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Home My WebLink About05-09-11 (3)1,50561,01,49 EX (01-10) REV-1500 OFFICIAL USE ONLY Pennsylvania - PADepartment of Revenue ~'^"iMeNrar•c~eHUr. County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280801 Harrisburg, PA 17128-0801 RESIDENT DECEDENT 21, 1J 0 0 8 5 8 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 284 26 8527 08 1,0 201,0 09 15 1,92? Decedent's Last Name Suffix Decedent's Frst Narrle MI Henschen Mr• Homer E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Frst Name MI Henschen Mrs Leah R Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 2 0 4 O 1, 0 0 3 5 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate ~ 4a. Future Interest Compromise (date of D 5. Federal Estate Tax Retum Required death after 12-12-82) ~ 6. Decedent Died Testate D 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -This section must be completed. All Correspondence and Confidential Tax Information Should be Directed to: Name Dayl:irne Telephone Number Robert C • Saidis 71,7 243 ~b,222 ~.a Frst line of address 26 W• High Street Second line of address City or Post Office Carlisle State ZI P Code PA 1,7013 O ~.' ~.~ REGISTERI~BV6 LS USE 0, W~ -r-~F ~~,. ~ r'T'~ I C/7 ~ ~ i, i ~-~U n ~ c._ _~: ~ ~; C~ .~ ~-~_ .~ DATE FILED Correspondent's a-mail address: rSaIdIS~SSr-attorneys.com Under penalties of perjury, I declare that I have exarnined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of the preparer other than personal representative is based on all information of which preparer has any knowledge. SIGNATUR /~~ RSON R~PONSIBLE FOR FILI G RETURN DATE AD D RE s 634 Belv ere Street t ~ ~ ` Carlisle, PA 13 SIGNATURE O, REP E ERTHANREPRESENTATIVE DAT ~~ .~~.~ 5 ~ d ~ ~ ;~ AD D I~.ss 2,6"11V~~t't'lig Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Slde 1 150561,0149 1,5D561,01,49 J ~~ 1505610249 Rev-1500 EX Decedent's Social Security Number 2 8 4 2 6 8 5 2 7 Decedent's Name: Homer E. Henschen Mr. RECAPITULATION 0 • 0 D 1. Real estate (Schedule A) • . • • • • • • • • ............................... 1 • 2. Stocks and Bonds (Schedule B) •••••••••••••••••••••••••••••••••••~ 2• 872,746.22 0 • 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) • • • • • • 3. 4. Mortgages and Notes Receivable (Schedule D) • • • • • • • • • • • • • • • • • • • • • • • • • 4. 0 • 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) • . • • • • • 5. 12 , 6 4 3 •01 6. Jointly Owned Property (Schedule F) O Separate Billing Requested • • • • • • 6. D ' 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 9 7 5 , 8 5 2.71 (Schedule G) ~ Separate Billing Requested • • • • • • 7. 8. Total GrossAssets(totalLineslthrough7)•••••••••••••••••••••••••••• 8. 1,861,241.94 85,471.59 9. ••..•..•••..•.•••. Funeral Expenses and Administrative Costs (Schedule H) 9. 3 ~ 9 8 2.0 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 11. Total Deductions (totalLines9and10) ••••••••••••••••••• ••••••••• 11. 89,453.63 1,771,788.31 12. Net Value of Estate(Line8minusLinell)..•.••••••••••••••••••••••••• 12. 13. Charitable and Governmental Bequests/Sec 9113 Tnasts for which ' 0'00 ••••••••••••~•••••• an election to tax has not beenmade(Schedule))•••• 13. 1,771,788.31 14. Net Value Subject to Tax (Line l2 minus Line l3) .. •..•••••••••.•••••••• 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 042 •25 136 (a)(1.2)x.oo , 15. 16. Amount of Line 14 taxable 7 4 6 0 6 6 3 5 1 at lineal rate X .045 , , 16. 17. Amount of Line 14 taxable D ' 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 DUE ..................... ............................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 0.00 73,608.57 0.00 0.00 73,608.5? O 150561249 ],505610249 J Rev-1500 EX Page 3 ne..e.~lnr,t~c ~ .,mnlate~ A['I['IrP_CC~ File Number 21 10 0858 DECEDENTS NAME Homer E. Henschen Mr. STREET ADDRESS 624 Belvedere Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Prior Payments B. Discount (1) 73,608.57 60,000.00 3,157.80 Total Credits (A + B) (2) 3. Interest 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 63,157.80 (3) 0.00 (4) (5) 10,450.77 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN 1'HE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;•.••••••••••••••••••••••••••••••••••• ^ b. retain the right to designate who shall use the property transferred or its income; . • • • • • • • • • • • • . • • ^ c. retainareversionaryinterest;or ••••••••••••••••••••••••••••••••••••••••••••••••••• ^ d. receive the promise for life of either payments, benefits or care? • • • • • • • • • • • • • • • • • • • • • • • • • • • ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ••••••••••••••••••••••••••••••••••••••• ^ 3. Did decedent own an "intrust fog" orpayable-upon-death bank account or security at his or tier death? • . ^ 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which containsabeneficiarydesignation? ••••••••••••••••••••••••••••••••••••••••••••• Q ^ 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. Sect. 9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. Sect. 9116(a)(1.1)(ii)]. The statue 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 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. Sect. 9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. Sect. 9116(1.2) [72 P.S. Sect. 9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [;~2 P.S. Sect. 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+(6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCETAX RETURN RESIDENTDECEDENT ESTATE OF FILE NUMBER Homer E. Henschen Mr. 21 10 0858 All property jointly-owned with right of survivorhsip must be disclosed or>I Schedul e F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 ALLIED IRISH BANKS PLC 2,233.76 210 certificate shares 744.5993 plan shares 2 300 COVIDIEN PLC 11,475.00 Book entry shares Dividend on above stock declared prior to decedent's death 54.00 3 GENERAL ELECTRIC COMPANY 14,515.47 80 certificate shares 818.8717 plan shares 4 GENERAL MOTORS CORPORATION 38.71 40 Certificate shares 58.011355 book shares 5 INTERNATIONAL BUSINESS MACHINES CORPORATION 18,820.85 10 shares certificate form 132.983 book shares Dividend on above stock declared prior to decedent's death 92.94 6 HERSHEY FOODS CORPORATION 18,492.00 200 certificate shares 200 book entry shares 7 300 TYCO INTERNATIONAL LTD 11,275.50 Book entry shares Dividend on above stock declared prior to decedent's death 63.33 8 300 TYCO ELECTRONICS LTD 8,439.00 Book entry shares 9 7 JOHNSTON EQUIPMENT & SUPPLY CORP 0.00 Certificate shares Worthless 10 57.332 TYCO INTERNATIONAL LTD NEW 2,154.87 Shares held in dividend reinvestment program 11 57.7707 TYCO ELECTRONICS LTD 1,625.09 Total from continuation Schedule(s) 783,465.70 TOTAL (Also enter on line 2, Recapitulation) 872,746.22 (If more space is needed, insert additional sheets of the same size) Estate of: Homer E. Henschen Mr. Schedule B -Stocks and Bonds Item Number Description 11 Shares held in dividend reinvestment program 12 56.4199 COVIDIEN LTD Shares held in dividend reinvestment plan 13 FORD MTR CO DEL CUSIP: 345370860 Shares/Par: 774 Exchange: New York Stock Exchange COM PAR $0.01 14 COVIDIEN PLC CUSIP: G2554F105 Shares/Par: 22 Exchange: New York Stock Exchange SHS Div: 0.18 Ex: 07/29/2010 Rec: 08/02/2010 Pay: 08/20/2010 Dividend on above stock declared prior to decedent's death 15 EXXON MOBIL CORP CUSIP: 302316102 Shares/Par: 300 Exchange: New York Stock Exchange COM 16 GENERAL ELECTRIC CO CUSIP: 369604103 Shares/Par: 700 Exchange: New York Stock Exchange COM 17 LILLY ELI & CO CUSIP: 532457108 Shares/Par: 250 Exchange: New York Stock Exchange COM 18 PFIZER INC CUSIP: 717081103 Shares/Par: 1000 Exchange: New York Stock Exchange COM Div: 0.18 Ex: 08/04/2010 Rec: 08/06/2010 Pay: 09/01 /2010 Dividend on above stock declared prior to decedent's death Page 2 21 10 0858 Value at Date of Death 2,158.06 9,996.21 841.50 3.96 18,543.00 11,303.98 9,341.25 16,430.00 180.00 TOTAL. (Carry forward to main schedule) ...... 68,797.96 Estate of: Homer E. Henschen Mr. Schedule B -Stocks and Bonds Page 3 21 10 0858 Item Value at Date Number Description of Death 19 TYCO ELECTRONICS LTD SWITZERLD 618.86 CUSIP: H8912P106 Shares/Par: 22 Exchange: New York Stock Exchange SHS 20 TYCO INTERNATIONAL LTD 826.87 CUSIP: H89128104 ShareslPar: 22 Exchange: New York Stock Exchange SHS Div: 0.2111 Ex: 07/28/2010 Rec: 07/30/2010 Pay: 08/25/2010 Dividend on above stock declared prior to decedent's death 4.64 21 VISTEON CORP 5.72 CUSIP: 928390107 Shares/Par: 13 Exchange: Other OTC COM 22 WASTE MGMT INC DEL 6,859.00 CUSIP: 94106L109 Shares/Par: 200 Exchange: New York Stock Exchange COM 23 214 ALCATEL LUCENT 625.95 Per Estate Val 24 50 COVIDIEN PLC 1,912.50 Per Estate Val Dividend on above stock declared prior to decedent's death 9.00 25 4 LSI CORP 17.14 Per Estate Val 26 50 TYCO ELECTRON ICS LTD SWITZERLAND 1,406.50 Per Estate Val 27 50 TYCO INTERNATIONAL LTD 1,879.25 Per Estate Val Dividend on above stock declared prior to decedent's death 10.56 TOTAL. (Carry forward to main schedule) ...... 14,175.99 Estate of: Homer E. Henschen Mr. Schedule B -Stocks and Bonds Item Number Description 28 AMERICAN HIGH INCOME TR CUSIP: 026547307 Shares/Par: 1945.68 Exchange: Mutual Fund (as quoted by NASDAQ) CL C 29 LORD ABBETT HIGH YIELD FD CUSIP: 54400N300 Shares/Par: 1378.336 Exchange: Mutual Fund (as quoted by NASDAQ) CL C 30 NUVEEN MUN TR CUSIP: 67065Q749 Shares/Par: 3106 Exchange: Mutual Fund (as quoted by NASDAQ) HIYLDMUNA 31 OPPENHEIMER MULTI ST MUNICIPAL CUSIP: 683940100 Shares/Par: 8946.299 Exchange: Mutual Fund (as quoted by NASDAQ) PA MUN FD CL A 32 1239.162 LEGG MASON VALUE TR FD CL C 33 510.603 VANGUARD STRATEGIC EQUITY FUND 0114-09929168150 Per Estate Val 34 394.203 VANGUARD ENERGY FUND INVESTOR 0051-0992916815() Per Estate Val 35 1769.155 WELLS FARGO ADVANTAGE FUNDS ACCT #225- 390100360024 Per 12/16/10 letter 36 427.035 WELLS FARGO ADVANTAGE FUNDS ACCT #226-3900360024 Per 12/16/10 letter 37 1984.75 NATIONWIDE FUNDS ACCT 21-2311955600 Per 12/15/10 letter 38 1286.051 NATIONWIDE FUNDS ACCOUNT #22-1311955600 Per 12/15/10 letter 39 321.486 DREYFUS APPRECIATION FD ACCT 0141-10001499 TOTAL. (Carry forward to main schedule) ..... . Page 4 21 10 0858 Value at Date of Death 21,383.02 10,406.44 49,012.68 98,677.68 44,002.64 7,990.94 22,461.69 30,093.33 10,154.89 14,984.86 15,561.22 11,023.75 335,753.14 Page 5 Estate of: Homer E. Henschen Mr. Schedule B -Stocks and Bonds Item Number Description 40 DOW CHEM CO SR INTERNOTES CUSIP: 26054LDN0 Shares/Par: 20000 Exchange: Financial Times Interactive Data DTD: 04/03/2003 Mat: 04/15/2013 5.65% Int: 04/15/2010 to 08/10/2010: 360.97 Interest on above bond accrued as of decedent's death 41 PROTECTIVE LIFE SECD TRS CUSIP: 74367CBP9 Shares/Par: 25000 Exchange: Financial Times Interactive Data DTD: 08/19/2004 Mat: 08/10/2014 5.22% Full coupon paid on 08/10/2010 42 GENERAL MOTORS ACCEPTANCE CORP CUSIP: 3704AOLG5 Shares/Par: 48000 Exchange: Financial Times Interactive Data DTD: 05/25/2004 Mat: 05/15/2016 5.5% Int: 05/15/2010 to 08/10/2010: 623.33 Interest on above bond accrued as of decedent's death 43 FORD MTR CO DEL CUSIP: 345370BX7 Shares/Par: 50000 Exchange: New York Bond Exchange DTD: 07/27/1998 Mat: 08/01/2018 6.5% Int: 08/01/2010 to 08/10/2010: 81.25 Interest on above bond accrued as of decedent's death 44 GENERAL MOTORS ACCEPTANCE CORP CUSIP: 3704AOKT8 Shares/Par: 40000 Exchange: Financial Times Interactive Data DTD: 05/11 /2004 Mat: 05/15/2019 6.5% Int: 05/15/2010 to 08/10/2010: 613.89 Interest on above bond accrued as of decedent's death 45 HSBC FIN CORP HSBC FIN CUSIP: 40429XEF9 Shares/Par: 40000 21 10 0858 Value at Date of Death 20,988.90 360.97 24,747.00 46,295.18 623.33 48,812.50 81.25 34,474.64 613.89 39,993.84 TOTAL. (Carry forward to main schedule) ...... 216,991.50 Estate of: Homer E. Henschen Mr. Schedule B -Stocks and Bonds Page 6 21 10 0858 Item Value at Date Number Description of Death 45 Exchange: Financial Times Interactive Data DTD: 07/28/2005 Mat: 07/15/2020 5.6% Int: 07/15/2010 to 08/10/2010: 155.56 Interest on above bond accrued as of decedent's death 155.56 46 GE CAPITAL INTERNOTES 20,030.78 CUSIP: 36966RDM5 Shares/Par: 20000 Exchange: Financial Times Interactive Data DTD: 04/03/2003 Mat: 04/15/2023 5.45% Int: 07/15/2010 to 08!10/2010: 75.69 Interest on above bond accrued as of decedent's death 75.69 47 PRUDENTIAL FINL INC INTERNOTE 24,904.15 CUSIP: 74432ALA6 Shares/Par: 25000 Exchange: Financial Times Interactive Data DTD: 10/20/2005 Mat: 1 0/1 5/2025 5.65% Int: 04/15/2010 to 08/10/2010: 451.22 Interest on above bond accrued as of decedent's death 451.22 48 WASHINGTON REAL EST INV TR MTN 53,321.40 CUSIP: 939671AA1 Shares/Par: 50000 Exchange: New York Bond Exchange DTD: 02/25/1998 Mat: 02/25/2028 7.25% Int: 02/25/2010 to 08/10/2010: 1661.46 Interest on above bond accrued as of decedent's death 1,661.46 49 PRUDENTIAL FINL INC INTERNOTE 22,601.15 CUSIP: 74432AFS4 Shares/Par: 25000 Exchange: Financial Times Interactive Data DTD: 02/10/2005 Mat: 02/15/2030 5.55% Int: 02/15/2010 to 08/10/2010: 674.48 Interest on above bond accrued as of decedent's death 674.48 50 BEAR STEARNS COS INC 13,675.47 CUSIP: 07387EHD2 Shares/Par: 15000 Exchange: Financial Times Interactive Data TOTAL. (Carry forward to main schedule) ...... 137,551.36 Page 7 Estate of: Homer E. Henschen Mr. 21 10 0858 Schedule B -Stocks and Bonds Item Value at Date Number Description of Death 50 DTD: 03/17/2005 Mat: 03/15/2030 5.5% Int: 03/15/2010 to 08/10/2010: 332.29 Interest on above bond accrued as of decedent's death 332.29 51 PRUDENTIAL FINL INC INTERNOTE 9,714.71 CUSIP: 74432ANY2 Shares/Par: 10000 Exchange: Financial Times Interactive Data DTD: 05/18/2006 Mat: 05/15/2031 6.3% Int: 05/15/2010 to 08/10/2010: 148.75 Interest on above bond accrued as of decedent's death 148.75 TOTAL. (Carry forward to main schedule) ...... 10,195.75 REV-1508 EX+(6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Homer E. Henschen Mr. 21 10 0858 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 PSECU CHECKING ACCT 47.86 Per 11 /18/2010 letter 2 PSECU SAVINGS ACCT 1,126.62 Per 11/18/2010 letter Interest on above item accrued as of decedent's death 0.11 3 NATIONWIDE FUNDS MONEY MARKET ACCT 24-8011955600 556.45 Per statement 4 FEDERATED CAP RESERVES MONEY MARKET (DELTA) 1,878.66 Per Statement 5 VANGUARD MONEY MARKET FUND 0030-09929168150 136.11 Per statement 6 VANGUARD MONEY MARKET FUND 0011-09929168150 36.80 Per statement 7 VERIZON REFUND 16.78 8 BANK OF AMERICA REFUND 16.50 9 NJ EZ PASS REFUND 8.56 10 GRADY WHITE SEAFARER 22 BOAT/TRAILER 5,300.00 Per Sales price 11 EVERGREEN SETTLEMENT CHECK 208.56 12 WESTMINISTER CEMETERY PLOT/INTERMENT 3,310.00 TOTAL (Also enter on line 5, Recapitulation) ( 12,643.01 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+(07-10) a>t Pennsylvania DEPAR'TMEN7 Of REVENUE INHERITANCETAX RETURN RESIDENTDECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Homer E. Henschen Mr. 21 10 0858 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Andrea M. Warner 3795 Carlisle Road Granddaughter Gardners, PA 17324-9511 B. c. JOINTLY-OWNED PROPERTY: ITEM NUM. LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OFPROPERTY.INCLUDENAMEOFFINANCIAL INSTITUTION AND BANK ACCT NUMBERORSIMILARIDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUEOFi>SSET %OF DECD'S INTEREST DATE OF DEATH VALUEOF DECEDENTSINTEREST 1 A 02/02/07 FOR INFORMATION ONLY 0.00 50.000 0.00 DELTA EQUITY SERVICES CORPORATION 39K-220224 Joint with Decedent's grand-daughter, Andrea Warner Note: Funds in this account were from Andrea's insurance from her mother - Decedent's name was on this account for convenience purposes only. This asset is exempt from PA Inheritance tax per 72 PS 8111 (n). Total value of account $33,411.18 TOTAL (Also enter on Line 6, Recapitulation) I 0.00 If more space is needed, use additional sheets of paper of the same size. REV-150 EX+{os-O9) .~~ r` ~ Pennsylvania pEpAHTMENT'Of REVENUE INH ERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Homer E. Henschen Mr. 21 10 0858 This schedule must be completed and filed if the answer to any of questions ~ through 4 on page three of the RE:V-1500 is yes. ITEM NUM DESCRIPTION OF PROPERTY INCLUDE NAME OFTRANSFEREE, RELATIONSHIPTO DECEDENT& DATE OF TRANSFER. ATTACH COPYOFDEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSET %OF DECD'S~ INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1 $50,000 GENERAL MTRS ACCEP CORP 49,443.85 100 49,443.85 SMARTNOTES Interest on above bond accrued as of 49,443.85 100 515.63 decedent's death 2 500 AT&T INC 13,433.75 100 13,433.75 3 500 BRISTOL MYERS SQUIBB CO 13,270.00 100 13,270.00 4 600 CANADIAN OIL SANDS LTD 16,254.00 . 