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HomeMy WebLinkAbout03-08-12 (3) 1505611185 REV-1500 EX (02-11) (FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes Po Box zaoeol INHERITANCE TAX RETURN 21 11 D 8 2 D Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 174-20-7421 07122011 04261912 Decedent's Last Name Suffix Decedent's First Name M I CONLEY CHARLOTTE M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ ^ ^ 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ^ ^ ^ 9. Litigation Proceeds Received 10. Spousal Poverty Credit (Date of Death 1 1. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number LINDA J- LUNDBERG VP 717-730-2265 First Line of Address 4242 CARLISLE PIKE Second Line of Address P•0- BOX 308 City or Post Office State ZIP Code CAMP HILL PA 17011 REGISTER OF WILLS USErONLY {~ , _.:~ -rj ~ ~ J z.>..~ rz1 r , - _c;~~ .. r-}~ ~ - AT~FILED ~-- .. ~.• .t-1 •~ i (` __ _.~~ Correspondent'se-mail address: LINDA •LUNDBERG&PNC • COM Under penalties of perju~,I~Ki~l~tav~x~i~ed this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct an¢-egmplete. Declaration ~f-preparer gtfiFr than the personal representative is based on all information of which preparer has any knowledge. ADDRESS M14G~+~~,t=~ =+~adti-'r+evice `~ P•0- BOX 308 CAMP HILL, PA 17001-0308 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE PLEASE USE ORIGINAL FORM ONLY 1505611185 Side 1 OM4647 3.000 1505611185 J J 15D5611285 REV-1500 EX (FI) Decedent's Social Security Number 174-2D-7421 Decedent's Name: CONLEY CHARLOTTE M RECAPITULATION 1. Real Estate (Schedule A) 1 D • D D 2. Stocks and Bonds (Schedule B) . 2 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3 4. Mortgages and Notes Receivable (Schedule D) 4 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) 8 9. Funeral Expenses and Administrative Costs (Schedule H). g, 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 11. Total Deductions (total Lines 9 and 10) , 11. 12. Net Value of Estate (Line 8 minus Line 11) _ 12. 13. Charitable and Governmental BequestslSec 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. ]„848.44 0•DD 0.00 4,577•D5 D•DD 903,519.15 9D9,944.64 45,639.33 7,864.74 53,5D4•D7 856,44D•57 28,DDD•DO 828,44D•57 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 16. Amount of Line 14 t xable ~ at lineal rate X 0 4 D D D . • 16. 17. Amount of Line 14 taxable at sibling rate X .12 414 , 2 9 5. 2 9 17. 18. Amount of Line 14 taxable at collateral rate X .15 414 ,14 5.2 8 1 a. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 15D5611285 OM4648 3.000 D•DD D•DD 49,715.43 62,121.79 111,837.22 REV-1500 EX (Fp Page 3 Decedent's Complete Address: File Number 2~, ~,~, ^g2^ DECEDENTS NAME CONLEY CHARLOTTE M STREET ADDRESS CUMBERLAND CITY MECHANICSBURG STATE PA ZIP 17055- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 8 8, 5 4 0. 0 0 B. Discount 4 , 6 6 0.0 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) (1) 111,837.22 Total Credits (A + B) (2) 9 3 , 2 0 0 •0 0 (3> 0.00 0.0 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 18 , 6 3 7 • 2 2 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred b. retain the right to designate who shall use the property transferred or its income c. retain a reversionary interest d. receive the promise for life of either payments, benefits or care? Yes ~ ^ No ^ 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(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. OM467'I 2.OOD REV-1502 EX + (01-10) pennsylvania DEPARTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: CHARLOTTE M. CONLEY 21 11 0820 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant fads. Real property that is jointlyowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH None TOTAL (Also enter on Line 1, Recapitulation.) I $ 0.00 swasss z.ooo If more space is needed, use additional sheets of paper of the same size. REV-1503 EX + (6.98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS ~ BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTA' FILE NUMBER CHARLOTTE M CONLEY 21 11 0820 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1.44 Shares METLIF'E INC COM. CUSIP: 591568108 3 W 4696 1. D00 DESCRIPl10N TOTAL (Also enter on line 2, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 1,848.44 1,848.44 REV-1507 EX+ (6-98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES 8c NOTES INHERITANCE TAX RETURN RFSloerrr ~ECE~ENT RECEIVABLE ESTATE OF FILE NUMBER CHARLOTTE M. CONLEY 21 11 0820 All property jointlyowned with right of survivorship must be disclosed on Schedule F. 3w4snC 1.000 (If more space is needed, insert adddional sheets of same size) REV-1508 EX+ (11-10) Pennsylvania SCHEDULE E DEPARTMENTOF REVENUE CASH, BANK DEPOSITS, 8c MISC. ESIDENTDECEDENTTURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: CHARLOTTE M. CONLEY 21 11 0820 Include the proceeds of litigation and the date the proceeds were received by the estate. All propert 'ointl owned with ri ht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CASH 5 9.12 2 METLIFE INC. UNLASHED DIVIDEND CHECK PAYABLE 12/15/08 32.56 3 PNC BANK CHECKING ACCOUNT # 5140012639 VALUE AS OF 07/12/11 PER ATTACHED LETTER AS FOLLOWS: BALANCE 07/12/11 1,000.00 ACCRUED INTEREST .O1 TOTAL 1,000.01 1,000.01 4 PA PUBLIC SCHOOL EMPLOYEE PENSION BENEFIT AS FOLLOWS: JULY BENEFIT 1,908.24 LESS REFUND 949.34 NET BENEFIT 958.90 958.90 5 HOLY SPIRT HOSPITAL REFUND OF OVERPAYMENT 50.21 6 THE PATRIOT NEWS NEWSPAPER SUBSCRIPTION CANCELLATION REFUND 151.25 7 ROWES AUCTION SERVICE PROCEEDS OF SALE OF PERSONAL PROPERTY 1,004.00 8 ROWES AUCTION SERVICE PERSONAL PROPERTY VALUE AS OF 07/12/11 PER LETTER APPRAISAL DATED 08/17/11 270.00 9 ESTIMATED 2011 PA INDIVIDUAL INCOME TAX REFUND 104.00 10 ESTIMATED 2011 FEDERAL INDIVIDUAL INCOME TAX REFUND 947.00 OW46AD 2.000 TOTAL (Also enter on line 5, Recap If more space is needed, use adddional sheets of paper of the same size. $I 4,577.05 REV-1509 EX+(01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: CHARLOTTE M. CONLEY 21 11 0820 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule ~ SURV N RJG JOINT TBJA NT(S) NA NIE(S) JOINTLY OWNED PROPERTY: RELATIONSHIP TO DECEDENT ~~ NLMIBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCR~TION OF PROPERTY INCLUDE NAM: OF FlNANCIAL INBTRUTION AND BANK AOCOUN7 NUM3ER Oft SIMLAR IDENTIFYINGNUASER.ATTACHDEEDFORJOINTLYHELDREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECFDBdTS INT62EST DATE OF DEATH VALUE OF DEC®B~lTSRJTH2EST None TOTAL (Also enter on Line 6, Recapitulation) E 0.00 9W46AE 2.000 If more space is needed, use additional sheets of paper of the same size. REV-151 D EX + (OB-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDEt~ti ATE NUMBER CHARLOTTE M. CONLEY 21 11 0820 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBS DESCRIPTION OF PROPERTY INCLLDETHENNAEOFTFETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAI~ TFEDATEOFTRANSFER.ATTACHACOPVOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE 1• REVOCABLE DEED OF TRUST DATED MAY 30, 1996, RESTATED AND AMENDED SEPTEMBER 21, 2000 BETWEEN CHARLOTTE M.CONLEY SETTLOR AND PNC BANK N.A. TRUSTEE, A COPY OF WHICH IS ATTACHED HEREWITH. THE ASSETS ARE VALUED AS OF JULY 12, 2011, DATE OF DEATH PER THE ATTACHED ESTATE TAX SECURITIES VALUATION STATEMENT. 903,519.15 100.0000 0.00 903,519.15 2 FOR INFORMATIONAL PURPOSES ONLY: THE DECEDENT WAS RECEIVING A MONTLY PENSION FROM THE COMMONWEALTH OF PENNSYLVANIA. WITH THE EXCEPTION OF THE FINAL PAYMENT REPORTED ON SCHEDULE E, ITEM 4 ALL BENEFITS TERMINATED AT THE DEATH OF CHARLOTTE M. CONLEY WITH NO FURTHER BENEFITS DUE HER HEIRS OR THE ESTATE 0.00 100.0000 0.00 0.00 TOTAL (Also enter on line 7, Recapitulation) $ SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY 903,519 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+00.09) pennsylvania DEPARTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER CHARLOTTE M. CONLEY 21 11 0820 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ STONE & HURRAY FUNERAL HOME FUNERAL SERVICES 8,131.00 Total from continuation schedules . B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) PNC BANK N. A. Street Address 4242 CARLISLE PIKE City CAMP HILL State PA ZIP 17011 Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4. 5. 6. 7. 1 City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: ROWES AUCTION SERVICE AUTIONEERS COMMISSION Total from continuation schedules . 77.99 27,325.00 9,419.00 351.40 334.94 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 45 , 639.33 swaeAC z.ooo If more space is needed, use additional sheets of paper of the same size. Estate of: CHARLOTTE M. CONLEY Schedule H Part 1 (Page 2) Item No. Description 2 VIRGINIA RAUDABAUGH REIMBURSEMENT FOR FUNERAL CLOTHING 21 11 0820 Amount 77.99 Total (Carry forward to main schedule) 77.99 Estate of: CHARLOTTE M. CONLEY Schedule H Part 7 (Page 2) 2 CN7TRT.F.S E . SHIELDS III , ESQUIRE REIMBURSEMENT FOR: PROBATE COSTS 93.50 LEGAL ADVERTISING 211.34 TOTAL 304.94 3 REGISTER OF WILLS PA INHERITANCE TAX RETURN AND INVENTORY FILING FEE 21 it 0820 304.94 30.00 Total (Carry forward to main schedule) 334.94 REV-1512 EX+ (12-OB) pennsylvania SCHEDULE I DEPARTMENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS RFCIf1FAlT f1F(`Ff1CAIT ESTATE OF FILE NUMBER CHARLOTTE M. CONLEY 21 11 0820 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. 