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Home My WebLink About95-01202l -q~-vi ~ This is to certify that the certificate hereunto attached is a true and accurate copy of the original death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed and commissioned as directed by Act 66 of the General. Assembly, approved 29 June 1953, P.L. 304. AUG 1 ~ 2002 Date N106.1e3 Rev. 2187 TrrElm~T M PERMANENT iN.AC1C TNK a 5 Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS li U L ' :J 1 CERTIFICATE OF DEATH I,AnE DF DECEDENflFi0. Mieda. Wd SE)t 8000LL 8ECURT'NUMSQ, ORE OF DERV PA«m, O•%Ner) 236 . 24 - 5681 y7anuary 28, 1995 Male Jr Clifford Carroll H , . = , ,• . AGE M1ar a:+b.» uNDER,rEAR IRIDER,DAV TLQEOFent}I TNR,IiIACE )Lily ana PIACE DF OERNlCh•au «a,oa-as ineeual«ran Dew aiaa) 1"p Mrrl. = Den lloua i MTraa laAarwn.D•%%1•d srla«F«ei~ca«ry) (11/30/ 1912 Clarlaesville -pr.a ^ ERA7dprrn, ^ DDA ^ „"~° ^ ,,,,~,11Oe [~} ^ 82 rr a COIMrtY OF DERV CrtY, B01q,1WPOF OERN IaAMEp notirsYeNOn.11h+YMandrunber) NRSOECEOENTOF IRBFAIaC ORgIN4 RACE•Anrrk~n brrl, &sak, Wlre, e,e L1rrt. l K~.ngS Arms Apt. Meran,Rwblirr4 ~ Halrq~den ZOJp. Cumberland white ~ , aa DECEOE~Tr'8 QaxwRgN IalvooFlRrBwESSTeaousmr xReDECeoo,rEYERw OECEDEIe,'BEDUCRIDN MAIrwsWUlt•,Arrrd .~, sURVIVI1xiSPOUSE (Give Nndarrdta«ry~eyb~onrrl ni E d d lS d a u.B.AR 1ED FORCES? ~w ~J C•~•S• ~ M•a•. yr. maiden name/ nP on re .) a« a; uwn Distric „` Petrol um , , Me W No ^ ,: ,a. ~°'~ +4 „+«s«, ,~ Irlaizi,ed , Diana Dibble DECEDErma-wIrGADDaESSlslreel.cnwr~.e.sur.zocoa~ DECEDERrs a~e~.ar Hampden 1w ,7. Pennsylvania [~9~.. ,7 1 Kings Arms Apt. p. ~e . . w ~ Mechanicsburg, PA 17055 ^ Na. a>~~ «, Cumberland ~'•ba .l y7 ,a 'x ~ d ,7b. ary+n«a. IiRlIER'8 NAME,Rr, nYdde, laM) MO'f/EiYS NMIEIFrr. Mitlde. GtlMn Sunw~ry ,~ Harry Clifford, Sr. n•Nan Warren $ D °io Carroll "`i'$gs~L ~p~'.`Qry/`'~fec~ani°~sburg, PA 17055 ME'y110D OFD~ITgN ~~p+yy ORE OF OSP09fRON PIACEOF DISIOBTfION-NamadCwr~M%Grlrbry IOCRgN•CY~6ee. 91ab, ZIpCOOe Os%'~M «Otlrr Pree '• . Cnmrbn {~+ Rsmwslfr«n SYr^ ^ Dantlan^ Garr ~anuary 30, 1995 =,~on-O-Lite Co. Crematory r fferstown, PA 17088 „~ „ AssucN I.,cENSE NUraER NAME ANDADDRESSOFFACa1rv („`, aas. CaaaDrb M,an aellNynip mtlM aramybowrep..eueloon.nerurwr.ar..nap.c. rrea. ucEnsE R sgRED NyreYn Yna srrMrrYmaddasnb eandTal Paaah, Oa%Nnl eray errsaaran. ~ - . Ilaen 2ela muramepr.eby TIME OF DERV DRE PRONOUNCED DEAD PAyah, Ds%,e•r) Ye18 CARE REFERRED A7 Pr•envnoPle,ww.'••w•ln 7' S A `AN~~ Not,-: ~ _ 2g-~R D M. ae. M aa. r.IMRTI: Errwa.w...Mur.«m~,rt.wNCn~.e..am.a.rn. DO ea.rr nr ewusaa,arro.wcn«warc«~ewM•bn.wr. anon«n.wrw.. ApPmmrr. PART a: omr rpenur mern«u mareumgnena,nd LW anyaaeaw on Been br. ~aeervr ba,eeen «.r wdwn net rewsYp lniMUWMtyYq ceuae yrwtr PARfL aa~ ~~ ~ a ~ r ,..Ad,,:, d.an,-y (OR AS A CONSEQUENCE BplwelaayYmndepr D. i __ ary, raalriybrrrrN DUETO (CR ASACONSEQUENCE OFy. 1 errs. Enrr IwOBILYwS ~ ~ aul i1Nieled evens nrAYp n da,ml l.ABY DUE TO (OR AS A CONSEQUENCE OFT: T MRSAN AUTOPSY WERE AUTOPSY F8IDING3 MANNER OF OF VN ORE OF wJURV TIME OFINJURY INIUFIY RIYORI(4 DESCRIBEIgN wJURY OCCURRED. PERPDRw,Em R,RAAaIP PRIOR ro tMaan. D•Y. wrl coarl.ETaNQFCAUSE Nr kiw ^ r ' N ~ « ~ om w. ^ No^ Attiwnl ^ Pram Mwerlpe,Ian ^ M ya ^ ' No~ Yee ^ No ^ Sukke ^ CouW ro, be wbrmrad ^ . PIACE OF wJURY-N home, lrm, after, ter. olfce LOCRION (seer, cnyr>own, slre> ~. •~ ISPedIY) aal• r, aa. aa. oRITIRMaTCh.a.«ayoe.) slG oFQERTIF •CBRIFYND P,aya1C1A11 (Pnraaan avYlyep eewe a~eem v.hen anomer d rm a«i«mcetl wen riE ~omPiaeo nem 23) TeYr bardry rrwMdP•,dM,aeeunaddwbtlr eauaya)and mYelefa abbd ..................................................... al . 'PRDNOUNCN/O ANDClIfTIFYPq PRY81C111N n b R r i n i El l wM o dw m G' 1 D~~Z ~L ~ ( ty c a o pronouv np an car yrq oteuae e ) tea.e.ramrlmerrew,s.wteeneweau»ur.,a.....nearu..rewbnrewrele).esm.nn.re.r.re .......................... ^ gJ D~~3-l ~ b~ - a,e. s,a. • NAME AND ADORE330F PERSON WNO COMPL CAUSE OF OERN Qtem 271 Type or Prin, ~~~s ~ ~kPu{,ma MEDICAL EXAIRNEWCORONER y /' h On Dla balsa/ rlrNnaDOn and/or Illvaatlpatim, In my op{MOn, deMh ocewrad a1 D,a,Ima, ONa, and pha, and dw b tlN eaaa(s) aM mrmaraaabd ^ - J ~Y'~`~`~'T , F^ ~ ~ .................................................................................................. a,,. az. ~c YP ~ 7v fEG1S 'S SIONRIIRE AND NUMBE _ J_ ., DRE RtED(MaMn. Oay, Y9«) Q C U \.V T REV-1547 EX AFF+ (12-95) LOMMDNMEALTH OF PENNSYLVANIA ACN 1 0 1 DEPARTMENT of REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 08-05-96 HARRISBURG, PA 17128-0601 ESTATE OF CAR OLL H FILE N0. ci y~-uicu DATE OF DEATH 01-28-95 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT 70 YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT T0: CHARMAINE BELL PNC BANK NA 4242 CARLISLE PIKE reMa uTit PD 17011 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Amount Remitted CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS- ~ _____________________ ------------------------------------------------------------------------------------------- REV-1547 EX AFP (12-95) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CARROLL H C FILE N0. 21 95-0120 ACN 101 DATE 08-05-96 TAX RETURN WAS: ( l ACCEPTED AS FILED ( Xl CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN•BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 155,000.00 2. Stocks and Bonds (Schedule B) (2) 360,273.47 3. Closely Held Stock/Partnership Interest (Schedule C) (3l .00 4. Mortgages/Notes Receivable (Schedule Dl (4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule El (5) 32,668.0 3 6. Jointly Owned Property (Schedule F) (6l .0 0 7. Transfers (Schedule G) (7) .00 941.50 547 8. Total Assets , (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 45,750.76 9. Funeral Expanses/Adm. Costs/Misc. Expenses (Schedule H) (9l 10. Debts/Mortgage Liabilities/Liens (Schedule Il (10) 121,691 .56 (11) 167.442.32 11. Total Deductions 380 , 499.18 12. Net Value of Tax Return (121 00 13. Charitable/Governmental Bequests (Schedule J) (131 . T t t t (141 380,499.18 14. o ax e Subjec Net Value of Esta NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will