100 16,254.00 5 400 CHEVRON CORP NEW 31,527.00 100 31,527.00 6 2 FAIRPOINT COMMUNICATIONS INC 0.07 100 0.07 7 312 FRONTIER COMMUNICATIONS CORP 2,421.12 100 2,421.12 8 1000 GENERAL ELECTRIC CO 16,148.55 100 16,148.55 9 200 HEINZ H J COMPANY 9,126.00 100 9,126.00 10 900 PPL CORP 23,771.25 100 23,771.25 11 1300 VERIZON COMMUNICATIONS INC 38,805.00 100 38,805.00 12 2307.876 AMERICAN BALANCED FUND 38,241.51 100 38,241.51 CLASS C 13 500 APOLLO INVT CORP 4,902.50 100 4,902.50 14 3416.272 LORD ABBETT INTERNATIONAL 37,442.34 100 37,442.34 CORE EQUITY FUND 15 3475.118 OPPENHEIMER GLOBAL 48,304.14 100 48,304.14 ALLOCATION FUND 16 4823.013 OPPENHEIMER GLOBAL 20,401.34 10C~ 20,401.34 STRATEGIC INCOME FUND 17 $50,000 SEARS ROEBUCK ACCEP CORP 52,250.00 100 51,250.00 MAT 8/15/2011 Total from continuation Schedule(s) 560,594.66 TOTAL (Also enter on Line 7, Recapitulation) 975,852.71 If more space is needed, use additional sheets of paper of the same size. Estate of: Homer E. Henschen Mr. Schedule G -Inter-Vivos Transfers and Misc. Non-Probate Property Item Date of Death % of Dec's Exclusion Num Description of Property Value of Asset Interest _ (if applicable) Interest on above bond accrued as of 52,250.00 100 decedent's death 18 $20,000 HARTFORD LIFE GLOBAL FDG TRS 19,426.20 100 Interest on above bond accrued as of 19,426.20 100 decedent's death 19 $25,000 MERRILL LYNCH & CO INC 27,033.83 100 Interest on above bond accrued as of 27,033.83 100 decedent's death 20 $20,000 PRUDENTIAL FINL INC INTERNOTE 19,597.20 101) Interest on above bond accrued as of 19,597.20 100 decedent's death 21 $50,000 BANK AMER CORP SUB INTNTS BE 48,687.15 100 Interest on above bond accrued as of 48,687.15 100 decedent's death 22 DELTA EQUITY IRA MONEY MARKET 16,685.63 100 FUNDS Items 1-22 above are all included in Delta Equity Services Corp IRA Account 39K- 633798 Beneficiary: Estate of Homer E. Henschen 23 VANGUARD IRA 22651744 426,528.60 100 Beneficiaries: Decedent's children, Deborah Subashi and Douglas Henschen Page 2 21 10 0858 Taxable Value 1,640.63 19,426.20 66.53 27,033.83 112.85 19,597.20 172.64 48,687.15 643.40 16,685.63 426,528.60 TOTAL. (Carry forward to main schedule) ...... 560,594.66 REV-1571 EX+(10-09) ~~ ~ ., Pennsylvania SCHEDULE H DEpARTkEENT OE REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENTDECEDENT ESTATE OF FILE NUMBER Homer E. Henschen Mr. 21 10 0858 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See schedule attached 3,959.18 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 37,500.00 Name(s) of Personal Representative(s~-eah R. Henschen Street Address 624 Belvedere Street city Carlisle state PA Z;p 17013 Year(s) Commission Paid: 2010/2011 2. Attorney Fees 37,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,500.00 aaimant Leah R. Henschen street Address 624 Belvedere Street city Carlisle state PA zip 17013 Relationship of Claimant to Decedent SUrVIVInq SpOUSe 4. Probate Fees: 598.50 5. Accountant Fees: 6. Tax Return Preparer Fees: See schedule attached 2,413.91 TOTAL (Also enter on Line 9, Recapitulation) I 85,471.59 If more space is needed, use additional sheets of paper of the same size. 1. Page 2 Estate of: Homer E. Henschen Mr. Schedule H, Part A -Funeral Expenses 21 10 0858 Item Number Description Amount 1 Leah Henschen, reimbursement for funeral expenses: 2,122.59 Hoffman-Roth Funeral Home, deposit $1,300 Deb Brandberg, sexton $150 Rev. Jeff Gibelius $150 Rev. Jennifer McKenna $150 Andy Hoke, music director $150 Second Presbyterian Church $80 Nells Market, funeral luncheon $142.59 2 Hoffman-Roth Funeral & Crematory, Inc. 1,836.59 TOTAL. (Carry forward to main schedule) ...... 3,959.18 Estate of: Homer E. Henschen Mr. Schedule H, Part B -Administrative Costs Miscellaneous Expenses Item Number Description 7 Delta Equity Services Corporation, statement paper surcharge June, July, August 2010 statement fee 8 Delta Equity Services Corporation, statement paper surcharge 9 Delta Equity Services Corporation, special request fee, SIPC annual assessment 10 Delta Equity Services Corporation, SIPC annual assessment 11 Lakeside Marine, Inc., repairs/maintenance to boat 12 Saidis Sullivan Law, reimbursement for payments to Cumberland Law Journal and The Sentinel for legal advertising 13 Lakeside Marine, Inc., commission for sale of boat/trailer 14 Cash debit interest for 10/27/10 15 Expenses associated with sale of 200 shares of Hershey Company 16 Expenses associated with sale of 300 shares of Covidien PLC 17 Delta Equity Services Corporation, statement paper surcharge 18 Expenses associated with sale of 200 shares of Hershey Company 19 Expenses associated with sale of 144.322 shares of IBM 20 Expenses associated with sale of 210 shares of Allied Irish 21 Expenses associated with sale of 80 shares of General Electric Company 22 Expenses associated with sale of 300 shares of Tyco International Inc. 23 Expenses associated with sale of 300 shares of Tyco Electronics 24 Cumberland County Register of Wills, short certificate 25 M&T Bank, check order 26 Expenses associated with sale of 98.011355 shares of General Motors 27 Cost of sale re: 825.5338 shares of General Electric Company Page 3 21 10 0858 Amount 3.00 3.00 5.00 5.00 169.85 294.40 530.00 3.25 39.00 51.00 3.00 39.00 29.50 31.00 22.00 45.00 51.00 4.00 30.50 5.19 133.83 TOTAL. (Carry forward to main schedule) ...... 1,497.52 Estate of: Homer E. Henschen Mr. Schedule H, Part B -Administrative Costs Miscellaneous Expenses Item Number Description 28 Vanguard expenses re: sale of 50 shares of Covidien PLC 29 Expenses re: sale of 4 shares of LSI Corp 30 Expenses associated with sale of 50 shares of Tyco Electronics Ltd Switzerland 31 -Expenses re: sale of 50 shares of Tyco International Ltd 32 Expenses re: sale of 214 shares of Alcatel Lucent 33 Saidis, Sullivan & Rogers, out of pocket expenses 34 Saidis, Sullivan & Rogers (reserve for out of pocket expenses) 35 Register of Wills, additional probate fee 36 Register of Wills, filing fees for PA Inheritance Tax Return and Inventory 37 Delta Equity Services Corp, statement paper surcharges 38 Delta Equity Services Corp, maintenance fee 39 Delta Equity Services Corporation, termination fee -IRA Account 40 Delta Equity Services, termination fee -individual account Page 4 21 10 0858 Amount 2.06 2.01 2.04 2.05 2.03 133.20 250.00 350.00 30.00 3.00 30.00 50.00 60.00 TOTAL. (Carry forward to main schedule) ...... 916.39 REV-'1512 EX+(12-08) .... -. :f,R ~ ;1 Pennsylvania DEPARTMkN7 OF REVENUE INHERITANCETAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Homer E. Henschen Mr. 21 10 0858 Report debts incurred by decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Second Presbyterian Church, remainder of 2010 pledge 1,140.00 2 Morgan Stanley Smith Barney I 75.00 $-75 cash balance in account 3 Leah R. Henschen, reimbursement for payment to PPL (08/26/10) 180.06 4 Leah R. Henschen, reimbursement to for payment to Comcast (8/14/10) 67.14 5 Leah R. Henschen, reimbursement to Deb, cleaning services (6/16/10- 210.00 8/25/10) 6 I Leah R. Henschen, reimbursement for payment to AAA Financial Services I 1.34 for credit card balance 7 I Leah R. Henschen, reimbursement for payment to AT&T Universal Card for I 190.96 credit card balance 8 I Leah R. Henschen, reimbursement for payment to American Express for I 18.95 credit card balance 9 (Leah R. Henschen, reimbursement for payment to Century Link (7/25/10) ~ 61.27 10 Leah R. Henschen, reimbursement for payment to Frank's Screens, LLC 176.22 (7/1 Spinnaker #223) 11 Leah R. Henschen, reimbursement for payment to Borough of Carlisle 1;35 65.94 Cambridge Court water/sewer) 12 Leah R. Henschen, reimbursement for payment to Borough of Carlisle (624 236.52 Belvedere St, water/sewer) 13 Leah R. Henschen, reimbursement for payment to Verizon (8/11 42.51 internet/voice services) 14 Leah R. Henschen, reimbursement for payment to Atlantic City Electric 121.61 (Spinnaker Court) 15 Leah R. Henschen, reimbursement for payment to Precision Mowing 178.08 16 Leah R. Henschen, reimbursement for payment to Water & Sewer Dept 255.00 (Sea Isle City) Total from continuation Schedule(s) 961.44 TOTAL (Also enter on Line 10, Recapitulation) 3,982.04 If more space is needed, insert additional sheets of the same sizt;. Estate of: Homer E. Henschen Mr. Schedule I -Debts of Decedent, Mortgage Liabilities, and Liens Item Number Description 17 Leah R. Henschen, reimbursement for payment to Verizon (7/23/10- 8/22/10) 18 AAA Financial Services, credit card balance 19 James E. Holland, CPA, 2009 tax preparation 20 Leah R. Henschen, reimbursement for payment to Good's Tree Services (624 Belvedere Street) Page 2 21 10 0858 Value at Date of Death 40.60 268.38 400.00 252.46 TOTAL. (Carry forward to main schedule) ...... 961.44 REV-1513 EX+(01-10) Pennsylvania SCHEDULE J A£pANTMENT of REVENt1F INH ERITANCE TAX RETURN BENEFICIARIES RESIDENTDECEDENT ESTATE OF: FILE NUMBER: Homer E. Henschen Mr. 21 10 0858 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY Do Not List. Trustees OF ESTATE z TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and transfers under Sec. 9116(a)(1.2).] Deborah Subashi Daughter 213,264.30 920 Oak Creek Drive Dayton, OH 45440 Douglas Henschen Son 213,264.30 3101 Columns Drive Cumming, GA 30041 Homer Henschen Family Trust 1,209,217.46 c/o M&T Investment Group One West High Street Carlisle, PA 17013 Leah R. Henschen Surviving spc>use 136,042.25 634 Belvedere Street Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR D ISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUG H 18 OF REV-1500 (COVE R SH EET, AS APPROPRIATE. z z NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. If more space is needed, use additional sheets of paper of the same :size. REV-1514 EX+(4-09) .~~- ~ ~~ Pennsylvania pEpAR7MENT O} REVENUE INHERITANCETAX RETURN RESIDENTDECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN :k Box 4 on REV-1500 Cover SI -_ _ - - ESTATE OF FILE NUMBER Homer E. Henschen Mr. 21 10 0858 This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest below and attach a. copy of it to the tax return. ~( WIII ~ Intervivos Deed of Trust ^ Other • ~ NAMES OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE Leah R. Henschen 06/30/1919 91 ~( Life or ^ Term of Years i ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable •••••••••••••••••••••••••••••••••••••• 2. Actuarialfactorperappropriatetable ••••••••••••••••••••••••••••••••••••••••••••• 1,341,949.71 0.09891 Interest table rate - ^ 3.5% ^ 6% ^ 10% ~ Variable Rate 2.6 % 3. Value of life estate(LinelmultipliedbyLine2) ••••••••••••••••••••••••••••••••••• 132,732.25 NAMES OF LIFE ANNUITANT DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ••••••••••••••••••••••••••••••••••••••• 2. Check appropriate block below and enter corresponding number • • • • • • • • • • • • • • Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually'(1) ^ Other. { ) 3. Amount of payout per period ••••••••••••••••••••••••••••••••••••••••••••••••••• 4. Aggregate annual payment, Line2multipliedbyLine3 .••.••....•.•••••••.••..•••.•••• 5. Annuity Factor (see instructions) Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate % 6. AdjustmentFactor(Seeinstructions)•••••••••••••••••••••••••••••••••••••••••••••• 7. Value of annuity - If using 3.5, 6, or 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 X Line 5 X Line 6 . • . • . • • • .... • • .. If using variable rate and period payout is at beginning of period, calculation is: (Line 4 X Line 5 X Line 6) + Line 3 NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. If more space is needed, use additional sheets of the same sizE:. REV-1847 EX+(02-io) SCHEDULE M ~;~ ~`~ y~ ~aennsylvania FUTURE INTEREST COMPROMISE pEpARTMENT QFREVENUM ESTATE OF FILE NUMBER Homer E. Henschen Mr. 21 10 0858 This Schedule is appropriate only for estates of decedents dyfng after December 12, 1982. This schedule is to be used for all future interestes where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach ~~ copy to the tax return. ® Will ^ Trust ^ Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. Deborah Subashi Daughter 04/04/1953 58 2. Douglas Henschen Son 02/10/1960 51 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within nine months of the decedent's death, check the appropriate box below and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer: See attached. IV. Summary of Compromise Offer: 1. Amount of future interest . $ 1,209.217.46 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (Also include as part of total shown on Line 13 of REV-1500.) . $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One [~ 6%, Q 3%, ~ 0% . $ (Also include as part of total shown on Line 15 of REV-1500.) 4. Value of Line 1 taxable at lineal rate Check one Q 6%, ~ 4.5% . • $ 1 ,209 21~ 7.46 (Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate (12%) (Also include as part of total shown on Line 17 of REV-1500.) . $ 6. Value of Line 1 taxable at collateral rate (15%) (Also include as part of total shown on Line 18 of REV-1500.) . $ 7. Total value of future interest (sum of Lines 2 thru 6 must equal Line 1) . $ 1,209,217.46 If more space is needed, use additional sheets of paper of the same size. Estate of Homer E. Henschen Date of Death: August 10, 2010 SS# 284-26-8527 Pennsylvania Inheritance Tax Return Schedule M, Future Interest Compromise Decedent was survived by his wife, Leah R. Henschen ("Mrs. ~[enschen"), two children, Deborah Subashi and Douglas Henschen, and three grandchildren, each child of Decedent having at least one child. As of the filing of this return, all children and grandchildren remain alive and are in good health. This future interest compromise is offered with respect to Decedent's assets subject to The Homer Henschen Family Trust created pursuant to the Decedent's Will. The personal representative proposes that the entire remainder interests in the Trust be subject to Pennsylvania inheritance tax at the rate of 4.5%, as it is extremely unlikely that any assets in The Homer Henschen Family Trust will pass to someone other than the Decedent's issue. REV-1649 EX+(6-98) SCHEDULE O COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCETAXRETURN (SPOUSAL DISTRIBUTIONS) RESIDENTDECEDENT ESTATE OF FILE NUMBER Homer E. Henschen Mr. 21 10 0858 Do not complete this schedule unless estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Homer Henschen Family Trust Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113(A) trust or similar arrangement. Description Value 1 Homer Henschen Family Trust 1,341,949.71 Total value of Trust is calculated to be $1,341,949.71. An election to pay Pennsylvania inheritance tax is made for this Trust; the taxable portion is $1,209,217.46. Part A Total ~ 1,341,949.71 Part B: Enter the description and value of all interests included in Part A for which the Section 9113(A) election to tax is being made. uescnption vawe Homer Henschen Family Trust ~ 1,341,949.71 Total value of Trust is calculated to be $1,341,949.71. An election to pay Pennsylvania inheritance tax is made for this Trust; the taxable portion is $1,209,217.46. Part B Total ~ 1,341,949.71 (If more space is needed, insert additional sheets of the same size) ., iIIJiIvi~Iv.~t!-._' ~ li' Ptfvf:'~~ _'/r,iJ~r, DEPARTfJ~ENT Or REVENUE 6UREAU OF INDIVIDUAL TAXES DEP?.280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: 'r.!_ I .,_ _. ~ JtV. PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 013579 SAIDIS ROBERT C ESQUIRE SAIDIS SULLIVAN LAW PC 26 W HIGH STREET CARLISLE, PA 17013-2922 -------- told ESTATE INFORMATION: SSN: 284-26-8527 FILE NUMBER: 2110-0858 DECEDENT NAME: HENSCHEN HOMER E DATE OF PAYMENT: 1 1 / 01 / 201 O POSTMARK DATE: 1 1 /30/201 0 COUNTY: CUMBERLAND DATE OF DEATH: O8/ 1 O/ 201 0 REMARKS: ACN ASSESSMEN-~ AMOUNT CONTROL NUMBER 101 ~ 560,000.00 TOTAL AMOUNT PAID: $ 60, 000.00 CHECK# 1002 INITIALS: SAP SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER cony c? L OF HUI~sER E . HEI~JSCHF~h! ? , HUMEFZ E . HET~SC:HEN , the with ~ n n«med Testator , do r,ereby ma},e a.ncl publi_sr~. this Codicil to my Last wi 11 and Testament dated l~~ovember 27 , 1991 . FIB:~ Z' I hereby amend the TriirG provision. of s~~ i_d V~ill to provide as follov,~s: In the event tl^idt my beloved vaife, LEAH R. HEiaSCHEA?, fails to survive me, then I give, devise and. bec~uea.th my real estate located i_n Sea. Isle City, Cafe P-,.ay Ccur~ty, Neva ~7ersey ar~d other real estate locatted at 3 ~~ Coml.>ridge Court, Carlisle, Cumberland County, Pennsylva.ni~. as follows a A . Gne--rialf (1/2) to be di_vio.ed as follows (i) One--third (1/3 j each to SIIAY.ON DeVEA?]~TE~' and 2yAT~-CIE EiC>C7TN, Per stirpes ~ and ( i.i) Gne-~tl~ircf (1/3 ') to be rti.vided equa ily between A1~DREP• A7 . UTARNEF and ADDI SC)1~? F.. VJA.Y.lJER, or trig SL.rV7_VC%r Gf trieICl. )IS, G~lID® ~ASLAND i. High Street arlisle, Pa. Provided, however, that i_f any benefi.ci_ary L~nC)er tl-~is prcvisi_on 3A of my ~i_11 has not attained tl":e age of twenty-two (22) a.t tl~e time of my death , then I give, devise and bequeath saic~ benef ici..ary' s sria_re of my estate, together with any other pro~~erty which may be added, unto FARMERS Z'kt157' C:DN:~YAl~TY, Carlisle, Pennsylvania., Trustee under the Last Vv'i 11 and Testa.zti.ent of my beloved wife, LEAH R. HEI~SC~IEl~?, on the same terms and condi.tiorzs as contained therein. R . The other one--ria if (1/2 ? to be di vi.c7ed equally arrtong my children, DEI.3GP.AH SUEASHT and DC}UGLAS HETvSCHFAa , per ~;tirpes~ . In ai1_ other respects I hereby ratio%, cor~f irrr~ a.nd republish my Last Wa ]_1 and Testa.raent dateG Novezrtber 27 ; 1991 together wi_tl-, tl~~is so~_e Codicil as cinca for ~.~1- Last ~v"ill and Testament. i i IN tn'I`1'NESS 1NHEhEUF', 7~, HOMEY E. HENSC.HEN, have hereunto set ''~ rrsy r~anu and Ceal to tr~is Codicil to my Last W~_11 and Testartterat this `+ day of ~ ly9 ~ . --~ /,~ ~%''~ ..r"~r"'/ !:' y/ ;yam/ ~ .~ / - Homer E . Henscrten ~ ~ s Signed., sealed, publ~_shed and declared by the above-named Testator. , HOMER E. HENSCHET?, as anu for the Cod.~cil to his Last G7i ll and Testament in trie presence of us, v~7ho have hereunto subscribed cur names at h:iS request as witnesses thereto, in tree ~~reser.•ce of said Testator and of each otr~er . y.. ,.-t f`; ,'.°:.~~ t:~..,~..._: ;: ~ ~~ ~~,,~, kDnRES~ ,, ii..