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Home My WebLink About06-02-11 (2)J 1505610101 REV-1500 Ex (O1.1°' ' OFFICIAL USE ONL`f PA Department of Revenue Pennsylvania ---- DERARTMENT OF REVENUE Count Bureau of Individual Taxes ~/ Illy Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ~ ~ ~ ~-~ ~~ ~ Cs (~,, ) ENTER DECEDENT INFORMATION BELOW ~-- Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY i Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 4. Limited Estate ~ 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) ® 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number First line of address Second line of address City or Post Office State ZIP Code ~... ~... REGISTER OF WILILS lls~ ~NLY n w~;~ ~~:r~'' ~ ;_ ~; ~~~ . ~ _ , .~ i_ ...., ~) . ~ ...) D ~ FILED 1~"' i == ,...~ ~_ Correspondent's a-mail address: (~ 1„y 41 ^C3~~ i S~~ ~' ~ ~. ~ ~'~1 ~ ~ v~ ~. , n ~'~,.. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best oaf my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE O/F~PE~RSON RESPO SIBLE FOR FILIjVG RETURN DATE ~~ ~ _~~ ~ 1r.~3.~.i.~ f ~ ii ADDRESS - ---- ~~--y-~~ j ~ J ~ ~ f~ ~3 j ; >, ,c~ e C: ~'cw f~ LI -~ ;. C : w~ r, ~s `~ ~ t ... , ~;~~,- ~G J .~ `; SIGNATURE OF PREPARER OTHER THAN REPRESENI-ATIVE DATE ~~ ADDRESS -'~.`.___.. .._~ ®-_____~...~~.,__..__--.~ PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 1505610105 REV-1500 EX Decedent's Social Security Number ~~ ~•_ Decedent's Name: [, ~' 3":^~ ~;" ~^°. `~ /L '' ' _ --- ~~ 1 ~~ L ~ ~~ ~~ i RECAPITUCATION 1. Reat Estate (Schedule A) ...............................: . 2. Stocks and Bonds (Schedule B) ....................................... 2 1~-~ ,` ~ , I • ..~ ~_ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank De osits and Miscellaneous Personal Pro a Schedule E ....... p P rtY ( ) 5. ~ 1~ ~ 1 a, ~'" ~- ~: ~ ~ a 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... fi. • 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property Billi R ested t S 7 ._ j ~ ~ i U ~~ . "1 ........ equ epara e ng (Schedule G) p . - 8. ( g) ............................ Total Gross Assets total Lines 1 throu h 7 8. ~~~ ~ Lo• ~~ 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. (~; v~ 'L ~ . ~; ~ 10. 9 9 ( ) .............. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I 10. AL'S ~' . ~j ~l 11. Total Deductions (total Lines 9 and 10) ................................. 11. ~ ~ ~ ~ • C ~ 12. Net Value of Estate I;Line 8 minus Line 11) .............................. 12. ~ R`Y ~ ~ ~ ~ + S 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable ~ ; at lineal rate X .0 ~~ ~ ~_., ~ ~ ~. } • ~ 17. Amount of Line 14 taxable at sibling rate X .12 • 18. Amount of Line 14 taxable at collateral rate X .15 15. ,(_ ' ~ ~ 1 17. + 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (~ Side 2 1505610105 1505610105 J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME STREETADDRESS CITY -STATE ~ n - _-~ ZIP , Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2'. CreditslPayments _ ,~,~ ~_~~. GL' A. Prior Payments ___ B. Discount ~s q ~ ~ 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ', ~~ *y~ Ma§~~ke check payable to: REGISTER OF WILLS, AGENT. yp y~, ...~.~"~~. ii ,~~.~/' «1' ~~~`~ ~"'3 ~ r :~'~ i F ua,~,~4'L~"n t~ir,n . 7 .t ~ tie~a~~ ~. .. M"~,VF' ~"`G~~ L .3R%' F`~ .*..: ~~K~:s~~~~ ~ya:~i: PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ 0 c. retain a reversionary interest; or .......................................................................................................................... ^ r~~~ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ Iii 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death ^ without receiving adequate consideration? .............................................................................................................. 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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. §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. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 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. §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. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on-the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Total Credits (A + B) (2) (3) REV-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~~ i All real property owned solely or as a tenant in common mus be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT' ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANII~ CASH, BANK DEPOSITS, & MISC. INHRESIDENT DECEDENT RN PERSONAL PROPERTY _- ESTATE OF FILE NUMBER ~ ~~ ®O~~ ~° Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ . ~^,~e,r~n~~ ~r~~ ~5'~- ~ec~~;s'u~ C:r~.c~:'~ '..~n ~~.~ ,~ CL~,~y ~'r ~ ~ ~'~ ~~ c(`' ~ (~~:,~ ,~ J ~~ , t`7 fir,~` ( ~,,,, ~~ ( ~C ` , ~ J ,~~qq ~~V~ C>c,~/ 1 Y1CAS J ~ ~Q jj ~~,„, j c~ o ~ s .~r~ u~ z~ ~ ~-; ~ ~.i ~ .~1 ~ ~ 7S ` j .- ~~ v y ~~.=~ t ~~ ~ ~,y .:35 ©~' S Z c..~ '~ V ®J~. ~1 C~US ~ C~ 7~~~~ .~ r" ~-~;~~, '~ ~~ ~r vY',~r ~ ~ ~Y'`. c~,~N.~+ ~'~ ~~~~~=~r ~c~\l ` 1C~S 1`~-~ cr ~ ~ ~,'T~"~ .~I" ~~ t~~ ~~) , t~ 2 } ,, _, .~ t t TOTAL (Also enter on line 5, Recapitulation) I $ ~ J~ ~: -i ~ ~i '~ (If more space is needed, insert additional sheets of the same size) REV-1510 EX ~ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER n ,, ~ _ ~ This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE: VALUE 4 ~t M1/t. ~~t71Y`,.." .~t`~ "" "~ j~i \ ~ :'..Ti.1. ~ti l~G1l1C~\[,;~) _f: vr.. , j `.~ 1~':,~;•+if',J ~ In ,~ ~. ~. `'~' a ~ ff ~~ ~ ,l ,. mow. ~~ ~ ~ V O ~/ y.. s ~\. , _ ~ .t.. ~ i 1 L` t~ TOTAL (Also enter on line 7, Recapitulation) $ ~ ~ ~ ~ ,~ ~ ~ . : D .~..~ m d$ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) ~~ COMMONWEALTH OF PENfJSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~-'`: +..~ ~`~ ~.. ~ ~ :~~,-~-~ Gn SAS ~/ ~ C e - ~`+O ~ t- ~'`i ~.. ~ ~' ~ ~~ y (' , ~a':" , ~ v~~~=. `1~u ~r.:*~~'.~i ~ ~l ~,1,,`~113 f ~f~. ~ ~"V r`-~r c;``~ 'i~'~,~ r~`~S}1,'1f\~'.(1~`~ ..~ `~ `~ l~~ t.,.. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Cornmission Paid: 2 3 4 5 6 7 State Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Zip Zip Tax Return Preparer's Fees ,x~ ~~..~~~ ~.. J '~t.~ n-a, C11 r'1~:~ ~ t~ ~ ~''y (~ (. ~ ~,',--~-~ s i' ~ ~.'~ ~"~ c~.a' Er ~~~ 1 i`~ ~1s ~`~ .'~r j G l ~ i'.~-~:~L , ~. ~~~ ~ .- ; ~ ~ ~~ ` ~ ;. 1 -l` ~~ `rt ~ ~ ~ ~ ~ sad. ~~ C ~ v~~l~\! 1~~ J+ \ T ~L~ i~ :g+' ~ } TOTAL (Also enter on line 9, Recapitulation) ~~~ ~ ~ (~ (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ~ FILE NUMBER ~ ~. Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) ~.. a. SCHEDVLE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~ NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. S ~ ~ ~ ~y _~,_ C~ c,~ ~e~A\ c, e n ~ c~~~'~~~3 ~/ .3 ~ ~ ~~ ~ C~,~~~ ~y~ / ~~ del ~ ~ / s~ ~w.r ^ ~ , ~~ `*.1 `..• ~1 ~ v ~ i~ \ , P Z ~ c~~ ~.~,r'c~ '~ T~ E'.~-St. ~ ~~ ,~' ~ ~ ~~ I ~ ~ ~(~r ~ ~S~WtI ~~r~~~5~~/'~,~ lei ~~~/~ .2 ~1~ ~"~ n ~ CC:. ~~.- ~ w c~ y ~ _ ~..J ~•, ~, vq~~~ s,~ '' `` \ ~1G In d ~ ~ ~~~min ~~;m~ ~1~ C~1~Gi ~ ` ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (It more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT (Pour-Over Will) OF ESTHER M. HEISEY IDENTITY I, ESTHER M. HEISEY, residing in the County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other former Wills and Codicils to Wills heretofore made by me. My Social Security Number is 461-86- 3383. I have the following children: Sandra Jo Chamberlain, born November 28, 1949, and Edward Alan Heisey, born December 17, 1950, and Janice Lynn Swain, born December 14, 1952. DEBTS, TAXES AND ADMINISTRATION EXPENSES I have provided for the payment of all my debts, expenses of administration of property wherever situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other than any tax on ageneration-skipping transfer that is not a liability of my Estate (including interest and penalties, if any) that become due by reason of my death, under THE ESTHER M. HEISEY REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust"). If the Revocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items from the residue of my Estate passing under this Will, without any apportionment or reimbursement. In the alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary to pay all or part of these items, plus claims, pecuniary legacies, and family allowances by court order. PERSONAL AND HOUSEHOLD EFFECTS It is my intent that all my personal and household effects were transferred to the Revocable Trust as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me this date in accordance with the provisions of the section titled "Residue of Estate." RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devices), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of the execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance with the provisions of the said Trust, including any amendments thereto made before my death. POUR-OVER WILL Page 1 ._ Testatrix If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their substitutes and successors under the Trust, described herein above, to be held, managed, invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to the period beginning with the date of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any, hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. EXECUTOR I hereby nominate and appoint Edward Alan Heisey to serve without bond as my Independent Executor of this my Last Will and Testament. In the event the first named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint Sandra Jo Chamberlain to serve without bond as my Independent Executor. In the event the second named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint Janice Lynn Swain to serve without bond as my Independent Executor. Whenever the word "Executor" or any modifying or substituted pronoun therefore is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally named herein. EXECUTOR POWERS By way of Illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind of partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry out the purpose of this my Will, without being limited in any way by the specific grants or power made, and without the necessity of a court order. POUR-OVER WILL Page 2 ,~~~ Testatrix My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others. In determining the Federal Estate and Income Tax liabilities of my Estate, my Executor shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions. CONTESTS AND SPECIFIC OMISSIONS If any beneficiary under this will, singly or in conjunction with any other person or persons, directly or indirectly: 1. contests in any court the validity of this will or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 2. contests in any court the validity of the Testator's/Testatrix's Will or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 3. seeks to obtain an adjudication in any proceeding in any court that this trust or any of its provisions or that Testator's/Testatrix's Will or any of its provisions is void; 4. claims entitlement by way of any written or oral contract to any portion of the Testator's/Testatrix's