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HomeMy WebLinkAbout11-09-12 (4)~ 1505610105 REV-1500 Ex (o2-u) (FI) ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania .,~dF~~.4 ~~~ a:~:~,~~ County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6oi ~ % /'~ n ~ J Harrisburg, PA 1'7128-0601 RESIDENT D ECEDENT r~ o'er G, ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 211-18-1230 02/14/2012 04/21 /1927 Decedent's Last Name Suffix Decedent's First Name MI Warner Martha L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust U 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. 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 T0: Name Daytime Telephone Number Michael R. Warner, Exec. First Line of Address 101 Penns Run Road Second Line of Address City or Post Office Mechanicsburg State ZIP Code PA 17050 REGISTER OF WILLS USE ONLY ,- _>J ~7 ~ +' ~ r ~~yy. __ ) C~ _f_ ~. `._ !` <.. .. l ~7 `... ; DATE JL D ~~ . z. _ _ ; .~ Correspondent's a-mail address: reneewarner COmCaSt.net ~~..? `~..! _ .Z~J ' -_ ~~_ ~~;x ~.' - ;-.; Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU E OF P SO RESpON BL FOR FILING RETURN DATE 101 Penns Run Road, Mechanicsburg, PA 17050 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J I~~~ J 1505610205 REV-1500 EX (FI) Decedents Name: Martha L. Warner Decedent's Social Security Number 211-18-1230 RECAPITULATION 1. Real Estate {Schedule A) ............................................ . 1. 316,000.00 2. Stocks and Bonds (Schedule B) ...................................... . 2. 43,115.94 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) .......................... . 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. 68,694.83 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... . 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 55 588 913 (Schedule G) O Separate Billing Requested....... . 7. , . 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 1,016,724.30 9. Funeral Expenses and Administrative Costs (Schedule H) .................. . 9. 22,661.18 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) .............. . 10. 13,234.63 11. Total Deductions (total Lines 9 and 10) ................................ . 11. 35,895.81 12. Net Value of Estate (Line 8 minus Line 11) ............................ . . 12. 980,828.50 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J} ...................... .. 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 980,828.50 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 921,978.79 16. 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17, 18. Amount of Line 14 taxable 849 71 58 . , at collateral rate X .15 18 19. TAX DUE ...................................................... ... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 0.00 41,489.05 0.00 8,827.46 50,316.51 O J REV-1500 EX (FI} Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Martha L. Warner STREET ADDRESS 17 Pheasant Street CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 2.368.35 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line ZO to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) 50,316.51 47,368.35 2,948.16 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: Yes No a. retain the use or income of the property transferred .................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income ...................................... ...... ^ c. retain a reversionary interest ........................................................................................................................ ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 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 "intrust 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)~. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 45,000.00 ~ ~--~ -~ j -_; LAST WILL AND TESTAMENT _1 V , -r ; ~ - ~-,~;~-.~-, . ~-.._ C7 , , ~..~ - , - _ MARTHA L. WARNER :--~ ~=- _._ _ _ l-+ ' - ~ ~~ `•~ `J ~~ I, MARTHA L. WANNER, now of 17 Pheasant Street, Mechanicsburg, Cumberland County, Pennsylvania, 17055, do publish and declare this to be my Last Will and Testament, hereby revoking all other prior wills and codicils made by me. FIRST: Family Background and Appointment of Ezecutor. (A) Family and Background Information. I am married to JAMES E. WARNER. The children of our marriage are MICHAEL R WAIEtNER and JAMES T. WARNER. Throughout this Will, JAMES E. WARNER will be referred to as "my husband" or "my spouse", and MICHAEL R WARNER and JAMES T. WARMER will be referred to as "my children" or "my sons". The term "issue" will refer to my children as well as my other descendants. (B) Appointment of Ezecutor. I appoint as my Executor and Successor Executrix (al] hereinafter referred to as Executor) under this Will, the following named persons to serve without bond and without being required to account to any court: Ezecutor: My son, MICHAEL R WARNER. Successor Ezecutriz: My daughter-in-law, RENEE E. WA~lE2..NER. (C) Inter Vivos Trust. The inter vivos trust agreement referred to in this Will is entitled "THE MARTHA L. WARNER FAMILY REVOCABLE TRUSTS" dated April 17, 1997, by and between MARTHA L. WARNER, as Settlor, and MARTHA L. WARNER, as Trustee, as now in effect or as may hereafter be amended. SECOND: Funeral and Last Illness Ezpenses; Tazes. (A) Ezpenses of Funeral and Last Illness. Notwithstanding that my husband, JAMES E. WARNER survives me, I direct my Executor to pay my funeral expenses (regardless of amount) and the expenses of my last illness from my estate. In addition, my Executor ma~~ notify the Trustee of the Trust described in Paragraph FIRST (C} of any such expenses and my Executor may accept reimbursement from such Trustee. .~~, I ; -,_ , i. j ,-~ ~ !~~~.t. .~~~ " l ~'+ ~~ ~!•~ ~~.~, LAST WILL AND TESTAMENT OF MARTHA L. WA~FtNER PAGE 2 (B) Tazes. I direct my Executor to pay any and all estate, inheritance, succession, legacy, transfer and other death taxes or duties, by whatever name called, including any and all interest and penalties thereon, imposed under the laws of any jurisdiction by reason of my death upon or with respect to any and all property included in my gross estate for the purpose of such taxes, whether such property passes under or outside of this Will. Without any apportionment otherwise required by law and without being prorated or apportioned among or charged against the respective devises, legatees, beneficiaries, transferees, or other recipients of any such property or charged against any property passing or which may have passed to any of them, I direct that any taxes so paid shall be charged against my residuary estate. My Executor shall not be entitled to reimbursement for any portion of any such taxes from any such person. The foregoing provisions of this Article SECOND shall not apply to such portion or portions of said taxes, interest and penalties which may be required to be paid, or are actually paid or reimbursed, by the Trustee of the Trust described in Paragraph FIRST (C), above. THIRD: Tangible Personal Property. Except for those items excluded below and those items enumerated in the Letter of Instruction, I bequeath all my tangible personal property, including but not limited to clothing, jewelry, heirlooms, furniture, household furnishings, personal effects, motor vehicles, and all other similar articles, which I own, and the insurance thereon, to my husband, JAMES E. WARNER, if he survives me. Tangible personal property shall not include: (1) any and all property used by me in any business, (2) cash on hand or on deposit in banks, (3) stock or securities, (4) any type of evidence of indebtedness, and (5) any life, health or accident insurance policies. If my husband, JAMES E. WARNER, does not survive me, I leave such tangible personal property to my children, MICHAEL R WAIEtNER and JAMES T. WARNER, per stirpes, to be divided among them as they may select in as nearly equal shares as is practical. If there is any disagreement as to distribution, I direct my Executor to make such distribution. The decision of my Executor shall be final and binding. Any items not selected or any items which my Executor considers unsuitable for my children may be distributed or sold in the sole discretion of my Executor and, if sold, the net proceeds therefrom shall be added to the residue of my estate. Any such article allocated to a minor may, as my Executor deems advisable, either be delivered to the minor or to any person to safeguard on behalf of the minor. ?Tot«~ithstanding and- other provisions in this Article THIRD, I may leave a separate, dated and unsigned Letter of Instruction. v~-hich I shall place with m~~ W'ill, containing directions as to the ultimate disposition of certain of the propert}' Ilequeathed under this Article THIRD. and ~~`',,~~G, ' ~~~~~~ / ;. ,~~~", . f, ~~ LAST WILL AND TESTAMENT OF MARTHA L. WA~1tNER PAGE 3 such Letter of Instruction shall determine the distribution of such items. FOURTH: Residuary Estate. I devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wherever situated to which I am legally or equitably entitled, to the then-acting Trustee(s) of the Trust described in Paragraph FIRST (C) of this Will, to be held, administered and distributed pursuant to the terms thereof, as the same may be amended from time to time. By this devise and bequest of my residuary estate I hereby exercise all Powers of Appointment I possess at the time of my death except any power of appointment which I possess under the Trust described in Paragraph FIRST (C) of this Will. FIFTH: Powers of Executor. In addition to the powers and duties as may have been granted elsewhere in this Will, but subject to any limitations stated elsewhere in this Will, the Executor shall have and exercise exclusive management and control of the Estate and shall be vested with the following specific powers and discretion, in addition to the powers as may be generally conferred from time to time upon the Executor by law: (A) In the management, care and disposition of the Estate, the Executor shall have the power to do all things and to execute such instruments, deeds, or other documents as may be deemed necessary or proper, including the following powers, all of which may be exercised without order of or report to any Court: (1) To sell, exchange or otherwise dispose of any property at any time held or acquired hereunder, at public or private sale, for cash or on terms, without advertisement, including the right to lease for any term notwithstanding the period of the Estate, and to grant options, including any option for a period beyond the duration of the Estate; except that, in lieu of any binding shareholder agreement or buy/sell agreement to the contrary, the Executor shall not be permitted to sell the stock or any other ownership interest in any business ov~~ned by me, or held in trust, at my death, without first offering the same for sale to my children, or without next offering the same to the corporation or business represented by such ownership interest for redemption. (2} To invest alI monies in such stocks, bonds, securities, mortgages, notes, choses in action, real estate or improvements thereon. and an~~ other property as the Executor ma}' deem best. «~ithout regard to any la«~ now or hereafter enforced limiting in~-es~ments of fiduciaries. except that the Executor ma~~ not invest in an~~ securities ,. ,.~ _ , ., ~ I ~ _ ~~ , _ 2 f' ~ ? j ;.~ ~; ,_.: ; LAST WILL AND TESTAMENT OF MARTHA L. WARMER PAGE 4 issued by the corporate Executor, or issued by a parent or affiliate company of such Executor. (3) To retain for investment any property deposited with the Executor hereunder; except that the Executor may not retain for investment any stock in the corporate Executor, or in a parent or affiliate company of such Executor. (4) To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security. (5) To use attorneys, real estate brokers, accountants and other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. ' (6) To compromise, settle or adjust any claim or demand by or against the Estate and to agree to any rescission or modification of any contract or agreement affecting the Estate. (~ To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging, pledging or conveying any property of the Estate. (8) To retain and carry on any business in which the Estate may acquire an interest, to acquire additional interest in any such business, to agree to the liquidation in kind of any corporation in which the Estate may have an interest and to carry on the business thereof, to join with other owners in adopting any form of management for any business or property in which the Estate may have an interest, to become or remain a partner, general or limited, in regard to any such business or property and to hold the stock or other securities as an investment, and to employ agents and confer on them authority to manage and operate the business, property or corporation, without liability for the acts of such agent or for any loss, liability or indebtedness of such business if the management is selected or retained «~ith reasonable care. (9) To register any stock. bond or other securit<~ in the name of a nominee. «~ithout the addition of «-ords ipdicating that such securit~~ is held in a fiduciar~~ cal~acit~~, i ,, ,- rM L C _. r -. LAST WILL AND TESTAMENT OF MARTHA L. WA,ItNER PAGE 5 but accurate records shall be maintained showing that such security is a Estate asset and the Executor shall be responsible for the acts of such nominee. (B) Whenever the Executor is directed to distribute any Estate assets in fee simple to a person who is then under twenty-one (21) years of age, the Executor shall be authorized to hold such property in Trust for such person until he/she becomes twenty-one (21) years of age, and in the meantime shall use such part of the income and the principal of the Estate as the Executor may deem necessary to provide for the proper support and education of such person. If such person should die before becoming twenty-one (21) years of age, the property then remaining in trust shall be distributed to the personal representative of such person's estate. (C) In making distributions from the Estate to or for the benefit of any minor or other person under a legal disability, the Executor need not require the appointment of a guardian, but shall be authorized to pay or deliver the same to the custodian of such person, to pay or deliver the same to such person without the intervention of a guardian, to pay or deliver the same to a legal guardian of such person if one has already been appointed, or to use the same for the benefit of such person. (D) In the disbursement of the Estate and any division into separate trusts or shares, the Executor shall be authorized to make the distribution and division in money or in kind, or both, regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Executor shall be binding and conclusive on all persons taking hereunder. The Executor may in making such distribution or division allot undivided interests in the same property to several trusts or shares. (E) The Executor shall be authorized to lend or borrow, including the right to lend to or borrow from any trusts which I or my spouse may have established during life or by will at an adequate rate of interest and with adequate security, and upon such terms and conditions as the Executor shall deem fair and equitable. (F) The Executor shall be authorized to sell or purchase at the fair market value as determined by the Executor, any property to or from any trust created by me or my spouse during life or by Will, even though the same person or corporation may be acting as Executor of my estate or as Trustee of any of my other trusts. (G) The E~:ecutor shall ha~~~e discretion to determine ~~~hether items should be charged ~~~ ~' ,,~` .. ~ ,~ ~%. ,. ._; , LAST WILL AND TESTAMENT OF MARTHA L. WARNER PAGE 6 or credited to income or principal or allocated between income and principal as the Executor may deem equitable and fair under all the circumstances, including the power to amortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal, to treat any dividend or other distribution of any investment as income or principal, or apportion the same between income and principal, to charge any expense against income or principal or apportion the same, and to provide or fail to provide a reasonable reserve against depreciation or obsolescence on any assets subject to depreciation or obsolescence, all as the Executor may reasonably deem equitable and just under all the circumstances. If the Executor does not exercise the above discretionary power, the cash or accrual allocation shall be in accordance with Chapter 81 of Title 20 of the Pennsylvania Consolidated Statutes, or the corresponding provisions of subsequent state law. (H) If at any time the total fair market value of the assets of any trust established or to be established hereunder is so small that the corporate Trustee's annual fee for administering the trust would be the minimum annual fee set forth in the Trustee's regularly published fee schedule then, in effect, the Trustee in its discretion shall be authorized to terminate such trust or to decide not to establish such trust, and in such event the property then held in or to be distributed to such trust shall be distributed to the persons who are then or would be entitled to the income of such trust. If the amount of income to be received by such persons is to be determined in the discretion of the Trustee, then the Trustee shall distribute the property among such of the persons to whom the Trustee is authorized to distribute income, and in such proportions, as the Trustee in its discretion shall determine. (n Except as otherwise provided in this Will, when the authority and power under this Will is vested in two (2) or more Executors or Trustees, the authority and powers are to be held jointly by the Executors or Trustees, respectively. A majority of the Executors or Trustees may exercise any authority or power granted under this Will or granted by law, and may act under this Will. Any attempt by one such Executor or Trustee to act under this Will on other than ministerial acts shall be void. The action of one such Executor or Trustee under this Will may be validated by a subsequent ratification of the act by a majority of the Executors or Trustees. SIXTH: Rights and Liabilities of Executor. ~/~ t . ~~. ;~ ~~__ // /~~;~ f. ~ !./, ; LAST WILL AND TESTAMENT OF MARTHA L. WARNER PAGE 7 {A) No bond or other security shall be required of any Executor. . (B) This instrument always shall be construed in favor of the validity of any act or omission by any Executor, and any Executor shall not be liable for any act or omission except in the case of gross negligence, bad faith or fraud. Specifically, in assessing the propriety of any investment, the overall performance of the entire Estate shall be taken into account. (C) Each Executor shall be entitled to receive reasonable compensation for services actually rendered to my estate, in an amount the Executor normally and customarily charges for performing similar services during the time which he/she performs the services. SEVENTH: Spendthrift Provision. No beneficiary shall have the power to anticipate, encumber or transfer his or her interest in the estate in any manner other than by the valid exercise of a power of appointment. No part of the estate shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. EIGHTH: Taz Elections. (A) In determining the estate, inheritance and income tax liability relating to my Estate, the Executor's decision as to ail available tax elections shall be conclusive on all concerned. If the Executor joins with my spouse in filing income tax returns, or consenting for gift tax purposes to having gifts made by either of us during my life considered as having been made one-half by each of us, any resulting liability shall be borne by my Estate and my spouse in such proportions as they may agree. In accordance with IRC Section 2632(a) and without regard to ~~hether a Federal estate tax return is actually filed, my Executor shall allocate so much of the Federal Generation Skipping Transfer (GST) exemption amount as will fully exempt any generation skipping transfer which may occur under this Will. (B) The Executor may, in its discretion, determine the date as of which my gross estate shall be valued for the purpose of determining the applicable tax payable by reason of my death. (C) The Executor may, in its discretion, decide v~-hether alI or an}~ part of certain deductions shall be taken as income tax deductions (even though they may equal or exceed the taxable income of rn~~ estate and «~hether or not claimed or of benef t on m~~ estate's income tax ~~ i' , .i~~• ~ ~ - JN~,, r J. -~ .;:` LAST WILL AND TESTAMENT OF MARTHA L. WA,,RNER PAGE 8 return) or as estate tax deductions when a choice is available; and in the event that all or any part of such deductions