reflect figures that include the total of ALL returns assess ed to date. ASSESSMENT OF TAX: 195,127.68 X .00_ .00 15. Amount of Line 14 at Spousal rats (151 16. Amount of Lina 14 taxable at Lineal/Class A rate (16) 185,371.50 X .06= 11,122.29 17. Amount of Line 14 taxable at Collateral/Class B rats (17) .00 X .15. .00 18 al Tax Due i i P (181 11 ,122.29 . p r nc TAY f_QFf1TTC~ PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST (-) AMOUNT PAID 04-28-95 AA023097 556.11 13,300.00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT 13,856.11 BALANCE OF TAX DUE 2,733.82CR INTEREST AND PEN. .00 TOTAL DUE 2,733.82CR ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A '•CREDIT" (CR), YOU MAY BE DUE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXE~ -('A\Jncr-..PHICt 0: INHERITANCE TAX INHERITANCE TAX DIVISION nl::,,),,)'I;)LU \,.; ,cSTATEMENT OF ACCOUNT PO BOX 2806Dl - :' HARRISBURG PA 17128-0601 '* REV-1607 EX AFP (03-05) 2GUo Gel 3 \ ~~\ \D~ 22 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-02-2006 CARROLL 01-28-1995 21 95-0120 CUMBERLAND 101 AIIount R..i ttad H C C\ r.:pY\ Or l._c- " /"",(>\, \n, nc,r-U!,l " .,/\\ CHARMAINE BELL ~t',\~[c', ,..::-('r'" ,?p., PNC BANK NA 0.0: ,\ 4242 CARLISLE PIKE CAMP HILL PA 17011 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper cradi t to your 8CCOunt. SURi t the upper portion of this fo... with your tax paYllant. CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS +-- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF CARROLL H C FILE NO. 21 95-0120 ACN 101 DATE 10-02-2006 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A sutltARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-29-1996 PRINCIPAL TAX DUE: 11.122.29 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-28-1995 AA023097 556 . 11 13.300.00 07-29-1996 REFUND .00 2.733.82- TOTAL TAX CREDIT 11.122.29 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl. YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l tb `REV-1470 EX (0-88) V' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME H. C. Carroll INHERITANCE TAX EXPLANATION OF CHANGES w~\ PROBATE ® JBA ^ DATE:7/23/9 UMBER 2195-0120 101 SCHEDULE ITEM EXPLANATION OF CHANGES NO. B 16 Added 212.707 shs International Fund @ 22.52, $4,790.16 total. H C-7 Added Cumberland Co. Register of Wills fees, $37.00. The Future Interest Box has been deleted. It is not necessary to complete the future interest compromise process, since the remainder interest can be valued using commonly accepted methods of valuation and actuarial data. TAX EXAMINER: Shawn E. Young PAGE 1 ' i_ ~ SPOUSAL REFUND ~`• •~~~ `~'~ V ry FOR DATES OF DEATN AFii~t,1I1I3S$1-1 CHECK HEiI INHERITANCE TAX RETURN IF A SPOUSAL ` RESIDENT DECEDENT PovERn cREDir is cuiM ~ ^ FILE NUM COMMONWEALTH Of PENNSYLVANIA DE (TO BE FILED IN DUPLICATE BER PARTMENT OF REVENUE DEPT. 280601 HARRI59URG P 1 WITH REGISTER OF WILLS) 21 95 0120 , A 7129.0601 COUNTY CODE YEAR NUMBE DE EDENT'S NAME (UST, FIRST, AND MIDDLE INITIAu DECEDENT'S COMPLETE ADDRESS ~ CARROLL, H. CLIFFORD 1 KING'S ARMS W SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF 81RTH MECHANICSBURG, PA W 236-24-5681 1/28/95 11/30/12 ~,,, CUMBERLAND p (If AffIICMIE) SURVIVRVn afOUSE'S NAME MAST, FIRST AND MIDDLE INnLll) SOCIAL SKURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONSI DIANA CARROLL 054-14-8663 402,094.02 '+' ~ 1. Original Return 2. Supplemental Return ^ 3. Remainder Return f- ~~Y (for dates of death prior to 12-13-8: _ ~ w ~ 4. Limi»d Esfate ®4a. re Intenat Com romise ~ P ®5. Federal Estate Tax Return Required w ea r da»s of death after 12-12-82) ~] 6. Decedent Died Tata» ® 7. ent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes IAHoell mov of Willl ee«...~ .__.. _t r_.wl . _,.. . . y' f' NAME COMPLETE MAILING ADDRESS ~= CHARMAINE BELL, PNC BANK, N. A. 4242 CARLISLE PIKE wg TEIEPHONENUM9ER (;AMP HTT.T._ PA 17(111 7171 730-2266 z 0 C W a: 0 i 0 w i f- 1. Real Estate (Schedule A) (1) 155, 000.00 2. Stocks and Bonds (Schedule B) (2) 3-r5 ,-~+'8~ : ~-i 3(Q ~j ~ `) ~ , Li 3. Gosfly Held Stock/Partnenhip Interest (Schedule C) (3 ) 4. Mortgages and No»s Receivable (Schedule Di (4 ) 5. Cash, Bank Deposks d~ Miscellaneous Personal Property (S) 32, 668.03 (Schedule E) 6. Jointly Owned Property (Schedule F) (6 ) 7. Transhn (Schedule G) (Schedule L) (7 ) 8. Total Gross Aswts (total Linea 1-7) ~.'~~ ~.~Q , ~ (o (g) 9. Funeral Exppeennas, Administrative Costs, Miscellansoua Expena: (5dtedule H) (9) . ~® 21. If Line 18 is greater than Line 19, enter the difference on Lins 21. This is the TAX DUE. (21) _ A. Enter the interest on the balance due on Line 21A. (21A) _ B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE. (21 g) _ Make. Cheek Payable to: Regis»r of Wills, Agent 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 121, 691.56 ! (,~ ~i ~-~ ~ e ~ aZ 11. Total Deductions (total Line:9 A 10) (11) -",-'4'05-:'3.2~ 12. Net Value of Estate (Line 8 minus Lins 11) / ~/ ,j ~~ ~j~Gl , ~~(12) ~ ~~~~•~- 13. Charitable and Governmental Bequests (Schedule 1) ! - (lg) 14. Nst Value Subject to Tax (Line 12 minus Lins 13) 6'~~r ;,~ ~' 114) 37-5; ~'~6,$~ 15. Spousal Transfers (for dates of death after 6-30.94) See Instructions for Applicable Psruntage on Rsverss (15) ~ Je `'~ ~'' ~ ~'2'-'b'-Z7-'-~~" x = Side. (inducts values from Schedule K or Schedule M ) h b ,_ . 16. Amount of line 14 taxable at 6% rats (16) ~ I,~~~ , S ~$3'~~$' ~3 x 06 = /; /d.~ ~;: ~0 ~"~84~-1~ (Inducts values from Schedule K or Schedule M.) . 17. Amount of line 14 taxable at 15% rats (17) x 15 (Indude values from Schedule K or Schedule M.) . ~ 0 , , ~~ , ~, ~ 18. Principal tax due (Add tax from Lines 15, 16 and 17.) 