25 NOV '~.~ . g:4~P ~_ ,~,_ lO:3fip · 'OPERATED BY UNITED EXPRESS/AT~NTIC COAST Claes - Seat UNITED 3C ECONOMY® MP Miles Meals Served Equip CRJ HARRISBURG to CHICAGO/OHARE Flight Departs Arrives ~ u # ~ · ! m HARRISBURG CHICAGO/OHARE 555 SAT 6 DEC SAT 6 DEC 8:15A 9:15A Terminal I Baggage ' Inflight.... Allowance ', Services 2PC NONE SAT 6 DEC Class Seat UNITED 19D ECONOMY® MP Miles Meals Served Equip 32O CHICAGO/OHARE to DENVER Baggage Inflight Allowance Services 2PC AUDIO SAT 6 DEC Page 2 of 3 l~Ticket,Receipt & Itinerary Page 3 of 3 Flight Departs w u # 1 1' ~ i} CHICAGO/OHARE 247 SAT 6 DEC 10:10A Terminal 1 Arrives DENVER SAT 6 DEC 11:41A Class UNITED ECONOMY® Mp Miles Meals Served Equip .... 777 DENVER to CASPER Flight Departs Arrives W u # 1 1' E D DENVER CASPER 6330 * SAT 6 DEC SAT 6 DEC 2:35P 3:41P OPERATED By UNITED EXPRESS/SKYWEST Baggage Allowance 2PC ClaSs UNITED ECONOMY® MP Miles Meals Served Equip Baggage .E. M2 Allowance 2Pc· . . ,, Important United Information SIGN UP NOW FOR EASY UPDATE RECEIVE UPDATES ON FLIGHT INFORMATION AND UPGRADE STATUS. REGISTER AT Y~v.unlted.com/easvuodate Valuable Offem Seat 22D Inflight Services AUDIO SAT 6 DEC Seat 7B Inflight . Services NONE' ,©2002 United Air Lines, Inc, SWAIM HEALTH CENTER 210 BIG SPRING ROAD NEWVILLE PA 17241-9486 (717) 776-8256 ALVIN MCCULLOUGH cio LOIS* MCCULLOUGH 39 CEDAR CIRCLE NEWVILLE PA 17241 ACCOUNTS RECEIVABLE STATEMENT Statement Date: 12/3112003 :Pre s t eria n q[ome s, .mc. Balance Due: 51.00 Account Number: 61166GRV Balance Forward: 0.00 11/24/2003 - 11/24/2003 Personal Tmnsporlatton 1.00 51.00 51.00 ) TOTAL: 54.oo o.0o 5t.00 y check includes a donation to GRV of $ to be used for the GRV fund or SWAIM HEALTH CENTER: ALVIN MCCULLOUGH 61166GRV STEPHEN L. BLOOM =\ 'I'T() R N I:, ¥ .\ N 1) C () [~ N S 1'~ 1, l.() R ,\ T I. ,.\ W W W W. P R A CT lC A I.C 0 U N S l,.' L COM 2100 I.{)N(;S (; Al' R{>AD (~.,\}/l. lShh:, PI':NNSYI.V.,\NI,,\ 17013 S 1:, I.{)() M ~) P I', .,\ CT I C :\ [.C(~ [' N S I( I. C('~ 51 '[' I.~ I, I.; P II () N E ]: A C S I lXl I L l,i Tol, I, F R I(},i 717-249-7717 717 249-7757 877-548-96/}2 Invoice submitted to: McCullough, Alvin D. Estate/Trust 39 Cedar Circle Newville PA 17241 Lois H. McCullough, Trustee February 17, 2004 In Reference To: Estate/Trust Administration Invoice #1365 Professional Services SLB Prepare for and attend conference with Trustees/Beneficiaries; Consultation and Advice re Estate/Trust Administration; Documentation of file SLB Preliminary administrative matters SLB Administrative matters; Conference with Trustees SLB Administrative matters; Preparation of Pennsylvania Inheritance Tax Return SLB Prepare and file IRS Form SS-4 (Application for Federal Employer Identification Number); Review FEIN and correspondence from IRS re same; Preparation of Pennsylvania Inheritance Tax Return and analysis of issues regarding same and Federal Estate Tax matters; Correspondence with Accountant (Mr. Nace) SLB Preparation of Pennsylvania Inheritance Tax Return and Schedules; Actuarial analysis and calculations re present and future interest components of Credit Shelter Trust; Tax and discount calculations