are taken as income tax deductions, no adjustment of income and principal accounts in my estate shall be made as a result of such decisions. NINTH: Definitions and General Provisions. (A) Survival. Any beneficiary who dies within sixty (60) days after my death shall be considered not to have survived me. (B) Cations. The captions set forth in this Will at the beginning of the various articles hereof are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their construction and application. (C) Children. As used in this Will, the words "child" and "children" shall include persons who are legally adopted and the issue of said persons, whether born in or out of wedlock, so long as any person born out of wedlock is acknowledged in a written instrument executed by the one of their natural parents who is a descendant of mine to be the child of said descendant. The word "issue" shall include descendants of all generations including adopted persons. A posthumous child shall be considered as living at the death of his parent. The birth to me or the adoption by me of a child or children subsequent to the execution of this Will shall not operate to revoke this Will. Except for discretionary distributions which may be made unequally among a group of persons and distributions pursuant to a valid exercise of a power of appointment, in making a distribution to the children of any person, the property to be distributed shall be divided into as many shares as there are living children of the person and deceased children of the person who left children who are then living. Each living child shall take one share and the share of each deceased child shall be divided among his then-living descendants in the same manner. (D) Code. Unless otherwise stated, all references in my Will to section and chapter numbers are to those of the Internal Revenue Code of 1986, as amended, or the corresponding provisions of any subsequent federal tax laws applicable to my estate. (E) Other terms. The use of any gender includes the other genders, and the use of either the singular or the plural includes the other. (F) Powers of Appointment are Exercised. By this Will I exercise anv and aII Po«•ers of appointment «~hich I possess at the time of m~~ death except an~~ power of ,~ 1 ~/~ ~ ~~- ~~, ~ ~ ~ , ~ t ~_ ,. ,,-,, ,~. .; LAST WILL AND TESTAMENT OF MARTHA L. WARNER PAGE 9 appointment which I possess under the Trust described in Paragraph FIRST (C), above. IN WITNESS WHEREOF, I, MARTHA L. WARNER, the Testatrix, have to this my Last Will and Testament, typewritten on den (10) pages, including the Acknowledgment and Affidavit, set my hand and seal this day of February, 2010. MARTHA L. WAIEZNER Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our names at her request, as witnesses hereto, in the presence of the said Testatrix, and in the presence of each other. Each of us further declares that he or she believes the Testatrix to be of sound mind and memory. The preceding instrument consists of this and nine (9) other consecutively numbered typewritten pages including the Acknowledgment and Affidavit. ~.. '~~-j ~~ ~ ~=~~jr' residin at ~`~ -, , ~ ~' -~- (print name) ,,- ; ~: - ~' ..L ~~1:~ `'~ ,-~ `. residing at ~ ° -~ ~'~ f r-- , it ~ i .:- . ; `_ r (~rlnt nall~e~ ' ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA f~~ COUNTY OF t ~_' /~ l.' (.~c.L `C C (~1L tc,(`'~,~ SS: The Testatrix and the witnesses whose names are signed and subscribed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do hereby acknowledge, depose and say to the undersigned authority, that the Testatrix signed and executed the instrument as her Last Will in the presence of the witnesses; that she signed it willingly or willingly directed another to sign it for her; that she executed it as her free and voluntary act for the purposes therein expressed; that each of the witnesses were present and saw the Testatrix sign and execute the instrument as her Last Will; that each subscribing witness in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. 1 ~: ~. Testatrix ~;,~ i ~~ 0 ~-.. f! W1tneSS r ~~-, ,, Witness Sworn to or affirmed, subscribed to, and ackno~~ledged, before me by the above-named Testatrix and witnesses, this .~ ~ `~'~ day of February, 2010. E ~er-tayale Born: ~~t-~~ti~.~,ij Geu^c;- E t,~y Comrr~~ssiort EY.~rbs,~~~E. ~~J. 2~~ Notar~~ Public '~1~_ Coznznis~ion 1/~.1,ires: f~~2fTi~9~, PSI?:^.Sa~~:=,r1~^- ~=SS'!~EHiI~ ~~ Elf hl~~~~I(:S AMENDMENT TO THE MARTHA L. WARNER FAMII~Y REVOCABLE TRUST ;, ~ ~_. THIS AMENDMENT TO TRUST is executed in triplicate on this ;` ~ day of February, ZO10, by and between MARTHA L. WARNER, now of 17 Pheasant Street, Mechanicsburg, Cumberland County, Pennsylvania 17055 (herein called "Settlor") and MARTHA L. WARNER, now of 17 Pheasant Street, Mechanicsburg, Cumberland County, Pennsylvania 17055 (herein called "Trustee"). WHEREAS, Settlor and Trustee entered into The Martha L. Warner Family Revocable Trust dated April 17, 1997, (herein called the "Trust"); and WHEREAS, Settlor now desires to amend and revise the Trust, to make the within described deletions, amendments and corrections. NOW, THEREFORE, the parties hereto, in consideration of the mutual covenants herein stated, agree as follows: 1. Settlor's son, MICHAEL R WARNER, is hereby appointed to serve as Trustee jointly or individually with the Trustee, MARTHA, L. WARNIER, upon the execution of this Amendment. 2. Articles III through VII of the Trust inclusive are hereby deleted in their entirety and new Articles III through VII are hereby inserted to read as follows: ARTICLE III. DISTRIBUTIONS FROM TRUST 3.01. Distributions During Settlor's Life. If more than ONE HUNDRED DOLLARS ($100) worth of cash, property or other assets is added to the Trust during the Settlor's life, then the Trustee shall pay to, or apply for the benefit of, the Settlor: (1) so much of or all of the income and so much of or all of the principal as the Trustee deems desirable for the most comfortable care, support, maintenance, welfare, education, happiness, luxuries and any needs arising from illness, accidents or other emergencies of the Settlor; and (2) so much of or all of the income and so much of or all of the principal as the Settlor shall request. 3.02. Distributions Upon the Death of the Settlor Survived by the Settlor's Spouse. If the Settlor's spouse, JAMES E. WARNER, survives the Settlor by more than thirty (30) days, then the balance of the Trust shall be distributed to the Settlor's spouse. 3.03. Distributions Upon the Death of the Settlor If the Settlor's Spouse Does Not Survive the Settlor. Upon the death of the Settlor and if the Settlor's spouse does not survive the Settlor by thirty (30} days and following the payment of all necessary and appropriate taxes, fees, costs and expenses, or upon the Settlor's death if the Settlor's spouse has predeceased Settlor, the remaining trust estate shall be distributed as follows: (a) THIRTY-FIVE PERCENT (35%) of the remaining trust estate shall be distributed to Settlor's son, JAMES T. WARNER, per stirpes; and (b) THIRTY-FIVE PERCENT (35%) of the remaining trust estate shall be distributed to Settlor's son, MICHAEL R. WARNER, per stirpes; and (c) THIRTY PERCENT (30%) of the remaining trust estate shall be divided equally among the following individuals: the Settlor's friend, DEBORAH E. BARB, the Settlor's grandchildren, BROOK M. WARNER, MARISSA K. WARNER, KELSEY N. WARNER and ZACHARY J. WARNER, per capita, provided that the share for ZACHARY J. WARNER shall be held, administered and distributed IN FURTHER SEPARATE TRUST for his benefit, in accordance with the terms set forth in Subparagraph 3.03 (c)(1), below: (1) This trust is established for the purpose of improving the quality of life of Settlor's grandson, ZACHARY J. WARNER, for and during all the term of his natural life. Settlor's grandson suffers from disabilities which may require continuing medical care. He may be entitled to benefit from various governmental programs which provide for his basic or supplemental care. It is the purpose of this trust to provide Settlor's grandson with a higher quality of life beyond that which would be provided by these public entitlement programs and to provide him with a proper funeral and burial. (2) Settlor`s intent is that the Trustee use this trust to promote the happiness, welfare and benefit of Settlor's grandson through income and principal distributions, without in any way reducing the services or financial assistance and basic maintenance, support, medical or dental care which he may receive without charge from any local, state or federal government agency or department thereof, and without using any portion of the trust income or principal to reimburse any 2 local, state or federal government agency or department thereof for basic maintenance, support, medical or dental care received by him. Settlor's intent is that the trust income and principal are not to be considered income, assets or resources of Settlor's grandson for any purpose, including but not limited to, the determination of income, assets or resources as stated in any rules or regulations set forth by any local, state or federal government agency or department thereof. In the event the Trustee is requested by any department or agency to release principal or income of the trust to or on behalf of Settlor's grandson to pay for equipment, medication or services which other organizations or agencies are authorized to provide, or in the event the Trustee is requested by any department or agency administering such benefits to petition the court or any other administrative agency for the release of trust principal or income for this purpose, the Trustee shall deny such request and is directed to defend, at the reasonable expense of the trust estate, any contest or other attack of any nature. (3) The Trustee shall distribute to Settlor's grandson or expend and apply foi- his benefit, so much of or all of the income and principal of this trust, as the Trustee, in his sole and absolute discretion, determines to be advisable for the grandson's special needs for happiness and comfort to achieve the purpose of the trust herein set forth. The "special needs" which the Trustee may provide for Settlor's grandson shall include, but are not limited to, spending money, additional food, clothing, birthday gifts, gifts for major holidays, small appliances that would provide him with entertainment or amusement, computer equipment, camping excursions, vacations, athletic contests, movies, trips, money to purchase appropriate gifts for relatives and friends, any recreational items that would be of use to him and other monetary requirements to enhance his self-esteem or situation. "Special needs" shall also include medical and dental expenses, annual independent check-ups, rehabilitation and physical therapy equipment, programs of training, education, treatment, physical therapy and rehabilitation, private residential care, eye glasses, transportation (including vehicle purchase and maintenance), insurance (including payment of premiums of insurance on the life of Settlor's grandson) and other requisites for maintaining his good health, safety and welfare when, in the discretion of the Trustee, such requisites are not being provided by any public agency, office or department of any state or of the United States. Nothing herein shall preclude the Trustee from purchasing those services and items which promote the grandson's happiness, comfort and welfare. The Trustee shall also have authority in his absolute and sole discretion to make gifts to any community residence in which Settlor's grandson may be residing. 3 (4) Any net income not expended for, or applied to, the special needs of Settlor's grandson shall be accumulated and added to the trust principal. (~ The Trustee shall have no obligation to expend trust assets for the grandson's special needs, but if the Trustee, in his sole discretion, decides to expend trust assets, under no circumstances should any amounts be paid to, or reimbursed to, the federal government, any state or any governmental agency for any purpose, including for the care, support and maintenance of Settlor's grandson. This trust is created expressly for the grandson's extra and supplemental care, maintenance, support and education in addition to, and over and above the benefits he otherwise receives or may receive as a result of handicap or disability, from any local, state or federal government, or from any other private agency, any of which provides services or benefits to persons with disabilities. It is Settlor's express purpose that this trust be used only to supplement other benefits that Settlor's grandson may receive. (~ Because Settlor's grandson may be dependent on the support and aid of others, the Trustee shall, in the exercise of his best judgment and fiduciary duty, seek support and maintenance for him, or request the guardian of Settlor's grandson, if any, to seek support and maintenance for him, from all available public resources, including, but not limited to, Social Security Administration benefits, the Supplemental Security Income Program (SSI), any such supplemental income program offered by or through the Commonwealth of Pennsylvania, the Old Age Survivors and Disability Insurance or successor programs, U.S. Civil Service Commission benefits, Medicaid and federal Social Security Disability Insurance (SSDI), and any other comparable programs, state, federal or local. The Trustee shall take into consideration applicable resource and income limitations of any public assistance programs for which Settlor's grandson is eligible when determining whether or not to make any discretionary distributions. In carrying out the provisions of this separate trust, the Trustee shall be mindful of the probable future needs of the remaindermen of this trust. If necessary, the Trustee may seek appropriate authority to collect, expend and account for separately all such governmental assistance benefits, but shall not commingle them with the trust assets. In addition, in making distributions for the special needs of Settlor's grandson, the Trustee shall take into consideration the applicable resource limitations of the public assistance programs for which he is or may become eligible. 4 (7) The Trustee shall regard this trust as existing for the welfare and benefit of Settlor's grandson. Accordingly, the Trustee shall exercise his discretion as to disbursements and investments with this standard in mind. Consistent with the purpose of this trust, Settlor may establish a life plan to be periodically updated, signed and dated. It is intended that the Trustee read the life plan as it exists at the time of Settlor's death and use it as guidance in administering this trust according to the terms set forth herein. In no event shall the life plan be binding upon the Trustee or otherwise diminish the Trustee's discretion as described herein. (S) The Trustee shall not be required to make an accounting to any public official except to the extent otherwise required by law. The Trustee shall, however, keep and maintain complete and open accounts of the trust principal and income and any expenditures from the trust. Any person having an interest in the trust shall have a right to inspect the accounts at reasonable times and with reasonable notice to the Trustee. A11 discretion conferred on the Trustee shall be absolute and unlimited, and its exercise by the Trustee shall be conclusive and binding on all persons. (9) The Trustee shall pay reasonable burial expenses including a suitable and proper grave marker for Settlor's grandson. (10) This trust shall terminate upon the death of Settlor's grandson. Upon termination, the Trustee shall distribute the remaining trust estate to the issue of Settlor's grandson, ZACHARY J. WARNER, or if he has no surviving issue, then to Settlor's surviving issue in equal shares, per stirpes. ARTICLE IV. POWERS OF TRUSTEE 4.01. General Powers. In addition to such other powers and duties as may have been granted elsewhere in this Trust, but subject to any limitations contained elsewhere in this Trust, the "hrustee shall have the following powers and duties: (A) In the management, care and disposition of this Trust, the Trustee shall have the power to do all things and to execute such deeds, mortgages, instruments and documents as may be deemed necessary and proper, including the following powers, all of which may be exercised without order of or report to any court: 5 (1) To sell, exchange, or otherwise dispose of any property, real, personal or mixed, at any time held or acquired hereunder, at public or private sale, for cash or on terms, without advertisement, including the right to lease for any term notwithstanding the period of the Trust, and to grant options, including an option for a period beyond the duration of the Trust; and to execute such deeds or other instruments as are necessary. (2) To invest all monies in such stocks, bonds, securities, investment companies or trust shares, mortgages, notes, choses in action, real estate, improvements thereon and other property as the Trustee may deem best, without regard to any law now or hereafter in force limiting investments of fiduciaries; except that the Trustee may not invest in any stock or securities issued by a corporate Trustee or issued by a parent or affiliate company of a corporate Trustee. (3) To retain for investment any property deposited with the Trustee hereunder; except that the Trustee may not retain for investment any stock or securities in a corporate Trustee or in a parent or affiliate company of a corporate Trustee. (4) To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security held by this Trust. (5) To use lawyers, real estate brokers, accountants and other agents, if~ such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. (6) To compromise, settle or adjust any claim or demand by or against the Trust and to agree to any rescission or modification of any contract or agreement affecting the Trust. ('~ To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging, pledging or conveying any property of the Trust, including the power to borrow from the Trustee (in the Trustee's individual capacity) at a reasonable rate of interest. (8) To retain and carry on any business in which the Trust may acquire any interest, to acquire additional interests in any such business, to agree to the 6 liquidation in kind of any corporation in which the Trust may have any interest and to carry on the business thereof, to join with other owners in adopting any form of management for any business or property in which the Trust may have an interest, to become or remain a partner, general or limited, in regard to any such business or property and to hold the stock or other securities as an investment, and to employ agents and confer on them authority to manage and operate the business, property or corporation, without liability for the acts of any such agent or for any loss, liability or indebtedness of such business if the management is selected or retained with reasonable care. (9) To register any stock, bond or other security in the name of a nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that the stock, bond or other security is a trust asset, and the Trustee shall be responsible for the acts of the nominee. (10) To merge this Trust with any other trust created in Settlor's Will or otherwise, with similar provisions and purposes and the same beneficiary or beneficiaries, but only to the extent that the merger of the trusts will not cause the imposition of gift tax, or generation-skipping tax, federal or otherwise. (B) Unless otherwise designated, whenever the Trustee is directed to distribute any trust principal in fee simple to a person who is then under eighteen (18) years of age, the Trustee shall be authorized to hold such property in trust for such person until he becomes eighteen (18) years of age, and in the meantime shall use such part of the income and the principal of the Trust as the Trustee may deem necessary to provide for the proper support and education of such person in the standard of living to which he has become accustomed. If such person should die before becoming twenty-one (21) years of age, the property then remaining in trust shall be distributed to the personal representative of such person's estate. (C) In making distributions from the Trust to or for the benefit of any minor or other person under a legal disability, the Trustee need not require the appointment of a guardian, but shall be authorized to pay or deliver the distribution to the custodian of such person, to pay or deliver the distribution to such person without the intervention of a guardian, to pay or deliver the distribution to the legal guardian of such person if a guardian has already been appointed, or to use the distribution for the benefit of such person. (D) Subject to the limitations in Paragraphs 3.02 