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HomeMy WebLinkAbout03-23-1015056041114 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280801 I ` Harrisburg, PA 17128-0801 RESIDENT DECEDENT 1 6~ (~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 168-26-5497 04092009 10071932 Decedent's Last Name Suffix Decedent's First Name MI ROUSH JAY W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL INAPPROPRIATE OVALS BELOW 1. Original Retum 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) [~ 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 0 2. Supplemental Return ~] 4a. Future Interest Compromise (date of death after 12-12-82) © 7. Decedent Maintained a Living Trust (Attach Copy of Trust) ~] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~J 3. Remainder Retum (date of death prior to 12-13-82) 0 5. Federal Estate Tax Retum Required 0 8. Total Number of Safe Deposit Boxes 0 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number STEPHEN D. TILEY Firm Name (If Applicable) FREY AND TILEY First line of address 5 SOUTH HANOVER STREET Second line of address City or Post Office CARLISLE 717-~4~-5R~R State ZIP Code PA 1.7013 Correspondent's a-mail address: 5 t i l e y@ f r e yt i l e y. c om REGISTER OF _ USE ONt,~ ~; ~ ~: r ~ ...Z~ 7 `]is :.~ I ° i-?-r =~-~ r.a C..O ~ -_ ~ ,- -; r., ~_' :" G"1 ZJ t =,~ r '_.) r, '~.7 --~ - • ~_:~ _;~--~ . ,.y i 3~1 v 3 ~_) -z Under penalties of perjury, I declare that t have examined this return, including aaompanying schedules andstatements, and to the best o my now a ge and be ie , it is true, correct and complete. Declaration of preparer other than the personal representative is based o~n all info~rma~tion of which preparer has any knowledge. SIGNATURE OF PERSON RFyS ONSIBLE FOR FILING RETURN L~:.~.-/lam-(/~YL(~~ DATE ~/fS/lO Y enn~ JODI6L'. WAGNER, 85 SOUTH SIDE DR., NEWILLE, PA 17241; CONSTANCE ADAMS, 50 PARKER ST., CARLISLE, PA 17013 SIG ARER OTHE THA EP NTATIVE DATE A / cJ~ /S-~~/© ADDRESS STEPHEN D. TILEY, 5 SOTH HANOVER ST., CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041114 15056041114 J J 15056042115 REV-1500 EX Decedent's Social Security Number Decedent's Name: JAY W ROUSH 16$-26-5497 RECAPITULATION 1. Real estate (Schedule A) ........................................... 1. 9 717 5. 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages & Notes Receivable (Schedule D) ............................ 4. NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 14 O 3 4.14 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ...... .. 6. NONE 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ...... .. 7 4 9 412.0 0 8. Total Gross Assets (total Lines 1-7) ................................ .. 8. 160 621.14 9. Funeral Expenses & Administrative Costs (Schedule H) .................. .. 9. 15 8 5 7.62 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. .. 10. 19 4 4 3 . 6 2 11. Total Deductions (total Lines 9 & 10) ............................... .. 11. 3 5 3 O 1 . 2 4 12. Net Value of Estate (Line 8 minus Line 11) ........................... .. 12. 12 5 319.9 0 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... .. 13, 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... .. 14. 12 5 319.9 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 O 1 5. 0. 0 0 16. Amount of Line 14 taxable at linealrateX.O 45 $125, 319.90 i6. 5639.00 17. Amount of Line 14 taxable at sibling rate X • 12 17. O . 0 0 18. Amount of Line 14 taxable at collateral rate X . 15 18. 0. 0 0 19. TAX DUE .......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 5639.00 0 L 15056042115 15056042115 J REV-1500 EX Page 3 168-26-5497 Decedent's Complete Address: Flte Number DECEDENTS NAME AY W ROUSH DECEDENTS SOCIAL SECURITY NUMBER 168-26-5497 STREET ADDRESS 916 PINE ROAD CITY CARLISLE STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments $4,000.00 C. Discount $210.52 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 5639.00 Total Credits (A + B + C) (2) 4210.52 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1428.48 A. Enter the interest on the tax due. (5A) $10.84 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 1439.32 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: f t tr d f th i Yes ^ No 0 ; ........... e proper y ans erre ncome o a. retain the use or b. retain the right to designate who shall use the property transferred or its income : ................ ^ ^ c. retain a reversionary interest; or ..................................................... . ^ Q d. receive the promise for life of either payments, benefits or care? ............................ . ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................ . ^ ^ 3. Did decedent own an "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? ...................................................... ^ ^ 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 (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve {12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (11-Ot3) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE ESTATE OF FILE NUMBER Jay W Roush 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 property that 1s jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 916 Pine Road, Carlisle, PA 17013 Former personal residence Dickinson Township, Cumberland County, PA Assessment: $93,950.00 Implied fair market value of assessment: $18,774 See expenses in section "I" of this return See copy of deed and settlement sheet, Exhibit "A" Sold to Charles W. Roush, et. ux.: $97,175.00 TOTAL (Also enter on Line 1, Recapitulation) ~ $ 97,175 If more space is needed, insert additional sheets of the same size. 217 REV-1508 EX+(6-98) SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN ESTATE OF FILE NUMBER Jav W Roush Include the proceeds of litigation and the date the proceeds were received by the estate. All ro ointl -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE 1. 2002 Ford Ranger Pickup Truck See Exhibit "B" Edmonds.com "private party" value $5,931 Distributed to Roxanne Weaver at a value of $3,000.00 $5,931.00 2. Sovereign Bank P.O. Box 12646 Reading, PA 19612 Checking Account No. 2891033639 $6,711.80 3. I Household Personal Property: Lawn Tractor distributed to Constance Adams $300.00 Snow Blower dstributed to Jodi Wagner $50.00 Rototiller distributed to Edward Roush $25.00 Miscellaneous tools distributed to Charles Roush $10.00 Bedroom Suite distributed to Charles Roush $20.00 Lift Chair distributed to Constance Adams $20.00 4. US Treasury -Tax Refund - 2008 $120.00 5. PA Rentlf-ax Rebate $300.00 6. Globe Life -premium refund check $506.34 7. US Treasury -Tax Refund - 2009 $40.00 TOTAL (Also enter on line 5, Recapitulation) $ I 14,034 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+(OB-09) SCHEDULE G Pennsylvania INTER-VIVOS TRANSFERS & DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Jay W Roush This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER 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. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION pF APPLICABLE) TAXABLE VALUE 1. National Western Life Insurance Company 0 Annuities paid directly to Benficiaries 0 Not assets of Trust 0 Policy No.: 0101123437 $11,904.34 100.00% 11,904 Policy No.: 0101123443 $5,795.17 100.00% 5,795 Policy No.: 0101123444 $5,795.17 100.00% 5,795 Policy No.: 0101123436 $1,949.67 100.00°Jo 1,950 0 See Exhibit "D" 0 0 2. Prudential Annuities Life Assurance Corporation 0 IRA Annuity No. E0456922 0 Paid drectly to Beneficiaries -Not an asset of the Trust 0 DOD (est as of 4/20/09) value $11,836.26 $11,836.26 100.00% 11,836 0 See Exhibit "E" 0 0 3. American Equity Inventment Life Insurance Company 0 IRA Annuity Contract No. 34928 0 Trust was sole owner and Beneficiary 0 Vale at DOD $12,132.12 100.00% 12,132 0 See Exhibit "F" 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on Line 7, Recapitulation);I 49,412 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX + (10-09) Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT DECEDENT URN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Jay W Roush Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hollinger Funeral Home & Crematory, Inc. $8,646.97 2. Eby Granite Works $390.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: Frey and Tiley $5,800.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) $500.00 Claimant Roxanne Weaver Street Address 16742 Centerway city Guemeville state CA zIP 95446 Relationship of Claimant to Decedent Daughter 4. Probate Fees: 5. Accountant Fees: Frey and Tlley $-0- 6. Tax Return Preparer Fees: Frey and Tiley $-0- 7. Check printing fees $20.65 8. Bank service fees -Sovereign Bank $30.00 9. Reserve -Filing fee for Inheritance Tax Return $15.00 10. Reserve -Filing fee for Account $180.00 11. Reserve -Advertising Trust (Cumberland Law Journal $75.00 -Sentinel $200.00) $275.00 (Line B-3 Explanation) Roxanne Weaver Lived in decedent's house until September 9, 2009. TOTAL (Also enter on Line 9, Recapitulation) $ 15,85 If more space is needed, use additional sheets of paper of the same size REV-1512 Ex+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8~ LIENS ESTATE OF FILE NUMBER Jav W Roush Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. Jay W. Roush Trust SCHEDULE I-1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS 1 2 3 4 5 6 7 8 9 10 11 2009 9-Apr Sovereign Bank Checking Account No. 2891033639 Checks Cleared After Death: No. 1063 Hollinger Funeral Home AutoPay to FH PFFS Hlth Prem. No. 106b Sovereign Bank No. 1061 Globe Life and Accident Ins. Company No. 1062 JC Penney No. 1059 Leni No. 1057 Brittany Wagner No. 1058 Danielle Roush 6-May Met-Ed 6-May Embarq 6-May Erie Insurance 6-May Direct TV 6-May Sovereign Bank -Loan Payment 10-Jun Reimburse Frey & Tiley Sovereign Bank -Loan Payment Church of Gog Homes, Inc. Met-Ed Erie Ins. Group Direct TV Embarq Carlisle Regional Medical Center Carolyn R. McQuillen, Tax Collector 2009 County & Townshipo Real Estate Tax 15-Jul Erie Insurance 15-Jul Carolyn R. McQuillen, Tax Collector 2009/10 School Real Estate Tax 15-Jul Cumberland -Goodwill Fire Rescure Two ambulence calls 15-Jul Carolyn R. McQuillen, Tax Collector Schedule I-1 Jay Roush Trust 3.10.10.x1s Page 1 r 1,000.00 96.00 300.00 42.49 20.11 25.00 25.00 25.00 87.39 25.39 186.00 70.65 50.00 50.00 1,646.00 169.11 186.00 70.65 51.67 50.00 262.96 229.00 1,319.37 300.00 3/ 10/ 10 at 5:37 PM 12 15-Jul 13 15-Jul 14 16-Jul 15 16-Jul 16 16-Jul 17 12-Aug 18 9-Sep 19 9-Sep 20 15-Sep 21 1-Oct 22 11-Nov 23 11-Nov 24 24-Nov 25 24-Nov 2010 26 10-Mar Per Capita Tax West Shore EMS -Carlisle Met-Ed Sovereign Bank -Loan Payment Direct TV Discover Card Sovereign Bank -Loan Payment Sovereign Bank -Loan Payment Church of God Homes, Inc. Direct TV Sovereign Bank -Loan Payment Sovereign Bank -Loan Payment Erie Insurance Expenses from sale of Real Estate: Se1lerAssist for Purchaser's Closing Costs: Realtor's Commission - Re/Max Realty Professionals Transfer Tax Courier Fee to Shumaker Williams, PC Peck's Septic Service Net Tax Proration Payoff Sovereign Bank Sovereign Bank -Refund from Loan Payoff National Recovery Agency -West Shore EMS Bill from 2002 TOTAL SCHEDULE I-1 11.00 150.00 167.96 100.00 70.65 59.44 50.00 50.00 725.00 148.36 50.00 50.00 115.00 5,247.65 1,675.00 971.75 15.00 662.00 (830.75) 3,436.58 (1.51) 232.70 19,443.62 Schedule I-1 Jay Roush Trust 3.10.10.x1s Page 2 3/10/10 at 5:37 PM REV-1513 EX+ (11-OS) ESTATE OF by 1A/ Rn~ ich pennsyivania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN FILE NUMBER RELATIONSHIP 70 DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under SeC. 2116 (a) (1.21_] 1) Roxanne Weaver formerly 916 Pine Road, Carlisle, PA 17015 Now of 16742 Centerway, Guerneville, CA 95446 Daughter 1 /6 2) Constance Adams 50 Parker Street, Carlisle, PA 17013 DBUght@C 1 ~6 3) Patty Daron (formerly Patty Brymesser) 3166 Ritner Highway, Newville, PA 17241 $t@p-D8llgIlteP 1~s 4) Charles Roush Formerly of 3286 Wakefield Road, Harrisburg, PA 17109 Now of 916 Pine Road, Carlisle, PA 17015 -SO]R 1 ~s 5) Jodi L. Wagner 85 South Side Drive, ewville, PA 17241 Daughter 1 /6 6) Edward Roush 75 Bonnybrook Road, Carlisle, PA 17013 SOR 1 ~s ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 1 B OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: ~ A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ; Q If more space is needed, insert additional sheets of the same size. . 