8W46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) SCHEDULE J pennsylvania DEPARTbENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: l.L].F]tCLV 11 L' 1`7. I.VNl~t'iS 21 1 1 0820 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. MELVIN RAUDABAUGH 1/3 OF BALANCE OF RESIDUARY ESTATE/TRUST PER ATTACHED STATEMENT VALUE: 138,048.43 Nephew 136,048.43 2 RICHARD RAUDABAUGH 6607 NORFOLK PLACE HARRISBURG, PA 17111 1/3 OF BALANCE OF RESIDUARY ESTATE/TRUST PER ATTACHED STATEMENT VALUE: 138,048.43 Nephew 138,048.43 ENTER DOLLAR AMOUM'S FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 B OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBU710NS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1• See Attached 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 28 , 000.00 ewasni z.ooo it more space is neeaea, use ao0icionai sneers or paper of the same size. Estate of: CHARLOTTE M. CONLEY Schedule J Part 1 (Page 2) Item No. Description 3 STEPHANIIE SCHWARTZ 2 FAIRFIELD LAINE MECHANICSBURG, PA 17050 1/3 OF BALANCE OF RESIDUARY ESTATE/TRUST PER ATTACHED STATEMENT VALUE: 138,048.42 4 EARL P. CONLEY 5225 WILSON LANE, APT. 4106 MECHANICSBURG, PA 17055-6670 50~ OF RESIDUARY ESTATE PER ATTACHED STATEMENT VALUE: 414,220.29 5 VIRGINA L. RAUDABAUGH C/O STEPHANIE SCHWARTZ 2 FAIRFIELD LANE MECHANICSBURG, PA 17050 PERSONAL PROPERTY DISTRIBUTED PER ATTACHED STATEMENT VALUE:75.00 Niece Relation Brother Sister 21 11 0820 Amount 138,048.42 414,220.29 75.00 Estate of: CHARLOTTE M. CONLEY 21 11 0820 Schedule J Part 2B (Page 1) Item No. Description Amount 1 FIRST CHURCH OF GOD 323 RENO AVENUE NEW CUMBERLAND, PA 17070 CASH BEQUEST 20,000.00 20,000.00 2 CUMBERLAND COUNTY CANCER SOCIETY A/K/A AMERICAN CANCER SOCIETY C/O BILL M. ROBERTS PO BOX 720366 OKLAHOMA CITY, OK 73162 CASH BEQUEST 5,000.00 5,000.00 3 COMMISSION ON NATIONAL MISSIONS OF THE CHURCH OF GOD A/K/A CHURCHS OF GOD GENERAL CONFERENCE, CROSS CULTURAL MINISTRIES 700 E. MELROSE AVENUE P.O. BOX 926 FINDLAY, OH 45839 CASH BEQUEST 1,000.00 1,000.00 4 SOUTH CENTRAL PENNSYLVANIA CHAPTER OF THE HEART ASSOCIATION A/K/A AMERICAN HEART ASSOCIATION ATTN: BETSY WOODMAN- BEQUEST ADM. P.O. BOX 22249 ST. PETERSBURG, FL 33742 CASH BEQUEST 1,000.00 1,000.00 5 NAVAJO MINISTRIES INC. P.O BOX 1230 2103 W. MAIN STREET FARMINGTON, NM 87499 CASH BEQUEST 1,000.00 1,000.00 ESTATE OF CHARLOTTE M. CONLEY FILE # 21 11 0820 ATTACHMENT TO SCHEDULE J, BENEFICIARIES CALCULATION OF RESIDUARY ESTATE/TRUST SCHEDULE B- STOCKS AND BONDS 1,848.44 SCHEDULE E- CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY 4,577.05 SCHEDULE G-INTER-VIVOS TRANSFERS AND MISCELLANEOUS NON-PROBATE PROPERTY 903,519.15 TOTAL GROSS ASSETS 909,944.64 LESS: SCHEDULE H- FUNERAL AND ADMINISTRATION EXPENSES 45,639.33 SCHEDULE I- DEBTS OF DECEDENT 7,864.74 CHARITABLE BEQUESTS PER SCHEDULE J 28,000.00 TOTAL 81, 504.07 81, 504.07 RESIDUARY ESTATE/TRUST 828,440.57 THE RESIDUARY ESTATE IS PAYABLE TO THE CHARLOTTE M CONLEY REVOCABLE DEED OF TRUST (ESTATE SETTLEMENT TRUST) AND IS PAYABLE OUTRIGHT AMONG THE FOLLOWING HEIRS AS DETAILED BELOW: NAME OF HEIR ITEMS INTEREST ALLOCATED DIST. AMOUNT EARL P. CONLEY PERSONAL PROPERTY 195.00 OTHER PROPERTY 414,025.29 TOTAL 414,220.29 50% 414,220.29 VIRGINIA L. RAUDAUGH PERSONAL PROPERTY 75.00 TOTAL 75.00 75.00 THE BALANCE OF THE 50% INTEREST IN THE RESIDUARY ESTATE PASSES TO NEPHEWS AND NIECES OF THE DECEDENT PER THE ATTACHED DISCLAIMER: MELVIN RAUDABAUGH OTHER 138,048.43 138,048.43 RICHARD RAUDABAUGH OTHER 138,048.43 138,048.43 STEPHANIE SCHWARTZ OTHER 138,048.42 138,048.42 414,145.28 TOTAL 828,440.57 COMMONWEALTH OF PENNSYLVANIA DEPAR7fv1EN7 OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17728-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT No. co 0~~030 PNC BANK N.A. PO BOX 308 CAMP HILL, PA `1701 1 ACN ASSESSMENT - CONTROL NUMBER load ESTATE INFORMATION: SSN: 174-20-7421 FILE NUMBER: 21 1 1 -0820 DECEDENT NAME: CONLEY CHARLOTTE M DATE OF PAYMENT: 10/04/201 1 POSTMARK DATE: 10/04/2011 couNTY: CUMBERLAND DATE OF DEATH: 07/ 12/ 201 1 101 ~ $8$,540.00 1 REV-3162 EX(11-96) AMOUNT TOTAL AMOUNT PAID: REMARKS: $88, 540.00 GHECK# 514659 INITIALS: DB SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER LAST WILL AND TESTAMENT OF CHARLOTTE M CONLEY I, CHARLOTTE M. CONLEY, single woman, currently of Bethany Village, Lower Allen Township (Mechanicsburg), Cumberland County, Pennsylvania, being of sound and disposing mind, memory, and understanding, declare this to be my Last Will and Testament, hereby revoking all prior wills and codicils. FIRST: I direct that my clothing be given to VIltGINIA RAUDABAUGH, Box 37, New Kingstown, Cumberland County, Pennsylvania, for her use or to be discarded as she deems appropriate. SECOND: In the event that I have determined to make any specific bequests to any particular persons, I will have done so on a separate piece of paper which will have been enclosed herewith