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Home My WebLink About10-21-10:.~ /'~' ~~ 15056041125 REV-1500 ~ (x"05) OFFICIAL U8E ONLY PA Depararrent of itsver-ue County Code Year ', FNe Number B""AB1I °~ ~~~ T Po eox 280601 INHERITANCE TAX RETURN 2 1 0 7~ 0 0 3 9 3 Flanitbrr PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORNU-TION BELOW ~, Social Security Number Date of Death Date of Binh ~, 1 9 8 3 0 1 1 1 1 0 7 1 0.2 0 0 5 0 5 1 4 1 9 3 8 Deoedent'a Last Name Suffix Decedent's First Name ~~ Mt HEN D R I C K S O N J U D I T H ~ N ' i (H Applicable) Errtsr Surviving 8pouss's intormat{on Below ~ ~, Spouse's Laat Name Suffoc Spouse's First Name ~ MI H EN D R IC KS ON DONALD Ii G Spouse's Socal Security Number TH15 RETURN MUST BE FILED IN DUPLICATE WI THE REGISTER OF WILLS FILL IN APPROPRUTE OPALS BELOW ® 1.Originai Retum ~ 2. Supplemental Retum _ ~ 3. Remainder Re m-(date of death prbrto 12-13-8 ) 4. Limited Estate 0 4a. Future Interest Compromise (date of ~ 5. Federal Estate ax Retum Required death after 12-12-82) ® 6. Decedent Died Testate [] T. Decedent Mairrtained a living Trust ~ 8. Total Number of Ssfe Deposit Boxes (Attach Copy of Wilq (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Eledlon to tax u der Sec. 9113(A) betweien 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -TINS SECTION MIST BE COMPLETED. ALL CORRESPONDENCE AND CONFOENTW. TAX NIFORMATION BE DIRECTED T0: Name Daytime Tel~hone Nu ter I~ A R O L D S I R W I N I I I E S Q 7 1 7 2 4 6 0 9 0 ' Finn Name (If Applicable) REQISTER QFjM U8E _ I R W I N L A W O F F I C.E ~ ~' ~ ° Y_ "` ' First line of address czj .~~ ~ ~ ---I E' 6 4 S O U T H P ITT S T R E E T ~' ~ ~' ,~v~~ `~`-~ Second line of address ~ ~ ~~ a 3C _ C, ~ _ " o ~ State ZlP Code D F .. .~ ~ City or Post 01fioa , i -s C A R L I S L E P A 1 7 0 1 3 CorreapondeM's e-mail address: fcom - ~ tinder perralYea of perjwy, dedere I Have e~irred sae return, itKiudlig aoooirg scAedules and atalunerds, and 1o the best of my isnd tre6ef, and of are peraorrad represenmuve is breed on ap itr(ormaaon of whkA has ~y SIGNA 4E LING RETURN / ~ ~ ~ QA 4 64 SOUTH PICT S 150.56041125 HUNTINGTOWN REPRESENTATNE CARLISLE PLEASE U8E OR113{NAL FORM ONLY Side 1 MD 120539 PA 117.013 15056041125 J e __.! ~ X5056042126 REV-1500 EX _ .. _ _ _:__~_ ...;~.,..,._......~: DeoedeM's Sodial Security Number ~,~; JUDITH N. HENDRICKSON 1 9 8 ~ 0 1 1 1 1. RECAPITULATION 0 0 0 1. Real estate (Schedub A) ........................................ 1. 4 ~ 6 5 7 4 5 2. Stocks and Bonds(Schedub B) .............................. 2. 0 0 0 3. Glossy Held Corporation, Partnership or Sob-Proprbtorship (Schedule C) ..... ~ 3. ~ :._ ~ a o 0 4. Mortgages do Notes Reoeivsbb (Schedub D) ........................ 4. ~~ 7 8 1 3 1 5. Cash, Bank Deposits b MbceNar-eous Personal Property (Schedub E) ....... 5. ~ 6. Jointly Owned Property (Sdtadub F) ^ Separate Billing Requested ....... 8. ' 0 0 0 7. inter-Vivos Transfers d~ Misoellarieorai N~-Probate Property BiAi u sted t R S 7 2 4 4 0 9 ....... r~ epara e eq e (Sdredub G) . B. Total Gross Assets (total Lines 1-7) ........................... 8. 5 6 8 2 8 5 9 1 4~ 8 4 7 5 0 ................ 9. Funeral Expenses 8 Admfiistrative Costs (Schedub H) . I 5 1 ~~ 2 4 6 0 7 10. Debts of Decedent, Mortgage Liabilities, & Lbns (SchedUb q ............ 10. ~ I 6 6 0 9 3 5 7 11. Total Dsductlons (heal Lines 9$ 10) ........................... 11. ................... 12. Net Value of EstaEe (Line 8 minus Una 11) ...... 12. - 6 ~~ 4 i, 1 0 7 2 13. Charitabb and GovemmeMal Bequests/Sec 9113 Trusts for which 0 0 0 an ebdion to tax has not been made (Schedub J) .................. 13. - 6 4 1 0 7 2 14. Nst Valve Subject to Tax (Line 12 minus Una 13) 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxabb at the spousal tax rate, or transfers urxter Sec. 9118 Q 0 0 (s)(1.2) X .000 15. 1t3. Amount of Line 14 taxabb 0 0 0 at lineal rate X .045 18. 17. Amount of Line 14 taxabb 0 0 0 at sibling rate X .12 17. 18, Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18. 19. Tax pus ................... ...................... .... ..:•19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Stde 2 25056042126 1505604212 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 REV 1500 EX Pape 8 ~ Fib Number Decedent's Complete Address: oo5s5 DECEDENTS NAME . JYi1NTN N, NEi~lt/CKiON STREETADDRESS ~ COY STATE ~ ZIP GAIft/JlLE rA 17015 Tax Payments and Credits: I 1. Tax Due (Page 2 Line 19) (1) 0 ~ 0 2. CreditslPayments . 