~ %! ~,~•l . ~'~ i'~~ +:..,..s-~~~ i`/J / ~ I f ~t )IS, GiJID® 'iASLAND ~. High Street arlisle, Pa. i COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND We, Homer E . Henschen, Edward E . Guido and Tracie Myers, the Testator and witnesses, respectively whose names are signed to the foregoing or attached instrument, being f:Lrst duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as a Codicil to his Last Will and Testament and that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Codicil as witnesses a:nd that to the best of their knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence . I `.T ~ i 1 Homer E . ~en~chen 1 ~ ~-.... _~ -~ Edward E. Guido, Witness Tracie Myers, W'i'tness .. Subscribed, sworn to and acknowledged before me by Homer E . Henschen, the Testator, and subscribed to and sworn or affirmed to before me by Edward E . Guido and Tracie Myers , witnesses , this [UFF & ~ ~` day of ~~~`~ '`'~ ~ ' 19 9 4 . .BLAND ~ ~J , High Street ~ - /' ~~ f~~ i Aisle, PA ~~_ '~~~~ ~`~ ' ;~j '~ry Pub`Ic I 1 i,'.;~~ij>.r;AL S~ML SAL~ic Ng'!~~'+~ hk~tary F•ub1-c Carli:~le gsro, Gu,,~~eri~<<U Jaunty, Ph. ~ 1~ -,py Commission E%:~+~ as ~,i1. i•" f.~ L~,ST V~; ILL. AND TE S'I'~:~MEr~ T { OF i 1 HUMEF. E . HENSCHET~~ I, HC)r~1LR E. ~IErJSCI-'ETA of Carlisle, Cumberland County, Pennsylvania, being of sound and ctiisposing mina, memory and understancZing, do hereby mare, publish and declare this as a.nd for my Last Y~ill and Testament, hereby revo]ting all ether byi.lls and Codicils heretofore made by me. FIRST I direct the pa.lTmerlt of my just debts a.nd expenses of my last illness and funeral from my estate as soon after my deatrl as conveniently r.~ay be done. If there k~e nc cemetery lot available for my interment owned by me at the time of my death, i authorize ~ ray percor~a 1 representative to purcr~ase such cemetery lot with a contract for perpetual carer using therefore funds from my estate i n such amount as he sha 11 cons:id.er necessar1~ a.nd deSira.hle, and I authorize my personal_ represer~ta.tive to cause title to or ~' I oti~~nerchip of such lot so purchased to be vested. in such. person as my personal representative shall designate. Further r I authorize my per:~ona l representative to experac~ funds from my estater i_n sucr~ a.rnount as my personal AIDIS, GiJIDO & MASLAND I representative sl~lall consider necessary and c~esira.ble for the 26 VV. High Street Carlisle, Pa. purcY~ase, erection a.nd inscription of a suitahi.e marker for my grave. SECOND I I direct my persona 1 representative to pay any liabilit~.es 4Jh1C:h I have at the time of rr~y death r including those joint liabilities I share with my beloved wife, LEAH k. HENSCI~EN, from my estate as soon after my death as eonven__ently may be clone. I autr~ori ze my persona 1 representative to use tl~e proceeds f rolrl any insurance plan S have at .the c{ate cf my death payable to m~~ estate and to liquidate any other assets as necessary to pay said liabi_lit~_es . TH IP.D In the event that my beloved wife, LEAH F:. HErJSCHEN, fail.C., `v to survive me, then i give, devise., and bequeath my real estate ocated in Sea Isle City, Cape lylay County, New Jersey, and otlier real estate located at 3E Cambridge Court, Carlisle, Cumberlanc, County, Pennsylvania to be divided as followso A. One-half to be divided equally ar_rtong my k'ife's children, SHARUI~ De1'ENh'EY, NAT~IC~~E E•OOmH and. P7.AF:S~lA 47AF.NER, per stirpes. E. The otl-per one-rialf to be divided equally among my children, DEBOF.AH SUBASHI. and. DOUGLAS HEr~SCHEI~', per stirpes. FOURTH I give, devise and beataeath my Employee Savings and Tx~rift AID1S, GUIDO 8: MASLAND 26 1~1'. High Street Carlisle, Pa. Flan from my employment at ANiP in equal shares unto my cr:ilclren, DI~BURl-~fl StIF~~aSH~_ ar~d DOUGLAS I:IErJSCHEN, per stirpes . This bequest is contingent upon tl;e beneficiary making elections necessary to exclude this asset from my estate for Federal Estate Tax purposes . Tf tl.lis asset, or any portion thE.reof , is czetermined to be inclvdabl e i n my estate for f eder2.1 estate ta~> purposes , then this bequest i.s void with regard to that portion that :is inc7_udab~e :in my estate f.or said feceral_ estate ta~> purposes and - L that portion steal] rye ~_ncluded in one of tl-te t.rLSts referred t.o in t~a:~ragraphs F'a.fth or Sig>th be1_ow. FIFZ'I-] if my 1`~eloved wife, LEAH I~ . HENSCHIi~, survives r;~e by tliirty '', w (3Q) days, I dive, dev ise anc~ bequeatl-~ to F'~iRMERS 2'ktIST COMPANY, Carlisle, Pennsylvania , as Trustee cf tl~e Flomer I~enschen r~ar~ to 1 Deduction Trust an amount ec~uaJ_ in vGlue to (, ~~_) tl~e unlimiteca federal estate tux rrtar_~ tal deduction allowa.hle to my estate rr~inus (2) tree tTalue for federal estate tax purposes of all i terms in my gross estate ~~~hich cJuali fled for tl~e d.eductiorl and which pass cr have r-assed frorr- rnE, to my wife in a form goal _fyir~g for the deduction otl-terwise t~iar, under this gift . In making tl~,e conl~?Utat i orAJ necessary to ceterminE' the arn.oun~~ of this pecuniary gift, values as finally determined for federal estate tax purposes shall k~e used . This g_i f t shall be recJ uceca by the amount , i f any , needed to increase my to.xa}::le e st~lt.e to tl~-~ e largest amount treat will result in no federal estate tax l:~eyng payable by my estate, after allowing for the cinifi ed credi_t agoi_nst the federal esi.~ate tax but no other credit, upon the following trust tern~~s a.rzd conc~i.ti_orrs A. During the l:i.fetime c}f my beloved wife, the t1S, GU1D0 gASLAND ~. High Street arlisle, Pa. P~]ar' t.al Deduction Trust shall ri.stribute all of tl~e net income of the T1;aritGl Deduction t1:~ust to rrly wwfe in convenient i_nstallment~: at 1_east rnontl~~ly„ In adcli.tion, the Trustee at an~T time anc:' from tirr,E tc~ time may di.~,tribute to my wife or ap~,ly for hEr }_~Enefit so much or all cf the rsari tal Deciucti.or~ ^'ru~,t e~;ta~:e ~>r nc i paJ_ as, i_n tl-~e - ~ - J Trustee's sale discretion, is sufficient to provide for my l~?ife's neec.?s for health, support, welf~~re and r~tair~teriance in the standard of living to which she was accustomed at my death, taking into consi.derat:ion any ocher source of support (both principal and income) vahich ray wife stay have to the }~~nowledge of the Trustee . F~ . Upon the ca eath of my wife , the Liar i to l Deduct i_on Trust shall terminate. Upon termination, any net income of the Marital Deduction Trust ~~r_icr~ has not been. distributed to my wife shall be distributed to tier personal representative as part of her general probate estate. The rest, residue and remainder of the Marital Deduction Trust estate sriall be distributed to my children , in equal shares , ~ DFBORA~3 SUBASIi3 and DOUGLAS HENSCHEN, per stripes . C . I f my beloved vaif e' s ~~ill cont:air~.s no contrary directi.an.s, the Trustee shall pay from the Marital Deduction "~ ~ Trust estate the entire Gdditional cteat.h taxes payable by reason of my wife's death, _~ncl.uding any interest or penalties thereon, as a result of this Marital Deduction Trust estate r~eing included in her e_:;tate . D. It is my intent that the Marital Deduction Trust MIDIS, GUIDO . MASLAND and the property comprising the Marital. Deduction Trust 26 W . High Street Carlisle, Pa. estate shal)_ cua.lify for the rnara_ta.l deduction. allowed by the federal estate tax law applicable t:o my estate. All questions appli-cable to tree mar~.ta1 deduction gift in this A-Iari tal Deduction Trust shall. be resolved accordingly. To ~ this end, the powers anc di.scretioris of tl~;e Trustee witri f i ~ - - respect to allocations of property to this Niar.i.tal Deduction Trust, and v,~ith respect to the administration of trust during my wife's lifetime, shall not be e~;ercised or exercisable except in a manner consistent v,~ith my intent as expressed. in tl~is paragraph . The IJ~,ect~tor shall make tree election under Section 2056(b)(7) of the internal Revenue Code to have the Nla.ri_tal Deduction Trust treated as qualified terminable interest property. SIXTH I give, devise and bequeatri tl~~~e rest, resi_GUe anc~ rern_ainder ~ of my estate, unto FARN`1ERS TRUST COMPANY, Carlisle, Pennsylvania, Trustee of tree Homer ~Ienschen Family Trust, upon the following terms and conditions: fi . The Trustee shall distribute t:o my beloved vy i fe, LEAH R_ . HEIdSCHEN, the net income of thE~ trust at least mon try ly . B. The Trustee (s) shall_ from. time ~o ti_me pay such sums f ron~ the principal of this trust ~~o or for the l:~enef it of my wife as may in tYae discretion of the Trl.tstee (s) seem. necessary for her health support, vaelfare, and muintenarice in the standard of living maintained b~~ her d.ur.~_rzg my MIDIS, GUIDO IviASLAND lifetime, taking into account such. other sources of support ?6 VV. High Street Carlisle, Pa. (botla principal and income) which my wi.f e may have to tl;e ' JLnov~~ledge of the Trustee . Tay first priority for the income ~ and principal of this trust taken tocet.her is the support, nta; r.tenance, and health care of my ~~ife for life. Tn i Ueterrcu_ni.ng wrzetlaer ax~y ir;~rasi_Un sl-~aJ_1 be mace for the - 5 benefit of my wife from the principal of the Marl tal Deduction Trust or from the principal of triis trust, such _nvasion shall be made from the I~iar~ tal Deduction "'rust as far as practs.ca.l. Nc beneficiary of tl-tis trust shall participate as a co-Trustee in any decision under tl-iis subparagraph B. C . Trie "'rust shall terminate upon the death of r_1y beloved wife, and shall be distributed in equal sr:~ares unto my children , DEBUP~AH StIBASHI and. DOUGLAS HENSCHEIi , i f living, otherwise to their surviving issue, per stirpes, SEVENTH In tree event that a.ny beneficiary under this t~'ill, including the beneficiaries under the trusts provided herein, has not attained the age cf twer~t~%-two (22) at tl~e time of my death, tl~en I give, devise and bequeath said beneficiary's share of my estate, together vaith any other property whicY~. may be added, Unto FAF.MERS TRUST COMPANY, Car 1 ~_s le , Fer~nsy lvania , IN TRUST , upon the following terms and conditions: A. To hoJ_d, manage, invest and re~_nvest the principal -ID1S, GUIDO c 1VfiASLAND V~'. High Sireet Carlisle, Pa. so received, and accumulats_on cf income thereof, and to use, pay anc~ apply the income and pr:i_ncipal ~ar so much. thereof as ~_n Trustee's sole discretion may be necesc>ar~~ f.or the ma.~._ntenance, support, med~_ca.l expenses ,end education of sas_d child . Il , The payments author ~. zed by thi,~ trust play be mad e by my trustee directly to said child, if, in tl~~e sole opinion of trustee, he or she ~ s of suc7~ age and abil~ ty to - 6 - har~d~_e properly the funds sc pald, or may be made directly 1 to the person having custody and care cif said child, or may be made directly to any institution en#:i.tled to such payment by reason of services rendered or to bc, rendered to said child . C. The amount to be paid for t~-~e benefit of sai-d child shall be determined from. time to time by the need of said child, and the amounts a.nr~ times of said payments shall be determined by such need, provided that payments k>e made at least monthly, unless otherwise prohibited above. D. All payments of principal ands income hereby given shall be free from anticipation, assiRrtraent, pledge or obligatl_ons of beneficiaries, and sY~al~_ riot be subject to anl~ execution or a.ttachrnent . E. All pr~_ncipal and accumulated income, not so applied, sha_11 be distributed unto said child, per stirpes, when he or she attains trze age of twenty-two (22) years or graduates college, whichever is sooner. EI GHZ'H No beneficiary shall have the mower to anticipate, encurriber or transfer his interest i.r~ or to any trust estate in any n~tan.ner ~.IDIS, GUIDO NiASLAND ~ other tYian by valid e~>ercise of a power cf appointment . No part ?6 V~'. High Street Carlisle, Pa. Uf any trust estate shall be liable far r~r charged with any debts ~contr-acts , liabi litres , or torts of a benef i-ciary or ub j ect t.o seizure or otraer process by any creditor of_ a beneficiary. rINTH 7n aduition to stash otl-,er powers acid dut ~ es as may be - 7 - ~ Granted elsewhere r~erein or which may be grantee; by law, the E~~ecutor and Trustee riereunder slial_1 }lave the following powers and dut.~es, without the necessity of notice to or consent by any court: F , To retain in the form received , or to sell either at publ?.c or private sale ar~y real or personal property; B. To e~;erc i se any options to su:bscrik~e for Mocks, bonds, or other investments; i C. To join in any plan of lease, mortgage, consolidation, exchange, reargarizatia:n or foreclosure ` ~ of ar_y corporation in which. my estate or any trust may hole stoc}~s, bonds or other securit~_es; D. To sell, transfer, convey, mortgage, pledge, lease or excr~ange any property, real o:r personal, which i ~ at any tune may farm r~ar.t of my estate, for the payment of debts or taxes, or for ar_y purpose of administration or distr~.~>uti.or~, for such prices and upon ~~uch terms as my personal representative, in her ,sole discretion] may deem vaise~ and to execute and deliver deeds cf convey an ce or transfer thereof ; MIDIS, GUID4 ~ MASLA~ID E. To rna}-.e settlenterats and comprcamises en such :6 V+'. High Street Carlisle, Pa. terms as my personal repr. esentative in her sole discretion Wray deem wise without tl-,e necessity of ol~tai nirzg any court approval tr3ereof ; ~ ~ ~ .; j F, To ma.l~~e caistrik~uti.on hereunGer eitl~,er ~n cash - g - I cr ]~.~ nd, as my per.somal representative i:rt her discretion ~ may deem wise; G. To emr~lc:~y such }~~rokers, ksanks; custodians, investment counci 1 , Gt.tarneys , and other agents , and t.o delegate to t.riem such duties, rights and Powers as tl-~ey may ~ c etermi.ne , and far su.cl~~ periods a.s they t.l"a ink fit ; H. To register any securit~.es at al~y time n the?_r ~ names as f i duciar~~, ar_ in the names of nominees, v,~ith or witl~~out -? ndicati.ng the trust. character o:~ the security so registered; I. With respect to ar~y secu.riti.es held hereunder,- to ~ i ~ vote upon any proposition or election dt any rteet_ng o~f tl"ze ,, person or entity i ssuing~ such securit~.es,~ and to c~rar_t prox~_es, c?iscretionary ar otherwise, to vote at an~~ such meeting ; to joint or k~ecome a ~-a.rt1% of ar~y rear gani nation , ~ readjustment, r,terger, voting trust, consolicat:i.an or iI I exchange, and tc: deposit a.ny sucr~ seruri tai es w7 th any (-~~ comm:ittee, depasitory, Trustee or otherw_~se, and. to pay out of the trust created herein , any fees, e~~per~ses ar~d assessments inrurrecz in connection therewi.tr~; to exercise 1 ~_ _ _ ~ conversJ_C~n , subscript. ort or o Sher rights ; end to re.ce~ ve o~ -1S, GUIDO 1ASLAND held any new securit~i_es issued d.s a r.esu:! t of ar~y suc]~~ '. High Street arlisle, pa. seosganiza.tior~_, read justment., ntergez , vot_~ng trust., consol~~.dation, excliangEw ar exercise of conveys ~_or~, i j subscription or otl~~~er ra_ghts anc: ,generally to take all acts an w_i th respect to any sas.d sE'curlt7.E=s as could 1=~e taken ]~y tl:~Er «l~so~_utE3 oti~ner thereof ; _. o _ J. To make all nec:essar.y proofs of c~eatl~~ under the 1 ~ insurance poll c_~_es of wriich tY~ey are the benefi.ciar~T, to execute arty receipts for the ~>roceeds anc~ to snst~.tute any ~ act~_on to collect saic:' proceeds and to make ac' justments of { any claim thereunder , prov ded , however , tl'iat they need not ~_nst~~_tute any act~_on unless they shall 1~~~~ve r>een indemnified against all expenses arlct liabilj.ties to ~-~r~lch they may become dtae subject as a result thereof . 1f , however, they desire to institute such action wit~yiout i. rictemnification, they a.re hereby authorizecz to be reimbur.>~d f_or all expenses a.nd iia~~i l~ ties incurred as a result. tY.~ei~~of from any amounts whs_ cl~~ may be held in tr. ust hereunder tt;.en or t]~tereaf ter ; F'. To e«ercise all elections which they may have oath ~~ respect to :income, gift, estate, inher~.tance or other taxes, ~.ncluding without iimitatiort execution of ~;Gint income tax retui:ns, election to deduct expenses in c:ompu.twr!g one tax or another, electron to split gifts, and erection to pay cr to defer payment of any tax, in all eve:r;ts w~_tx~,out tYteir heirag bound to r. eruire contribution from any other person . ~'E1~]TN -1S, GUID® [ASLAND ~- do hereby norn~.nat.e, constitute anc: appoir.~t my wife, LEF~H . High Street ~rlisle, Pa. '~ P. IIEIJSCHEN, to act as ExE~cutriy, of th~_s my Last Tr7J.11 and Testament. Provic'ed , however , that if she i s ur~vai 1J_ing or una}~lE i to act as E~.ecutri x, 1 direct the dut?_es of ~.lterr~ute E~,ecut_or be 1 perforr~ec~ ].~y ray ch.i ldren , DEBOR.F~I-i SL1~F;SI~ ~ a.nd TGUGLF',~ I-IEN~CHEN . 1C FLEVF;PJT~-] direct. that no personal repr.e~ er~tative, gua.rc~ian, trustee or of}-per fiduciary apr~oint~:d under tl~,is i_nstrurr~ent sha~_1 be requ_ red to glue k~ond for the fai thful perfor:r~ance of their c~t~t_~ es in any jurisdicoon . TU1EL~~T~1 t?r,~.ess the context indicates otherwise, ~~ny use of the rnascL±line genc'er herein shall alsc ~.nciude t},e feminine Wender. 1N tivITTdE~;S ti~HEF.EOF, 1~ , HUI~IER E. HENSCHEl`?, }-~a.ve hereunto set Hc~r^er_ E, Henschen Signed, sea.iec, pu.b1_ ~_shed and declared ~~~~ trze above-r~a.mec': )1S, GUIDO RA,SLAND %. High Street arlisle, Pa. my ha.nc ar~d seal to tYt:~s my Last j~Jill and Testa.rlent, consisting of eleven (11) typev,rritten pages, the f1_rst ten (1G i of which bear my sa_gnatLire in t};e margin for identification, this day o f tL- ;"~,N~^ -,~ "..,'-'', 19 91 . Testator , F?OT~IER E . NrIJSCI3EI:~T: a.s ar~d f cli: }~~ i s Last ~~ i 11 a_nca mestazr~ent n the presenr.e of_ us, whc nave herE~unto su}ascribed our namea at his rec1ue~;t as witr~.esses t}-~ereta, in tY:~e presE~nce of said mestatc~r_ and cf each other. ~~ _ . ---/, ;~ ~- ADPFT_,SS _.... -- f i~ /1 .. - ~• r7 ~~ - ~/,it~~,,- i ~ AUDRFSS ~~ _. ~~ ,.