and 3.04, above, in the distribution of the Trust and any division into separate trusts and shares, the Trustee shall be authorized to make the 7 distribution and division in money or in kind or in both, regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Trustee shall be binding and conclusive on all persons taking hereunder. The Trustee may, in making such distribution or division, allot undivided interests in the same property to several trusts or shares. (E) If at any time after Settlor's death the total fair market value of the assets of any trust established or to be established hereunder is so small that the Trustee's annual fee for administering the trust would be equal to or less than the minimum annual fee set forth in the Trustee's regularly published fee schedule then, in effect, the Trustee, in his discretion, shall be authorized to terminate such trust or to decide not to establish such trust, and in such event the property then held in or to be distributed to such trust shall be distributed to the persons who are then or would be entitled to the income of such trust. If the amount of income to be received by such persons is to be determined in the discretion of the Trustee, then the Trustee shall distribute the property among such of the persons to whom the Trustee is authorized to distribute income, and in such proportions, as the Trustee, in his discretion, shall determine. (~ The Trustee shall be authorized to lend or borrow, including the right to lend to or borrow from the Settlor's estate or the estate of the Settlor's spouse, at an adequate rate of interest and with adequate security and upon such terms and conditions as the Trustee shall deem fair and equitable. (G) The Trustee shall be authorized to sell or purchase, at the fair market value as determined by the Trustee, any property including any property to or from Settlor's estate or the estate of the Settlor's spouse, or any trust created by Settlor or Settlor's spouse, during life or by will, even though the same person or corporation may be acting as executor of Settlor's estate or as trustee of any of such other trusts and as the Trustee of this Trust. (I~ Subject to the limitations in Article III, above, the Trustee shall have discretion to determine whether items should be charged or credited to income or principal or allocated between income and principal as Trustee may deem equitable and fair under all the circumstances, including the power to amortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal, to treat any dividend or other distribution on any investment as income or principal or to apportion the same between income and principal, to charge any expense against income or principal or apportion the same, and to provide or fail to provide a reasonable reserve against depreciation or obsolescence on 8 any asset subject to depreciation or obsolescence, all as the Trustee may reasonably deem equitable and just under all of the circumstances. ARTICLE V. SPENDTIIItIFT PROVISION 5.01. General Provisions. No beneficiary shall have the power to anticipate, encumber or transfer his interest in the trust estate in any manner other than by the valid exercise of a power of appointment. No part of the trust estate shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a benef ciary. ARTICLE VI. CONSTRUCTION OF TRUST 6.01. Choice of Law. This Trust shall be administered and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. 6.02. Code. Unless otherwise stated, all references in this Trust to section and chapter numbers are to those of the Internal Revenue Code of 1986, as amended, or corresponding provisions of any subsequent federal tax laws applicable to this Trust. 6.03. Other Terms. Unless the context otherwise requires, the use of one or more genders in the text includes all other genders, and the use of either the singular or the plural in the text includes both the singular and the plural. 6.04. Captions and Table of Contents. The underlined captions set forth in this Agreement at the beginning of the various divisions hereof and the Table of Contents appearing at the beginning of this Agreement are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their construction and application. 6.05. Situs of Trust. The Trust shall have its legal situs at Cumberland County, Pennsylvania. ARTICLE VII. COMPENSATION OF TRUSTEE AND APPOINTMENT OF SUCCESSOR TRUSTEE 9 7.01. Compensation. The Trustee shall receive as his compensation for the services performed hereunder that sum of money which the Trustee customarily charges for performing similar services during the time which he performs these services. 7.02. Removal or Resignation of Trustee. Settlor may remove the Trustee at any time or times, with or without cause, upon thirty (30) days written notice given to the Trustee. After the Settlor's death, a majority of the current beneficiaries may remove the Trustee at any time or times, with or without cause, upon thirty (30) days written notice given to the Trustee. The Trustee may resign at any time upon thirty (30) days written notice given to the Settlor if Settlor is living, or after Settlor's death, upon thirty (30) days written notice given to the current beneficiaries. Upon the removal or resignation of the Trustee, a successor trustee shall be appointed in accordance with the terms set forth in Paragraph 7.03, below. 7.03. Successor Trustee. Upon the death, resignation, removal or incapacity of the Trustee, the Settlor's son, MICHAEL R. WAItN]ER, is hereby appointed Successor Trustee. Upon the death, resignation, removal or incapacity of the Trustee and Successor Trustee, the Settlor's daughter-in-law, RENEE E. WARNER, is hereby appointed to act as Second Successor Trustee. Upon the death, resignation, removal or incapacity of the Trustee, the Successor Trustee, and the Second Successor Trustee, the succeeding Trustees of this Trust or any Trust hereunder shall occur in the following order: first I~IVIBERLY OPPERMAN, then KELSEY WARNER. Upon the death, resignation, removal or incapacity of the Trustee and all of the aforenamed Successor Trustees, a successor trustee may be appointed by a majority of the current beneficiaries. Any successor trustee thus appointed shall be a financially sound and competent corporate trustee or an individual nominated by athen-currently serving Trustee. Any duly appointed successor trustee shall succeed to all the duties and powers, including discretionary powers, herein granted to the Trustee. Except as otherwise provided herein, Settlor prohibits the appointment of any beneficiary's natural or legal guardian or legal representative as successor trustee, and any attempt to do so shall be without authority under this Agreement. 3. In all other regards, the Trust referenced above shall remain in full force and effect and is not amended unless specifically provided herein. 10 IN WITNESS WHEREOF, the Settlor and Trustee have hereunto set their hands and seals as of the day and year first above written. WITNESS: ,,~ ~~ .~ ,, A ,, , ~ .~ ~~-, , .~ ~ - , - (SEAL) ~ `~ ~ e L.L. t....- MARTHA L. WARNER, SETTLOR COMMONWEALTH OF PENNSYLVANIA. SS: COUl~ITY OF CUMBERLAND On this the ~`~ ~`da of February, 2010, before me, a Notary Public, the undersigned Y officer, personally appeared MARTHA L. WARI~TER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Amendment to Trust, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal:- «eco(r < r:~fif~N~'JcF-iL~-~=Cr=i ENi'~SY~..':%~~f~if.. _.._. _ - , 1Votarial Seal Yeri L. wa!!«r, i~3UYa~~ ~'u~ic~ Lemoyne Boro, Cun~k~~rland ;otani rally Commission ~xpiros tarp. 20, 20~ ' . Notary Public Ivry Commission Expires: ~Jlembsr~ f'~nnsul~~ania ~„~ri~$inf~ n7 Y41!~Yari~~ 11 The foregoing Amendment_ to Trust was delivered, and is hereby accepted, at Lemoyne, Pennsylvania, on February ~~' , 2010. WITNESS: ,. _~ ~ ~ : ,, F. ;~ ,= f f' ~~1 ~ r' `rat: i't ~° F= ~ . ~~.~: ~ (SEAL) F ~ c e MARTHA L. WARNER, TRUSTEE ~- ;,. ~-~. (SEAL) MICHAEL R. WARNER, TRUSTEE 12 THE MARTHA L. WARNER FAMILY REVOCABLE TRUST '~ 6~. THIS TRUST, AGREEMENT is executed in triplicate on this ~'~ day of ~~`~ 1997, by and between MARTHA L. WARNER, now of 5614 Moreland Court, Mechanicsburg, Cumberland County, Pennsylvania 17055 (herein called "Settlor"), and MARTHA L. WARNER, now of 5614 Moreland Court, Mechanicsburg, Cumberland County, Pennsylvania 17055 (herein called "Trustee"). ARTICLE I. PARTIES, PERSONAL DATA AND TABLE OF CONTENTS 1.01. Parties and Personal Data. The Settlor is married to JAMES E. WARNER. The Settlor's children are MICHAEL R. WARNER and JAMES TODD WARNER. Throughout this Trust Agreement: (a) MARTHA L. WARNER will be referred to as the "Settlor"; (b) JAMES E. WARNER will ~be referred to as the "Settlor' s spouse" ; (c) MICHAEL R. WARNER and JAMES TODD WARNER will be ref erred to as the "children of the Settlor" or the "Settlor's children"; and (d) the term "issue" will include the Settlor's children as well as Settlor's other descendants. 1.02 . Table of Contents . Pate ARTICLE I. PARTIES, PERSONAL DATA AND TABLE OF CONTENTS 1.01 Parties and Personal Data 1 1.02 Table of Contents 1 ARTICLE II. TRUST ESTATE 2.01 Transfer to Trust 2 2.02 Additional Transfers to Trust 2 ARTICLE III. DIST 3.01 3.02 3.03 3.04 EZIBUTIONS FROM TRUST Distributions During Settlor's Lif e 3 Formula Division into Non-Marital and Marital Portions 3 Disposition of Non-Marital Portion; the By-Pass Trust 6 Disposition of Marital Portion 12 ARTICLE IV. POWERS OF TRUSTEE 4.01 General Powers 12 ARTICLE V. SPENDTHRIFT PROVISION 5.01 General Provisions 16 ARTICLE VI. CONSTRUCTION OF TRUST 6.01 Choice of Law 16 6.02 Code 16 6.03 Other Terms 17 6.04 Captions and Table of Contents 17 6.05 Situs of Trust 17 ARTICLE VII. COMPENSATION OF TRUSTEE AND APPOINTMENT OF SUCCESSOR TRUSTEE 7.01 Compensation 17 7.02 Removal or Resignation of Trustee 17 7.03 Successor Trustee 17 ARTICLE VIII. PERPETUITIES CLAUSE 8.01 General Provisions 18 ARTICLE IX. REVOCATION AND AMENDMENTS 9.01 Reservation and Powers 18 9.02 Effect of Settlor's Incapacity 18 ARTICLE X. ACQUISITION OF UNITED STATES TREASURY BONDS ELIGIBLE FOR TAX PAYMENT; PAYMENT OF TAXES, FUNERAL EXPENSES AND EXPENSES OF ADMINISTRATION 10.01 Acquisition of Bonds 20 10.02 Payment of United State Estate Tax by Bond Redemption 20 10.03 Payment of Death Taxes and Other Estate Settlement Costs 20 ARTICLE II. TRUST ESTATE 2.01. Transfer to Trust. Settlor does hereby assign, transfer and deliver to the Trustee and his successors and assigns the property described in Schedule "A" attached hereto and made a part hereof, or as Schedule "A" may be amended. As further evidence of such assignment, the Settlor has executed or will execute or cause to be executed such other instruments as may be required for the purposes of completing the assignment or transfer of title to such property to the Trustee. The Trustee accepts such transfer and assignment to himself as Trustee, and the Trustee undertakes to hold, manage, invest and reinvest the assets of this Trust and to distribute the income and principal of the Trust in accordance with the provisions of this Agreement. 2.02. Additional Transfers to Trust. The Settlor, and any other person(s) with the consent of the Trustee, shall have the right at any time to make additions to the corpus of this Trust 2 or any shares thereof hereby established. All such additions shall be held, controlled and distributed by the Trustee in accordance with the terms and conditions of this Agreement. ARTICLE III. DISTRIBUTIONS FROM TRUST 3.01. Distributions During Settlor~s Life. If more than ONE HUNDRED DOLLARS ($l00) worth of cash, property or other assets is added to the Trust during the Settlor's life, then the Trustee shall pay to, or apply for the benefit of, the Settlor: (1) so much of or all of the income and so much of or all of the principal as the Trustee deems desirable for the most comfortable care, support, maintenance, welfare, education, happiness, luxuries and any needs arising from illness, accidents or other emergencies of the Settlor; and (2) so much of or all of the income and so much of or all of the principal as the Settlor shall request. 3.02. Formula Division into Non-Marital and Marital Portions. (A) General Explanation of Plan. If the Settlor's spouse survives the Settlor, then upon the Settlor's death the Trustee shall divide the trust property into non-marital and marital portions pursuant to the formula set forth in Subparagraph 3.02(B), below. If the Settlor's spouse does not survive the Settlor, then all of the trust property shall be disposed of as provided in Subparagraph 3.03(D), below (applicable to the non- marital portion of this Trust). (B) Formula Division into Non-Marital and Marital Portions. (1} Non-Marital Portion. The non-marital portion of this Trust shall be an amount equal to the largest amount that can pass from the Settlor's estate free of any federal estate tax as a result of the allowance of the Unified Credit under Internal Revenue Code (hereinafter "IRC") X2010 and the State Death Tax Credit under IRC X2011, but only to the extent that the use of such Death Tax Credit does not incur or increase any state death taxes otherwise payable by Settlor's estate. The non-marital portion of this Trust shall be determined after taking into consideration, among other things, the following: (i) the value of any and all bequests or transfers from the Settlor's estate or this Trust which do not qualify for the marital or charitable deduction; (ii) all charges against principal in the Settlor's estate or this Trust that 3 are not allowed as deductions in computing the federal estate tax; (iii) all administration and other expenses claimed on the Settlor's estate tax return; {iv} any prior adjusted taxable gifts made by Settlor; (v) all disclaimers, renunciations and elections (except any elections under IRC ~2056(b)(7)) which may be available with respect to the disposition in this Article III; and (vi) any available elections under IRC §2056(b}(7) with respect to any interests in property other than the disposition under this Article III shall, for purposes of computing the fraction, be conclusively presumed to have been made, whether or not any such election is in fact made. (2) Marital Portion. The marital portion of this Trust shall be the portion remaining after reducing the entire amount held in this Trust by the non-marital portion. (C) Non-Marital Portion to Pass to the By-Pass Trust. The non-marital portion of this Trust shall pass into a trust (herein referred to as the "By-Pass Trust") to be held and disposed of in accordance with the terms set forth in Paragraph 3.03, below. (D) Distribution of Marital Portion. The entire marital portion shall be disposed of as provided in Paragraph 3.04, below. (E) Valuation Elections and Selection of Assets. (1) Valuation Elections, Meaning of Terms and Date of Distribution values to Govern. For the purpose of determining the amount of the marital portion, values shall be those which are finally determined for federal estate tax purposes. Elections made by the Settlor's fiduciaries with respect to an alternate valuation date and with respect to taking certain deductions for income tax purposes (rather than estate tax purposes) shall determine the values and thus the formula amount as computed under Subparagraph 3.02(B), above. Throughout this instrument, the words "marital deduction," "gross estate" and "alternate valuation date" shall have the same meanings as such words have for marital deduction purposes under the f ederal tax laws applicable at the time of Settlor's death. Subject to the requirements of Subparagraphs 3.02(E)(2) and (3), below, the Trustee is authorized, in his sole discretion, to satisfy the marital portion in cash or in kind, or partly in each, and if wholly or partly in 4 kind, to place in the marital portion the specific asset(s) so selected; provided, however, that any assets placed in the marital portion in kind shall be valued for the purpose of being placed in the marital portion at their fair market value as determined as of their respective dates of distribution to the marital portion. The Trustee is further authorized, in his sole discretion, to estimate the size of the marital portion and to fund that portion subject, however, to any adjustments which may be required upon final determination of the federal estate tax on the Settlor's estate. (2} Assets to go into the Marital Portion. Unless and except to the extent that other assets of the Settlor's estate which qualify for the marital deduction are not sufficient to satisfy the amount to be placed in the marital portion in full, the marital portion shall be satisfied with assets which are includable in the Settlor's gross estate for federal estate tax purposes and which are also subject, by reason of the Settlor's death, to any estate, transfer, inheritance, legacy, succession or other death tax or duty imposed by any foreign country or a possession or political subdivision thereof, or the proceeds from such assets. The marital portion shall not, under any circumstances, be satisfied with assets which would not qualify for the marital deduction or with any unmatured life insurance policy or in any other manner which would not qualify for the marital deduction under applicable law. If the Settlor's estate includes United States bonds redeemable to pay the federal estate tax at more than their market value, any excess of such bonds over the amount needed to pay said tax due by reason of the Settlor's death shall be first used to satisfy the marital portion, whether said bonds are held in this Trust at the Settlor's death or subsequently distributed to this Trust from the Settlor's estate. Any reference in this Agreement to a distribution of an asset not includable in the decedent's gross estate for federal estate tax purposes shall be deemed to include that portion of any asset partially includable in the decedent's estate that is not so includable. (3) Special Treatment for Certain Cther Assets. If any distributions which are includable in the Settlor's gross estate are made from any pension, stock bonus, profit-sharing or other plan or trust funds, 5 retirement annuity contract, self-employed retirement plan or individual retirement account, annuity or bond qualified for special tax treatment under IRC §401, 403, 408 or 409, or Chapter 73 of Title 10 of the United States Code, or if any death benefits paid by an employer which are distributions not includable in the Settlor's gross estate shall be payable to the Trustee, then such distributions shall be added to the non- marital portion, after being segregated, as provided herein, if the Settlor's spouse survives the Settlor, and administered in the same manner as is the non- marital portion. If the Settlor's spouse does not survive the Settlor, then such distributions shall be held under the terms of this Agreement as any other property received from the Settlor's estate. However, where any distributions not includable in the Settlor's gross estate are received by the Trustee hereunder from any such qualified plan, trust, contract, account, annuity or bond, or received as death benefits paid by an employer not includable in the Settlor's gross estate, then such distributions shall be segregated until such time as all of the death taxes on the Settlor's estate are paid in full. The Trustee is prohibited from using any portion of such distributions for the payment of the Settlor's death taxes, debts, administration expenses of Settlor's estate or Settlor's funeral expenses. The provisions of this Subparagraph 3.02{E)(3) shall not apply to distributions includable in the Settlor's gross estate, except insofar as the Trustee, in his sole discretion, desires to make some or all of said provisions applicable, and the term "distributions not includable in the Settlor's gross estate" includes a distribution received by the Trustee where the recipient may elect whether to include or exclude said distribution and has elected to exclude it. 3.03. Disposition of Non-Marital Portion; the By-Pass Trust. The non-marital portion, after compliance with Paragraph 3.02, above, shall be placed in a trust called the By-Pass Trust, to be held and disposed of as follows: (A) Hold By-Pass Trust Undivided Until Death of Spouse. The Trustee shall hold the By-Pass Trust undivided until the death of the Settlor's spouse. The Trustee shall distribute to, or for the benefit of, the Settlor's spouse, for and during the spouse's lifetime, so much of the net income and/or principal from the Trust as the Trustee, in his sole discretion, shall deem advisable for the health, education, support and maintenance of 6 Settlor's spouse, and the Trustee shall accumulate and add to the principal of the Trust any of the net income not so expended. (B) Spouse's Special Power of Appointment. The Settlor's spouse shall have the power at any time or times, exercisable either (i) by written instrument(s) delivered to the Trustee during the spouse's life or (ii) by the spouse's will, admitted to probate within three hundred and sixty-five (365) days from the spouse's death, specifically referring to this Subparagraph 3.03(B), to appoint all or any portion of the principal and any accumulated and accrued income of this Trust, except any policies of insurance on the life of the Settlor's spouse. Any appointment made under this Subparagraph 3.03(B) may be upon any terms and conditions (including further trusts) to or for the benefit of whomever the spouse desires. However, no such appointment may be made to the Settlor's spouse, the spouse's estate, the spouse's creditors or the creditors of the spouse's estate, nor for the health, education, support or maintenance of any children whom the Settlor or the Settlor's spouse is legally obligated to support or maintain, nor may any general powers of appointment be created by the exercise of the special power of appointment created herein. If Settlor's spouse fails, either in whole or in part, to exercise the power of appointment herein granted, the unappointed principal shall continue in trust and shall be administered according to the terms of this By-Pass Trust . (C} Spouse's Limited General Power of Appointment. The Settlor's spouse is hereby granted the power to appoint a maximum amount of the principal of this By-Pass Trust by written instruments} delivered to the Trustee during the spouse's life, to the spouse, the spouse's estate, the spouse's creditors or the creditors of the spouse's estate, or any other individual, in such proportions and upon such terms (in trust or outright gifts), as the Settlor's spouse deems advisable. The maximum amount which the Settlor's spouse may appoint under this Subparagraph 3.03(C) per calendar year shall be the greater of f ive thousand dollars ( $5 , 000.00 ) and f ive percent ( 5~ } of the entire principal of the By-Pass Trust. At the end of each calendar year, the spouse's right to appoint the maximum amount shall lapse if not exercised, and the unused maximum amounts shall not accumulate. This power shall not be exercisable under the Settlor's spouse's will. If Settlor's spouse fails, either in whole or in part, to exercise the power of appointment herein granted, the unappointed principal shall continue in trust and shall be administered according to the terms of this By-Pass Trust. 