0 A_ Spousal Poverty Credit ~ - B. Prior Payments. C. Discount ~ ` Total Crests (A + B + C) (2) ~ 000 3. InterestlPer-alty ff applk~le D. Interest ~ E. Penalty Total IntetesUPenalty (D + E) 4. ff Line 2 is greater than L'me 1 + Line 3, enter the d'ifferenoa. This is the OVERPAYMENT. (3) ! 0.00 FNI to oval on Pape 2, LMe ZO to request a refund. (4) I 0.00 5. ff Line i + Line 3 is greater than Line 2, enter the difference. Th(s is the TAX DUE. (5) ~ 0.00 A. Enter the intere~ on the tax due. (~) B. Enter the tots of Line 5 +5A. This is the BALANCE DUE. (5B} 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT ~'i PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROP~ 1. . Did decedent make a transfer and: Yes a. retain the use «incane of the property transferred : ...................................................................... ^ b. ret~n the right to designate who shall use the property transferred «Rs Income; ............................... ^ I c. retain a reversionary interest; « ............................:................................................................... ^ ~d. receive the promise for life of either Payments, t~efits «cae? ....................................................... ^ 2. ff death occurred after December 12,1982, ~d decedent transfer property within one year of death without receiving adequate consideration? ..:.......................... .......................................................... D 3. Did decedent own ~'in trust for" «payable upon death b~k account «security at his «her death? ......... ^ 4. Did decedent awn ~ Incfrvidual Retirertrerrt Accarnt, annuity, or other non-probate propeAy which ~oorr~ains a t~f'idary desi9nation? .................................................................................................. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE t3 AND FILE R AS TE 'BLOCKS No OF THE RETURN. F« dates of death on «after July 1,1994 and before January 1,1995, the tax rate imp~ed on the net v~ue of transfers to «f« the use of th surviving spouse is three (3) percent (72 P.S.. §9116 (a) (1.1) (ip. F« da4as of doh on «after Janu~y 1,1995, the tax rate imposed on the net value of transfers to «for the use of the.survniing spouse is (O) percent ji'2 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 disdosu of assets and ti~ng a tax returt- are stiN applicable even ff the surviving spouse !s the only ben~idary. F« dates of death on «afler Jury 1,2000: '' The tax rate imposed on the net value of transfers from a deceased child twenty-0ne years of age «younger at death to «f« the use of a nah~ral parent, an . adaptive parent, «a stepparent of the child is zero (0) percent(72 P.S. §9116(aK1.2)]. The tax rate imposed on the nd value of transfers to «f« the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §911ti(1.2) (72 P.S. §9111i(a~1)]. 'fire tax rate unposed on the net value of transfers to «f« the use of the decedents siblings is twelve (12) percent (72 P.S. §91 i6(aK1.3)]. A siding is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood «adoption. REV-152 EX + {8-98) spcCy~~~vT~-E A COt~AONWEALTH OF PENNSYLVANIA REAL E~71 M 1 E INHERITANCE TAX RETURN RESIDENT DECEDENT . ;.. .:. ESTATE t~ FEE IrTlJlS1BER - wan+ w ~ore~csoN ~ ooasvs , !~ AM reel propeA)I owned sofay or ~ ~ rant In oomnan nwM 6e reported at fair merkrt vsiw. Fair market vepre b dented as the prbe at praperiy would be exchanged between a w~lkrg buyer and a wing asset, nehher bekrp b buy or seN, bath having reeearable knowledpa of She facb. ReN wtdch b w~ of eurvivore moot M dfedoeed on S3chedule F. ITEM ~ VALUE AT DATE NUMBER DESCRIPTION OF DEATH t nroNE I aoo ', TOTAL Atao enter on line 1, : a00 (M mae epaoe is needed, insert addlt~ aheeSa ~ the acme afae) REV-1503 EX + (8-98) scNEOVtE s colulNONwEA~TIi of PENNSrivANw STOCKS $ BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTA'PE OF _ FI:E IW~ER rvarrN x NwaeNUCSON oossP3 ~ ProP~Y joindY~oMnnd wNh ripM of wwi~ronhip mint ba dtscload on Schidula F. ITEM VALUE AT DATE w IuRFR ~ DESCRIPTION OF DEATH i RI/EL CORI~OItA710N ihar~s to~on Stock t E~rhJb/t '71" uco of stock ! EXIdb/t " ty r s TOTAL {Akso enter on line 2; R~rl) (K mae speoe Is needed,. ir~ert add~onal sheer of the same sins) 85s.T2 47~79e.73 REV~SOaEX+~~~' SCHEDULE C CLOSELY•HELD CORPORATION; COIuMOMWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN BOLE-PROPRIETORSHIP RESIDENT DECEDENT ESTATE OF FILE NUIMRER ~~, JODITN t~ ERlIIOMC/CSON 003A4 Schedule C-1 er C-2 {kxiuding eN supporti~p iniomretion) must be