1~ uy ,~ ~ ~ ~ ~~ ~ i 2~ ~ l ~, y~. 5 t\ U~~ ~ ~ N ED SUNIlI~IARY OF TRUST OTARIZ THE JAY W. ROUSH REVOCABLE LIVING TRUST AGREEI~~ENT The undersigned hereby certifies that be created a Revocable Living Trust. This Trust is known as: THE AY W. ROUSH REVOCABLE LIVING TRUST, dated the ~ day of ~ ~ , 19~. JAY W. ROUSH, Settlor and Trustee, having an address at 916 Pine Road, the City of Carlisle, the Commonwealthof Pennsylvania,the County of Cumberland: IT IBS AGREED BETWEEN THE PARTIES I~ERETO AS FOLLOWS: Description of Trust The party hereto desires to confirm the establishment of a Revocable Tntst on this date, for the benefit of the Settlor and containing herein the following provisions: 1. The Settlor is designated as the Trustee to serve until his death, resignation or incompetence. 2. Upon the end of the terms. of the original Trustees, JODI L. WAGNER and CONSTANCE ADAMS are designated as Joint Successor Trustees. 3. Any Trustee/Settlorhas the power and authority to manage and control, buy, sell, and transfer the trust property, in such manner as the. Trustee may deem advisable, and shall have; enjoy and exercise all powers and rights over and concerning said properly and the proceeds thereof as fully and amply as though said Trustee were the absolute and qualified owner of same, including the power to grant, bargain, sell and convey, encumber and hypothecate, real and personal property, and the power to invest in corporate obligations of every kind, stocks, preferred or common, and to buy stocks, bonds and similar investments on margin or other leveraged accounts, except to the extent that such managementwould cause includability of an irrevocable trust in the Estate of a Trustee. 4. Following the death of the Trustee, the Trust continues or is distributed in whole or in part for the benefit of other named Beneficiaries according to the terms of the Trust. 5. While Settlor is living and competent, except when there shall be a Corporate Trustee, Trustee may add money to or withdraw money from any bank or savings and loan or checking account owned by the Trust. 6. Unless otherwise indicated to a prospective transferee, the Trustee has full power to transfer assets held in the name of the Trust and subsequent transferees are entitled to rely upon such transfers provided the chain of title is not otherwise deficient. 7. The Trust Agreement, also states that any bank, corporation, brokerage firm or other entity or any individual may conclusively presume that, the ,Trustee has full Bower. and .authority and such person or institution shall be held harmless~and shall incur no liability by reason of so presuming. 8. The situs of the Trust is the Commonwealth of Pennsylvania. TRUST SUR~.RY Page 1 9. The use of this Summary of Trust is for convenience only and the Trust solely controls as to provisions and interpretations, and any conflict between this abstract and the Trust shall be decided in favor of the Trust. IN WITNESS W1TER)JOF, the party has hereto executed this Summary of Trust this date. SETTLOR/TRUSTEE: JAY W~ ~ O COMMONWEALTHOF PENNSYLVANIA COUNTY OF CUMBERLAND --- On this the ~ day of ~ ~ , 19 y~ ,before me, a Notary Public, personally appeazed JAY W. ROUSH, personally known to me to be the person whose name is subscribedto this instrument, and acknowledgedthat he executed it for the purposes herein exYr~ssed. ._,~ l~ ~ota~al Seat Public; Commonwealth of Pennsylvari;z Don Codel N Cheltenham, r ~Y Pubfic M 'P n ~ ont9om®ry Co MY Commlesio }e~. ~G.l Oct 8 2 01 ~., Yi '...'.,; , 0 ;,~. f :,~:•.t, ~~~ ~ c 4~ ~ ~ Y ) FX i ~l •~ •-L_ e. . ft ~ „ f~; ......,,. TRUST SUMMARY ' Pase 2 T;r~ JAY W. ROUSH Notarial s ' LIVING TRUST AGREEMENT Don Godel, Notary Publics Cheltenham T M Com ssl ry ~ ~ ,19~~, BETWEEN: JAY W. ROUSH, AS SETTLOR AND: JAY W. ROUSH, AS TRUSTEE JAY W. ROUSH, a resident of the Commonwealth of Pennsylvania, County of Cumberland, does hereby establish a Trust upon the conditions and for the purposes hereafter set forth. ARTICLE ONE Section 1.01. Trust Estate Defined This Revocable Trust is formed to hold title to real and personal property for the benefit of the Settlor of this Trust and to provide for the orderly use and transfer of these assets upon the death of the Settlor. The "Trust Estate" is defined as all property, transferred or conveyed to and received by the Trustee, held pursuant to the terms of this instrument. The Trustee is required to hold, administer, and distribute this property as provided in this Trust Agreement. Section 1.02. Definitions As used in this Trust Agreement, a) The term "Settlor" shall mean JAY W. ROUSH. b) The term "descendant" shall mean the lawful issue of a deceased parent in the line of descent but does not include the issue of any parent who is a descendant of the deceased person in question and is living at the time in question. c) The terms "child" and "descendant" include any issue born to decedent or legally adopted by the decedent or a posthumous child of a decedent, and a posthumous child is to be considered as living at the time of his or her parent's death. d) The term "survives" or "surviving", unless otherwise indicated herein, shall be construed to mean surviving the decedent for at least sixty (60) days. If the person referred to dies within sixty (60) days of the death of the decedent, the reference to him or her shall be construed as if he or she had failed to survive the decedent; REVOCABLE LIVING TRUST AGREEMENT Page 1 provided, however, that any such person will have during such period the right to the use and the enjoyment as a life tenant of all property in which his or her interest will fail by reason of death during such period. e) The term "issue" will include all natural and adopted children, if applicable, and descendants and those legally adopted into the line of descent. f) The term "per stirpes" means strict per stirpes and does not mean per capita with representation. Beneficiaries entitled to take under a "per stirpes" clause will include both natural and adopted children and their descendants. g) The terms "Trust Assets" and "Trust Estate" include all. assets of any trust created hereunder and income derived from such assets and all proceeds of any description derived from the sale, exchange or other disposition of such assets. h) When required to give reasonable effect to the context in which used, pronouns in the masculine, feminine or neuter gender include each other, and nouns and pronouns in the plural or singular number include each other. Section 1.03. Trustee Designation Settlor is hereby designated as Trustee. The term "Trustee" as used in this Trust Agreement shall refer to Settlor so long as he or she serves as Trustee, and/or to any successor Trustee who assumes the role of Trustee. These Trustees shall serve in the order as provided in Section 8.01 of this Trust Agreement. Section 1.04. Additions to Trust Properties a) The Trustee, at any time during the continuance of this Trust in his or her sole discretion after consideration of the possible tax consequences to all concerned, is authorized to receive into the Trust additions of cash and other properties from any source whatsoever, whether by gift, will, or otherwise. However, the Trustee shall accept all assets which any person or persons may give, devise, or bequeath by Last Will and Testament to this Trust, and shall accept all assets transferred to this Trust pursuant to the provisions of any other Trust document or documents. b) In addition, any person or persons may designate this Trust as the -Beneficiary, Primary or Contingent, of death benefits, whether insurance benefits, pension benefits, or other benefits. Until such benefits mature, the Trustee shall have no responsibilitywith respect to those benefits. Section 1.05. Apportionment The Trustee of the Trust is directed to apportion receipts and expenditures of the types described below between principal and income as follows: REVOCABLE LIVING TRUST AGREEMENT Page 2 a) Whenever the principal, or any part thereof, of the trust property is invested in securities purchased at a premium or at a discount, any premium will be charged against principal and any discount will be credited to principal; b) Any stock dividends and rights to purchase additional stock issued on securities held in trust will be treated as principal, but all other dividends, except liquidating distributions, will be treated as income; and c) The amount of any applicable depletion allowance for federal income tax purposes will be treated as income. Section 1.06. DiscretionarvTermination The Trustee may terminate any trust when, in the opinion of the Trustee, the principal is reduced to such an extent that it is not in the best interest of the Beneficiary or Beneficiaries to continue the trust. The judgment of the Trustee with respect to this decision to terminate will be final and not subject to judicial review. If the Trustee terminates a trust according to this Section, the date the trust terminates will be deemed the date fixed for termination of the trust, and the Trustee will distribute the assets of the terminatingtrust tothe Beneficiaryor Beneficiariespursuant to this Agreement. Section 1.07. Amendment and Revocation At any time during the life of the Settlor, the Settlor may, by a duly executed instrument filed with the Trustee: a) Amend this Trust Agreement in any manner; and/or b) Revoke this Trust Agreement in part or in whole. If the Trust Agreement is revoked in whole, the Trustee shall transfer title to all Trust property of every kind and description back into the individual name of the Settlor. The instrument of amendment or revocation shall be effective immediately upon its proper execution by the Settlor, but until a copy has been received by a Trustee, that Trustee shall not incur any liability or responsibility either (i) for failing to act in accordance with such instrument or (ii) for acting in accordance with the provisions of this Trust Agreement without regard to such instrument. c) Withdraw from the Trust Estate all or any part of the principal and accumulated income of the Trust to