~ /.. - .~ f r.. _, ~ ; ,~' ~~ j ?7 r .. cor~raol~v~LxL~~~-~ or ~~~,nris~~LVA1~a_~ . ss COUr~TY C)T' CUI`~IBE~-:L~=AND VdE s ~iOr~lER E . HEI~~SCHF;T'v , EDWAP.D F~' . GU ~_DU are c7 JC;Hr~I~?F J . DE? L~' , the Testator ;/,nd witnesses ,~ respectzvel.y whosE~ mantes are signed to tl~~e foregoing or atta crteG instr. uTrter~t , being f _rst duly sworn , coo herelJy decl.a_re to the undersigned authority that the Testator s ~ gnec~ ar~c~ e~~eeu_ted the instrument as l,i s Last 4~ill anca Testament and that he signed willingly and tryat he e._ecutec as h~ s free and voluntar1~ act for the purposes therein expressed, anr'~ that each of the w~~.tnesses; in the presence and hearing of the Testator slgrnect tr-e tiu111 a_s v~~tne~~s ~.nct treat to the bC..st Uf the~_r }~ncwlec~cYe the Testator `-Va.s G T r t the t ~ me lE car more 1ea.~ s of age, os sourtd mind anca under r~o constraint or undue ir>f luence . C~ Homer F . Hens-c~,en .C / Edward. E. Guido, Witness ._,,: f ~ ~- Johnr~'~ J. Dei11~,''' Witness sul•~scri.hed, sworn to and acJ,nov,7ledgeci before it:le by HC)I~IER F. ~I~1•JSCHEN , the Test~3tor , and subscribed to ar~d ,stiaarn er a f _f. i rmec3 -IS, GUIDO [ASLAND ~ to k>ef_ ar_ F r,te by r,DV~AI:D E . GUIDG and JGHTINA J . 1~EIL5', w_~trec ses , .High Street irlisle, Pa. ~ tl_i 1 s ~~ "~ ~~` O i=t y O f ''`~ -`v`?=^'''' , 1 J X31 . Estate Valuation Date of Death: 08/10/2010 Valuation Date: 08/10/2010 Processing Date: 04/26/2011 Shares Security nr Par nPSCrlDtlOn Estate of: Estate of Homer E. Henschen Report Type: Date of Death Number of Securities: 1 File ID: Henschen, Homer E. Estate Allied Irish Mean and/or Div and Int Security High/Ask Low/Bid Adju:~tments Accruals Value 1) 959.5993 ALLIED IRISH BK5 P L L ~UlyZL~4UG) SPON ADR ORD New York Stock Exchange 08/10/2010 Total Value: Total Accrual: Total: $2,233.76 2.40000 2.28000 H/L 2.340000 2,233.76 aL,LJ3.~n $0.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (R.evision 7.1.0) v Z Q _ ~ W ~ ~ ~ LL O O N S ~ 5 Q ~ x ~ 3 y ~ _ ' u ~~ .~ G'p . ~ n , ~ 11..1 ' ~0. =' It .,,,. - W a a: W ~ , ~, D yo:. ~~ p Z O ~ ~' ~ ~ :~ a W :i. w~ Q H ~ ~ a V O U Z ~fl fEf t~ ~~ r ~~ ~~:. a ,~ ~ [~ F- a Y W ~ U W LL. ~ ~ a 0 ~~ >-`;_ W a ~: ~- a`~a ~W Z ~ ~ ~ ~ ~ O a U O . z n.ZZ o a " ~. Z ~ ~. CO Q ~ N ,~' U Z¢OO ~ W Q • vi m 2 D w =e Q Z. ~ 1Q: w; ~_ ~~ ;~ h,- fir. ~._~ _ ~' ' C n O "~ d-. ~ r !x ,ry x ,J" H' ~ Y c r v i?D. ,%X •¢S' :X rib;. '~v$~r $~ w` - Z ~t '4"~ ~ r ~;~ s al y m ~ ~ ~` ~ z'~ g W 00 ;~ ~pp~ ~ ~~~ _ ~ o ~ r y ~~~~ ~ ~ r,b ~ 13 ~ ~~i~ky s~~r i- \ _ y _ ~j~~ ~~~~ s ~~~ W ~ 4 v /tl,d/ ~ ~ / - F .~, a $ ~ ~~~ ~~ ~'` z ~- ~"g=6 #¢Y s ~ Q ~~ ~ _ ~ '~~ - ~ vyg - m ,l i ~~ ~N~_°^N _ r -°~ ~,a,s2y Z~ = 4 _;-~ yy(( $gg $~~^^Sp, J N T err v ~.~ ~° § W ~~~ - ^7 ~~3~~ ~",~,~ r ark ~ ~ '~ ~ ~~ ~;~ ~8 r/ onr "~~3 ~ ~ =ga ~;~ ~ ~t ~~ ~, qt ~yi ry Si~ 3~ ~p~ ~~ ~ ~~ ~~ $~.~ ~~a off- ~ „~.. i:~-s ~ ,.mss - ~ .,s„~y~~ ~ - a 1 "'f" c 'L ~= ~' a E~ W U :~~,, red; ;~ ~±% ~ ~yr~'~~y~~~~~~~~ ~°~ 'v ~ ~ i ~i'i.~ yfy-~!fi.r, rb _ y ~: utP~~df ~r'~~i6^~~'' y ] ", li E~ ~ N o "~fi s v1 ~ _ a~~~ _ ~~ g ~~ ~ c ~ _ "21G 2 '3 .~ Y\ u X '~' .SRC S ¢ g_ q~ T ~\ ., 'w1W, a _ oz R of u~'^c N~.u ~x aG. k'n~' S _ V r ~ n F''~ u¢ E e co ,.i oY ti 1' p~`~yCyS(~\l, 4~ g.n f:, _ _^. ~5 - _ _ ' ~ ; iT 's W ~ ~ = 1o U z 1 ,~. ~r~~=~6~ yd w ~ 3 your U:. ~~ ~~ BNY Mellon Shareowner Services r PO Box 3526 transaction advice So. Hackensack, NJ 07606-9226 Company: ALLIED IRISH BANKS PLC Registration: 00000434.01 MB 0.382 D1 TR OOD04 SGYD0101 000000 CUSIP: 01922840 ~_ HOMER E HENSCHEN 624 BELVEDERE 5T CARLISLE PA 17013-3507 lip,i,~.Ali,,,I..viii.i..~~.i.ili>I..,.ii~~>I~rilliii~liiilii~i~~ll Your Broker-Dealer Broker-Dealer ID Broker-Dealer Account Number investor ID ~ 1251G2852~33 Account Key ~ HENSCHEN-HOMEE0000 Transaction ' December 22, 2010 Date Transaction , 0001080378 Advice Number This is a record that the indicated book-entry shares have been transferred in accordance with your instructions. These shares are transferable on the books of the Transfer Agent, BNY Mellon Shareowner Services, upon receipt of properly completed transfer documents, instructions and assignment. There may be rights, priveleges, restrictions and conditions attached to the securities covered by this Advice. A full copy of these can be obtained by writing to the Secretary of the Company. Manage Your Account With Ease Visit BNY Mellon Shareowner Services Online Login to Investor ServiceDirect~ at www. bnymellon.com/shareowner/isd ~~.~ ,_ ;_ View Information • Account Detail • Book-entry history • Pending transactions • Transaction history • Payment history • Tax information • Historical stock price information Issue: A,DR Shares: 744.5993 Sign up for M Li n kSM for secure 24/7 online access 'to your shareowner documents. Manage your statements and 1099 Perform Transactions tax documents! Simply login to your • Change your address account at Investor ServiceDirect~' • Sell book-entry shares where step-by-step instructions will • Replace a dividend check prompt you through enrollment. • Certify your taxpayer ID • Change your dividend election* ---- - -~--------J-------~- --------- _ --------1 anamore! * Online service not offered by a1/ issuers. RETAIN THIS DOCUMENT FOR YOUR RECORDS C t Estate Valuation Date of Death: 08/10/2010 `a~uat_or. Date: 08/10/2010 processing Date: 01/16/2011 Est~ite of: Estate of Homer E. Henschen Report Type: Date of Death Number of Securities: 1 File ID: Henschen, Homer E. Estate Covidien Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adju:~tments Accruals Value _) 300 COVIDIEN PLC (G2554F105) SHS New York Stoc}: Er>change 08/10/2010 38.51000 37.99000 H/L 38.250000 11,475.00 Div: 0.18 Ex: 07/29/2010 Rec: 08/02/2010 Pay: 08/20/2010 54.00 Total Value: Total Accrual: Total: $11,529.00 $54.00 $11,475.00 Page 1 orris report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) THE CHECK BELOW REPRESENTS A DIVIDEND PAYMENT COVIDIEN PLC To inquire about your account, contact BNY IVlellon Shareawner Services Toll Free Number 866-210-6572 Outside the U. S. (Collect) 201-680-6578 Hearing Impaired 800-231-5469 aCCUUl1L WIL(1 ~d5~! LOS, I1Z to Investor ServiceDirect`'~ ar v~rww.bnymellon.com/shareowner/isd Would you like your Dividend Payment Deposited into your bank account instead of receiving checks by mail? Simply enroll in our self-service program by using the option below. Login to Investor Service Direct at www.bnymellon.com/shareowner[isd • Choose your account from the My Portfolio page which will take you to the Account Summary page. • Select Account Preferences from the menu. • Click Edit » on the Dividends and Direct Deposit box. • Select Electronic Deposit. • Click Continue » and follow the enrollment instructions. Have one of your personal checks handy. You will need to refer to the bank information printed across the bottom of your check. RETAIN FOR YOUR RECORDS SHAREHOLDER OF TRANSACTION DESCRIPTION COVIDIEN PLC DIVIDEND INVESTOR ID CUSIP ACCOUNT KEY -SSUE/CLASS OF STOCK REGORD DATE PAYABLE DATE 125162852533 205 102 G2554F10 ~ HENSCHEN-HOMEE0000 COMMON 08/02!2010 08/20/2010 RATE PER SHARE CERTIFICATED SHARES OOK-EIJT SHARES GROSS AMOUNT TAX WITHHELD CURRENT DIVIDEND $0.1800000 0 300.0000 $54.00 $0.00 $54.00 DIVIDEh1D PAID YEAR TG DATE TAX WITHHELD YEAR TO DATE TAX IDEFJTIFiCATIUM IJUMBER Please detach and ret 81r1 th15 form fOr our records $162.00 $0.00 ON FILE Y PLEASE DETACH BELOW CHECK NUMBER: 76195E Estate Valuation Date of Death: 08/10/2010 `:valuation Date: 08/10/2010 Processing Date: 01/17/2011 Shares Security cr Par Description i; 898.8%1? GENERAL ELECTRIC CO (369604103) COM New Yor}_ Stoc}: Exchange 08/10/2010 Total Value: Total Accrual: Total: $14,515.47 Estate of: Estate of Homer Henschen Report Type: Date of Death Number of Securities: 1 File ID: Henschen, Homer E. Estate General Electric Mean and/or Div and Int Security High/As Y. Low/Bid Adju:>tments Accruals Value 16.34000 15.95710 H/L 16.148550 14,515.47 $14,515.47 $0.00 Page 1 T'r~is report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (F.evision 7.1.0) •7U1bUi U1U~lZtiU~LLUI~ ~_~._ , / ~ P.O. Box 358035 Pittsburgh, PA 15252-8035 Charnhnl~ler nf' "aye 1 ul 0102728 Ul AT 0.35"7 "AUTO T2 0 8315 17013-350724 COl BTMAI -1 - Illt" '111~~~1ItIt1'Itl " 111 " t1~1~1'~t11'lll'11~111'11I~IIIII HOMER E HENSCHEN 624 BELVEDERE ST CARLISLE PA 17013-3507 GENERAL ELECTRIC COMPANY GE STOCK DIRECT PLAN STATEMENT PRINT DATE: 1 012 8/2 0 1 0 CUSIP: 001-450-36960410 SYMBOL: GE ACCOUNT KEY: HENSCHEN-HOMEE0000 INVESTOR ID: 125162852533 FOR QUESTIONS CONCERNING YOUR ACCOUNT PLEASE CALL 1-800-786-2543 Y__e_ar-To-Date Account Summary_ _ _ Save this Statement for Tax Purposes __ , AS OF: 1012612010 CASH Dlb IDENDS NET AMOUNT TOTAL MARKET VALUE ($) I CLOS!!`IG-PRICE ($) INVESTMENTS ($) TOTAI. ($) TAX WIl"HHEL.D ($) -AMOUNT TO INVEST (3) INVESTED ($) 14,633.43 16.1600 374.38 374.38 374.38 TRADING FEES PAID BY ($) SERVICE FEES PAID BY ($) SALE OF PLAN SHARES ($) CERTIFICATED SHARES HELD SHARES HELD BY TOTAL COMPANY HAREHOLDER COMPANY SHAREHOLDER GROSS PROCEEDS TAX WITHHELD SHARES HELD BY YO!J BY PLAN OTHER PLAN(S) SHARES 80 825.5338 905.5338 ~.....,.....• A ..f:..:4., l.~fr.rm~finn .~........- ..- RECORD DATE -- - -v ---- - TRANSACTION DIVIDEND SHARES ACQUIRED CASH TOTAL THDRAWN W INVESTMENT ($) GROSS ($) PAYABLE DATE 09/20!2010 -- _ DESCRIPTION COMMON DIVIDEND RATE 0.1200000 OR I 6.6621 107.86 - - - 10/25/201 D PARTICIPATING RECORD DATE DISTRIBUTION TAX TRADING FEES PAID BY (;) SERVICE FEES PAID BY (;) TOTAL CERTIFICATED SHARES SHARES HELD SHARES HELD BY AN S P TOTAL SHARES WITHHELD ($) COMPAN'f SIiARENOLDER COMPANY SHAREHOLDER NET ($) HELD BY YOU BY PLAN ( ) OTHER L 107.86 80 818.8717 898.8717 I Cq/- / V-LJt7aC I I ci^/vv~.arv„ a.. ..a..,. TRANSACTION CASH NET TRADING SERVICE AMOUNT PRICE PER SHARES ACQUIRED SHARES HELD DATE DESCRIPTION INVESTMENT ($) DISTRIBUTION ($) FEES ($) FEES ($) INVESTED ($) SHARE ($) OR WITHDRAWN BY PLAN 803.2501 BALANCE FORWARD 33 88 88 33 16.3750000 5.3942 808.6443 01!25/10 COMMON DIVIDEND . 88 86 . 88.86 19.2350000 4.6197 04!26/10 COMMON DIVIDEND . 33 89 89 33 15.9300000 5.6077 18 8717 07!26/10 10!251'10 -- COMMON DIVIDEND C:Oi~riMOly DIVIf;LND I ------- -- -- -- --_ _ - _ _ -- --._ . 107.8E .-- -- -_ ----- _ - _ __ _ _ - ___ 107 8~3 ___ - _ -- --- __ 16.1900U00 -- _ ----------- 5.6621 - ------ 82S 5338! __ _ __ __ --- GENERAL ELECTRIC COMPANY Partial Withdrawal (Continue Plan Participation) Adiditional Cash Investments CUSIP: 001-450-36960410 ACCOUNT KEY: HENSCHEN-HOMEE0000 Issue a certificate for this Write the amount enclosed. HOMER E HENSCHEN number of shares: 624 BELVEDERE ST Make check payable to: CARLISLE PA 17013-3507 Sell this number of shares: I BNY MELLON/GENERAL ELECTRIC YOU MAY INCREASE YOUR SHARES WITH OPTIUPJAL CASH INVESTMENTS OF $10 Full Withdrawal (Terminate Plan Participation) UP TO $10,000 PER INVESTMENT Issue a certificate for atl full shares and a check for fractional shares. D'°pOSlt of Certificates All owner(s) must sign and dale above Deposit the enclosed number Sell all plan shares. of shares: Con(act Nurr>ber 7575 1251,62852530 OD1,4500696041,DHENSCHEN-H0~1EED000IROD1,14 7 I i, l / 1 I z . ~ ~ ~ ~~ ~~.~.~ i (~`~ I , M ~ I ; j t~d',, ~ .,^~~ii •'4 •~i I' ~~ i a v `~ ::%r~~-r. ~ ~ ~~ j~~'1~~~ .I t ~\ Z~L !\\ \ j1~=~ - 1 ZS \ i L ,I ~ i , ~=: :~ ~~ ,.I ~+i ,d / /^1 ~. ,,II a ~,_',~ =~v ~' :- ~~'~ L Y~ y' f SS, .1 ~_ ~ '~' ~~ "' +i . -~ ~. ,.~ :. 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It' ~ ~J .r.. :1'r, r rite:. ::.~y'rl.. r,";,4 ? .`).`: ~,.~i. 7f eir' ~tll:j pYl ~' r l ,~,'~ Estate Valuation Date of Death: 08/10/2010 Valuation Date: 08/10/2010 Processing Date: 03/31/2011 Shares Security or Par Description 1) 98.011355 MOTORS LIQ CO (370442105) COM Other OTC 08/10/2010 Total Value: Total Accrual: Total: $38.71 High/Ask Low/Bid Estate of: Homer E. Henschen Report Type: Date of Death Number of Securities: 1 File ID: Henschen, Homer E. Estate Mean and/or Div and Int Security Adjustments Accruals Value 0.40000 0.39000 H/L 0.395000 $0.00 38.71 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (R~=_vision 7.1.0) I .,., _~ ,,_ z _ - ~i f ~ i ., '-~ COUNTERSIGNED AND REGISTERED. ~ .; ,.~ MORGAN SHAREHOLDER SERVICES TRUST COMPANY ~' \\\ E - w Z `~ ,'r,t , ~ Q = ///tQQ~ TRANSFER AGENT 1 ~ f ~ /~'`~ W ~ O BY / / ~ AND REGISTRAR I ~ti W V~ ~ ~A_ ~ 'yam > W ~ /~ ~ ~ /~/ / ~ !. ~~~ l ~ ~'~ N ~ G AUTHORIZED OFFICER ~ r~ rI \ E~ ,r ~ ' C' ~ ~ S ;ail ~ ~,~ ~ a F - i p;6 i ;t((tit ltl it ( ~ ~~' ~ 1= '~ ~~ r ~ ~ ~- Q ~ 6 1,11 Y ~, i ° ~ a ~ : \\~ `\~ ~ _ ~ ~`~,.,~,'~~.~.-;~r i~-'`s J F i:~ 3: .rs ,;;. 2;• 3'r \ ~ ` \ ~ ~ m fib,1,i)~;; r `fv< ay .. o >~~~ 4 I r~ -~ ~ . ~ ;..~ „, -- ' KA ~ Y t '~ ~. F - ~ r ~fhp t° , - ` `i<u~ I }`\ ~ ! i ~, .. ~. ~ (h F' I N ~ w ~ ~ ~ ,,, ,, ~.; r. ~ i. ~ /i J 'r r i r. r ~i r, Q 1" ~A~~r `f~t1~(!e{ ~ ~" I` __ -,~ ~~ ~"' 1~. CYJ .~ N yy~~ 1~1 ,T,ww~ w v/~ r~.N. `~ ~~ W ~ 4 ~~ 1 , ~.~' I.b.~ ~~ 11~1~ W 11'~',{~M 4J~J i ~ V lJN ~~~ ~R~ '" ~.,1~ ~~ may, > ~, .- 0 f L~ ~;~. ~~ ~~ ~ ~~ z r ~ ~:. D , ., , ~ o o ~ LL' S \~ \ ~ \ ~ \ 2 IL \\\e \ ~ a` K ~ ~~ ~~ S ~ ~ \.~. ~ ~ \ ~ W i \ ~ ~ 'S~ \ 2 \ ~ ~ m `~, ,;~ ~ ~ ~ . 4 ~ ~ ~ .~ .L +. ~ ~ k Y ~ ~J' ` .. .~ \ ` '` \ `~ ~~ \ \ ~ i Q f 7 \ ~ \ ` \ ~ H k " ,~ ~ yy1 ` \ ~ \ . ` \ ~ \ \\ ~ ~ W Q Q F U `\ ~ 1 ~ \ ~` N U 1 ' ~ ` \ \ ~ ~ • •\ N I J ' \ ~ ~ \ \ \ . ~ ~ L_ ` \ \ 1 \ \ \~ ~` \ \ \ ~ ` `\ \ \ ` ~ ~ \ \ \ \ \ `.~ ? ~ P+ ~ - ~ ~ \ ~~ \ \ \ \ ~ I i \ \ \ \ vv ` \ \ \ ~ ' , w ~ •~ ~ ~ ~ ,. ~'' ~ ~ ~ _ \ ~ ~ ~ _ _ ~. •~. \' ~ •~ ` r - \ \ \ \ ~_ '"i Z t `; 4 ~ ` mow: ~' ~ rr , ,.:~ ~~-; , ~. ~kt ' ~,:, y"I{Sltfl + ~ ~Ss~ ~~:` ~.r.. .>>....._.._._S..a`....-~+.<.i.__. .._.._lu~?_....te'""!' ~__ _~y `-L ~MM'"'" ~( ~~__,~~.., r~ IL ~- _ ~ rOUNTERSIGN[D AND REGI STEREO: ~ a ~ '` ~~ _' '' r~ ~ MORG.AN GUARANTY TRUST GOh~'~ANY ~~~'~' ~;yam - w z u+ OF NEW YORK 71AAN SiCR AGCNT ~ Kam'-1'~t`.l~x ~6~ ~ F p oy AMD REGISTRAR I 1 ftCfy ,.tly a'cY°l '' GJ' ~~~ ul W /ry~Q` ~1 ~~ 1«11 II ?.. ~ ~ LL ~' 1 ~~' ~~. ~e rM~e"~~1 a ..` ~ ~ N o O AUTN O~RIZEO OFFICER ! ~ v ~' 7 ~ ~ asr~ i k O i ~ ~', `~~ . IIIIIR ~~1 ,r Q b II /~ R:. .= ?• = ^ ~'\~ ~ ~~ F' \ y~~~'1d~li] ~. 4 r !C Q, n ~, "a ~ ! a .. ~ ~~ ~ \ z ~~ v~ M :.r .n ,~ ,\ U ") . - ¢ .' :I i ~ c ~ ~ V ~ ~ w J tea., . i _ 5:~ ~_ W ~`\ V~% ~: ar ~ -- ~ ~ `' .g 0 4 - ~k III }' ~ C ~ .~ ~ .. \ ZO . ~j~`~ ~ li i i :~ \ r 4' 1 I `I L' ~ ~~ ~ ~ z ~Z ~\ a . u. ~ C ~; ~ g ~, ,~ , ~~' ~. u '` ~ ~ ~ \ ~ a- ~. ~~ ~ ~~. I ~ "1 ~ 1 ~ 1 ( ~ fA[e. ~ \ \ Sep ~~ < I ~ d <. `~ ~ '\ w S~~ v, f ~ ~ tel. i r`14~~}~ ~ rl: ~ 'vim. - ~~ ~ ~\ ~ ~ ~ __ ~'aC~E- ~~ Oi L Motors Liquidation Company ~,omputershare 000588 ,II11~~~11,~111~1„~111~1~,1,III,~l111~111,11,1,1~'~~~I,1~~,,,1~1 HOMER E HENSCHEN CIO SAIDIS SULLIVAN & ROGERS 635 NORTH 12TH ST SUITE 400 LEMOYNE PA 17043 Computershare Trust Company, N.A. PO Box 43078 Providence, RI 02940-3078 Within USA, US territories 8 Canada 800 331 9922 Outside USA, US territories b Canada 781 575 3990 www.computershare.com/gm Motors 1_iquidation Company is incorporated under the laws of the State of DE. Holder Account Number 0000)9946292 SSNITIN (:ertified Symbol Yes MTLQQ 001 C50003.U.1.. M IX 3 ] 9010005Kb/(ri)0G751i Motors LiquidationCompany - :Summary of AccountHoldings and Tra~ns~action Form It is important to retain this statement for tax reporting purposes and for use as a reference when you access your account online at our website or when contacting Computershare. Holder Account Number: 00009946292 - ACCOUNT SUMMARY As of close of stock market on 08 Mar 2011 Stock:Class Certificated Sharesl 'Direcf Registration ` I ``Investment Plan ( Total I Closing Price I Market Description ( Units Held by. You ~ Book ShareslUnits Book ShareslUnits. ShareslUnits Per SharelUnit'($) 1 Value (~) Common Stock 0.000000 0.000000 0.000000 (1.000000 0.052900 0.00 Transaction History From: 08 Mar 2011 To: 08 Mar 2011 This section pertains only to book-entry shareslunits. Transaction Transaction Deduction Deduction D t Net Price Per Transaction Total Book a e I Description I Amount ($) I Description I Amount ($) I Amount ($) I SharelUnit ($) ShareslUnits l ShareslUnits Plan Transactions Common Stock Balance Forward 58.011355 08 Mar 2011 Deposit 40.000000 98.011355_ OS Mar 2011 Transfer -98.011355 0.000000 OOTPPA (Rev 10/~~) Estate Valuation Date of Death: 08/10/2010 Estate of: Estate of Homer E. Henschen ~.'aluation Date: 08/10/2010 Report Type: Date of Death Processing Date: 01/16/2011 Number of Securities: 1 File. ID: Henschen, Homer E. Estate IBM Shares Security Mean and/or Div and Int Security or Par Description High/As k_ Low/Bid Adjustments Accruals Value _, 14.983 INTERNATIONAL BUSINESS MACHS (459200101) COM New York Stock Exchange 08/10/2010 132.49000 130.77000 H/L 131.630000 18,820.85 Div: 0.65 E~: 08/06/2010 Rec: 08/10/2010 Pay: 09/10/2010 92.94 Total Value: Total Accrual: Total: Si8,913.79 592.99 518,820.85 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (F.evision 7.1.0) iii%% ~1~~~i7 ~) t ~~ ~~i~ i . ~r ~~~ ~ ~Illf ~u,.,, l ~ ~~ ~ ~, ~ n~'ti))~ I _ -~ ,i~ ~~ J (l i L^ r L + a ~~ ~+ a t ~i-W~; ~ !?