attached for each doeehr-t-eld oorporatloNpeMeiahip merest of decedent otl~er ih~ a sole-propllebnship. See Instrucdona for the suppotdng a~fonr~etlor- Uo be submitted fa sole-proprblorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE i a00 TOTAL (Also enter on line {If mole speoe is needed, kreert eddidonal cheats of the same sise) Rte/-1507 EX f (8-88) - SCHEDIl1>E D - COA~AOWWEALTN of FENNSnvANIA ~ MORTGAGES $~ NOTES INHERITANCE TAX RETURN. RECENABLE . RESIDENT DECEDENT ESTATE OF FILE NUMBER JYO/T!lliL NENgtlCKfON ~ 003s-F AN properly jcN~yowned wHA the right of eun+ivorship must be dtecbeed on SclnduN F. ITEM VALUE AT DATE NUMBER DESCRIPTfON OF DEATH ~. No~rE aoo " I :; _ ` :. . '~ I i .TOTAL (Also enter on Nrle 4, Remotion) S 0.00 (if mae apace fe needed, insert additional sheets of the amine sfze) REV-1508 EX + (8-98) N COMdONWEALTH OF PENNSYLVANIA CASH, BlU\K IJGPVS~~7~ a[ MIS. INHERrrANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUA~ER - ~ JIID/TN IIL NENDI~IClCSON ~ 009>P9 ~ lncNlde ~ proceeds M ~~ ~ ~ I/YP Y10 IOW~t7Y I~ ~ QOIOO. ~ Propwh~ ~!" vdtll of sunMors~ be dMdaed on ScheduM F. ITEM ~ YALUE AT-DATE NUMBER DESCRIPTION OF DEATH 1. PRtIDENT/AL 1,670.57 Aooo~M Na 6916-s~A4 Ohldand Incon», /ntanst /nNconH, and Broketi9ailar Prorse~ofs Z. • YNITEO NEALTN~GARE CORPORATION .: _ ibp/aciliaarnt It41'fvrirel C/MCk .: ~ PRUCO RNJttnd CJ-~ck 4. 11~ASI//NOTON NATIONAL Rrnficana~nt CMdc 0. 490.00 3 T7 1,600.00 11.47 TOTAL (Ako enter or- line 5, Recapitulefiorl~ _ (If mae apace is needed k~ert eddttlonal sheds of the amne af~e) REV-1509 EX + (8-98) N CANNAONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN SCHED!/LE F JOINTLY-OWNED PROPERTY ESTATE OF FE.E NU~ER JODRN Id. HENDRtCKiON 0093 Nan e~aet wee made jokrt within one yar of the decroderrt'e d~be of loth, it moat be n~~ on I G. SURVMNG JOINT TENANT(S) NAME ADDRESS I RELATIONSH{P TO DECEDENT A. wvne ' _ __ . ` ~ ~; _ _ .._ f3 ~ C .IOINTLY-OYMNED PROPEi'tTl(: REM NUMBER LETTER FORJOM(f Ti3iM(T . DATE MADE JOINT DESCRIPTION OF PROPERTY MICLUDE NA#E OF FINANCUIL INSTITUTION AND BANK AOCOINJT NUMBER OR SIMNAR IDENTIFYING NUMBER ATTACH DEED FORJOINTLY-HELD REAL ESTATE. QATE OF DEATH VALUE OF ASSET' % OF OECDS INTEREST DATE OF DEATH VALUE OF ~CEDENTS INTEiB=ST 1. A. N~ aao II i II -. I: }. i a t>b TOTAL (Also enter on tine 6, Recapitulation) (ti more is needed, tr~ert addtuor-al eheeta of the same size) REV-1510 EX + (&9a) SCHEDULE G INTER-VIVOS TRANSFERS ~ C INS HER ~ANCE~AXRNETURNANa MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE t7F FILE NUMBER JI/D/TN 1W NEll~lt/CK>~N _ __ _ _ ~~ This schedule moat be oampbled and ttied ff the area tD arty of questions 1 thnwgh 4 on the reveres side d tits REV-1500 COMER SHEET b yes. ITEM NUIwti~R DESCRIPTION OF PRQPERTY' ~ Ma~nfwwr:oFnEm~we~,neseaAnaar~vioue~eirA-c T~~~~ATTAdIACOR'OFTHEO~PoRPFJI~TATE DATE OF DEATH VALUE OF ASSET 9L OF DECD'S M{TEREST EXCLUSION p~ TAXABLE VALUE 1. ty1rELLi irAR00 7,244.09 100. 7,244.09 !RA JlacorJe! No. 631a-2646 • i ~~ TOf fAL Also enter on line 7 s 7 09 (If more space is needed, kreert add~orrel sheela of the name sire) REV-~sti Ex+ f~2-se) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN JuD/T// scHEavr..E x FUNERAL EXPENSES $ ADMINISTRATNE COSTS FN.E MUM9ER r- - Dtrbb of decederd mrat be nporkd oa SrAaduk I. ~,I ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1. NOLJNO!°R Ft/NFRAL NOME 2 :ECOND !~1[EiDVT1E1t/AN CNURCN , ~. OeRALO Z/NM~1lMAN -Transport A;hns 4. FLOWERS ~ "IJ 0. DEATH CERT/F/GATES H. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions ~I Nana of Personal Represerltetiva (a) JENNIFER DRAXTON KRAMMES Social Sea-rKy Number(s~EIN Number of PeraonaJ RA(s) Street Address 4240 NAl tOEITY ROAD City /I(JA111y/IfOTOWN S~ MD Z~ 201t9>P Year(s) Cammfsaior- Paid: 2010 ~ A1lomay Fees IRNRN LAW OFFICE ~ 2. I 3, Famiy ExempMon: (if decedent's address is not the same es daimerrCa, attach mrplanedon) ~~I ~~ DONALD O, NENOR/CKSON ~ S1reetAddroaa 1125 L/NN DR/YE City CARL/SLE Sf~ PA ~ 17011 RelaUonshq of Ciaimerd b geoerieM ~~~ 4. Probate Fees CU~MDERLAND COt/M'y REO/sTFR OF WILIS 5. AcoountanYs Fees 6. Tax Re1um Preparers Fees 7, JOSEPH BYCKLEI~ eSQ - /nltld Attorney Fofs 0. c+owrPUrERSHARE - AdiMn/stradvi Fw a CI/MBERLAND tNll//NT'y' REO/STFR OF W1LLS - Fgli-S /nwntory aired ApprtiJsunN-t AMOUNT 1,533ti50 700.00 T50.00 400.00 40.00 9,000.00 4,000.00 9,500.00 189 00 50800 140.00 90.00 - - - _ _ TOTAL (Also enter on kne 9, RacapitulaHon) ~ : - ,.~ .