re same; Correspondence with Accountant re income tax matters; Correspondence with Trustees; Preparation of Estate Information Document for filing with Inheritance Tax Return at Register of Wills SLB Consultation with client for review and execution of Pennsylvania Inheritance Tax Return, Trust matters and miscelleneous administrative matters; Finalize and assemble Pennsylvania Inheritance Tax Return, Schedules and Exhibits for filing at Office of Register of Wills; Appearance at Register of Wills for filing of same and Estate Information Document; Reserve for preparation, review and filing of Federal Estate Tax Return, miscellaneous correspondence, consultations and other matters of administration For professional services rendered 2/17/2004 Payment - thank you PRACTICAL COUNSEL · CHRISTIAN PERSPECTIVE Amount 585.83 154.17 169.58 688.25 1,153.12 872.33 1,876.72 $5,500.00 ($5,5oo.oo) McCullough, Alvin D. Estate/Trust Total payments and adjustments Balance due Page 2 Amount ($5,5OO.OO) $0.00 PAYABLE UPON RECEIPT - THANK YOU PRACTICAL COUNSEL ,I~ CHRISTIAN PERSPECTIVE TRUST CHAMBERSBURG BOILING SPRINGS MARION MONT ALTO NEWVILLE SHIPPENSBURG WAYNESBORO CARLISLE AccoLmt: 329984,* Statement Date 12/19/'2(.)(.). Page I McCULLOUGH FAM RV LVG ~ ~U.YIN D. McCULLOUGH LO~$ H, Mr'CULLOUGH, 7RU~TEE~ ,.~.=-, ~ 'd_. I. Fi*ss ' ' O OO~uuuu~ 12/]0/03 Check ~1437 ~ount $200.00 McCULLouGH FAM RV LVG TRST 3..27.9~ ~%":.~-. 16 1 4 3 4 AL~tlN 0. McCULLOUGH LOIS H. klcCUU.OUGH, TRU~TF.~$ 12/02/03 Check #1434 Amount $100.00 12/11/03 Chcck#1436 Amoum ._ $50.00 Delivery Date DELIVER TO: Address T W TH 333 Green Spring Road Nowville, PA 17241 (717) 776-4778 F S SU City Phone FRESH State__Zi~ SILK PLANTER DRIED BOXED LOOSE VASE H.B. ANN. SYM. G.W. HOE CONG. T.O.Y. THANKS Boy/G~rl SOLD TO: ~ '~ ' : '( '!' .f :~ Address ..~ City Phone (work) State (home) Credit Card #. Expiration Authorization # !~'.Amount $ I Delivery Charge Zip Service Charge Sub Total Sales Tax Credit Card Used / ,~ _. / --, FILLING FLORIST: TEL/FTD # Contact: Phone: ~ ~, !Ti~: ~OV City/State: Date: Comments: After 30 Days, add 18% per Annum from Date of Invoice NEWVILLE POST OFFICE NEWVILLE. Pennsyl vani a 172419998 4134870241 -OO98 12/04/20D3 (800) 275-8777 09: 53: 45 F Sales Receipt ~roduct Sale Unit Final 3ascrt pti on Qty Price Price ]LEVELAND OH 44118 :irst-Class Issue PVI: ~ARWICK RI 02887 :ir'st-Class Return Receipt Certified AM ~0.60 $0.60 $0.37 $1.75 $2.30 Label Serial #: 70022410000255898449 Issue PVI: $4.42 )HILADELPH[A PA 19101 $0.60 :lrst-Class Return Receipt $1.75 Certified $2.30 Label Serial #: 70022410000255898456 Issue PVI: $4,65 ~ARTFORD CT 06102 $1.29 :trst-Class Return Receipt $1.75 Certified $2.30 Label Serial #: 70022410000255898463 Issue PVI: $5.34 ~7.40 Flag 1 $7.40 - $7.4G ~SA Book - )oublesided ;7.40 Flag 1 $7.40 -- $7.40 )SA ~ook - )oublestded ;7.40 Flag 1 $7.40 )SA Book - )oub] esi ded total: $37.21 )aid by: Dash :hangs Due: -$2.79 )rder staap5 at USPS.coa/shop or call i-800-Staap24. Go to JSPS.coa/cllcknshlp to print shipping abels with postage. For other nfom~atlon call 1-800-ASI(-LtSPS. H]]#: 1000200752862 :lark: 05 - A11 sales