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HomeMy WebLinkAbout04-08-10' 15056041114 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 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 09 00849 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 201-18-3610 08312009 01041926 Decedent's Last Name Suffix Decedent's First Name MI THOMPSON ALBERTA C (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix' Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 0 1. Original Retum 0 4. Limited Estate 0 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 Retum 3. Remainder Return (date of death prior to 12-13-82) 0 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes 0 11. Election to tax under Sec. 9113(A) (Attach Sch. O) 0 4a. Future Interest Compromise (date of death after 12-12-82) 0 7. Decedent Maintained a Living Trust (Attach Copy of Trust) C] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number STEPHEN D. TILEY 717-243-~~ E~ ;~.,• a Firm Name (If Applicable) r..~ .. r ` REGISTE USE Y ~~^7 FREY AND TILEY ~ ~ ,~'T« First line of address ~ ~ ~ ~--.~ 5 SOUTH HANOVER STREET ~ ~ ~ ~` ~` Second line of address , ~~ 7 ~ ~ a CrJ City or Post Office State ZIP Code DATE FILED CARLISLE PA 17013 Correspondent's a-mail address: s t i l e y@ f r e yt i l e y. c om Under penalties o perjury, I declare that I ave examined this return, including accompanying schedules and statements, and to the best o my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge SIGNATURE OF PERSON R ONSIBLE FOR FI NG RETURN DATE ~, ADDRESS _ ~ a D, MARY ELLEN GROVE, 14 WOODCREST DR., CARLISLE, PA 17015 SIGN E 0 EPARER~HER THA `REPRESENTATIVE DATE ~~ ~' .~i0 ADDRES STEPHEN D. TILEY, 5 SOUTH HANOVER STREET, 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: ALBERTA C THOMPSON 201-18-3610 RECAPITULATION 1. Real estate (Schedule A) ........................................... 1. NONE 2. Stocks and Bonds (Schedule B) ...................................... 2. 10 8 3 8 2 2.81 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. 7 5 6 3 2 4.14 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ........ 6. NONE 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ........ 7 216 5 6 9 . 0 0 8. Total Gross Assets (total Lines 1-7) .................................. 8. 2 0 5 6 715.9 5 9. Funeral Expenses & Administrative Costs (Schedule H) ................... . 9. 4 7 318.16 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. 3 3 0 2 . 7 9 11. Total Deductions (total Lines 9 & 10) ................................. 11. 5 O 6 2 O . 9 5 12. Net Value of Estate (Line 8 minus Line 11) ............................. 12. 2 O O 6 O 9 5 . 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... 13. 2 5 0 0 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... 14. 19 81 O 9 5 0 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 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 4 5 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate x, 15 $1, 9 81, 0 9 5. 0 0 1 s. 2 9 716 4.0 0 19. TAX DUE .......................................................1s. 297164.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 L 15056042115 15056042115 J REV-1500 EX Page 3 201-18-3610 Decedent's Comalete Address: File Number DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER LBERTA C THOMPSON 201-18-3610 STREET ADDRESS 1 LONGSDORF WAY CITY STATE ZIP CARLISLE PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments $290,000.00 C. Discount $14,858.20 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 297164.00 Total Credits (A + g + C) (2) 304858.20 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) 7694.20 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT _W....... ~ _ ..v, . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................... ~ 0 b. retain the right to designate who shall use the property transferred or its income : ................ c. retain a reversionary interest; or ...................................................... d. receive the promise for life of either payments, benefits or care? ............................. ~ a 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. ~ ^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. . ~ ....w,~. ~ ~ q,. 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. §91`16(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. 217 REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Alberta C Thompson, Ms. 21 09 00849 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. See Schedule B-1 attached $1,083,822.81 TOTAL (Also enter on line 2, Recapitulation)~$ 1,083 (If more space Is needed, Insert additional sheets of the same size) 1 ESTATE OF ALBERTA C. TFIOMPSON 21-09-00849 SCHED~TLE B-1 1) Fidelity Investments c/o Fidelity Distributors Corp. 82 Devonshire Street Boston, MA 02109 Account No.: Y94-748072: SEE EXHIBIT "A" 106.172 Advisors Inner Circle FD II at $10.81 1,147.72 149.927 American Beacon FDS at $15.30 2,293.88 726.439 DWS Mun Tr at $11.54 8,383.11 48.741 Fidelity Invt Tr at $28.41 1,384.73 .2331.57 Fidelity Municipal Income at $12.32 28,724.94 1612.03 Fidelity Short-Intermediate Muni Income at $10.58 17,055.28 272.719 Fidelity Secs Fd at $ 8.67 2,364.47 22.174 Fidelity Select Portfolios at $37.29 826.87 231.788 Goldman Sachs Tr at $9.92 2,299.34 46.667 John Hancock Cap Ser at $23.19 1,082.21 52.694 Hartford Mut Fds Inc at $27.62 1,455.41 58.643 Janus Invt Fd at $23.25 1,363.45 56.363 Lazard Fds Inc. at $16 ?8 917.59 103.133 MFS Ser Tr I at $13.03 1,343.82 210.997 Manning & Napier Fd Inc New at $7:47 1,576.15 39.01 Morgan Stanley Instl Fd Trust at $24.08 939.36 756.473 T. Rowe Price Tax Free Income Fd at $9.64 7,292.40 77.287 T Rowe Price Mid Cap Value Fd at $18.66 1,442.18 200.02 Fidelity Cash Reserves at $1.00 200.02 Estate of Alberta C. Thompson SCHEDULE B-1 Page 1 of 3 a F f 10101.17 Fidelity AMT Tax-Free Money Fd at $1.00 