or which will have been previously delivered to my executor. THIRD: I give, devise, and bequeath all the rest, residue, and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, to PNC Bank, National Association. Trustee Linder my FUNDED REVOCABLE TRUST AGREEMENT of May 30, 1996 and the RESTATEMENT AND AMENDMENT thereto of even date herewith, heretofore executed by me as Settlor, to be added the principal held thereunder. FOURTH: I appoint PNC BAI~TK, National Association, as Executor of this, my Last Will and Testament. My corporate Executor shall be compensated as per its standard fee schedule in effect when services are rendered. No fiduciary acting hereunder shall be required to post bond or enter security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~~ day of ~y~%~~- , A.D. 2000. a (SEAL) CHARLOTTE M. CONLEY Signed, sealed, published and declared by the above-named CHARLOTTE M. CONLEY, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscri our names as witnesses. e /~~~~ ~ ~~~ ~'f~~ WHEREAS, CHARLOTTE M. CONLEY, single woman, formerly of the Borough of New Cumberland, Cumberland COunty, Pennsylvania, as Setflor, entered into a FUNDED REVOCABLE TRUST AGREEMENT with PNC BANK, National Association, as Trustee, dated the 30th day of May, 1996; and WHEREAS, the said CHARLOTTE M. CONLEY is desirous of continuing the said TRUST as currently administered and managed, but is desirous of amending the directions for division and distribution of assets in the event of her death as currently appear in Item SECOND, subparagraph (B); and - WHEREAS, the said PNC BANK, National Association is also desirous of amending parts of the said TRUST that address administration and management powers; and WHEREAS, for the sake of convenience and clarity, it has been deemed advisable to make such amendment in the form of an integrated restatement of the said TRUST, the same is accordingly done hereinbelow with a newly amended Item SECOND, subparagraph (B) which revokes and replaces the former (B) which provided for a general distribution to the executor of the Settlor's estate and with newly added paragraphs and subparagraphs.pertaining to powers of the said Trustee. WITNESSETH: This RESTATEMENT AND AMENDMENT is executed in duplicate this a/y~ day of , 2000, between the said CHARLOTTE M. CONLEY, as Settlor, and the said PNC BANK, National Association, as Trustee. FIRST: Settlor grants, assigns and sets over to Trustee and its successors, all the property described in Schedule "A", annexed hereto and said property, together with all other property, real or personal, that may be added to the Trust (such property and additions being hereinafter called principal), shall be held by Trustee, IN TRUST, upon the following terms. SECOND: Trustee shall manage all property comprising the principal of this Trust and shall collect the income therefrom and accretions thereto and shall pay the net income and hold and distribute the principal of said Trust as follows: (A) Trustee shall pay the net income therefrom to Settlor for and during his or her lifetime, subject to the provisions of Item FIFTH, in such periodic installments as Trustee shall find convenient but at least as often as quarter-annually. (AA) All of the death taxes due on the assets passing under Settlor's will or under this revocable trust shall be paid from the residue of this trust without apportionment among the beneficiaries. - -ter- _ _ . (B) Upon the death of Settlor, after the payment of any outstanding debts, fees, taxes, administrative costs and the like which may be associated with the settlement of my worldly affairs, Trustee shall divide and distribute the then remaining principal and any accumulated or undistributed income in the following manner, to wit: 1.) twenty thousand ($20,000.00) dollars to the First Church of God, of New Cumberland, PA 17070; 2.) five thousand ($5,000.00) dollars to the Cumberland County Cancer Society, 117 North Hanover Street, Carlisle, PA 17013; 3.) one thousand ($1,000.00) dollars to the Commission on National Missions, of the Church of God, P. O. Box 926, Findlay, OH 45840; 4.) one thousand ($1,000.00) dollars to the South Central Pennsylvania Chapter of the Heart Association, Harrisburg, PA; and 5.) one thousand ($1,000.00) dollars to the Navajo Mission, 2103 West Main Street, Farmington, NM 87401. If, for any reason, the trust assets are insufficient to pay in full all of the above listed specific bequests, then they shall be proportionally abated. 