7 (D) Disposition of Remainder of By-Pass Trust. Upon the death of Settlor's spouse, to the extent the spouse has not exercised the spouse's powers of appointment under Subparagraphs 3.03(B) and 3.03(C), above, or upon the Settlor's death if the Settlor's spouse has predeceased Settlor, the remaining trust estate shall be distributed as follows: (1) FIFTY PERCENT (50~) estate shall be distributed to TODD WARNER, per stirpes; of the remaining trust Settlor's son, JAMES (2 ) FORTY PERCENT ( 4 0~ ) estate shall be distributed to R. WARNER, per stirpes; and of the remaining trust Settlor's son, MICHAEL (3 ) TEN PERCENT (10 0 ) of the remaining trus t estate shall be held, administered and distributed IN FURTHER SEPARATE TRUST for the benefit of Settlor's grandson, ZACHARY J. WARNER, in accordance with the terms set forth in Subparagraph 3.03(E), below. (E) Separate Trust for the Benefit_ ofZachary J. Warner. The separate trust established for the benefit of Settlor's grandson, ZACHARY J. WARNER, under Subparagraph 3.03(D)(3), above, shall be held, administered and distributed in accordance with the following terms: (1) This trust is established for the purpose of improving the quality of life of Settlor's grandson for and during all the term of his natural life. Settlor's grandson suffers from disabilities which may require continuing medical care. He may be entitled to benefit from various governmental programs which provide for his basic or supplemental care. It is the purpose of this trust to provide Settlor's grandson with a higher quality of life beyond that which would be provided by these public entitlement programs and to provide him with a proper funeral and burial. (2) Settlor's intent is that the Trustee use this trust to promote the happiness, welfare and benefit of Settlor's grandson through income and principal distributions, without in any way reducing the services or financial assistance and basic maintenance, support, medical or dental care which he may receive without charge from any local, state or federal government agency or department thereof, and without using any portion of the trust income or principal to reimburse any local, state or federal government agency or 8 department thereof for basic maintenance, support, medical or dental care received by him. Settlor's intent is that the trust income and principal are not to be considered income, assets or resources of Settlor's grandson for any purpose, including but not limited to, the determination of income, assets or resources as stated in any rules or regulations set forth by any local, state or federal government agency or department thereof. In the event the Trustee is requested by any department or agency to release principal or income of the trust to or on behalf of Settlor's grandson to pay for equipment, medication or services which other organizations or agencies are authorized to provide, or in the event the Trustee is requested by any department or agency administering such benefits to petition the court or any other administrative agency for the release of trust principal or income for this purpose, the Trustee shall deny such request and is directed to defend, at the reasonable expense of the trust estate, any contest or other attack of any nature. (3) The Trustee shall distribute to Settlor's grandson or expend and apply for his benefit, so much of or all of the income and principal of this trust, as the Trustee, in his sole and absolute discretion, determines to be advisable for the grandson's special needs for happiness and comfort to achieve the purpose of the trust herein set forth. The "special needs" which the Trustee may provide for Settlor's grandson shall include, but are not limited to, spending money, additional food, clothing, birthday gifts, gifts for major holidays, small appliances that would provide him with entertainment or amusement, computer equipment, camping excursions, vacations, athletic contests, movies, trips, money to purchase appropriate gifts for relatives and friends, any recreational items that would be of use to him and other monetary requirements to enhance his self-esteem or situation. "Special needs" shall also include medical and dental expenses, annual independent check-ups, rehabilitation and physical therapy equipment, programs of training, education, treatment, physical therapy and rehabilitation, private residential care, eye glasses, transportation (including vehicle purchase and maintenance), insurance (including payment of premiums of insurance on the life of Settlor' s grandson) and other requisites for maintaining his good health, safety and welfare when, in the discretion of the 9 Trustee, such requisites are not being provided by any public agency, office or department of any state or of the United States. Nothing herein shall preclude the Trustee from purchasing those services and items which promote the grandson's happiness, comfort and welfare. The Trustee shall also have authority in his absolute and sole discretion to make gifts to any community residence in which Settlor's grandson may be residing. (4) Any net income not expended for, or applied to, the special needs of Settlor's grandson shall be accumulated and added to the trust principal. (5) The Trustee shall have no obligation to expend trust assets for the grandson's special needs, but if the Trustee, in his sole discretion, decides to expend trust assets, under no circumstances should any amounts be paid to, or reimbursed to, the federal government, any state or any governmental agency for any purpose, including for the care, support and maintenance of Settlor's grandson. This trust is created expressly for the grandson's extra and supplemental care, maintenance, support and education in addition to, and over and above the benefits he otherwise receives or may receive as a result of handicap or disability, from any local, state or federal government, or from any other private agency, any of which provides services or benefits to persons with disabilities. It is Settlor's express purpose that this trust be used only to supplement other benefits that Settlor's grandson may receive. (6) Because Settlor's grandson may be dependent on the support and aid of others, the Trustee shall, in the exercise of his best judgment and fiduciary duty, seek support and maintenance for him, or request the guardian of Settlor's grandson, if any, to seek support and maintenance for him, from all available public resources, including, but not limited to, Social Security Administration benefits, the Supplemental Security Income Program (SSI), any such supplemental income program offered by or through the Commonwealth of Pennsylvania, the Old Age Survivors and Disability Insurance or successor programs, U.S. Civil Service Commission benefits, Medicaid and federal Social Security Disability Insurance (SSDI), and any other comparable programs, state, federal or local. The Trustee shall take into consideration applicable resource and income limitations of any public 10 assistance programs for which Settlor's grandson is eligible when determining whether or not to make any discretionary distributions. In carrying out the provisions of this separate trust, the Trustee shall be mindful of the probable future needs of the remaindermen of this trust. If necessary, the Trustee may seek appropriate authority to collect, expend and account for separately all such governmental assistance benefits, but shall not commingle them with the trust assets. In addition, in making distributions for the special needs of Settlor's grandson, the Trustee shall take into consideration the applicable resource limitations of the public assistance programs for which he is or may become eligible. (7) The Trustee shall regard this trust as existing for the welfare and benefit of Settlor's grandson. Accordingly, the Trustee shall exercise his discretion as to disbursements and investments with this standard in mind. Consistent with the purpose of this trust, Settlor may establish a life plan to be periodically updated, signed and dated. It is intended that the Trustee read the life plan as it exists at the time of Settlor's death and use it as guidance in administering this trust according to the terms set forth herein. In no event shall the life plan be binding upon the Trustee or otherwise diminish the Trustee's discretion as described herein. (8) The Trustee shall not be required to make an accounting to any public official except to the extent otherwise required by law. The Trustee shall, however, keep and maintain complete and open accounts of the trust principal and income and any expenditures from the trust. Any person having an interest in the trust shall have a right to inspect the accounts at reasonable times and with reasonable notice to the Trustee. All discretion conferred on the Trustee shall be absolute and unlimited, and its exercise by the Trustee shall be conclusive and binding on all persons. (9) The Trustee shall pay reasonable burial expenses including a suitable and proper grave marker for Settlor's grandson. (10) This trust shall terminate upon the death of Settlor's grandson. Upon termination, the Trustee shall distribute the remaining trust estate to the issue of Settlor's grandson, ZACHARY J. WARNER, or if 11 he has no surviving issue, then to Settlor's surviving issue in equal shares, per stirpes. 3.04. Disposition of Marital Portion. (A) Marital Bequest. The distributed to the then-current FAMILY REVOCABLE TRUST, dated in effect or as may hereafter be of in accordance with the terms entire marital portion shall be Trustee (s ) of the JAMES E . WARNER 1997, as now amended, to be held and disposed of that Trust . (B) Disposition of Marital Portion in Event of Disclaimer by Spouse or Spouse's Fiduciary. Notwithstanding anything to the contrary contained in this Agreement, the Settlor's spouse may disclaim the spouse's rights to all or any part of the Marital Portion. If the Settlor's spouse dies or has a fiduciary (which term includes, for purposes of this Paragraph 3.04, but is not limited to, an executor, administrator, conservator, committee, guardian, curator or tutor) appointed by a court to act for the spouse within nine (9) months after the Settlor's death and if the spouse has not fully exercised the spouse's disclaimer rights, then the spouse's fiduciary may, within the nine (9} months, file one or more disclaimers on behalf of the spouse and the estate of the spouse in the same manner as the spouse could have disclaimed had the spouse been then-living without a fiduciary acting for the spouse. A disclaimer by the spouse or the spouse's fiduciary shall be made in one or more written instrument(s), signed by the spouse or the spouse's fiduciary, as the case may be, and delivered to the Trustee within nine (9) months after the Settlor's death, and in such event the disclaimed portion shall pass to and shall be managed in accordance with the By-Pass Trust hereinafter more fully described in Paragraph 3.03, above. (C) Restrictions Regarding Marital Portion. It is the Settlor's intent that the marital portion established by Subparagraph 3.02(8), above, shall qualify for the marital deduction allowed under the United States Internal Revenue Code. All questions relating to the administration of the marital portion shall be resolved accordingly. ARTICLE IV. POWERS OF TRUSTEE 4.01. General Powers. In addition to such other powers and duties as may have been granted elsewhere in this Trust, but subject to any limitations contained elsewhere in this Trust, the Trustee shall have the following powers and duties: 12 (A) In the management, care and disposition of this Trust, the Trustee shall have the power to do all things and to execute such deeds, mortgages, instruments and documents as may be deemed necessary and proper, including the following powers, all of which may be exercised without order of or report to any court: (1) To sell, exchange, or otherwise dispose of any property, real, personal or mixed, at any time held or acquired hereunder, at public or private sale, for cash or on terms, without advertisement, including the right to lease for any term notwithstanding the period of the Trust, and to grant options, including an option for a period beyond the duration of the Trust; and to execute such deeds or other instruments as are necessary. (2) To invest all monies in such stocks, bonds, securities, investment companies or trust shares, mortgages, notes, chows in action, real estate, improvements thereon and other property as the Trustee may deem best, without regard to any law now or hereafter in force limiting investments of fiduciaries; except that the Trustee may not invest in any stock or securities issued by a corporate Trustee or issued by a parent or affiliate company of a corporate Trustee. (3) To retain for investment any property deposited with the Trustee hereunder; except that the Trustee may not retain for investment any stock or securities in a corporate Trustee or in a parent or affiliate company of a corporate Trustee. (4) To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security held by this Trust. (5) To use lawyers, real estate brokers, accountants and other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. (6) To compromise, settle or adjust any claim or demand by or against the Trust and to agree to any rescission or modification of any contract or agreement affecting the Trust. 13 (7) To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging, pledging or conveying any property of the Trust, including the power to borrow from the Trustee (in the Trustee's individual capacity) at a reasonable rate of interest. (8) To retain and carry on any business in which the Trust may acquire any interest, to acquire additional interests in any such business, to agree to the liquidation in kind of any corporation in which the Trust may have any interest and to carry on the business thereof, to join with other owners in adopting any form of management for any business or property in which the Trust may have an interest, to become or remain a partner, general or limited, in regard to any such business or property and to hold the stock or other securities as an investment, and to employ agents and confer on them authority to manage and operate the business, property or corporation, without liability for the acts of any such agent or for any loss, liability or indebtedness of such business if the management is selected or retained with reasonable care. (9) To register any stock, bond or other security in the name of a nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that the stock, bond or other security is a trust asset, and the Trustee shall be responsible for the acts of the nominee. (10) To merge this Trust with any other trust created in Settlor's Will or otherwise, with similar provisions and purposes and the same beneficiary or beneficiaries, but only to the extent that the merger of the trusts will not cause the imposition of gift tax, or generation-skipping tax, federal or otherwise. (B) Whenever the Trustee is directed to distribute any trust principal in fee simple to a person who is then under twenty-one (21) years of age, the Trustee shall be authorized to hold such property in trust for such person until he becomes twenty-one (21) years of age, and in the meantime shall use such part of the income and the principal of the Trust as the Trustee may deem necessary to provide for the proper support and education of such person in the standard of living to which he has become accustomed. If such person should die before becoming 14 twenty-one (21) years of age, the property then remaining in trust shall be distributed to the personal representative of such person's estate. (C) In making distributions from the Trust to or for the benefit of any minor or other person under a legal disability, the Trustee need not require the appointment of a guardian, but shall be authorized to pay or deliver the distribution to the custodian of such person, to pay or deliver the distribution to such person without the intervention of a guardian, to pay or deliver the distribution to the legal guardian of such person if a guardian has already been appointed, or to use the distribution for the benefit of such person. (D) Subject to the limitations in Paragraphs 3.02 and 3.04, above, in the distribution of the Trust and any division into separate trusts and shares, the Trustee shall be authorized to make the distribution and division in money or in kind or in both, regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Trustee shall be binding and conclusive on all persons taking hereunder. The Trustee may, in making such distribution or division, allot undivided interests in the same property to several trusts or shares. (E) If at any time after Settlor's death the total fair market value of the assets of any trust established or to be established hereunder is so small that the Trustee's annual fee for administering the trust would be equal to or less than the minimum annual fee set forth in the Trustee's regularly published fee schedule then, in effect, the Trustee, in his discretion, shall be authorized to terminate such trust or to decide not to establish such trust, and in such event the property then held in or to be distributed to such trust shall be distributed to the persons who are then or would be entitled to the income of such trust. If the amount of income to be received by such persons is to be determined in the discretion of the Trustee, then the Trustee shall distribute the property among such of the persons to whom the Trustee is authorized to distribute income, and in such proportions, as the Trustee, in his discretion, shall determine. (F) The Trustee shall be authorized to lend or borrow, including the right to lend to or borrow from the Settlor's estate or the estate of the Settlor's spouse, at an adequate rate of interest and with adequate security and upon such terms and conditions as the Trustee shall deem fair and equitable. 