Sub-Total: 92,194.10 2) 848 Shares PP&L Corporation Common Stock at $29.43 3) ~ Edward Jones 201 Progress Parkway Maryland Heights, MD 63043-3042 Brokerage Account No.: 896-09569-1-3 SEE EXHIBIT "J" Edward Jones Money Market Account 10,000 Philadelphia Authority Bonds at $.9169 10,000 Southeastern PA Transit Authority at $.9655 50,000 JPMorgan Chase & Co. at $.8864 1,607.159 American Balance Fund at $15.27 3,421.899 American High Income Municipal Bond at $12.97 589.646 Capital Income Builder at $45.89 919.187 Capital World Growth/Income at $31.62 18,052.034 Federal PA Municipal .Income Fund at $10.36 15,808.049 Franklin High Yield Tax Freee Inc. at $9.44 3,786.100 Franklin PA Tax Free Income at $10.05 6,993.014 Goldman Growth/Income Strategies at $9.49 2,075.838 Goldman Growth Strategies at $9.46 15,667.474 Goldman High Yield Municipal Bond Fund at $7.82 1,729.617 Income Fund of America at $14.53 968.820 Investment Company of America at $24.07 5,604.393 Lord Abbett PA Tax Free at $4.81 Estate of Alberta C. Thompson SCHEDULE B-1 10,101.17 24,956.64 36,764.28 9,168.50 9,654.50 44,320.00 24,541.32 44,382.03 27,058.85 29,064.69 187,019.07 149,227.98 38,050.31 66,363.70 19,637.43 122,519.65 25,131.34 23,319.50 26,957.13 Page 2 of 3 f { 4,634.528 Lord Abbett Bond Debentures at $6.85 31,746.52 4,484.406 Van Kampen High Yield Municipal Fd at $8.64 38,745.27 Sub-Total 953,672.07 4) United States Savings Bonds -Series HH SEE EXHIBIT "K" D532167HH 500.00 D5285655HH 500.00 M7446782HH 1,000.00 M7487699HH l ,000.OQ M7446783HH 1,000.00 M7534423HH 1,000.00 M7534422HH 1,000.00 M75 34421 HH 1,000.00 M7557292HH 1,000.00 M7557293HH 1,000.00 M7557294HH 1,000.00 M7557295HH 1,000.00 M7585896HH 1,000.00 M7585897HH 1,000.00 S ub-Total 13 ,000.00 TOTAL SOHEDULE B-1: 1,083,822.81 Estate of Alberta C. Tlzofnpson SCHEDULE B-1 Page 3 of 3 217 REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA p p p INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Alberta C Thompson, Ms. 21 09 00849 Include the proceeds of Iltlgatlon and the date the proceeds were received by the estate. ", .,,..,.. ~Na~~ ~~ IIGGIJGU, ~~~~G~~ auwu~nal sneers ortne same size) ESTATE OF ALBERTA C. THONIPSON SCHEDULE E-1 1) M&T Bank SEE EXHIBIT "B" Checking Account No. 9848264132 Certificate of Deposit No. 31003920248480 Accrued Interest to DOD 2) M&T Investment Group SEE EXHIBIT "C" MTB Money Market Class A 3) PNC Bank 105 Noble Boulevard Carlisle, PA 17013 SEE EXHIBIT "E" Certificate of Deposit No. 31200334469 Accrued Interest to DOD Checking Account No. 5140504502 Accrued Interest to DOD 4) Member's .First Federal Credit Union SEE EXHIBIT "F" Savings Account No. 315209-00 Accrued Interest to DOD Certificate of Deposit No. 315209-41 Accrued Interest to DOD 5) Wachovia. Bank N.A. SEE EXHIBIT "H" Certificate of Deposit No. 247412050906731 Accrued Interest to DOD 6) Susquehanna Bank SEE EXHIBIT "I" Certificate of Deposit No. 405100004291 Accrued Interest to DOD a 21-09-00849 0.00 100,000.00 144.48 195,712.46 41,313.52 118.45 59,889.67 1.88 5.00 0.00 100,000.00 211.23 100,000.00 41.22 100,000.00 411.16 Page 1 of 2 Estate of Alberta C. Tlzompsoia SCHED ULE E-1 t 7} 2003 Buick LaSabre Automobile Title No.: 59033172002 TH Sold to unrelated parry 8) Refund -The I-lartford -Auto Insurance 9) Refund - AARP Membership 9) Refund - OnStar 10) Refund -IRS re Final Form 1040 11) Estate of Dorothey K. Malone Balance of Inheritance TOTAL SCHEDULE B-1: Estate of Alberta C. Thompson SCHEDULE E-1 6,800.00 47.00 16.00 191.78 4.,136.00 47,284.29 756,324.14 Page 2 of 2 REV-1510 EX+(08-09) SCHEDULE G pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS & RESIDENT DECEDENT URN MISC. NON-PROBATE PROPERTY CsiAit yr FILE NUMBER Alberta C Thompson, Ms. _ 21-09-00849 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST QFAPPLICABLE) VALUE 1. Western & Southern Life 0 P.O.Box 2918 0 Cincinnati, OH 45273-9034 Annuity Contract No.: W001499826 Death benefits paid to Mary E. Grove, niece $216,569.46 ~ 100.00% TOTAL (Also enter on Line 7, Recapitulatior If more space is needed, use additional sheets of paper of the same size. 0 0 0 216,569 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21 t i REV-1511 EX + (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Alberta C Thompson, Ms. 21-09-00849 Decedent's debts must be reported on Schedule I. ITEM " NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. John E. Neumyer Funeral Home $710.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. Attorney Fees: Frey and Tiley $45,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: $1,160.00 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Reserve for additional probate fees $150.00 8. Advertising -Cumberland Law Journal $75.00 9. Advertising -The Sentinel $198.16 10. Filing fee -Inheritance Tax Return $15.00 11. Filing fee -Releases $10.00 TOTAL (Also enter on Line 9, Recapitulation) $ 47,318 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 & LIENS ESTATE OF FILE NUMBER Alberta C Thompson, Ms. 21-09-00849 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. n rnvre space is neeaea, inser[ aaamonai sneers or the same size. REV-1513 EX+ (11-08) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Alberta C Thom son Ms. 21-09-00849 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] Henry M. Albright, 4607 Coventry Rd., Harrisburg, PA 17109 Nephew Specific bequest of $10,000.00 pursuant to paragraph 3 of Will $10,000.00 2. May Ellen Grove, 14 Woodcrest Drive Carlisle, PA 17015 None 100% of residuary 100% of residuary ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Our Lady of the Blessed Sacrament Church, 2121 N. 3rd St., Harrisburg,PA 17110 $25,000.00 Specific bequest of $25,000.00 pursuant to paragraph 4 of Will TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ _ 25,000 it more space is neetled, insert additional sheets of the same size. LAST WILL AND TESTAMENT OF ALBERTA C. THOMPSON I, ALBERTA C. THOMPSON, widow, of South Middleton, Cumberland County, Pennsylvania (1 Longsdorf Way, Carlisle, PA 17013), being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executor or Executrices to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I further direct that all inheritance, transfer, succession, estate and death taxes, including interest and penalties thereon, which may be payable on account of my death shall be payable from the residue of my estate regardless of whether the. assets upon which such taxes are based are included in my probate estate. 