~~ sn ~ more space is needed, insert additlonal streets otthe same alas) F~V-1512 FJC + (12-03) SCH4D~,lLE COMMONWEALTH OF PENNSYI.VANU1 DEBTS OF DECEDENT, MIHERRANCE TAX RETURN MORTGAGE LIABILITIES, ~: LIENS RESIDENT DECEDENT ESTATE OF - - - FILE NU1I~BER JvarH lL 'rrENmtlcKSON oosas Rupoit da6b Mwrra! by the dandaM prior to death whkh remaNled unpaid ae of.the date of death, including un ITEM NUMBER DESCRIPTION II 1. RETAILER NATIONAL BANK oEau- CrMIIt wooouM ~ I z rwROEr NAr~o~uu. BANK open cr.arr Accou~ s. crrticoR- cieEn/T Open Crod/t Account I ~ sEwRa ~ ~ ~~ op«- c..alr Account ~ ~i a. wwLMiuer Open Cndk Account 8. CHASE MANHATTAN Open Crud/t Account T. BANK OF AMERICA Open Cndk Account Pubt wlth spouse, Donald O. Nenddakson (Total 6,7!.!'!4.78) medical expenses. VALUE AT DATE QF DEATH 8,7sl.00 gssa.sa ~s,7aa.o~ ad71.07 a~aZo 11,7017 3,36Ztia • TOTAL (Also enter on fine 16; Rec~pi~latlor-) ~ (if owns apace B needed, Insert additional sheela ot>he erne size) REV-1513 EX+(9-00) N ~TH.OF PENNSYWANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF J1/ 111. NENDItt/CKiON SCW~DULE J ` . BENEFfCIARtES I NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABI.~ DISTRIBUTIONS (irldude outrt~ ~ ~, and traneiafs under Sec. 9116 ( ) (1.2' 1. FILE NUtINER 0098 RELATtONSH{P TO DECEDENT Do Not Ibt Trust~{s) 3pousd ENTER DOUAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON UNES 15 THROUGH 1$, AS APPROPRIA' jj, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BE1NG MADE 1. DONALD Q NlIMfJwR/CKiON 1126 uNN DINVlS c~Alae-sLly ~w 1ro1s - B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. OF ESTATE 1-1500 COVER SHEET 100% REd/DUE I TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET 0 ~, (If rtrore specs is needed, insert additional sheets of the same size) . !, i ~~ LAST WII.L AND TESTAMENT OF JUDITH G. NORRIE ~'I I, JUDITH G. NORRiE, domiciled .and resident at 1126 Linn Driv Carlisle, County of Cumberland, Commonwealth of Pennsylvania, declare that this d ent is my Will and revoke all my previous Wills and Codicils. . - I. IDENTIFICATIONS AND DEFRJITIONS I am married to DONALD G. HENDRICKSON {"my husband"). I hav two (2) children, J]ENfNIFER DRAXTON of Huntington, MD, and JOELLYN NO of Carlisle, PA, they and any other children born to or adopted by my husband me are referred to in the Will as "my childrenichild". II. PAYMENT OF EXPENSES, DEBTS, AND TAXES I direct my Executor to pay medical, funeral, and administrative expense taxes payable by reason of my death, before any division of my estate. My Exec not attempt to have any part of such taxes apportioned among the recipients of includible in determining the amount of such taxes. Proceeds on insurance on n to the maximum allowable as an exemption from Pennsylvania Inheritance distn'butions from pension and profit sharing plans exempt from federal estate t which are payable to my Trustee or any beneficiary (other than my estate), sha used to pay,debts, taxes, expenses of administration or other charges against my e III SPOUSE SURVIVING If my husband survives me, I devise, bequeath, and appoint to him all which I own, or over which I have a testamentary power of appointment. N. SPOUSE FAII,ING TO SURVIVE ff my husband does not survive me, I dispose of my property as follows: Tan' ble Personal Propgrt~t: I give my tangible personal property in equal shares to my children who survive me, to be divided among them as they (or their Guardians, in the case; of minor children) shall agree; if they .fail to reach agreement within sixty (60) days of my and all ~r shall life up uc and ail of not be r death, this tangible personal property shall be divided among my children as my Executor determines appropriate, in shares • af~ substantially equal value. I recommend, but do not require, that all such items of tangible personalty be appraised and that the children (or their Ouardians in the case of minor children) select in rotation items at the appraised value, the order of choice to be determined by lot. If any child is a minor at the tune of such division, my Executor may distribute his/her share of tangible personal property to him/her for his/her use or =for his/her use to his/her Guardian in any combination of items, or to both, without further responsibility, and the distributee's receipt shall be sufficient discharge to my Executor. 