~ ~ ~"~ ~ a ~--, ~~ ~ z ~-~ ~ o ,-~ ~ o -~ ~ L O r"~~ ~ ~ ~Q ~' y _U ---__ ~ Z ,~. U O j } n 3 ;~ ^ W Z f=) ~ m a '~~ '~ w ~~ o Z a Q ~~ ~ a u ~ w !~~~ H =--' U v. F W ~1 ~ U N x ^-~ ~ ti~ i=~ (1~f ~-- ~~ ,~ ~. 1 ~ ~ •~. \ ~ ~ ~\ `' ~ ~ ~ ~ ~ ~ \ u v r ~, : \\\\~ . ~ \ ' `~ ~ ~ ~ ~ ~ v' ' E \~ \ ~, ~ ~ \ ~ ~' .~ ~ ~ \ ~ ~ ~ ~ \ ~ V ~ ~... v ~ ~ \ \ .~. \ fV ~~ b . ~ ~~ \o v ~ f--- ~, ~~ ,~ ~ v ~`~° •v O ~ '~;: ~~, `~v ~ \ U ,` V •~,y --~ ~ -~ 9 ~ ~ ~ ~ 1 '~; ~ ~: `~ ~, \ v v ~` V c ~ cr~ \ n ~ O C ~ \ °C `~ v ~, L__ ~ L l ,N \ \ ~ :..\,u, y a C `~ ~ V "~ v L ~ ~ ~ V se e-. ~ ~ ~ v a °' m ~ v 0 ~ ~~ n ~' ~ U CJ ~~ `~. ~, ,~ti v c v, U N ~^ V ~~ ~~ \~ ~ ~ r_ ~ ~ ~; G\ ca -o ~, ~~ v ~~~ ~ , ~ ~ ~ I ~~ `~ v ~ ~ o ~ CT ,'' `~ ~ 'v '~ .c ~1 ,~ v ~, ~ ~ v ~, ~ \ ~' ~ •'~ ~ rr't N ~v ~~ -- - --- - - ---- _ ____ - -- - - - --- ----- ~~ ~ ...~ -_ ~ +i+~t++ts•t~• +~ - _ AUTO 3 DIGIT 170 000121/0045141 0 4 5141, .l.l. I„~ ~ ~ .I ~~ ~III~~I .11 I~ ~ ~ ~ 1 11...1 _ 1 1111 1111!11 1 1 1 I II I III 11111 11 HOMER E HENSCHEN 624 BELVEDERE ST CARLISLE PA 1709 3 = 1~3.(~~i Sham ~ ~ yy~~ I -~ ~I J~~ J~v ~~-~ It is important to retain this statement for tax reporting,purposes, and for use as a reference when you access your account online at our website or when contacting Computershare. IBM's Investor Relations website contains information to help you stay informed on the company. Go to www.ibm.comlinvestor to access the site. OOICSOODG RPS.D[. PGI.IBM.I12521 35353/D4S141/04514iJi Hlolder Account Number: 00003016587 - ACCOUNT SUMMARY As of close of stock market on 10 Sep 2010 Stock Class I Certificated Shares Direct Registration 1 I :Investment Plan I Total I Closing Price Market Description - Held b I Book Shares Book Shares -: Shares Per Share ($) I Value ($) DSPP -Common Stock 10.000 0.000 133 .690 143.690 127.990 18,390.88 Dividend Reinvestment Activity As of record date This section includes information only for shares for which dividends are reinvested, . Record Payment Dividend I Stock Class I Dividend Gross Taxes l Net Date Date Rate ($) I Dpscrip#ion Rein:~estment Shares I Dividend ($) I 'vYitnheld ($) f Dividend ($) 10 Aug 2010 10 Sep 2010 0.65 Common 142.983 92.94 92.94 Transaction History From: 01 Jan 2010 To:10Sep 2010 This section pertains only to book~ntry shares. Date I Transaction Transaction I I Deduction I Deduction I Net I Price Per I Transaction I Total Description Amount ($) Description Amount ($) Amount ($) Share ($) Shares Book Shares Plan Transactions DSPP -Common Stock Balance Forward 131.673 10 Mar 2010 Dividend Reinvestment 77.92 Transaction Fee 1.56 76.36 126.757 0.602 13 .275 10 Jun 2010 Dividend Reinvestment 92.48 Transaction Fee 1.85 90.63 127.987 0.708 132.983 10 Sep 2010 Dividend Reinvestment 92.94 Transaction Fee 1.86 91.08 128.854 0.707 133.690 Page 1 of 2 ~pmputershare Computershare Trust Company, N.A. PO Box 43078 Providence, RI 02940-3078 Within USA, U:> territories i7 Canada 888 IBM 6700 Outside USA, U~> territories 8 Canada 781 575 2727 ibm@computershare.com vuww.ibm.com~investor (Go to Stockholder ~>ervices and then Registered Stockholder Access) International Business Machines Corporation is incorporated under the laws of the State of NY. Holder Account Number 00003016587 1111111II IIII III I II ~I IIII Ilfl ICI IflR 9~ IIII INI OOTPPA-IBM Estate Valuation Date of Death: 08/10/2010 Valuation Date: 08/10/2010 Processing Date: 09/26/2011 Shares Security or Par Description 1) 400 HERSHEY CO (427866108) COM New York Stock Exchange 08/10/2010 Total Value: Total Accrual: Total: $18,492.00 High/Ask Low/Bid l~state of: Homer E. Henschen Estate Report Type: Date of Death Number of Securities: 1 File ID: Hens~~hen, Homer E. Estate Hershey Foods Mean and/or Div and Int Security Adjustments Accruals Value 46.57000 45.89000 H/L 46.230000 18,492.00 $18,492.00 $0.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (F,evision 7.1.0) i"~1 ~J a W J W ~ W ,,~ J ~ ~ ~;'3 Q a ~ o W a C7 Z = w ~ ~ o ~°~ ~ ~. ;...~ Q ° o 0 LL ~ , : 1 ~ ~ Q . . O Q' O U Z ~ ~" r-1 Q ~!1 D n..~ H O ~ ^~ V O O O s 'Y "~ ~~ ~~~ i~`"h .~~ u. `~~ ~ ` \ .~~-~ \ ~~ \ 1 \ \ ¢ ~ 4 ~ ' 4 to ,• ~ ~ /i ~~` W W L .- 'h%% ' . W 2 yZj M- /~ ,, /l ~ Q ': ,~~ , "'fin,%" ,. \ u O ;/ i ~ v LL i / a z ~ ~ \ ~ W ~~ \ \ > Y ~ ~ ~ ~ o o \ ~ ~~~ z ° ~ \ ~ ~~ ~ j~,~~,\ a W \. rte., ./% :..;:!~ } i/..\ N F Q (~ \ ~ _ ~ ~~ ~ ~\ LL i'• '~V k?S ~\\ Q \~/%i~ ~i~~4i ~;~~ ~ \ w ~ ,~. ~' ~~`~ W ~ ~~.%i~! Y~~ Q ` ~Tii `n~i. , \ .... \ .. ~.,~, ..,:.~. ,.,.y a • ~v; ~~`~%~y`% ~, ~~ ~~ ' %iis/ n 1 \ ~ % \ \ - J a \ iK r '~ ~. ~ ~ ~~ ~~~_ ~ ` \ ., ` .\ `\\,\ "~ m :ee w J fl O ff3 `~f a J w w Q ~ a ~ w w z = o F= O ~ ~ w O O o ~ a 0 U z ec No ~'+.+ z 0 2 L O V N O O LL a d s N L d1 x \\ `1 '~ .\~.~ ; \~\~ ~~~ '> ~ C ~ ~ ~ O "~~ ~ ~ ~. ~ ~ L \ \.~ ~ ~~ O ~ ~~~~ ;` a ~ ~ ~ ~r. i ~ ~~ C v ~ ~_~~~ N \~ ~ `^, O _~_ C ~ ~ C ~ ~ ~ ~`~ ~ LL ;~Q L ~.'~ ~\ \ C ~ ~~'~~`, `\~ mac. ~...,~ p \ ~ ~ ~ c \\ ~?~ ~: ~ ~~ 1 ~ - 's w sQ, ~; - .: w U J J u~ w V ( :~ w \~ ~ ~ < ~ :J w ~O U W H ~ U ~ (~ a G Z z 1~ ¢ ~ Q 0 ~ J W~ zw ~w p ~ ~ ~ ~ ~ C ~a ~. ~ ~ C a \n ~,;\ r~ ~ ~ ~ \~ Q ~ e ~~ u \~\~ \' w J .~ ~; m~~ ,A~~: cQn ~\~. o cn : ~ ~ ~ `~ w ~ ~ ~ \`.\~~: ~ ~~`;~~ ~ Q ~ ~' ~.~~~' y ~ ~~~:~. \ ~ \ 1 h ~ p ,`~~1,; ~ ~ ~: z ~ ~ ~~ z \ ; ~:T Q ~ v `:\ o~~\~'` ~ ,~ 4 ~ 1~ J ~ .rte, .~ v ~~ l'" ' \ CC C ~ ~. `\ C 1 ~ .N ~ •~ ~~\,. ` `~~ a~ ~ ~~ \ \ ~` .\ \^\ ., ~. ~ `~ ~ N Za -~ ° ~ m \ y. ~ Mf~ \ +~ ` ` • ~, .~ C~ '~ ~, t ~- \ . .. ~%. .. THE CHECK BELOW REPRESENTS A DIVIDEND PAYMENT i ~ The Hershey Ccmpany i To inquire about your account, contact BNY Mellon Shareowner Services To11 Free Number 800-851-4216 ' Outside the U.S. ;Collect) 201-680-6578 ,I Hearing Impaired 800-231-5469 ~ ~. n z Visit http~//www thehersheycompany.com/irfoi lnvestor Relations information. Are ~~+our name and ~~ address current in our records? Call 800-859-4216 or 800-539-0261. -- - •- -RETAIN FOR YOUR•RECOR~S - •• _ - . _ ~ I '~~ 1 f. i TRANSACTION DESCRIPTION SHAREHOLDER OF THE HERSHEY COMPANY pN1DEND PAYABLE DATE INVESTOR tD CUSIP ACCOUNT KEY HO C N ISSUEICLASS OF STOCK EOD00 COMMON f2ECORD DATE 08/25/2010 --- D9/15l2010 _ 925162852633 RE - 17 2786610 HENS CERTIFICATED SHARES OOK-ENTRY SHAR - - --- GROSS AMOUNT TAX WrrHHELD 00 $0 CURRENT DIVIDEND $128.00 RATE PER SHA 00 200 ~ $128.00 . $0.320000D ` X WITHHELD YEAR TO DATE T TAX IDENTIFICATION NUMBER Please detach and retain this form for your records. DIVIDEND PAID YEAR TO DATE A en nn ON FILE __ NUMBER: 761 • ~ ~ ,. • ;,: - - `PAYABLE DATE '~ CHECK.NUMBER '• 60-960 • - ~ 433 - I ~ - ~ ' ; ~ > ; .09/15/2010. 76128990 ' ~ ..r. ,r < ~ ti ~ ' . .: '; CI16Hlrtll! GCRt Myi~..i ?' ~ 5 , , ~ ~ ~ .. ` ' a~ ', '~ ~ ` ` ' ~, . THE BANK OF NEW YORK MELLON PAYABLE AT . 25 ' P.O. BOX 3 S, HACKENSACK,.NJ07808-92.5 '' ~ " ~~~ ~,'' .. '' '- . . , iN U.S. DOt_L;ARS. . , a t ' ;~.:. - ~ T:~ ~ti't 00't,750 42786610 }: ; 0000 fHE , ~3 ~ »s, ~:~ '' :. ~ _ : ~~ 00000459 01 AT 0.357 01 TR 00003 SOQDBA01 000000 , . ~%:~ piVID~ND pgYME~iT 323 ;% - , . .'.:PAY?TD THE:;: ~:>;f t^'<,` __ ,,f oRD~R Oi=~ ~~"~ ~ PAY «*;~,~«*~~~ *****«***~***:~~~n*$128.00 °~ ,,:. ,;. ~ ~- HOMER E HENSCHEN 624 BELVEDERE STREET - CF.RLISLE PA 17013-3507 '""'""r~ ' - . 'il Ii'li'iill'lllil'111!11'!1'1'itililllllli'I'i'lll'tlllillllll - AUTHORIZED SIGNRTURE ~ _, 11'76 ~ 2899011' i:0~330 L60 L~~ 09 Lf117396i~' BNY Mellon Shareowner Services is dedicated to providing you with the best shareowner experience! Did you know that you could manage your portfolio online 24 hours a day, seven days a week? .Ci~nnly log i1z to lnvestor ServiceDirect®(ISD) at www bnyme{{on.com/shareowner/isd Estate Valuation Date of Death: 08/iG/20i0 Estate of: Estate of Homer E. Henschen Valuation Date: 08/10/2010 Report Type: Date of Death Processing Date: 01/16/2011 Number of Securities: 1 File ID: Henschen, Homf>_r E. Estate Tyco International Ltd Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value _, 30G TYCC INTERNATIONAL LTD (H89128104) SHS New Yor}; Stock Exchange 08/10/2010 37.91000 37.26000 H/L 37.585000 11,275.50 Div: 0.2111 Ex: 07/28/2010 Rec: 07/30/2010 Pay: 08/25/2010 63.33 Total Value: Total Accrual: Total: 511,338.83 563.33 $11,275.50 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) THE CHECK BELOW REPRESENTS A DIVIDEND PAYMENT TYCO INTERNATIONAL LTD To inquire about your account, contact BNY IVlellon Shareowner Services Toll Free Number 800-685-4509 Outside the U.S. (Collect) 201-680-6578 Hearing Impaired 800-231-5469 SHAREHOLDER OF RETAIN FOR YOUR RECORDS TRANSACTION DESCRIPTIOIJ TYCO INTERNATIONAL LTD INVESTOR /D GUSIP ACCOUNT KEY ISSUE/CLASS OF STOCK 925162852533 205 102 H8912810~ I~;,b„ E0000 COMMON RATE PER SHARE CERTIFICATED SHARES BOOK-ENTRY SHARES GROSS AMOUNT $0.2111000 0 300.0000 $63.33 DIVIDEPJD PAID YEAR TO DATE TAX WITHHELD YEAR TO DATE TAX IDENTIFICATIOIJ hJUMBER $187.80 $0.00 ON FILE DIVIDEND RECORD DATE PAYABLE GATE 07130/2010 08!25/2010 TAX WITHHELD CURRENT DIVIDEPJD $0.00 $63.33 Please detach and retain this form for your records PLEASE DETACH BELOW CHECK NUMBER: 76115`. BNY Mellon Shareowner Services is dedicated to providing you with the best shareowner experience! Did you know that you could manage your portfolio online 24 hours a day, seven days a week? Sit~xpl~' IOg In to Investor ServiceDirect® (ISD) a# www.bnymellon.com/shareowner/isd Estate Valuation Date of Death: 08/10/2010 Estate of: Estate of Homer E. Henschen Valuation Date: 08/10/2010 Report Type: Date of Death Processing Date: 01/16/2011 Number of Securities: 1 File ID: Henschen, Homer E. Estate Tyco Electronics Ltd Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 30G TYCO ELECTRONICS LTD SWITZERLD (H8912P106) SHS New York Stoc}: Exchange 08/i0/2010 28.31000 2"1.95000 H/L 28.130000 8,439.00 Total Value: $8,439.00 Total Accrual: $0.00 Total: $8,439.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations ~ Pricing SystE°ms, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) THE CHECK BELOW REPRESENTS A DIVIDEND PAYMENT TYCO ELECTRONICS LTD To inquire about your account, contact BNY Mellon shareowner Services Toll Free Number 866-258-4745 Outside the U.S. (Collect) 201-680-6578 Hearing Impaired 800-231-5469 -- - - - -- - - -RETAIN FOR YOUR RECORDS -- - - - - - - - -~ - - -- - - -• - - - SHAREHOLDER OF ICS LTD TYCO ELECTRO N INVESTOR /D _ _ CUSIP ACCOUNT KEY __ - ,_.1261828b2633 ___. _ - _ _. , ?05 102 H8912P10~ HENSC~ oo EE0000 RATE PER SHARE CERTIFICATED SHARES r•BOOK-ENTRY SHARE $0.1800000 0 DIVIDEND PAID YEAR TO DATE r•www nn ~ TAX WITHHELD YEAR TO DATE ~n nn TRANSACTION DESCRIPTION DNIDEND ISSUE/CLASS OF STOCK FIECORD DATE PAYABLE DATE COMMON 09/07/2010 09/15/2010 GROSS AMOUNT T'AX WRHHELO CURRENT DIVIDEND $48.00 $0.00 $48.00 TAX IDENTIFICATION NUMBER AN FILE Please detach and retain this form for your records. PLEASE DETACH BELOW CHECK NUMBER: 76163959 • .: ~ ., • ` ' ~~ - - -~: PAYABLE PATE ~, CHECK NUMBER'' _60 160 r - {3< w - p`~ ~ 09/1572010 76163959. ~ 433 ~7YCO ELECTRONICS LTD ~~ ~~~ %~ ~~ ~ ~ ~ ~'~ „ •a , , . • ,,# ,;~ .• P.O. BOX 3525 ~ `~:': y may' '~7 ~'~y~o s.;. r~ J #s' ~n>';~:~ ¢'~,}F.y~ , "PAYABLE AT THE'BANK OF•NEW -YORK MELLON • - S. HACKENSACK, NJ 07806 9225 `%ss:;<'! ~'~', s >,~•,i f `~.<i%. ~€`,r`•'K ~', ~,~~ °', - ;,. ~ri~ : ~ .~, , ry >c< ; >r IN U S: DOLLARS c~. - ~ }~. ,~£ ~ 7{{~9r ., - ~,'~~ fit, ~~ii~ ~~~d~• ~~r3f .. ,~ • )~ ~?2 H8912P 10 - >Y ,~. w H~;fJS~~~1~EN~~O(yJ~E0000 ,~>~~. > y1~f '~' {~• Y~ ..} }WiCsvi'y~ /•','•,~5~~"/. ~ rf Ss~.C. YC~y7G-i1r£ S '- <O~> , ~ )yyaf v ~ .. eT ~5 y ~ '~' :.ssf.' .. y`~ _ /r»y , {,y} ~ ~. +r f s ' . t~,:> ,~~; ~ 00008623 01 AT 0.357 01 TR 00028 SOSDBA01 000000 ,~ y s ~~ .~>4.~ ~ ~ . r'~'„~ y3¢ S 'S T.$' Y '~' •~AYY7~f3k,Tl~ - '~• ~;.~>;;. ~;- i ~l :`.s / };2 ~~ Al{ f ; b:':~ ~ - > u ~-•~ ~~F.. ~... , .. ~, 4~£~ r two ORI3~4~Q1~,~ ~: PAY*'~~**~~.~*+~**********~r~~:~„~,~~r~48 00 5 ~, - ~.. 1.+.. T f ,~:~ ~ HOMER E HENSCHEN .. ~. . ~~ 624 BELVEDERE ST - , . . `. ; . CARLISLE PA 17013-3507 ~:°:- ~:~ ,.,_,.r.... -,.: ••`~ .! •~. • 'lllli'll,tlll,!l111'llilil'1!'!'1~1l1lli!!11'1'1'i!1'I1111li1lit - .AUTHORIZED SIGNATURE ;- - i :F+; 11' ?6 16 39 5911' x:04 3 30 L60 1~~ i.9 1i11' 28011' BNY Mellon Sharecwner Services is dedicated to providing you with the bes>f shareowner experience! Did you know that you could manage your portfolio online 24 hours a day, seven days a week? ,Sll?2jlly ZOg t'12 to Investor ServiceDirect®(ISD) at www.bnymellon.com/shareowner/isd r I O _, - ..~.~~ S _ o.. V /, - w'. - ~, }-:. ,,, ,, ,, , ;~ .. ~~~ ~~~Ip~i': is ~.. II : ~~lu;, ~~~!,~, ,~, ~~~ ~~,~ ~ ~~ ~~ ~~1~+ ;Uh v `` I ~~j 1 ~.:,. c, ~~ i I i ~,~ ~ti ~ ~~~ ~ ~ ~: ~ ~~ ~ ,~ ~~~ ~ ~ ~~ • ,I ~ ',U '~ -~ ~ ~ ~ f ~~ r,~ ~~ ~ ~ ~ ~ `'~ ~ ~~. ~~ ~ <: .~ ~ ~ ~ ~ ~ ,V ~ it ~ _ ~ ~. `;C:\ ~ '~~.~ _ ``; 11 ~ ~ ~``~°' h n~ ~' " ~~ l4 ~ . - :~T ~ ~ ~ ~ ~} ~ 1~ y ~ ~~ ~ "~ ~~ ~, ~ II Z _ ~+~ `~~~ „ham !L~ ~~• - ~ ~, ice' Q w~ c• ~ >•,v •-• % .~ ~_ _ _ r-r-r A~~ ~' '~~ >~.. ii ~~1i . n ~" .~~I '~ _ i ~I :~I ~'~ ~' ~i _., i ~~_ ~ ~ r ~~ ~ /,/, t , ~ ! //~ ' I - ppi 1 \~+/ /f N 1 z z W 111 Wall St. Nevd Yorl., N1' 10005-3509 Atin: Stocl; Plan Sernces Departmentl2Uth Floor. 1-800-367-4777 (US, Canada, and Mexico) ; or 1-210-677-3652 (Eisewherej -T- - -- --- --- ----- - - -. Plan No: .account No. -~ Trade Date TTrans.Code' Shares/Full and Frac6onel Name of Security Market" Pnce JJ) I 33G XXX-XX-X527 08J25/10 DRI .3012 TYCO INTERNATIONAIL LTDNE 1 38.3800 Reference Na. Amount Dividend Amount Commission Vlrtlhholding Tex Other Charges Net Amount Cnsh Bdnncs 00025 12.10 .54 11.5fi CUSIP Number ACCUMULATED SHARES H Q 9~ 2 Q.~ 1 V~ 4 Previous Balance Prsserrt Bdance ~~~Ill~~~lll~~~~~~ll~~ll~~~ll~~l~l~ll~~~l~~~i~~l~l~l~„II~~~ GSP-33G-240SCA01-000725-01 HOMER E HENSCHEN 624 BELVEDERE ST CARLISLE, PA 17013-3507 57.3332 ~ 57.6344 MorganStanley Sm~thBarney Please retain this statement for your tax records. Please notify Morgan Stanley Smith Barney imrnediately of any discrepancies. It is understood and agreed that all transactions are subject to the constitution, rules, regulations, customs EXPLANATION OF TRANSACTION CODES and usages of the exchange or marketplace where transactions are executed. PDI ............. Payroll Deduction Investment •Unless you have directed that the order be executed on a specified exchange or market and we BUY ••••••••••• SEL Direct Purchase Sold Shares have agreed to such execution, we will, at our sole discretion and without prior notification to you, ............. RE.C ... ....... Received Shares from Client execute any of your orders to purchase or sell securities on the over-the-counter market in any . . DE,L . ... . Delivered Shares to Client location or on any exchange, including a foreign exchange, where such security is traded, either . . ..... JNL Journaled Shares to Client's on a principal or agency basis. Should the Firm communicate an erroneous report of an execution ............. Retail Account that is more favorable than the actual execution price the Firm may at its discretion, and without CC-V ............ Dividend Paid by Check notice to you, automatically pass on the price improvement to you. TN~~D ............ Shares Tendered for Cash •For NASDAQ principal transactions, any mark-up or mark-down shown on this statement DF;I ............. SDV Dividend Reinvestment Stock Dividend represents the difference between the reported price to NASDAQ and your price. Your Financial ............ SP~L ............ Stock Split Consultant receives a portion of any mark-up or mark-down as compensation in connection with EX.C ............ Exchange these transactions, and may receive additional compensation from these transactions. Your CX;LB Cancel BUY Financial Consultant usually receives compensation from transactions that have no mark-up or .......... CX;LS .......... Cancel SELL mark-down. RLS ............ Received Restricted Stock •In some cases, we receive remuneration for directing orders to particular broker/dealers or market centers Shares from Client for execution. When such remuneration is received, it is considered compensation to us and the source MARKET/CAPACITY and amount of any such compensation received by us in connection with your transaction will be disclosed 1 .,. .............. New York Stock Exchange upon request. 2 ................. American Stock Exchange •The time of execution will be furnished upon written request. In transactions where we act as agent, the 3 ................. 4 Other Exchanges Over-the-Counter name of buyer or seller will be furnished upon written request. ................. (1-4) ............ Citigroup Global Market inc. •A financial statement of this organization is available for your personal inspection at its office or a copy of it acted as Agent will be mailed upon your written request or by calling 1-800-367-4777. 5 ................. Over-the-Counter: We acted as Principal or Market Maker •Funds arising out of any free credit balance carried for any customer account are not segregated and may 6 ................. We acted as Principal b~ used in ttie operation of the busir-ess of sucri b-uker or dealer, and unless restricted by the provisions of the plan, such funds are payable on the demand of the customer. Other Market Origins Provided on Request i ~:~~' ~..• i i ...i -.~ 1 !'kw'.1 .. (c) 2010 Morgan Stanley Smith Barney LLC. Member SIPC. Accounts carried by Citigroup Global Markets Inc. Member SIPC. Morgar~ Sranlev Smith Barne~~ l efephone: 111 Wali Si. New York, Nl' 10005-3509 Attn: Stock Plan Services Department120th Floor. 