2. I declare that I am an unremarried widow and that I have no children. 3. 1 give and bequeath to my husband's nephew, HENRY M. ALBRIGHT, the sum of $10.,000.00. 4. I give and bequeath the sum of $25,000.00 to Our Lady of The Blessed Sacrament Church, 2121 North Third Street, Harrisburg, PA. 5. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to my sister's niece, MARY ELLEN GROVE, her heirs and assigns. Should Mary Ellen Grove predecease me then in such event all of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to her husband, RICHARD GROVE, his heirs and assigns, per stirpes. 6. I hereby nominate, constitute and appoint my sister's niece. MARY ELLEN GROVE, as Executrix of this my Last Will and Testament, but should she predecease me or fail to qualify or cease serving as such, then in such event I nominate, constitute and appoint her husband, RICHARD GROVE, as Executor, and I further direct that neither of them shall be required to post any bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. 7. In addition to the powers conferred by law-, my hereinbefore named Trustees and Executors and their respective successors, are empowered: a. To invest. any part of the trust corpus in such securities, investments, or other property as may be deemed advisable and proper, irrespective of whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction. b. With respect to any corporation, the stocks, bonds, or other securities of which may be held, to vote in person or by proxy on any shares of stock; to consent to the merger, consolidation or reorganization of such corporations; to consent to the leasing, mortgaging or sale of the property of any such corporations; to make any surrender, exchange or substitution of such stocks, bonds or other securities as an incident to the merger, consolidation or reorganization of such corporations; to pay all assessments, subscriptions and other sums of money which may be deemed wise and expedient for the protection and maintenance of the proportionate interest of the investment in such corporations; to exercise any option or privilege -which may be conferred upon the holders of such stocks, bonds, or other securities of such corporations either for the conversion of the same into other securities or for the purchase of additional securities, and to make any and all necessary payments which l~ ~ may be required in connection therewith; and generally to have and exercise as to all such stocks, bonds and other securities, the powers of an individual owner who is not under trust obligation. c. To hold the trust corpus in one or more consolidated funds in which separate shares shall have undivided interests. d. To sell at public or private sale for cash or upon credit, or partly for cash and partly on credit, and upon such terms and conditions as shall be deemed proper, any part, or .parts of the estate, and no purchaser at any such sale shall be bound to inquire into the expediency or propriety of any such sale or to see to the application of the purchase moneys arising therefrom. e. To keep on hand and uninvested such money. as may be deemed proper and for such period as may be found expedient. f. To compromise, settle or arbitrate any claim or demand in favor of or against the trust estate. g. And authorized in the discharge of fiduciary duties, to employ counsel and to determine and to pay such counsel reasonable compensation which shall be charged against the principal or income of the trust fund, and shall further be entitled to charge against the principal or income such other reasonable expenses and charges as may be necessary and proper to incur for the proper discharge of fiduciary duties and for the proper management and administration of the trust estate. h. In making any division of property into shares for the purpose of any distribution thereof directed by the provisions of the trust, to make such division or distribution, either in cash or in kind, or partly in cash and partly in kind, as shall be deemed most expedient, and in making any division or distribution in kind may allot any specific security or property or any undivided interest therein to any one or more of such shares, and to that end may appraise any or all of the property so to be allotted and the judgment as to the propriety of such allotment and as~ to the relative value for purposes of distribution of the securities or property so allotted shall be final and conclusive upon all persons interested in the trust or in the division or distribution thereof. i. And authorized to register any shares of stock or other assets of any trust in their own names or in the name of a nominee. To retain and invest in shares of stock of my Trustee. k. To retain any investments including mutual funds which I may own at the time of my death and in addition to invest any part of the Trust corpus in such mutual fund or mutual funds as may. be deemed advisable or proper, irrespective of whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction.. I. To determine from time to time whether all or some portion of realized capital gains shall be treated as ordinary income for distribution to a beneficiary or treated. as principal to be retained as part of the corpus, and such designation need not be consistent from one year to another. ~~ IN WITNESS WFIEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on three (3) pages, this f j ~~ day of ~~~' , 2008 r. ,~' L~~~?