8esidu~: I give all other properly which I own or over which I have a testamentary power of appointment, to and for the benefit of my issue who survive me, as follows: To each who has attained the age of twenty-five {25) years, the share which he/she would take if all such property then were being distnbuted to my issue who survive me, per stapes. To my Trustee hereinafter named, the balance of such property, to be held, administered and distributed as provided in the article of this Will entitled TRUST FOR ISSUE. v. TRUST FOR ISSUE This trust is established for the benefit of my issue from time to time have not attained the age of twenty-five (25) years and who do not have a received either a part of the residue at my death under Article N or a poi corpus of this trust subsequently at age twenty-five (25) years. In~me: The net income shall be accumulated and thereafter treated as corpus. From the carpus of the trust, the Trustee shall pay from time to time or. for the benefit of such one or more beneficiaries such variable amounts (even to the exhaustion of the trust) as are appropriate, in the discretion of the Trustee, for support and care where the benefiaary is not self-supporting through no fault of his own, for education (defined as four years of college, or equivalent preparation in business, technical or trade training} if the beneficiary strives therefor in good faith, and for extraordinary requirements occasioned by illness or .other misfortune. Amounts of corpus so distributed shall not be taken into account in making division of the trust when a beneficiary attains the age for distribution to him ~g who it who of the Page 2 r 'provided' in the next four paragraphs. It is my expectation anc~ intention that if guardians of the person are appointed for a mino child, the Trustee will exercise the foregoing power in order t supply funds to the guardians adequate to maintain and support th minor child and to protect the guardians, to the extent possible, fo suffering any :significant financial burden by reason of th ' appointment. When each beneficiary attains the age of twenty-five (25) years, the Trustee~shall pay to him the share to which he would be entitled if the then existing trust fund were distributed to my issue then living, per stirpes, on the hypothesis that my only issue then living are such beneficiary and all younger beneficiaries of this Trust. This trust shall terminate when the youngest beneficiary attains the age of twenty-five (25} years. ff this last beneficiary dies before attaining that age, then upon his death Trustee shall distribute the fund to my issue, then living, per stirpes. If, at the end of my accounting period, the current market, vah~e of the corpus of the trust does not exceed Five thousand ($5,000.00) dollars, the corpus shall forthwith be paid to the beneficiaries of the trust then living, per stirpes (my children to be the stocks); provided that if a distributee is a minor under the Revised Uniform Gifts to Muiors Act as that Act exists at the execution of this Will and, for the purpose, that Act is incorporated by reference. If this trust is still in existence on the date that is twenty-one (2l) years after the death of the last to die of my issue living at my death, Trustee shall divide the fund, per stirpes, among the then beneficiaries of the trust (my children to be the stocks). The share of each beneficiary shall be paid to him, provided the Trustee shall hold, administer the share of any distributes who then is a minor as Custodian in accordance with the provision in the last preceding paragaph. VI. FIDUCIARIES Ex~t~r: I nominate and appoint my daughters, JIBNNIFER DRAXT Nand 3OELLYN NORRIE as Co-Executors of this Will to serve without bond. ff eith does not survive me, declines to act, or having qualified, resigns, dies, or is rem ved, I nominate the other to serve as sole Executor to serve without bond. Tna~: I nominate ORRSTOWN BANK as Trustee. M Trustee shall I of be Y required to file an inventory or accountings with the Clerk or the Court having juri fiction over this Will. ~i ~I Page 3 I direct that it receive as compensation for its services as Trustee such aunts as it customarily charges for similar services at the time those services are perform PQ~: I give my fiduciaries, including successor fiduciaries, all a powers contained in Chapter ?1 of the Pennsylvania Probate, Estates and Fiduciaries C de at the time of the execution of this Will, and those powers are incorporated by referee VII. - MISCELLANEOUS Survival Defined: No person shall be deemed to have survived me or t be living at my death if he/she shall die within thirty (30) days after my death. Issue Defined; The term issue