satisfy liabilities lawfully. incurred in the administration of this Trust. Section 1.08. Revocation or Alteration by Settlor Alone The rights of revocation, withdrawal, alteration and amendment reserved in this Article must be exercised by the Settlor, and may not be exercised by any other person, including an agent, a guardian or a conservator. REVOCABLE LIVING TRUST AGREEMENT Page 3 Section 1.09. Irrevocability Except as otherwise provided, on the death of Settlor, the designation of Beneficiaries of specific gifts in this Trust shall become irrevocable, and not subject to amendment or modification. Section 1.10. Settlor Powers The Settlor shall be the Trustee unless and until she resigns in writing, or is determined incompetent under the -terms provided herein. The Settlor shall retain all absolute rights to discharge or replace any successor Trustee, so long as the Settlor is competent. ARTICLE TWO Section 2.01. Trust Income During the life of the Settlor, the Trustee shall at least annually, unless otherwise directed by Settlor in writing, pay to or apply for the benefit of Settlor, all of the net. income from the Trust Estate. Section 2.02. Protection of Settlor in Event of Incapacity During the life of the Settlor, should Settlor become incapacitated as defined in Section 2.03 below, the Trustee may, in the Trustee's absolute discretion, pay- income and principal for the benefit of the incapacitated Settlor, and may pay to or apply for the benefit of that Settlor such sums from the net income and from the principal of the Estate as the Trustee, in the Trustee's absolute discretion, believes is necessary or advisable for the medical care, comfortable maintenance, and welfare of the Settlor. Section 2.03. Incapacity In the event that any Trustee or any Beneficiary hereunder comes into possession of any of the following: a) A jurisdictionally applicable court order holding the party to be legally incapacitated to act on his or her own behalf and appointing a guardian or conservatorto act for him or her, or b) Written certificates which are duly executed, witnessed, and acknowledged of two licensed physicians, each certifying that the physician has examined the person and has concluded that, by reason of accident, mental deterioration, or other cause, such person has become incapacitated and can no longer act rationally and prudently in his or her own financial best interests, or REVOCABLE LIVING TRUST AGREEMENT Page 4 c) Evidence which such Trustee or Beneficiary deems to be credible and currently applicable that a person has disappeared, is unaccountably absent, or is being detained under duress, and that he or she is unable to effectively and prudently look after his or her own best interests, then in that event and under those circumstances: 1) Such person is deemed to have become incapacitated, as that term is used in this Trust Agreement, and 2) Such incapacity is deemed to continue until such court order, certificates, and/or circumstances are inapplicable or have been revoked. A physician's certificate to the effect that the person is no longer incapacitated shall revoke a certificate declaring the person incapacitated. The certificate which revokes the earlier certificate may be executed either (i) by the originally certifying physician or (ii) by two other licensed, board certified physicians. No Trustee shall be under any duty to institute any inquiry into a person's possible incapacity. The reasonable expense of any such inquiry shall be paid from the Trust Assets. Section 2.04. Principal Invasion During the life of the Settlor, should the net income of assets contained in this Trust at the time of the Settlor's death be insufficient to provide for the care, maintenance or support of the Settlor as herein defined, the Trustee may, in the Trustee's sole and absolute discretion, pay to or apply for the benefit of the Settlor, or any of their dependents, such amounts from the principal of the Trust Estate as the Trustee deems necessary or advisable for the care, maintenance or support of the Settlor. Section 2.05. Residence If the Settlor's residence property is a part of the Trust, the Settlor shall have possession of and full management of the residence and shall have the right to occupy it rent free. Any expenses arising from the maintenance of the property and from all taxes, liens, assessments, and insurance premiums are to be paid from the Trust to the extent that assets are available for payment. It is the intent of the Grantors to retain all homestead rights available to them under the applicable state law. ARTICLE THREE Section 3.01. Death On the death of the Settlor, the Trustee shall distribute the principal of the Trust and any accrued ar undistributed income from the principal of the Trust in such a manner and to such persons, including the Estate or the Creditors, as directed in this Trust Agreement. Section 3.02. Payment of Death Expenses REVOCABLE LNING TRUST AGREEMENT Page 5 On the death of the Settlor, the Trustee shall pay from the Trust the expenses of the Settlor's last illness, funeral, burial and any inheritance, estate or death taxes that may be due by reason of the Settlor's death, unless the Trustee in his or her absolute discretion determines that other adequate provisions have been made for the payment of such expenses and taxes. Section 3.03. Trust Income and Principal Distribution a) The Trustee shall apply and distribute the net income and principal of each of the shazes of the resulting Trust Estate, after giving effect to the section of this Trust Agreement entitled "Special Directives" to the following Beneficiaries in the indicated fractional shares: ROXANNE WEAVER 1/6 CONNIE ADAMS 1/6 EDWARD ROUSH ~(J 1/6 PATTYH~t ~!~-~' ~ ~ f ~~ 1/6 CHARLES ROUSH 1 /6 JODI L. WAGNER 1/6 b) If any of the above Beneficiaries, or any other Beneficiary, is under the age of 25 years when the distribution is to be made, the Benef ciary's shaze shall vest in interest indefeasibly but the Trustee may, in his or her discretion, continue to hold that shaze as a sepazate trust for such period of time as the Trustee deems advisable, but not to extend beyond the 25th birthday of the Beneficiary. In the meantime, the Trustee is to use as much of the income and principal for the education, comfortable support, maintenance and health of the Beneficiary as the Trustee determines is required. When the Beneficiary reaches the age of 25 years, the Trustee shall distribute to that Beneficiary one hundred percent (100%) of the then balance of the principal of his or her share of the Trust Estate. c) If all of the Settlor's Beneficiazies and their children should fail to survive the final distribution of the Trust Estate, all of the Trust Estate not disposed of as hereinabove provided shall be distributed as provided for in this Trust Agreement. Section 3.04. Principle of Representation If a Beneficiary of the Settlor's should fail to survive to collect his or her share, that share shall pass to the surviving issue of that deceased Beneficiary per stirpes and with right of representation. REVOCABLE LIVING TRUST AGREEMENT Page 6 ARTICLE FOUR Section 4.01. Non-Income Producing Property During the life of the Settlor, the Trustee is authorized to retain in the Trust for so long as the Trustee may deem advisable, any property received by the Trustee from the Settlor, whether or not such property is of the character permitted by law for the investment of Trust funds. Section 4.02. Trustee Powers The Trustee shall have all powers conferred upon a Trustee by law for the orderly administrationof the Trust Estate. If any property is distributed outright under the provision of this Trust Agreement to a person who is a minor, distribution may be made under the Pennsylvania Uniform Transfer to Minors Act ("PAUTMA"). The Trustee is further authorized to sign, deliver and/or receive any documents necessary to carry out the powers contained within this Section. The Trustee of any trust created under this Trust Agreement (including any substitute or successor trustee) will have and be subject to all of the powers, duties, and responsibilities granted or imposed by the PennsyIvaniaConsolidatedStstues (20 Pa. C.S. Section 101 et seq.) as such Statute may provide at the time of administration of the trust, except to the extent that the same are inconsistent with the provisions of this Agreement. Section 4.03. Specific Powers of Trustee In addition, the Trustee will have the following specific powers: a) Trust Estate -The Trustee may leave invested, any property coming into its hands hereunder in any form of investment, even though the investment may not be of the character of investments permitted by law to trustees, without liability for loss or depreciation in value. The Trustee may sell, exchange, or otherwise dispose of and reinvest property which may at any time be a part of the Trust Estate upon such terms and conditions as the Trustee may deem advisable. The Trustee may invest and reinvest the Trust Assets from time to time in any property, real, personal, or mixed, including without limitation securities of domestic and foreign corporations and investment trusts or companies, bonds, debentures, preferred stocks, common stocks, mortgages, mortgage participations, and interests in common trust funds, all with complete discretion to convert realty into personalty or personalty into realty or otherwise change the character of the Trust Estate, even though such investment (by reason of its character, amount, proportion to the total Trust Estate, or otherwise) would not be considered appropriate for a fiduciary apart from this provision, and even though such investment caused part or all of the total Trust Estate to be invested in investments of one type or of one business or company. b) Holding Property -The Trustee may hold property in the Trustee's name, as trustee, or in the name of a nominee without disclosingthe Trust. REVOCABLE LIVING TRUST AGREEMENT Page 7 c) Release of Power - If the Trustee deems it to be in the best interest of the Trust and its beneficiaries, the Trustee, by written instrument signed by such Trustee, will have the power and authority to release, disclaim or restrict the scope of any power or discretion granted in this Trust Agreement or implied by law. d) Agents, Employees -The Trustee may employ one or more agents to perform any act of administration, whether or not discretionary, including attorneys, auditors, investment managers or others, as the Trustee shall deem necessary or advisable. The Trustee may compensate agents and other employees, and may delegate to them any and all discretions and powers. e) Leases -The Trustee may lease any Trust Assets generally or for oil, gas and mineral development, even though the lease term may extend beyond the term of the trust of which the property is a part. The Trustee may enter into any covenants and agreements relating to the property so leased or any improvements which may then or thereafter be erected on such property. f) Common Funds -The Trustee may hold any of the Trust Assets in a common fund with property from other trust estates and to make investments jointly with any other trust, the property of which is included in the common