18 ( ) 'xv-~ ? og ~-~- 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + 13,300.00 + 549.21 _ (lq) 13,849.21 20. If line 19 is greater than Line 18, en»r the difhnnu on Line 20. This is the OVERPAYMENT. (20) 2 , 865 09 ___ . M Under penalties of perjury, I dedl it is true, correct and complete. I ~ based on all information of which SBIC.N.ATUIK FEE' ON RESPONSIBLE K YY11VVll:. DD L LV LiER:7~[K] x o arro I have examined this return, inducting occompanYing schedules and statements, and to the bes that all real estate has been reported at true morkket value. Declaration of prsparsr other than er has anv knowledge_ VV ~'y~ Co-Executor 27+ ar isle Pi e ('amn Ai 11 PA 1 7f11 1 5~r3;3-53:~4- IF my knowledge and belie is personal representative DATE DAT '' S = ~ r Act /!48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of the spouse. The rates as prescribed by the statute will be: • 3°,~ (.03) wilt be applicable for estates of decedents dying nn nr after 7/1/94 and before 1/1/96 • 2°,~i (.02) will be applicable for estates of decedents dying nn nr after 1/1/96 and before 1/1/97 • 1% (.01) will be applicable for estates of decedents dying on of after 1/1/97 and before 1/1/98 • Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (I/ ) IN THE APPROPRIATE BLOCKS. 1. Did decedent bake a transfer and: a, retain the use or inco>we of the property transferred . ......................... .......................... b, retain the right to designate who shall use the property transferred or its incone . ..................... c, retain a reversionary interest or ....................................................................... d. receive the prolaise for life of either pay~lents, benefits or care? .............................. 2. If death occurred on or before Dece~ber 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after Dece~lber 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............. 3. Did decedent own an "in trust for" bank account at his or her death?........ ... ............................. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND Fti_.E (T AS PART OF THE RETURN. REV~1502 Ex+ (12-85) 1 T COM!loNHEALTH OB PENNSYLVANIA INHERITANCE TAZ RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE PAGE 1 ~~~^ ~ ~r FILE NUMBER CARROLL, H. CLIFFORD 1224500 21-95-00120 (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing blryer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ITEM NUMBER DESCRIPTION VALt1E AT DATE OF DEATH 1 1 KINGS ARMS MECHANICSBURG, PA CONDOMINIUM CONTAINING 3 BEDROOMS, 2.5 BATHS APPRAISED BY GEORGE C. CLAUSER TOTAL (Also enter on line t. Recapitulation) (I/ more space is needed, insert additional cheats of same cizel 155,000.00 $155,000.00 1 AEA{. 1503 Ex± f 4-136 ) • t 1 COMPIONHEALTB O8 PENNSYLVANIA INHERI TIINCE TAE AETIIAN AE9IDENT DECEDENT SCHEDULE B STOCKS AND BONDS i t PAGE 1 ESTATE OF FILE NUMBER CARROLL, H. CLIFFORD 1224500 21-95-00120 (All property Jointly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 5,000 BONDS PAR ALLEGHENY CNTY PA ARPT REV GTR 7.75% DUE 1/1/2019 ~ 105.7178 INTEREST FROM 1/01/95 TO 1/28/95 2 10,000 PAR ALLEGHENY CNTY PA SAN AUTH 7.50% DUE 12/1/2016 ~ 107.7788 INTEREST FROM 12/01/94 TO 1/28/95 3 5,000 PAR CANON MCMILLAN SCH DIST PA 7% DUE 2/1/2000 ~ 101.6020 INTEREST FROM 8/01/94 TO 1/28/95 4 5,000 PAR CUMBERLAND VALLEY PA SCH DIST 4.80% DUE 9/1/2002 (~ 93.6916 INTEREST FROM 9/01/94 TO 1/28/95 5 20,000 PAR DERRY TWP PA 5.70 DUE 9/15/2013 C~1 92.3030 INTEREST FROM 9/15/94 TO 1/28/95 6 2,293.967 PAR GNMA PASS-THRU X SINGLE FAMILY 8.50% FIR 2/15/06 ~ 100.6863 INTEREST FROM 1/01/95 TO 1/28/95 7 10,000 PAR GEISINGER AUTH PA HEALTIi SYSTEMS 7.50% DUE 7/1/99 ~ 102.7293 INTEREST FROM 1/01/95 TO 1/28/95 8 5,000 PAR PENNA ST NIGHER ED FAC AUTH COLL Rc UNIV REV 6TH SER OF 74 6.40% DUE 1/1/09 ~ 99.8576 INTEREST FROM 1/01/95 TO 1/28/95 9 5,000 PAR PENNA STATE TPK COMMN TPK REV 7.50% DUE 12/1/19 ~ 109.7918 INTEREST FROM 12/01/94 TO 1/28/95 TOTAL (Also enter on line 2, Recapitulation) in mnre space is neeaed Insert additional sheets of same size ) REy. 1503 Ex~+ (4-86> ' P SCHEDULE B COIRYOtiHaALTB O8 PaNN9Y LVANIA I88EAITAIaca TAa RarvRN STOCKS A N D BOND S aaslnatrr aacaaarrr S F PAGE 2 ESTATE OF FILE NUMBER CARROLL, H. CLIFFORD 1224500 21-95-00120 (AII properly jointly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 10 20 000 PAR PENNSYLVANIA STATE TURNPIKE COMMN 7.40% DUE 12/1/2017 22,075.85 ~ 110.3793 INTEREST FROM 12/01/94 TO 1/28/95 234.33 11 20,000 PAR PENNA ST 6% DUE 12/1/17 19,207.45 ~ 96.0373 INTEREST FROM 12/01/94 TO 1/28/95 190.00 12 15,000 PAR PHILADELPHIA PA MUN AUTH REV 6.90% DUE 3/15/98 15,464.63 ~ 103.0975 INTEREST FROM 9/15/94 TO 1/28/95 382.38 13 5,000 PAR WILLIAM PENN PA SCH DIST 7.750% DUE 08/01/95 5,075.11 101.5022 INTEREST FROM 8/01/94 TO COMMON STOCKS 1/28/95 190.52 14 1,222.363 SHS DELAWARE GROUP TAX FREE PENNA FUND 9,815.57 ~ 8.0300 15 3,432 SHS EXXON CORP COMMON 214,500.00 ~ 62.5000 t +' ~,_. ~ 7 7 C '-~j J ~U j TOTAL (Also enter on line 2, Recapitulation) ~--x.3._.3 (If more space is needed insert additlonal sheets of sam? size.) Rsy.lSOa E~. ~Z-e,; ~ SCHEDULE E CASH, BANK DEPOSITS AND COHl7pNNEALTB OF PENNSYLVANIA MISCELLANEOUS ~ F IN RE9IDEN~T DECEDENT~N PERSONAL PROPERTY GE 1 P1aasQ Print or Typ ESTATE OF FILE NUMBER CARROLL, H. CLIFFORD 1224500 21-95-00120 (All property jointly-owned with Rlght of Survivorship must be disclosed on Schedule F) ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH M I AN 0 1 1 1985 LINCOLN CONTINENTAL GASH 2,000.00 2 ANDREWS & PATEL ASSOC REFUND OF MEDICAL EXPENSES 5.10 3 EXXON MEDICARE SUPPLEMENT PLAN INSURANCE BENEFITS 148.52 4 CAPITAL HEALTH SYSTEMS REFUND 119.20 5 T ROWE PRICE PRIME RESERVE ACCOUNT DATE OF DEATH BALANCE 15,326.40 6 JANNEY MONTGOMERY SCOTT INC BROKERAGE ACCOUNT //HB24-2053-2925 DATE OF DEATH BALANCE 15,066.52 INTEREST TO 1/28/95 2.29 15,068.81 TOTAL IAlso enter on line 5, Recapitulation) (Attach additional 9 1/2" x 11" sheets if more space is needed.) REV.1511 Ex+ l7-88) COMMONNEALTH OF PENNSYLVANIlf I NI[>ZAZTlItiCt Tl12 RETOAN SCHEDULE H FUNERAL EXPENSES ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES VHR RVLL n. ~LIrrUKU 1224 00 ITEM NUMBER DESCRIPTION A• Funeral Expenses: 1 4/17/95 GILBERT PARTHEMORE FUNERAL IiOME FUNERAL EXPENSES 2 4/17/95 DIANA D CARROLL REIMBURSEMENT FOR FUNERAL HOME DOWNPAYMENT 3 5/05/95 PARTHEMORE FUNERAL HOME INC FUNERAL SERVICES B. Administrative Costs: 1. Personal Representative Commissions SEE ATTACHED ITEMIZATION Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees SEE ATTACHED ITEMIZATION 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees C• Miscellaneous Expenses: SEE ATTACHED ITEMIZATION l , PAGE 1 Please Print or Typs FILE NUhBER AMOUNT 2,354.00 100.00 34.83 TOTAL (Also enter on line 9, Recapitulation) 21,174.00 21,174.00 ~ r.3 . t ',~ '~S°L) , '~ .