means all my lineal descendants, imm 'ate and remote, living on the date the persons who comprise that class must be ascertain .When distnbution is to issue, per stirpes, distribution shall be by right of represent tion, my children to be the stocks. ~ i A~d~tiQn:. Where a person has been adopted prior to attaining the age of eighteen (18) years, such person shall be treated for all purposes of this Will as the natur child of the adopting parents. I~1o _Imnl;~ , .ontrart: This Will is being executed on the same date as is a Will of my wifelhusband; but in na event shall our Wills be considered joint or mutual, it being our express intention that the survivor shall in no way be restricted in a use, management, enjoyment, or disposition of her/his separate estate or property eceived under the other's Wll. Tl 'matp Takerc: If, at any time, there is no one to take under the tern Will or Trust described in Article V, my fiduciary shall pay over half the fund persons who would take my estate if I had then died intestate, unmarred, dor Pennsylvania, under the laws of Pennsylvania then in effect, the shares and prop< be determined by said laws, and the balance to those persons who would wife'sJhlisband's estate if shelhe had then died intestate, unmarried, don Pennsylvania under the laws of Pennsylvania then in effect, the shares and props be determined by said law I.aYin;~ Will: In the unfortunate event that I should by reason of physical or disability, become unable to take part in decisions for my own future by virtue of commonly referred to as "brain dead" ar imminent death, I order and direct that, there is no reasonable expectation of my recovery from physical or mental disabilil permitted to die and that I not be kept alive by artificial means. It is my express des; II I not be permitted to suffer the indignities of deterioration, dependence and hopele of this those fled in ons to ke ~my led in ons to is ,Ibe tit N and that, therefore medication be mercifully administered to me only to allleviate my suffering even though. this may hasten the -moment of death. In testimorry of which I now sign this Will, in the presence of witnel sea whose names will appear below, and request that they witness my signature and a est to the execution of this Will, this .J - day of May, 1998 at 1237 Holly P' ,Carlisle, Cumberland County, Pennsylvania. ~` TH G. NORRIE JIJDIT'H G. NORRI>~, in our presence, signed this instrument. Before a signed it, she declared to us that it was her Will and requested that we act as witnes to its execution. We believe her to be of sound mind, possessing testamentary capaci ,and not subject to undue influence, fraud, or coercion. We now, in her presence, din the presence of each other, sign below as witnesses, aU on this ~`` day of y, 1998, at 1237 Holly Pike, Carlisle, Cumberland Courrty, Pennsylvania. residing at 1237 Holly Pike, Carlisle, PA 17013. c idmg at 139 Easterly Drive, Mechanicsburg, PA 17055 ~I Page 5 r~ COMMONWEALTH OF PENNSYLVANIA ss , COUNTY OF CUMBERLAND We, Joseph D. Buckley and Susan H. Goodridge, the witnesses whose es are signed to the foregoing instrument, being duly qualified according to law, do d se and say that we were present and saw Testator sign and' execute the instrument her Last Will: that she signed willingly and for the purposes therein expressed; that each o us in the hearing and sight of the Testator signed the Will =as witnesses; and that to the st of our knowledge the Testator was at that time eighteen (18) or more years of age, of sound mind, and under no constrairrt or undue influence. Sworn or affumed to and subscribed to before me by Joseph D. Buckley d Susan H. Goodridge, witnesses, this ~'~ day of May, X98. /1 / Not Public i ~~ seal PubNc My Commission Expires June 28, 2001 ~` 4'~.~} 1•` Page 6 r FJCHIBIT "B" Safeco Bond No. 5926165 Date: September 14, 2009 Registered Owner: Judith G Norris ' SAFECO INSURANCE O.OF AMERICA Lost Securities suit for Computeraha Accounts Account Number. 