1-800-367-4777 (US, Canada, and Mexicoj ; or 1-210-077-365? (Elsewhere) - - ~ - - _ _ _ - --- ---- - - ------ - --T .. - - _ _--- -- -- _ . _ _- ---- - - ---- ------ - --- --- - ----- ---- ------- Plan No: Account No. 1 Trade Date i Trans.Code' ; ShareslFull and Frec[ional I Name or Security j Markets Price 47G ~ XXX-XX-X.527 12 / 15 / 10 DRI Reference No. ,Amount Dividend Amount 00028 CUSIP Number H8912P-10-6 .2552 TYCO ELECTRONICS LTD 1 i 34.7600 Commission Wtthholding Tax Other Charges ~ Ne[ Amount Cash Balance 9.281 .41 _~ 8.87 ACCUMULATED SHARES Previous Balance Present Balance 58.02591 58.2811 ,,111~~~111~~~~~~11~~11~~~11~~1~1~11~~1,1~~~1~~1~1~1~~11~>;~ GSP-47G-352SCA02-002717-01 HOMER E HENSCHEN 624 BELVEDERE ST CARLISLE, PA 17013-3507 ~MorganStanley _~ Sm~thBarney 1.i ~ r Please retain this statement for your tax records. Please notify Morgan Stanley Smith Barney immediately of env discrepancies. It is understood and agreed that all transactions are subject to the constitution, rules, regulations, customs E)-PLANATION OF TRANSACTION CODES and usages of the exchange or marketplace where transactions are executed. PDI ............. Payroll Deduction Investment •Unless you have directed that the order be executed on a specified exchange or market and we BUY ........... Direct Purchase SE:L have agreed to such execution, we will, at our sole discretion and without prior notification to you, ............. Sold Shares RE:C Received Shares from Client execute any of your orders to purchase or sell securities on the over the-counter market in any ............ DE:L Delivered Shares to Client location or on an exchan e, includin a forei n exchan a where such securit y g g g g , y is traded, either ............ JAIL Journaled Shares to Client's on a principal or agency basis. Should the Firm communicate an erroneous report of an execution ............. Retail Account that is more favorable than the actual execution price the Firm may at its discretion, and without CDV ............ Dividend Paid by Check notice to you, automatically pass on the price improvement to you. TND ............ Shares Tendered for Cash •For NASDAQ principal transactions, any mark-up or mark-down shown on this statement DRI •~•~~•••••••• Dividend Reinvestment represents the difference between the reported price to NASDAQ and your price. Your Financial SC~V ............ Stock Dividend SF L Consultant receives a portion of any mark-up or mark-down as compensation in connection with ............ Stock Split E};C ............ Exchange these transactions, and may receive additional compensation from these transactions. Your C>CLB Cancel BUY Financial Consultant usually receives compensation from transactions that have no mark-up or .......... C)CLS Cancel SELL mark-down. .......... RL.S ............ Received Restricted Stock •In some cases, we receive remuneration for directing orders to particular broker/dealers or market centers Shares from Client for execution. When such remuneration is received, it is considered compensation to us and the source MARKET/CAPACITY and amount of any such compensation received by us in connection with your transaction will be disclosed 1 ,..,,.,•,..•••.., New York Stock Exchange upon request. 2 ................. American Stock Exchange •The time of execution will be furnished upon written request. In transactions where we act as agent the 3 ................. Other Exchanges , name of buyer or seller will be furnished upon written request. 4 .•.....•.....•... Over-the-Counter (1•~) ............ Citigroup Global Market Inc. •A financial statement of this organization is available for your personal inspection at its office or a copy of it acted as Agent will be mailed upon your written request or by calling 1-800-367-4777. 5 ................. Over-the-Counter: We acted as Principal or Market Maker •Funds arising out of any free credit balance carried for any customer account are not segregated and may 6 ................. We acted as Principal be used in the operation of the business of such broker or dealer, and unless restricted by the provisions of the plan, such funds are payable on the demand of the customer. Other Market Origins Provided on Request (c) 2010 Morgan Stanley Smith Barney LLC. Member SIPC. Accounts carried by Citigroup Global Markets Inc. Member SIPC. MOfQafi Stanle;~ Smltll carne; ~ ~ 1 ~nr~n St. New `(ork, Nl' 10005-3509 Attn: Stock Plan Services DepartmenU20th Flool . Plan Nn: Account No. ~ Trade Date Trans.Code• Shares/Full and Fractional Neme of Security s eiephone: 1-t3UU-367-477 i (U~, Canada, and Mexico) ; or '1-2'I U-677-3652 (Elsewhere) Market' j Price 29G XXX-XX-X527: 08/20/10 DRI .2514 COVIDIEN LTD 1 38.6200 Referonoe 1do. Amount Dividend Amount Commission VYithholding Tax Other Charges Net Amount Cash Baance OOD~7 10.16 .45 9.71 CUSIP Number. ACCUMULATED SHARES /'-e~ 5 ~~~ ~ 1 0 ~ C Previous Balance Present Balance ~7L a7 56.4199 56.6713 ~~~111~„III~~~~~~I1~~11~>,~11~~1~1~11~~~1~~~1„I~I~I~~II~~~ GSP-29G-237SCA01-004199-01 HOMER E HENSCHEN 624 BELVEDERE ST CARLISLE, PA 17013-3507 MorganStanley SmithBarney Please retain this statement for your tax records. Please notify Morgan Stanley Smith Barney immediately of any discrepancies. It is understood and agreed that all transactions are subject to the constitution, rules, regulations, customs EXPLANATION OF TRANSACTION CODES and usages of the exchange or marketplace where transactions are executed. P[71 ............. Payroll Deduction Investment •Unless you have directed that the order be executed on a specified exchange or market and we BEJY ........... SE.L Direct Purchase Sold Shares have agreed to such execution, we will, at our sole discretion and without prior notification to you, ............. REC .. . . Received Shares from Client execute any of your orders to purchase or sell securities on the over the-counter market in any .. . ..... DI.L ............ Delivered Shares to Client location or on any exchange, including a foreign exchange, where such security is traded, either JNL .... ........ Journaled Shares to Client's on a principal or agency basis. Should the Firm communicate an erroneous report of an execution . Retail Account that is more favorable than the actual execution price the Firm may at its discretion, and without CDV ............ Dividend Paid by Check notice to you, automatically pass on the price improvement to you. Tt~D ............ Shares Tendered for Cash •For NASDAQ principal transactions, any mark-up or mark-down shown on this statement DI~I ............. SI V . .. Dividend Reinvestment Stock Dividend represents the difference between the reported price to NASDAQ and your price. Your Financial ~ . ..... ... SE L ............ Stock Split Consultant receives a portion of any mark-up or mark-down as compensation in connection with E.~CC ............ Exchange these transactions, and may receive additional compensation from these transactions. Your C;KLB ...... ... Cancel BUY Financial Consultant usually receives compensation from transactions that have no mark-up or . C,KLS Cancel SELL mark-down. .......... RLS ............ Received Restricted Stock •In some cases, we receive remuneration for directing orders to particular broker/dealers or market centers Shares from Client for execution. When such remuneration is received, it is considered compensation to us and the source MARKETlCAPACITY and amount of any such compensation received by us in connection with your transaction will be disclosed 1 ................. New York Stock Exchange upon request. 2 ................. American Stock Exchange •The time of execution will be furnished upon written request. In transactions where we act as agent, the 3 ................. 4 Other Exchanges Over-the-Counter name of buyer or seller will be furnished upon written request. ••••••••••••••••• (1-4) ............ Citigroup Global Market Inc. •A financial statement of this organization is available for your personal inspection at its office or a copy of it acted as Agent will be mailed upon your written request or by calling 1-800-367-4777. 5 ................. Over-the-Counter: We acted as Principal or Market Maker iFunds arisin5 cut of any free cred>< balu;,cs carried for a;T, cu:~tomer acc3unt are nct sagragated and rr:ay S ............. ~l!re acted as Principal be used in the operation of the business of such broker or dealer, and unless restricted by the provisions of the plan, such funds are payable on the demand of the customer. Other Market Origins Provided on Request (c) 2010 Morgan Stanley Smith Barney LLC. Member SIPC. Accounts carried by Citigroup Global Markets Inc. Member SIPC. Estate Valuation Date of Death: 08/10/2010 Valuation Date: 08/10/2010 Processing Date: 01/16/2011 Shares Security Estate of: Homer E. Henschen Estate Account: Delta Equity Services Corporation Report Type: Date of Death Number of Securities: 26 File ID: Henschen, Homer E. Estate Delta 39K-218665 Mean and/or Div and Int Security High/Ask Low/Bid Adjustments Accruals Value 1) 20000 DOW CHEM CO SR INTERNOTES (26054LDN0) Financial Times Interactive Data DTD: 04/03/2003 Mat: 09/15/2013 5.65 08/10/2010 Int: 04/15/2010 to 08/10/2010 2) 25000 PROTECTIVE LIFE SECD TRS (79367CBP9) Financial Times Interactive Data DTD: 08/19/2004 Mat: 08/10/2019 5.22 08/10/2010 Full coupon paid on 08/10%2010 3) 98000 GENERAL MOTORS ACCEPTANCE CORP (3704AOLG5) Financial Times Interactive Data DTD: 05/25/2009 Mat: 05/15/2016 5.5~ 08/10/2010 Int: 05/15/2010 to 08/10/2010 9) 50000 FORD MTR CO DEL (395370BX7) New York Bond Exchange DTD: 07/27/1998 Mat: 08/01/2018 6.5~ 08/10/2010 Int: 08/01/2010 to 08/10/2010 5) 40000 GENERAL MOTORS ACCEPTANCE CORP (3704AOKT8) Financial Times Interactive Data DTD: 05/11/2004 Mat: 05/15/2019 6.5$ 08/10/2010 Int: 05/15/2010 to 08/10/2010 6) 90000 HSBC FIN CORP HSBC FIN (90429XEF9) Financial Times Interactive Data DTD: 07/28/2005 Mat: 07/15/2020 5.6$ 08/10/2010 Int: 07/15/2010 to 08/10/2010 7) 20000 GE CAPITAL INTERNOTES (36966RDM5) Financial Times Interactive Data DTD: 09/03/2003 Mat: 04/15/2023 5.45$ 08/10/2010 Int: 07/15/2010 to 08/10/2010 8) 25000 PRUDENTIAL FINL INC INTERNOTE (74432ALA6) Financial Times Interactive Data DTD: 10/20/2005 Mat: 10/15/2025 5.65$ 08/10/2010 Int: 04/15/2010 to 08/10/2010 9) 50000 WASHINGTON REAL EST INV TR MTN (939671AA1) New York Bond Exchange DTD: 02/25/1998 Mat: 02/25/2028 7.25$ 06/10/2010 Int: 02/25/2010 to 08/10/2010 10) 25000 PRUDENTIAL FINL INC INTERNOTE (79932AFS4) Financial Times Interactive Data DTD: 02/10/2005 Mat: 02/15/2030 5.55 oa/lo/2010 Int: 02/15/2010 to 08/10/2010 104.94450 Mkt 109.944500 20,988.90 360.97 98.98800 Mkt 96.988000 24,747.00 96.94830 Mkt 96.448300 96,295.18 623.33 97.62500 Mkt 97.625000 98,812.50 81.25 86.18660 Mkt 86.186600 34,474.64 613.89 99.98960 Mkt 99.989600 39,993.89 155.56 100.15390 Mkt 100.153900 20,030.78 75.69 99.61660 Mkt 99.616600 24,909.15 451.22 106.69280 Mkt 106.642800 53,321.40 1, 661.96 90.90960 Mkt 90.909600 22,601.15 679.48 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Date of Death: 08/10/2010 Estate of: Homer E. Henschen Estate Valuation Date: 08/10/2010 Account:: Delta Equity Services Corporation Processing Date: 01/16/2011 Report Type: Date of Death Number of Securities: 26 File ID: Hensche~n, Homer E. Estate Delta 39K-218665 Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 11) 15000 BEAR STEARNS COS INC (07387EHD2) Financial Times Interactive Data DTD: 03/17/2005 Mat: 03/15/2030 5.5~ 08/10/2010 91.16980 Mkt 9:..169800 13, 675.47 Int: 03/15/2010 to 08/10/2010 332.29 12) 10000 PRUDENTIAL FINL INC INTERNOTE (79932ANY2) Financial Times Interactive Data DTD: 05/18/2006 Mat: 05/15/2031 6.3~ 08/10/2010 97.14710 Mkt 9"' . 19 7100 9, 714 .71 Int: 05/15/2010 to 08/10/2010 148.75 13) 22 COVIDIEN PLC (G2554F105) SHS New York Stock Exchange 08/10/2010 38.51000 37.99000 H/L 3E~ .250000 841.50 Div: 0.18 Ex: 07/29/2010 Rec: 08/02/2010 Pay: 08/20/2010 3.96 14) 300 EXXON MOBIL CORP (302316102) COM New York Stock Exchange 08/10/2010 62.17000 61.45000 H/L 6:..810000 18, 543.00 15) 774 FORD MTR CO DEL (395370860) COM PAR $0.01 New York Stock Exchange 08/10/2010 13.03000 12.80000 H/L 12.915000 9,996.21 16) 700 GENERAL ELECTRIC CO (369604103) COM New York Stock Exchange 06/10/2010 16.39000 15.95710 H/L 16.198550 11,303.99 17) 250 LILLY ELI & CO (532457108) COM New York Stock Exchange 08/10/2010 37.92000 36.81000 H/L 3'] .365000 9, 341.25 18) 1000 PFIZER INC (717081103) COM New York Stock Exchange 08/10/2010 16.60000 16.26000 H/L 16.430000 16,930.00 Div: 0.18 Ex: 08/09/2010 Rec: 08/06/2010 Pay: 09 /01/2010 180.00 19) 22 TYCO ELECTRONICS LTD SWITZERLD (H8912P106) SHS New York Stock Exchange 08/10/2010 28..31000 27.95000 H/L 213. 130000 618.86 20) 22 TYCO INTERNATIONAL LTD (H89128109) SHS New York Stock Exchange ' 08/10/2010 37.91000 37.26000 H/L - 3'7.585000 826.87 Div: 0.2111 Ex: 07/28/2010 Rec: 07/30/2010 Pay: 08/25/2010 4.64 21) 13 VISTEON CORP (928390107) COM Other OTC 08/10/2010 0.99000 0.39000 H/L 0.440000 5.72 Page 2 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Date of Death: 08/10/2010 Estate of: Homer E. Henschen Estate Valua tion Date: 08/10/2010 Accoun~:: Delta Equity Services Corporation Proce ssing Date: 01/16/2011 Report Type: Date of Death Number of Securities: 26 File ID: Henscht:n, Home r E. Estate Delta 39K-218665 Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 22) 200 WASTE MGMT INC DEL (99106L109) COM New York Stock Exchange 08/10/2010 39.53000 39.06000 H/L 31.295000 6, 659.00 23) 1945.68 AMERICAN HIGH INCOME TR (026547307) CL C Mutual Fund (as quoted by NASDAQ) 08/10/2010 10.99000 Mkt 10.990000 21,383.02 24) 1378.336 LORD ABBETT HIGH YIELD FD (544OON300) CL C Mutual Fund (as quoted by NASDAQ) 08/10/2010 7.55000 Mkt .550000 10,406.99 25) 3106 NUVEEN MUN TR (67065Q749) HI YLD MUN A Mutual Fund (as quoted by NASDAQ) 08/10/2010 15.78000 Mkt 15.780000 49,012.68 26) 8996.299 OPPENHEIMER MULTI ST MUNICIPAL (683940100)- PA MUN FD CL A Mutual Fund (as quoted by NASDAQ) 08/10/2010 ~ 11.03000 Mkt 17..030000 98, 677.68 Tot al Value: ~ $613,805.99 Total Accrual: $5,367.99 Total: $6 19,173.43 - Page 3 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Estate Valuation Date of Death: 08/10/2010 Estate of: Estate of Homer E. Henschen ~.'aluation Date: 08/10/2010 Report Type: Date of Death Processing Date: 01/16/2011 Number of Securities: 1 File ID: Hensc:~en, Homer E. Estate Morgan Stanley Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 1239.162 LEGG MASON CAP MGMT VAL TR INC (524659109) CL C Mutual Fund (as quoted by NASDAQ) 08/10/2010 35.51000 Mkt 35.510000 44,002.69 Total Value: TOtdl Accrual: Total: 544,002.64 ~44,UUL.64 50.00 Page 1 This report was produced with Estateval, a product of Estate Valuations & Pricing SystE~ms, Inc. If you have questions, please contact EVP Systems at {818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Estate Valuation Date of Death: 08/10/2010 Valuation Date: 08/10/2010 Processing Date: 01/25/2011 Shares Security nr Par Description 1) 214 ALCATEL-LUCENT (013904305) SPONSORED ADR New York Stock Exchange 08/10/2010 Total Value: Total Accrual: Total: $625.95 Estate of: Estate of Homer E. Henschen Report Type: Date of Death Number of Securities: 1 File ID: Henschen, Homer E. Estate Alcatel Lucent Mean and/or Div and Int Security High/Ask Low/Bid Adjustments Accruals Value 2.98000 2.87000 H/L 2.925000 625.95 $625.95 $0.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (R.evision 7.1.0) Estate Valuation Date of Death: 08/10/2010 Estate of: Estate of Homer E. Henschen Valuation Date: 08/10/2010 Report Type: Date of Death Processing Date : Oi/25/2011 Number of Securities: 1 File ID: Henschen, Homer E. Estate Covidien Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 50 COVIDIEN PLC (G2559F105) SHS New York; Stock Exchange 08/10/2010 38.51000 37.99000 H/L 38.250000 1,912.50 Div: 0.18 Ex.: 07/29/2010 Rec: 08/02/2010 Pay: 08/20/2010 9.00 Total Value: $1,912.50 Total Accrual: 59.00 Total: 51,921.50 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Estate Valuation JaLe of Death: 08%10/2010 Valuation Date: 08/10/2010 Processing Date: Oi/17/2011 Shares Security or Par Description. ?) 