estate, whether in probate or under this instrument; 5. unsuccessfully challenges the appointment of any person named as Executor or successor Executor of the Testator's/Testatrix's Will; 6. objects in any manner to any action taken or proposed to be taken in good faith by the Executor of the Testator's/Testatrix's Will; 7. objects to any construction or interpretation of this Will, or any provision of it, that is adopted or is proposed in good faith by the Executor; 8. unsuccessfully seeks the removal of any person acting as the Executor of the Testator's/Testatrix's Will; 9. files any creditor's claim in Testator's/Testatrix's estate (without regard to its validity), whether the claim arose before or after the date of this instrument, but excepting claims for cash advanced or paid for expenses of the Testator's/Testatrix's last illness or funeral paid by said claimant; I0. attacks or seeks to invalidate any designation of beneficiaries for any life insurance policy on Testator's/Testatrix's life; 11. attacks or seeks to invalidate any designation of beneficiaries for any pension or IRA or other form of qualified or non-qualified asset or deferred compensation account, agreement or arrangement; 12. attacks or seeks to invalidate any will which Testator/Testatrix has created or may create during Testator's/Testatrix's lifetime, or any provision thereof, as well as any gift which Testator/Testatrix has made or will made during Testator's/Testatrix's lifetime, whether before or after the date of this instrument; 13. attacks or seeks to invalidate any transaction by which Testator/Testatrix sold any assets (whether to a relative of Testator's/Testatrix's or otherwise); or 14. refuses a request of Testator's/Testatrix's, Executor or other fiduciary to assist in the defense against any of the foregoing acts or proceedings, POUR-OVER WILL Page 3 ~~a~ 1~ Testatrix then that person's right to take any interest given to him or her by this trust shall be determined as it would have been determined if the person had predeceased the execution of this will instrument without issue surviving. The provisions of the foregoing paragraph shall not apply to any disclaimer by any person of any benefit under this will. In the event that any of this provision is held to be invalid, void or illegal, the same shall be deemed severable from the remainder of this provision and shall in no way affect, impair or invalidate any other provision in this will; and if such provision shall be deemed invalid due to its scope or breadth, such provision shall be deemed to exist to the extent of the scope or breadth permitted by law. SIMULTANEOUS DEATH If any other Beneficiary should not survive me for sixty (60} days, then it shall be conclusively presumed for the purpose of this my Will that said Beneficiary predeceased me. ~ /! ,1 ~y Z,C~t~ _ . f ~~ ESTHER M. HEISEY Testatrix This instrument consists of 6 typewritten pages, including the Attestation Clause, Self-Proving Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at the bottom of each of the preceding pages. phis r~strument is being signed by me on this ~~~- day of POUR OVER WII,L Page 4 ATTESTATION CLAUSE The Testatrix whose name appears above declared to us, the undersigned, that the foregoing instrument was his/her Last Will and Testament, and he or she requested us to act as witnesses to such instrument and to his/her signature thereon. The Testatrix thereupon signed such instrument in our presence. At the Testatrix's request, the undersigned then subscribed our names to the instrument in our own handwriting in the presence of the Testatrix. The undersigned hereby declare, in the presence of each of us, that we believe the Testatrix to be of sound and disposing mind and memory. Signed by us on the same day and year as this Last Will and Testament was signed by the Testatrix. WITNESSES: 1 ,"~ ".,./'mar l - __ ~! (Printed Name of Witness) [ ~, 6. L u.. ADDRESSES: ~1 1 ~` i City, State, Zip " (Printed Name of Witness) / ~ . ,~ ~ City, State, " ip / ;- ~/ f,' ~~ POUR-OVER WILL Page 5 ~';~"~ Testatrix COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SELF-PROVING CLAUSE „BEFORE ME, the undersigned authority, on this day personally appeared ESTHER M. HEISEY .1 ~-t- ~~ ia. ~- - ~.~',~- ~_ ~=~ .~ ,.~ ~~ and I ~~~%J-~ ~r./>t=-- f~ ~ I~~;~ ~ ,known to me ~.~T_ I to be the Testatrix and the witnesses, respectively, whose names are subscribed to the foregoing instrument in their respective capacities, and all of them being by me duly sworn, ESTHER M. HEISEY, Testatrix, declared to me and to the witnesses, in my presence, that the instrument is his/her WiII and that he or she had willingly made and executed it as his/her free act and deed for the purposes therein expressed; and the Witnesses, each on his or her oath, stated to me in the presence and hearing of the Testatrix, that the Testatrix had declared to them that the instrument is his Will and that he or she executed the same as such and wanted each of them to sign it as a witness; and upon their oaths, each witness stated further that he or she did the same as a witness in the presence of the Testatrix, and at his request and that he or she was at that time eighteen (18) years of age or over and was of sound mind, and that each of the witnesses was then at least fourteen (14) years of age. t r~ ~/ ~~ ESTHER M. HEISEY Testatrix '`~ - l~ . ~,ness ~ ~ (Printed Name of Witness) ~' --~~'~ r, ~,~-/-~ f'l off ~ !,~~~~ .~ ~. Wien/ess - (Printed Name of Witness) SUBSCRIBED AND ACKNOWLEDGED before me by ESTHER M. HEISEY, Testatrix, and subscribed and sworn to _before me by ~i ;~ ~ `~ ~~; ~ ~~ ,~ r ~ - ~-f ~ "~ ~" and ^- ,~~-~ r ~~ ~ - G-- ~- l-t /~- ~ witnesses, this the _ ~ day of ~ y~ ``.~ (r" ~-~~ 1 5 ~\ / / \\\ / (/ •`l r ~ Nd F~~blic, Common ea th of Pennsylvania { ~~o~~t~ oF'~sn.v~ '' w ton, nay ~~8 Twp-. D~elawa~„o MY C~missicm ~~ ' 24.2006 POUR OVER WILL Page 6 REVOCABLE LIVING TRUST AGREEMENT TH S AGREEM~NT AND DECLARATION OF TRUST, made effective the day of `~ '~" , 20 ~ - b ESTHER M. HEISEY Grantor Settl r ~ ~ Y • ant Trustcc, who residcs at 1233 York Road, Mechanicsburg, County of Cumberland, Commonwealth of Pennsylvania, does hereby establish a Trust upon the conditions and for the purposes hereafter set forth. WITNESSETH: WHEREAS, in order to provide the future comfort and security to himself and the other beneficiaries hereafter mentioned, Grantor desires to create a revocable trust for the purposes hereinafter set forth; ARTICLE ONE Terms of the Trust Section 1.01 -Trust Estate Defined NOW, THEREFORE, in consideration of the premises and of the Covenants herein contained this Revocable Trust is formed to hold title to real and personal property for the benefit of the Settlor of this Trust and to provide for the orderly use and transfer of these assets upon the death of the Settlor. The "Trust Estate" is defined as all property transferred or conveyed to and received by the Trustee held pursuant to the terms of this instrument. The Trustee is required to hold, administer, and distribute this property as provided in this Trust Agreement. The name of this Trust Agreement shall be: THE ESTHER M. HEISEY REVOCABLE LIVING TRUST AGREEMENT r. DATE ~ (~ ~ _ 20 ~ --~ ~ . ~ Section 1.02 -Definitions of Terms As used in this Trust Agreement: 1. The term "Settlor" shall mean ESTHER M. HEISEY. 2. The term "Descendant" shall mean the lawful issue of a deceased parent in the line of descent, but does not include the issue of any parent who is a descendant of the deceased person in question and who is living at the time in question. 3. The terms "Child" ~ (`Descendant" include any issue born to decedent, a child legally adopted by the decedent, and a posthumous child of a decedent. A posthumous child is to be considered as living at the time of his or her parent's death. 4. The term "Survives" or "Surviving", unless otherwise indicated herein, shall be construed to mean surviving the decedent for at least sixty (60) days. If the person referred to dies REVOCABLE LIVING TRUST AGREEMENT Page 1 2. Any stock dividends and rights to purchase additional stock issued on securities held in trust will be treated as principal. All other dividends, except liquidating distributions, will be treated as income; and The amount of any applicable depletion allowance for federal income tax purposes will be treated as income. Section 1.06 -Discretionary Termination The Trustee may terminate any Trust when, in the opinion of the Trustee, the principal is reduced to such an extent that it is not in the best interest of the Beneficiary or Beneficiaries to continue the Trust. The judgment of the Trustee with respect to this decision to terminate will be final and not subject to judicial review. If the Trustee terminates a Trust according to this Section, the date the Trust terminates will be deemed the date fixed for termination of the Trust, and the Trustee will distribute the assets of the terminating Trust to the Beneficiary or Benef ciaries pursuant to this Agreement. Section 1.07 -Amendment and Revocation At any time during the life of the Settlor, the Settlor may, by a duly executed instrument filed with the Trustee: 1. Amend this Trust Agreement in any manner; and/or 2. Revoke this Trust Agreement in part or in whole. If the Trust Agreement is revoked in whole, the Trustee shall transfer title to all Trust property of every kind and description back into the individual name of the Settlor. The instrument of amendment or revocation shall be effective immediately upon its proper execution by the Settlor, but until a copy has been received by a Trustee, that Trustee shall not incur any liability or responsibility either (i) for failing to act in accordance with such instrument or (ii) for acting in accordance with the provisions of this Trust Agreement without regard to such instrument. 