~ (If more space is needed, insert addltlonal sheets of same size.) ~ o v , SCHEDULE "H" PAGE 2 PERSONAL REPRESENTATIVE roMMISIONS .STATE OF CARROLL, H. CLIFFORD 1 1224500 FILE NUMBER 21-95-00120 10/10/95 PNC BANK, N.A. EXECUTOR'S COMMISSION TOTAL PERSONAL REPRESENTATIVE COMMISSIONS 21,174.00 21,174.00 t ESTATE OF CARROLL, H. CLIFFORD 1 10/10/95 SCHEDULE "H" ATTORNEY FEES 1224500 FILE NUMBER 21-95-00120 SAIDIS, GUIDO, SHUFF & MASLAND COUNSEL FEE TOTAL ATTORNEY FEES ~ r PAGE 3 21,174.00 21,174.00 t r =STATE OF CARROLL, H. CLIFFORD SCHEDULE "H" MISCELLANEOUS EXPENSES 1224500 FILE NUMBER 21-95-00120 PAGE 4 1 3/20/95 EVP SYSTEMS FEE FOR DATE OF DEATH VALUATION 60.00 2 3/30/95 REGISTER OF WILLS SHORT CERTIFICATES 18.00 3 4/17/95 SAIDIS GUIDO & MASLAND REIMBURSEMENT FOR ADVANCED COSTS LETTERS TESTAMENTARY 340.00 CERTIFIED COPY OF DIVORCE DECREE 9.00 LEGAL ADVERTISING CUMBERLAND LAW JOURNAL 40.00 PATRIOT 62,71 ------ 451.71 4 4/17/95 ANDREWS & PATEL ASSOCIATES PC PROFESSIONAL SERVICES 86.72 5 5/05/95 GEORGE C CLAUSER APPRAISAL RE 1 KINGS ARMS 250.00 6 6/05/95 EVP SYSTEMS DATE OF DEATH VALUATION FEE 10.50 TO TAL MISCELLANEOUS EXPENSES 876.93 } ~~ y~ ~~~° ~~'~ s ~s 37, ~~ ~~~_~. - ~~ ~3 ~, REV. 1512 Ex+ l7-88) 1 r COHMONNEALTR OF PENNSYLVANIA INHERITANCE TA$ RETVRN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS ESTATE OF CARROLL, H. CLIFFORD 1224500 ITEM NUMBER 2 3 4 5 6 7 8 9 10 11 1/28/95 4/10/95 4/17/95 4/17/95 4/ 17/95 4/17/95 4/17/95 4/24/95 5/19/95 5/22/95 7/20/95 DESCRIPTION FIRST FEDERAL SAVINGS & LOAN MORTGAGE BALANCE AS OF 1/28/95 KINGS ARMS CONDOMINIUM ASSOC ASSESSMENT DATED 4/1/95 AND 5/1/95 HARRISBURG HOSPITAL MEDICAL EXPENSES A Z RITZMAN ASSOC PROFESSIONAL SERVICES CRUMAY PARNES ASSOCIATES INC PROFESSIONAL SERVICES HEALTHSOUTH PROFESSIONAL SERVICES CONNER-RICH-KEARNEY-TORCHIA PROFESSIONAL SERVICES A Z RITZMAN ASSOC PROFESSIONAL SERVICES UNIVERSITY PHYSICIANS MEDICAL EXPENSES MOFFITT PEASE LIM ASSOC MEDICAL EXPENSES PHYSICIANS OF REHABILITATION MED MEDICAL SERVICES TOTAL (Also enter on line 10. Recapitulation) (If more space is needed insert additional sheets n/ samA 51T? ) Please Print or Typi E 1 FILE NUMBER 21-95-00120 AMOUNT 120,075.94 1,050.00 149.00 31 .91 15.50 139.20 138.86 5.85 9.39 2.16 73.75 1 REY•1513 EX+ (2•B7i P COMMONWEALTH OF PENNSYLVANIA INHERttANCE TAX RETURN REfIDENT DECEDENT ESTATE OF Carroll, H. Clifford FILE NUMBER 21_95-00120 ITEM NUMBER NAME AND iADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: 1• John C. Carroll Son 1/3 Remainderma 7 Chamberlain Road of Residuary Tx Westford, MA 01886 2. Diana Carroll Wife Life Estate in 1 Kings Arms condominium. L Mechanicsburg, PA 17055 Estate in Resid Trust. 3. Martha Carroll Daughter 1/3 Remainderma 1113 Camino Consuelo of Residuary Tr Santa Fe, NM 87505-5040 4. Warren H. Carroll Son Bequest of auto P. 0. Box 308 valued at $2 00 Camp Hill, PA 17001-0308 , Income interest life in 1/3 of Residuary Trust death of Diana Carroll. ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: t. N 0 N E SCHEDULE J BENEFICIARIES n ust. ife nary n ust. ).OC foz at TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I$ _0_ (If more space is needed, insert additional sheets of same size) REV•151~ EX+ (12.68) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATElANNUITY/ TERM CERTAIN ESTATE OF Carroll, H. Clifford FILE NUMBER 21-95-00120 This schedule is to be used for all single life, concurrent~single life, term certain, and joint or successive life estates when no election is filed to prepay future interest taxes. Special factors to calculate the interest involving more than one life can be obtained from the Bureau of Individual Taxes. ®Will ^Deed of Trust ^Other Specify ^ Life Estate Name(s) of Life Tenant(s) Date of Birth Present Age Term of Years Life Estate is Payable Diana Carroll 5/7/18 77 ~~~_ Life t~ D~ ~ ~" ~' ~~' 1. Value of Fund from which income is payable ................................... $ 34, 924.06 2. Life Estate Factor (see instructions) .......... , , 9.67 Table S .51553 ~~`~ 3. Value of Life Estate (Line 1 times Line 2) ...................................... $ 18, 004.40 (inc uds on Recapitulation, lines 15 or 16) ^Annuity 2. Frequency of payout ..................................................... 3. Annual payment ........................................................ $ 4. Annuity Factor (see instructions) ............................................ . 5. Adjustment Factor (see instructions) ..................... .................. . b. Value of Annuity (lines 3 times lines 4 and 5) .................................. S (inc uds on Recapitu ation, lines 15 or 161 (If more space is needed, insert additional sheets of same size 1. Value of Fund from which annuity is payable .................................. S REV•1514 E%+ (12-88) ,/~ • COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE/ANNUITY! TERM CERTAIN ca~~a~e yr Carroll, H. Clifford FILE NUMBER 21-95-00120 This schedule is to be used for all single life, concurrent single life, term certain, and joint or successive life estates when no election is filed to prepay future interest taxes. Special factors to calculate the interest involving more than one life can be obtained from the Bureau of Individual Taxes. ^Will ®Deed of Trust ^Other Specify ®Life Estate Name(s) of Life Tenant(s) Date of Birth Present Age Term of Years Life Estate is Payable Diana Carroll 5/7/18 77 Life 1. Value of Fund from which income is payable ............ ..................... $ 338 , 821.96 2. Life Estate Factor (see instructions) ......... , .9.67 Table S .51553 3. Value of Life Estate (Line 1 times Line 2) ...................................... $ 174, 672.89 lint ude on Recapitu ation, fines 15 or 161 ^Annuity 1. Value of Fund from which annuity is payable .................................. $ 2. Frequency of payout ..................................................... 