6.) All the rest, residue, and remainder of the trust assets shall be further divided and distributed as follows: a.) one-half (1/2) thereof shall go to Settlor's brother, EARL CONLEY. In the event that he has predeceased Settlor, then his shaze shall go to his wife, FLORENCE CONLEY. In the event that she also has predeceased Settlor, then this share shall go to Settlor's sister, VIRGINIA RAUDABAUGH, in the manner provided for below. b.) one-half (1/2) thereof shall go the Settlor's sister, VIRGINIA RAUDABAUGH. In the event she has predeceased Settlor, her share shall be equally divided and distributed amongst her three (3) children, to wit: MELVIN RAUDABAUGH, RICHARD (RICK) RAUDABAUGH, and STEPHANIE SCHWARTZ. in the event any of the said three (3) said children has also predeceased Settlor, his or her share, as the case may be, shall go to his or her children in equal shares, ner stirpes. In the further event that any of the three (3) said children has also predeceased Settlor, but has not been survived by children, then his 2 or her share, as the case may be, shall go to his or her brothers and/or sister, as the case may be, or the children of such brother or sister if he or she has also predeceased Settlor, Der sri~es. THIRD: The principal and income of this Trust shall be free from anticipation, ! assignment, pledge or obligation of Settlor and shall not be subject to any execution or attachment j or to voluntary alienation. FOURTH: Trustee shall have the following powers in addition to those vested in it by law and by other provisions of this Trust, applicable to all property, whether principal or income, exercisable without court approval, and effective until actual distribution of all property: (A) To retain any or all of the assets of this Trust, real or personal, including stock of Trustee, or of its parent holding company without regazd to any principal of diversification or risk. (B) To invest in all forms of property, including stock, common trust funds and mortgage investment funds whether operated by Trustee, or its parent holding company, without restriction to investments authorized for Pennsylvania Fiduciaries, as it deems proper, without regazd to any principal of diversification or risk. (C) To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as it deems proper. (D) To allocate receipts and expenses to principal or income or partly to each as Trustee from time to time thinks proper in its sole discretion. (E) To hold property in the name of Settlor or in its name without designation of any fiduciary capacity, or in the name of a nominee or unregistered. (F) No rule of law against self-dealing, divided loyalty, or conflict of interest shall be applied to render any transaction effected by the fiduciaries void, voidable, or otherwise subject to attack solely for violation of such rule, nor shall the fiduciaries incur any liability, nor shall any fiduciary commissions for acting hereunder be reduced, solely for violation of such rule. Any transaction which involves self-dealing, divided loyalty, or conflict of interest by the fiduciaries shall be judged by the rules of law which would apply to the same transaction at arm's length between strangers free of any element of self-dealing, divided loyalty, or conflict of interest. Thus, by way of illustration and not of limitation, all fiduciaries are authorized, without giving any notice required by statute, to: 1 J Employ and compensate any fiduciary or any affiliate as broker, agent, or professional advisor for any purpose. 2.) Borrow from the commercial department of any corporate fiduciary ~i' or any affiliate at current interest rates. 3.) Buy, retain, and sell any debt or equity security issued or underwritten by any corporate fiduciary or any affiliate and any debt security secured, supported, and/or otherwise enhanced by a letter of credit issued by any corporate fiduciary or any affiliate. 4.) Buy, retain, and sell any security of any investment company or trust registered under the lnvesiment Company Act of 1940 to which any corporate fiduciary or any affiliate renders services for compensation. 5.) Buy property from or sell property to any beneficiary or fiduciary acting hereunderor otherwise on arm's length terms. An "affiliate" means any entity which owns, directly or indirectly, an interest in any corporate fiduciary, any entity in which any corporate fiduciary owns an interest, duectiy or indirectly, and any entity in common control with any corporate fiduciary. (G) To employ and compensate as they deem appropriate, without diminution of any fiduciary's compensation hereunder, any brokers, advisors, professional persons, and other agents and, in their discretion, to delegate revocably investment and management discretion to any such broker, advisor, professional person or agent. (H) To make distributions in cash or in kind or partly in each at fair market values on the date of distribution. (I) Without the permission of any court any individual fiduciary