3. Withdraw from the Trust Estate all or any part of the principal and accumulated income of the Trust to satisfy liabilities lawfully incurred in the administration of this Trust. Section 1.08 -Revocation or Alteration by Settlor Alone The rights of revocation, withdrawal, alteration, and amendment reserved in this Article may only be exercised by the Settlor and may not be exercised by any other person, including an agent, a guardian, or a conservator. Section 1.09 -Irrevocability Except as otherwise provided, on the death of Settlor, the designation of Beneficiaries of specific gifts in this Trust shall become irrevocable and not subject to amendment or modification. Section 1.10 -Settlor Powers The Settlor shall be the Trustee unless and until he or she resigns in writing or is determined incompetent under the terms provided herein. The Settlor shall retain all absolute rights to discharge or replace any Successor Trustee so long as the Settlor is competent. REVOCABLE LIVING TRUST AGREEMENT Page 3 ARTICLE TWO Trust Administration Section 2.01- Trust Income During the life of the Settlor, the Trustee shall at least annually, unless otherwise directed by Settlor in writing, pay to or apply for the benefit of Settlor, all of the net income from the Trust Estate. Section 2.02 -Protection of Settlor in Event of Incapacity During the life of the Settlor, should Settlor become incapacitated as defined in Section 2.03 below, the Trustee may, in the Trustee's absolute discretion, pay income and principal for the benefit of the incapacitated Settlor, and may pay to or apply for the benefit of that Settlor such sums from the net income and from the principal of the Estate of the Trustee, in the Trustee's absolute discretion, believes is necessary or advisable for the medical care, comfortable maintenance, and welfare of the Settlor. Section 2.03 -Incapacity In the event that any Trustee or any Beneficiary hereunder comes into possession of any of the following: A jurisdictionally applicable court order holding the party to be legally incapacitated to act on his or her behalf and appointing a guardian or conservator to act for him or her; or 2. Written certificates which are duly executed, witnessed, and acknowledged of two licensed physicians, each certifying that the physician has examined the person and has concluded that, by reason of accident, mental deterioration, or other cause, such person has become incapacitated and can no longer act rationally and prudently in his or her own financial best interest; or 3. Evidence which such Trustee or Beneficiary deems to be credible and currently applicable that a person has disappeared, is unaccountably absent, or is being detained under duress, and that he or she is unable to effectively and prudently look after his or her own best interests, then in that event and under those circumstances: a. Such person is deemed to have become incapacitated, as that term is used in this Trust agreement; and b. Such incapacity is deemed to continue until such court order, certificates, and / or circumstances are inapplicable or have been revoked. A physician's certificate to the effect that the person is no longer incapacitated shall revoke a certificate declaring the person incapacitated. The certificate which revokes the earlier certificate may be executed by either the original certifying physician or by two other licensed, board certified physicians. No Trustee shall be under any duty to institute any inquiry into a person's possible incapacity. The reasonable expense of any such inquiry shall be paid from the Trust Assets. Section 2.04 -Principal Invasion During the life of the Settlor, should the net income of assets contained in this Trust at the time of the Settlor's incapacity be insufficient to provide for the care, maintenance, or support of the Settlor as herein defined, the Trustee may, in the Trustee's sole and absolute discretion, pay to or apply for the benefit of the Settlor or any of their dependents, such amounts from the principal of the Trust estate as the Trustee deems necessary or advisable for the care, maintenance, or support of the Settlor. REVOCABLE LIVING TRUST AGREEMENT Page 4 Section 2.05 -Residence If the Settlor's residence property is a part of the Trust, the Settlor shall have possession of and full management of the residence and shall have the right to occupy it free of rent. Any expenses arising from the maintenance of the property and from all taxes, liens, assessments, and insurance premiums, are to be paid from the Trust to the extent that assets are available for payment. It is the intent of the Grantor to retain all homestead rights available to him or her under the applicable state law. ARTICLE THREE Administration/Distribution of Trust Section 3.01-Death On the death of the Settlor, the Trustee shall distribute the principal of the Trust and any accrued or undistributed income from the principal of the Trust in such a manner and to such persons, including the Estate of the Creditors, as directed in this Trust Agreement. Section 3.02 -Payment of Death Expenses On the death of the Settlor, the Trustee shall pay from the Trust Estate constituting the Settlor's last illness, funeral, burial and any inheritance, estate, or death taxes that may be due by reason of the Settlor's death, unless the Trustee in his or her absolute discretion determines that other adequate provisions have been made for the payment of such expenses and taxes. Section 3.03 -Trust Income and Principal Distribution 1. The Trustee shall apply and distribute the net income and principal of each of the shares of the resulting Trust Estate, after giving effect to the section of this Trust Agreement entitled "Special Directives" to the following Beneficiaries in the indicated fractional shares: Sandra Jo Chamberlain 1/3 Edward Alan I~eisey 1/3 Janice Lynn Swain 1/3 2. If any of the above Beneficiaries, or any other Beneficiary, is under the age of 21 years when the distribution is to be made, the Trustee shall have authority to distribute the same, in whole or in part, to a custodian for the minor appointed under a Uniform Gifts or Transfers to Minors Act, or the Trustee may retain any such property and administer and distribute the same for the benefit of the minor, paying to or for the benefit of such minor so much of the income and principal of the retained property from time to time as the Trustee deems advisable for the health, education, support, and maintenance of the minor. When the person for whom the property is held attains the age of 21 years, the property shall thereupon be distributed to him or her free of trust unless otherwise stated in this Agreement. If the minor should die before attaining the age of majority, the property shall then be paid and distributed to the estate of the minor. 3. If all of the Settlor's Beneficiaries and their children should fail to survive the final distribution of the Trust Estate, all of the Trust Estate not disposed of as hereinabove provided shall be distributed as provided for in this Trust Agreement. REVOCABLE LIVING TRUST AGREEMENT Page 5 Section 3.04 -Principle of Representation If a Beneficiary of the Settlor should fail to survive to collect his or her share, that share shall pass to the surviving issue of that deceased Beneficiary per stirpes and with right of representation. ARTICLE FOUR Trustee Powers & Provisions Section 4.01 -Non-Income Producing Property During the life of the Settlor, the Trustee is authorized to retain in the Trust, for so long as the Trustee may deem advisable, any property received by the Trustee from the Settlor, whether or not such property is of the character permitted by law for the investment of Trust funds. Section 4.02 -Trustee Powers The Trustee shall have all powers conferred upon a Trustee by law for the orderly administration of the Trust Estate. If any property is distributed outright under the provision of this Trust Agreement to a person who is a minor, distribution may be made under the Pennsylvania Uniform Transfer to Minors Act ("PAUTMA"). The Trustee is further authorized to sign, deliver, and/or receive any documents necessary to carry out the powers contained within this Section. The Trustee of any trust created under this Trust Agreement (including any substitute or successor Trustee) will have and be subject to all of the powers, duties, and responsibilities granted or imposed by the Pennsylvania Consolidated Statutes (20 Pa. C.S. Section 101 et seq.) as such Statute may provide at the time of administration of the Trust, except to the extent that the same are inconsistent with the provisions of this Agreement. Section 4.03 -Specific Powers of Trustee In addition, the Trustee will have the following specific powers: 1. Trust Estate: The Trustee may leave invested any property coming into its hands hereunder in any form of investment even though the investment may not be of the character of investments permitted by law to trustees, without liability for loss or depreciation in value. The Trustee may sell, mortgage, exchange, or otherwise dispose of and reinvest property which may at any time be apart of the Trust Estate upon such terms and conditions as the Trustee may deem advisable. The Trustee may invest and reinvest the Trust Assets from time to time in any property, real, personal, or mixed, including without limitation, securities of domestic and foreign corporations and investment trusts or companies, bonds, debentures, preferred stocks, common stocks, mortgages, mortgage participation, and interests in common trust funds, all with complete discretion to convert realty into personalty or personalty into realty or otherwise change the character of the Trust Estate, even though such investment (by reason of its character, amount, proportion to the total Trust Estate, or otherwise) would not be considered appropriate for a fiduciary apart from this provision and even though such investment caused part or all of the total Trust Estate to be invested in investments of one type or of one business or company. 2. Holding Property: The Trustee may hold property in the Trustee's name, as trustee, or in the name of a nominee without disclosing the Trust. REVOCABLE LIVING TRUST AGREEMENT Page 6 3. Release of Power: If the Trustee deems it to be in the best interest of the Trust and its Beneficiaries, the Trustee, by written instrument signed by such Trustee, will have the power and authority to release, disclaim, or restrict the scope of any power or discretion granted in this Trust Agreement or implied by law. 4. Agents, Employees: The Trustee may employ one or more agents to perform any act of administration, whether or not discretionary, including attorneys, auditors, investment managers, or others, as the Trustee shall deem necessary or advisable. The Trustee may compensate agents and other employees and may delegate to them any and all discretions and powers. 5. Leases: The Trustee may lease any Trust Assets generally or for oil, gas, and mineral development, even though the lease term may extend beyond the term of the Trust of which the property is a part. The Trustee may enter into any covenants and agreements relating to the property so leased or concerning any improvements which may then or thereafter be erected on such property. 6. Common Funds: The Trustee may hold any of the Trust Assets in a common fund with property from other trust estates and may make investments jointly with any other trust, the property of which is included in the common fund. 7. Securities: With respect to securities held in the Trust Estate, the Trustee may exercise all the rights, powers, and privileges of an owner, including but not limited to, the power to vote, give proxies, and to pay assessments and other sums deemed by the Trustee necessary for the protection of the Trust Estate. In addition, the Trustee may participate in voting trusts, foreclosures, reorganizations, consolidations, mergers, and liquidations, and in connection therewith, to deposit securities with and transfer title to any protective or other committee under such terms as the Trustee may deem advisable. In addition, the Trustee may exercise or sell stock subscription or conversion rights and may accept and retain as an investment any securities or other property received through the exercise of any of the foregoing powers, regardless of any limitations elsewhere in this instrument relative to investments by the Trustee. In addition, The Trustee may Buy, sell exchange, assign, convey, settle and exercise commodities future contracts and call and put options on stocks and stock indices traded on a regulated options exchange and collect and receipt for all proceeds of any such transactions. Establish or continue option accounts for the principal with any securities of a futures broker. In general, exercise all powers with respect to commodity and option transactions that the principal could if present. 