00000023272 Company Name: CORVEL CORPORATION I -,. Issas ID: CRVE 'i Lost Securkies: Certiflcata Number(s) Shares Date Issued Certificate Number(s) Shama Date Issued 00004217SPP 6 03131/95 000071TTLU 6 06/14/99 00016342LU 9 12/08/06 Total Lost Shares: 21 Current Marie Value: ;639.66 Safeco Bond Premium (;US): ;20.00 . Processing Fee: ;50.00 Total Due (Please make check payable to Compute'share): ;70.00 This affidavit constitutes an application for coverage for the benefit of Computenthara "Transfer Agent") under the Lost Securities Bond issued by Safeco Insurance Co. of America. Safeco res ryes the right to accept or reject this affidavit. The Safeco Bond Premium amount set forth above shall valid for 6 months from the date sat forth above. Safeco reserves the right after 6 months to inc the Premium amount if the market value of the Lost Securities increases. The Transfer Agent will fo rd the Safeco Bond Premium to Safeco. i 1 Please print OWNER name. (OWNER shall also mean Owners, representative or agent) (OWNER) BEING DULY SWORN ONO TH, DEPOSES AND SAYS the following: ~ - 2 The Owner is of legal age and the Lost Securities have been lost, mislaid, or destroyed a d cannot be produced. The Owner has made or caused to be made a diligent search for the Lost Sec rites, and has been unable to find or recover the Lost Securities, and makes this Affidavit for the purpos of inducing the issuance of new or replacement Securities ("Replacement Securities") in lieu of the sa d Lost Securit~s, - or the distribution to the Owner in the form of liquidation proceeds. The Owner hereby agr to surrender immediately the Lost Securities #o the Transfer Agent for cancellation should they, at any e, come into the Owner's or any other person's possession, custody, or control. - i 3 The Owner agrees that this Affidavit may be delivered to and made part of the Safeco Boni described above. ~ ~~ r- 4 Circle Ail That Apply (Items A, B, C, D): A. The Lost Securities were signed, pledged, or were listed in a previously signecb transfer request (including having executed a stock power). B. The Lost Securities have been stolen. Please submit a copy of the police re C. The Lost Securities are/wrere involved in a divorce (If the Market Value exceed $25K, please submit a copy of the divorce decree). D. I am the executor/administrator of the deceased shareholders estate (pleases bmit proof of court appointment.) 5 IN CONSIDERATION OF THE ISSUANCE OF (1) SUCH REPLACEMENT SECURITI S N LIEU OF THE LOST SfCURtTIES, OR OF THE DISTRIBUTION TO THE OWNER OF THE PROLE DS THERE FROM, AND (2) SAFECO INSURANCE CO.OF AMERICA ASSUMING. LIABILITY UNDER S BOND, THE HIS/HER HEIRS, SUCCESSORS AND ASSIGNS, AGREE TO INDEMNIFY, OWNER PROTECT AND , SAVE HARMLESS [Computershare Trust Company, NA, Ccmputershare], SAFE O INSURANCE CO.OF AMERICA, AND THE ISSUER JOINTLY AND- SEVERALLY, AND THEIR A NTS, REPRESENTATNES, SUCCESSORS AND ASSIGNS, FROM AND AGAINST ALL L ES, COSTS AND DAMAGES (INCLUDING COURT COSTS AND ATTORNEYS' FEES) TO WHIG THEY MAY BE SUBJECT TO OR LWBLE BY REASON OR ON ACCOUNT OF ASSUMING LIABIL .UNDER ITS INDEMNITY BOND. ANY PERSON WHO, KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSU CE COMPANY OR OTHER PERSON, FILES A STATEMENT OF CLAIM CONTAINING ANY MATER Y FALSE INFORMATION OR CONCEALS FOR THE PURPOSE Of MISLEADING, INFORMAT ON CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, HtCH IS A CRIME. All parties agree and acknowledge that as part of the Safeco requirement for record sto and retention, this document may be microfilmed, scanned, or maintained in the form of an ectronic digitized copy which shall be as effectrve as the original for all purposes. ~ 6 Replacement securities are issued in the form of book-entry, unless unavailable t rough the issuer. A book statement or certificate representing ownership and confirmation of the lacsment of the Lost Securities will be sent to the above address. 7 Ali owners must sign each copy of thls affidavit as an original in the presence of Notary Public. Legal documents (as required above) must be enclosed. a. SIGNATURE DATE (MM/Dq/YY): SIGNATURE DATE b. IN WITNESS WHEREOF,1 hereunto subscribe my name this day of ao c. NOTARY PUBLIC MY COMMISSION EXPI a Safeco Bond No. 5926165 Date: March 15, 2010 Registered Owner. Judith G Norris SAFECO INSURANCE C . OF AMERICA Lost Securities davit for Computenthare counts Account Number: 00000023272 Company Name: CORVEL CORPORATION Issue ID: CRVE Lost Securities: Certificate Number(s) Shares Date Issued Certificate Number(s) Sh Date Issued 00009349LU 6 08/31/01 Total Lost Shares: 6 ~ Current Market Value: 5219.06 ~ 3afeco Bond Premium (5US): ~ 520.00 Processing Fse: 150.00 ~i, Tote! Due (Please make check payable to Computersharej: 570.00 This affidavit canstiitutes an application for coverage for the benefit of Computershare ( ransfer Agent") under the Lost Securities Bond issued by Safeco Insurance Co. of America. Safeco es the right to accept ar reject this affidavit. The Safeco Bond .Premium amount set forth above shall valid for 6 months from the date set forth above. Safeco reserves the right after 6 months to incre a the Premium amount ff the market value of the Lost Securities increases. The Transfer Agent wilt fo rd the Safeco Bond Premium to 3afsco. 