acting hereunder may resign by a writing lodged with the permanent records hereunder. (7) To compromise controversies. (K) To borrow money from any source, and to mortgage or pledge estate assets as security. FIFTH: Trustee may apply the net income of this Trust for the support of Settlor should he or she by reason of age, illness or any other cause, in the opinion of the Trustee, be incapable of disbursing it; and Trustee is further authorized to expend or apply from the principal of this Trust such sums as it, in its sole discretion, may, from time to time, think advisable for the support of Settlor to maintain him or her in the station of life to which he or she is accustomed at the creation of this Trust, or during illness or emergency. SIXTH: Subject to the approval of Trustee, anyone may add property, real or personal, to the principal of [his Trust by deed, will or otherwise. 4 .. :.... .. ~ .. .. :: .. .~ .._. :.... L SEVENTH: Trustee shall receive compensation for the performance of its functions hereunder in accordance with its standard schedule of fees in effect from time [o time during the period over which its services are performed. EIGHTH: Settlor reserves to himself or herself the right by an instrument in writing intended to take effect during Settlor's Iifefime signed by Settlor and delivered to Trustee to revoke or amend this Agreement in whole or in part provided that the duties, powers and liabilities of Trustee shall not be substantially changed without its written consent. NINTH: The situs of this Trust for administration and accounting purposes shall be in the County of Cumberland and Commonwealth of Pennsylvania, and all questions pertaining to the construction or validity of the provisions of this instrument shall be governed by the laws of that Commonwealth. IN WITNESS WHEREOF, Settlor has hereunto set her hand in the day and year first above written and Trustee has executed this instrument and caused its corporate seal to be affixed hereto. ATTEST: ~ Q (CORPORATE SEAL) CHARLOTTE M. CONLEY PNC BANK National Association By: 5 ~~. ~.,t . COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND On this, the ~2~ day of - , 2000, before me a Notary Public, the undersigned officer, personally appeared HARLOTTE M. CONLEY, known to me (or` satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal. Notary Public Notarial Seal Charles E. Stdelds III, Notary Publb Monroe Twp., Cumberland County My ConrMssion E~Ires June 20, 2004 MarllUBf, P8IMi8y11rarrlaAS90CIallOrl of NOfarie6 In Re: Restatement and Amendment of Funded and Revocable Trust of May 30, 1996 of Charlotte M. Conley, Deceased, Late of Lower Allen Township, Cumberland County, Pennsylvania,. and the last Restatement and Amendment thereof having taken place on September 21, 2000. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DOCKET NO. 21-11-0820 ORPHANS' COURT DIVISION / REGISTER OF WILLS n ~~ '- o ~: ~~ T~~ j~ ~_ -~ ^ 1° 1 . ,-; C S A § 6201',"' DISCLAIMER IN ACCORDANCE WITH 20 Pa - ` ' - . . . . i~ ~ - -.~.~ . [ 1 t ~; - -; r, ~.~ _ -i T -y 4`3 ~`_ T w `' 1 1.~7 ~1 ~_ 1. Charlotte M. Conley, departed this earthly life on July 12, 2011, at the Holy Spite Hospital, in East Pennsboro Township, Cumberland County, Pennsylvania. Decedent resided at Bethany Village in Lower Allen Township, Cumberland County, Pennsylvania and had a mailing address at the time of 5225 Wilson Lane, AL246, Mechanicsburg, Cumberland County, Pennsylvania 17055. 2. Decedent was never married and was survived by a brother and a sister. The brother is Earl Conley, currently of 5225 Wilson Lane, Apartment 4106, Mechanicsburg, PA 17055-6670. The sister, Virginia L. Raudabaugh, who makes this instant Disclaimer, has a current address of 28 Nottingham Drive, Mechanicsburg, PA 17050. 3. Decedent's probate estate was minimal and consisted of various assets having a total value of approximately Five Thousand Four Hundred and No/100ths ($5,400.00) Dollars. 4. Decedent's estate also consisted of significant non-probate assets. More specifically these assets consisted of various stocks, bonds, mutual funds, and money market funds held i.n the above-referenced and captioned Funded Revocable Trust Agreement. The date of death value of these assets was approximately Nine Hundred Four Thousand and No/100ths ($404,000.00) Dollars. S. The combined probate and non-probate estate is subject to the payment of inheritance takes, costs, fees, expenses and debts. The said estate is well mare than sufficient to bear the payment of the same with no danger of insolvency. b. The said Virginia L. Raudabaugh, sister of decedent, is not indigent, necessitous nor impoverished and has sufficient means and property of her own to comfortably maintain herself in the style to which she is accustomed. 