~'~~~ G~,'% '~~'~,/~,-~ (SEAL) Alberta C. Thompson .Signed, sealed, published, and declared by ALBERTA C. THOMPSON, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~~ .~ 0~1~5 G.. ~ ~-Q!~ October 14, 2009 Stephen D Tiley JD C/O Frey & Tiley 5 South Hanover St Carlisle, PA 17013 Dear Stephen D Tiley JD: We are responding to your request for information regarding Alberta C Thompson's Fidelity Investments account(s). All information in the enclosed valuation'report(s) is (are) based on assets in the Fidelity account(s) as of the date indicated on the report(s). Valuation information is provided through a third parry valuation service provider. Fidelity does not warranty the accuracy of this information for any particular purpose, nor does Fidelity provide legal or tax advice. Consult with an attorney or tax professional 'regarding any specific legal or tax situation. We hope this information is helpful. If you have any questions about account holdings or need instructions on how to transfer the ownership of the accounts, please visit us at Fidelity.com and search under "Change Account Registration" or call us at 800-544-0003. Fidelity Inheritor Services Representatives are available Monday through Friday from 8:00 a.m. to 6:30 p.m. Eastern time. Sincerely, Carla Goins Fidelity Investments Account Re-Registration Services Representative Our file: W064671-070CT09 DDODCNFM 531298.1.0 ~" A, ~i O N N O `H O O ~ N [~ ~ O `~ M d+ !!2 H fLf O ~ ~ Ol ~~ A ~n~ ~ ~ ~ ~ ~ O cLS u " }y ~ N M N ,Li ~ 4-1 • r-I • • H 'Z'3 O ~ A J..1 • ~ r..i N ~ M ~ ~ V • N -r-I J..1 ~ N U rl , ~ ~ A 0 N -- a v 1 ~ ~-1 H Cl~ w N .. 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O t"t ~ ~ rr N [~ C1 U1 ct ct trJ c-r b C A~ U1 F-' `'C fn c-r N (D ~ ~ U1 ti O ~ a t-t C n ~~ --~ o ~~ t~ w ~ N rt w ~ rd I c-t ~ rn cD cq w ~p oC o ~ c.n O G -'i A~ rt N. 0 • m c~ ~ ro ~ n ~n r- • n n r- ~~ . ~ ~~ ~1 c-r cn cu C ~ ~- cn N- O H ~ ~ CZ J N H N t-h v O C (D c~ to C7 -~• O o ~ ro a ct H O ~ c-t ~ O n 1/ (D ~ c'r (D A~ A~ to c-r O ~' i-~ cn N- r-n n C '~ ~ ~ d O ~ ~ (D c 't ~ ~~N b~ R Sy rt ~' .. .. .. rr ~ .. ~ .. ~ .. N F-~ O O OQOOO N ~~~ ~ I-~ w w ~ ~~~ ~~~ F-' NNN O O O O O O O l0 lD lp n n O ~ L~7 C't U] .. ~ ~ ~ ~ zro m O ~ ~-i I O (" r J h-fi (D ~P . -~ ~-i H o0 o ~ oy o O J F-+ hh (D N ~}'' O .. (D 'TJ U] H ~"i N• cD d ~ ct ~n w ts~ (D s/ c-r N- ~ n m C ~ lfl H N. N. N CJ ct O ¢~ H .. N . ~ ~ ~' ~ ~ ~ ~ ~~ ~ ~ .. O A~ H ~n F-~ vNCtOO ::~~ a~~ 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone~(8S8) 502-4349 Fax (302) 934-2955 September 24, 2009 Frey & Tiley Attorneys at Law 5 South Hanover Street Carlisle, Pennsylvania 17018 Re: Estate of Alberta C. Thompson Social Security: 201-18-3610 Date of Death: August 31, 2009 Dear Sir or Madam: Per your inquiry dated September 18, 2009, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type ofAccount CheckingAccount Account Number 9848264132. Ownership (Names oj~ ~ Alberta C Thompson* Opening Date 2/13/08 Balance on Date of Death $ 0.00 Accrued Interest $ 0.00 Total $ 0.00 2. Type ofAccount Certificate of Deposit Account Number 31003920248480 Ownership (Names o,~ Alberta C Thompson Opening Date 12/15/08 Balance on Date of Death $100, 000.00 Accrued Interest $ 144.48 Total $100,144.48 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Stonehedge Office # 717-240-4524. Sincerely, ,, f 1 t.."1~ ~ a ~ ' fL 4.'''Y Tracie Hare Adjustment Services /~! MST ~~~~~~~~ G~~~~ . M&T Securities, Inc. 285 Delaware Avenue, Suite 2000, Buffalo, NY 14202-1885 December 28, 2009 Alberta C Thompson Date of Death 8/31/09 AZC043652 Description of Security. Quantity in Valuation Price per share Shares Date - 8/31 /09 MTB Money Market Class A 195,712.46 $1.00 We have received the information presented above from sources, which we believe to be accurate. However, we do not guarantee their accuracy. The stock price per share on valuation date is the closing price on that: date: The mutual fund price per share is the low/nav price on that date. Please note this account offers check-writing privileges therefore the balance does not reflect any check not presented for payment by the date of death. Please contact Client Solutions with any further questions, or if we may be of further assistance to you at 1-800-724-7788, Option #1. Thank you. Since y .,~' Robin Brown Brokerage Operations Specialist M&T Securities, Inc. ~IIpIIIIVIII~~BII~n~II~W~YY~11911VII~~InII~YII~~~I~VNiI~IIUUV~lllA1 Investment and Insurance Products: • Are NOT Deposits • Are NOT FDIC-Insured • Are NOT Insured By Any Federal Government Agency • Have NO Bank Guarantee • May Go Down In Value M&T Investment Groups"' is a service mark of M&T Bank Corporation and consists of M&T Securities, Inc., the investment-related areas of M&T Bank and investment advisory firms MTB Investment Advisors, Inc., and Zirkin-Cutler Investments, Inc. Brokerage services and insurance products are offered by M&T Securities, Inc. (member FINRA/SIPC), not by M&T Bank. M&T Securities, Inc. is licensed as an insurance agent and acts n rance policies are obligations of the insurers that issue the policies. Insurance products may not be available in all states. (NYSE) U.S. Dollar Date Price High Low Volume 8/31 /09 29.40 29.60 29.26 1,617,800 No Splits Get another quote any day after 1/2/1970 :: i`~~iJrrt~~ t:C{ail;~~"~ .,~ „,~ ~-•`. 1 rte. _ .~"~ ;!-.~'a ~ro..,,_lnt ~F ..,,, f,~. ,:~~.j ,~, ~ ., t =~ &~: Imo 2mo 3mo 6mo 1~ 3~ir 5vr 1 /2/1970 ...~~~, _ Symbol: ! Date: 8/31/2009 ?~~ (j~~ w - n 3 S= ~ '~ ~ 8 ~ i~xkN ~m ~~ Quotes delayed at least 15 minutes. Market data provided by Interactive Data. Terms & Conditions. Powered and implemented by Interactive Data Managed Solutions. it~~,r- ~a wY.. 4 i^ i^ i^ i^ ^ `J~T, (, L'~Uu '!:U(~!