fund. g) Securities -With respect to securities held in the Trust Estate, the Trustee may exercise all the rights, powers, and privileges of an owner, including, but not limited to, the power to vote, give proxies, and to pay assessments and other sums deemed by the Trustee necessary for the protection of the Trust estate; to participate in voting trusts, foreclosures, reorganizations, consolidations, mergers, and liquidations, and in connection therewith to deposit securities with and transfer title to any protective or other committee under such terms as the Trustee may deem advisable; to exercise or sell stock subscription or conversion rights; and to accept and retain as an investment any securities or other property. received through the exercise of any of the foregoing powers, regardless of any limitations elsewhere in this instrumentrelative to investments by the Trustee. h) Purchases from Estate -The Trustee may purchase property of any kind from the executor or administratorof our estates. i) Lending -The Trustee may make loans, secured or unsecured, to the executor or administratorof our estates, to any beneficiary of the Trust or to the Trustee. Further, the Trustee may use Trust Assets to guarantee obligations of any income beneficiary of the Trust (unless such beneficiary is serving as trustee). j) Distributions to or for Beneficiaries -The Trustee may make any distribution contemplated by this Trust Agreement (1) to the beneficiary, (2) if the beneficiary is under a legal disability or if the Trustee determines that the beneficiary is unable to properly manage his or her affairs, to a person furnishing support, maintenance or education for the beneficiary or with whom the beneficiary is residing, for expenditures on the beneficiary's behalf, or (3) if the beneficiary is a minor, to a trustee of an existing. trust established exclusively for the benefit of such minor, whether created by this Trust Agreement or otherwise, or to a custodian for the beneficiary, as selected by the Trustee, under the Pennsylvania Uniform Transfer to Minors Act. Alternatively, the Trustee may apply all or REVOCABLE LIVING TRUST AGREEMENT Page 8 a part of the distribution for the beneficiary's benefit. Any distribution under this pazagraph will be a full discharge of the Trustee with respect thereto. On any partial or final distribution of the Trust Assets, the Trustee may apportion and allocate the assets of the Trust Estate in cash or in kind, or partly in cash and partly in kind, or in undivided interests in the manner deemed advisable at the discretion of the Trustee and to sell any property deemed necessary by the Trustee to make the distribution. The Trustee may distribute gifts of up to $10,000.00 per year per donee out of principal or interest. k) Insurance -The Trustee may purchase new life insurance and to pay the premiums on existing life insurance on the life of any trust beneficiary and to purchase annuities (either commercial or private) from any corporation, trust or individual; and to procure and pay the premiums on other insurance of the kinds, forms and amounts deemed advisable by the Trustee to protect the Trustee and the Trust Estate. 1) Borrowing -The Trustee may borrow money from the Trustee and others, and to secure the repayment thereof by mortgaging or pledging or otherwise encumbering any part or all of the Trust assets and, in connection with the acquisition of any property, to assume a liability or to acquire property subject to a liability. m) Repairs -The Trustee may make ordinary and extraordinary repairs and alterations in buildings or other Trust Assets. n) Reserves -The Trustee may establish such reserves out of income for taxes, assessments, repairs and maintenance as the Trustee considers appropriate. o) Continuation of Business -The Trustee may continue any business or businesses in which I have an interest at the time of my death for so long as the Trustee may, in his or her sole discretion, consider necessary or desirable, whether or not the business is conducted by me at the time of my death individually, as a partnership or as a corporation wholly owned or controlled by me, with full authority to sell, settle and discontinue any of them when and upon such terms and conditions as the Trustee may, in his or her sole discretion, consider necessary or desirable. p) Retain Property for Personal Use -The Trustee may retain a residence or other property for the personal use of a beneficiary and to allow a beneficiary to use or occupy the retained property free of rent and maintenance expenses. q) Dealings with Third Parties -The Trustee may deal with any person or entity regardless of relationship or identity of any trustee to or with that person or entity and may hold or invest all or any part of the Trust Estate in common or undivided interests with that person or entity. r) Partitions, Divisions, Distributions -The Trustee will have the power to make all partitions, divisions, and distributions contemplated by this Trust Agreement. Any partitions, divisions, or distributions may be made in cash, in kind, or partly in cash and partly in kind, in any manner that the Trustee deems appropriate (including composing shares differently). The Trustee may determine the value of any property, which valuation will be binding on all beneficiaries. No adjustments are required to compensate for any partitions, divisions, or distributions having unequal consequences to the beneficiaries. REVOCABLE LIVING TRUST AGREEMENT Page 9 s) Claims, Controversies -The Trustee may maintain and defend any claim or controversy by or against the Trust without the joinder or consent of any beneficiary. The Trustee may commence or defend at the expense of the Trust any litigation with respect to the Trust or any property of the Trust Estate as the Trustee may deem advisable, and may employ, for reasonable compensation, such counsel as the Trustee shall deem advisable for that purpose. t) Merger of Trusts - If at any time the Trustee of any trust created hereunder shall also be acting as trustee of any other trust created by trust instrument or by trust declaration for the benefit of the same beneficiary or beneficiaries and upon substantially the same terms and conditions, the Trustee is authorized and empowered, if in the Trustee's discretion such action is in the best interest of the beneficiary or beneficiaries, to transfer and merge all of the assets then held under such trust created pursuant to this Trust Agreement to and with such other trust and thereupon to terminate the trust created pursuant to this Trust Agreement. The Trustee is further authorized to accept the assets of any other trust which may be transferred to any trust created hereunder and to administer and distribute such assets and properties so transferred in accordance with the provisions of this Agreement. u) Termination of Small Trust -Any corporate trustee which is serving as the sole trustee of any trust or any share thereof may at any time terminate such trust or share if, in the trustee's sole judgment, the continued management of such. trust or share is no longer - economical because of the small size of such trust or share and if such action will be deemed to be in the best interests of the beneficiary or beneficiaries. In case of such termination, the trustee will distribute forthwith the share of the Trust Estate so terminated to the- income beneficiary or beneficiaries, per stirpes. Upon such distribution, such trust or share will terminate and the trustee will not be liable or responsible to any person or persons whomsoever for its action. The trustee will not be liable for failing or refiising at any time to terminate any trust or a share thereof as authorized by this paragraph. v) Power to Determine Income and Principal -Dividends payable in stock of the issuing corporation, stock splits and capital gains will be treated as principal. Except as herein otherwise specifically provided, the Trustee will have full power and authority to determine the manner in which expenses are to be borne and in which receipts are to be credited as between principal and income, and also to determine what will constitute principal or income, and may withhold from income such reserves for depreciation or depletion as the Trustee may deem fair and equitable. In determining such matters the Trustee may give consideration to the provisions of the Pennsylvania Statutes (or its successor statutes) relating to such matters, but will not be bound by such provisions. w) Generation-Skipping Taxes and Payment - If the Trustee considers any distribution or termination of an interest or power hereunder as a distribution or termination subject to a generation-skippingtax, the Trustee is authorized: 1) To augment any taxable distribution by an amount which the Trustee estimates to be sufficient to pay such tax and charge the same to the particular trust to which the tax related without adjustment of the relative interests of the beneficiaries; REVOCABLE L]vING TRUST AGREEMENT Page 10 2) To pay such tax, in the case of a taxable termination, from the particular trust to which the tax relates without adjustment of the relative interests of the beneficiaries. If such tax is imposed in part by reason of the Trust Assets, the Trustee will pay only the portion of such tax attributable to the taxable termination hereunder taking into consideration deductions, exemptions, credits and other factors which the Trustee deems advisable; and 3) To postpone final termination of any particulartrust and to withhold all or any portion of the Trust Estate until the Trustee is satisfied that the Trustee no longer has any liability to pay any generation-skipping tax with reference to such trust or its termination. Section 4.04. Special Provision for S Corporation Stock Notwithstanding what is otherwise provided in this Trust Agreement, if at any time the Trust contains any stock of a corporation which elects or has elected treatment as an "S Corporation" as defined by Section 1361(a)(1) of the Internal Revenue Code (or any corresponding successor statute), such stock will be segregated from the other assets of such trust and treated as a separate trust. The Trustee will further divide the separate trust into shares for each Beneficiary and such shares will be distributed outright or held in trust as herein provided. In addition, all other provisions of this Trust Agreement will apply to each share held in trust (and constituting a separate trust) except that the Trustee will distribute all of the income from each separate trust to its beneficiary in convenient installments at least annually. It is our intent that each separate trust will be recognized as a "Qualified Subchapter S Trust" (QSST) under Section 1361(d)(2) of the Internal Revenue Code (or any corresponding successor statute). Notwithstanding any provisions of this Trust Agreement to the contrary, the Trustee's powers and discretions with respect to the administration of each separate trust (including methods of accounting, bookkeeping, making distributions and characterizing receipts and expenses) will not be exercised or exercisable except in a manner consistent with allowing each separate trust to be treated as a QSST