1 Please print OWNER name. (OWNER shall also mean Owners, representative or agent) (OWNER) BEING DULY SWORN ON OA H, DEPOSES AND SAYS the following: 2 The Owner is of legal age and the Lost Securities have been lost, mislaid, or destroyed an cannot be produced. The Owner has made or caused to be made a diligent search for the Lost Seca ' ies, and has been unable to find or recover the Lost Securities, and makes this Affidavit for the purpos of inducing the issuance of new or replacement Securities ("Replacement Securities") in lieu of the sal Lost Securities, or the distribution to the Owner in the form of liquidation proceeds: The Owner hereby agr to surrender immediately the Lost Securities to the Transfer Agent for cancellation should they, at any ti e, come into the Owner's or any other person's possession, custody, or control ~ 3 The Owner agrees that this Affidavit may be delivered to and made part of the Safeco Bon~f described above. s 4 Circle All That Apply (Items A, B, C, D): A. The Lost Securities were signed, pledged, or were listed in a previously signed ', transfer request {including having executed a stock power). B. The Lost Securities have been stolen. Please submit a copy of the police report C. The Lost Securities are/were involved in a divorce (If the Market Value exceeds19 please submit a copy of the divorce decree). D. I am the executor/administrator of the deceased shareholders estate (please su proof of court appointment.) 5 `` " IN CONSIDERATION OF THE ISSUANCE OF (1) SUCH'f~EPLACEMENT SECURITIE LOST SECURITIES, OR OF THE DISTRIBUTION TO THE OWNER OF THE PROCE AND (2) SAFECO INSURANCE CO.OF AMERICA ASSUMING LIABILITY UNDER IT OWNER, HIS/HER HEIRS, SUCCESSORS AND ASSIGNS, AGREE TO INDEMNIFY, SAVE HARMLESS [Computershare Trust Company, N.A., Computershare], SAFEC CO.OF AMERICA, AND THE ISSUER JOINTLY AND SEVERALLY, AND THEIR AGES REPRESENTATIVES, SUCCESSORS AND ASSIGNS, FROM AND AGAINST ALL LO AND DAMAGES (INCLUDING COURT COSTS AND ATTORNEYS' FEES) TO WHICH SUBJECT TO OR LIABLE BY REASON OR ON ACCOUNT OF ASSUMING LUIBTLIT INDEMNITY BOND. IN LIEU OF THE IS THERE FROM, BOND, THE ROTECT AND 1 INSURANCE SES, COSTS 'HEY MAY BE UNDER ITS ANY PERSON WHO, KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSU CE COMPANY OR OTHER PERSON, FILES A STATEMENT OF CLAIM CONTAINING ANY MATER LY FALSE INFORMATION OR CONCEALS FOR THE PURPOSE OF MISLEADING, iNFORMATI wrONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, W ICH IS A CRIME. All parties agree and acknowledge that as part of the Safeco requirement far record sty retention, this document may be microf~imed, scanned, or maintained in the form of an digitized copy which shall be as effective as the original for all purposes. 6 Replacement securities are issued in the farm of book-entry, unless unavailable A book statement or certificate representing ownership and confirmation of the the Lost Securities will be sent to the above address. 7 Ali owners must sign each copy of this affidavit as an original in the presence of a Legal documents (as required above) must be enclosed. a. SIGNATURE DATE SIGNATURE DATE b. IN WITNESS WHEREOF,1 hereunto subscribe my name this day of 20 c. NOTARY PUBLIC MY COMMISSION EXPIRES and the issuer. lent of Public. .~ • r EXHIBIT "C" ,,•,. s . PRUCO SECURITIES, LLC ' One North Jefferson St. Louis, MO 63103 The following are included in this check: ~ ~ V Date Description ` ~ 8 11/03/09 CHECK ISSUED s ~ ~ ~ . ~/~ ~- ~N 4/ _ Z _ ~ ~ Z _ ~ z Z . Z Z Z Z Z . Z Z Z oo2xsi November 3, 2009 Account No.IBR12-4131-7725 Chick No. 7304475 CUSIP Type Payment Type ~ '~ Amount 1 CHK !, $47,768:25 ..~ ~ laloul~ ~dl~e~~d Accounts carved by First Clearing, LLC, Member New York Stock Exchange and SIPC. PLEASE DETACH t3EFORE DEPO$tTiNCi I oo2~s~ ~•' . PRUCO SECURITIES, LLC December 3, 2009 One North 3efferson St. Louis, MO 63103 Account Nr~ BR12-4131-7725 G eck No. 7383536 The following are included iri this check: " . ~ Date Description CUSIP Type Payment Type .I, ' .w Amount ~_ 8 12/03/09 CHECK ISSUED 1 CHK I , .. $30.48 i~ ~ ~ I ~ ._.. ~~ ~_ W ~ ~~ Z II : ~ ~ Z z ~ Z z z ~ ~ ~ ~. !, z i i~ a ~ ~ ~~~ Ads carried by First Ciearu~p, LLC, Member New York Stock Ewcham~e and SIPC. PLEASE DETACH SPORE DEPOSITING f I~ . I: - I