3. Annual payment ............ ......................... ................. $ 4. Annuity Factor (see instructions) ............................................ . 5. Adjustment factor (see instructions) ................ . ......................... 6. Value of Annuity (lines 3 times lines 4 and 5) .................................. S (include on Recapitulation, lines 15 or 16) (If more space is needed, insert additional sheets of same size.) ESTATE OF H. CLIFFORD CARROLL - RIDER TO SCHEDULE K FILE N0. 21-95-00120 NET VALUE OF DEVISE PER III OF WILL One King's Arm Condominium Mechanicsburg, PA Appraised for . Less: Outstanding mortgage balance as of 1/28/95 Net Value of One King's Arm Condo 155,000.00 120,075.94 34,924.06 NOTE: Diana Carroll, Surviving Spouse has right to reside in condominium for her life. ESTATE OF H. CLIFFORD CARROLL - RIDER TO SCHEDIIT.F u FILE N0. 21-95-00120 CALCULATION OF RESIDUE Gross Estate Less: Net Value of devise of condominium Bequest of TPP Less : Schedules~L-Fr-~K ~ Q~. ~ Residue 543,151.34 (34,924.06) (2,000.00) 506,227.28 (167,_ 405.32) 338,821.96 REV-167 EX+ (10-si4} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Carroll, H. Clifford 21-95-00120 This schedule is appropriate only for Estates of decedents dying after December 12, 1982. This schedule is to be used for ail future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty The Instrument creating the future Interest Is. (Please attach copy of instrument) Will ®Trust ^ Other o. .r.- ...•v ~o~ "c.7 NAME OF DATE OF AGE TO BENEFICIARY RELATIONSHIP BIRTH NEAREST GIRT ~•Diana Carroll Wife 05/07/18 77 2•John C. Carroll Son 02/05/42 53 3•Martha Carroll Dau hter 03/09/45 50 4•Warren H. Carroll Son 06/16/49 46 5. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise one ~ following within 9 months of the decedent's death, check the appropriate block and supply a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal DAY the -..r.a^.o.~..~~ ~+~ vV11I~/1V11115C utter. ~Ir more space Is needed, attach additional 8.5 X 11"sheets) SEE ATTACHED IV. Summary of Compromise Offer: 1. Amount of Future Interest ............................. $ 34, 924.06 2. Value of Line 1 exempt from tax as amount passing to charities, etc ............. $ (also include as part of total shown on Line 13 of Cover Sheet) 3. Value of Line 1 passing to spouse at appropriate tax rate ..................... $ 18, 004.40 Check 1 Block ^ 6% , ~ 3%, ^ 2°~, ^ 1 %, ®Exempt (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 Taxable at Lineal Rate .................................. $ 16, 919.60 (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 Taxable at Collateral Rate ............................... $ -0- (also include as part of total shown on Line 17~ of Cover Sheet) 6. Total Value of Future Interest (sum of Lines 2 thru 5 must equal Line 1) ......... $ 34, 924.06 SCHEDULE M FUTURE INTEREST COMPROMISE ~~TTE~T~_S?EI~CLIFF9RD CARROT ~ + • 21-900120 ~CHFDi1i F ~jB Item III of decedent's will devise's to Diana. Carroll the right to occupy his condominium at One King's Arms, Mechanicsburg, PA for her the rest of her life. Should Diana Carroll cease to occupy the condominium it then passes to decedent's children. The. uncertainty regarding this devise would center on whether Diana Carroll will "cease to occupy" the condominium prior to her death. While it is not possible to predict with certainty whether Mrs. Carroll will live in the condominium for the remainder of her life it is the executor's position that she will. This has been her home since her marriage to H. Clifford Carroll; being a condominium, all of the major maintenance responsibilities are handled by the condominium association; the upkeep required of her is minimal and perfectly suited for an older, single person. While there could be situations in the future which might require Mrs. Carroll to move from the condominium, based on the information currently available it is the executor's position that Diana. Can-o11 will live in this condominium for the rest of her life. Accordingly, we have calculated the value of Mrs. Can-oll's interest in the condominium based on a complete life estate as shown on Schedule K. This life estate would be taxed at zero percent with the remainder taxed at 6% since it will pass to the decedent's children. REV-1649 EX+(8/95) coaosoNweN.nt or rpra~rrv,va,~ w~ernmxsrv:aEnisx sr,~rrnecrnrxr SCHEDULE O TRANSFERS TO SURVIVING SPOUSE ESTATE OF $, Clifford Carroll FileNumber 21-95-00120 PART A: Enter the description and value of all interests, both taxable and son-taxable, n~dless of location, (net of deductions) which pass to the decederu'a surviving spouse by will, intestacy, operation of law, or otherwise. Description of items ~~ 1 Trust under Item II of Deed of H. Clifford Carroll dtd. 8/24/88, as Amended. Trust will be funded with residue of estate (see calculation attached) 2. Right to occupy condominium at One King's Arms, Mechanicsburg, PA per III of Will. Net Value (See Sch. A, Sch. I, 4~1, Sch. K & Sch. M) 3. Connecticut General Life Insurance Co. Group Life Insurance Policy ~i~2044589 Family Income Insurance (Settlement option provides for monthly payments of $417.00 for life of Diana Carroll. Payments cease at her death. 