7. Letters Testamentary were duly and properly granted to PNC BANK, N.A. by the Register of Wills in and for Cumberland County on the 25~' day of July 2011. 8. Under the terms of decedent's duly probated Last Will and Testament dated the 21~` day of September 2000 {true and correct copy of which is attached hereto and made a part hereof), most particularly in Item THIRD of the said Will, decedent gives, devises, and bequeaths all the rest, residue and remainder of her estate, real, personal, and mixed, whatsoever and wheresoever situate to the said PNC Bank, N.A. as her duly appointed Trustee under the aforesaid Funded Revocable Trust Agreement of May 30, 1996 and the Last Restatement and Amendment thereto of September 21, 2000. Said probate estate is to be added to the principal held in said Trust. 9. ITEM SECOND {B) 6.) b.) of said Funded Revocable Trust Agreement of May 30, 1996 and the last Restatement and Amendment thereto of September 21, 2000 (a true and correct copy of the said Trust is attached hereto and made a part hereof) provides that one-half (tfz} of the residuary portion of said Trust is to go to the said Virginia L. Raudabaugh. It further provides that in the event she had predeceased her sister, the decedent herein, then Virginia L. Raudabaugh's share was to be equally divided and distributed amongst her three (3} children, to wit: Melvin Raudabaugh, Richard (Rick) Raudabaugh, and Stephanie Schwartz, now by more recent marriage known as Stephanie Madden. 10. The afore-named three (3) children have all survived both the said decedent and their said mother, Virginia L. Raudabaugh, and continue to so survive as of this date. 11. All of the afore-named three (3) children are combos mends individuals in excess of twenty-one (21) years of age. 12. Virginia L. Raudabaugh, has accepted no benefits from the aforesaid one-half (~i) residuary interest, has exercised no dominion over the same, and, in the event there have been or are any automatic credits made to her benefit in said Trust account, she has or shall disgorge all of the same back into the said Trust from whence they came, to the favor of her said three (3) children. 13. Virginia L. Raudabaugh, in her capacity as decedent's surviving sister, and in her capacity as a residuary beneficiary, provided for in decedent's aforesaid residuary disposition in her aforesaid Trust, desires to disclaim any and all of the above referred to residuary share. The operation of this disclaimer will deem her to be legally dead for the purposes of the distribution provided for in the said residuary portion of the said Trust and will result in the distribution of the balance of the same remaining after the payment of all death taxes, costs, fees, expenses and debts, as well as specific bequests unto her said three (3) children, the said alternate beneficiaries of the said Trust. NOW THEREFORE, intending to be legally bound hereby, I, Virginia L. Raudabaugh, the surviving sister and residuary beneficiary as above set forth more fully at large, do hereby disclaim any and all interest in and to the aforesaid one-half (~/z} interest as such residuary beneficiary and any fruits 2 thereof, to which I would otherwise have been entitled under the laws of the Commonwealth of Pennsylvania. I have hereunto set my hand and seal this ~ ~ day of t' ~•~~~ 2012. .• f ;~~~ ~- ~~~ . Witness ( VIR IA L. RAUDABAUGH Witness COMMONWEALTH OF PENNSYLVANIA } } S5: COUNTY OF CUMBERLAND } On this, the Z ` day of r ~"`'~ , 2012, before me, the undersigned officer, personally appeared VIItGllvIA L. RAUDABAGH, who being duly sworn according to law, deposes and says that the foregoing Disclaimer is her act and deed and that she desires the same to be recorded as such. IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal the day and year aforesaid. Notary Public ~-/ My commission expires: (SEAL) C~~,9RFGtFdt'U~l.l'~'i o~ ='`t_;-.~;~ ;•~_ ~:~:'~,;;; ~: Caris;s FS~, Cun-~~el;a{~d .^c~•.~rv Ky Co,;=rrss:io(I ~=:s~~s ~;c.E.~.:~ ;_f~i Nemhet, Pe~rts4'iv2ri3?;~:;:r_~:~yo;i ^.ii;:'~ :; :-<-,! 3 J u 1. 28. 