8. Purchases from Estate: The Trustee may purchase property of any kind from the Executor or Administrator of the Estates. 9. Lending: The Trustee may make loans, secured or unsecured, to the Executor or Administrator of the Estate, to any Beneficiary of the Trust, or to the Trustee. Further, the Trustee may use Trust Assets to guarantee obligations of any income Beneficiary of the Trust (unless such Beneficiary is serving as Trustee). 10. Distributions to or for Beneficiaries: The Trustee may make any distribution contemplated by this Trust Agreement (1) to the Beneficiary; (2) if the Beneficiary is under a legal disability or if the Trustee determines that the Beneficiary is unable to properly manage his or her affairs, to a person furnishing support, maintenance, or education for the Beneficiary or with whom the Beneficiary is residing for expenditures on the Beneficiary's behalf; or (3) if the Beneficiary is a minor, to a trustee of an existing trust established exclusively for the benef t of such minor, whether created by this Trust Agreement or otherwise, or to a custodian for the Beneficiary, as selected by the Trustee, under the Pennsylvania Uniform Transfer to Minors Act. Alternatively, REVOCABLE LIVING TRUST AGREEMENT Page 7 the Trustee may apply all or a part of the distribution for the Beneficiary's benefit. Any distribution under this paragraph will be a full discharge of the Trustee with respect thereto. On any partial or final distribution of the Trust Assets, the Trustee may apportion and allocate the assets of the Trust Estate in cash or in kind, or partly in cash and partly in kind, or in undivided interests in the manner deemed advisable at the discretion of the Trustee and to sell any property deemed necessary by the Trustee to make the distribution. The Trustee may distribute gifts of up to the maximum allowable per year per donee out of principal and/or interest. 11. Insurance: The Trustee may purchase new life insurance, pay the premiums on existing Life insurance on the life of any Trust Beneficiary, purchase annuities (either commercial or private) from any corporation, trust, or individual, and may procure and pay the premiums on other insurance of the kinds, forms, and amounts deemed advisable by the Trustee to protect the Trustee and the Trust Estate. 12. Borrowing: The Trustee may borrow money from the Trust Estate and others. To secure the repayment thereof, the Trustee may mortgage, pledge, or otherwise encumber part or all of the Trust Assets, and in connection with the acquisition of any property, the Trustee may assume a liability or may acquire property subject to a liability. 13. Repairs: The Trustee may make ordinary and extraordinary repairs and alterations to buildings or other Trust Assets. 14. Reserves: The Trustee may establish such reserves out of income for taxes, assessments, repair, and maintenance as the Trustee considers appropriate. 15. Continuation of Business: The Trustee may continue any business or businesses in which the Trust has an interest at the time of the Settlor's death for so long as the Trustee may, in its sole discretion, consider necessary or desirable, whether or not the business is conducted by the Settlor at the time of his/her death individually, as a partnership, or as a corporation wholly owned or controlled by him, with full authority to sell, settle, and discontinue any of them when and upon such terms and conditions as the Trustee may, in its sole discretion, consider necessary or desirable. 16. Retain Property for Personal Use: The Trustee may retain a residence or other property for the personal use of a Beneficiary and to allow a Beneficiary to use or occupy the retained property free of rent and maintenance expenses. 17. Dealings with Third Parties: The Trustee may deal with any person or entity regardless of relationship or identity of any Trustee to or with that person or entity. The Trustee may hold or invest any part of or all of the Trust Estate in common or undivided interests with that person or entity. 18. Partitions, Divisions, Distributions: The Trustee will have the power to make all partitions, divisions, and distributions contemplated by this Trust Agreement. Any partitions, divisions, or other distributions may be made in cash, in kind, or partly in cash and partly in kind, in any manner that the Trustee deems appropriate (including composing shares differently). The Trustee may determine the value of any property, which valuation will be binding on all Beneficiaries. No adjustments are required to compensate for any partitions, divisions, or distributions having unequal consequences to the Beneficiaries. 19. Claims, Controversies: The Trustee may maintain and defend any claim or controversy by or against the Trust without the joinder or consent of any Beneficiary. The Trustee may commence REVOCABLE LIVING TRUST AGREEMENT Page 8 or defend at the expense of the Trust any litigation with respect to the Trust or any property of the Trust Estate as the Trustee may deem advisable. The Trustee may employ, for reasonable compensation, such counsel as the Trustee shall deem advisable for that purpose. 20. Merger of Trusts: If at any time the Trustee of any trust created hereunder shall also be acting as trustee of any other trust created by trust instrument or by trust declaration for the benefit of the same beneficiary or beneficiaries and upon substantially the same terms and conditions, the Trustee is authorized and empowered, if in the Trustee's discretion such action is in the best interest of the Beneficiary or Beneficiaries, to transfer and merge all of the assets then held under such trust created pursuant to this Trust Agreement to and with such other trust and thereupon to terminate the trust created pursuant to this Trust Agreement. The Trustee is further authorized to accept the assets of any other trust which may be transferred to any trust created hereunder and to administer and distribute such assets and properties so transferred in accordance with the provisions of this Agreement. 21. Termination of Small Trust: Any corporate Trustee which is serving as the sole Trustee of any Trust or any Share thereof may at any time terminate such Trust or Share if, in the Trustee's sole judgment, the continued management of such Trust or Share is no longer economical because of the small size of such Trust or Share and if such action will be deemed to be in the best interests of the Beneficiary or Beneficiaries. In case of such termination, the Trustee will distribute forthwith the share of the Trust Estate so terminated to the income Beneficiary, per stirpes. Upon such distribution, such Trust or Share will terminate and the Trustee will not be liable or responsible to any person or persons whomsoever for its action. The Trustee will not be liable for failing or refusing at any time to terminate any Trust or a Share thereof as authorized by this paragraph. 22. Power to Determine Income and Principal: Dividends payable in stock of the issuing corporation, stock splits, and capital gains will be treated as principal. Except as herein otherwise specifically provided, the Trustee will have full power and authority to determine the manner in which expenses are to be borne and in which receipts are to be credited as between principal and income. The Trustee has the power to determine what will constitute principal or income and may withhold from income such reserves for depreciation or depletion as the Trustee may deem fair and equitable. In determining such matters, the Trustee may give consideration to the provisions of the Pennsylvania Statutes (or its successor statutes) relating to such matters, but it will not be bound by such provisions. 23. Generation-Skipping Taxes and Payment: If the Trustee considers any distribution or termination of an interest or power hereunder as a distribution or termination subject to a generation-skipping tax, the Trustee is authorized: a. To augment any taxable distribution by an amount which the Trustee estimates to be sufficient to pay such tax and charge the same to the particular trust to which the tax related without adjustment of the relative interests of the Beneficiaries; b. To pay such tax, in the case of a taxable termination, from the particular trust to which the tax relates without adjustment of the relative interests of the Beneficiaries. If such tax is imposed in part by reason of the Trust Assets, the Trustee will pay only the portion of such tax attributable to the taxable termination hereunder taking into consideration deductions, exemptions, credits, and other factors which the Trustee deems advisable; and REVOCABLE LIVING TRUST AGREEMENT Page 9 c. To postpone final termination of any particular trust and to withhold any portion or all of the Trust Estate until the Trustee is satisfied that the Trustee no longer has any liability to pay any generation-skipping tax with reference to such trust or its termination. Section 4.04 -Special Provision for S Corporation Stock Notwithstanding what is otherwise provided in this Trust Agreement, if at any time the Trust contains any stock of a corporation which elects or has elected treatment as an "S Corporation" as defined by Section 13 61(x)(1 } of the Internal Revenue Code (or any corresponding successor statute), such stock will be segregated from the other assets of such and treated as a separate trust. The Trustee will further divide the separate trust into shares for each Beneficiary and such shares will be distributed outright or held in trust as herein provided. In addition, all other provisions of this Trust Agreement will apply to each share held in trust (and constituting a separate trust) except that the Trustee will distribute all of the income from each separate trust to its Beneficiary in convenient installments at least annually. It is the Settlor's intent that each separate trust will be recognized as a "Qualified Subchapter S Trust" ("QSST") under Section 1361(d)(2) of the Internal Revenue Code (or any corresponding successor statute). Notwithstanding any provisions of this Trust Agreement to the contrary, the Trustee's powers and discretions with respect to the administration of each separate trust (including methods of accounting, bookkeeping, making distributions, and characterizing receipts and expenses) will not be exercised or exercisable except in a manner consistent with allowing each separate trust to be treated as a QSST as above described. ARTICLE FIVE Trustee Powers with a Probate Estate Section 5.01 -Coordination with Settlor's Probate Estate 1. At any time during the continuance of this Trust, including subsequent to the death of Settlor, the Trustees may, in their sole and uncontrolled discretion, distribute to the deceased Settlor's Probate Estate cash and/or other property as a Beneficiary of the Trust. 