338,821.96 34,924.06 28,348.00 Part A -total: Ewer the amour sFrown on the recapitulation sheet in the Decedent Intormatlon Section. s Election To Subject Property To Tau Under Section 2113(A) As A Tazable Transfer By Thia Decedent. If a trust or similar arrangement melts the requirements of Section 2113(A), aad: a. The trust ~ similar arrangement is listed on Schedule O, and b. The value of the ttuat or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferor's personal representative may apeciscauy identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust ar similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transtbr ar Schedule O. the personal representative shall be coroidered to have made the election only as to a fraction of the trust or similar arrangement, The numerator of this fraction is equal to the amourrt of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement, ELECTION: Do you elect under Section 2113(A) to heat a a taubk transfer in this estate all or a portion of a trust or shnilar arras=ement created for the sok use of this decedents survivin= a ~ ~~~ spouse's entire litethne? YES a NO [~ Si~ratare BY • y ~ae _ /D~~~i~° Note: If the election applks to more than one trust or similar arras=emeat, then a separate form must be sipred and Sled. Part B: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, (net of deductions) which peas to the decedent's surviving spouse for which a Section 2113 (A) election is being made. Desert lion of items ~~ Trust under Item II of Deed of H. Clifford Carroll dated 8/24/88, as Amended. (See Part A, 1) 338,821.96 LAST MILL AND TESTAMENT OF H. CLIFFORD CARROLL, JR. SAIDIS, GUIDO do MASLAND 2109 Market Street Camp Hill, PA I, 8. CLIFFORD CARROLL, JR. of Hampden Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II - I bequeath certain items of my tangible personal f property, not including cash and securities, in accordance with a written list made by me during my lifetime. III - I devise and bequeath to my wife, Diana Carroll, the right to occupy my condominium at One Kings Arms, Mechanics- burg, Pennsylvania, for the rest of her life, subject to the payment of the fees, expenses and the outstanding monthly nortgage payment. Should she cease to occupy the condominium, :hen I devise and bequeath my condominium to my children, John :. Carroll, Warren H. Carroll and Martha A. Carroll. ~ i ~ Page 1 IV - I devise and bequeath my tangible personal property, not including cash or securities or specified on the itten list made by me, to my wife, Diana Carroll. V - I exercise any power of appointment given to me by my deceased wife, Katherine S. Carroll, and specifically that power of appointment given to me in her Agreement of Trust dated June 26, 1984 and direct that the assets made payable to that trust, either during her lifetime or from her estate, be dis- tributed to my three children, John C. Carroll, Warren H. Carroll and Martha A. Carroll, in equal shares, the share of a ceased child to be paid to his or her issue per stirpes, and :hat the following provisions shall apply: A. Adopted children shall be considered as .s sue; B. The share of Warren~H. Carroll shall continue SAIDIS, GUIDO & MASLAND 2109 Marka Stmt Camp Hill. PA .o be held iR TRVBT by the trustee for the rest of his natural ife. Out of the income derived by the trustee, trustee shall ay all the necessary costs and expenses of the trust, including he reasonable compensation of the trustee, and at its sole and bsolute discretion may make expenditures from the income or rincipal of the trust as it may deem necessary for the support Page 2 and maintenance of my son, Warren H. Carroll. Upon his death, the trust shall terminate and the balance then remaining shall be paid to his issue per stirpes, or should he die without issue surviving him, it shall be divided between my remaining child- ren, John C. Carroll and Martha A. Carroll, or their issue per ~~stirpes. VI - I devise and bequeath all the rest, residue and r of my estate of whatever nature and wherever situate unto CCNB Bank, N.A., under and subject to the terms of a certain Trust Agreement between myself as settlor and said bank trustee dated August 24, 1988, as amended. VII - I appoint my son, John C. Carroll and CCNB Hank, SAIDIS, GUIDO & MASLAND 2109 Marko Street Camp Hill. PA IN.A., Coexecutors of this, my Last Will and Testament. Neither of my personal representatives shall be required to post bond in this or any jurisdiction. I~ 11iT1~SS 11HEREOF, I have hereunto set my hand and seal on this, the /,1 ~% day of / ~ ' _ , 1992. //• ~` r(SEAL) . Clifford Carroll, Jr. Page 3 Signed, sealed, published and declared by H. CLIFFORD C1IRROLL, JR., Testator therein named, on this and three (3) other sheets of paper as and for his Last Will and Testament, in our pres- ence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. N e Ad ess ~'Lt ; ~ ~. ~'• . Name ~ Addres SAIDIS, GUIDO at M.',SLAND 2109 Marks Stmt Camp Hill, PA Paqe 4 C01~4IONWEALTH OF PENNSYLVANIA, ) COUNTY OF C~ERLAND SS. wE, the undersigned, the testator and the witnesses, respectively, whose names are signed to the foregoing instru- ment, being first duly sworn, do hereby declare to the under- signed authority that the testator signed and executed the instrument as his Last Will and Testament and that he signed willingly (or willingly directed another to sign for him), and that ha executed it as his free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator signed the will as witnesses and that to the best of their knowledge the testator was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. Testator MIDIS, GUIDO. & MASLAND ' 109 Muka Scree Camp Hill, PA witnea n ' ~'" witness ~~ ~~ ~~ ~' Subscribed, sworn to and acknowl3dged before ma by the ~~testator,~and subscd and swo ~witneases, this ,Z r~o before me by both ~; ~_ day of ~Gc~ 1992. Notary Public NOTARIAL SEAL. THELMW S. Mt~AUS!-N, Norary Public Camp Hill, Cumberlar>a County My Commission Expires July 3,1996 Y~ ~ ~~_ ~~ ~~ cam, ~ ~9~r ~~o ~~ S _~ ~~ ~ . ~~ ~ ~` ~~Q~~~ 2 fir, X992 REVOCABLE TRUST AGREEMBrI'P THIS AGRF~N'~' made this ~ y ~- day of 1988 by and between H. CLIFFORD CARROLL, JR. of Camp Hill, Cumberland County, Pennsylvania, hereinafter called "settlor" and CCNB BANK, N.A., Camp Hill, Cumberland County, Pennsylvania, hereinafter called "trustee," WITNESSETH: WHEREAS, settlor desires to create a revocable trust of certain assets for the purposes hereinafter contained; NOW, THEREFORE, in consideration of the mutual covenants con- tained herein, settlor has or will cause certain assets to be delivered to trustee or to be made payable to trustee, and settlor directs that said assets be invested and held by trustee upon the following trust: I Trustee shall pay to settlor, at least quarterly, the net income of the trust estate and shall further pay to settlor all of the prin- cipal or such portion of the principal as