15 (G) The Trustee shall be authorized to sell or purchase, at the fair market value as determined by the Trustee, any property including any property to or from Settlor's estate or the estate of the Settlor's spouse, or any trust created by Settlor or Settlor's spouse, during life or by will, even though the same person or corporation may be acting as executor of Settlor's estate or as trustee of any of such other trusts and as the Trustee of this Trust. (H) Subject to the limitations in Article III, above, the Trustee shall have discretion to determine whether items should be charged or credited to income or principal or allocated between income and principal as Trustee may deem equitable and fair under all the circumstances, including the power to amortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal, to treat any dividend or other distribution on any investment as income or principal or to apportion the same between income and principal, to charge any expense against income or principal or apportion the same, and to provide or fail to provide a reasonable reserve against depreciation or obsolescence on any asset subject to depreciation or obsolescence, all as the Trustee may reasonably deem equitable and just under all of the circumstances. ARTICLE V. SPENDTHRIFT PROVISION 5.01. General Provisions. No beneficiary shall have the power to anticipate, encumber or transfer his interest in the trust estate in any manner other than by the valid exercise of a power of appointment. No part of the trust estate shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. ARTICLE VI. CONSTRUCTION OF TRUST 6.01. Choice of Law. This Trust shall be administered and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. 6.02. Code. Unless otherwise stated, all references in this Trust to section and chapter numbers are to those of the Internal Revenue Code of 1986, as amended, or corresponding 16 provisions of any subsequent federal tax laws applicable to this Trust. 6.03. Other Terms. Unless the context otherwise requires, the use of one or more genders in the text includes all other genders, and the use of either the singular or the plural in the text includes both the singular and the plural. 6.04. Captions and Table of Contents. The underlined captions set forth in this Agreement at the beginning of the various divisions hereof and the Table of Contents appearing at the beginning of this Agreement are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their construction and application. 6.05. Situs of Trust. The Trust shall have its legal situs at Cumberland County, Pennsylvania. ARTICLE VII. COMPENSATION OF TRUSTEE AND APPOINTMENT OF SUCCESSOR TRUSTEE 7.01. Compensation. The Trustee shall receive as his compensation for the services performed hereunder that sum of money which the Trustee customarily charges for performing similar services during the time which he performs these services. 7.02. Removal or Resignation of Trustee. Settlor may remove the Trustee at any time or times, with or without cause, upon thirty (30) days written notice given to the Trustee. After the Settlor~s death, a majority of the current beneficiaries may remove the Trustee at any time or times, with or without cause, upon thirty (30) days written notice given to the Trustee. The Trustee may resign at any time upon thirty (30) days written notice given to the Settlor if Settlor is living, or after Settlor~s death, upon thirty (30) days written notice given to the current beneficiaries. Upon the removal or resignation of the Trustee, a successor trustee shall be appointed in accordance with the terms set forth in Paragraph 7.03, below. 7.03. Successor Trustee. Upon the death, resignation, removal or incapacity of the Trustee, the Settlor~s spouse, JAMES E. WARNER, is hereby appointed Successor Trustee. Upon the death, resignation, removal or incapacity of the Trustee and Successor Trustee, the Settlor's sons, MICHAEL R. WARNER and JAMES TODD WARNER, or the survivor of them, are hereby appointed to act jointly as Successor Trustees. Upon the death, 17 resignation, removal or incapacity of the Trustee and all of the aforenamed Successor Trustees, a successor trustee may be appointed by a majority of the current beneficiaries. Any successor trustee thus appointed shall be a financially sound and competent corporate trustee. Any duly appointed successor trustee shall succeed to all the duties and powers, including discretionary powers, herein granted to the Trustee. Except as otherwise provided herein, Settlor prohibits the appointment of any beneficiary's natural or legal guardian or legal representative as successor trustee, and any attempt to do so shall be without authority under this Agreement. ARTICLE VIII. PERPETUITIES CLAUSE 8.01. General Provisions. Notwithstanding anything to the contrary in this Trust, each disposition Settlor has made herein, legal or equitable, to the extent it can be referred in its postponement of becoming a vested interest to a duration measured by some life or lives in being at the time of Settlor's death is definitely to vest in interest, although not necessarily in possession, not later than twenty-one (21) years after such lives (and any period of gestation involved); or to the extent it cannot be referred in any such postponement to such lives, is to so vest not later than twenty-one (21) years from the time of Settlor's death. ARTICLE IX. REVOCATION AND AMENDMENTS 9.01. Reservation of Powers. The Settlor expressly reserves the powers to: (i) revoke this Agreement by an instrument in writing delivered to the Trustee while the Settlor is alive; and (ii) to alter, amend or modify this Agreement at any time or from time to time by an instrument or instruments in writing delivered to the Trustee while the Settlor is alive, but no such alteration, amendment or modification shall increase the duties nor change the basis for compensation of the Trustee without the Trustee's written consent. Any such withdrawal by the Settlor shall be considered a revocation of this Trust solely with respect to the policy or other property withdrawn. 9.02. Effect of Settlor~s Incapacity. (A) If Settlor Incapacitated. If at the time of any attempted exercise of (a) the powers reserved to the Settlor or (b) any other powers to demand and receive the principal of this Trust (if any are granted in this Agreement), the Settlor is incapacitated (as defined below in Subparagraph 9.02(C)), through 18 illness, age or other cause, then the Trustee shall disregard any instructions from the Settlor which have the effect of remaking, altering, amending or modifying this Agreement in whole or in part or enabling the Settlor to withdraw from the Trust any lif e insurance policy or any other property forming a part of this Trust. (B) Settlor's Retained General Power of Appointment. Notwithstanding the above provisions, the Settlor shall always have the right to exercise a general power of appointment, by a will, specifically referring to the reservation of this general power of appointment in this Subparagraph 9.02(B), to appoint all or a portion of the Trust property to the Settlor's estate, the Settlor's creditors, the creditors of the Settlor's estate, or whomever the Settlor desires. (C) Definition of Incapacity. For purposes of this Trust, the Settlor or a Trustee shall be deemed to have become incapacitated upon the happening of either one of the following events: (1) Admission of Incapacity. Delivery, by hand or by mail, to the Trustee then serving of a written instrument from the Settlor or a Trustee declaring that said person no longer considers that he should possess the power (as Settlor) to exercise any of the powers reserved by the Settlor in this Article IX or any other powers to demand and receive the principal of this Trust, except the general power of appointment reserved above in Subparagraph 9.02(B), or the power (as Trustee) to continue to serve as Trustee, or (2) Medical Certification of Lack of Capacity. Delivery, by hand or by mail, to the Trustee then serving of written instruments by two physicians licensed to practice medicine, one of whom must be a board certified psychiatrist and the other of whom may be the attending physician, that the Settlor or a Trustee no longer has the capacity, as a result of illness, age or other cause: (i) in the case of the Settlor, to exercise any powers reserved by the Settlor over the Trust under the terms of this Article IX or any other powers to demand and receive the principal of this Trust, except that notwithstanding any other provision to the contrary, the reserved general power of appointment of the Settlor, as set forth in Subparagraph 9.02(B), above, shall always be exercisable by the Settlor, or (ii) in the case of a Trustee, to continue to serve as a Trustee. 19 (3) Powers Personal to Settlor. The powers reserved by and to the Settlor in this Article IX shall be personal to the Settlor and shall not be exercisable by any conservator, committee, guardian or like fiduciary, except a valid Durable Power of Attorney, nor shall they be assignable to nor extend to the executor or administrator of the Settlor's estate, nor to any beneficiary named herein. Upon the death of the Settlor this Trust shall be deemed irrevocable. ARTICLE X. ACQUISITION OF UNITED STATES TREASURY BONDS ELIGIBLE FOR TAX PAYMENT; PAYMENT OF TAXES, FUNERAL EXPENSES AND EXPENSES OF ADMINISTRATION 10.01. Acquisition of Bonds. The Trustee may, at any time, without the prior approval or direction of the Settlor and whether or not the Settlor is able to manage his own affairs, acquire United States Treasury Bonds selling at a discount, which bonds are redeemable at their par value plus accrued interest thereon for the purposes of applying the proceeds to the payment of the United States estate tax on the Settlor's estate; and the Trustee may borrow from any lender, including himself, with or without security, to so acquire these bonds. 10.02. Payment of United States Estate Tax by .Bond Redemption. After the Trustee has complied with the provisions of Paragraph 3.02, above, by establishing marital and non-marital portions, the Settlor directs that any United States Treasury Bonds which may be redeemed at their par value plus accrued interest thereon for the purpose of applying the proceeds to the payment of the United States estate tax imposed on the Settlor's estate, and which are held by the Trustee, shall, to the extent of the amount determined to be required for payment of the estate tax, be distributed to the legal representative of the Settlor's estate to be used by the legal representative ahead of any other assets and to the fullest extent possible to pay the estate tax. 10.03. Payment of Death Taxes and Other Estate Settlement Costs. After the Trustee has complied with Paragraph 10.02, above, and has ascertained from the legal representative that all ~uc~r~ bc~nd~ t~~ave been redeemed in payment of the United States estate tax, the Trustee shall also ascertain from the legal representative whether the legal representative has sufficient assets to pay the remaining inheritance, estate and other death taxes or duties (except the additional estate tax imposed by IRC ~2032(c)), levied or assessed against the Settlor's estate (including all interest and penalties thereon), all of which taxes, interest and penalties are hereinafter referred to as the 20 death taxes, interest and penalties. If the legal representative advises the Trustee that insufficient funds exist to pay all the death taxes, interest and penalties, the Trustee shall then pay to the legal representative from the trust property remaining after compliance with those provisions of Paragraphs 3.02 and 3.04, above, an amount equal to all the death taxes, interest and penalties in excess of the funds available to the legal representative for this purposes, which payments are to be made without apportionment. In making the payments, the Trustee shall use only those assets or their proceeds which are includable in the Settlor's gross estate for purposes of the United States estate tax, and shall not impair the marital portion without first exhausting the entire non-marital portion. If the Settlor's legal representative advises the Trustee that there are sufficient funds available to pay the death taxes, interest and penalties, then the Trustee may nonetheless pay to the legal representative from the trust property remaining after compliance with the provisions of Paragraphs 3.02 and 3.04, above, which set aside the marital portion, all or any portion, as the Trustee, in his sole discretion, deems advisable and in the best interests of the Settlor's beneficiaries named in this Trust, of (a) any such death taxes, interest and penalties, whether or not on property held in or payable to the Trust, said payments to be made without apportionment, (b) the Settlor's funeral expenses, (c) claims and other debts of the Settlor, whether allowed against the Settlor's estate or not, (d) expenses of administering the Settlor's estate and (e) bequests under any will or codicil executed by the Settlor. In making any such payments, other than to satisfy bequests under any will or codicil executed by the Settlor, the Trustee shall use only those assets or their proceeds which are includable in the Settlor's gross estate for purposes of the United States estate tax and shall not impair the marital portion without first exhausting the non-marital portion. IN WITNESS WHEREOF, the Settlor and Trustee have hereunto set them°"hands and seals as of the day and year first written above. TNES~: ~,~ - - ~ ~.~~,; ~ ~, ~.., .~~..~ (SEAL) ~ -~~-, MAR HA L . WARNER, S ETTLOR 21 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND ~ ~ a On this, the ~ day of ~'~-~tr'~j ~~ 1997, before me, Notary Public, the undersigned officer, personally appeared MARTHA L. WARNER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Trust Agreement, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official Sea 1. ~~'-'1 .. /' ~ 1 .. f.'! ~ ~1 • a.... _ ~ tary Public y Commission Expires: iranat ~;. ''`ic~i;~cCiC). ~~~7i~C',r p1li~fir. n t The orego'ng Trust Agreement was delivered, and is hereby acc~~ted, a;t ,_ ~.zf~~Jti=~.~~ _, Pennsylvania, on the ~ ~l day of ----Lei~~__ ' 19 9'7 . ,~ ._ _. .-___,.,,, ~s _-_ WITNESS a /, C , MAR'IiHA L . WARNER, TRUSTEE 22 ~ pennsyLvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Martha L. Warner 2012-00231 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 facts. Real property that is jointly-owned 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 OF DEATH DESCRIPTION 1' Real ro ert located at 17 Pheasant St., Silver S rin Tw Mechanicsbur ,Cumberland P P Y P~ 9 p~, 9 County, PA - titled in the name of decedent and spouse, James E. Wamer, who previously died on March 3, 2011. Value per appraisal attached 170,000.00 2 Real property located at 116 Linden Drive, Lower Allen Twp., Camp Hill, Cumberland County, PA -titled in the name of decedent and spouse, James E. Warner, who previously died on March 3, 2011. Value per appraisal attached 146,000.00 TOTAL (Also enter on Line 1, Recapitulation.) I $ 316,000.00 If more space is needed, insert additional sheets of the same size. v~ ~i~ ci ~ poi i~wrr~ ~, i n i ~ v ~ i (717) 737-4600 04/10/2012 Michael R. Warner Re: Property: Borrower: File No.: Opinion of Value: $ Effective Date: 17 Pheasant St Mechanicsburg, PA 17050 N/A PHEASANTST17 170,000 03/29/2012 In accordance with your request, we have appraised the above referenced property. The report of that appraisal is attached. The purpose of the appraisal is to develop an opinion of market value for the property described in this appraisal report, as improved, in unencumbered fee simple title of ownership. This report is based on a physical analysis of the site and improvements, a locational analysis of the neighborhood and city, and an economic analysis of the market for properties such as the subject. The appraisal was developed and the report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice. The opinion of value reported above is as of the stated effective date and is contingent upon the certification and limiting conditions attached. ft has been a pleasure to assist you. Please do not hesitate to contact me or any of my staff if we can be of additional service to you. Sincerely, ~~ John S. Boswell License or Certification #: RL001405L State: PA Expires: 06/30/2013 john@paappraisers.com LOCATED AT 17 Pheasant St Mechanicsburg, PA 17050 Deed Book 00272, Page 04697, LOT 133, PH 5, PB 61, PG 67 FOR Michael R. Warner OPINION OF VALUE 170,000 As of 03/29/2012 BY John S. Boswei{ Central Penn Appraisals, Inc. 24 W Main Street Shiremanstown, PA 17011 (717) 737-4600 john a~paappraisers.com Subject Address 17 Pheasant St Legal Description Deed Book 00272, Page 04697, LOT 133, PH 5, PB 61, PG 67 City Mechanicsburg County Cumberland State PA ~~ Zip Code 17050 Census Tract 0118.02 Map Reference PA Atlas 78 C1 Sale Price $ Date of Sale Borrower N/A Lender/Client Michael R. Warner Size (Square Feet) 1,452 Price per Square Foot $ Location Average Age 21 Condition Good ' Total Rooms 4 Bedrooms 2 Baths 2.0 ' Appraiser John S. Boswell Date of Appraised Value 03/29/2012 Opinion of Value $ 170,000 ~ ~ u uva ~ v. l_.J . .... ~ ~ ......--.......-... ~~ - - -r - _. _. '__~ Market Area Name: West Fields in Silver S rin Townshi Map Reference: PA Atlas 78 C1 Census Tract: 0118.02 The ur ose of this a raisal is to develo an o inion of: .Market Value as defined , or ^ other a of value describe This re ort reflects the followin value 'rf not Current, see comments : ®Current the Ins action Date is the Effective Date ^ Retrospective ^ Pros active z A roaches develo ed for this a raisal: I^ Sales Com orison A roach ^ Cost A roach ^ Income A roach See Reconciliation Comments and Sco a of Work ~ Pro a Ri hts raised: ®Fee Sim le ^ Leasehold ^ Leased Fee ^ Other describe ~ Intended Use: For Estate Purposes - a Intended Users b name or e Client: Michael R. Warner Address: 5315 E Trindle Rd. Mechanicsbur , PA 17050 A praiser: John S. Boswell Address: 24 W Main St. Shiremanstown , PA 17011 Location: Urban Suburban Rural Predominant One-Unit Housing Present Land Use Change in Land Use Occupancy PRICE AGE One-Unit 65 % ^ Not Likel Built up: ^ Over 75% ®25-75% ^ Under 25% y ~ Growth rate: ^ Rapid ®Stable ^ Slow ®Owner $(000) (yrs) 2-4 Unit 5 % ^ Likely * ®In Process * ~= Property values: ^ Increasing ®Stable ^ Declining ^ Tenant 55 Low 0 Multi-Unit 2 % * To: Attached & Single Demand/supply: ^ Shortage ®In Balance ^ Over Supply ®Vacant (0-5%) 650+ Hi h 220+ Comm'I 3 % Family Residential N Marketing time: ^ Under 3 Mos. ®3-6 Mos. ^ Over 6 Mos. ^Vacant >5% 180 Pred 25 Vacant 25 % o Market Area Boundaries, Description, and Market Conditions (including support for the above characteristics and trends): This suburban neighborhood has Q average characteristics and is bounded on the north, east, south, & west by the township line. This suburban neighborhood has relatively easy ~ access to employment and services, and is competitive with other neighborhoods in the general area. Most have similar amenities. There are ~ no foreseeable economic trends which might signficantly influence market conditions in this area. The current mortgage market offers a wide Y variety of conventional loans with competitive rates As a result, the terms of financing have little, if any, impact on sales pnces. If interest rates oC remain reasonable, property values and marketability should be stable Current supply and demand are in balance. Interest rates are ranging ~ from 3 6% with 0 6 points typically being paid for origination or discount. -_ Dimensions: See attached lot ma Site Area: 0.15 ac Zoning Classification: R-2 Description: High Density Residential Zoning Compliance: ®Le al ^ Legal nonconforming grandfathered ^ Illegal ^ No zoning Are CC&Rs a licable? ^ Yes ®No ^ Unknown Have the documents been reviewed? ^ Yes ®No Ground Rent rf a plicable $ / Highest & Best Use as improved: ~ Present use, or ^ Other use (explain) Actual Use as of Effective Date: Single Family Residence Use as appraised in this report Same Z Summary of Highest & Best Use: N/A 0 a ~ Utilities Public Other Provider/Description Off-site Improvements Type Public Private Topography Level - Sli ht Slo e w Electricity ® ^ 200 Amp Street Asphalt ® ^ Size Typical for the area ~ Gas ^ ^ Curb/Gutter Concrete ® ^ Shape Irre ular ~ Water ® ^ Sidewalk Concrete (~ ^ Drainage ears Ade uate _ N Sanitary Sewer ® ^ Street Lights Pole ® ^ View Average Storm Sewer ® ^ Alle None ^ ^ Other site elements: Inside Lot ^ Corner Lot ^ Cul de Sac ®Underground Utilities ^ Other describe FEMA S ec'I Flood Hazard Area ^ Yes ^ No FEMA Flood Zone X FEMA M # 42041 C0258E FEMA Ma Date 03/16/2009 Site Comments: Site has average site improvements, average landscaping, and typical maintenance. General Description Exterior Description Foundation Basement None Heating # of Units 1 ^ Acc.Unit Foundation Concrete Slab 100% Area Sq. Ft. Type EHP/CA # of Stories 1 Exterior Walls Vin 8~ Brick Crawl Space 0 % Finished Fuel Electric Type ^ Det. ^ Att. ®End of Row Roof Surface Shin le/Rubber Basement 0 Ceiling Design (Style) Rancher /FOR Gutters & Dwnspts. Aluminum Sump Pump ^ Walls Cooling ® Existing ^ Proposed ^ Und.Cons. Window Type Double Insulated Dampness ^ Floor Central Yes F Actual Age (Yrs.) 21 StornVScreens No /Yes Settlement None Observe Outside Entry Other w Effective Age rs. 10 Infestation None Observe w Interior Description Appliances Attic ^ None Amenities Car Storage ^ None > Floors C t/Ceramic -Good Refrigerator ^ Stairs ^ Fireplace(s) # 0 Woodstove(s) # 0 Garage # of cars ( 4 Tot.) ~ Walls D all -Good Range/Oven ~ Drop Stair ^ Patio Front Attach. 