2011 10: 45AM PNC BANK ~- L~~i~tG TIDE WAY July 23, 2011 Carol Koscienski PNC Bank Wealth Management RE: Charlotte M Conley SSN: 174-20-7421 DOD: 07-12-2011 Dear Ms. Koscienski: No, 0622 P, 2/2 In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checlung Account Account # 5140012639 Established: Ol-O1-1978 CHARLOTTE CONLE~SC DOD balance: $ 1,000.00 + 0.01 accrued interest Please note that this office provides date of deat}z balances for deposit accounts (IRAs, CDs, Checking and Savings). ~Ve do not process an~+ financial transactions or provide statements, zf you need assistance with any of these items, please call 1-$88-PNC-DANK (1-888-762-2265) or stop by your ]ocal PNC Bank brane}z office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC phis message is intended for the use of the individual or entity to which It is addressed and may contain information that is privileged, confrdential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for deliver-ing this message to the Intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error, please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this fazed document. Page 1 of 1 ,. aJIA~A~d Rowe's Auction Service 2505 Ritner Highway Carlisle, PA 17015 717-574-1008 249-1978 215-1044 To: Linda Lundberg Vice President PNC Bank Wealth Management P.O. Box 380 Camp Hill, PA 17001-0308 From: Rowe's Auction Service 2505 Rimer Highway Carlisle, PA 17015 Re: Personal Property Appraisal Estate of Charlotte Conley * 1896 Morgan type Silver Dollar on chain *Antique Brass School Hand Bell *Reclining Dog Figurine *Framed Coin Assemblage, Silver & Half Dollars, Type coins *2 Copper Pictures, Indian on Horseback and Sailing Ship *Copper Picture, The Last Supper August 17, 2011 u ~: $25.00 2 ~ ' + 40.00 ~r U ' ~~ 10.00 1 ~ ' + 150.00 1 7 ~ • + 30.00 ~ v • -. 15.00 1 7 • + ~7 ;. W. David Rowe Issues sorted by security. ESTATE TAX SECURSTIES V?T,UATICN FACE N0. 1 ?_CCOUNT: ?1072^'_ -001-27-27 - METLIFE Name of Estate: CHAP.LOTTE M. CONLEY DATE OF DEATH: Tuesday, July 12 2011 ITEM CUSIP NO. SHARES/ DESCRIPTION PRICE HIGH/ASK LOW/ST_D MEAN SECURITY ACCRUED COML~NTS PAR VALUE DATE PRICE PRICE _______________ _____ __________ __________ PRICE VALUE DIV/INT __________ _____________ ____________ ________ ____ _________ _ 1) 591568106 ___________ 44 ____ _______________ METLIFE It7C 07/12 42.5600 41.4600 42.01000 1,898.44 NYSE COM Grand Totals Total Priacipai plus Accrued interest and dividends ________________ ____________ 1,648.44 D.00 1,848.44 This report was prepared using APPRAISE Ver. 7.6.0 software, an EVALVATZON SERV2CE5, INC. product. Phone 201 784 8500. Visit our web sites at WWW.APPRAZSENJ.COM and WW47. UiPITALCHANGES0NLIliE.C0M. Please compaze the data oa this documeat cazefully with your source document to verify its accuracy. Issues sorted by securit~~. ESTATE TAX SECIIRITZES VALUATION ACCOUNT: 3107201-001-27-27 Name of Estate: CHARLOTTE M. CONLEY DATE OF DEATH: Tuesday, Jnly 12 2011 ITEM CUSIP NO. SHP~tES/ DESCRS PTION PRICE HIGH/ASK LOW/BID MEAN SECURITY PAR VALUE __ DATE PRICE ____ ______________________________ _____ __________ _ PRICE _________ PRICE __________ _ VPS.UE _____ ____ 1) _________ _ 256210105 _________ 8,251. 3550 DODGE E COX INCOME FD 07/12 13.4700 13.47000 _______ 111,145.75 COM 2) 313372J96 50,000 FEDERAL HOME LOAN SANHS 07/12 101.1250 101.0938 101.10940 50,554.70 CONE SD 3.4$16 Iat. From: 02/15/2011 to 07/12/2011 3) 423725KB5 50,000 HEMPFIELD PA AREA SCH DIST WES 07/12 103.5290 103.4810 103.50500 51,752.50 DT 06/01/2004 3.700$ 09/15/2012 Int. From: 03/15/2011 to 07/12/2011 4) 464267176 500 ZSHARES TR 07/12 111.9600 111.5100 111.74500 55,872.50 HARCLYS TIPS BD 5) 548573CN2 SO,OOD LOWER SALFORD TWP PA AUTH SWR 07/12 101.1890 101.16900 50,594.50 DT 10/15/2006 3.700$ 11/15/2015 Iat. From: 05/15/2011 to 07/12/2011 6) 693390700 9,403. 0460 PIMCO FDS PAC I27PT MGMT SER 07/12 11.0400 11.04000 103,809.63 TOTAL RETRN PT 7) 70917NNK6 50,000 PENNSYT.VANIA ST HIGHER EDL FAC 07/12 100.2530 100.2500 100.25150 50,125.75 DT 06/01/2002 4.300$ 03/01/2019 Iat. From: 03/01/2011 to 07/12/2011 8) 77957N2D9 16,964 .0130 AOWE T PRICE SUI~ffiT MUN FDS Ili 07/12 11.3800 11.38000 193,050.47 MUN INTER FD 9) 77957N308 5,525 .1920 RDWE T PRICE SUMt~IIT MUN FDS IN 07/12 10.9700 10.97000 60,611.36 MUN INCOME FD 10) 912828KW9 50,000 UNITED STATES TREAS NTS 07/12 108.7657 108.7344 108.75005 54,375.03 03.250$ 05/31/16 Iat. From: 05/31/2011 to 07/12/2011 11) 912826MW7 50,000 UNITED STATES TREAS NTS 07/12 105.8753 105.8440 105.85965 52,929.83 2.500$ 03/31/15 Iat. From: 03/31/2011 to 07/12/2011 12) 999527641 14,051 .2700 HLACEROCK LIQ FDS TEMPFUI7D ADM SHS #Hl 14,051.27 INCOME CASH 13) 999527641 51,706 .0600 BLACKROCK LIQ FDS TEMPFUND ADM SHS #H1 51,708.08 PRINCIPAL CASH Graad Totals Total Principal plus Accrued interest aad dividends 2AGE :70 . 1 ACCRUED COMMFLTTS DZV/INT MUT FUND GVT AGENCY 698.89 NASDAQ 606.39 PACIFIC EX NASDAQ 298.06 MUT FUND NASDAQ 788.33 MUT FUND GVT AGENCY 190.92 GVT AGENCY 355.19 0.00 MANUAL o.oo MANUAL ________________ ____________ 900,581.37 2,937.76 903,519.15 This report was prepazed using APPRAISE Ver. 7.6.0 software, an EVALUATION SERVICES, INC. product. Phone 201 784 8500. Visit our web sites at WWW.APPRAISENJ. COM and WWW.CAPITALCHANGESONLINE.COM. Please compare the data oa this document caze£ully with your source document to verify its accuracy.