2. All other provisions to the contrary notwithstanding, under no circumstances shall any restricted proceeds, as hereinafter defined, be either directly or indirectly: (i) distributed to or for the benefit of the Settlor's Executors or the Settlor's Probate Estate; or (ii) used to pay any other obligations of the Settlor's Estate. The term "Restricted Proceeds" means: a. All qualified plans, individual retirement accounts, or similar benefits which are received or receivable by any Trustee hereunder, and which are paid solely to a Beneficiary other than the Executor of the Settlor's Gross Estate for Federal Estate Tax purposes; and b. All proceeds of insurance on the Settlor's life which, if paid to a Beneficiary other than the Settlor's Estate, would be exempt from inheritance or similar death taxes under applicable state death laws. Section 5.02 -Direction to Minunize Taxes In the administration of the Trust hereunder, its Fiduciaries shall exercise all available tax related elections, options, and choices in such a manner as they, in their sole but reasonable judgment (where appropriate, receiving advice of tax counsel), believe will achieve the overall minimum in total combined present and reasonably anticipated future administrative expenses and taxes of all kinds. This applies }fat only to said Trust, but also to its Beneficiaries, to the other Trusts hereunder and their Beneficiaries, to the Settlor's Probate Estate. REVQCABLE LIVING TRUST AGREEMENT Page 10 Without limitation on the generality of the foregoing direction (which shall to that extent supersede the usual fiduciary duty of impartiality), such Fiduciaries shall not be accountable to any person interested in this Trust or to Settlor's Estate for the manner in which they shall carry out this direction to minimize overall taxes and expenses (including any decision they may make not to incur the expense of a detailed analysis of alternative choices}. Even though their decisions in this regard may result in increased taxes or decreased distributions to the Trust, to the Estate, or to one or more Beneficiaries, the Fiduciaries shall not be obligated for compensation readjustments or reimbursements which arise by reason of the manner in which the Fiduciaries carry out this direction. Section 5.03 -Judgment and Discretion of Trustee In the absence of proof of bad faith, all questions of construction or interpretation of any trusts created by this Trust Agreement will be finally and conclusively determined solely by the Trustee, according to the Trustee's best judgment and without recourse to any court. Each determination by the Trustee is binding on the Beneficiaries and prospective Beneficiaries hereunder, both in being and unborn, as well as all other persons, firms, or corporations. The Trustee, when exercising any discretionary power relating to the distribution or accumulation of principal or income or to the termination of any trust, will be responsible only for lack of good faith in the exercise of such power. Each determination may be relied upon to the same extent as if it were a final and binding judicial determination. In the event of a conflict between the provisions of this Trust Agreement and those of the Pennsylvania Statutes, the provisions of this Agreement will control. ARTICLE SIX Resolution of Conflict Section 6.01 -Resolution of Conflict Any controversy between the Trustee or Trustees and any other Trustee or Trustees, or between any other parties to this Trust, including Beneficiaries, involving the construction or application of any of the terms, provisions, or conditions of this Trust shall, on the written request of either or any disagreeing party served on the other or others, shall be submitted to arbitration. The parties to such arbitration shall each appoint one person to hear and determine the dispute and, if they are unable to agree, then the two persons so chosen shall select a third impartial arbitrator whose decision shall be final and conclusive upon both parties. The cost of arbitration shall be borne by the losing party or in such proportion as the arbitrator(s) shall decide. Such arbitration shall comply with the commercial arbitration rules of the American Arbitration Association, 140 West 51st Street, New York, NY 10200. Section 6.02 -Incontestability The beneficial provisions of this Trust Agreement are intended to be in lieu of any other rights, claims, or interests of whatsoever nature, whether statutory or otherwise, except bona fide pre-death debts, which any Beneficiary hereunder may have in Settlor's Estate or in the properties in trust hereunder. Accordingly, if any Beneficiary hereunder asserts any claim (except a legally enforceable debt), statutory election, or other right or interest against or in Settlor's Estate, or any properties of this Trust, other than pursuant to the express terms hereof, or directly or indirectly contests, disputes, or calls into question, before any court, the validity of this Trust Agreement, then: 1. Such Beneficiary shall thereby absolutely forfeit any and all beneficial interests of whatsoever kind and nature which such Beneficiary or his or her heirs might otherwise have under this Trust REVOCABLE LIVING TRUST AGREEMENT Page 11 Agreement and the interests of the other Beneficiaries hereunder shall thereupon be appropriately and proportionately increased; and 2. All of the provisions of this Trust Agreement, to the extent that they confer any benefits, powers, or rights whatsoever upon such claiming, electing, or contesting Beneficiary, shall thereupon become absolutely void; and 3. Such claiming, electing, or contesting Beneficiary, if then acting as a trustee hereunder, shall automatically cease to be a Trustee and shall thereafter be ineligible either to select, remove, or become a Trustee hereunder. Section 6.03 -Trust Contests and Specific Omissions If any beneficiary under this trust, singly or in conjunction with any other person or persons, directly or indirectly: 1. contests in any court the validity of this trust or, in any manner, attacks or seeks to impair or invalidate any of its provisions:. 2. contests in any court the validity of the Settlor's Trust or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 3. seeks to obtain an adjudication in any proceeding in any court that this trust or any of its provisions or that Settlor's Trust or any of its provisions is void; 4. claims entitlement by way of any written or oral contract to any portion of the Settlor's estate, whether in probate or under this instrument; 5. unsuccessfully challenges the appointment of any person named as Trustee or successor Trustee of this Trust, 6. objects in any manner to any action taken or proposed to be taken in good faith by the Trustee Settlor's Trust; 7. objects to any construction or interpretation of this Trust, or any provision of it, that is adopted or is proposed in good faith by the Trustee; 8. unsuccessfully seeks the removal of any person acting as Trustee of any Trust created under this instrument; 9. files any creditor's claim in Settlor's estate (without regard to its validity), whether the claim arose before or after the date of this instrument, but excepting claims for cash advanced or paid for expenses of the Settlor's last illness or funeral paid by said claimant; 10. attacks or seeks to invalidate any designation of beneficiaries for any life insurance policy on Settlor's life; 11. attacks or seeks to invalidate any designation of beneficiaries for any pension or IRA or other form of qualif ed or non-qualified asset or deferred compensation account, agreement or arrangement; 12. attacks or seeks to invalidate any trust which Settlor has created or may create during Settlor's lifetime, or any provision thereof, as well as any gift which Settlor has made or will made during Settlor's lifetime, whether before or after the date of this instrument; 13. attacks or seeks to invalidate any transaction by which Settlor sold any assets (whether to a relative of Settlor's or otherwise); or 14. refuses a request of Settlor's Trustee, Executor or other fiduciary to assist in the defense against any of the foregoing acts or proceedings, then that person's right to take any interest briven to him or her by this trust shall be determin~t~ as it woi,l(~ have been determined if the person had predeceased the execution of this trust instrument without issue REVOCABLE LIVING TRUST AGREEMENT Page 12 surviving. The provisions of the foregoing paragraph shall not apply to any disclaimer by any person of any benefit under this trust or under the Settlor's Trust. In the e~rent that any provision of this Article is held to be invalid, void or illegal, the same shall be deemed severable from the remainder of the provisions of this Article and shall in no way affect, impair or im~alidate any other provision in this Article; and if such provision shall be deemed invalid due to its scope or breadth, such provision shall be deemed to exist to the extent of the scope or breadth permitted by la«-. Section 6.04 -Benefits Confidential The Settlor further declare that it is his/her desire and intent that the provisions of this Trust Agreement are to remain confidential as to all parties. The Settlor directs that only the information concerning the benefits paid to any particular Beneficiary shall be revealed to such individual and that no individual shall have a right to information concerning the benefits being paid to any other Beneficiary. ARTICLE SEVEN General Provisions Section 7.01 -Distribution in Kind or in Cash On any division of the assets of the Trust Estate in to shares or partial shares, and on any final or partial distribution of the assets of the Trust Estate, the Trustee, at his or her absolute discretion, may divide and distribute undivided interests of such assets on a pro rata or non-pro rata basis, or may sell any part of or ail of such assets and may make divisions or distributions in cash or partly in cash and partly in kind. The decision of the Trustee, either prior to or on any division or distribution of such assets, as to what constitutes a proper division of such assets of the Trust Estate, shall be binding on all persons interested in any trust provided for in this Trust Agreement. Section 7.02 -Spendthrift Provision Neither the principal nor the income of the trust shall be liable for the debts of a Beneficiary. Except as otherwise expressly provided in this Agreement, no Beneficiary of any trust shall have any right, power, or authority to alienate, encumber, or hypothecate his or her interest in the principal or income of this Trust in any manner, nor shall the interests of any Beneficiary be subject to the claims of his or her creditors or liable to attachment, execution, or other process of law. The limitations herein shall not restrict the exercise of any power of appointment or the right to disclaim. Section 7.03 -Definition of Children The terms "Child" and "Children" as used in this Agreement mean the lawful issue of a Settlor. This definition also includes children legally adopted by a Settlor. Section 7.04 -Handicapped Beneficiaries Any Beneficiary who is determined by a court of ~~~petent jurisdiction to be incompetent shall not have any discretionary rights of a Beneficiary with r~pcct to this Trust, or to their share or portion thereof. The Trustee shall hold and maintain such incompetent Beneficiary's share of the Trust estate and shall, in the Trustee's sole discretion, provide for such Beneficiary as that Trustee would provide for a minor. Notwithstanding the foregoing, any Beneficiary who is diagnosed for the purposes of governmental benefits (as hereinafter delineated) as being not competent or as being disabled, and who shall be entitled REVOCABLE LIVING TRUST AGREEMENT Page. 13~ to governmental support and benefits by reason of such incompetency or disability, shall cease to be a Beneficiary of this Trust. Likewise, they shall cease to be a Beneficiary if any share or portion of the principal or income of the Trust shall become subject to the claims of any governmental agency for costs or benefits, fees, or charges. The portion of the Trust Estate which, absent the provisions of this section, would have been the share of such incompetent or handicapped person shall be retained in trust for as long as that individual lives. The Trustee, at his or her sole discretion, shall utilize such funds for the maintenance of that individual. If such individual recovers from his or her incompetency or disability and is no longer eligible for aid from any governmental agency, including costs or benefits, fees, or charges, such individual shall be reinstated as a Beneficiary after 60 days from such recovery and the allocation and distribution provisions as stated herein shall apply to that portion of the Trust Estate which is held by the Trustee subject to the foregoing provisions of this section. If said handicapped Beneficiary is no longer living and shall leave children then living, the deceased child's share shall pass to those children per stirpes. If there are no children, the share shall be allocated proportionately among the remaining Beneficiaries. ARTICLE EIGHT Successor Trustee Appointments Section 8.01 -Trustees All Trustees are to serve without bond. The following will act as Trustees of any Trusts created by this Trust Agreement, in the following order of succession: First: The undersigned, Esther M. Heisey. Second: At the death or incapacity of Esther M. Heisey, Edward Alan Heisey shall serve as First Successor Trustee. Third: Sandra Jo Chamberlain shall serve as Second Successor Trustee. Fourth: Janice Lynn Swain shall serve as Third Successor Trustee. Last: A Trustee chosen by the majority of Beneficiaries, with a parent or legal guardian voting for minor Beneficiaries; provided, however, that the children of any deceased Beneficiary shall collectively have only one vote. Section 8.02 -Allocation and Distribution of The Trust Assets The Trustees shall allocate, hold, administer, and distribute the Trust Assets as hereinafter provided: 1. Upon the death of the Settlor, the Trustee shall make any separate distributions the Trust Assets in the manner hereinafter prescribed. Section 8.03 -Personal Property Distribution Notwithstanding any provision of this Trust Agreement to the contrary, the Trustee must abide by any memorandum by the Settlor, particularly that contained in the section entitled "Special Directives" incorporated into this Trust Instrument, directing the disposition of Trust Assets of every kind including, but not limited to, furniture, appliances, furnishings, pictures, china, silverware, glass, books, jewelry, wearing apparel, and all policies of fire, burglary, property damage, and other insurance on or in REVOCABLE LIVING TRUST AGREEMENT Page 14 connection with the use of property. Otherwise, any personal and household effects of the Settlor shall be distributed with the remaining assets of the Trust Estate. Section 8.04 -Liability of Trustee The Trustee will not be responsible or liable for any loss which may occur by reason of depreciation in value of the properties at any time belonging to the Trust Estate nor for any other loss which may occur, except that the Trustee will be liable for each Trustee's own negligence, neglect, default, or willful wrong. The Trustee will not be liable or responsible for the acts, omissions, or defaults of any agent or other person to whom duties may be properly delegated hereunder (except officers or regular employees of the Trustee) if such agent or person was appointed with due care. The Trustee may receive reimbursement from the Trust Estate for any liability, whether in contract or in tort, incurred in the administration of the Trust Estate in accordance with the provisions hereof, and the Trustee may contract in such form that such Trustee will be exempt from such personal liability and that such liability will be limited to the Trust Assets. Section 8.05 -Successor Trustees Any Successor Trustee shall have all the power, rights, discretion, and obligations conferred on a Trustee by this Trust Agreement. All rights, titles, and interest in the property of the Trust shall immediately vest in the successor Trustee at the time of appointment. The prior Trustee shall, without warranty, transfer to the Successor Trustee the existing Trust property. No Successor Trustee shall be under any duty to examine, verify, question, or audit the books, records, accounts, or transaction of any preceding Trustee; and no Successor Trustee shall be liable for any loss or expense from or occasioned by anything done or neglected to be done by any predecessor Trustee. A Successor Trustee shall be liable only for his or her own acts and defaults. ARTICLE 1vINE Rule Against Perpetuities Section 9.01 -Perpetuities Savings Clause Notwithstanding any other provision of this instrument, the Trusts created hereunder shall terminate not later than twenty-one (21) years after the death of the last survivor of the Settlor and any other Beneficiary or Beneficiaries named or defined in this Trust living on the date of the death of the Settlor. The Trustee shall distribute remaining Trust principal and all accrued or undistributed net income hereunder to the Beneficiary or Beneficiaries. If there is more than one Beneficiary, the distribution shall be in the proportion in which they are Beneficiaries; if no proportion is designated, then the distribution shall be in equal shares to such Beneficiaries. ARTICLE TEN General Provisions Section 10.01- Governing Law It is not intended that the laws of only one particular state shall necessarily govern all questions pertaining to all of the Trust hereunder. REVOCAB~.E LIVING TRUST AGREEMENT Page 1 S 1. The validity of the Trust hereunder, as well as the validity of the particular provisions of that Trust, shall be governed by the laws of the state which has sufficient connection with the Trust to support such validity. 2. The meaning and effect of the terms of this Trust Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. 3. The administration of this Trust shall be governed by the laws of the state in which the principle office of the Trustee then having custody of the Trust's principal assets and records is located. The foregoing shall apply even though the situs of some Trust Assets or the home of the Settlor, a Trustee, or a Beneficiary may at some time or times be elsewhere. Section 10.02 -Invalidity of Any Provision If a court finds that any provision of this Trust Agreement is void, invalid, or unenforceable, the remaining provisions of this Agreement will continue to be fully effective_ Section 10.03 -Headings The use of headings in connection with the various articles and sections of this Trust Agreement is solely for convenience and the headings are to be given no meaning or significance whatsoever in construing the terms and provisions of this Agreement. Section 10.04 -Internal Revenue Code Terminology As used herein, the words "Gross Estate," "Adjusted Gross Estate," "Taxable Estate," "Unified Credit," "State Death Tax Credit," "Maximum Marital Deduction," "Marital Deduction," and any other word or words which from the context in which it or they are used refer to the Internal Revenue Code shall be assigned the same meaning as such words have for the purposes of applying the Internal Revenue Code to a deceased Settlor's Estate. Reference to sections of the Internal Revenue Code and to the Internal Revenue Code shall refer to the Internal Revenue Code amended to the date of such Settlor's death. REVOCABLE LIVING TRUST AGREEMENT Page 16 SPECIAL DIRECTIVES OF ESTHER M. HEISEY I, ESTHER M. HEISEY, a resident of the County of CUMBERLAND, Commonwealth of Pennsylvania, being of lawful age, and of sound and disposing mind and memory, and not acting under duress, fraud, or undue influence, hereby make, publish and declare this to be my Special Directive, and I incorporate THE ESTHER M. HEISEY REVOCABLE LIVING TRUST AGREEMENT. FIRST The natural objects of my affection are: My Children - Sandra Jo Chamberlain Edward Alan Heisey Janice Lynn Swain SECOND I direct that all estate and inheritance taxes payable as a result of my death, not limited to taxes assessed on property, shall be paid out of the residue of my Estate, and shall not be deducted or collected from any Legatee, Devisee, or Beneficiary hereunder. THIRD In the event any of my named Beneficiaries should predecease me, all of that person's share of the Trust Estate is to be divided equally among that person's issue per stirpes. In the event any such predeceased beneficiary leaves no surviving children or issue, then all of that person's share shall be distributed to the remaining Beneficiaries. FOURTH In the event all of my named beneficiaries and their children and issue predecease me, all of the trust estate is to be distributed to my heirs at law. FIFTH I direct that all outstanding debts and/or loans owed by any beneficiary shall be forgiven and deemed as having not existed. SIXTH I direct that, before any distribution of the assets of the Trust Estate to the named Beneficiaries, cer~si~ specific distributions, if any, shall be made from the assets as set forth on the list attached hereto and~rked "Exhibit A." REVOCABLE LIVING TRUST AGREEMENT Page 17 ..._~ DATED to be effective this =. day of ~ ~' , ~~~~. SETTLOR: ESTHER M. HEISEY ACCEPTED BY TRUSTEE: A '~ ~~~/f ESTHER M. HEISEY COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND This instrument was aclalowledged before me on the date herein set forth by ESTHER M. HEISEY as Settlor and Trustee to certify which witness my hand and seal of office. ~_ No blic Commonw lth of Pennsylvania C~~rH of ~Nrvsnv~w r e~ .