~'I !'IVt, ~~HIVf`\ 41L-(U7-L 14( P~vc t ean~NCtr+ewAr October 7, 2009 Stephen D Tiley, Esq. Frey & Tiley 5 S Hanover St Carlisle, PA 1701.3 RE: Alberta C Thompson SSN: 201-18-3610 DOD: 08-31-2009 Dear Mr. Tiley: Iv e. UL r, I~ In response to your request for Date of Death (DOD) balances for the customer noted above, oux records show the followin¢: Certif cite of Deposit Account # 31200334469 ALBERTA C THOMPSON DOD balance: $ 41,313.52 + 118.45 accrued interest Interest paid 01--01-2009 thru 08-31-2009 $1,050.46 YTD Cbec~b Accost Account # 5140504502 ALBERTA C THOMPSON DOD balance: $ 59,889.67 -x-1.58 accrued interest Interest paid O 1-01-2009 thru 08-31-2009 $ 3 O.S4 YTD Established: 10-04-200 S Established: 0 S -03 -1993 Please note that this office provides date of death balances for deposit accounts (IItAs, CDs, Checking and Savings). We do not process auy finaaciml tra~nssrtions or provide statenieats. if you need assistance with aay of these items, please call 1-S8S-PNC-HANK (1-SSS-762-2265) or stop by your local PNC Bank branch office, Sizacerely, National Financial .Services Center PNC Bank, N.A. Member FDIC ~u~ '' ~~ ., Page 1 of 1 ~~ 0 MEMBERS 1St FEDERAL CREDIT UNION SAVINGS ACCOUNT: Account Number/Suffix 315209-00 Date Account Established 10/03/2007 Principal Balance at Date of Death $5.00 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $5.00 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix 315209-41 Date Account Established 05/02/2009* Principal Balance at Date of Death $100,000.00 Accrued Interest to Date of Death $211.23 Total Principal and Accrued Interest $100,211.23 Name of Joint Owner None *Rollover from certificate 315209-40, originally established 10/03/2007. M BERS 1ST FED RAL CREDIT UNION . ~ , ~_ Danielle A. Kline Insurance Services Specialist September 29, 2009 Estate of: ALBERTA THOMPSON Date of Death: 08/31/2009 Social Security Number: 201-18-3610 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmembersl st.org Form 712 (Rev. April 2006) Life Insurance Statement OMB No. 1545-0022 Department of the Treasury Internal flevenue Service Decedent-Iftsured (fo be filed by the executor with Form 706, United States Estate (and Generation-Skipping Transfer) Tax Return, or Form 706-NA, United States Estate (and Generation-Skipping Transfer) Tax Return, Estate of nonresident not a citizen of the United States.) 1 Decedent's first name and middle initial 2 Decedent's last name 3 Decedent's social security number 4 Date of death Alberta C Thompson (if known) 201-18-3610 8-31-2009 5 Name and address of insurance company 14 WOODCREST DR CARLISLE PA 17015 6 Type of policy 7 Policy number ,.. SINGLE PREMIUM ANNUITY W0021499826 8 Owner's name. If decedent is not owner, 9 Date issued 10 Assignor's name. Attach copy of 11 Date assigned attach copy of application. assignment. SAME AS DECEDENT 01-02-2008 12 Value of the policy at the 13 Amount of premium (see instructions) 14 Name of beneficiaries time of assignment MARY GROVE $200,000.00 15 Face amount of policy 15 $ - 16 Indemnity benefits 16 $ 17 Additional insurance _ 17 $ 18 Other benefits . 18 $ 19 Principal of any indebtedness to the company that is deductible in determining net proceeds 19 $ 20 Interest on indebtedness (line 19) accrued to date of death. 20 $ 21 Amount of accumulated dividends 21 $ 22 Amount of post-mortem dividends 22 23 Amount of returned premium 23 $ 24 Amount of proceeds if payable in one sum 24 $ 25 Value of proceeds as of date of death (if not payable in one sum) 25 $ 216,569.46 26 .Policy provisions concerning deferred payments or installments. ~~ -~~-~~ ~, ~~ Note. If other than lump-sum settlement is authorized for a surviving spouse, attach a copy of the insurance policy. 27 Amount of installments ... - - . - _ - _ - ~.. - . ~ ~ ~. ~ ~. _ ~ 27 ~ 28 Date of birth, sex, and name of any person the duration of whose life may measure the number of payments. 29 Amount applied by the insurance company as a single premium representing the purchase of ~°:' ~ ~,_ ~~.~ installment benefits 29 $ 30 Basis (mortality table and rate of interest) used by insurer in valuing installment benefits. ...__.. ................................................................ .... 31 Ih~ere there ary transfers of the policy within tha three years prior to the death of the decedent? .... : .......+~J ...___.. ... ^ ~ ~ ^ Nv 32 Date of assignment or transfer: / / Month Day Year 33 Was the insured the annuitant or beneficiary of any annuity contract issued by the company? , ^ Yes ^ No 34 Did thre decedent have any incidents of ownership on any policies on his/her life, but not owned by him/her at the date of death? ^ Yes ^ No 35 Names of companies with which decedent carried other policies and amount of such policies if this information. is disclosed by your records. ..__.-.•--••--•----•-•---~- -•----...---•---•-••a •-•-- •-----• ................•-----•---..._.._._._..--••----•-•--._...._. ti - The undersigne officer oft abov - me ins ance company.,~A•~ , opr'ate federal agency or retirement system official) hereby certifies that this statement sets forth true and rrect info ion. s ~ ~+:~~~ Signature - Title - Date of Certification - For Paperwork Reduction ct N is ee page 3. Cat. No. 1017oV Form 712 (Rev. 4-2006) x ~ ~ ,=~ ~ Form 712 (Rev. 4-2006) Page 2 Living Insured (File with Form 709, United States Gift (and Generation-Skipping Transfer) Tax Return. May also be filed with Form 706, United States Estate (and Generation-Skipping Transfer) Tax Return, or Form 706-NA, United States Estate (and Generation-Skipping Transfer) Tax Return, Estate of nonresident not a citizen of the United States, where decedent owned insurance on life of another.) SECTION A-General Information 36 First name and middle initial of donor (or decedent) 39 Date of gift for which valuation data submitted . . 