final on staa~3s ar~3 postage. -- Refunds for guaranteed services only. That,( you for your business. Cust~ Cc~)y NEWVILLE POST OFFICE k~'WILLE, Pennsylvania 172419998 4134870241-0097 12/09/2003 (800)275-8777 10:17:58 Sal es Recei pt Product Sal · Unit Fi nai Description ~y Price Price F( UTICA N~ 13504 First-Class UTICA NY 13504 First-Class $0.60 Issue PVI: $0.60 $0.37 Issue PVI: $0.37 - CN~TON NA 02O21 P Fi rst-Cl ass J, Return Receipt Regi stem Insured Value : Article Value : Label ~ial #: $1,75 $7.50 RB142731940US Issue PVI: $9.85 Total: ~ Paid by: Cash $20. O0 Change Due: -$9.18 Bll)#: 1000300871679 Clerk: 02 -- All sales final on sta~ps ~ postage. -- Refunds for guaranteed services only. Thank you for' your business. Customer Copy ,ate Stamp -- E '~opy I - Customer ~ation on Reverse) .usps. com® his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9898428 No. Local Registrar NOV 2 6 2003 Date mos.:~.l n~, 2/a7 COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH · VITAL RECORDS ,,, CERTIFICATE OF DEATH ~.~. ' ' ~.~.~ m,. p~ I~ .............. I~'= , ...... a ~,a ~ ~uu~lan~ West Pennsborol 0 ...... I~ ~,~ I~ ____ '~ ,. ~__ Cumberland ~ ~ ~m::~:~ [~~,~ =. ........... I~= ue~ar Oirel~ Ne~vi11~ p~ 172~1 ~a ~' '~ ..... ~-..O ~.~. , ~.~ .............. I,~-:~..~ '~" U 1 ' , 1,,J-/26/03 {,~ozlznger Crematory IMf. Holly Sprlnos V~ ' I-~. 17 0 6 5 ~..~~~ ~A- ~.. FD 13895 L ~'F~ Home Inc 15 Bi S rin -'~. ~~;:~, ~ m~ ~ · ~...,, ,. ~, ~ ~ ~ ~ fl P g Ave ~:--,~ . I~ f,~/ f'~.. i ......... REGISTRAR'S .~ NATURE AND NUMBEH ~'~ CO. MMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) O03571 BLOOM STEPHEN L, ESQ. 2100 LONGS GAP ROAD CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 192-18-4287 FILE NUMBER: 2100-0000 'Z.l-,o~.l- I~1 DECEDENT NAME: MCCULLOUGH ALVIN D DATE OF PAYMENT: 02/17/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 00/00/0000 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $6,711.86 TOTAL AMOUNT PAID: $6,711.86 REMARKS: RECEIVED OF LOIS H MCCULLOUGH IN C/O STEPHEN L BLOOM ESQ CHECK//1473 · INITIALS: JA ~'.' SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DZVTSTON DEPT. 280601 HARRTSBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOHANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-15¢7 EX CFP STEPHEN L BLOOH 2100 LONGS GAP RD CARLISLE PA 17013 DATE 08-23-2004 ESTATE OF HCCULLOUGH DATE OF DEATH 11-25-2003 FILE NUHBER 21 04-0151 COUNTY CUNBERLAND ACN 101 I Amoun~ Remi~ed ALVIN HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUH~ERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG2:THz, s LZ,~. ~ RETATN LOWER PORTION FOR YOUR RECORDS ~ :):: .... '! D~ALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX F~C .... ~ ALVIN D FILE NO. 21 04-0151 ACN 101 DATE 08-23-2004 ESTATE 0 ., CULL~GH ,:~ ~ *~)~ RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es'l:a~:e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~cock/Per~cnership Zn~eres~ (Schedule C) ($) r+. Hor:kgages/No~es Receivable (Schedule D) (~) 5. Cash/Bank Deposi~cs/Hisc. Personal Proper~y (Schedule E) (5) 6. Jointly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse*s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Cos~cs/Hisc. Expanses (Schedule H) (9) 10. Debts/Hot,gage L1abili~1es/Liens (Schedule Z) (10) 11. To'al Deduc~ ions 12. Ne~ Value of Tax Re~urn 15. lq. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Ne~ Value of Es*a~e Subjac~ ~o Tax O0 O0 O0 962~908.21 O0 NOTE: To insure proper O0 cradi* ~o your account, O0 submi~ ~he upper portion of ~his form wi~h your ~ex payment. .0O (11) 11.38o.50 (~2) 951,527.71 (13) .00 (1~) 951,527.71 NOTE ASSESSHENT OF TAX: 15. Amoun~ of Line 1~ a~ Spousal ra~e 16. Aeoun~ of Line 1~ ~axable a~ Lineal/Class A ra~e 17. Aeoun~ of Line 1~ a~ Sibling re~e 18. Amoun~ of Line lq ~axable a~ Collateral/Class B ra~e 19. Pr/ncipal Tax Due TAX CREDITS: I PAYMENT RECEIPT DATE NUNBER 02-17-2004 CD003571 (~5). 794,52~;'-96 x O0 = .00 (16) 157,002.75 x 045 = 7,065.12 (17) . O0 x 12 = . O0 (i8) .00 x 15 : .00 (l~)= 7,065.12 DISCOUNT (+) INTEREST/PEN PAID (-) 353.26 ANOUNT PAID 6,711.86 Z~ an assess, ant Nas issued prev/ously, 1/nas 14, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 962,908.21 18 and 19 will TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 7,065.12 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT ZS REDUZRED. ~,~ ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY DE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) (8) 11,380.50 RESERVATION: Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collataraZ) beneficiaries of tho decedent after the expiration of any estate for 1ifa er for years, the CommonaeaZth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collatmral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfiZZ the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section Detach the top portion of this Notlce and submit with your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-361-Z050; services for taxpayers aith special hearing and / or speaking needs: 1-800-4fi7-3010 (TT only). Any party in interest not satisfied eith the appraisement, alloeanca, er disalloaanca of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --aritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281011, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal reprassntative~ OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, Dept. 280601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appeaZable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the data of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated et a daily rate of .000164. AZ! taxes ahich became delinquent on and after January 1, 1981 sill bear interest at a rate which aiZl vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through ZOO4 are: Interest Daily Interest Daily Interest DaiZy Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOZ .000548 ~'~'8-1991 111 .000301 ~'~ 91 .000247 1983 161 .000438 1992 91 .000147 ZOOZ 61 .000164 19&fi 112 .000301 1993-1994 71 .O00Z9Z Z003 51 .000137 1985 132 .000356 1995-1998 92 .000147 2004 42 .000110 1986 102 .0D0274 1999 72 .000191 1987 101 .000174 ZOO0 71 .000192 --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DELINI~UENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.