- w LeiQhcon, ~iic Maple Twp., O'erawe/iB County Expi-~es Deoeniber 24, 2006 REVOCABLE LIVING TRUST AGREEMENT Page 18 THE ESTHER M. HEISEY REVOCABLE LIVING TRUST AGREEMENT Declaration of Intent The undersigned hereby declares that, as Trustee of THE ESTHER M. HEISEY REVOCABLE LIVING TRUST, he or she is acquiring and will hold in the name ESTHER M. HEISEY, but without further reference to his/her fiduciary capacity, all items listed on the attached schedule(s) hereto and incorporated herein as amended, from time to time, as well as household furnishings, automobiles. jewelry, bank accounts, securities, bonds, clothing and other personal property of any kind in his/her name and henceforth such assets shall and will belong to said Trust and not to him or her individually; and he or she further declares that, except to the extent of interest provided to him or her under the terms and provisions of said Trust, he or she has no personal interest in any of the above itemized personal properties, it being intended and this Declaration constitutes an affirmation of Trust ownership and an assignment to this Trust and shall be binding on his/her heirs, administrators, executors and assigns. r ~ IN WITNESS WHEREOF the~idersigned has executed this instrument this o~ day of ESTHER M. HEISEY Settlor/Trustee ` COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND BEFORE ME, the undersigned authority, on this day personally ESTHER M. HEISEY, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that he or she executed the same for the purposes and consideration therein expressed and in the capacity therein stated. t ~~ r SUBSCRIBED AND SWORN this `~ _ ,. day of ~ ..-~-~` t' ~~ ~ .._~~ ,~ •~ l ~ ~, / l N ~ b ~c Comr~riorf ealth of Pennsylvania ' =' 1 r°~ Ytv,~ w. t~ron ^~- _MY Gamrth'Sg~rWa`~'A~ Gout 24, 2Q06 Previous editions are obsolete A. Settlement Statement $. Type of Loan form NUD-1 (3/86) ref Handbook 4305.2 U.S. Department of Housing and Urban Development (1MR ~nnmv~l tiln o~no_no~+^ nTwTa r - I. ^FHA 2. ^FmHA 3. ^Conv. Unins. 4 ^VA ^ 6. Filc Number 2011-077 ••. .. ~ .v. w ~ 7. Loan Number -va. s 1a~t~~• 8. Mortgage Insurance Case Number This form is fumished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. C. Note: Items marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals. WARNING: It is a crime to knowingly make false statements to the United States on this or anyy other similar form. Penalties upon conVi lion can inrl irla a fine ~n~i 'mnrienmm~nl G .+ t •~ Tulr ,o ~ ~ as ~~cuon ~t~01 ana Se tlon 1010 TitieExpreS5 Settlement System 4 D. NAME OF BORROWER: Deborah A. Heckendorn ADDRES E. NAME OF SELLER: >/stlier M. Heisey Revocable Trust ADDRESS• F. NAME OF LENDER: N/A ADDRESS: G. PROPERTY ADDRESS: 305 Touchstone Drive, Carlisle, PA 17015 - SouthMiddleton Townshiu x. sETTLEMENT AGENT: PA Real Estate Settlement Services LLC, Telephone: 717-249-6333 Fax: 717-249-7334 PLACE OF SETT M -NT 354 Alexander Sprin>`? Road, Carlisle, PA 17015 I. S- L M NT DATE: O4/ 19/2O 1 1 _ J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 10 OS AM UNT DUE R M B W R 400. GROSS AMOUNT DUE TO LLER 101 Contract sales price 235 000.00 1. C I r' 235 000 .00 102. Personal Property 4 P r P 103. Settl _ment charges fn hnrrnsrar QlII~ 3 94 6.75 _ 144. -105. d'u t en s for items aid b e l r 106. City/town taxes in advan t en fri ms id b s Iler in v nce 1 04 19 11 12 31 11 328.76 04 19 11 12 31 11 328.76 04 19 11 06 30 11 425.42 04 19 11 06 30 11 _ 2 109. 110. "°" 111. 411. 112. 12 R AM NT DUE FR B OWER 239 700.93 42 GR S AM NT DUE TO SELLE 235 754 .18 ' 0 NT PAID BY R ON BEH F B RR W R _201. DeDOSit nr Barnett money TION IN AM U T DUE T SELLER 202 Principal amount of new loans I r 14 3 019 53 203. Existing loan() tak n al~bj~rt to I n . _204. 4 a o 205. _207. 208, 9. Ad'us m is f r i m un i b ell er dust n s for i em un i b sell er X10. City/town taxes 510 City/town taxes ___ -.211. County taxes _212. School taxes X13. 1. 214. 4 ~_Z15. 216. ~~ 17. 517. x_218. _ _219. 2 T TAL PAID Y F R B R O R 3 0. ASH AT TT EME ROM OR T B RRO ER _~ 1. r s m r w in 12 239 700.93 520. T TAL R D CTION AMOUNT DUE SELLER 3 019.53 6 0. CA AT S TTLEMENT TO OR FROM SEL ER 1. n I r lin 4 235 754 118 i _ 303. CASH FROM BORROWER 239 700.93 60 ASH TO SELLER 3 019.53 232,.734.65 ~- -~_E `C Rl.t ? . ~ ~ SELLER STATEMENT: The information contained herein is important tax information and is bein fumished to the Internal Revenue Service. If you are required to file a return, .- -; ~;e-:~e per.aity cr ct:^er sanc;con vri!I be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Sales Price described c~ ~~ i above constitutes the Grws Prcceeds of this transaction. !•'revious editions are obsoie,z form HUD-1 (3186) ref Hancbook 4305.2 U.S. DEPAR"1'MENT OF HOUSING AND URBAN DEVELOPMENT File Number: 2011-077 FINAL PAGE 2 SETTLEMENT STATEMENT T:.,_~.._____ ~_..,____. ~.__.___ ~-_._ ......,..,..._ _ . . L. SETTLEMENT CHARGES PAID >=ROM PAID FROM 700. TOTAL LES/BR KER'S MM I N ba n rice 235 000.00 = BORROWER'S SELLER'S FUNDS AT FUNDS AT --701. 5 to SETTLEMENT SETTLEMENT r 702. S to i lement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 1 ri i n __°lo 2 L Discount % 803. Aonraisal Fee 4 r i R Len r' ns e 6. A I' n F 7. t' n F 1. 900 ITEMS REQUIRED BY LENDER TO B P ID IN ADVAN E Interest From to ta'~$ /day 02. Mortgage Insurance Premium for to 903 Hazard Insurance Premium for to 904. .~ i 1 00. RE RVE D OSITE WITH LENDER FOR 1 r 1 mo aC~ $ /mo _ 1 n e _ 1 T mo ta~~_ /mo 1004. Countv Pro°erty Tax mo. Cud ~ Imo 1 ch ! mo an ~ /mo 1 A r t n t _ 0. 00 J 0.00 110 . TI LE CHAR ES 11 1 Imp r 'n 11 A r r i 1103. Ti ex m'n ' 11 4 Ti I nce i r 1 t r i to Salzmann Huc~thes, P.C. :L75 00 1 N t F . 1107. At rn s in I v i s o• 1108. Title Insuranc io Stewart Title Guaranty/PA RE SS 1, 533.75 i bove items No• ~ 11 ender's PoliEy 111 wn lic 235 000.00 - 1 533.75 / 111. I --' 11 . _1113. 120 .GOVERNMENT RECD DING AND TRANSFER CHARGES 1 1 F d 63.00 • Mortaaae ~ • R I asP 63 00 _ i o Deed $ 2 , 350.00 • Mortgage $ ~ . 2 350 .00 sa 2 350.00 •M ____ 2 350 00 . 1 1300. ADDITIONAL SETTLEM NT HAR ES T Robert Cairns Tax Collector 466.92 'i Robert Cairns Tax Collector I i 5.00 iA to South Middleton Township Authority ~ ~ 22 61 1 00. TO L SETT MENT CHA li and 502. Section K) 3 , 946. 75 ~ 3_, U19 . 53 HUD CERTIFICATION OF BUYER AND SELLER "" 1,~f' ••~~ 1 ha "direfully reviewed the HUD-1 ettement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account~~" in t is tr nsac n. 1 further certify h I hav deceived a copy of the HUD-1 Settlement Statement. ~~ / i Quarterly Account Statement July 1, 2010 through September 30, 2010 INVESTMENTS Deutsche Bank croup AT 02 039381 268298208 A"`3DGT III„I~~~++~+I~+II~+~I~I~'II..~~111~1~1+~~II~+IIlI~~II!"~Illll'I ~ Shareholder Services: (800) 728-3337 ESTHER M HEISEY TTEE 7 a.m. to 7 p.m. (CT} t~tonday through Friday ESTHER M HEISEY REV LIV TR Auto-nated.4ssistan~e Z4 hours a day U/A 10/26/2005 International: Call collect {816) 435-7177 305 TOUCHSTONE DRIVE 7 a.m. to 7 p.m. (CT) Monday through Friday CARLISLE PA 17015-6950 ~~~ Web Site: vwvlv.d~vs-investments.com r~~ Your Primary Account Number: 4295095939 To better serve ti~our needs, representatives are na~iT available from 7 a.m. to ? p.m. Central rime, ~landay through Frida~~. rind remember: You can obtain DWS fiord and account information and initiate transactions 24 hours a day, seven days a week on dws-investments.com or through the automated DWS telephone line. Call (801)) <21-104 for Class A, B, C and IIVST shares, or (800} 728-3337 fc~r Class S shares. Period Year to Date Your Portfolio Value 07/01 - 09/30/2070 01/01 - 09!30/2010 Beginning Portfolio Value $125,765.16 $122,847.61 Purchases/Reinvested Distributions $2,534.65 5130,629.30 Redemptions $0.00 -5125,085.48 Change in Value 56,047.14 $5,955.52 Transfers $0.00 $0.00 I Ending Portfolio Value on 09/30/2010 $134,346.95 $134,346.95) Your Portfolio by Asset Type Talk with your Portfolio Fulrr~ 1~i7111e financial advisor or call shareholder 100,00% Income Funds services ro learn 100.00°,% DWS High Income Plus Fund-S about manai;ing Total Income Funds risk rhrougli divc•rsificarion. 0.00% Multicategory/Asset Allocation Fund 0.00% DWS Lifecompass Retirement Fund-5 Total Multicategory/Asset Alfiacation Fund -- tftrlue orr _ 091.30/2oro $134,346.95 '- $134,346.95 ... 50.00 $o.oo $o.oo 50.00 50.00 SO.vo Total Portfolio Value Your Portfolio Summary by Fund Name 7 ot-71 Feud Name ShrlrE~i Ol~~lrer~ Non-Retirement DWS High Income Plus Fund-S 19,756,905 DWS Lifecompass Retirement Fund-S 0.000 $6.80 $10.81 ~t7~11E' 1771 (J~/-i~I?(,7j0 $134,346.95 $0.00 ~US,'" ~!!.i l ~ rr-o±t of 1711'E°il7)1P11t~ $130,E29.30 $0.00 Total Portfolio 5134,346.95 $130,629.30 Page 1 of 4 ~''rtlr-e ol- C/ittuge 0%Itll/?Ol p ~ This Perro~l 5125,765.16 $8,581.79 5125,765.16 $8,581.79 $125,765.16 $8,581.79 $134,346.95 S{~i7ri' P~7r e' 039381 113 is Quarterly Account Statement July 1, 2010 through September 30, 2010 Registered to: ESTHER M HEISEY TTEE ESTHER M HEISEY REV LIV TR U!A 10/26/2005 Share Shares Tasrrl ,Shares Price = This I r«rtsaetio~i C~tnned S6A'9 19,378.299 $6.67 133.127 19,511.426 $6•~ 116.916 19,628.342 $6.77 128.563 19,756.905 ~'-~ 19,75b.905 Registered to: ESTHER M HEISEY TTEE ESTHER M HEISEY REV LI V TR U/A 10/26/2005 Shrtre Shores Total Shires - Price = This 1 ra~asactiu)i Ottmed $10.21 0.~ Account Activity ^ Account Number 4295095939 Fund Name DWS High Incame Plu s Fund-5 Fund Number 2100 NASDAQ SGHSX Tra~.lx Late Transgr.-tiorr. T)esc)•x~tio)a Dollar An~nrrnt Beginning Balance on 07l01/20i0 $125,765.16 07/26/2010 income Reinvest $887 96 08/25/2010 Income Reinvest $776 32 09/24!2010 Income Reinvest $870.37 Change in Value $6,047.14 Ending Balance on 09/30/2010 $134,34b.95 ^ Account Number 4295095939 Fund Name DWS Lifecompass Retirement Fund-S Fund Number 2pg0 NASDAQ SCQCX Trade Date Transacti~~rr Dercriptiun Dollar Anto)snt Beginning Balance on 07/01/2010 X0,00 No Transactions This Period Change in Value x.00 Ending Balance on 09/30/2010 X0.00 Your Distributions Summary This Year Frrrrcl 1'V'iC)ne F7rna(-Account Nrrntfier DWS High income Plus Fund-5 2100-4295095939 DWS Lifecompass Retirement Fund-S 2080-4295095939 $10.81 0.0~ it~avr:~ ~~ v~r~v'r~; I'~~:au4s~,hh~ l3~sr~{~ Crau~r Irtco)ire T~rr~ideruls/ Sh~~)•t-7 err3r (:aitr I,otzg- lean Ga/3r 7 ntal $5,543.82 - $ 5,543.82 Total Earnings $5,543.82 $0.00 $5,543.82 - - -- Not FDIC Insured • ~_ ~--- -~ No Bank Guarantee • May Lose Value Page 2 of 4 c~s-r ooor,32~t~ I~a.~~, ~~ Send Inquires to: 5000 Louise-Drive po Box 4o Statement of Accounts Mechanicsburg, PA 17055 www.memberslst:org Aug Q1, 2010 thru Aug 31, 2010 Main:Switchboard:. (717)'.697-1161 ort8oo)283-2328 AcGOUnt Number EZ Call: (71 n :697.4372 or (800) 283.4372 282197 ~' TDD: (717) 697312 or (800) 283-2328 ext. 5312 ~C`~~~~ .[~~ TeleBranch: (717) 795-6049 oi•-(800) 237-7288 Ba{antes at a Glance: : ,~ [ . ~~~ ~R A~:~)t.~)31~r Dt~t~ N Checking: 2,172.07 ESTHER M HEISEY REVOCABLELIVHVG T :Savings: :5.00 C/O ESTMER M_WEiSEY Certificates: 47,229.75 305 TOUCHS70NE DR1VE Loans: CARLISLE PA 17015 0.00 Money Management: 14,778.75 Swipe 5 YTD Reward:: 0.50 Page: 1 of 3 Your current Member Loyalty Rewards level is Platinum and: your: aggregate balance as of August 1 is ~fi2,334.47. An aggregate balance of x75,000.00 and having 3 products will move you to the Titanium level. Buying or buildings home? Attend one of our FREE seminars! See the enclosed insert for more details. CHECKfNC ACCOi~NTS 0011 - CHECKING - Date Tcansaatian [Sescriatlon Additions Subtractiiarts Qaiance Aug 01 Balance Forvrard 82.92 Aug Q2 Deposit Transfer From Share ;0000 1,959.60 2,042.52 Aug U2 Withdrawal ACM ST PAULS-EVAN 200.00= 1,842.52 TYPE: CONTRtBUTN ID:341.17$66C~4'DATA:.59]4734545 C0: ST PAULS EVAN. Aug 03 :Deposit Transfer From Share 0000 643.00 2,4'5;1.52 Aug 03 Withdrawal Members 1St Online Trartisfer To Share 0005 - 1,900.00.