4 LSI CORPORATION (502161102) COM New York Stock Exchange 08/10/2010 Iota; Value: Total Accrual: Total: 517.14 Estate of: Estate of Homer Henschen Report Type: Date of Death Number of Securities: 1 File ID: Henschen, Homer E. Estate LSI Corp Mean and/or Div and Int Security High/Ask Low/Bid Adjustments Accruals Value 4.37000 4.20000 H/L 4.285000 17.14 $17.14 $0.00 Page 1 Th:~s report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. if you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Estate Valuation Date of Death: 08/10/2010 Estate of: Estate of Homer E. Henschen Valuation Date: 08/10/2010 Report Type: Date of Death Processing Date : 01/25/2011 Number of Securities: 1 File ID: Henschen, Hamer E. Estate Tyco Electronics Ltd Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 50 TYCO ELECTRONICS LTD SWITZERLD (H8912P106) SHS New York Stoc}: Exchange 08/10/2010 28.31000 27.95000 H/L 28.130000 1,406.50 Total Value: $1,406.50 Total Accrual: $0.00 Total: $1,406.50 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If y.ou have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Estate Valuation Date of Death: 08/10/2010 Est,3te of: Estate of Homer E. Henschen Valuation Date: 08/10/2010 Report Type: Date of Death Processing Date: 01/25/2011 Number of Securities: 1 File ID: Henschen, Homer E. Estate Tyco International Ltd Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adju:~tments Accruals Value 1) 50 TYCO INTERNATIONAL LTD (H89128109) SHS New York Stock Exchange 08/10/2010 37.91000 37.26000 H/L 37.585000 1,879.25 Div: 0.2111 Ex: 07/28/2010 Rec: 07/30/2010 Pay: 08/25/2010 10.56 Total Value: Total Accrual: Total: $1,889.81 $10.56 $1,879.25 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Estate Valuation Uate of Ueath: 08/10/2010 Estate of: Homer E. Henschen Valuation Date: 08/10/2010 Account: 91P-12590 Processing Date: 09/08/2011 Report Type: Date of Death Number of Securities: 2 File ID: 41P-12590 Shares Security Mean and/or Div and Int Security or Par Uescription High/Ask Low/Bid Adjustments Accruals Value 1) -75 Cash (CASH) -75.00 2) 1239.162 LEGG MASON CAP MGMT VAL TR INC (529659109; LMVTX) CL C Mutual Fund (as quoted by NASDAQ) 08/10/2010 35.51000 Mkt 35.510000 99,002.69 Total Value: Total Accrual: Total: $93,927.69 $0.00 593,927.69 Page 1 Please be aware of the following important information: The attached valuation provides y~~u with the value of the assets of the estate shown on page 1 of this document held through Morgan Stanley Smith Barney LLC, member SIPC (MSSB) as of the date shown on page 1 of this document. The valuation is provided to you using software by Estate Valuations and Pricing Systems, Inc. (EVP), a separate company that is not part of MSSB. MSSB provides the EV~ service to you at cost. The references to EVP should in no way be considered to be an endorsement of EVP by MSSB. Th~~ purpose of this valuation is solely to assist you in preparing required estate (Form 706) and gift tar: returns for submission to the Internal Revenue Service. This report is not an official account statement and while it may contain data :regarding income, liabilities, capital gains and losses, it is not an official tar: statement. Please refer to the origin;31 statement for current account information and any Form 1099's and related materials. All data is believed to be reliable, however, it is not guaranteed for accuracy, or completeness. MSSB and its affiliates do not provide taz or legal advice. To the e:;tent that this material or any attachment concerns tal matters, it is not intended to be used and cannot be used by a taxpayer for the purpose of avoiding penalties that may be imposed by law. Any such ta::payer should seek ;advice based on the taxpayer's particular circumstances from an independent tar•. advisor. Access to this information by MSSB, and your FA, does not imply or create new or additional duties to you, new or additional knowledge or information ab~~ut you, your relationships or your accounts M C W O 0~ N Q y ~ m ~ ~ ~ y ~ a c ~~ ... ~., ~ ~ tC Q. a N "Q G> of v e- ~ .C '~ C ~ M ~ ~~ ~ ;~ ha°~' 'Q ~ O oU ~ O ~> O N V N:~'~bga C ~ ~ ~ ~ ~ r., ~ a v o V ~ O V ~ 3 •ti ~ N ~, Q •; off, ~ V O ~ ~ •~ h ~ ~ ~ ~~ >_ N Qj h fi ~ ~ ~ h ~ o~•~fi ~. 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O fi ~ ~ 0 ~ b N C . b , C i C1 ~ :~~ ~ A h Gi ? i >T O fi p O~ C .~ ~ d ,a; h pQ ~ L ca ~U ~ H~ w~ ro~ ° y e a ~•~ a j ~:, ~ • V1 ..~ .~ ~ CS Vl O .~ . .,, p i ~ C ~ V ~ V ~ O ~~ Q tiC` ro ro •s: Estate Valuation Date of Death: 08/10/2010 Valuation Date: 08/10/2010 Processing Date: 01/25/2011 Shares Security or Par Description 1) 510.603 VANGUARD HORIZON FD INC (922038104) STRATEGIC EQ Mutual Fund (as quoted by NASDAQ) 08/10/2010 Estate of: Estate of Homer E. Henschen Report Type: Date of Death Number of Securities: 1 File ID: Henschen, Homer E. Estate Vanguard Strategic Equity Fund Mean and/or Div and Int Security High/Ask Low/Bid Adjustments Accruals Value 15.65000 Mkt 15.650000 Total Value: Total Accrual: Total: $7,990.94 7,990.94 $7,990.94 $0.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Estate Valuation Date of Death: 08/10/2010 Estate of: Estate of Homer E. Henschen Valuation Date: 08/10/2010 Report Type: Date of Death Processing Date: 01/25/2011 Number of Securities: 1 File ID: Henschen, Homer E. Estate Vanguard Energy Fund Investor Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 394.203 VANGUARD SPECIALIZED PORTFOLIO (921908109) ENERGY PORTFOL Mutual Fund (as quoted by NASDAQ) 08/10/2010 Total Value: Total Accrual: Total: $22,461.69 56.98000 Mkt 56.980000 22,461.69 50.00 $22,461.69 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision x.1.0) Welts Fargo Advantage Funds"" 1;.0. Box 8266 ' Boston, Massachusetts 02266 www.wellsfargo.comiadvantagefunds December 16, 2010 ~~~ a SAIDIS SULLIVAN LAW A PROFESSIONAL CORPORATION ATTN KIMBERLY A HAMILTON 2109 MARKET ST CAMP HILL PA 17011-4723 REFERENCE: 06368961 Dear Ms. Hamilton: We are contacting you in regard to Homer E. Henschen's Individual accounts previously held with YVells Fargo Advantage Funds®. The balances of the accounts in the Wells Fargo Adva~Ztage Classic Value Fund- Administ~°ator Class and the I~Vells Fargo Advantage Core Equity F und-Administrator Class are provided in the following table as of August 10, 2010: Account Number Share Balance Share Price Account Value 226-~~~X9222 1,769.155 $17.01 $30,093.33 225-~~:~~XS 185 427.035 $23.78 $10,154.89 The Individual accounts were transferred to Estate accounts on No~~ember 15, 2010, and subsequently redeemed. If you have any questions or require further assistance, please call Iris at 1-800-222-8222. Representatives are available 24 hours a day, 7 days a week. Sincerely, ~ ~~ ,~ = Steve Perry Client Service Team Wells Fargo Funds Management, LLC, a wholly owned subsidiary of Wells Fargo & Compa~~y; provides investment advisory and administrative services for l~'ells Fargo Adva~~tage Ftu~ds~`. Other affiliates of Wells Fargo & Company provide subadvisory and other services for the Funds. The Funds are distributed by Fells Fargo Funds Distributor, LLC; Member FINRA/SIPC, an affiliate of Wells Fargo & Company. ~ NOT FDIC 1NSUREO NO BANK GUARANTEE iVIAY LOSE VALUE Nationwide Funds On Your Sideg P.O. Box 5354 Cincinnati, OH 45201-5354 12/ 1 S/2010 SAIDIS SLILLIVAN LAW OFFICES ATTIC': ILIMBERLY HAMILTON 109 MARILET ST CAMP H1LL PA 1701 1 Reference id: KCFOOL Re: Nationwide Funds Account No. L'ai•ir~us .ACGU2I71X5' To Whom It Ma}~ Concern: Please accept our condolences on the passing of Hamer Henschen. We appreciated the opportwlit)~ to have Ml•. Henschen as a shareholder. This letter is in reference to your recent request for a Verification of Date of Deat;h Value. The information is as follows: Account Account Value Total Shares NAV 21-23119SS600 $14,984.86 1,984,7SU 7.SS 22-1~119SS600 $1S,S61.22 1,286.OS1 12.10 24-80119SS600 $0 0 0 Should you have an}' questions, please feel fi-ee to contact Nationwide Funds between the weekday hours of 8:00 a.m. and 7:00 p.m. Eastern Standard Tune at 1.800.848.0920, and a Shareholder Services Representative will be available to assist you. You may also obtain current infor nation on the Nationwide Funds form our Internet home page at www.nationwidefunds.com. We appreciate yow- business and the oppor-twlity to service yow• account. Sincerely, Nationwide Funds ERIN MADDY, SHLDRSVCS Encl.: Copy of Request .~--~.re~U.S A BNl' Mellon Compare}~'- ACCOUNT STATEMENT Page 1 of 1 07/01 /10 through 09/30/10 Dreyfus Appreciation Fund 403710528 For questions about your account please cal! 1-800-645-6561 or go to www.Dreyfus.com to view your account on line. _ .,. ~~ FMS YQ'LJR'INFQIiMATIt3N Dreyfus is pleased to present our 3rd quarter client newsletter- "Letter from the Liori". This quarters newsletter presents "Tire lacy CI-voices fur Dncer~iair'~ iviarkets''. To learn more, please read the enclosed newsletter. .Investors should consider the investment objectives, risks, charges, tax features anti expenses of the fund carefully before investing. Coritact your financial advisor and obtain a prospectus that contains this rind other information about the fund and read it carefully before investing. ' A.CGt)UNT AT-A-GLANCE Personal account Total Market Value MBSC Securities Corporation, Distributor fDll ]277 DM.1-5.202 107016 190254 7 DRE5T07 M.J570B0.0001.267488 HOMER E HENSCHEN 624 BELVEDERE ST CARLISLE PA 1701-3507 Dividend/distribution summary. This period Year-to-date Dividend income $0.00 $3.95 as of 09/30/10 $11,342.03 ACCC~UnTT A~:7riV1<TY Dreyfus Appreciation Fund Account number: 0141-1000149946 Trade Shares this Total shares date Description Dollar amount Share pricE~ transaction owned Market Value as of 06/30/10 $10 ,117.16 $31 .47 321 .4 Market -Value as of 09/30/10 $11, 342.03 35.28 .486 INVESTMENT SLIP To purchase additional shares, make your check payable in U.S. dollars to: The Dreyfus Family of Funds and mail together with this slip to: The Dreyfus Family of Funds P.O. Box 105 Newark NJ 07101 -0105 Minimum investment: $~ 00.00 Amount enclosed: $ Dreyfus Appreciation Fund Fund Account #: 0141 -1000149946 HOMER E HEP~SCHEN 624 BELVEDEI~E ST CARLISLE PA ~ 7013-3507 X If your address is incorrect, please make any changes above, have all registered owners sign and return this slip. Do not write in the white area below. PSEC~ November 18, 2010 Account # 0284XXXXXX JO ANN SEKER C/O SAIDIS SULLIVAN LAW 2109 MARKET ST CAMP HILL, PA 17011 Dear MS. SEI{ER: The following is the status of HOMER E. HENSCHEN's account with PSECU as of the date of death. Joint Owner's Name NONE Date of Death 08.10.2010 Date of Birth 09.151927 ~~V 1 9 2010 ~o ~a(~t~<<o Share Description Open date Balance Accrued Di~~idend S O 1 Regular Shares 10.05. i 992 $1,126.62 $0.11 S 04 Checking 10.05.1992 47.86 0.00 The dividend earned from January ], 2010 through the date of death was $2.71. The decedent had no loans with us. We do not have safe deposit boxes for our members. The check for the proceeds will be sent under separate cover. If you have any duestions, please call 234-8484 in Harrisburg or our toll-free number, (~~00) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, l ~ 0 Meacie Fairf M~iT~hei• Service I; nl~rE',$P71t'tiVP Finance Support Unit Pennsylvania State Employees Credit Union Moin Address: 1 Credit Union Place, Harrisburg, PP, 171 10-2990 717.234.8484 800.237.7328 Mailing Address: PO. Box 67013, Harrisburg, PA 17106-7013 • 717.777.2100 (TDD) • 800.472.1967 (TDD) psecu.com Tnis credit union is {ederally insured by the I~lational Credit Union Administration. Equal Opportunity Lender ~r.~r i•! Flr_ '. Nationwide Funds« J~ •`%~~ -.. r• _. ~, .. , -, $32,109.56 Irvv'~r~1G ~Ur•1r1hP` Y~AF i ~ ~f,"~ cndrnc 09,/30/2010 Tax Deferred Beginning Value 528,591.81 Dividends/Short- $0.00 Term Capital Gains Change in Value ''''1~ 7' Long-Term $0.00 Ending Value $32,109.56 Capital Gains ~:~~ ~~at_lrtl~ ~'J!~1~~AF~Y' .<•.F- TG ~~~T~_ Fund Account Name NATIONWIDE GROWTH FUND CLASS D (MUIGX} NATIONWIDE FUND CLASS D (MUIFX) NATIONWIDE MONEY MARKET FD PRIME SHARES (MIFXX) Fund -Account Value as of Value as of Share Number Number 07/01/2010 09/30/2010 Price of Shares 21-2311955600 513,134.47 515,600.14 47.86 1,984.750 22-1311955600 514,300.89 515,952.97 511.38 1,288.608 24-8011955600 8556.45 51556.45 51.00 556.452 _ 1~ IJaUOnwide Fund 49.7% IJalionvdrde GroaJlh Fund 48.6% ~ Nv,~ Monev Market Fund 1.7% Fund -Account Fund Account Name Number NATIONWIDE GROWTH FUND CLASS D 21-2311955600 (MUIGX) NATIONWIDE FUND CLASS D (MUIFX) 2%-1311955600 NATIONWIDE MONEY MARKET FD Z4-8011955600 PR-ME SHARES (MIFXX) Total Dollar Value .•r HOI~IEF E HENSCHEN 6~4 BELVEDENE ST CARLISLE PA 1701-3507 GROVE, ANDREW Taxable NATIONWIDE SECURITIES, L LC $71.40 30 RED HILL COURT NEWPORT PA 17074 $0.00 ~ ~ Shareholder Services Change in 1-800-848-0920 r value g:30am to 7:OOpm ET 51,8!».6 Automated Line 51,6:12.08 1-800-848-0920 50.00 Internet www.nationwidefunds.com NEV~.!S AI~lC` INEORM,~,Tf01~! ~UMhi.-.R" ~,~ i-iOLJU~JG~ ?~~ ASSE ~ ~.-. ~GOR~~ Streaml!ned Account Statement Gives You Easier Access to Your UCLargeBtencl 49.7% Account Information. Please take US LargeGrowu~ 4s.5°i° ° a close look at our new, simplified ~~ US 1~loney Macke( Taxable 1.7 /° Purchases 5,0.00 50.00 SO.UO $0.00 I~.l~_TI,~f,lyvyl:JE ~,:,F?QVJT;-; ~=UNL~ ~'_~-'.:_ ~ ! r~UI~.~%' HOMER E HENSCHEN ACCT # 21-2311955600 624 BELVEDENE ST CARLISLE PA 17013-3507 Oaic De~cr!PUon C-oila~ Anx~un! 07/Ol/2010 Begmn!ny Balance 513.734.47 09!30/2010 Ending Balance 515.60GJ4 r shareholder statement. It was designed to give you easier access to all of your account '- information. You can use the statement as a guideline the next _._ time you meet with your financial Dividends/Short- Reductions3 Long-Term advisor. - Term Cap Gains Cap wins OU SU.00 SO 50.00 The updated statement: . prominently displays changes in _ the value of all of your holdings; 50.00 571.40 50.00 summarizes all of your income; 50.00 50.00 SU.00 uses pie charts to clearly __ illustrate your account holdings ~~ $0.00 $71.40 $0.00 by Fund and Asset Category; __ includes your financial advisor contact information; teaches you more about Nationwide Funds; encourages you to sign-up for _ e-delivery; and informs you about = any operational changes to your ,__ accounts. :;narE~ Pr!c~- ~I~rare: Tiu~ lransachon Tota! Share 56.92 1,984.750 i~7.86 1,984.750 Nati®nwide ~~ Funds On Your Side` 1. Change in Value: Ti-!~ aa~lreraate of all tramacr!on~, ;purd-~ase~. redemr~t!on~, exchange,, d!videnrJs ano change, !n marke! - f~Jat~or,vt~!de mounds distributed by value dur!ng tip!, penoc. 2. % of holdings: TI~~ ;~ercenta_ e of our r.otal noldm :represented by th!s fund or acLoun?. Nationwide Fund Distributors g y g~ LLC (NFD), Merni7er rllJR~. 100-~ 3. RedUCtlOnS: ~ fib ~gafe~ldt~ 0' rill reaen1pt!ol?`,'~N!II1GraV~~ai~, e~cnallues0' d11V Otlief reClUCilUnr, tQ the aCCOUni ~~Uflf1G tnlS r r r' ~a _ _,ont~nenta! Dr~~i„ ~~.~i,_._ 40C~ Kinc; ~ - ~ ~ ~ ~~ M V'1 ~D 1f1 Y1 V 6 CD N ~O M Ih N1 1`~ n P~- O1 ~ 01 Q1 . GD LIl 1J1 m '~ ~ N N ~ ~ .M~` ,;' ~ _ '' ~ ~ ~.. 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'> ., . ., ~•' . :.~• m• O• .a:- ~: ~~ N ~.: ~ •o. ~. f;7.. ~ ~ ~: :{fY .•pl : :i C Q'' ~ .LL, •~ ~ .~ , • f+-. ~:. .•.N , ,;~ , . , ~_. ..Oft ro> p. , r,,. if ~ :. ~: .. 5111. ; ~ . ~ r • ~. p ..:N::.. :~: ~ • , : ~~.,. .~ ~,: :-Q.. O; , ~. ~• ~ _ ~. : ~ ' .~~ . ~ U ~; ~' ~ '~, ~ ,. Ei9~ ~ h ~ . ~ - ~ m ~~ ~ . ~ cV N. m: . , ~• i. ~ om . o Q;. n . ;'~ ~ : ~ ~ o o j W c~ 0 ra c+rt ~ IM O O C o] a ~ CV _\ G'7 rN- c 0 a~ v fD N Q7 c .~ .~ N [~ a_ G N 11 N_ v m m CII 'C lit N N w.- O CD J~ tU t~ LL G ~: U .. ~. ~. '. ~': i ~. .~ •N • . }: • ~ ~ ~.. O c0 ~. . L: . w-. ,~ b G) tp' "~•• .',O, Q.. a~i'. :o~ , ~o. , ~ ~' •~ ~ . o, • ..~ , , ~~ ~ L•L . ~.., .. ' '(II:' ~. ~. ~, ~; fl:.' Q~ ` ~ ~ cfl ~ ~ 64 ' 7~ ~~ L: ~ :... ~•• _ ,`7 ~ ~ f11; , ~ .. ~` QI, , O:• ~ ~~. ~ .. ~,,. j O' o . ~. ` . C. ~ ~ ~- LL. ~, Z7 ~~ ~. ' C ~ ~, . ~ cv ~ ~ ~ • .. •~ i ' CA: ~ 7" fp ~ : i ~ : . ~ ~• m N ~~ . ~. cv i r'' c s ~ T- ~ ~- . ~ ~ > ~ LL a.c `~ • .~:: BankofAmeric ~~' February 3, 2011 Dear Homer E Henschen, Enclosed you will find a check which represents a credit balance refund from your Bank of America account. Remember that all credit balance refunds are subject to final audit. Any adjustments will be posted to your account. If you have further questions, please contact our Customer Satisfaction Department at 1-800-441--9977. We appreciate this opportunity to be of service to you. .< BANK 4F AMERICA :NA . a~s95~oz~ .DEPT AZ9-503-02-57 1825 E BUCKEYE RD - 91=17.0/1221 PHOENIX AZ 85034-4216:. Feb;ruary;3., 2011` .PAY TO THE. ; . ~ *~*********~***** oR~ER of Homer E Henschen $16.50 Sixteen and 50/100 ,~***************~-~**********,~********************~*****************~*****,~*y~***********~*****************~**~ DOLLARS Not Valid After 120 Days ai~no2os~ ~o~-o2s2s 4264 2960 2402 XXXX Homer E Henschen 624 Belvedere st BankofAmeric ~r~..,_ w ~ ~ ~ ~ . ~ ' Carlisle, PA 17013 ~ ,~~~`~~ ,i ~~'00 X89 5B0 ~ ~~~' ~: L 2 ~ LO L ~06~: X8900 3 ~ 3 3i~' NJTA, LE~+-D ~4GEIVC~ FOR THE ETC GRDUP P.O. BOX 52020 NEWARK, NJ 077 01 PAY TO THE -`_: ORDER OF ESTATE OF HOMER HENSCHEN JPMORGAN CHASE BANK, NA 0 x 2 8 7 3 6040 TARBELI_ RD SYRACUSE, NY 13206 50-937/21;3 4/s2/2o11 ~ **8.56 Eight-and 56/100-~-~-~~~~-~-~~~~~~-;~a;-~--~~-~-~.~~~~-~.~-~~~~~-~-~~-~~-~~~-.~~~-~~-~-~~-~-.~~~~~~~-~-~~~~~~~~~~~~-~~-~ DOLLARS i ~; .° ES~'AT,E-~F HOMER HENSCHEN - -=- ~35N~2fh STREET~'UITE4oo , TWO SIGNATURES REt~'D FOR $1001 OVER .. LEIVIOYNE, PA 1703 -_ ____ _ - _ - tl.~.- NOT VALID: AFTER 180 .DAYS nnEnno E :Zpass Acct #2000009$5262,3 ~ ,~ u'09 ~8'?3^ ~':0 2 ~3093~?9.~`~60 i.IB666 27u' NJTA LEAD AGENCY FOR THE ETC GROUP 4/12/2 01 ~ 092873 ESTATE OF HOMER HENSCHEN Refund E-Zpass Acct #2000009852623 NJTA LEAD AGENCY FOR THE ETC GROUP ESTATE OF HOMER HENSCHEN 8.56 8.56 .4/12/2 011 092873 8.56 Refund E-Zpass Acct #200000985262,3 8.56 i p~~~yg{~y ' f.9j'i Fif1C5 Ej{}!3~ i,(,~ixtt7'.I~iF ~? PFC. - 734 t ~r,~.in~ ~t,a ~~rytrut~X, s f'.Cl. f3mt $8'BCI~ (5102) eian'feb+~~, f'iR 1:~7tIK-99~? www.flsh.t~t~te ~e-~ ~~'~IDAV~'1' ()F P[.~RCHAS~:/UWNg ~~4 ~~~r~t~~. ~~~ ¢~~~a~~,x ~T~-~.m I)(? NO'i' USL. ~~Lg ~~~M IF'I'HH H()A~' Ill DISP'I.AVXN(. A PA BE+.[9I9~['BATEOId N[TMBF ~: __ ~_....,-._.._.....--.___.,~.-..--. _ nera~hi of boatB pur~b~ at t~ta mRrlvet>3, yaral~arsge sales, atictian/e~~-~' r3elet~, ~-ncl other This farm is osc~i to cstabli~h ow P MC't)} ~ not ~vailnbte egad t}ae boat w~ ~z ri~rate tra~us*ctions where w bill-of-ss~le or 1Kanuia~cturer,~ ccrtillcnte of Orin t of a bome~-dg o~ sp+~r.~I1~ P other state. Also use this form to show owne~hip with fog previously reg~stere~d in f'enns3'lvnoia or wny trotted boat (laclude bills-of-salt for moor componcnits~. T~ for~- is only valid when used coDK pnNon. REV-33d, Appb~at~on for Boot R~cg~s , ... Whale restdc-nee is _ _ ! - l _-~ that tb~ ~t~~ c under penalty of law {18 Pa. t'.S. X4904 (,retsting to unswormwtt~Bieud I-e ~ uIl'We cdeTtB`Y that the h~iat de•;~c~~zT herein are tr4ee and correct to the best of may/our knowledge, anf below bas been t+or+c from _r.. .._.