as above described. ARTICLE FIVE Section 5.01. Coordinationwith Settlor's Probate Estate a) At any time during the continuance of this Trust including subsequent to the death of either Settlor the Trustees may, in their sole and uncontrolled discretion, distribute to the deceased Settlor's Probate Estate cash and/or other property as a Beneficiary of the Trust. b) All other provisions to the contrary notwithstanding, under no circumstances shall any restricted proceeds, as hereinafter defined, be either directly or indirectly: (i) distributed to or for the benefit of the Settlor's Executors or the Settlor's Probate Estate; or (ii) used to pay any other obligations of the Settlor's Estate. The term "restricted proceeds" means: REVOCABLE LIVING TRUST AGREEl1'IENT Page 11 1) All qualified plans, individual retirement accounts, or similar benefits which are received or receivable by any Trustee hereunder, and which are paid solely to a Beneficiary other than the Executor of the Settlor's Gross Estate for Federal Estate Tax purposes; and 2) All proceeds of insurance on the Settlor's life which, if paid to a Beneficiary other than the Settlor's Estate, would be exempt from inheritance or similar death taxes under applicable state death tax laws. Section 5.02. Direction to Minimize Taxes In the administration of the Trust hereunder, its Fiduciaries shall exercise all available tax related elections, options, and choices in such a manner as they, in their sole but reasonable judgment (where appropriate, receiving advice of tax counsel), believe will achieve the overall minimum in total combined present and reasonably anticipated future administrative expenses and taxes of all kinds. This applies not only to such Trust but also to its Beneficiaries, to the other Trusts hereunder and their Beneficiaries, and to the Settlor's Probate Estate. Without limitation on the generality of the foregoing direction (which shall to that extent supersede the usual fiduciary duty of impartiality), such Fiduciaries shall not be accountable to any person interested in this Trust or to Settlor's Estate for the manner in which they shall carry out this direction to minimize overall taxes and expenses(includingany decision they. may make not. to-incur the expense of a .detailed. analysis of alternative choices). Even though their decisions in this regard may result in increased taxes or decreased distributions to the Trust, to the Estate, or to one or more Beneficiaries, the Fiduciaries shall not be obligated for compensation readjustments or reimbursements which arise by reason of the manner in which the Fiduciaries carry out this direction. Section 5.03. Judgment and Discretion of Trustee In the absence of proof of bad faith, all questions of construction or interpretation of any trusts created by this Trust Agreement will be finally and conclusively determined solely by the Trustee, according to the Trustee's best judgment and without recourse to any court, and each determination by the Trustee is binding on the beneficiaries and prospective beneficiaries hereunder, both in being and unborn, as well as all other persons, firms or corporations. The Trustee, when exercising any discretionary power relating to the distribution or accumulation of principal or income or to the termination of any trust, will be responsible only for lack of good faith in the exercise of such power. Each determination may be relied upon to the same extent as if it were a final and binding judicial determination. In the event of a conflict between the provisions of this Trust Agreement and those of the Pennsylvania Statutes, the provisions of this Agreementwill control. ARTICLE SIX Section 6.01. Resolution of Conflict REVOCABLE LIVING TRUST AGREEMENT Page 12 Any controversy between the Trustee or Trustees and any other Trustee or Trustees, or between any other parties to this Trust, including Beneficiaries, involving the construction ar application of any of the terms, provisions, or conditions of this Trust shall, on the written request of either or any disagreeing party served on the other or others, be submitted to arbitration. The parties to such arbitration shall each appoint one person to hear and determine the dispute and, if they are unable to agree, then the two persons so chosen shall select a third impartial arbitrator whose decision shall be final and conclusive upon both parties. The cost of arbitration shall be borne by the losing party or in such proportion as the arbitrator(s) shall decide. Such arbitration shall comply with the commercial arbitration rules of the American Arbitration Association,140 West 51st Street, New York, New York 10200. Section 6.02. Incontestability The beneficial provisions of this Trust Agreement are intended to be in lieu of any other rights, claims, or interests of whatsoever nature, whether statutory or otherwise, except bona fide pre-death debts, which any Beneficiary hereunder may have in Settlor's Estate or in the properties in trust hereunder. Accordingly, if any Beneficiary hereunder asserts any claim (except a legally enforceable debt), statutory election, or other right or interest against or in Settlor's Estate, or any properties of this Trust, other than pursuant to the express terms hereof, or directly or indirectly contests, disputes, or calls into question, before any court, the validity of this Trust Agreement, then: a) Such Beneficiary shall thereby absolutely forfeit any and all beneficial interests of whatsoever kind and nature which such Beneficiary or his or her heirs might -- otherwise have under this Trust Agreement and the interests of the other Beneficiaries hereunder shall thereupon be appropriately and proportionately increased; and b) All of the provisions of this Trust Agreement, to the extent that they confer any benefits, powers, or rights whatsoever upon such claiming, electing or contesting Beneficiary, shall thereupon become absolutely void; and c) Such claiming, electing, or contesting Beneficiary, if then acting as a Trustee hereunder, shall automatically cease to be a Trustee and shall thereafter be ineligible either to select, remove, or become a Trustee hereunder. Section 6.03. Specific Omissions . Any and all persons and entities, except those persons and entities specifically named herein, have been intentionally omitted from this Trust Agreement. If any person or entity shall successfully challenge any term or condition of this Trust Agreement, then, to that person or entity shall be given the sum of one dollar ($1.00) in lieu and in place of any other benefit, grant, or interest which that person or interest may have in the Trust Estate. Section 6.04. Benefits Confidential The Settlor further declares that it is his or her desire and intent that the provisions of this Trust Agreement are to remain confidential as to all parties. The Settlor directs that only the information REVOCABLE LIVING TRUST AGREEMENT Page 13 ~ r concerning the benefits paid to any particular Beneficiary shall be revealed to such individual and that no individual shall have a right to information concerningthe benefits being paid to any other Beneficiary. ARTICLE SEVEN Section 7.01. Distribution in Kind or Cash On any division of the assets of the Trust Estate into shares or partial shares, and on any final or partial distribution of the assets of the Trust Estate, the Trustee, at his or her absolute discretion, may divide and distribute undivided interests of such assets on a pro rata or non-pro rata basis, or may sell all or any part of such assets and may make divisions or distributions in cash or partly in cash and partly in kind. The decision of the Trustee, either prior to or on any division or distribution of such assets, as to what constitutes a proper division of such assets of the Trust Estate shall be binding on all persons interested in any Trust provided for in this Trust Agreement. Section 7.02. Spendthrift Provision Neither the principal nor the income of the 'Trust shall be liable for the debts of a Beneficiary. Except as otherwise expressly provided in this Agreement, no beneficiary of any trust shall have any right, power or authority to alienate, encumber or hypothecate his or her interest in the principal or income of this Trust in any manner, nor shall the interests of any Beneficiary be subject to the claims of his or her creditors or liable to attachment, execution or other process of law. The limitations herein shall not restrict the exercise of any power of appointment or the right to disclaim. Section 7.03. Definition of Children The terms "child" and "children" as used in this Agreement mean the lawful issue of a Settlor. This definition also includes children legally adopted by a Settlor. Section 7.04. Handicapped Beneficiaries Any Beneficiary who is determined by a court of competent jurisdictionto be incompetent shall not have any discretionaryrights of a Beneficiarywith respect to this Trust, or to their share or portion thereof. The trustee shall hold and maintain such incompetent Beneficiary's share of the Trust Estate and shall, in the Trustee's sole discretion, provide for such Beneficiary as that Trustee would provide for a minor. Notwithstandingthe foregoing, any Beneficiary who is diagnosed for the purposes of governmental benefits (as hereinafter delineated) as being not competent or as being disabled, and who shall be entitled to governmental support and benefits by reason of such incompetency or disability, shall cease to be a Beneficiary of this Trust. Likewise, they shall cease to be a Beneficiary if any share or portion of the principal or income of the Trust shall become subject to the claims of any governmental agency for costs or benefits, fees or charges. REVOCABLE LIVING TRUST AGREEMENT Page 14 The portion of the Trust Estate which, absent the provisions of this section, would have been the share of such incompetent or handicapped person shall be retained in trust for as long as that individual lives. The Trustee, at his or her sole discretion, shall utilize such funds for the maintenance of that individual. If such individual recovers from his or her incompetency or disability, and is no longer eligible for aid from any governmental agency, including costs or benefits, fees or charges, such individual shall be reinstated as a Beneficiary after 60 days from such recovery, and the allocation and distribution provisions as stated herein shall apply to that portion of the Trust Estate which is held by the Trustee subject to the foregoing provisions of this section. If said handicapped Beneficiary is no longer living and shall leave children then living, the deceased child's share shall pass to those children per stirpes. If there are no children, the shaze shall be allocated proportionatelyamong the remaining Beneficiaries. ARTICLE EIGHT Section 8.01. Trustees All Trustees are to serve without bond. The following will act as Trustees of any Trusts created by this Trust Agreement, in the following order of succession: First: The undersigned, JAY W. ROUSH. Second: Upon the end of the terms of the original Trustees, JOAI L. WAGNER and CON5TANCE ADAMS are designated as Joint Successor Trustees. Third: In the event that one of my Joint Successor Trustees is