40 Date of decedent's death for which valuation data submitted _ _ 38 Social security number .... . - SECTION B-Policy Information 4i Ivarne of insured 44 Name and address of insurance company 45 Type of policy 49 Gross premium 51 Assignee's name 46 Policy number 53 If irrevocable designation of beneficiary made, name of 54 Sex beneficiary 57 If other than simple designation, quote in full. Attach additional sheets if necessary. 43 Date of birth 47 Face amount ~ 48 Issue date 50 Frequency of payment 52 Date assigned 55 Date of birth, 156 Date if known designated 58 If policy is not paid up: ~ a Interpolated terminal reserve on date of death, assignment, or irrevocable ~ • designation of beneficiary . 58a , b Add proportion of gross premium paid beyond date of death, assignment, ~`~ or irrevocable designation of beneficiary _ 58b : ~ -~ >. c Add adjustment on account of dividends to credit of policy 58c '~```" d Total. Add lines 58a, b, and c. 58d e Outstanding indebtedness against policy . 58e f Net total value of the policy (for gift or estate tax purposes). Subtract line 58e from line 58d 58f 59 If policy ;s either Naid up or a jingle premiurr: a ~~ a Total cost, on date of death, assignment, or irrevocable designation of beneficiary, of asingle-premium policy on life of insured at attained age, for . original face amount plus any additional aid-u p p insurance (additional face amount $ ) _ 59a (If asingle-premium policy for the total face amount would not have been ' issued on the life of the insured as of the date specified, nevertheless, assume that such a policy could then have been purchased by the insured and state the cost thereof, using for such purpose the same formula and basis employed, on the date specified, by the company in calculating single premiums.) b Adjustment on account of dividends to credit of policy 59b :' ~ ' c Total. Add lines 59a and 59b _ 59c d Outstanding indebtedness against policy . 59d e Net total value of policy (for gift or estate tax purposes). Subtract line 59d from line 59c. 59e The undersigned officer of the ove-named insurance company (or appropriate federal agency or retirement system official) hereby certifies is ~t m~ forth true and correct informatidn. Signature - r~• ~j' ~" ~~, Date of . ~ ~ ~ ~~ ~`°~>~ - Certification - r Form 7'12 (Rev. 4-2006) i t ~~ S'~5-I7.C5115II1.]C'ZXG-Gl 1/ 4/ ~UlV 1G :'fG : ll'~ Yl`7 YAlar. 1/ VVl t'a.X 7~Z'V~r' ~r .; :: ~~~'` ~~ Reference ID: 2881132 Wachovia Bank N.A. Balance Confirmation Services - P OBox 40028 Roanoke, VA 24022-7313 December 18, 2009 ' FREY & TILEY ATTN: STEPHEN D TILEY ** SUBJECT: Verification /Confirmation of Account and Balance Information provided for: Customer: ALBERTA C ~THONII'SON (SSN# I~X X~-3610) Date of Death: August 31, 2009 Deposit Accoun# Infocnaation Accourrt _ Account Date of Death Average Date Maturiiy Intarest Accaved 1''I'D Data Type Number Balance Balance* Opened Date Rata Iirterest Lrtarest paid Closed CERTIFICATE OF 731 $100,000.00 9rZ4/1999 ~ $41.22 ,$2,023.68 1114/2009 DEPOSIT LEGALTITLE: ALBERTA C THOMPSON MARY ELLEN GROVE POA * Date of death balance does not include accrued interest. - * ff date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. Audrey Troutt Servieenter Associate Phone:(540)~63-7323 ~~ e>,~~ ~ ~ ~ t+ . ~%t~~ a a~ ,~ Sus uehanna q Susquehanna Bank 26 North Cedar Street P.O. Box 1000 Lititz, PA 17543-7000 Toll free 800.311.3182 September 25, 2009 STEPHEN D. T1LEY, ESQUIRE 5 S HANOVER ST CARLISLE, PA 17013 RE: Alberta C. Thompson Estate SS # : 201-18-3610 DOD: August 31, 2009 To Whom It May Concern: In response to your letter of September 18, 2009, here is the above customer account information as of August 31, 2009. • Account Title: • Account Type/# • Date Opened /Maturity • Interest Rate: • Account Balance*: • Accrued Interest: • YTD Interest: Account #1 Alberta C Thompson CD/405100004291 8/2/07 / 5/2/ 10 5.30% 100,000.00 411.16 3, 441.11 *Account balance does not include accrued interest. Papers received 3/ 12/09 naming Mary Ellen Grove POA. There is no safe deposit box in the name of the decedent. If I can be of further assistance, please feel free to call. Sin erely, ~ ~'l . ~ ~ c.-c., Dawn M. Berrier Exhibit "I" Support Services Lead 1-717-625-6546 DMB/Ijr t ~ ~ 1 t oa o n °° a ~~ D v v ~. o- a •° a~ m a~ ~ ~ o 0 ~o - ~ ~ W ~ ~ ~ W ~ ~ ~ n ~ ~Q ~ ~ v v ~ ~ n cn ~ ~ o ~ cn ~. ~ o ~ ~ ~ d ~ a. ~ p c~ m ~' a ~• ~ ~ a ~ c m~ y ,~ a~ a~ cD cn ? ~ c C7 ~ d ~ c C7 ~• ~ ~D W ~ o ~ ~ c~ < c ~ p Q y o ~ O n w Q?~ ~; < c ~ ~ ~ C' (~D U~ ~ n H ~ ~ (D ~ ~ a (D O (D ~ ~ ~. p' Q ~ p (D a o. p cn ~ ~ ~ ~ • ~, ~ c~ ~+ co ~ n~ N ~ ~ ~ D C n {~ fA {~ {~H ffl {~R {~9 ~ {y9 ffl fA ~ N ~ t0 rr ~~ O ~ n ~ ~ ~Q ~ ~ ~ N Q ~ ~• ~ O Q O "D O ~ ~ ~ ~ ~ ~ O N ~ ~ ~ ~ ~ ~ d ~ O ~ C~J~ ~ W ~ ~ `C _ W W ~ ~ ~. N ~ ~ W ;P d Sy N ~ ~ p ~ ~O pNp C7 ~ O ~, O O (D ~ N« ~ ~ ~ ~ ~~ ~ ~ N Q ~ ~ <_ ~ p AQU ~ Q (D <. ~ `G ~ t3D Q Q -,. O ~ ~ ~ (D (~ '~ fn '~ ~ ~ ~j m N ~. ~ ~' o ~ ~' a w c ~ o su ~ o v, c g: ~' ~. n Q om' ~N ~ ~ ~ N O Q. ~ O p ~ (~D Q CD ~ ~ n (D ~ ~: ~ n ~ Q N-~' (D ~~ ~ O C ~ ~ ^: -i. ~ ~ n - Q C ? ~ ~ `G ~ ~ ~ ~. S. d ~ cn (D ~ .Exhibit "J" ~ ~o ~ ~~ i Np Q O O CG OD D 0 .p ~~ 0 0 a m ~. v D ~ ~ ~~ n o co -~v N n O C ~. C Q CO O CO CJ1 W v c~ m •v 0 N O O CO rn ~. N .art O n ~D ~_ O 3 !~ H ~m ~ ~ ~ Q N ~ N ~ N tD N O ~ co ~ ~ ~ N Q. o ~,~ ~ ~ s ~; ~ ~ o ~ ~Q -~ o ~~ ~ o ~_~ ~( ~ m ~' ~ O ~' ~ O ~ ~ ~ O w -t ~- `< (AD ~. o ~ ~~ -a o can o ~'• ~ -o ~Q ~ < N ~• Q c~ ~_ O CD~ ~ < ~ ~ O ~ ..~ ~ O '~ N m n c~ n ~~ ~ ~ ~ ~ ~~ ~ ,_« m ~ ~; Q ~. 0 ,~ ~ ,< N No O O co Oo V O C,T1 ~ W N -+ O c0 OD ~! ~ CJt ~i W N j ~C ~ O C t11 W ~ .~ O O ~ ~ ~ ~ O ~_ a ~ 0 v c~ o ~ 'a °o C ~ y O ~ ~ D ~ ~ rn m c ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ as ~ ~ N ~ ~ cc ~ ~ 3 N ~ C~1 ff! {~R fig ~R E!3 ~ {~9 Efl ffl {fl ffl ~! {A ffl fy9 fig ffl {f? tM O ~_ N ~ C7~ y _ ~ Oo t0 W ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ c ° , a °~ N ? o~ ~ .