2 ~ TrinyFinish Wood -Good Disposal ®Scuttle ^ Deck Detach. w Bath Floor Vin I -Good Dishwasher ®Doorway ^ Porch Enclosed Blt.-In ~ Bath Wainscot Fiber lass -Good FaNHood ®Floor ^ Fence Carport o Doors Luan 6 Panel -Good Microwave ®Heated ^ Pool Driveway 2 Washer/D er ^ Fnished ^ Surface As halt o Finished area above grade contains: 4 Rooms 2 Bedrooms 2.0 Baths 1 452 S uare Feet of Gross Livin Area Above Grade a Additronahfieatures: Newer roof• Electric water heater. w Describe the condition of the property (including physical, functional and external obsolescence): These improvements are of average quality brick & vinyl design ~ .+.~rl ri+F7i+i.~ .....+.1 m.~:~ii+.,..~n~ T4.r~ ,......•.,II n~r+r1:{:`. r. i.+F iL... n..L. i..~.i ie...~+...d VVYIVV J VV4111 IGI,VIVJ VIIIIIIG 2nd Prior Subject Sale/Transfer Date: 05/21/2003 Price: $143 000 Sources : Coun records online SALES COMPARISON APPROACH TO VALUE if FEATURE SUBJECT develo The Sales Compariso COMPARABLE SALE # 1 n Approach was not developed for this app COMPARABLE SALE # 2 raisal. COMPARABLE SALE # 3 Address 17 Pheasant St Mechanicsbur , PA 17050 42 Westfields Dr Mechanicsbur PA 17050 32 Burwick Dr Mechanicsbur PA 17050 21 Greenspring Dr Mechanicsbur PA 17050 Proximi to Subject Sale Price $ 0.12 mites W $ 169 900 0.53 miles N $ 189 900 0.16 miles NW $ 168 900 Sale Price/GLA $ /s .ft. $ 113.87 /s .ft. $ 129.71 /s .ft. $ 123.10 /s .ft. Data Sources Ins ection MLS #10218702 MLS #10203534 MLS #10210762 Verification Sources VALUE ADJUSTMENTS Courthouse Online DESCRiPT10N Courthouse Online DESCRIPTION + - $ Adjust. Courthouse Online DESCRIPTION + - $ Adjust. Courthouse Online DESCRIPTION + - $ Adjust. Sales or Financing Concessions Conv. Rea irs $420.12 Conv. None VA Seller Hel -6,320 Date of Sale/Time 03/08/2012 -190 01 /27/2012 - 373 10/06/2011 - 44 Ri hts raised Fee Sim le Fee Sim le Fee Sim le Fee Sim le Location Avera a Avera a Avera a Avera e Site 0.15 ac 0.21 ac 0.24 ac 0.16 ac View Avera a Avera a Avera a Avera e Desi n S le Rancher /FOR Rancher I FOR Rancher I FOR Rancher /FOR Ouali of Construction Ave. - BrickNin I Ave. - BrickNin I Ave. - BrickNin I Ave. - BrickNin I A e 21 22 10 -5 000 23 Condition Good Good Good Good Above Grade Total Bdrms Baths Total Bdrms Baths Total Bdrms Baths Total Bdrms Baths Room Count 4 2 2.0 4 2 2.0 4 2 2.0 4 2 2.0 Gross Living Area 1,452 s .ft. 1,492 s .ft. 0 1 464 s .ft. 1 372 s .ft. Basement & Finished Rooms Below Grade Slab NIA Slab N/A Slab NIA Slab N/A Functional U61i Avera a Avera a Avera a Avera e Heatin Coolin EHP / CA EHP / CA GFHA / CA EHP / CA Ener Efficient ttems T ical for the area T ical for the area T ical for the area T ical for the area ~ Gara a/Car ort 2 Gar. Attached 2 Gar. Attached 2 Gar. Attached 2 Gar. Attached Porch/Patio/Deck Small Porch Small Porch Small Porch Small Porch Enclosed Porch Enclosed Porch Sunroom -2 500 Enclosed Porch None None Patio -1 500 Patio -1 500 i None None None Whirl ool Tub -1,000 ! None None None None ' None None None None c Net Ad'ustment otal ^ + ^ - $ ^ + ®- $ -9,000 ^ + ®- $ -8,820 ~ Adjusted Sale Price ~ of Com arables Net % Gross % $ 169 900 Net 4.7 % Gross 4.7 % $ 180 900 Net 5.2 % Gross 5.2 % $ 160,080 Summary of Sales Comparison Approach All three sales are considered to be reliable indicators of value, and are weighted similarly in the final i reconciliation The subject and all comps are located in the same township i~ school district. Comparables sales used are ail closed sales. A ro riate ad'ustments have been made for all differences. = ESTIMATED ^] REPRODUCTION OR ^ REPLACEMENT COST NEW OPINION OF SITE VALUE ___________________________.___.___________-_._-_.-__ _$ Source of cost data: DWELLING S .Ft. @ $ _ _ _$ Q p Quali ratin from cost service: Effective date of cost data: Sq.Ft. @ $ ------. _$ a depreciation, etc.): Comments on Cost Approach (gross living area calculations Sq.Ft. @ $ ___.-__ _$ , '~O ~ Gara e/Car ort S .Ft. @ $ __-_- _$ ~~ Total Estimate of Cost-New ______ _$ Less Ph sical Functional External De reciation =$ Depreciated Cost of lm rovements __-__.______________________....__.__.___ _$ "As-is" Value of Site Improvements _._..._-___.._____..___-__.__.__._.._- _$ _$ _$ Estimated Remaining Economic Life if required : Years INDICATED VALUE BY COST APPROACH -..______________________.______- _$ = INGOME APPROACH TO VALUE if develo d The Income Approach was not developed for this appraisal. Q Estimated Monthl Market Rent $ X Gross Rent Mufti tier = $ Indicated Value Income A roach a Summary of Income Approach (including support for market rent and GRM): a a w O V z PROJECT INFORMATION FOR PUDs if a licable ^ The Sub~ect is part of a Planned Unit Development. Le al Name of Pro~ect: Describe common elements and recreational facilities: e a Indicated Value b :Sales Comparison Approach $ 170 000 Cost Approach (if developed) $ Income Approach ('rf developed) ~ Final Reconciliation See attached addenda. z O 4 This appraisal is made ~ "as is", [] subject to completion per plans and specifications on the basis of a Hypothetical Condition that the improvements have been v completed, ^ subject to the following repairs or alterations on the basis of a hypothetical Condition that the repairs or alterations have been completed, ^ subject to Z the following required inspection based on the Extraordinary Assumption that the condition or deficiency does not require alteration or repair: O v W ^ This re ort is also subject to other H pothetical Conditions and/or Extraordinary Assumptions as specified in the attached addenda. Based on the degree of inspection of the subject property, as indicated below, defined Scope of Worlc, Statement of Assumptions and Limiting Conditions, and Appraiser's Certiticat[ons, my (our) Opinion of the Market Value (or other specified value type), as defined herein, of the real property that is the subject of this report is: $ 170,000 , as of: 03/29/2012 ,which is the effective date of this appraisal. If indicated above, this Opinion of Value is subject to Hypothetical Conditions and/or Extraordinary Assumptions included in this report. See attached addenda. ~ A true and complete copy of this report contains 17 pages, including exhibits which are considered an integral part of the report. This appraisal report may not be w properly understood without reference to the information contained in the complete report. ~ Attached Exhibits: a ®Scope of Work ®Limiting Cond./Certifications ®Narrative Addendum ®Phatograph Addenda ~ Sketch Addendum ®Map Addenda ^ Additional Sales ^ Cast Addendum ^ Flood Addendum ^ Manuf. House Addendum Q ^ H othetical Conditions ^ Extraordina Assum lions ®A raiser Certification ®Plat Ma & Summa Pa a ®Cover Letter & Invoice Client Contact: Client Name: Michael R. Warner E-Mail: Address: 5315 E Trindle Rd. Mechanicsbur PA 17050 APPRAISER SUPERVISORY APPRAISER (if required) or CO-APPRAISER (if applicable) w ~ Supervisory or Q Appr ' er Name: John S. Boswell Co-Appraiser Name: ~ Inc Company: Central Penn Appraisals Company: . , rn Phone: (717} 737-4600 Fax: (717) 737-9123 Phone: Fax: aappraisers com E-Mail: iohn@ E-Mail: p ,a.~.runiu.i u~ua uw uuu w awvu ui~u n~u~~auauuw ui~u, u~u~u~v~v, .nn iwa iui~uui u,iy vNnnv~w uvvua uw uuu. ~i~u Nivf-u~a~ w u~F+~uwuu vii uuu vu.nv ~f it being under responsible ownership. -The appraiser may have provided a sketch in the appraisal report to show approximate dimensions of the improvements, and any such sketch is included only to assist the reader of the report in visualizing the property and understanding the appraiser's determination of its size. Unless otherwise indicated, a Land Survey was not performed. - If so indicated, the appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted in the appraisal report whether the subject site is located in an identified Special Flood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantees, express or implied, regarding this determination. -The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do so have been made beforehand. -- If the cast approach is included in this appraisal, the appraiser has estimated the value of the land in the cost approach at its highest and best use, and the improvements at their contributory value. These separate valuations of the land and improvements must not be used in conjunction with any other appraisal and are invalid if they are so used. Unless otherwise specirfically indicated, the cost approach value is not an insurance value, and should not be used as such. -The appraiser has noted in the appraisal report any adverse conditions (including, but not limited to, needed repairs, depreciation, the presence of hazardous wastes, toxic substances, etc.) observed during the inspection of the subject property, or that he or she became aware of during the normal research involved in performing the appraisal. Unless otherwise stated in the appraisal report, the appraiser has no knowledge of any hidden or unapparent conditions of the property, or adverse environmental conditions (including, but not limited to, the presence of hazardous wastes, toxic substances, etc.) that would make the proper~r more or less valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, express or implied, regarding the condition of the property. The appraiser will not be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, the appraisal report must not be considered as an environmental assessment of the property. -The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he or she considers to be reliable and believes them to be true and correct. The appraiser does not assume responsibility for the accuracy of such items that were furnished by other parties. -The appraiser will not disclose the contents of the appraisal report except as provided for in the Uniform Standards of Professional Appraisal Practice, and any applicable federal, state or local laws. - (f this appraisal is indicated as subject to satisfactory completion, repairs, or alterations, the appraiser has based his or her appraisal report and valuation conclusion on the assumption that completion of the improvements will be performed in a workmanlike manner. - An appraiser's client is the party (or parties) who engage an appraiser in a specific assignment. Any other party acquiring this report from the client does not become a party to the appraiser-client relationship. Any persons receiving this appraisal report because of disclosure requirements applicable to the appraiser's client do not become intended users of this report unless specifically identified by the client at the time of the assignment. -The appraiser's written consent and approval must be obtained before this appraisal report can be conveyed by anyone to the public, through advertising, public relations, news, sales, or by means of any other media, or by its inclusion in a private or public database. - An appraisal of real property is not a 'home inspection' and should not be construed as such. As part of the valuation process, the appraiser performs anon-invasive visual inventory that is not intended to reveal defects or detrimental conditions that are not readily apparent. The presence of such conditions or defects could adversely affect the appraiser's opinion of value. Clients with concerns about such potential negative factors are encouraged to engage the appropriate type of expert to investigate. The Scope of Work is the type and extent of research and analyses performed in an appraisal assignment that is required to produce credible assignment results, given the nature of the appraisal problem, the specific requirements of the intended user(s) and the intended use of the appraisal report. Reliance upon this report, regardless of how acquired, by any party or for any use, other than those specified in this report by the Appraiser, is prohibited. The opinion of Value that is the conclusion of this report is credible only within the context of the Scope of Work, Effective Date, the Date of Report, the Intended Users), the Intended Use, the stated Assumptions and limning Conditions, any Hypothetical Conditions andlor Extraordinary Assumptions, and the Type of Value, as defined herein. The appraiser, appraisal firm, and related parties assume no obligation, liability, or accountability, and will not be responsible for any unauthorized use of this report or its conclusions. Additional Comments (Scope of Work, Extraordinary Assumptions, Hypothetical Conditions, etc.): None. IIIV JItItV111V11tJ V/ IuVt VVIIlu111VV 111 II IIV IV'.lVlt ulV LtuV ullu VVIIVVI. -The credibility of this report, for the stated use by the stated user(s), of the reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my personal, impartial, and unbiased professional analyses, opinions, and conclusions. -- I have no present or prospective interest in the property that is the subject of this report and no personal interest with respect to the parties involved. --Unless otherwise indicated, I have performed no services, as an appraiser or in any other capacity, regarding the properly that is the subject of this report within the three-year period immediately preceding acceptance of this assignment. - I have no bias with respect to the properly that is the subject of this report or to the parties involved with this assignment. - My engagement in this assignment was not contingent upon developing or reporting predetermined results. . - My compensation for completing this assignment is not contingent upon the development or reporting of a predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended use of this appraisal. - My analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity with the Uniform Standards of Professional Appraisal Practice that were in effect at the time this report was prepared. - I did not base, either partially or completely, my analysis and/or the opinion of value in the appraisal report on the race, color, religion, sex, handicap, familial status, or national origin of either the prospective owners or occupants of the subject property, or of the present owners or occupants of the properties in the vicinity of the subject property. -Unless otherwise indicated, I have made a personal inspection of the property that is the subject of this report. -Unless otherwise indicated, no one provided significant real property appraisal assistance to the person(s) signing this certification. Additional Certifications: None. DEFINITION OF MARKET VALUE *: Market value means the most probable price which a property should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller each acing prudently and knowledgeably, and assuming the price is not affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: 1. Buyer and seller are typically motivated; 2. Both parties are well informed or well advised and acting in what they consider their awn best interests; 3. A reasonable time is allowed for exposure in the open market; 4. Payment is made in terms of cash in U.S. dollars or in terms of financial arrangements comparable thereto; and 5. The price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions granted by anyone associated with the sale. * This definition is from regulations published by federal regulatory agencies pursuant to Title XI of the Financial Institutions Reform, Recovery, and Enforcement Act (FIRREA) of 1989 between July 5,1990, and August 24,1990, by the Federal Reserve System (FRS), National Credit Union Administration (NCUA), Federal Deposit Insurance Corporation (FDIC), the Office of Thrift Supervision (OTS), and the Office of Comptroller of the Currency (OCC). This definition is also referenced in regulations jointly published by the OCC, OTS, FRS, and FDiC on June 7,1994, and in the Interagency Appraisal and Evaluation Guidelines, dated October 27,1994. Client Contact: E-Mail: APPRAISER W 4 tZ9 Client Name: Michael R. Warner Address: Appr ' er Name: John S. Boswell Company: Central Penn Appraisals, Inc. Phone: (717) 737-4600 Fax: (717) 737-9123 E-Mail: john p~paappraisers.com ?~. 5315 E Trindle Rd. Mechanicsburg, PA 17050 SUPERVISORY APPRAISER (if required) or CO-APPRAISER (if applicable) Supervisory or Co-Appraiser Name: Company: Phone: _ E-Mail: Fax: 17 Pheasanf ~t Sales Price Grass Living Area 'Z ,~52 Total Rooms 4 Tota! Bedrooms 2 Total Bathrooms 2.0 l.ocatian Average Viety Average Site 0. ~ 5 ac Quality Ave. - BrickNinyl Age 21 ~; ~~ . ... r~ :_. _: _ ~-. ~~ ~Y.. ft ~ ~1 ~ ~~r y~ R t ~ Y 'sy~}~}~ ~$,~ . F r ,. ~~ A ~ .. '..'Y`om 1} ,~ ~ + `~ -.. i :i . P "` .~ r r., t F h' ~F _. '~-+ ,_.. V ~t ~j4~ ~` ~ } ~i ~ M d i ~, 3' _ ~ F . ~, ,~ ~y3 "r 3 '~ Street Side Comparable 42 Westfields Dr Prox. to Subject Sales Price Gross Living Area Total Rooms Total Bedrooms Total Bathrooms Location View Site Quality Age 0.12 miles W 169,900 1,492 4 2 2.0 Average Average 0.21 ac Ave. -BrickNinyl 22 Comparable 2 32 Burwick Dr Prox. to Subject 0.53 miles N Sales Price 189,900 Gross Living Area 1,464 Total Rooms 4 Total Bedrooms 2 Total Bathrooms 2.0 Location Average View Average Site 0.24 ac Quality Ave. -BrickNinyl Age 10 Comparable 3 21 Greenspring Dr Prox. to Subject 0.16 miles NW Safes Price 168,900 Grass Living Area 1372 Total Rooms 4 Total Bedrooms 2 Total Bathrooms 2.0 Location Average View Average Site 0.16 ac Quality Ave. -BrickNinyl Age 23 14' Dining Area Kitchen 00 N Dining Area 2 0' ~ 12' L ~ ^ a a~i ~ ~ ~ o ~ c ~' W Living Room 14' Master Bedroom Walk-In Closet First Floor [1452 Sq ft] Utility Laundry Foyer 6' N 2 Ca r Attached [440 Sq ft] 20' Master Bath ~ o ~ ra d. Bath Bed room d- Open Porch [ 24 Sq ft] TOTU shah by a e mode, :.c. Area Calculations Su Living Area First Fbor 1452 Sq ft Total Living Area (Rounded): 1452 Sq ft Non-Irving Area Enclosed Porch 168 Sq ft Open Porch 24 Sq ft 2 Car Attached 440 Sq ft Calculation Dctails 50 x 14 = 700 26 x 28 = 728 6x4 = 24 14 x 12 = 168 6x4 = 24 22 x 20 = 440 a la mode, inc. c .:,~ `' K^ ~YU (_ 9FSr f. • G ~, .~.>>c: `~: ~~ A~ ~' 1 i :l .~ i~ ft,r r'i ~ ' ~,\ -` \~ . ,~` • ~- : J `~'J 7 J ~ L+i YL• - ~: ~ y~i. ~:- ~;;` , ~ ~ ~ *~: . ` ` l~ . ~q ; ~ ~ k ~9 .. 1 ~ ~ a a, ~ -" & s, ~~~` ° s ~ L` '~i ~ . r . ~ /~~ ~~~IC~tt`.°.C r .i. r n ~' ~ ~ 4 4 n ' F ~" ~1/ '„! -- -, ~ ~ C ~ ~ ' • . ~ v ~~ `, - ~ - ~ - '= ~J `~~ _~. ~~~ ..- 1~ Q r ~ ~~ ~=;' /~. ct~r : ~ ~~ i ~. .:. ~ , `, fit, ;Sc1z'~ n`.4~Y•Yy ~ r~ .f ti>>t 7,,i:• ~ ,r~~ ~~. y1,~tir #~ti4'-m J ;, Y ~, ~/ ~ J ~ a ~ <<~' ~ i V '~ ~~' r~l iJ~ s jli C r v^ ~ ` ~ - ! its" y ~ § , - 3' 4 ~~ 'a t Y " fir:' . _. t.`~r _ ~ ^ 6~s1 ;j`t: ~~ C ~y i. q;:+',~ iJ`, c~~ S ,, r`2~~~ SC `Y 1`~ ~~ ~ •G 1 `~~ _ «~ \~ ,~ ~ t 6 >1 .~~,t ~ .r •i ~v arc `- 1 ~• a r ~\~t' ~• ~.f• ~~ ~ .~ i S ': r: I' ~ V ' .- ~. .i ... : 1 ~~?~v J ~~ c ~ _= ~;, t~ /~, ~ ,i r fl'•~5,,-~, `' -' ~i ~~~~~~ J ~ 'y~ ,r~~ ~~ 17, t14 ~tLt''~ " ~t. 4.~ .~,,~_ 4,~~. ti~til~ 1_:; ~~ L` u ~. .. i .~ w ~~ I ;! :. Commonwealth of Pennsyivania D~e.PaY went of State Bureau of Pro ~ s~ot~~d~~and ~cEU~ational affairs ,~ PO Bo 2¢~4~Harrisburg PA~-2`x,105-2649 Certificate T~•pe a +=:: :- =~~=~-~,:-;; -. Certified Residential Appraiser ~ --- .~ = " ~~'~--~ =''~ ~ ~;' f~ ~ ~i. ~.. JOHN STEPHEN BOSWELL Certificate 1402 WELLGATE LANE Number MECHANICSBURG PA 17Q55 RL001405L a:.~~ ~ - Si~,na~ r :~ct~nR Cumm~ssiunrr al Prvieasiunal and ~ccuvati~~nal .~ffarn ~ `~ ~'rr-~?~J~7 1 ~~ ~ ~J Certificate Status Active initial CertiCcation Date 02/04/1993 Fxpira#ion Date 06130/2013 v~uici~ic+~i.~avrr~y ~ n i r v ~ ~ (717) 737-4600 04/10/2012 Michael R. Warner Re: Property: Borrower: File No.: Opinion of Value: $ Effective Date: 116 Linden Dr Camp Hill, PA 17011 N/A LINDENDR116 146,000 03/29/2012 In accordance with your request, we have appraised the above referenced property. The report of that appraisal is attached. The purpose of the appraisal is to develop an opinion of market value for the property described in this appraisal report, as improved, in unencumbered fee simple title of ownership. This report is based on a physical analysis of the site and improvements, a locational analysis of the neighborhood and city, and an economic analysis of the market for properties such as the subject. The appraisal was developed and the report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice. The opinion of value reported above is as of the stated effective date and is contingent upon the certification and limiting conditions attached. It has been a pleasure to assist you. Please do not hesitate to contact me or any of my staff if we can be of additional service to you. Sincerely, ~~ John S. Boswell License or Certification #: RL001405L State: PA Expires: 06/30/2013 john@paappraisers.com LOCATED AT 116 Linden Dr Camp Hill, PA 17011 Deed Book 0031 S, Page 00911, LOT 9, SEC A, PB 6, PG 49 FOR Michael R. Warner OPINION OF VALUE 146,000 AS OF 03/29/2012 BY John S. Boswell Central Penn Appraisals, Inc. 24 W Main Street Shiremanstown, PA 17011 (717) 737-4600 john@paappraisers.com Subject Address 116 Linden Dr Legal Description Deed Book 0031 S, Page 00911, LOT 9, SEC A, PB 6, PG 49 City Camp Hi11 County Cumberland State PA .. Zip Code 17011 Census Tract 0110.02 Map Reference PA Atlas 78 C2 Sale Price $ Date of Sale Borrower NJA Lender/Client Michael R. Warner Size (Square Feet) 1,437 Price per Square Foot $ Location Average 38 Age Condition Average Total Rooms 6 Bedrooms 3 Baths 1.0 ' Appraiser John S. Boswell ' Date of Appraised Value 03/29/2012 Opinion of Value $ 146,000 .... .... .......... .....