unwilling or unable to serve, then the remaining Joint Successor Trustees shall continue to serve. Last: A Trustee chosen by the majority of Beneficiazies, with a parent or legal guardian voting for minor Beneficiaries; provided, however, that the children of any deceased Beneficiary shall collectively have only one vote. Section 8.02. Allocation and Distribution of the Trust Assets The Trustees shall allocate, hold, administer and distribute the Trust Assets as hereinafterprovided: a) Upon the death of the Settlor, the Trustee shall hold, administer and distribute the Trust Assets in the manner hereinafterprescribed. REVOCABLE LIVING TRUST AGREEMENT Page 15 Section 8.03. Personal Property Distribution Notwithstanding any provision of this Trust Agreement to the contrary, the Trustee must abide by any memorandum by the Settlor, particularly that contained in the section entitled "Special Directives" incorporated into this Trust Instrument, directing the disposition of Trust Assets of every kind including but not limited to furniture, appliances, furnishings, pictures, china, silverware, glass, books, jewelry, weazing apparel, and all policies of fire, burglary, property damage, and other insurance on or in connection with the use of this property. Otherwise, any personal and household effects of the Settlor shall be distributed with the remaining assets of the Trust Estate. Section 8.04. Liability of Trustee The Trustee will not be responsible or liable for any loss which may occur by reason of depreciation in value of the properties at any time belonging to the Trust Estate, nor for any other loss which may occur, except that the Trustee will be liable for such trustee's own negligence, neglect, default, or willful wrong. The Trustee will not be liable or responsible for the acts, omissions, or defaults of any agent or other person to whom duties may be properly delegated hereunder (except officers or regular employees of the Trustee) if such agent or person was appointed with due care. The Trustee may receive reimbursement from the Trust Estate for any liability, whether in contract or in tort, incurred in the administration of the Trust Estate in accordance with the provisions hereof, and the Trustee may contract in such form that such Trustee will be exempt from such personal liability and that such liability will be limited to the Trust Assets. Section 8.05. Successor Trustees Any Successor Trustee shall have all the power, rights, discretion and obligations conferred on a Trustee by this Trust Agreement. All rights, titles and interest in the property of the Trust shall immediately vest in the successor Trustee at the time of appointment. The prior Trustee shall, without warranty, transfer to the successor Trustee the existing Trust property. No successor Trustee-shall be under any duty to examine, verify, question, or audit the books, records, accounts, or transaction of any preceding Trustee; and no successor Trustee shall be liable or responsible in any way for any acts, defaults or omissions of any predecessor Trustee, nor for any loss or expense from or occasioned by anything done or neglected to be done by any predecessor Trustee. A successor Trustee shall be liable only for his or her own acts and defaults. REVOCABLE LIVING TRUST AGREEMENT Page 16 ARTICLE NINE Section 9.01. Perpetuities Savings Clause Notwithstandinganynther provision of this instrument,the Trusts created hereunder shall terminate not later than twenty-one (21) years after the death of the last survivor of the Settlor and any other Beneficiary or Beneficiaries named or defined in this Trust living on the date of the death of the Settlor. The Trustee shall distribute each remaining Trust principal and all accrued or undistributed. net income hereunder to the Beneficiary or Beneficiaries. If there is more than one Beneficiary, the distribution shall be in the proportion in which they are Beneficiaries; if no proportion is designated, then the distribution shall be in equal shares to such Beneficiaries. ARTICLE TEN Section 10.01. Governing Law It is not intended that the laws of only one particular state shall necessarily govern all questions pertaining to all of the Trust hereunder. a) The validity of the Trust hereunder, as well as the validity of the particular provisions of that Trust, shall be governed by the laws of the state which has sufficient connection with this Trust to support such validity. b) The meaning and effect of the terms of this Trust Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. c) The administrationofthfs Trust shall be governed by the laws of the state in which the principal office of the Trustee then having custody of the Trust's principal assets and records is located. The foregoing shall apply even though the situs of some Trust assets or the home of the Settlor, a Trustee, or a Beneficiary may at some time or times be elsewhere: Section 10.02. Invalidity of any Provision If a court fmds that any provision of this Trust Agreement is void, invalid or unenforceable, the remaining provisions of this Agreement will continue to be fully effective. Section 10.03. Headines The use of headings in connection with the various articles and sections of this Trust Agreement is solely for convenience, and the headings are to be given no meaning or significance whatever in construing the terms and provisions of this Agreement. REVOCABLE LIVING TRUST AGREEMENT Page 17 Section 10.04. Internal Revenue Code Terminolo~y As used herein, the words "gross estate", "adjusted gross estate", "taxable estate", "unified credit", "state death tax credit", "maximum marital deduction", "marital deduction", and any other word or words which from the context in which it or they are used refer to the Internal Revenue Code shall be assigned the same meaning as such words have for the purposes of applying the Internal Revenue Code to a deceased Settlor's Estate. Reference to sections of the Internal Revenue Code and to the Internal Revenue Code shall refer to the Internal Revenue Code amended to the date of such Settlor's death. REVOCABLE LIVING TRUST AGREEMENT Page 18 SPECIAL DIltECTIVES OF JAY W. ROUSH I, JAY W. ROUSH, a resident of the County of Cumberland, Commonwealth of Pennsylvania, being of lawful age, and of sound and disposing mind and memory, and not acting under. duress, fraud, or undue influence, hereby make, publish and declare this to be my Special Directive, and I incorporate this into THE JAY W. ROUSH REVOCABLELIVING TRUSTAGREEMENT. FIRST The natural objects of my affection are: 1) My Children - ROXANNE WEAVER CONSTANCE ADAMS EDWARD ROUSH PATTY. CHARLES ROLTSH JODI L. WAGNER SECOND (/~3~9 I direct that all estate and inheritance taxes payable as a result of my death, not limited to taxes assessed on property, shall be paid out of the residue of my Estate, and shall not be deducted or collected from any League, Devisee or Beneficiary hereunder. THIRD In the event any of my named Beneficiaries should predecease me, all of that person's share of the Trust Estate is to be divided equally among that person's issue per stirpes. FOURTH I direct that before any distribution of the assets of the Trust Estate to the named Beneficiaries certain specific distributions, if any, shall be made from the assets as set forth on the list attached hereto and marked "Exhibit A." FIFTH ~e /.~~'ec~ l3/~/ SIXTH td0'1'A~t1A1.5E~ ,,Ip~f C. BRICKI-t~oo~~eerr~~ ~~ Tom' s pec.13, 2t~U4 ~y comma REVOCABLE LIVING TRUST AGRE Page 19 ~~LG~ ~s ter' ~~6,y?a~. .:.... r~:: ~~itL'.L a~ ~~'. C14P~~~.t~ ~~u~, a~~~r~ F'c t~pp°( ~iJ~ii1 ~Vil~l., ~r~{~CF~~'P1Q!'~f ~ A try Com~issien ~~ 7, 2 ~~ r `sc.! - rJc~,nIA~D ~2E0~.2 Jl~or~r7- ,~-~ a (= Gr L s / ~'~.~- ZooG- ~'~ ~g/ ~~, REVOCABLE LIVING TRUST AGREEMENT Page 20 DATED to be effectivethis ~_day of ~ ~~ _,19~ SETTLOR: JAY W. ~ OU ACCEPTED BY TRUSTEE: JAY W H COMMONWEALTHOF PENNSYLVANIA COUNTY OF CUMBERLAND This instrument was acknowledged before me on the date herein set forth by JAY W. ROTJSH as Settlor and Trustee to certify which witness my hand and seal of office. REVOCABLE LIVING TRU5T AGREEMENT Page 21 THE JAY W. ROUSH REVOCABLE LNING TRUST AGREEMENT Declaration of Intent The undersigned hereby declares that as Trustee of THE JAY W. ROUSH REVOCABLE LNING TRUST, he is acquiring and will hold in the name of JAY W. ROUSH, but without further reference to his fiduciary capacity, all items listed on the attached schedule(s) hereto and incorporated herein as amended, from time to time, as well as household furnishings, automobiles, jewelry, bank accounts, securities, bonds, clothing and other personal property of any kind in his name and henceforth such assets shall and will belong to said Trust and not to him individually; and he further hereby declares that, except to the extent of interest provided to him under the terms and provisions of said Trust, he has no personal interest in any of the above itemized personal properties, it being intended that this Declaration constitutes an_ affirmation of Trust ownership and an assignment to this Trust and shall be binding on his heirs, administrators, executors and assigns. ~~1N WITNESS WHEREOF, the undersigned has executed this instrument this ~ day of -lam ,19 Q ~- . /Y 3AY W. U Settlor/Trustee COMMONWEALTHOF PENNSYLVANIA COUNTY OF CUMBERLAND BEFORE ME, the undersigned authority, on this day personally appeared JAY W. ROUSH, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that he executed the same for the purposes and consideration therein expressed and in the capacity therein staled. SUBSCRIBED AND SWORNthis~_dayof ~> ,19 ~~ . ~~ Godel,~No ublic ommonwea~thof Pennsylvania AA eltenham Twp., Montgome Y ~mmission Exp}res pot 8, 2~Opj~ 4 D Il~'t0 ,~ MUST ONE ~Op~gT1ES TRAZ`js ~ oboe h~es~ pERS fimn~`~ date ,~ ~'~r1r`sde 1. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ~-~-~" .~ 28 29 ~-~----"' 30 ?_-- ~,~" IlWESTMENT SAVINGS TRANSFERRED INTO THE TRUST (i.e., stocks, bonds, C.D.'s) Date No. Account # Location Transferred 1 ~h~ ,$cc6~i ~ ~ S ~ ©L~(d t Z~ ~7~ 2 ~ ~ .- H~~ ,a rr~cj :n~ 4 ` 5 6 2 ~- w~ ~' L. ~-~ ~ a o o ©o v l 6 ~~ 8~ ~.~.~.~;~ ~ go 0 6~$ 2z~- Rr~ ,~-~,.~ ~ 3 0 4~ ~ g ~'~ z z-/ X 2 3 ~c s 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ~Gf/Y` ~. _ ~- T ~. /1 n s1 n inn ~.ti.i ~ ^ 7 26 27 28 29 30 } REAL ESTATE PROPERTIES TRANSFERRED INTO THE TRUST Date No. / Location / Transferred 2 d~' r -G %~ 3 4 S 6 7 8 9 10 11 12 13 14 1S 16 17 18 19 20 21 22 23 24 2S 26 27 28 29 30 A• Settlement Statement U.S. Department of Housing and Urban Development , r OMB Approval No. 2502-02.65 B. T of Losn 1.^ FHA 2. ^ FmHA 3. ^Conv. Unins 4.(~ VA 5.^ Conv. Ins. 6. File Number 39061ROUSH 7. Loan Number 0278629811 8. Mortgage Insurance Case Number C. NOTE: This form is famished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent aze shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. NAME OF BORROWER: Chazles W. Roush and Linda M. Roush ADDRESS OF BORROWER: 304 South 31st Stree Harrisbur PA 17109 E. NAME OF SELLER: The Jay W. Roush Revocable Living Trust ADDRESS OF SELLER: 5 South Hanover Stree Cazlisle PA 17013 F. NAME OF LENDER: SunTtvst Mortgage, Inc. ADDRESS OF LENDER• G. PROPERTY 916 Pine Road LOCATION: Cazlisle, PA 17013 H. SETTLEMENT AGENT: SHUMAKER WILLIAMS, P.C. 3425 SIIvIPSON FERRY ROAD, CAMP HILL, PA 17011 PLACE OF SETTLEMENT: 425 SI)VfPSON FERRY ROAD CAMP HILL PA 1701 I L SETTLEMENT DATE: J. SUMMARY OF BORROWER'S TRANSACTION K SUMMARY OF SELLER'S TRANSACTION 100. R SS D FR M BO O R 400. R AM D T L n .el w e1400 4 4 0. 