- -.. -..--. ---- -- {Name of'S~Tjer or ().gan~at~n) whose r~denee his !._ ___.. _- D~rlptiou of Bowt porcbwsed: Mskc of Boat Mod,e1 of Boat Hull Identitf~catlon Number (HIN) or Scrist Number ~,ength of Gott P'arthase. Daft Purchase f"riee ~ . ~~ ~ 1-~~. _._...-._. ... , ,. _ _ ~'N.'~k..ti ~-~... '~...•~ L~.~ ~~._.__._,..._.. ,..._.._. _ . _.. _.. _ . t C1~t~ ~-~ ~~~J Daeg the boat rurrendy have a Pennsylvania or other state str$~+~~r aon~t~~?~`' If ~ lwce the r~strution number bere . ~ ~ ~~ ~1--1.1 ~' - y ,p x Signwturc(s) 4 '~'~ (~~ ~,, Datae _..___ _.....-_~.__,..._.__~... --~-.- - - I t r r r I ' _ r + ., I ~ _ .. _ _ _ _ , 11! 1r , r 11t r li Ir t{fr rr I \' 1i1[L[l[ ..s ,~y U r11 ~. 11~ I i~- rnry II 111i11,.tillrt ~\h4n'1' d .Q./1~ • / ~ (/ '~ - ~-~ r `~,,I ~, ~ I r~ ! 11 ;.il q4n + S 11 111 t~ly1 55./~ i N Ir i ~. •J~`' T / .iF~ 7"f ~+ i +r'Irrlir;,, ;~4r - ~;4f~ln•jl, .~ `~n4~ ~ "'~ri 1 AIr ` ~ r i ",, r11lA1r ~ \ r ~!IIrr11r ti e m:.. ,~5.4, ,.,rune, ; ~Pl'h. .rpuut,., .`~fl ~~,,,, Y~ A Cam' '' ~ DEPARTMENT OF TRANSPORTATION '' e~~ ~ixa ~..~ • ~.E FE7R ~ I E CyF ~~ T ==~ ~~~ ~ERTIF"IE~ ~EIF-~1C:LE ~~;.~~ `~i ~~ 545 ~~ 9~120005900088C-00]I ~+CXBC>._ycaPS~Oc'704 I 9~ ( CALkIN_I I 4611,8762011 HE l~ VEHICLE IDENTIFICATION NUMBER YEAR MAKE OF VE}{ICLE TITLE NUMBER ~ TRU 0 I I I ~ Sy=!50 ,j BODY TYPE DUP SEAT CAF UNLADEFI WEIGHT GVWR GCWFt TITLE BRANDS ~ Sf 1,2/9 I 5/1,C/93 I SJI~c/9~ I I 000000 I 4 _ q ~! DATE PA TITLED DATE OF ISSUE PRIOR TITLE STATE OD01v! PROCD GATE ODUM MILES ` ' ' ' " ODOM. STATUS ODQNiETER DISCLOSURE EXEMPT B~' FEZEP.AL LAk REGISTERED OWNERISI HOMER E HENSCHEN 6E4 BEUL~EDERE ST CARLISUE PA 1701!3 FIRST LIEN FAVOR OF: SECOND LIEN FAVOR OF ODOMETER STATUS 0 = AC7UAl. MILEAGE 1 - MILEAGE EXCEEDS THE MECHANICAL LIMITS - NOT THE ACTUAL MILEAGE 3 - NOT THE ACTUAL MILEAGE-ODOMETEA TAMPERING VERIFIED 4 - EXEMPT FROI+1 ODOMETER DISCLOSURE TITLE BRANDS A. = ANTIQUE VEHICLE C: = GLASSlG VEFIICLE F = UUT OF COUNTRv G ° ORIGINALLY MFGD FOR NON-U.:, DISJ w5u I IoN ~, H =AGRICULTURAL VEHICLE L =LOGGING VEHICLE P = FORMERLY A POLICE VEHICLE R =RECONSTRUCTED S =- STREET ROD T =RECOVERED THEFT VEHICLE V =VEHICLE CONTAINS REISSUED VIN Y. = FORMERLY A TAX! If a second penholder is fisted, upon satisfaction of the fvst lien. the first penholder must forward this Title to the Bureau of Motor Vehicles with the FIRST LIEIJ RELEASED appropnate torro and fee. z DATE BY SECOND LIEN FELEASED __' AUTHORIZED REPRESENTATIVE DATE =` MAILING ADDRESS gY '"! AUTHORIZED REPRESENTATIVE _°_ HOMER E NENSCNEN '~~- 6~4 FsELVEDERE cT -_== CAF~LIS~.E PR 17013 _. 1 certify as of the date of issue, the official recoros pf the Pennsylvarna Department H O W A R D Y E R U S A L I M pf transportation reflect that the persontsl or company named herein Is the lawful owner of the said vehicle. SCCretat'1 of 'Transportation is ~ 1 •• 1 • •' F ~ •. 1 • :•. •~ • • •• . • SUBSCRIBED AND SWORtJ When applying for tllle wHh a co-owner, other than your spouse. check. one of these blocks. If no block is checked, fille will be Issued as "Tenants in Common'. -r TU BEFORE ME H ^ Joint -~enanls with Rlghl of Survivorship ton death of one owner, tdle goes -7 MG DAB' PEAR to the survwmu owner] B ^ tenants In Common (on death of one owner. interest of deceased owner _~ goes to his or her hems or eslatel __ SIGWATURE OF P'eR50W AUMIMISTEAIWG OATH LIEn~ IF NG LIEr: ^ DATE CHECI; BOY FIR:;T LIENHOLCIER a tJAME ~ f w STREET _ = ~ -- Cn CIT`r -;-~ STAT'E ZIP .~ -~ I ~?= LIEN DATE ^ IF NO LIEF; CHECk: 80f ~; __ ~ Tile undersigned h.~reiiy make, a{lpfica lion for Cerhllcale of Tltlc; w tn:- vehicl!:~ desenbec SECOIJD LIENEIOLDER = -_ __ above. subject to the encumbrances and other legal claims sot Inrth hem -r NAME O ~~ t SIGIJATUR~ C' APPLICAr:? OP. AUTHCRI?Ei. SIGriE r' STREET W ?> CITY O ~_~ ;TATF ZIF SICiNA7URE GF GG-APFLIGAiJTiTIiL~ G% AUTHORIZED SI(~NEH (((;;; rn "~ ~ 1 d, Irk}~iJl-fi./•.u.. r. .r1 ,(i 'li v., ..rr tp ~..; ! 1.. rn .r tv r:..~' !N•4,.ru ..Ir+{g U.) h•~un.r :S r...~ ):• r.. ..rr !:! II+1 h.+....r~ f ( !!! 4,..u Ijf ~(ujl'1?rJ~ jt:j Evergreen Fund Administrator Evergreen Distribution Fund PO Box 2263 Faribault, MN 55021-2383 IIIIIIIIIIIIIIIIIIIIi1111111i~II~IIIIIIRIIItlllll Q~ois4 ~,~ q~o~~ ~ **T164/P56***AUTD**ALL FOR AADC 17U ~ HOMER E HENSCHEN 624 BELVEDERE ST CARLISLE PA 17013-3507 I~FFIIII~FIII~F~11~111~11,~FlI~~IFIFII~~IIFFFI~FIFI~IFFII~~~tl November 15, 2010 RE: In the matter of Evergreen Investment, LLC; Evergreen Investment Services, Inc.; Evergreen Service Company, LLC; and Wachovia Securities, LLC., ADMINISTRATIVE PROCEEDING FILE N0. 3-12805 Dear Shareholder: On September 19, 2007, the Securities and Exchange Commission ("SEC") approved a settlement of an administrative proceeding against Evergreen Investment Management Company, LLC; Evergreen Investment Services, Inc.; E=vergreen Service Company, LLC; and Wachovia Securities, LLC, and established a fair fund, the Evergreen Distribution Fund. You are receiving the attached check because the independent distribution consultant has deterrnined that you are eligible to receive a distribution payment from the Evergreen Distribution Fund. This check must be cashed within 90 days of the issue date. It is very important that you understand the tax implications that may arise in connection with this payment, so please access and review the Statement to Eligible Investors, located on the website at www.evergreenfairfundsettlement.com, and consult your tax advisor. If this distribution payment is associated with a retirement plan, in addition to the Statement to E=ligible Investors, please also review the information on the back of this letter. If you have further questions related to the distribution payment or need to obtain a copy of the Statement to Eligible Investors, please call the Evergreen Fund Administrator at 877-625-9418 or reference the website at www.E~vergreenfairfundsettlement.com. Sincerely, Evergreen Fund Administrator Account Losses Gross Federal Tax :state Tax Distribution Number Component Amount Withheld Withheld Amount 00205455185 $202.11 $208.56 $0.00 $0.00 $208.56 PLEASE RETAIN THIS INFORMATION FOR TAX PURPOSES •aaw n +rZt~waow~r~. . --...... ... ,_...~ -r ..~... .....,,:k.. _ , .._,. :, ...-.. - q,..:.,J: -, ~ ..rn .4:....c.n. q ..,rc., ~; a.'L t .w.z.pw^f~ {F.i~ r+•`+R a~vaxro r"+Y 1iy' rtl w"+) '?.An~.Ft .5 - :.ice, ~ ~{. - . ~- - ~ •: r., :.t~,~ -.1, ~i ,c~x~~ ~;:~, ~~ f-r;,~ c : fir- ~`lf ;n@p. .!",*`~', ~." .lt.'','F m . __. ... _ .. 4,. .~.....__. .-. _ . . ~-- . < e..., ,.. .~ z .. ...~....~.,-... <.Y.e .rtsf+,.:,>v..,be.,~+~.... .mss.: ~. ...,.+e~-~s .~.ic.c::.J',:4<.w.i_:•.7~'..~:.a»J+n..and«r...«;.:;,h«,:.i4i11~afio,M~lifi 'w:.~~:a.-s~"P'P=+d'~~1wv~asas~T~aw~ax~ars~eas~w~~~. .~ Evergreen Distribution Fund QSF P.O. Box 2263 Faribault, MN 55021-2383 Pay: **Two Hundred Eight Dollars and Fifty Six Cents ** Payable tO: HOMER E HENSCHEN 624 BELVEDERE ST CARLISLE Pk 17013-3507 Deutsche Bank Trust Company Delaware Wilmington, DE 19805 62-38 00~1oo'f 6L OO 311 VV LV[70 Date Control Number Amount 11/15/2010 0003080931/00205455185 $208.56 VOID AF l~: K yu uays NOT VALID FOR AIVIDUNT OTHER THAN $208.56 Payee's signature required on back in order for this instrument to be valid q~ SE/Y,„ ~` Authorized Signature(s) CURDEI' CC'1NTlaIN~~~ MICRUPRIP1Tfh1G - ---- -- ~ a ,~,,// F~-~ W O W H Q U U °~ _ ~ ~ v c~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ v ~ ~ ~ > -v o U v o ~ ° v ;-. ~ ~ o v ~ .~ ~ ,~ ~ v ~ ~ a U N r n ~ 4~ ~ r--' ~ r"'' v ~ ~ ~ ~ 'Z7 ~ ~; ~ ~ ~ a ~ ~ ~ Z ~ y,-, v~ ~ o ~ ~ ~ ~ ' v .Q ~ U ~ ~ " O ~ ~ > p + o ~ ~ ~ o ~z ~~ v ' W v U ~ o tv Q ,,, N ~ w ~ ~ .> o H ~ ~ ~ ~ v ~ U ° cr' ~ ' a ~ v U ° ~ + ~~ Wo ~ ~ . ~ ~ .~ o ~~~~,,~ ~ v ~ p- ~ N ~ '~ • ~ ~-. ~ ~ U 'b ~,j : c~ ~ ~ ~ v ~1 ~ ~' v~ 3 ,,,,~ O N v ~-' ~ v Z , ~? ~ ~ ~ ,s .~ O ~ '~ ^' W v ~ ~ ,~ .. 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V i i N N~~ i a ~ ~ ~ N ~ p O n Ol ~ C N p pp _ GG CJ1 COIF COJ~ N ~ Q W D O C C .~ v a a~ V t0 ~+ t ~~ i :%1 C C y o m V m ~ 0 O b °c ~ ~ ~ ~ z ~ ~ ti ti 4 ti a .~ a -, ~~ ~: IM ,y . 7 ~~ ' ~ ' ., fi' li C ~, ~ ~. ~ k. ' ~ 9 a r. ,~ ~ ~. ?. r, • a '' `o .. a to v U r o '~ CP K .~ My .~ g ~'~ ~ ~ ~' co ..~ ~, 2 3 ,b c o ~ u~ m d ~ ~ ~ ~ o ~ ~ O ~ G s ~' ~ ~ ~S ~• ~ _~, ~• ~ e~ ~ N o 1 ~ .,. n °' H O ~ 0 ~_ ? ~~ a~ ~~ ~, ~ .~ ~~• S e eo ~. a 0 1 ~_ 3 5 C ~d !p err ~v fD H N ~ a O 4 0 a m o N o 0 w iv 0 ~. a ~~ ~~; S ~. ~~~ m d ~ ~ `rhS•~ r^m .o ~ ~ ~ 1 ~• ~• 6 ~ ~~. m "f ~ <• Q7 ~ ~ ~ ~ CD G ~ CD _ ~ T v L''7 p (p ~ ~ n' ~ O ~ ~ v ~? c"7 rn c~ V °y v V~ W Estate Valuation Date of Death: 08/1G/2010 Estate of: Estate of Homer E. Henschen ''aiuat~or. Date: 08/10/2010 Account: Delta Equity Services C orporation IRA Processing Date: 01/17/2011 Report Type: Date of Death Number of Securities: 21 File ID: Henschen, Homer E. Estate Delta IRA 39K-633798 Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 50000 SEARS ROEBUCK ACCEP CORP (812404BH3) Financial Times Interactive Data DTD: 08/13/2001 Mat: 08/15/2011 6.750 08/06/2010 102.50000 A/B 08/13/2010 102.50000 A/B 102.500000 51,250.00 Int: 02/15/2010 to 08/10/2010 1,640.63 50000 GENERAL MTRS ACCEP CPSMARTNBE (37042GRQ1) Financial Times Interactive Data DTD: 09/25/2001 Mat: 09/15/2011 6.750 08;10/2010 98.88770 Mkt 98.887700 49,443.85 Int: 06/15/201C to 08/10/2010 515.63 3; 20000 HARTFORD LIFE GLOBAL FDG TRS (41659FAS3) Financial Times Interactive Data DTD: 12/16/2004 Mat: 12/15/2014 4.79% 08/10/2010 97.13100 Mkt 97.131000 19,926.20 Int: 07/15/2010 to 08/10/2010 66.53 4) 25000 MERRILL LYNCH « CO INC (590188JF6) New York Bond Exchange DTD: 07/15/1998 Mat: 07/15/2018 6.50 08/10/2010 108.13530 Mkt 108.135300 27,033.83 Int: 07/15/2010 to 08/10/2010 112.85 5) 20000 PRUDENTIAL FINL INC INTERNOTE (74432AEP1) Financial Times Interactive Data DTD: 12/16/2004 Mat: 12/15/2024 5.65% 08/10/2010 97.98600 Mkt 97.986000 19,597.20 Int: 06/15/2010 to 08/10/2010 172.64 6) 50000 BANK AMER CORP SUB INTNTS BE (06050XLC5) Financial Times Interactive Data DTD: 05/15/2003 Mat: 05/15/2028 5.458 08/10/2010 97.37430 Mkt 97.374300 48,687.15 Int: 05/15/2010 to 08/10/2010 643.90 500 AT«T INC (002068102) COM New York Stock Exchange 08/10/2010 27.07500 26.66000 H/L 26.867500 13,433.75 8) 500 BRISTOL MYERS SQUIBB CO (110122108) COM New Yor}: Stock Exchange 08/10/2010 26.78000 26.30000 H/L 26.540000 13,270.00 9) 600 CANADIAN OIL SANDS LTD {13642L100) COM Toronto Stoc}: Exchange 08/10/2010 27.11000 27.07000 A/B 27.090000 16,254.00 10) 4GG CHEVRON CORP NEW (166769100) COM, New York Stock Exchange 08/10/201C 79.48000 78.15500 H/L 76.817500 31,527.00 Page 1 '"~~~s report was produced with EstateVal, a product of Estate valuations « Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Date of Death: 08/10;2010 Estate of: Estate of Homer E. Henschen "dalua tion Date: 08/10/2010 Account: Delta Equ ity Services Corporation IRA Prcce ssin Date: 9 01/17/2011 Report Type: Date of Death Number of Securities: 21 File ID: Henschen, Homer E. Estate Delta IRA 39K-633798 Shares Security Mear. and/or Div and Int Security or Par Description High/As}; Low/Bid Adjustments Accruals Value 11' 2 FAIRPOINT COMMUNICATIONS INC (305560104) COM New York Stock Exchange 08/10/2010 0.04000 0.03200 H/L 0.036000 0.07 "~~, 3i2 FRONTIER COMMUNICATIONS CORP (35906A108) ~OM New York Stoc}: Exchange 08/10/2010 7.83000 7.69000 H/L 7.760000 2,421.12 i3) 1000 GENERAL ELECTRIC CO (369604103) COM New York Stoc}: Exchange 08/10/2010 16.39000 15.95710 H/L 16.148550 16,148.55 19; 200 HEINZ H ~ CO (423074103) COM New York Stock Exchange 08/10/2010 45.96000 45.30000 H/L 45.630000 9,126.00 15) 900 PPL CORP (693517106) COM New York Stock Exchange 08/10/2010 26.70500 26.12000 H/L 26.412500 23,771.25 16) 1300 VERIZON COMMUNICATIONS INC (92343V104) COM New Yor}; Stoc}. Exchange 08/10/2010 30.14000 29.56000 H/L 29.850000 38,805.00 17; 2307.876 AMERICAN BALANCED FD (024071300) CL C Mutual Fund (as quoted by NASDAQ) 08/10/2010 16.57000 Mkt 16.570000 38,241.51 18) 500 APOLLO INVT CORP (037610106) COM The NASDAQ Stock Market LLC 08/10/2010 9.96000 9.65000 H/L 9.805000 4,902.50 19) 3916.272 LORD ABBETT SECS TR (543915623) INTL CORE EQ C Mutual Fund (as quoted by NASDAQ) 08/10/2010 10.96000 Mkt 10.960000 37,442.39 20) 3975.118 OPPENHEIMER QUEST FOR VALUE (68380E601) GLOBAL ALLOC C Mutual Fund (as quoted by NASDAQ) 08/10/2010 13.90000 Mkt 13.900000 98,309.19 21) 9823.013 OPPENHEIMER GLOBAL STRATEGIC I (68380K10 2) INCOME FD CL A Mutual Fund (as quoted by NASDAQ) 08/10/2010 4.23000 Mkt 9.230000 20,401.34 Total Value: $529,986.80 Total Accrual: $3,151.68 Total: $5 32,638.98 Page 2 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) x• -~ ~ ~ ~ ~ n ° `" ~, o r- °oaz~DO7~0 O ~ A ~ ~i D o Hf ~ ~ ~ ~ O . 'f' r o n, D m ~ 70 b ~ o =•c ~ J p n ^7 ~ lJl ~ J ^ N cr Z ~ ~ Q° ~ m n O ' ° 1 ~ r7 ~ .--~ ' O O ~ OQ W O = ~ ~ -o ~ Z O =?~. 0 o N S~ D Z o A o a, Z C n 0 r o ~ O ~ ~ O ~ ~ fp -D ~ C j _ n D c ~ ~ ~'- T 0 , .--. Q. = Z O Q C ~ O O ~ O 70 ~ • O pD O rn rn w ~ ~ N o vzi w W rl w 2 _ m ~ o w Z ~ _ O N Vl O O _ O F O to fD ~ u~i ,~ ~ O O ~ N O N y O~~ `S •r o ' o ~ti~ o ~~ oca '~m`°o ,r OA~~ 's A S D OWN --~ ~o ~ m D y n ~ ~ -~ 3 O `D ~ o 0 0 ~ o Cl ~ ~ ~ a _ T ,~ m o0 m ._. 3 S (,~ ~ O O ~. C %~ Z S W A ~ f m W < ~, v o ~- u~ -_ 'r ~ p a ~ °" O ~ ~? = o ~ .o ~ v ea T n ~ ~ ° ~ W r Q1 o y O ~ ~ ~. ~ ~ O `t p 7 T I °~i, O ~' ~G 3 ~ ~ r.. a N 7 ~ v a ~ ~ v_ P7 v O c =- i~ OO ~' ~ iA ~ ~„ ~. ~. W W ~w ~O ~O o 0 A O O o+ o+ C a., m 3 ~ N ~ N to _ ~ ? 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O O w N O _ O -e ~ 0 0 0 0 0 ~• .s O 0 0 0 0 N S ~0 ~ r ~ .~. iA Y'1 ' O o O O Q O 0 0 O O O ~~ ht `~ Estate Valuation Date of Death: 08/10/2010 Valuation Date: 08/10/2010 Processing Date: 01/25/2011 Shares Security or Par Description 1) 470.136 VANGUARD INDEX FDS (922908710) 500INDEX ADMIR Mutual Fund (as quoted by NASDAQ) 08/10/2010 2) 185.354 VANGUARD WORLD FD (921910204) INTL GRTH PT FL Mutual Fund (as quoted by NASDAQ) 08/10/2010 3) 5775.484 VANGUARD/PRIMECAP FD INC (921936209) ADMIRAL SHARES Mutual Fund (as quoted by NASDAQ) 08/10/2010 4) 1298.802 VANGUARD WORLD FD (921910105) U S GROWTH PTF Mutual Fund (as quoted by NASDAQ) 08/10/2010 Estate of: Estate of Homer Henschen Report Type: Date of Death Number of Securities: 4 File ID: Hen:~chen, Homer E. Estate Vanguard IRA Mean and/or Div and Int Security High/Ask Low/Bid Adju;~tments Accruals Value Total Value: Total Accrual: Total: 5424,365.80 .~.. 1 °~ X11 ~ Y ~ ~cG~2~Ola /~ 0 J~41I ~~ ~ ~`I , q8 ~, , ~ ,_.....~~ 1 N1J~-~ 103.41000 Mkt 103..410000 48,616.76 17.19000 Mkt 17,190000 3,186.24 60.95000 Mkt 60,950000 352,015.75 15.82000 Mkt 15„820000 20,547.05 5424,365.80 50.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.U) t~ C: CJ ~ ~ U ~ ~ N v ~ Ca Lam. U O ~ L ~ U7 ~ 7~,- ~ ~ ~ O W io ~ ~ ~ Q `~ ~ i ~ ~ = U ~ tQ ~ i > Q ~ v- C .~ S2 .~ ~ ice'. i. .. ~; ~ .; p: ?. r'- :'r C :.rfr• p ~ .:. V p D p CO ~. ~ _. Q. .~ ~ +-~ O ~ O -Q N Q (D ' {~'d ~ ~. t1) _' N 7 ~' "fl . pN ~ p 00 fV ~ i ~ ~ t~> n ~ ~ ~ ~ ~ ~ ~ ~ N i ~. ~ ~ O U ? ~~ ~ ~ N '~ r.. ,~ ~. ""' .~ ? ~ ~ Y ~ .w . 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N O O O CD CLi r N r- ~F' ~ r• m d :Y O .C1 0 a a) _~ z C!7 0 0 CA c7 CD CA •.O¢. 0 0 0 0 r-~ C fL d- c w a~ 0 V C T a) m CD CU Y O .a 0 a. a) 3 N d z T O D ' _~ _~ O d v co co a fl J.! -v a) :o =v a~ 0 U C O 0 N ~' lrJ 117 cr 0 0 0 o' .ti.. a`~ ~, [d i N N w O >` r D1 ca Second Presbyterian Church 528 Garland Drive Carlisle, PA 17013 717-243-4571 Account Summary January 01, 20'10 -September 30, 2010 For: HOMER HENSCHEN 624 BELVEDERE ST. CARLISLE, PA 17013 Env: '156 Account Tax Deductible Total: Non-Tax Deductible Total; 2010 Pledge $1,980.00 $0.00 Per Capita $44.00 $0.00 09/30!2010 Total $1,980.00 $44.00 Tax Deductible Total: $2,024.00 Non-Tax Deductible Total: $0.00 Total Giving: $2,024.00 Pledge Summary: Received Remaining Pledged %Goal Duration Freq Payment 2010 Pledge $1, 980.00 $1,140.00 $3,120.00 63% 1 yr Omo Weekly $60.00 This is your 3rd Quarfter Summary of Contributi s nday September 26, 2010. We thank you for your support of the church, its mission partners and its programs. hrough your tithes and offerings, this year Second Presbyterian Church has made $28,700 in contributions to focal organizatio s such as Project Share, Samaritan Fellowship, C.A.R.E.S., and to the PC (l~SA) Local General Mission Fund. We also paid $6,750 o support PC (llSA) Nat'I and Internat'I Mission Fund. Through the 3rel Quarter offerings are 4.9 /o behind budget. If you can help us "catch-up", that would be great. $8,173 Per Capita Funds has been recei d to offset out annual $17,358 Per Capita in support of The Presbytery. If you have not done so, please make your $22/membe contribution to help offset this fee and free up money for otfier programs. If you have any questions concerning is statement, please contact me at 576-0726, through the church office at 243-4571 or email address DavidC~GrowWithSecond.Urg. Blessings, David Price Church Treasurer n m 7 (D m fD ~ 1 O ~ ~ u d C ~ m i v, o ~~ o ' o ` m ` x m i n _. ; i }w1 }1 1 W 1 W ~ I M t 01 t W t ~ ~ W N N N O ~ o ~ ~ ~ ~ d ~ s~ ~ ? o 0 ~ N ~ p~1' °' ~ d ~ ~ ~ ~, d N ro ~ a~ m ~• c ~ 0 1 3 ~ ~ 41 J ~-! a d ~ 0 c c~ O o ~ ~ N ~ r m ~ ~ °~ ~~° 3 ~ BQ ~ N y ~ s a ~ ~ ' w ~ ~ .W V ~ ~ W ~. ` C 1 C7 ~ ~ S :a y 'd'g o g c. o ZZoo ~ DD f7 O n ~ ~ CD y ~ ~ ~/) ~ m co ~ i~ - ~ C j ~ ~ m ~ ~ V ? 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