settlor may from time to time request in writing. In the event settlor becomes ill, incom- ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL. PA 17011 petent or requests, trustee, at its discretion, shall use so much of the income and principal of the trust estate as it believes necessary and proper for the support and maintenance of settlor, and may dis- burse such amounts in any one of the following ways: A. To that person or corporation who is taking care of or has custody of the settlor; B. Directly to the settlor; C. To any creditor of settlor for his benefit. II At settlor's death, should his wife survive settlor, trustee shall hold the balance of the trust estate, including any accumulated income, IN FURTHER TRUST, for the benefit of settlor's wife, Diana Carroll, and shall pay the net income therefrom to or for the benefit of settlor's said wife in installments at least quarter-annually. III Upon settlor's wife's death or upon settlor's death should she predecease settlor, trustee shall divide the principal of the trust and any accumulated and undistributed income among my children, John C. Carroll, Warren H. Carroll and Martha A. Carroll, the share of a deceased child to be paid to his or her issue per stirpes. Should any such beneficiary be under the age of 21, his or her share shall ARNOLD & SLIKE, ATTORNEYS•AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 17011 be held in a separate trust for the benefit of such person with provision that the trustee shall pay all the expenses of the trust and pay the balance of the income to or for the benefit of the bene- ficiary until he or she attains the age of 21, at which time the trust as to him or her shall terminate and the balance shall be distributed to the beneficiary absolutely. IV No interest in income or principal shall be assignable by, or available to anyone having a claim against, a beneficiary before actual payment to the beneficiary. V Trustee shall have the power but not the duty to make such expen- ditures out of this trust as, in its discretion, it may consider desirable in order to facilitate the settlement of the estate of settlor. In exercising such power, trustee may pay in whole or in part any of the following items: the expenses of last illness and burial, including cost of gravemarker; debts; income taxes; death taxes on any and all property included in the gross estate for tax purposes; and all other items in connection with the settlement of the estate. Any such items may be paid directly by trustee. or the ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL. PA 17011 funds for their payment may be transferred by trustee to the executor or the administrator of the said estate, and neither such executor or administrator nor any beneficiary of such estate shall be required to reimburse trustee for any funds so paid or transferred. VI settlor hereby reserves, exercisable whenever and as often as settlor may wish while settlor is living, the power to withdraw all or part of the principal, to add to the trust upon approval and acceptance by the trustee, and to revoke or alter this trust in whole or in part by writings other than a Will delivered to the trustee, but not to increase the responsibilities of the trustee without its written consent. VII Any corporation resulting from any merger, conversion or con- solidation to which CCNB Bank, N.A. may be a party or any corporation otherwise succeeding generally to all or the greater part of the assets and business of CCNB Bank, N.A. shall be the successor. to it as trustee hereunder without the execution nor filing of any paper or any further action on the part of any party hereto or beneficiary thereunder. ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 17011 VIII This instrument shall be construed and administered in accordance with the laws of the Commonwealth of Pennsylvania. The validity of the trust hereby created shall be determined in accordance with the laws of the Commonwealth of Pennsylvania. IX My trustee hereinafter named shall have the following powers and duties, in addition to those vested in it by law and other provisions of this Will: A. To retain any or all of the assets of this trust, real or personal, including its own stock, without regard to any principle of diversification or risk. B. To invest in all forms of property, including stock, common trust funds and mortgage investment funds whether operated by it or others, without restriction to investments authorized for Pennsyl- vania fiduciaries, as it deems proper, without regard to any principle 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 it from time to time thinks proper in its sole discretion. E. To make payment to the parents or guardians of any minor or incompetent beneficiary. " F. To hold property in my name or in its name, or in the name of a nominee or unregistered. ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA (1011 G. To lend to, or purchase from, my executor even though trustee may also be such executor. X Trustee shall receive compensation for the performance of its func- tions hereunder in accordance with it standard schedule of fees in effect from time to time during the period over which its services are performed. IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day and year first above written. WITNESS: ;1 H. ~ fford Carroll, Jr: ~~ ice; ATTEST: ~~~ ~5'1~, Secretary CCNB BANK, N.A. BY: , Trust icer ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET. CAMP HILL, PA 17011 AMENDMENT TO REVOCABLE TRUST AMENDMENT made this /,~ ~ day of ~l.-~ti.