4. 4 't in ' /tw /4 0 / 4 e /4/20 7 / 4 2/ 1/200 40 0 t / 1 A e o 4 Ass 109. hool Tax 11/24/2009 t / / 10 804.0 4 9 ch of Tax 1/24/ 00 t / 0/2010 4 to 4 112. 4 t 120.GROSS AMOUNT DUE FROM BORROWER ~ 102,260.65 420.GROSS AMOUNT DUE TO SELLER ' gg,0pg,75 200.AMOUNTS PAID BY OR OV BEHALF OF BORROWER SOO.REDUCTIONS OV AMOUNT DUE TO SELLER 201. it r e t n 5 .E cess d osit e i s i w 0 . xist'n ub'ect to 0 xi tin n t 4 4.P t m I 2 SOS.P o ofs c nd a an 20 .Princi al amount f Iler financin 506.Princi al amount f seller financin 7 7. 209 50 09 5 9 20 0 Adjustments for items unpaid by seller Adjustments for items unpaid by seller 1 i / 0 51 i /town to 1. to un t s n o 1 e amen to 0 14. to 14, t 6. 17. to 219. to 519, to 220.TOTAL AMOUNTS PAID BY OR IN BEHALF OF BORROWER ' 102,260.65 520.TOTAL REDUCTIONS IN AMOUNT DUE SELLER ~ 12,007.98 300.CASH AT SETTLEMENT FROM/f0 BORROWER 600.CASH AT SETTLEMENT TO/FROM SELLER 301.Gross amount due from borrower line 120 102 260.65 601.Gross amount due to seller line 420 98 005.75 302. s am ants aid b /for borrower line 220 102 260.65 602. Less reductions in amount due seller line 520 12 007.98 303.CASH ®From ^ To BORROWER ~ 603.CASH ®To ^ From SELLER ~ gg,997,77 ~' N~+ !~ PAGE 1 ~ HUD-1 (3-86) RESPA, HB 4305.2 ozoer ~Ma sr.u.~. ~.. laa> ra}ssss - ~..., c.~..~.a U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT PAGE 2 L. Settlement Cha es 7 o = Paid From Paid From 'vii i i I' 7 w • Borrower's Seller's Funds At Funds At 702. to Settlement Settlement t le '704. to 800. Items Pa able In Connectlon With Loan 1. i ee n % t I t O 815. to 900. Items R aired B Lender To Be Paid In Advance 0. / r o 03. i r ars to 905. ears to 1000. Reserves De sited With Lender 1 02. o in u ce h 1 e 4 r 7. 1008. months er month 1009. 1100. Title Cha es 1 1. I m nt r cl i f to 2. t t 4 t 1 7. i cl ve' r • ~ -- ~~~ ~ --- incl 't 1 4 "t..: a __ 1112. to 1 113. to 1200. Government Recordin and Transfer Cha es 1 2. / 7 1204. Pin Certification Recorder of Deeds 20.00 1205. 1300. Additional Settlement Cha es t 'v to r 1308. to 1309. to 1400. Total Settlement Charges (enter on lines 103, Section J and 502, SectionK) ~ 4,254.90 3,485.75 a.cnurr~,n uvi~ DATE: 1/2~ 009 I have car lly reviewed the HUD - 1 Se a ent element and to the best of my knowledge and belief, it is a true and accurate statemen4 oFait2tecmpts and dis se ism ee o~ unto in s transaction. I further certify that I have received a co f the HUD - 1 Settlement Statement. The Jay W. Roush Revocable Lr ' g Taut Borrower _ Seller C arles W~~~~Ryyous]~h ~ ~ j~~ Jodi agner, Trustee ~~~Y ~l IlV L J '~ ~' t Borrower yu/J _ eller Linda M. Roush nstance Adams, Truste The HUD-1 Settlement S ent whic I hav epared is a true and accurate account of this transaction. I have caused the funds to be disbursed in accord- ance with this statement. SHUMAKER WILLIAMS, P.C. N/~N Settlement Agent 11/24/2009 _ Date I~ WARNING: It is a crime to knowi m e else statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details s itle 18 U.S. Code Section 1001 and Section 1010. ' 39061ROUSH Tax Parcel No. 08-12-0336-036 THIS DEED, MADE THE~fJay of ~'~E~t'~~in the year of our Lord two thousand nine (2009). BETWEEN THE JAY W. ROUSH REVOCABLE LIVING TRUST dated December 5, 1997, of 5 South Hanover Street, Carlisle, Cumberland County, Pennsylvania, by its Joint Successor Trustees, JODI L. WAGNER, of 85 South Side Drive, Newvipe, PA 17241 and, CONSTANCE ADAMS, of 50 Parker Street, Carlisle, PA 17013, party of the first part, Grantor, and CHARLES W. ROUSH, and LINDA M.1tOUSH, husband and wife, of 3286 Wakefield Road, Harrisburg, Dauphin County, Pennsylvania 17109, parties of the second part, Grantees: WITNESSETH, that in consideration of Ninety Seven Thousand One Hundred Seventy Five and no/hundredths ($97,175.00) ---Dollars, in hand paid, the receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey to the said Grantees, their heirs and assigns, as tenants by the entirety, ALL THAT CERTAIN tract of land together with the improvements erected thereon situate in Dickinson Township, Cumberland County, Commonwealth of Pennsylvania, bounded and described as follows: BEGINNING at a stake said stake being at the intersection of the southern line of the Pine Road and the eastern line of a lane leading to property now or formerly of Samuel Stuart, et ux. (incorrectly referred to as "Grantor" in prior deed), thence North 53 degrees 47 minutes East along said southern line of said Pine Road a distance of 108 feet, more or less, to a stake; thence South 8 degrees 55 minutes East along property now or formerly of Samuel Stuart, et ux. (incorrectly referred to as "Grantor" in prior deed), a distance of 314.5 feet more or less, to a stake; thence North 79 degrees West along still property now or formerly of Samuel Stuart, et ux. (incorrectly referred to as "Grantor" in prior deed), a distance of 182 feet to a stake on the eastern side of said lane; thence North 10 degrees 12 minutes East along the eastern line of said lane a .distance of 316.2 feet, more or less, to a stake; the place of BEGINNING. THE ABOVE description being according to a survey of T. O. Bietsch, dated September 15, 1958. HAVING thereon erected a residence known as and numbered 916 Pine Road, Carlisle.,. PA 17015. BEING the same premises which J. W. Roush by deed dated November.l9, 1997 and recorded February 20, 1998 in the Office of the Recorder of Deeds, in and for Cumberland County, at Carlisle, Pennsylvania, in Deed Book 172, Page 376, granted and conveyed to Jay W. Roush in Trust and as Trustee for Jay W. Roush, which is one and the same as the Grantor herein. M~s A COPY of a "Notarized Summary of Trust" for '"The Jay W. Roush Revocable Living Trust Agreement" is attached hereto as Exhibit "A." Paragraph One of that Summary provides that the Settler, Jay W. Roush was to serve as Trustee until his death. Paragraph two of that Summary provides that upon the death of Jay W. Roush, Jodi L. Wagner and Constance Adams became Joint Successor Trustees. THE SAID Jay W. Roush died on April 19, 2009 a resident of 916 Pine Road, Carlisle, Cumberland County, Pennsylvania 17015. AND the said Grantors do hereby covenant and agree that they will warrant SPECIALLY the property hereby conveyed. IN WITNESS WHEREOF, said Grantors has hereunto set their hands and seals this day and year first above wrinen. Signed, Sealed, and Delivered in the Presence of Commonwealth of Pennsylvania The Jay W. Roush Revocable Living Trust Dated December 5, 1997 By: (SEAL) JODI AGNER, Trustee ~.U YflJ~L il.C GL Q't'u~ (SEAL) CONSTANCE A AMS, Trustee }SS. County of Cumberland •~ r/ On this, the ~ d ~dav of N~ ~h~ ~ 2009 before me. the undersigned officer, personally appeared JODI L. WAGNER, Trustee; and CONSTANCE ADAMS, Trustee, known to me (or satisfactorily proven) to be the - persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and. official seal.. "aw.,~ sue,,. 1 do hereby certify that the precise residence and complete post office address of the within named Grantee is Anthony J. Foschi, Esquire Attorney for Grantees r EX#~Ii'A' d~ a ~U~"~` ~ ~ NOTARIZED SUN111L.4RY OF TRUST THE JAY W. ROUSH REVOCABLE LIVING TRUST AGREEMENT The undersigned hereby certifies that he created a Revocable Living Trust. This Trust is known as: THE AY W. ROUSH REVOCABLE LNING TRUST, dated the ~_ day of (~ 19~_. JAY W. ROUSH, Settlor and Trustee, having an address at 916 Pine Road, the City of Cazlisle, the Commonwealth of Pennsylvania, the County of Cumberland. IT TS AGREED BETWEEN THE PARTIES HERETO AS FOLLOWS: Description of Trust The party hereto desires to confirm the establishment of a Revocable Trust on this date, for the benefit of the Settlor and containinghereinrhe following provisions: The Settlor is designated as the Trustee to serve until his death, resignation or incompetence. 2. Upon the end of the terms of the original Trustees, JODI L. WAGNER and CONSTANCE ADAMS aze designated as Joint Successor Trustees. 3. Any Trustee/Settlorhas the power and authority to manage and control, buy, sell, and transfer the trust property, in such manner as the. Trustee may deem advisable, and shall have; enjoy and exercise all powers and rights over and concerning said property and the proceeds thereof as fully and amply as though said Trustee were the absolute and qualified owner of same, including the power to grant, bargain, sell and convey, encumber and hypothecate, real and personal property, and the power to invest in corporate obligations of every kind, stocks, preferred or common, and to buy stocks, bonds and similar investments on margin or other leveraged accounts, except to the extent that such management would cause includability of an irrevocable trust in the Estate of a Trustee. 4. Following the death of the Trustee, the Trust continues or is distributed in whole or in part for the benefit of other named Beneficiaries according to the terms of the Trust 5. While Settlor is living and competent, except when there shall be a Corporate Trustee, Trustee may add money to or withdraw money from any bank or savings and loan or checking account owned by the Trust 6. Unless otherwise indicated to a prospective transferee, the Trustee has full power to transfer assets held in the name of the Trust and subsequenttransferees are entitled to rely upon such transfers provided the chain of title is not otherwise deficient. ' 7. The Trust Agreement alsg states that any bank, corporation, brokerage firm or other entity or any individual may conclusively presume that: the .Trustee has full gowe[. and .authority and such person or institution shall be held harmless and shall incur no liability by reason of so presuming. 8. The sites of the Trust is the Commonwealth of Pennsylvania TRUST SUI+IIYIARY Page 1 9. The use of this Summary of Trust is for convenience only and the Trust solely controls as to provisions and interpretations,and any conflict between this abstract and the Trust shall be decided in favor of the Trust. IN R'ITNESS WHEREOF, the party has hereto executed this Summary of Trust this date. SETTLORlIRUSTEE: l JAY W,r O COMMONWEALTHOF PENNSYLVANIA COUNTY OF CUMBERLAND On this the ~ day of ~ r~i , 19~_, before me, a Notary Public, personally appeared JAY W. ROUSH, personalty known to me to be the person whose name is subscribed to this instrument, and acknowledgedthat be executed it for the purposes herein expressed. NotarfelSaal Public;CommonwealthofPennsylvaria MYeftenhnmGTiv~,t'Mme •. ~ommlealon~ Ires0a,8,2~pp~ :,,:•.u,~,u•~'',::~o, lL• ..:.fi.. u }Fy: tie; TRUST SUMh24RY Pace 2 Edmunds used Ford Ranger car appraisal. Used Ford car pricing. 119 Reviews iWrite a Review Fuel Economy 23 mpg • Pricing RPViews & Soecs • Photos & Videos PARTNERSPOTLIGHT >ren~c:ao cansltnt . rARFpX~ Check Us.d Car History Reveal cosily hidden problems. 