* ~ _ C O o ~ D w ~~ ~ ~ Exhibit "J" D 0 c z c ~D .~ co rn O CC C?t O O W v 0 N O O cc l.l_, ^^ 0 n ~~. 3 C ~_ O ~s !~ v O A N ~m ~~ 'd Sy Q tD L N ~ ~ N ~ ~ ~ CD O ~ ~~ C O ~~ ~ N ~+ Q Q -~ O ~ ~ ~ ~,. C ~ ~g ~o ~~ 0 ~Q 0 ~~ ~o ~. ~ <. ~~ ~~ ~ ~o ~~ o~ a~ ~? o ~' ~~ ~ ~ ~. o ~ ~? ~ ~. o ~• ~' - O Q ~. n ~ m~ o m' ~ < ~ ~ o a o -~'o m °~ ~~ ~ o. c~ c- ~'. c o ~ N c w ~ ~ 5. Q w ~o ~~ ,~ W NO O O ~~ W fJt W ~P W W W N W -~ W O N co N Oo N V N O~ N U1 N A N W N N G f~9 {-~ ffl ffl ffl ff? ff1 ffl ffl ff3 ff? ffl ffl ffl ffl ffl ffl fig n H W ffl ffl ffl ffl fd3 ff3 ffl ffl {~ ffl ffl ff? ff! ff> ffl ffl ffl ffl ffl ff? ffl ff? ff? ffl ff? fA ff~ ff3 ffl ffl ffl ffl ffl ff? ffl ffl ff! ffl r Exhibit "J" n 0 .0 3 c~ m c~ m G ~D 3 0 c ~. Z C W CO O CO o~ W 0 m m c c~ v ~, a D~ .~+~ ~. SN o~ ~~ ~o nv ~, c~ m O N O 0 v c~ 0 0 y ~D O !P N ~o ~ c ~~ ~ N O g cc ~ ** ~ OD O ~ y C ~ ~. z c~ o as ~ ~ ~ N ~ ~ O ~ tD O ~ O ~~ ~~ ~~ Q ~ ry.~ 3 Q ~ 3 ~ ~. ~ ~ ~ c~ m ~ o Q a N ~ ~ -. m ~ ~ .* ~ ~ o N O ~ O ~ 3 N ~_ m S H ~ m ~ ~ C ~ 3 ~, ~~ 0 0, c ~ y ~ U1 ~ W N -+ O t0 OD ~I ~ f~1 P W N 1 !C T O O O CJt (gyp m ° ° ° c < o 0 o 0 o o o a? -' ~ ~ L ~ C ~ 7 ~ n lD ~ ~ ~ -~ v ~ o o rt a ~ ~ ~ ~I W W ~ ~ n OD cn ~ m y ~ ~ ~ _ ~ ~ w ~ > 3 > 3 ~ ~ ," ~ ~ m ~ ~. tD m ~ ~ W C O ~ Q H '~ ~ ~~ ~~ ~ v' ° i~ c c o o 00 ~ Qo x ~ j O C O W ~ CO CO A ~ X ~ W ~ w O ~ ~ -, ~ y ~ ~ ~ '~ U O 7f t ) O O O O O O O 4f! 69 ~6R Ei9 fig ffl 6R {f! Ei9 ~fl fA Ei4 ~fl ff? Efl {~H {~9 ~6R _ O f~ y.. •F vc ~~ ~ O O O O O ~ ~ Exhibit rrJrr 00 N v .-. a A 3 ~D O C N a A C ~' O CO O 0 co cn co w 0 N O O co rn y S ~~ O =. ~_ v ~D o, v ''~ ww`` ~I O y R~ v O !P N ~. w -p o ca c ~~ o c cc ao ~~ O ~ !'~ Q. a1 H n ~ c a °,; ~ ~ ~ ~ 3 O ~ f31 y ~. o~ ~o ~o z~ o~ -~ ~~ ~~ N ~ ~ ~ Q m 3 ~: c o '~ of c~ m ? o c~ ~ H Q .. . ~• ~ ~ ~ ~ °o c~ o H .i 0 ~ N m Z y ~D m _~ C ~ -e O -~* ~ ~ C C N H W N 1 O N ~ ~ ~ N ~ W N j C G 71 C O CG Oo V ~ c m ~ ~ .~ ~ ~ ~. y C~ s C c~ m ~ . ~_ ~ W W ~ O ~ ~ a .o y ~ ~ ~~ fig ffl ffl ffl ffl ff3 ffl ff! ffl ffl {~ ffl ffl ffl ffl ffl ffl ffl W ~ Q O X ~ O C X ~_ C~ ~ ~ N ~ ffl ffl ffl ffl ff3 ffl ffl ffl ff3 ffl ffl ff3 ffl ffl ffl ffl ff~ ffl 3 ° . vv ~~ ~ O ~D 0 y v y a 3 a H 0 _. C ~D a D C7 3 Q OD CO O t0 fJ1 co W v o~ 0 N O O CO m I~ y n v c~ °, v a C ~_ O O "! y lid ~~ v O !P N Exhibit "J" -~ o ~~ ~~ ~ No O O Cp OD ..l 1 .1 .1 .l ~ 1 ~i ~l O CJ7 .A W N ~ O c0 OD V O CJ7 .P W N 1 >C A .P A ~ fJt O Cfl O ~ V ~ ~ N C O CO W V ~ W O ~ CC ~ ~ W W ~ s ~ ~ ~- rn C ~ ~ CJt ~ W W N O ~ V ~ ~ O OWO O A ~ O O ~ O ~ O V A O CO ~ -. ~ ~ ~ ~ " ~ a a ~ ~ 0 c 0 c 0 a ~. ~ -+, ~ -+, a -~'v ~ 3 ~ ~ N ~ v v . . ~ ~ _ .o ~ c~ o co ~ ~ v ~ ~ c ~' 3 ~ v ~ ~ ~ ~; cc cc ~ ~ a ~ o ~. ~. x ~ ~_ v ~, ~- Q _. ~~ ~' d ~ w N c ~ o 0 w m 3 rn m c~ o ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ m ~ ~ c c~ m ~ ~ a o rn .p N ~ ~ ~ V o co ~ o co ~ o W s .p cn ~ N ~ cn oNO y 3 y ~ ~A OD Cn OD -~ O V U7 W OD N .P O .p CO O U7 ~A A. GJ O ~ N 00 GO CO V IV V ~ W ffl Efl {f} Efl f~R ffl {~9 ~i9 ff3 {f} ffl ~ ~G9 {~9 ~3 ~fl ~ ~ ~ O m o CJt W W OD W ~ N O N W N U7 N N -~ CO O O W ~ ~ CO OD V N CO N V ~ .P N .A ~ y V O ~1 ~ V .1~ CC Cn W ~ ~ W C3~ -~ O W W O O U1 N N O -~ O O O W f~1 O W _ y A C11 O V CC -~ Cfl V W O V CO A ~ N ~ O O V y U7 ~ ~ W~ 01 W V ~ CO O O W O W t0 ~i9 4fl ~ {~9 f!9 ~b9 {~ ffl ~i9 {~ fig ffl 69 ff? Efl {f~? ~fl Efl EA ~v c v ~ ~• ~ y ~ 0 ma y . y, ~ °~a ~~~ o~ Exhibit ri Jrr 3 .~ C y ~1 C H D °c c c~ 0 0 o~ 0 cc o~ co W O as O N 0 0 0 ~i ~~ ^^ ~^ n ~D ~, as c O ~c G O ~' t~D R+ O !~ N ~. 0 ~~ ~~ 0 N°o ca o0 W (Jt W P W W W N W ~ W O N CO N OD N ~I N ~ N CJ7 N ~ N W N N N j N O -1 CO -+ OD .. .. -~ 0 ~o m 3 m c~ c ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ _ < m ~ c o ~ -~ 3 a y ~fl fi9 ~fl 69 6A t~ ~A {~9 ffl ~UR 6R ffl ~ {~9 ~fl {~9 ER Efl ~f3 O m m C ~D ~v ~~~ ~ ~ ~ y ~ V ° a ?~~ ~ C O ~ 3 C C d 'T1 c a n 0 c c~ a a 0 c z c 3 c e~ o~ a~ 0 o~ W W v a~ 0 N O O m N y ~_^_ y O C~~ ~_ v c~ °, v c~ 0 0 y Z v O !p N L~'xhlblt rr Jrr cn' ~o ca c ~~ ~ N O O CD OD ~~ 0 0 c ~' c ~. 0 m a~' v- m c a~ a~ Q ~l . O . CJ1 . ~ . W . N ~ . O CO OD . ~I . O . CJ7 . ~ . W . N . -~ . X O C ~ O O O O vA ~ ~, ~w ~ ~ m c e a ~ =. ~ ~ v 2 y 0 rn n ,• C ~ v N ~ m ~ ~ -~ r rn p m °D m < ~ °' c ~ R c~ ~ m y ~ 3 0 0 0 m w ~ o o c ~ 0 0 0 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ p c ~ oo~ O ~ W 3 ~ ~ 3 ~ ~ ~ C?f o s~ N Exhlblt rr Jtt 0 m ~_ D ~a a~ go <' c a ~, '~ a ~ ~I 3I ~~ ~~ ~' r o~ c°o ~ ~ c co a~ ~ w m 3 c~ a ~v ~°~ ~ ~° :~ ~ O NI O O cfl rn ~F ^^ 0 ~_ v ~D ~, v a~ c O y v O D H 0 ~W ~ ~ ~ ~ cc o c ca ca o m ~~ ~ ~ ~ Q- ~ c~ 0 3 co ~ ~~ c~ ~N QQ o ~ ~ ~ ~. ~: ~o oN ~a 0 ~~ ~o ~~ ~< 'Np CAD ~• N• O r.. O ~ ~ ~ ~ ~ 3 ~' ~ ~. ~, o ~ ~? ~ N. o ~• ~• ~ -o a~ ~ ~N . Q. ~ ~ o a ,o ~ m m ~' ~~ c- ~: c o a~ c w as a s (~ Q 0 w a~ 0 0 co c~ j 0 0 v ~ o co ao v a n ~ < ~ ~ .. ~ ~ ~ o c o: ~ c o ~ c ~ ~ N a ~ ~ ~ o Q, ~ N ~ N ~' o ~ Q a ~ a ~ v -• <. ~ N ~ v o~ cn ~ w o a1 ~ ~ c~ ~ ~ ~ ~ ~ ~ ~ o ~ d ~ a~ ~ c C7 ° ~, y ~ ~ a N -- ~ . ~ as ~ n n ~ ~ s ~ _ ~ ~ a W w w N O W O . p ~ 0 O N d '~ ~ O o O Exhibit "J" F ~c ~~ ~~ ~ ~, a~ ~ ~ ~ o a~ ~ ~ c~ m ~* ~o a~ o o ~ ~? ~~ ~. oQ ~ ~' ~o ~~ ~N ~? tD O f% O cQ ~~ ~ N „~ N O O n ~'' O ~ ~ Q- D m~ m ~° o ~, ~_ c ~~~ ~`Dz ~m3 ~~ a Q n ~' ~ o ~ ~ ~- ~ o a~ a, o~ ~ ~• co ~~ a ~~ w c~ ~' a~ _~ ~~ o a a~ ~ c~ Gov c ~~ ~e°'.. ~' ~ v m v -' ~, o a- N O O ~ O Q O Q m y O. ~_ v ~D ~+ v a c o' 0 ~p.+ O D !~ N ~ 1 S~ `. ~ i ' ~. ~.~~ ~~.,i~~/'~.~~1 ~~'~(;i,~`~~,~'l C ,~{ f 1. .. ,r official use: only` :: ~ - _ Customer Name Customer No. PD F 1455E REQUEST BY F!®UClARY FOR ©lSTRlBUTlOl~ OF ~ ON16 No. 1535-0012 Department of the Treasury Bureau of the Pubic Debt. UMlTED STATES TREAS~lRY SECURlTlES (Revised June 2008) Visit us on the Web at www treasurydirect.aov .. IMPO.RTANT• : Follow. msfructions in filling out;this form ` Youshould:be.:awar "` ° '~ ~ ' ° - e, thatthe mak~ng~~of any false,~fict,tious: or fraudulent claim ar . statement to the United States is a cnme.that is punishable by fine and(or imprisonment r n ,. :. .. •, :`'. s _ .. ~~~ ~° .:::.