~ 1;,._,~:'- 1992 between H. CLIFFORD CARROLL, JR. and CCNB BANK, N.A., ~WITNESSETH; WHEREAS, by Agreement dated August 24, 1988, H. CLIFFORD CARROLL, JR., Settlor, entered into a Revocable Trust Agreement (with CCNB BANK, NA., TRUSTEE; and WHEREAS, settlor reserved the right to amend the Trust under (Paragraph VI of said agreement; NOW, THEREFORE, in consideration of the mutual covenants contained herein Paragraph III of my said Trust Agreement dated August 24, 1988 is amended to read as follows: III SAIDIS, GUIDO & MASLAIYD 2109 Market Street Camp Hill, PA Upon settlor's wife's death or upon settlor's death should she predecease settlor, trustee shall divide the principal of the trust and any accumulated and undistributed income among my children, John C. Carroll, Warren H. Carroll and Martha A. Carroll, the share of a deceased child to be paid to his or her issue per stirpes, under and subject to the follow- ing provisions: A. The share of Warren H. Carroll shall be charged with an advancement of $10,000 made to him during my lifetime. B. Adopted children shall be considered as issue; SAIDIS, GUIDO & MASLAND 2109 Market Street Camp Hill, PA C. The share of Warren H. Carroll shall continue to be held IN TRUST by the trustee for the rest of his natural life. Out of the income derived by the trustee, trustee shall pay all the necessary costs and expenses of the trust, including the reasonable compensa- tion of the trustee, and at its sole and absolute discretion may make expenditures from the income or principal of the trust as it may deem necessary for the support and maintenance of my son, Warren H. Carroll. Upon his death, the trust shall terminate and the balance then remaining shall be paid to his issue per stirpes, or should he die with- out issue surviving him, it shall be divided between my remaining children, John C. Carroll and Martha A. Carroll, or their issue per stirpes. D. Should any beneficiary be under the age of 21, his or her share shall be held in a separate trust for the benefit of such per- son, with provision that the trustee shall pay all the expenses of the trust and pay the balance of the income to or for the benefit of the beneficiary until he or she attains the age of 21, at which time the trust as to him or her shall terminate and the balance shall be distributed to the beneficiary absolutely. - 2 - IN WiTNEHS WHEREOF, the parties hereto, intending to be legally bound hereby, have set their hands and seals on the day and year first above written. ~, ;~ SAIDIS, GUIDO & MASLAND 2109 Market Street Camp Hill, PA "1, , ~~ , ~~ ATTEST: ~` i ! ~i Secretary; ~ ~ ''(SEAL ) H. C ffo d Carroll, Jr. CCNB BANK, N.A. . ~/`~ (SEAL ) Trust Offic - 3 - COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES, ,,~~^~" ~ ; ~C~, ~ ~~ INHERITANCE TAX INHERITANCE TAX DIVISION ,_ ~ ~ ~' ~` :STATEMENT OF ACCOUNT PO BOX 280601 - ~ - _- HARRISBURG PA 17128-0601 i"'_ ?~ ar 'r','-.e V ... a~.Rl I~.a ~,~ (~ -- " - - !'~ ', CHARMAINE BELL ,,~~` PNC BANK NA "` 4242 CARLISLE PIKE CAMP HILL PA 17011 REV-1607 EX AFP [03-OS) DATE 10-02-2006 ESTATE OF CARROLL H C DATE OF DEATH 01-28-1995 FILE NUMBER 21 95-0120 COUNTY CUMBERLAND ACN 101 Awount Rewitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subwit the upper portion of this fora with your tax peynent. CUT ALONG THIS LINE -1 RETAIN LOWER PORTION FOR YOUR RECORDS ~- --------------------------------------------------------------------------- REV-1607 EX AFP C03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ~~~ ESTATE OF CARROLL H C FILE N0. 21 95-0120 ACN 101 DATE 10-02-2006 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHONN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-29-1996 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 04-28-1995 AA023097 556.11 13,300.00 07-29-1996 REFUND .00 2,733.82- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. ^ IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ^CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 11,122.29 11,122.29 .00 .00 .00 5 PAYMENT: Detach the tap portion of this Notice and subwit with your paywent wade payable to the Hasa and address printed on the reverse side. If paywent if for a RESIDENT DECEDENT, hake check or woney order payable to: Register of R'Dls, Agent If paywent if for a NON-RESIDENT DECEDENT, wake check or woney order payable to: Commonwealth oFPennsylvania Failure to pay the tax, interest, and penalty due way result in the filing of a lien of record in the appropriate corm ty, or the issuance of an Orphans Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, way be requested by cowpleting an "Application for Refund of Pennsylvania Inheritance and Estate Tax^ CREV-1313). Applications are available online at www.revenue.state.os.us, miy Register of Nills or Revenue District Office, or frog the Departwant•s 24-hour answering service for foss orders: 1-800-362-2D50; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). REPLY T0: questions regarding errors contained on this notice should 6e addressed to: PA Oepartwent of Revenue, Bureau of Individual Taxes, ATTN: Post Assesswent Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601, phone (717) 787-65D5. DISCOUNT: If any tax due is paid within three (3) calendar wonths after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax awnesty non-participation penalty is cowputed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax awnesty period. INTEREST: Interest is charged beginning with first day of delinquency, ar nine C9) wonths and one (1) day frow the date of death, tc the date of paywent. Taxes which becawe delinquent before January 1, 1982 bear interest at the rate of six C6%) percent per annuw calculated at a daily rate of .DOD164. All taxes which becawe delinquent on and after January 1, 1982 will bear interest at a ratty which will vary frow calendar year to calendar year with that rate announced by the PA Departaent of Revenue. The applicable interest rates for 1982 through 2006 are: Interest Daily Interest Daily Interest Daily Yaar Rate Factor Year Rate Factor Year Rate Factor 1982 20% .OOD548 1988-1991 11% .000301 2001 9% .000247 1983 16% .000438 1992 9% .000247 2002 6% .000164 1984 11% .000301 1993-1994 7% .000192 2003 5% .ODD137 1985 13% .D00356 1995-1998 9% .000247 2004 4% .000110 198f, 10% .000274 1999 7% .000192 2005 5% .000137 1987 9% .000247 2D00 8% .000219 2006 7% .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becowes delinquent will reflect an interest calculation to fifteen C15) days beyond the date of the assesswent. If payaent is wade after the interest cowputation date shown on the Notice, additional interest oust be calculated.