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Window Stickers: Trade-In I Pnvate PaKV I Dealer Retail Buying a New Car? Get new car pricing in your area. Select a Make ~ Meat a: iNodet ~! ZIP. ' 17013 Buying This Car Used? Search 2002 Ford Ranger Listings Near You Zip Code: `.17013 PARTNERSPOTf.IGHr :aonsor:koconrzyr A.utoTrader.com: Find Your Car NQr Search over 3 mi6ion whlde listings and find `"` the car you Want NOW! ;,,~~ NIA 6115/09 6:12 PM TRUE MARKET VALUE Find Out What Others Are Paving For The Car With Edmunds N®you get a customrzed price estimate based on your Zip Code, your car, and your debited options. t RPVEtr+'i;£taGtlr Going to a car dealer.,. • •.. •. . . Grp to Deaiet Ratings & Reviews CLL~# TIPS R ADVICE t0 Steps to Buying a Used Car 10 Steps to Selling Your Car CoMessions of a Car Salesman Fue! Economy Canter Car Safety Guide Car Audio & Electronla Canter ~ PsediMed~~ Prictng~Trends `; s< ;z a viii the price of the car q f' you grant go up or do~vn~ ;. :>~ , ~' Find out now s http://www.edmunds.com/used/2002/ford!ranger/100002598/options.html?tmvactlon=vdpresuit ~~ Page3of4 Page: 1 Document Name: untitled DDHIST Demand Deposit Display History Request ALLTRANS Alpha key JAYWRRLTOI Last stmt 04/13/09 S --Date-- ----Description----- -Serial Nbr- -Reference- ------Amount------ * 04/03/09 DAILY BALANCE 6,822.40 * 04/07./09 DIRECTV INC 1054 00077900000 (60.65) CHECKPYMT 090406 1054 * 04/07/09 LIFE ALERT EMERG 00077900000 MONITORING BB015697-0 ~~ DAILY BALANCE * 04/10/09- CHECK 1063 06711701900 04/10/09 FH PFFS HLTH PREM 00077900000 090409 80152942701 * 04/10/09 DAILY BALANCE (49.95) (1,000.00) (96.00) 5,615.80 DDDHISTREQ _ DDDHISTBAL DDDMAIN _ DDDACCT DDDINT There is additional information before. and after this page. G1v20000203 COMMAND =__> F2=Retrieve F3=Exit F4=CRFwindow F7=Backward F8=Forward EJCH!®~BT "C" 6017 05/05/09 Date: 5/6/2009 Time: 11:18:03 AM ~~.®NATIONAL ,~r^ WESTERN LIFEINSURANCECOMPANY July 13, 2009 Stephen Tiley Attorney at Law 5 South Hanover St. Carlisle, PA 17013 Certificate Numbers: 0101123437, 0101123443 and 0101123444 Immediate Annuity: 0101123436 Annuitant: Jay W. Roush, deceased Dear Mr. Tiley: We are sorry to learn of Mr. Roush's death. Please extend our condolences to his family. The designated beneficiaries of all four annuities are ROXANNE WEAVER, CONSTANCE ADAMS, ED CHARLES, JODI WAGNOR and PATTY BARONI. As co-beneficiaries, they will receive equal shares of the policy proceeds„ Certificate numbers 0101123437, 0101123443 and 0101123444 were issued as Individual Retirement Annuities. Contributions made to the annuities were prior to federal income tax withholding. Under Internal Revenue Code, death benefit distributions are taxed to the beneficiary as ordinary income. .Listed below is the Certificate Value of each annuity as of the date of death: 0101123437 - $11,904.34 0101123443 - $ 5,795.17 0101123444 - $ 5,795.17 Annuity number 0101123436 was issued as a Single Premium Immediate Annuity. Contributions made to this annuity were also prior to federal income tax withholding. Distributions are full taxable to the beneficiary as ordinary income. As co-beneficiaries, each will need to elect either a lump sum payment of a 1/5 share of the current commuted value of $1,949.67, or continue to receive a 1 /5 share of the remaining monthly payments of $200.00 until the payments conclude in April 2010. 850 EAST ANDERSON LANE AUSTIN, TEXAS 78752-1602 512-836-1010 AUTOMATED VOICE RESPONSE TOLL-FREE 888-695-5001 •WATS 800-531-5442 CLIENT SERVICES DIRECT WATS LINE 800-922-9422 CLAIMS 800-531-5442 apWVPNATIONALWESTERNLIFE.COM 18~ sr ~r°NATIONAL ~~ WESTERN ~ LIFE INSURANCE COMPANY Stephen Tiley July 13, 2009 Page 2 The claims will receive prompt consideration upon receipt of the following documents: 1. The enclosed Claimant Statements completed by each beneficiary. 2. The enclosed W -9 forms completed by each beneficiary. 3. One ce rtified death certificate. 4. The on ginal policy contracts, if available (top 2 pages of contract). Should you have any questions, please contact our office at 800-531•-5442, ext. 585. We will be happy to assist you. Cordially, POLICY BENEFIT DEPARTMENT Enclosures do 850 EAST ANDERSON LANE AUSTIN, TEXAS 78752-1602 512-836-1010 AUTOMATED VOICE RESPONSE TOLL-FREE 888-695-5001 •WATS 500-531-5442 CLIENT SERVICES DIRECT WATS LINE 800-922-9422 CLAIMS 800-531-5442 d~Mr• K®~ WWW.NATIONALWESTERNLIFE.COM , r Prudential `"`" Annuity Services P.Q. Box 13467 Philadelphia, PA 19176 Advanced Series APEK II Annuitq Annuity Transaction Confirmation Page 1 of 3 Apri120, 2009' >02935 7217751 002 092001 Investment Professional: JAY W. ROUSH TROY H. LANDIS 916 PINE RD AMERICAN PORTFOLIOS FIN SVCS INC CARLISLE, PA 17013 74 WEST POMFROT ST CARLISLE, PA 17013 Annuity #: E0456922 Owner Name: Jay W. Roush Type: IRA Annuitant: Jay W. Roush To obtain the most up-to-date information about your account, please visit our interactive website: www.prudentialannuities.com, or call the Annuity Service Center at: ', 1-888-778-2888 (Investor line) / 1-800-513-0805 (Financial professionals). Our rcpresentatives are available to assist you Monday through Thursday (8:00 a.m. - 7:00 p.m. EST), and Friday (8:00 a.m. - 6:00 p.m. EST). Please recie~~ ~-oiu statement and contact us ~~~ithin 30 d:~~~s if }-ou find am- information ~-ou beliel-e to be inacctuate. Total Investment Value $11,836.26 Your Benefit Values as of Agri! 20, 2009 Guaranteed Return Option (GROG Pins The Benefit Fund Transfer(s) described below are associated with your election of Guaranteed Return Option (GRO) Plus, an optional. benefit designed to guarantee your account value and provide opportunities to capture greater guarantees. Your current guarantee(s) is/are as follows: $12,332.32 maturing oa 04/12/2013 In order to manage your Guaranteed Return Option (GROj Plus living benefit guarantee through all mazket cycles, each business day our mathematical. formula determines if any portion of your Account Value should be transferred to or from the Fined Allocations. At any given time, some, aIl or none of the Account Value may be allocated to the Fined Allocations. If all of your Account Value is allocated to a Filed Allocation, then all or a portvon of that amount may be transferred fives the Fined Allocation and re-allocated to the Sub-accounts, according to the following hierarchy: (ij first according to any asset allocation program that you may have in effect (iij if no such grogram is in effect, then in accordance with any automatic rebalancing program that you may have in effect and (iiij if neither such program is in effect, then to the AST Aloney Market Sub-account. With respect to any amounts held within the Filed Allocations, we can give no assurance how long the amounts will reside them or if such amounts will transfer out of the Filed Allocations. If you make additional purchase payments, they will be allocated to the Sub-aocounts according to your allocation instructions and they may or may not cause the formula to transfer mone}r in or out of the Filed Allocations. Once the purchase payments aze allocated to your Annuity, they will also be subject to the formula, which may result in immediate transfers to or from the Fined Allocations: These transfers in no way impact any guazantee that has already been locked in. Aay amounts invested in these Fred Allocations will affect your ability to participate in a subsequent market recovery. Conversely, the Account Value may be higher at the beginning of the market recovery , e.g. more of the Account Value may have been protected from market decline and volatility than it otherwise would have been, had the benefit not been elected. Higher balances in the Filed Allocations ma}~ be more likely to occur during periods of decline or volatility that affect the Account Value and/or due to withdrawals. Please refer to your contract and prospectus for complete details, or contactyour financial professional ~ EXkI~~ «~~ A.ge„r IIJ4B£?E~B'%r UlliFw ?~Z20.1C. 02935 7217751 004709009033 oollDll00002 ~, ,. "s: t,^, Advanced Series APES ~~ Ariria~~tga• Annnit~y Traasac#ioa Confsrma#i~n Apri120, 209 Page 2 of 3 Investment Transaction Activi~/ Transaction Investments ~ of United Unit Frice/ 'ii'alno/ Date *Interim Drxbe~~ *M!VA *Acconaet Vai~xe . 04/20/2009 Transaction Type: Benefit Fund Transfer GPGRO 04/12/2013 2.800% (128.20) fi2.90 ($13i.lOJ GPGRO 04/12/2013 2.470% (197.52) X2.63 - ($200.15) AST Money Market 31.56530 10.39532 $331.25 Transaction Total: ~fD.~ Transactions in your variable annuity contract are priced at the end of the business day (generally 4 p.m. Easter? timo) on the day the transaction was processed. The mazket value adjustment ('MVA') is an adjustment we make to your account that is calculated based on a formula dtsczibtd in pour prospectus. This adjustment may be positive or negative. GeneraIIy speaking, you can avoid an 1VIVA ifyour withdrawal occurs at, or for some contracts, near the end of the guarantee period. The particular "wndow' during which you may make such an ~A-iret erithrlrawal varies among different annuity products - - check your prospectus for derails. The figure shown in this statement for account value includes the effect of any MVA to which you would be subject if you made a withdrawal as of the date of this statement In cant:as#, the figure shown for interim value does not take a~ MVA into account Account Value as of April 20, 2009 Variable Investments # of Units Unit Frice Valve AST Money Market 188.16763 10.39532 $1,956.06 Total Variable Investments $1,956.06 Fixed Investments Acconat MVA Interim Valve Valise GPGRO 04/12/2013 3.43a"io vvOv.2I j$•`t3.75) $'v3i.9Fi GPGRO 04/12/2013 3.290% $1,813.12 ($67.53) $1,$80.65 GP GRO 04/12/2013 3.510% $1.,456.62 ($46.91) $1,503.53 GPGRO 04/12/2013 3.300% $1,527.36 {$70.66) $1,598.02 GP GRO 04/12/2013 3.050°io $2,390.31 ($17.99) $2,408.30 GP GRO 04/12/2013 3.050°/w $1,043.16 $8.94 $1,034.22 GP GRO 04/12/2013 3.050% $406.36 $3.27 $403.09 GP GRO 04/12/2013 2.800% $355.45 $2.31 $353.14 GP GRO 04/ 12/2013 2.800°'° $48.18 $0.89 $47.29 Total Fixed Investments $3,880 20 Total Investment Value '.$i 1,836,26 Total Investment Value reflects all charges that have been imposed, as of this statement date, but does not include charges that may be imposed in the future. ~l July 07, 2009 JAY W ROUSH RLT DTD 5-12-97 C/O JODI WAGNER & CONSTANCE ADAMS CO-TRUSTEES 85 SOUTH SIDE DRIVE NEWVILLE, PA 17241 Re: Jay WRoush -Deceased Annuity Contract No. 304928 Dear Jay W Roush Rlt Dtd 5-12-97: Please find enclosed our check in the amount of $12,212.95 representing the total claim payable for the above named contract. The claim check amount was calculated as follows: Gross Claim Amount $12,132.12 3.00% Interest from Date of Death $80.83 Less Federal Tax Withholding $0.00 Less State Tax Withholding $0.00 Total Check Amount $12,212.95 As a result of this payment of proceeds, $12,212.95 will be reported as income to the Internal Revenue Service (IRS). You will receive a 1099R tax form reflecting the distribution amounts. We hope this claim has been handled as desired. If you have any questions, please contact our office at 1-888-221-1234. Sincerely, Katie Bowen Annuity Service Technician cc: - Enclosure I~31T "E" EXHIBIT ~~- 0 . NSORANCS MARR[111AC[ STANDARDS A33OCIATION P.O. Box 71216 • Des Moines, IA 50325 • 1-888-221-1234 • 515-221-0002 • 515-221-9947(Fax) • www.american-equity.com