~,PR1NT IN:INK OR~TYPE ALL NFORMAT10Nt. ... _... t •~ One or more fiduciaries (individual or corporate) must use this form to establish entitlement and request distribution of United States Treasury Securities and/or related payments to the person lawfully entitled (e.g., termination of trust, distribution of an estate, attainment of majority, restoration to competency). PART A - REASON,FOR.DISTRIBUTION. ...... ,:. I/V1/e request distribution of the securities and/or related payments for the following reason: ^ Termination of trust distribution of an estate ^•'>~yment to the estate (Fiduciary must sign the back of the bonds or submit a PD F 1522) ^ Reissue to the estate ^ Distribution to person(s) entitled* *lf payment is requested by person(s) entitled a PD F 1522 is required. ~If reissue is requested by person(s) entitled a PD F 4000 is required. ^ Attainment of majority ^ Restoration to competency ^ Other: I/We request that the securities and/or related payments be distributed as follows. 1. Distribute to: C j~~ ~~ ~, ~,~~'~~ ~, '~W(~t~/~1'~v ~• ~ ~'~,~ ~~~ L I~~~'~C ~J~u.. (Name) , (Social Security Number) . ~ 2. Description of securities and/or related payments: 1-1 H Sfi~ l N C-rs ~U N~ ex~ 2G~a _ ~O ~l~l Shr V~I~L~tS $0 f~f ~ bin Zt)c~ ~~ ~H 5l~11 NUs ~QN~ a IzC~~ 1 c ~ C~ ~N S~hh1f~G~5 ~,o~D o5 200o Ic~o ~L W 5 ~~ ~c.-~ P,.~ov~ o Iz~~~? t0 ~ o. ~K 51'~(~~f~5 g ~N a o~ zooo I o~ o ~ SR~I~~Svs ~~(~c~o ~~a v H~ S~tN~,s ~bN~ ~~ Zooo Ie~ ~ 3. Extent of distribution: In full OR ~'~ ~ Z ~ L. Z ~ I '~ ~~~I~ and Telephone Numbe (Employer Identification Number) '~ I''~ 24 3. ~~? ~~32I~~( H~! - ~ 5 2~ ~`~ 5~ !-I !~ ~ ~ 4 `1 Z a~ ~ y ~~~~q N ~-I M ~53a~•~,~ ~ W M ~~ 3~~21 W~-! ~ ~~~ ~ a c . TtioMPsonl (Amount, Fractional Share, or Percentage) Exhibit "K" ~~T B - DI~TRIi?UTIOI`I O~ SEDURITIES ACID I~AY~riE~1TS (Confinued~ - I/V1le request that the securities and/or related payments be distributed as follows: 1. Distribute to: ~ST~~~ c~r~ A~ t~ct~T~ ~ . ~ >-)~~ PS~~~' ~Ull~f~~ ~~;~+~ C 2 EVE C E~: . (Name) ~ OR ~~~o2~~oZJ 5 (Social Security Number} 1 (Address and Telephone Number 2. Description of securities a nd/or relate d payments: :` TITLE OF SECURITY ISSUE `: ,:: D TE> FACE AM01 .. N~ 5 (~v ~~s(~,~ NA ~~ Zit? 1 da sr~ s oN~ a~ o~ tooo N~ SFt~I~t1~C,(S ~~ND ~~~~, t oo~ ~~ SP~~,~~s I~O~.D ~ ~ Zdt~ ~ oo ~~ ~ ~~~>> a Ana l~~a 3. Extent of distribution: ~ !n full IDENTIFYlNG,NUMBEi ~17j5'~2~~2 1'~ ~~~2~'1 ~ ~ H ~, X55'? Z~ ~ ~ ~ Wl ~~; ~'S~~ b ~ M ~s~~~~~ H ~! 4TlON Y3, .`•I (Amount, Fractional Share, or Percentage) I/We request that the securities and/or related payments be distributed as follows: 1. Distribute to: (Name) OR (Social Security Number) (Employer Identification Number) (Address and Telephone Number) 2. Description of securities and/or related payments: r .... .. ISSUE ; TITLI; OF SECURITY ~ ~• FACE A1il0UNT tDINTtFYING N.UMBEf2 . ~ ' REGfSTRATION -, :DATE. K .., .. ~~ 3. E;ctent of distribution: ^ ~n full • ^ (Amount, Fractional Share, or Percentage) Exhibit "K" ~. t2~ PD F 1455 (Employer Identification Number) . _ .. ,, .. 51~~1~1TU~c~S Ary.D CS3~T1FiC~,T10NS , ,> .. , a ctrrtif`j under penalty of perjury that the information provided herein is true and corrirct to the best of my/our iCnowtedge .,nd belief and agree to distribution of the securities as indicated in Part B. IM/e bind ourselves, our heirs, legatees, successors and assigns, jointly and severally, to hold the United States harmless on account of the transaction requested, to indemnify unconditionally and promptly repay the United States in the event of any loss which results from this request, including interest, administrative costs,' and penalties. I/We consent to the release of any information regarding this transaction, including information contained in this application, to any party having an ownership or entitlement interest in the securities or payments. :. .. :: :: .. :You must wait until ou are m tfie" res:rnce of a certi rn officer to's~ n ~h~s form -: Sign Here: ~ J `~ Z~~~ (Applicant's Signature) (Applican s Title} . ~ s. N A ~o~r/~. s ~. ~ C~us LL. Q ~- j ~C~ 1.3 (Number and Street, Ftural Route, or PO Box) (City) (State) (ZIP Code) ~~~~. 2~~:~~~ (Daytime Telephone Number) (E-Mail Address) Sign Here: ~ (Applicant's Signature) (Applicant's Title) (Number and Street, Rural Route, or PO Box) (City) (State) (ZIP Code) (Daytime Telephone Number) (E-Mail Address) :., , . _: . ``: Certifying,~Ofticer ~~Tf~e ~ndrv~duals,mus~ sign ~n,yourpresenc~ You~nust complete the: cert~cafror and affix y~urstamp oraeat ' I CERTIFY that tv~ any ~ LL~N ~ ~-~~~ ,whose identity is known or was proven to me, personally appeared before me this ~ ' day of ~ ~ • ~~~ j , C ~~--1 ~L~% (~ (Month) (Year) at - r ~ d signed t .is o'm. (City) ~ (State) . ~` ~~.~~~/~ ..C~' Y (Signature and itle of Certifying 0 icer} ~~ ~ , ~ s~A~~ ~ ~ ~lt~ ~ S 1 . -. __ .-- ,.._ .~ _. _.... _,.,~.~.._... ,, ......_... dumber and Street or Rural Route) ACCEP BLE , E IFICATIONS Financial Institutions . Ofi•icial Seal_or Stamp (Siaeh as;Corpo'rate Seal; Signature ~~r~" (City) (State) (ZIP Code) S Guaranteerd Stammp, or Nledalfion Starrp) ~~ } +~ ( ;. ,t .a _ _ _ .. _ _ -., .. ,.... ~, i a I CERTIFY that - ,whose identity is known or was proven to me, personally appeared before me this day of , {Month) (Year) at ,and signed this form. (City) (State) , (O~~iCI~-L STA~I~ (Signature and Title of Certifying Officer) OFD SEAL) (Number and Street or Rural Route) ACCEPTABLE CERTIFICATIONS: Financial Institution's Official Seal or Stamp (Such as Corporate Seat, Signature (City) (State) (ZIP Code) , Guaranteed Stamp, or Medallion Stamp). (3) < PD F 1455 Exhibit trKftr ~N ~ Illm.c~ ~ 1~~~ c~ ~~ ~* aq~~