- :555.52 Ac.~q Q3 1Afithdrawai ACti S M{DOLETON TWP 108.30- '447.22 TYPE: DIREGT DB 10: 223:1881662 GO: S MIDDLETGN TWP AUg 05 Check 000499 Tracer 000156tJ384 53.75- 383.47 Aug 10 tllfitttdrawal ACH. PPL EU 31.84- 361.63 TYPE: ELEC SVC ID: 1230959590..CO: PPL EU Aug 1~ Withdraws! ACH UGi UTILJTIES 12.31.- 349.32 TYPE: UGl B{LL ID: 3231174060 CO: UGP UTIL'tTIES Aug 18 Check OQ05fJ2 Tracer 0001166299 180.00- 169.32 Aug 21 Withdrawal at ATM #©03173. 60.Q0- 109:32 MEM$ERS 1ST FGU f166 WALNUT l30TTOM RD CARLISLE PA Rug 23 Deposit Transfer From Share Q(>Q5 2,200.00 - 2,3t1J.32 Aug 24 Check 000507 Tracer00Q1836628 70.00'- 2,239.32 Aug 30 Check 000506 'Tracer 0004208914 " 67.25- 2,172.07 Aug 31 Ending Balance 2,172.07 CHECK SUMMARY Check # Amount Date -Check # Amount Date 400499. 53:75. Auq 05, 000506+ 67:25 Auq 30 _000502' 980:00 Auq t8 000507 70:00. ' Auq 24 Asterisk next t0 number indicates skip in nUrriber sequence. 4 Cheeky Clearest for ~37f.Q0 - - -~ Continued an following page -. ~ , st Send Inquires.to: 5000 l:ouise Drive.: Main Switchboard: (717) 897-1161 or (80Q)-283-2328 AUg 01, :2010 thru AUg 31 , 2010 Po l3ox 40 t3 can: (717> s~7 4372 or (soo) 283-4372 a Account Number: 282197. 3tgNBERS ~• Mechanicsburg. PA 17055. TDD: (717) 697312 or(800) 283-2328 ext. 5312 www.memberslst.org TeleBranch (717) 795049 or (800) 237.7288 Page: 2 Of 3 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Aug 02 200.Q0 Withdrawal ACH ST PAUL:S EVAN Aug 10 3i .84 Withdrawal ACH PPL EU Aug 03 1,900.00 Withdrawal Members 1st Online Aug 13 12.31 Withdrawal ACti UGl UTILITIES Transfer To Share 0005- - Aug O3 108.30 Withdrawal ACM S MtDDLETON: .Aug 21 60.00 Withdrawal at ATM #003173 T1NP 6 Withdrawals add Other Charges for $2,312.45 .DEPOSITS. AND OTHER CREDITS Date Amount Description Date Amount Description Aug .02 1,959.60 Deposit Transfer From Share 0000 Aug 23 2,200:00 Deposit Transfer f=rom-Share 0005: Aug: 03 613.00 D®posiE Transfer. From Share 00013 3 Deposlis and Other-Credits for x4,772.60 SAVINGS ACCOUNTS 0000. -REGULAR SAVINGS Date Transaction _pescription Additions Subtractions Balance Aug 0?: Balance Forward 5:00 Aug 02 Deposit ACH DFAS-CLEVELAND 1,959.60:_: 1,964.60 Tl(PE: Af ANN PAY ID: 30410:16004 DATA: DO SYMBOL 8522-APS C O: DFAS-CLEVELAND Aug 02 Vlkthdrawal Transfer To Share 0011 1,9~v9.6p- >5.00 Aug 03 DeposifACH SOC SEC 613.00 61.8.00 ID: 3101036216 CQ: SOC SEC Aug 03 VWthdrawat Transfer To Share 0011' 613.00- 5,00 Aug 3? Ending>Balance - 5.fl0 OOQS ~ MCINEY MANAGEMENT Date - Transaction Description Additions Subtractions Balance Aug Q1 Balance Forward 15,073.24 Aug 03 Deposit Members istOnline Transfer From Share 0011 1,900.00 - 16,973.24 Aug 23 Withdrawal Transfer To Share 0011 2,200.00- 14,773.24 Aug ~? Deposit Dividend Tiered Rate 5.54 44,778.75 Annua! Vercentage Yield Earned D.40036 from 8/?/20?0 -through. 8/3?/20?0 Aug 3? Ending Balance 14,778 75 GE'RTIFIGATE AGCQUNTS tI049 - 7 MONTH CERT Maturity Date - Oct '(6, 2010 ` Date Transaction Description Additions Subtractions Balance Aug 0? Balance-Forward 10,556.44 Aug 31 Deposit Dividend 1.440% 12.91 10,569.35 Annua! Percentage Yield iEarned ?.43Oy from 8~l/2010 _~rough 8/31/2Q40 Aug 31 EndingrBalr,~nce 10,568;35 0050 - Ti4lOhITH CERT'Maturlty Datie -Nov: 10 2010 Date Transaction Description Additions Subtractions Balance Aug 01 B#Iance Forward 8,Q35.10 Aug 31 C3gposit Dividend 1.44U% 9.83 8,044.93 Annuhl Percentage Yle1d Eattred ?.4501% from 8/?/20?0 through 8/3?/2010 Aug 31 Ending Balance 8,Od4.93 0051 -11 MONTH CER7 Maturity-Date -Mar 16, 2011 Date Transaction Description Additions Subtractions Balance Aug 0? Balance Porward 11;046,50 :Aug 31 Deposit Dividend 1.440% ` 13.51 11,060,01 Annua! Percentage Yield Earned ?.45Q% from 87?/2010 through $131/Z07Q /lug 3~ ~~ding Qw/arrcv . . i ~ ,OGO.4S~ - Cq~rtinued on foibwing-page -- $end Inquires to: 5000 Louise Drive Main Sw"rbchboard: (717) 69Z-1.161 or{8oQ)-283-2328 Aug 01, .2010 tl'1rU -Aug. 31 , 2010: Po t3ox ao Ez call: (Tt7) 697 4372 or (800) 283.4372- Account Number;• 282197 n~seisBERS tr Mectranics6urg, PA 17055 tDD: (717) 697-5312 or (800) 283-2328 ext. 5317. ~ ~~.,`~„»x ~`~` vwvw.mamberslst.org TeleBrancttit (747) 7956049 or (800) 2s7.72s8 Pale: 3 of 3 t?aS2 - ~'! MONTH CERT Matarity Date -May 07; 201:1 Date Transaction Description Additions Subtractions Balance Aug 01 Balance-Forward 10,021.71 Aug. 31 Deposit Dividend 1.440% 12.26 10,033.97 Annual Percentage YIeJd Earned 1.450•/ from 8/1/2010 Through 8/39/Z070 Aug 31 Enalfng:Balance 10,033.97 0053 - 7 MONTH CERT Matucitty Datbe -Jan 10, 2011 Date Transaction Description Additions Subtractions Balance Aug D1 Balance Forward 7, 513.26 Aug 31 Deposit Dividend 1;290% 8.23 7,521.49 Annual Percentage veld-Famed 1.3Q09e from 8/1/2010 through 81/2010 Aug 31 Ending Balance 7,521 4g YTD SUMAIlAR1ES TOTAL DIVIDENDS PAID- 0000 REGULAR SAVINGS $0.6fl Ofl05 MONEY MANAGEMENT $23.96 0011 CHECKING gp.pp 0049 7 MONTH CERT $69:35 :0050 7 MONTH CERT $44.93 0051 11 MONTH CERT. $60.01 0052 11 MONTH CERT $33.97 (71753 7 MONTH CFRT $21.49 Tofia1 Year to. Date Dividends Paid NOTE: Total includes closed shares 429.77 .~. ~~;i~`' Bank of America, I.A. ~~~ !'.O. tioa tai ]t~ 'L'amha, 1' l.~ ;iati22-3 ! 1 t; rrrll~lirli~~iui~liiil~~rir,ilril,i,l~ll~ii,~~,~I~II~I~~~~I~ MD 09/24 0 0132 794 4 276 001931 #C~O1 AT 0.357 ESTHER M HEISEY TTEE ESTHER M HEISEY REV LIV TR DTD 10/26/05 305 TOUCHSTONE DR CARLISLE PA 17015-6950 H, Page 1 of 3 Statement Period Ofi- ] to-10 tau•ough 0!)-17-.I0 }; 1 ! 0 A 1' l'A 11 lumber of checks enclosed: 0 Acc;onnt lttnnber: 000;, 7117 0!192 Otir free Online Banking service alloti~rs you to check balances, track account activity and more. Enroll at ~v~viv.banl.ofamerica.coin. Customer;Service Information wwrnr.bankofamerica.cor'n For additional inforiiz<<tion or service, you mai- call: ~r you ma3- t~rrite to: 1.500.432.1000 Customer Servc+ 1.800:288.4408 TDD/TTY Users:Onl~~ $anli;'"of America, N.A. , P.O. -Box:- 25113 1.300.688.a;08G En Espaiial 'Tatiipa, FL 33622-5118_ Your Account at a Glance Account Nt_imber Beginning Balance on 08-19-10 Deposits and Other Additions Other Subtractions Ending Balance on 09-].7-10 0005 7117 0992 $ 9,549.74 + 3,437.02 - 5,354.73 $ 7,G32.03 An.n.ual. Percentage Yield. Earned. this Stdternertt. Period: 0.15%, Interest, Paid Year to Date: y`i20.%4 J Recycled Paper H H ESTHER M HEISEY TTEE ESTHER M HEISEY REV LIV TR llTD 10/26/05 Pagc2of3 Statement Period 08-19-10 through 09-17-10 B 1i 0 APPA Il Number of checks enclosed: 0 Account Nuatther: 0005 7.117 0992 Money Market Savings Additions and Subtractions Date Resulting Posted Amount($) Balances($) Transactions 08-20 276.73- 9,273.01 Bank Of America Credit Card Bill Payment 08-25 5,078.00- 4,195.01 Cumberland Cross Des:Dbt#3X0823 ID: Indn:Esther Heisey Co ID:9541194122 Ppd 09-08 3,436.27 + 7,631.28 Counter Credit 09-17 0.75 + 7,632.03 Interest Earned Daily Balance Summary Date Balance($) Date Balance($) Date Balance($i Beginning 9,549.74 08-25 4,195.01 09-17 7,632.03 08-20 9,273.01 09-08 7,631.28 0 2505 Ritner Highway ~ Carlisle, PA 17015 Pill Rost=e (AU 1538L) Dave Ro~~cTe (AU 2295L) 249-1978 697-4794 249-2677 suction Is Actio.~ Lall ~~.ow~" for Satisfcxction =,FLLEF~.S N A'~IE ~Al. s _ ~ t ~ " ,~~ t ~~ ~' a_ ;~ ~ j ~~ _. ~- , :ADDRESS ~ . ,. _ ;' `_! -= ~'-- ' -~ . _ . e ~ _ - PITt~,'+~ I '-- - l ~t "~ -L ~ ~ . ~UCTIO~I DATEiL~CATiQN Di`~~~R~PT~~I`i ~~ ~R~~A1V DB.~~ _ ~ t--- - - ALTC T I~:)NI~~~:K ~~% CI1E~ ~~~-- ____. .~l...t~e-- ~,. ~1 ~~' _~ ~~.~ls.t~~ .i•0. tis~ '"~ lT~~e°~ r ~ _._ _ __ ~_~_ Ws ..___._.._._.....___.___.__-._.____-.._~~_,-_____ `~~- c_ ate 1 w~- ~-~ E~~ .,~.. '+...'~' ~. ! y~'L ___'~ -~`~}i-'~,r__ _~_ _ R $$99 {y a Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. 11~Ierchandise ~o be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen- tative of the merchandise, goods and or property and have good title and the right to sell and that they are free from all incumbrances. i agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature refe~•red to in this agreement. -4C;CTION SI+~1riATURE SELLERS SIUiVATLTIZ.E..,~-~__ _ _ -. s__ __ . _ Total Sales (Clerking Tickets Attached) ~ ~ ~:-~ :.~'~-- _______.__ i:ess Sale Expense: ~1 J __._ ' f `~ °%~ Commission Auctioneer S ~ ~ ~r~- _ ___-.____ °7o Commission Clerks ~I-~OTAL SALE EXPENSE DEDUCTED ~ SELLERS ?~;ET __t . --- __ ~__' ~ i _. _.~ ~..,~ - ,~ _ ~,.,. \~ t i y'~ Page 1 of 1 ~Thrivent Financial for Lutherans~ EXPLANATION OF DEATH CLAtM PAYMENT ON CONTRACT LC4596060 Paid To: Edward A Heisey 13031 Triple Crown Loop Gainesville VA 20155 Notice Date: 10/05/2010 Claim Number: 453963 The following table summarizes the payments made on contract LC4596060 held on the life of Esther Mae Heisey BASIC COVERAGE+ ADDITIONS INDEBTEDNESS TOTAL PROCEEDS+ $92,959.47 $0.00 $0.00 $92,959.47 Basic Coverage =Cost Basis + Taxable Gain Additions = 0 Indebtedness = 0 DATE PAID PAYMENT TYPE AMOUNT PAID ** INTEREST PAID 10/05!2010 Check $ 30,989.41 $ 2.92 **Each payment includes the amount of interest shown in~ Interest Paid column. You have $0.00 remaining to be distributed from the claim on this contract. If you are required to report any taxable gain or interest payment as a result of this claim transaction, a form 1099R will be sent to you by January 31 of next year. Should you have any questions about this claim, please contact your financial associate MICHAEL P GALLAGHER, at phone 717-502-1100. + The Basic Coverage and Total Proceeds amounts represent the values of the variable annuity calculated on the date we received proof of loss. Until your properly completed claim form was received by us, your portion of the Total Proceeds remained subject to the investment experience of the variable account which may have increased or decreased daily. Edward A Heisey CC: MICHAEL P GALLAGHER 13031 Triple Crown Loop 0165 23908 00 Gainesville VA 20155 Deceased's Customer ID: 503388648 r Thrivent Financial for Lutherans® 4321 N. Ballard Road, Appleton, WI 54919-0001 Thrivent.com • 800-THRIVENT (800-847-4836) May 11, 2011 Vlr. Edward Heisey 13031 Triple Crown Loop Gainesville, VA 20155 Dear Mr. Heisey: This letter is regarding the death claim for Esther Mae Heisey. Securities offered through Thrivent Investment Management Inc., 625 Fourth Ave. S., Minneapolis, MN 55415--1665, a wholly owned subsidiary of Thrivent Financial for Lutherans. Member FINRA and SIPC. tsther held settlement agreement contract B2961063 with Thrivent Financial for Lutherans. The date or death value on that contract was $22,245.01. If you have any questions or concerns, please let us know. Sincerely, ~~ ~~~~, Kris Ristau, ALHC Claims Examiner Death Claims and Service Claim Operations Esther Mae Heisey 503388648