~ r wr.• 'Y V l_J Nv~ juu. !_J Nvr nwnu. ~ . Iv vva . v. L J ...~ l-J ~."__"_________ ~~ Market Area Name: Linden Gardens in Lower Allen Townshi Ma Reference: PA Atlas 78 C2 Census Tract: 0110.02 The pu ose of this a raisal is to develo an o inion of: Market Ualue as defined , or ^ other a of value describe This re ort reflects the followin value if not Current, see comments : ®Current the Ins ection Date is the Effective Date ^ Retros ective ^ Pros ective z A roaches develo ed for this a raisal: ®Sales Com arison A roach ^ Cost A roach ^ income A roach See Reconciliation Comments and Sco a of Work ~ Pro Ri hts raised: ®Fee Sim le ^ Leasehold ^ Leased Fee ^ Other describe ~ Intended Use: For Estate Pur oses. a intended Users b name or e : Michael R. Wainer Executor Client: Michael R. Warner Address: 5315 E Trindle Rd. Mechanicsbur PA 17050 A raiser: John S. Boswell Address: 24 W M ain St. Shiremanstown , PA 17011 location: Urban Suburban Rural Predominant One-Unit Housing Present Land Use Change in Land Use Built up: ®Over 75% ^ 25-75% ^ Under 25% Occupancy PRICE AGE One-Unit 75 % ®Not Likely 0 Growth rate: ^ Rapid ®5table ^ Slow ®Owner $(000) (yrs) 2-4 Unit 10 % ^ Likely * ^ In Process Property values: ^ increasing ®Stable ^ Declining ^ Tenant 55 Low 5 Muni-Unit 3 % * To: a ~ Demand/supply: ^ Shortage ®In Balance ^ Over Supply ®Vacant (0-5%) 450+ Hi h 220+ Comm'I 7 % y Marketing time: ^ Under 3 Mos. ®3-6 Mos. ^ Over 6 Mos. ^Vacant >5% 150 Pred 50 Vacant 5 % o Market Area Boundaries, Description, and Market Conditions (including support for the above characteristics and trends): This suburban neighborhood has average characteristics and is bounded on the north, east, south, & west by the township line. This suburban neighborhood has relatively easy ~ access to employment and services, and is competitive with other neighborhoods in the general area. Most have similar amenities. There are ~ no foreseeable economic trends which might significantly influence market conditions in this area. The current mortgage market offers a wide Y variety of conventional loans with competitive rates As a result, the terms of financing have little, if any, impact on sales pnces. If interest rates a remain reasonable, property values and marketability should be stable Current supply and demand are in balance. Interest rates are ranging... ~ from 3-6% with 0-6 oints icall bein aid for on ination or discount. Dimensions: See attached lat ma Site Area: 0.18 ac Zoning Classification: R-1 Description: Single Family Established Residential Zoning Compliance: ®Le a! ^ Legal nonconforming grandfathered ^ Illegal ^ No zoning Are CC&Rs a plicable? ^ Yes ®No ^ Unknown Have the documents been reviewed? ^ Yes ®No Ground Rent if ap licable $ / Highest & Best Use as improved: ®Present use, or ^ Other use (explain) Actual Use as of Effective Date: Single Family Residence /Group Home Use as appraised in this report Same Z Summary of Highest & Best Use: NIA 0 a v Utilities Public Other Provider/Description Off-site Improvements Type Public Private Topography Level - Sli ht Slo e w Electricity ~ ^ 60 Amp /Poor Street Asphalt ^ ^ Size Typical for the area o Gas ® ^ Curb/Gutter Concrete _ ® ^ Shape Rectan ular ~ Water [~ ^ Sidewalk Concrete ® ^ Drainage A ears Ade uate _ ~ Sanitary Sewer ~ ^ Street Lights Pole ® ^ View Avera e Storm Sewer ® ^ Alle None ^ ^ Other site elements: ~ Inside Lot ^ Corner Lot ^ Cul de Sac ^ Underground Utilities ^ Other describe FEMA S ec'I Flood Hazard Area Yes ®No FEMA Flood Zone X FEMA Ma # 42041 C0281 E FEMA Map Date 03/1612009 Site Comments: Site has average site improvements, average landscaping, and typical maintenance. __ General Description Exterior Description Foundation Basement None Heating # of Units 1 ^ Acc.Unit Foundation Concrete Block Slab 61 % Area Sq. Ft. 567 Type GFHA/CA # of Stories 2 Exterior Walls Vin 18~ Brick Crawl Space 0 % Fnished 80% Fuel Gas Type ®Det. ^ Att. ^ Roof Surface Shin le/Rubber Basement 3g% Ceiling D /Pla/Dro Design (Style) Slit-Level Gutters & Dwnspts. Aluminum Sump Pump ^ Walls D /Panel Cooling ® Existing ^ Proposed ^ Und.Cons. Window Type Double Insulated Dampness ^ Floor Vin Central Yes ~ Actual Age (Yrs.) 38 Storm/Screens No /Yes Settlement None Observe Outside Entry Yes Other w Effective Age rs. 20 Infestation None Observe ^ None St C w orage ar interior Description Appliances Attic ^ None Amenities > Floors HWNin/C t -Ave. Refrigerator ^ Stairs ^ Fireplace(s) # 0 Woodstove(s) # 0 Garage # of cars ( 3 Tot.) ~ Walls D all - Avera a Range/Oven ^ Drop Stair ^ Patia Attach. ~ Trim/Fnish Wood - Avera a Disposal ^ Scuttle ®Deck Detach. w Bath Floor Vin I - Avera a Dishwasher ®Doorway ^ Porch Rear Bit.-In ~ Bath Wainscot Fiber lass - Avera a Fan/Hood ^ Flaor ^ Fence Carport 1 Attached ~ Doors Luan - Avera a Microwave ^ Heated ^ Pool Driveway 2 Washer/D er ^ Finished ^ Surface As halt z o Finished area above rade contains: 6 Rooms 3 Bedrooms 1.0 Bath s 1 437 S uare Feet of Gross Livin Area Above Grade a Additional features: Basmenrt family room, rough bath, laundry hook-up; 2 gas water heaters. U w Describe the condition of the property (including physical, functional and external obsolescence): These improvements are of average quality brick & vinyl design ~ ..nrl r~ilnnf .~..~r.~nn w...ir.innr. r.ni. Th.. n.r., r..l) n~nrl iii.+n .+f ihn n. ~hir.~.~ in .+. re~rn~~ Th.. Alnn~rin nor. ,.nom .n .r. nn~a ..i ..n.d r.+in.r rl..n ~~ Fr... r...a V VYIVV V VV41I~r 1GVVI4J VIIIU IV 2nd Prior Subject Sale/Transfer Date: Price: Sources SALES COMPARISON APPROACH TO VAL UE if deveto ed The Sales Compariso n Approach was not developed for this a praisal. FEATURE SUBJECT COMPARABLE SALE # 1 COMPARABLE SALE # 2 COMPARABLE SALE # 3 Address 116 Linden Dr Cam Hill PA 17011 107 Cambridge Dr Mechanicsbur , PA 17055 1820 Pine St Cam Hill PA 17011 24 Scarsdale Dr Cam Hill PA 17011 Proxim' to Subject 2.77 miles W 0.91 miles E 1.64 miles SW Sale Price $ $ 150 000 $ 150 435 $ 154 000 Sale Price/GLA $ /s .ft. $ 79.58 /s .ft. $ 124.12 Is .ft. $ 117.02 /s .ft. Data Sources Ins ection MLS #10208591 MLS #10210675 MLS #10208569 Verification Sources Courthouse Online Courthouse Online Courthouse Online Courthouse Online VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION + - $ Adjust. DESCRIPTION + - $ Adjust. DESCRIPTION + - $ Ad~ust. Sales or Financing Concessions Conv. Seller Hel -4,500 Conv. None VA Seller Hel -7 700 Date of Sale(Time 12/29/2011 / 212 08/16/2011 / 4 08/10/2011 / 72 Ri hts raised Fee Sim le Fee Sim le Fee Sim le Fee Sim le Location Avera a Avera a Avera a Avera e Site 0.18 ac 0.19 ac 0.35 ac -1 700 0.23 ac -500 dew Avera a Avera a Avera a Avera e Desi n S le Slit-Level Slit-Level Slit-Level Slit-Level Qual' of Construction Ave. - BrickNin Ave. - BrickNin I Ave. -Brick/Alum. Ave. - Brick/Vin I A e 38 39 52 55 Condition Avera a Avera a Avera a Avera e Above Grade Total Bdrms Baths Total Bdrms Baths Total Bdrms Baths Total Bdrms Baths Roam Count 6 3 1.0 6 3 2.0 -2 500 6 3 1.0 6 3 1.1 -1,500 Gross Livin Area 1,437 s .ft. 1 885 s .ft. -6,700 1 212 s .ft. +3,400 1 316 s .ft. +1 800 Basement & Fnished Rooms Below Grade Part Basement Famil Rm. /Bath Part Basement Famil Rm. / 05 Ba +1 000 Part Basement Den /Bath Part Basement Famil Rm.lBedroo Functional Utility Avera a Avera a Avera a Avera e Heatin Conlin GFHA / CA EBB / No CA +7 000 GBBHW / No CA +3 500 GFHA / CA Ener Efficient ftems T ical for the area T ical for the area T ical for the area T ical for the area Gara e/Ca ort 1 Car ort 1 Gar. Inte ral -2,000 1 Gar. Inte ral -2,000 None +2,500 Porch/Patio/Deck Rear Porch Rear Porch Rear Porch Rear Porch None None None Small Porch -1 000 None 2 Fire laces/insert -4 500 1 Fire lace -2 500 None None None None None None None None None None None None None Net Ad~ustment otal ^ + ®- $ -12,200 ®+ ^ - $ 700 ^ + ®- $ -6 400 Adjusted Sale Price ~ of Com arables Net 8.1 % Gross 18.8 % $ 137 800 Net 0.5 % Gross 8.7 % $ 151 135 Net 4.2 % Gross 9.7 % $ 147 600 Summary of Sales Comparison Approach All three sales are considered to be reliable indicators of value, and are weighted similarly in the final i reconciliation Insufficient sales in close pro~amity to the subject property require the appraiser to extend search parameters. The subject and all comps are located in the same township 8~ school district It is noted that the Gross living Area for Comparable No. 1 is significantly greater than that of the subject; however, the sales chosen are the best available Other comparables anal yzed would have required less desirable adjustments and were not used for that reason Comparables sales used are ail closed sales App ropriate adjustments have been made for all differences After consideration of all relevant factors, the comparabfes used are the best indicators of value although they are all higher in price than the final value estimated for the subject A thorough search for comparable sales has been made to find sales which bracket the final estimate. = ESTIMATED ^ REPRODUCTION OR ^ REPLACEMENT COST NEW OPINION OF SITE VALUE __.._.._......___._.._....._._.____.____._._.___.__-_.._. _$ a Source of cost data: DWELLING Sq.Ft. @ $ _____ _$ O Quali rati from cast service: Effective date ofi cost data: S .Ft. @ $ .... _$ a Comments on Cost Approach (gross living area calculations, depreciation, etc.}: S .Ft. @ $ _ _ _$ N O =$ - - ~ Gara e/Car ort S .Ft. @ $ __ _$ Total Estimate of Cost-New _$ Less Ph sical Functional External De reciation =$ Depreciated Cost of Im rovements ___ .............._.___..._.___..____ _$ "As-is" Value of Site !m rovements _.._.....___...__...__________________. _$ _$ _$ Estimated Remaining Economic Life if re wired : Years INDICATED VALUE BY COST APPROACH _______..____ .............____. _$ = INCOME APPROACH TO VALUE if develo d The Income Approach was not developed for this appraisal. d Estimated Monthl Market Rent $ X Gross Rent Multi lier = $ Indicated Value b Income A roach a Summary of Income Approach (including support for market rent and GRM): a a W O v z PROJECT INFORMATION FOR PUDs if a Iicable ^ The Subject is part of a Planned Unit Development. Le al Name of Pro"ect: Describe common elements and recreational facilities: o a Indicated Value b :Sales Com orison A proach $ 146 000 Cost A proach (if developed) $ Income A proach (if developed) $ Final Reconciliation See attached addenda. z 0 a This appraisal is made ~ "as is", ^ subject to completion per pions and specifications on the basis of a Hypothetical Condition that the improvements have been ~ completed, ^ subject to the following repairs or alterations on the basis of a Hypothetical Condition that the repairs or alterations have been completed, ^ subject to z the following required inspection based on the Extraordinary Assumption that the condition or deficiency does not require alteration or repair: O U W ^ This report is also subject to other Hy othetical Conditions and/or Extraordinary Assumptions as specified in the attached addenda. Based on the degree of inspection of the subject property, as indicated below, defined Scope of Work, Statement of Assumptions and Limiting Conditions, and Appraiser's Certifications, my (our) Opinion of the Market Value (or other specified value type), as defined herein, of the real property that is the subject of this report is: $ 146,000 , as of: 03/29/2012 ,which is the effective date of this appraisal. If indicated above, this Opinion of Value is subject to Hypothetical Conditions and/or Extraordinary Assumptions included in this report. See attached addenda. ~ A true and complete copy of this report contains 17 pages, including exhibits which are considered an integral part of the report. This appraisal report may not be w properly understood without reference to the information contained in the complete report. ~ Attached Exhibits: Q ®Scope of Work ®Limiting Cond./Certifications ~ Narrative Addendum ®Photograph Addenda ~ Sketch Addendum ~ Map Addenda ^ Additional Sales ^ Cost Addendum ^ Flood Addendum ^ Manuf. House Addendum Q ^ H othetical Conditions ^ Extraordina Assum lions ® raiser Certification ®Plat Ma & Summa Pa a ®Cover Letter & Invoice Client Contact: Client Name: Michael R. Warner E-Mail: Address: 5315 E Trindle Rd. Mechanicsbur PA 17050 APPRAISER SUPERVISORY APPRAISER (if required) or CO-APPRAISER (if applicable) W ~ Supervisory or a Appr ' er Name: John S. Boswell Co-Appraiser Name: ~ Inc Company: Central Penn Appraisals Company: . , v~ Phone: (717) 737-4600 Fax: (717) 737-9123 Phone: Fax: E-Mail: john paappraisers corn E-Mail: t1JJU111Va! u~ua uw anw w yvvv ui~u ii~wiw~uuw ui~u, uw~uwrv, *ru~ uvt iviwv~ u~~y vN~niviw uvvut uw uuv. i~w N~vNu~L~ w uNNiuwvu vn uw uuv~a of it being under responsible ownership. -The appraiser may have provided a sketch in the appraisal report to show approximate dimensions of the improvements, and any such sketch is included only to assist the reader of the report in visualizing the property and understanding the appraiser's determination of its size. Unless otherwise indicated, a Land Survey was not performed. - If so indicated, the appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted in the appraisal report whether the subject site is located in an identified Special Flood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantees, express or implied, regarding this determination. -The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do so have been made be#orehand. - If the cost approach is included in this appraisal, the appraiser has estimated the value of the land in the cost approach at its highest and best use, and the improvements at their contributory value. These separate valuations of the land and improvements must not be used in conjunction with any other appraisal and are invalid if they are so used. Unless otherwise specirfically indicated, the cost approach value is not an insurance value, and should not be used as such. -The appraiser has noted in the appraisal report any adverse conditions (including, but not limited to, needed repairs, depreciation, the presence of hazardous wastes, toxic substances, etc.) observed during the inspection of the subject property, or that he or she became aware of during the normal research involved in performing the appraisal. Unless otherwise stated in the appraisal report, the appraiser has no knowledge of any hidden or unapparent conditions of the property, or adverse environmental conditions (including, but not limited to, the presence of hazardous wastes, toxic substances, etc.) that would make the property more or less valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, express or implied, regarding the condition of the property. The appraiser will not be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, the appraisal report must not be considered as an environmental assessment of the property. --The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he or she considers to be reliable and believes them to be true and correct. The appraiser does not assume responsibility for the accuracy of such items that were furnished by other parties. --The appraiser will not disclose the contents of the appraisal report except as provided for in the Uniform Standards of Professional Appraisal Practice, and any applicable federal, s#ate or local laws. - If this appraisal is indicated as subject to satisfactory completion, repairs, or alterations, the appraiser has based his or her appraisal report and valuation conclusion on the assumption that completion of the improvements will be performed in a workmanlike manner. - An appraiser's client is the party (or parties) who engage an appraiser in a specific assignment. Any other parry acquiring this report from the client does not become a party to the appraiser-client relationship. Any persons receiving this appraisal report because of disclosure requirements applicable to the appraiser's client do not become intended users of this report unless specifically identified by the client at the time of the assignment. -The appraiser's written consent and approval must be obtained before this appraisal report can be conveyed by anyone to the public, through advertising, public relations, news, sales, or by means of any other media, or by its inclusion in a private or public database. - An appraisal of real property is not a 'home inspection' and should not be construed as such. As part of the valuation process, the appraiser performs anon-invasive visual inventory that is not intended to reveal defects or detrimental conditions that are not readily apparent. The presence of such conditions or defects could adversely affect the appraiser's opinion of value. Clients with concerns about such potential negative factors are encouraged to engage the appropriate type of expert to investigate. The Scope of Work is the type and extent of research and analyses performed in an appraisal assignment that is required to produce credible assignment results, given the nature of the appraisal problem, the specific requirements of the intended user(s) and the intended use of the appraisal report. Reliance upon this report, regardless of how acquired, by any party or for any use, other than those specified in this report by the Appraiser, is prohibited. The Opinion of Value that is the conclusion of this report is credible only within the context of the Scope of Work, Effective Date, the Date of Report, the Intended User(s), the Intended Use, the stated Assumptions and Limiting Conditions, any Hypothetical Conditions and/or Extraordinary Assumptions, and the Type of Value, as defined herein. The appraiser, appraisal firm, and related parties assume no obligation, liability, or accountability, and will not be responsible far any unauthorized use of this report or its conclusions. Additional Comments (Scope of Work, Extraordinary Assumptions, Hypothetical Conditions, etc.): None. 1IIV VlUlV111V111V Vt IUVI VV11[UI114U 111 UItV IV'JVI[ UIV 114V UttV VVItVVI. -The credibility of this report, for the stated use by the stated user{s}, of the reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my personal, impartial, and unbiased professional analyses, opinions, and conclusions. - I have no present or prospective interest in the property that is the subject of this report and no personal interest with respect to the parties involved. -Unless otherwise indicated, I have performed no services, as an appraiser or in any other capacity, regarding the property that is the subject of this report within the three-year period immediately preceding acceptance of this assignment. - I have no bias with respect to the property that is the subject of this report or to the parties involved with this assignment. - My engagement in this assignment was not contingent upon developing or reporting predetermined results. --- My compensation for completing this assignment is not contingent upon the development or reporting of a predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended use of this appraisal. - My analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity with the Uniform Standards of Professional Appraisal Practice that were in effect at the time this report was prepared. - I did not base, either partially or completely, my analysis and/or the opinion of value in the appraisal report on the race, color, religion, sex, handicap, familial status, or national origin of either the prospective owners or occupants of the subject property, or of the present owners or occupants of the proper#ies in the vicinity of the subject property. -Unless otherwise indicated, I have made a personal inspection of the property that is the subject of this report. -Unless otherwise indicated, no one provided significant real property appraisal assistance to the person(s) signing this certification. Additional Certifications: None. DEFINITION OF MARKET VALUE *: Market value means the most probable price which a properly should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller each acting prudently and knowledgeably, and assuming the price is not affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: 1. Buyer and seller are typically motivated; 2. Both parties are well informed or well advised and acting in what they consider their own best interests; 3. A reasonable time is allowed for exposure in the open market; 4. Payment is made in terms of cash in U.S. dollars or in terms of financial arrangements comparable thereto; and 5. The price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions granted by anyone associated with the sale. * This definition is from regulations published by federal regulatory agencies pursuant to Title XI of the Financial Institutions Reform, Recovery, and Enforcement Act (FIRREA) of 1989 between July 5,1990, and August 24, 1990, by the Federal Reserve System (FRS}, National Credit Union Administration (NCUA), Federal Deposit Insurance Corporation (FDIC}, the Of17ce of Thrift Supervision (OTS), and the Office of Comptroller of the Currency (OCC). This definition is also referenced in regulations jointly published by the OCC, OTS, FRS, and FDIC on June 7,1994, and in the Interagency Appraisal and Evaluation Guidelines, dated October 27,1994. Client Contact: E-Mail: .APPRAISER W ~~ a z Client Name: Michael R. Warner Address: Appr ' er Name: John S. Boswell Company: Central Penn Appraisals, Inc. Phone: (717) 737-4600 Fax: X717) 737-9123 E-Mail: john paappraisers com SUPERVISORY APPRAISER (if required) or CO-APPRAISER (if applicable) Supervisory or Co-Appraiser Name: Company: Phone: E-Mail: Fax: ...... ,..,.... ................ ..., r.... ,,....,... r.. ,.~......r ..,...., ...,........,.................. ., ...r, r......,,......, r.. ,......,.., ., ...,.. r. ,,r.... ,,,. ..... r.... r.,.,..~ .. . valuation. The fact that the seller is, or is not, paying any portion of the closing cost has no effect on the market value of the subject. This appraisal assumes a reasonable marketing period for the subject property of three months. The Market Approach reflects recent activity in the market place. In view of the age of these improvements, the Cost Approach cannot be considered an accurate indicator of value. The Income Approach is inappropriate because few single family houses are rented in this market. Given the high quality of the available sale data, the value indicated by the Market Approach is used as the final estimated value. THIS IS A SUMMARY APPRAISAL REPORT. Subject Front 116 Linden Dr Sales Price Gross Living Area Total Rooms Total Bedrooms Total Bathrooms Location View Site Quality Age 1,437 6 3 1.0 Average Average 0.18 ac Ave. - BrickNinyl 38 Subject Rear Subject Street Street Electric .Service Comparable ~ 107 Cambridge Dr Prox. to Subject 2.77 miles W Sales Price 150,000 Gross Living Area 1,885 Total Rooms 6 Total Bedrooms 3 Total Bathrooms 2.0 Location Average View Average Site 0.19 ac Quality Ave. - Brick/inyl Age 39 Comparable 2 1820 Pine St Prox. to Subject 0.91 miles E Sales Price 150,435 Gross Living Area 1,212 Total Rooms 6 Total Bedrooms 3 Total Bathrooms 1.0 Location Average View Average Site 0.35 ac Quality Ave. -Brick/Alum. Age 52 Comparable 3 24 Scarsdale Dr ,,~ Prox. to Subject 1.64 miles SW _ Sales Price 154,000 -~_ . ~ Gross Living Area 1,316 ~; ~~ . Total Roams 6 Total Bedrooms 3 ._. Total Bathrooms 1.1 ` k ~_ ~ Location Average ~ ~ ice. ~ View Average °.. ite 0.23 c ti.,,-., ~ - ~ ~~~ ,~~ Quality Ave. aBrickNinyl ~~ _ ~ n~ ~ ~~~ ~~. ~, =^ Age 55 Open Porch [77 Sq ft] o~ N 11' L o r-.-, a~ a ~- V ~ L Q1 ~ ~ V M nrra. stetc-, M a m mode, ~,~. Living Area First Floor Second Floor Total Living Area (Rounded): Non-living Area Open Porch 1 Car Carport 18' Den 21' Dining Kitchen Area Bath Bedroom First Floor ~ [828 Sq ft] `r Second Floor [ 609 Sq ft] o, Staircase "' Staircase Living Room Bedroom Bedroom Stoop Area Cakulations Summary 828 Sq ft 609 Sq ft 1437 Sq ft 77 Sq ft 319 Sq ft Calculation Details 18 x 46 = 828 21 x 29 = 609 11x7 = 77 29 x 11 = 319 1~ a la mode, inc. ,. ._ c,«~_~.~,,, ,., _ n ,{ J J f.i • ' ~~.a ~ I v • J`J/ `'a .~ , ;>~ ~.. .r ~, :~ .~ •z .~ r~ it _ Gnod Nc~e -- s ~;ti '' .. ~ - ci~- ~C~' ~`1f J' i J G~ i ~ f /+ = A ~ C: - ~. 7C ~ `~f O~, t ~ J~~t •rf t ''•r ..~ ,l 3 ~~ ~ ~~ 5L;1 _ -~~, P`,. ' , ti , i1 ~ ~,~ G~~~L ~J~ H~~rr;sE~urc~ Expy `.ti`°,,~arrisbUCg ,nt~ F c t%~ tilt .. I t5 v 6di R~ ~~. '~.\ r C355C1C j ilL~r~dnOr ~~ ,r' !! r ti. ..~ _~ ~'~ {~k~ ~ ~~~ . - ~~, ~.~... r r ~ M . ` 'fir ~~' ~r r ,a ,. y ~~ i J l `~~ S' - ~i .f ~ _ Gr 11 i~ ~,5~ ~• i - lii~ << .i~ Lisburn s~ 3' Eo.:mansdale ~., -, _ ;. ~; Na:.vaa ~:J !. ^dc~5ontav; n Commonwealth of Pennsylvania D~a~ ment of State Bureau of Pro e~,s~on~~ ~anc~`f~c~upationat affairs NO Bo 2644'Harrisbur~ PA~1~~105-2649 R~ J~ .I Certificate Type ; ;.-' . ~ "-~~~_'~=~ _ ' 1 ~ t. ~ ~~ ) Certified Residential Appraiser ~ :;:. ~" A''~= ' ~*~- -~' -~ ~ t ~;~ j.. JOHN STEPHEN BOSWELL Certificate 1402 WELLGATE LANE Number MECHANICSBURG PA 17055 RL001405L a~ ACUnR C'ummusiunrr of Pr~~t'csiunrt and Occunat~~~naJ .at~la~r; r~ ~ r ~ ~ Certificate Status Active Initial Certification Date 02/0411993 Expiration Date 06130/2013 l ~ 5,~~,at REV-1503 EX+ (8-12) i pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Martha L. Warner 2012-00231 All property jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size Dreyfus Family of Funds P.O. Box 55263 Boston, MA 02205-8501 April 4, 2012 MICHAEL R WARNER 101 PENNS RUN RD MECHANICSBURG PA 17050-8231 REFERENCE: 06775327 - 20120404132652 THE DREYFUS FUND ACCOUNT NUMBER: XXXXXXX1319 MARTHA L WARNER Dear Mr. Warner: Thank you for your recent inquiry regarding the referenced account in The Dreyfus Family of Funds. Please accept this letter in lieu of an email. On February 14, 2012, account 0026-XXXXXXX1319 held 1,398.129 shares. The price per share on that date was $9.25. The account value on that date was $12,932.69. Accrued dividends are not applicable for the account. If you have any questions, please call a Dreyfus Service Representative toll-free at 1-800-645-6561, Monday through Friday, 8 a.m. to 6 p.m., Eastern Time. Alternatively, you may contact us via our web address at www.dreyfus.com. Sincerely, t '~~, -~~%~ , : f ~~ Steve Perry Vice President Sehe.dt,~.l~e- l~ . , ~-I-~-nom I ~~~~ATl:~ 1~ ~- F~„n P.O. Box 219579, Kansas City, MO 64121-9579 MICI-IAI:L R WARNER 101 PENNS RUN RD MECHANICSI3URG PA 17050 REFERENCE: 12567319 NATIXIS FUNDS MARTHA L WARNER Dear Mr. Warner: We are contacting you regarding the investment held with Natixis Funds. Apri 1 2, 2012 Please accept our written response by letter as it is not our policy to respond by less secure methods such as email or facsimile. We want to confirm the following: • "i'he account held in the Harris Large Cap Value Fund Class A maintained a balance of 1,312.0290 shares as of Fehruanf 14, 2.0 i 2_ The share price was $15.43 per share, with an ending account value of $20,244.6 l . There were no accrued dividends for the account. If you leave any questions, please call us at 1-800-225-5478 if you are within the United States, or if you are outside tl~e United States please call us at 1-617-483-8325. Alternatively, you may contact us via our web address at www.ngam.natixis.com. Our business hours are Monday through Friday 8:00 a.m. to 6:00 p.m., Eastern Time. Sincerely, ~.- Steve Perry Vice President Natixis Funds, P.O. Box 219579, Kansas City, MO 64121-9579 www.ngam.natixis.com Natixis Distributors, L. P. is located at 399 Boylston Street, Boston, MA 02116 3 , ~y -__ - -_.. 5 \ ~~ 'V '. 7, ~~~~ 1 -~,~ i `V ~~` y 1 ~ ~ i 5 Y ~+C '.1 ~. I-~ .. ~ fit.?` 1~~, il~i t _~... ~~ _ .. ~., i~ .. ~ (-._. .. 1 ... 'ill ~~_ March 30, 2012 MICHAEL R WARNER 10 PENNS RUN RD MECHANICSBURG PA 17050 REFERENCE: 06771079 Dear Mr. Warner: Thank you for your recent request in regard to Martha L. Warner's :Individual account with Wells Firrgo Advantage Funds'. The value of the Wells Fal•go Advantage Equity Vcrizle Fund-Class A account, number 1090-XXXX9627, as of February 14, 2012, was $9,938.64. The value was determined by multiplying the number of shares in the account, 758.096, by the net asset value (NAV} price per share on that day, $13.1 1. If you have any questions or require further assistance, please call us at 1-800-222-8222. Representatives are available 24 hours a day, 7 days a week. Sincerely, Kirstin J. Stahl Client Relationship rI'eain Wells largo funds Management, I,I.C, a wholly o~~~ned subsidiary of Wel)s Fargo & Company, provides investment advisory and administrative services for FYeI/s 1•rrr~v :adrun~a~e hiutds". Other affiliates of Wells Fargo & Company provide subadvisory and other services for the Funds. The Funds are distributed by wells Fargo Finds Distributor, LLC, fvlember FINRn/sIPC, an affiliate of Wells Fargo & Company. ~ + r ` +7r n ~ ~ k' ~~~q~ . iii: :.l~l.€,~~tJ ~ $.E@ ~:;,C~zt~ C,l~,b.t..=~ ~ ~~ (.~,1~1 ° °3~1* ~J;1~L'r'; _. __ __ _ ___ ~ehedc.~(~e j3, , ~ REV-1504 EX+ (6-98) Y. ~. , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNED~JLE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Martha L. Warner 2012-00231 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporationlpartnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) ~ SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT -_ __ ESTATE OF FILE NUMBER Martha L. Warner 2012-00231 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-15o8 EX+ (08-1~) SCHEDULE E i Pennsylvania DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Martha L. Warner 2012-00231 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, Orrstown Bank checking account #149000754 Cash principle on date of death (checks that cleared post date of death are listed on Schedule I) 44,620.12 Accrued interest to date of death 0.31 2 Myers-Buerhrig Funeral Home -prepaid funeral account (actual expenses listed on Schedule H) 12,968.00 3 2005 Lincoln Town Car -value per Kelly Blue Book 8,400.00 4 Misc. household furnishings 2,500.00 5 Highmark - reimbursement of insurance premium for drug plan 57.20 6 AMA Insurance Agency -refund due to death 1.57 7 BJ's Visa credit card -refund from credit balance 31.05 g US Treasury - 2010 Federal Income Tax refund 8.39 g Pa. Dept. of Revenue - 2009 income tax refund 108.19 TOTAL (Also enter on Line 5, Recapitulation) $ I 68,694.83 If more space is needed, use additional sheets of paper of the same size. t~~F .~ Lrr~rlitiori ~f~E.tc•~llc~lr~~c~ 1~~larch ?7, ?01? iVlichacl IZ. ~'~~atner. Executor 1 U I Penns Run RcI ~~Iechanicsbur~, PA 17OtiU renee~.~arner(«comcast.net Re: Estate ot~ vlartlla L. WaI-ncr Social Security Nulnlier- ? I I - I ~- I ? ~t1 Date ot~ Death ?~~ 1 ~'?O1 I"I~ IS 1-IEREHY' CF_.RTIF[E=D THAT "I'HE ABO~~E NAMED DEC,EDEN'I' HAD THE FOLLOWING ACC~OI`1NT WITH URRSTOWN BANK: C,l ~ly. 1. `Llll~rl7 : 1 ~~~•V ~~~1~1 f\ccount No.- Ac:coullt Typc- Date Opened- JOInt Acc~~unt (naulc~'datc)- I3alallce- ,~ ~::~I- ~ ~ r ,, t ~,-:,: t tr~c, „~~:.~,,.,~ I ~~?()~)t) / ~=~ Re~~arc~l Checking No ~r~ ; i ~,~,._. , Ens-losccl per yarn- rc~qucst is a print out of accoutlt ~~-=} 49()0()75=~ shO~Vln~ any checks that clcar~ci post February 14. ?OI?. Best Regards. ,Till R. VGorthin~tun Deposit Procetisin~ Clei-I: is . r ~ ` r :~+ € ; f~s` », i ,~y~ i i ~iy ` t~ ~N ~.sss.aRRSTOwN Sehe~~-. ~ ~, T-4~~,n ~ C.~~-t~-~ "fit 3/2`7/12 P~tartha L Warner CIF address change Last stmt balance: Current balance: Control: Posted Effect _ 1/17/12 1/17/1.2 _ 1./18/12 1/18/12 _ 1/20/12 1/20/12 2/03/12 2/03/12 _ 2/03/12 2/03/12 _ 2/02/12 2/02/12 _ 2/08/12 2/08/12 2/13/12 2/13/12 -~"~ `-217 l 2 2 / 17 / 12 _ 2/16/12 2/16/12 -~- _ 2/17/12 2/17/12 _ 2/14/12 2/14/12 _ 2/14/12 2/14/12 Deposit Inquiry Account number: Closed Messages P assport ATM/Dr Card .0 0 Last stmt date: .0 0 Statement cycle: -- C H E C K S -- _ Batch Sequence Src T/C Amount 0010 0120003700 P 091 450.00 0030 0020006000 P 091 121.87 0010 0010011800 P 091 44.24 0012 2534012549 C 183 512.99 0010 0120015300 P 091 4,950.00 0010 0100003600 P 091 106.00 0010 0310001000 P 091 951.00 5398 0019077297 C____~,_$3 44~ 800 0010 0210011400 P 091 ~ 11.00 0010 0020001200 P 091 1,2D6.93 0010 0120014600 P 091 28.00 0010 0180010100 091 2,000.00 0010 0300016300 P 091 3,000.00 0100 0040011$00 P 090 1,000.00 1..3:37:59 149000754 1 of 1 3/12/12 _ 63 Serial 162 163 164 165 166 167 169 170 171 17 2 C~~ , ~ ~~ ~~~ 17 3 OSt' ~ 17 4 C~~-e O~ 17 5 ~ ~=l-~'~1 177 Bottom F7=Scan forward FB=Scan backwards F17=Top F18=Bottom F20=Show Payee F22=T/C STATEMENT tJF FUNERAL ~r0®l®S AND SERVICES SELECTED Ch~u,~es are only ii~>r thi~se items that yI>u selected c,r that are required. It «-e are required by la~~~ or hy° a cemetery or crenrttort~ to use any items, we Rill c°xi~lain the r~~asi.m in writin.r belin~~. If Vou selected a funeral that nay rcyuire embalulin~;, such as a Eutx~ral ~~ic«~in~;. ~-ou m~n~ ha~~e to pay ror embalminf;. You do not ha~-e to pay For emballn- in~ ~~uu did not al~~pro~~c il~ you selected arrangements such as direct cremation or immrdiate burn-t!. If ~~-e chat~t;ec( for embalming, n~e mill explain ~~~hy helo~~~. Igor the Service of Date of Death (;har~;e to: ~~tl]ll' A. CIiAR(JE FOR SERVICES SELECTED: 1. NIItiFI'.:i:ilU'~:~i. ;~i~,ii;~It;F.;> ti~~n~ices of Funeral Director"Staff ...... w I?nifr,~lniin, ..................... ti .- tith~~r preparati~>n <,f bunt :address ~,It~ t)tiier cl~-xhins; Mate Cremation urn ................... S C1)«criptiim) _______ t )'I'I II:R szrx-'roTAI, of PROFESSIONAL SERVICES . .....:; ~ '. ;~;;C[LI~1'IE5 :1;~i1) SF:1~;~1CI•:~ f `se i,l~ I~acilitie.~ :uid tii~raices fi>r ~~ir~~in;; (~~isitation;C"ake) ......... 1 ~~~~ of lariliti~~s ;md selti~ic~~~ iin~ Iiuu•I;il ceremoin~ .......... '~ ['se ~~C -;tcilitic°s and tir~-~irc.ti f~,r :Memorial tier~~i~~e ........... . ... f'~~• of eyuipli~etit aril ~rn~icrs fi,r gray e~siele .ti~•r~ ire ............. Uthrl use ~,f facilities .SL1I3-TOTAL OF FACILITIES/EQUIPMENT ...........:; >. al 't O~I~ 1~Ci1"F: I•;t )I `IP;11:'ti"I' V"ehit•ie to tran.~fe~r rt°nr.iin.ti to Funeral Flume llear5e 1t:;i~la•t C~,arlil I,Im(HLSine l,i,tal ......................... "--------- I~amil~~ rar I~k,~~~er car or floral disposition Loral ...................... ~ --- Lead rar ~rlel~~i~ rar Lo, ;il ...................... '~ . C;ir fi>r pallhearer.~ I,oc,il ....................... ~ -- Uut of ti,«'n tran~pi>itation .......... `+ _ y SUB-TOTAL OF AUTOMOTIVE EQUIPi4iEN'r .........A, S TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQL?IPMEN'I' ................. ...............:~ I3. (;HAIZ(~I; I~€)IZ ;IfI:IZ£:II:1`tiI)I~iE SELI:C'rEC1: C;i,l:~~i ............. .......... ~ t>ther Receptacle ................. ti i I k•scriplion 1 ___-__~,_ ------ t biter burial ~~ontainer ......... . .. . ili~•.,rrilxirm) -------------------------- TOTAL MERCHANDISE SELECTED .................I3 C. sPECIAI. CHARGES: Fonrarding <,F remains to {Fiuieral Nome Recei~~in~~ of remains from ( Funeral home l Immediate burial ................. Direct Cremation ................. S ti SUB-TOTAI.OF SPECIAL CHARGES ...............c: D. CASH ADVANCED Opening curare ............... ... 5-__~ Cemetery Equipuient ........... ... S Lot and Deed ................ ... S tieit~spapcr \~ouces-Local ....... .... ', ~ ~~`J tie~l~spaper tioiices-Out-«t-t~~wn :.: ... `+ _ 'Telephone ~~: 'I'ele;~rams ......... ... S CIel,i;y 1las~ i ~fierin~; ........... ... `~ __ Pallbearers ............... . .. ... 5 Certified Copies of die Death . ... 5 °, Certificate ................... ... ti Police 1'sco11 ................ .... S -_ I'Ic>~~'crs .................... .... ti Vault Sei~~ice Charge ........... .... S ti S S - y ~~ SUB-TOTAL OF ADVANCES .......................I ~ s 2 2 `~ S"~ ,.... ;~'e charge you for our ser<-ices in obtaining: (sperif~' cash adt~a~tces tlx~t aa~ r»ask~ed-ttp) SU~4i'biARV OF CHAREsES :~. i'rr,tes~;ional St~r~=~iits. Fariiitirs ani.l Equilnnent, and ;1ut~~nx,li~~e ~ Equipment .... ~ - S ep .......... ...... ~ I3.:~ierch;indise ... S T~`e-r~1 ~ C. tipecial Charges .................. ~ - j Z l ~ ~ ... D. !;~ish _ldrances .................. S_-- TOTAL OF ALL SECTIONS ~___- "PAID AT TIME OF OR PRIOR TO ~ `- lZ~d ARRANGEMENTS ........ .......... ....... ti CE DLTE ......................... ....... S ca. a.a is uava, a a~aa va.aa• aa. a..~ va..a.a.v a..ai. I. PltOi~l?S5It)\~'iL SF1t1"i(:I~:S ~rr~'ices of Funcrll i)irector Staif~ ...... f.etl}')dill-ling.: `~ Other prep:u:uion c.( hndti .............................w SLIB-'I"OTAL OF PROFESSIONAL SERVICES ..........A i S ?. FACILI"I'!fS ;1:~1) Slatl'I(;la (~~~ of f~ICilitics and ser~•ic~e; iirr l~lt'l`,~tni; Il(.tittall~llil`~:liill [ sr t,ft~tcilities anti sen~iccs fin' funeral rcrernom' .... , .. S t ;~• of taciliti~~s anti ~en•iccs for ~lenutrial Sellicc .. . ............ [ '~~ of eyllil>nteni and sere ices It~r ~ir.t1'f'Sl(IC tilll'IC'l' . . . . . . . . . . . . . y t ether use of facilities ............................ti SUB-TOTAL OF FACILITIES/EQUIP?~IENT ...........:1' h i. Al'I-O3l0"fi\ f E(~1 [I'11Ia•I~ \i•hiclc to transfer Icruains to funera l Itume l.cx'al ..................... ....S Ifearse i(:,lsl:ct Coach) Loc:Il .................... .... Linuxlsinc i.oc a l ..................... .... ~----- }'alilil~" c'ar Local ..................... .... ~ -- I~lo~ti'er rlr or tlc~ral disposition Local ..................... .... ti Lead rarclel,~~' car is.,cal ..................... .... S Car f<x' p.Illbearers Local ..................... .... S (hlt c,,f w«-n transporrtlion ...... .... 5 ti SUB=TOTAL OF AUTOMO'T'IVE EQUIPMENT .........A3 TOTAI.OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT' ...................................A ti B. CHARGE FOR MERCI-IANDISE SELECTED: t )then itcreptac~h• ................. `? ([)e~trli)n(~Il) ____ _ (hu~•r hllrial container' ............. ti 1)r~cript is m) _,___-- ~._--___--- lchno~~~h°dgenlent earth ...... ...... ti 1lcnual-c folders ............ . . .... 5 Pray. car ,_:u•ds .......... ...... ti I'emporu'ti' gr<I~'c mark.•r ...... ...... 5 13111'1:11 clt;tiing ~? (;rcnruion ilrn .................. . `~ tl)escription) _______ ___ O"i~I iF.it ; TOTAL MERCHANDISF. SELECTED . ~ ................13 h_^---____-- C. SPECLAL CI-LARGES: fol•ta~arding of remains to _ _ _ i---` i ti ~' (I'Uneral IIonlCl ltecc°i~~ing of remains from ti _ i funeral I lomc) Immediate I31u~ia1 ................ . ~-------___.-- llirect Crealation ................ . ti ;; SUB-TOTAL OF SPECIAL CHARGES ...............c: ti D. CASH ADVANCT?D Opening C;r~~l~~c ............... ... S_ ~,etllf'[er~' I:CjUJl~llleill . ~+ _ Lot and ller•cI ................ ... ti let~.5p~!hel ~r,tice~-Lc,cal ..... .. ... ti ,_._ ~1 ~`~ :~e~~spaper lotices-tint-of-tt>«~n :.. ... ~-- Teleplutne ~~; "Celegrants ......... ... ti Airfare ..................... ... ti Clergy-,~Iass Offering .. . ........ ... `~ I'allttcarcrs ............... ... `~ Certified Copies of thc° lleatll ..... ... `~~_ :el-tificatc ................... ... '~ Fkn~'ers ..................... ... ~._~__.---- ~aul[ ,`iet~'ICC' i,hars;c' . . . . . . . . . . . . . . . ti__-_----- S ti ~ ti SL'B-TOTAL OF ADVANCES ....................... I ~ ti~~_ z~ 7S__ «~e charge you for our scn'ices in obtaining: (sf~ecifj~ cr~s{3 c~rtt~a;'aces t{xtt ~tre fsrrlr,~ecl-upl 5LIMMARY OF CHARGES A. Professional Sen~ices, facilities and 1?yuipment. and Autonxlri~'e I?cl! 2iI?ittenl 13. ;ikrchandise .................... ~------._--- C. Special (;barges .................. S----- _ f 2.. ~~j 3 -~ TOTAL OF ALL SECTIONS .. ~.___ j PAID AT TIME OF OR P. RIOR TO /~(~'~ Q~ l> # ARRANGEMENTS ........ .......... ....... ~ CE DLTE ...... .................. ....... ~- -- ---- REASON FOR EMBALMING If any la~~', cenietetti', ur rrc~llrlum- rec{uirements ha~~e re<luired the purchase of ant' of the items listed aho~-e, the law or reyuiremcnt is explained h~lo~~~. i a~~reC Ih:2I i httl'C c'tiaminCd [hC ItClllti c)I ~;U(3dti and tiel•11CCJ SC1C:C[f'll abt)1'C :IIiCI fOUnll [hc°nl fO bt' C(>t'reCt trod aCCOrding U) the :Il'r2in~r',Cil1C(115 I h1iCC rC(iUl'tiC(°CI. l aC{inOvV'le(li;c receipt of a cop}~ of this Statcvuent of funeral (;cods and Sen'ices Selected. I represen3 that I ha~~e sufficient funds .n~ai-ah}e Cur payment. of the cash price for the goods :Intl ser~~iccs selected. I also agree to nr.~ke payment of '~_ ~i-itflin _. day's. I a<„ree to he jointly and se>,'eetlly liable with :uly~otte else ~ti'ho si;~ns hero«~.:y late chat~~e of _ per month amounting to _ _ per year n'ill l,c applied to the unp~Iid halancc• beginning --.~-_-- days from the datr of this agrecmeni. I ~~'ill also pay ttI the Funeral Direcun- IIII reasonable costs paid by the Funeral Direct<~r to collect anuunus I o~~'c roofer this ,Il;recment. "I'hc.>se costs Iua~ include attorneys' fees. court costs and other costs. Ant' additional sen-ices of merchandise ordered or ref{nested ;titer the date of this agrerment «'ill he considered part elf dlis a;~reement and the cost thereof will be reflected on the tinal hill or statement. tSeall I F'urchascr) (I)ate7 - ------ i tic ;l) ------ -- -- --_-~-- t l'urchaserl (Licensed Funeral (7irectorl ;~ i~cic.ir~. Fu~n°;a! lli-;iu;: ~i,•~;ria!iun 1tHITE }4~n_~ral !>irc~u~r l'F:LLc7P: Funrral Uircctur PIA Cu<l~nnrr form - vU0 Revised 1/04 GHMnRK. Date: 04/17/2012 This Month Gross payment amount 57.20 Net payment amount 57.20 ,, r~ _. ~ ~ _~ REFCHK ****AUTO**MIXED AADC 541 ~831~,`~ ESTATE OF MARTHA WARNER ' 101 PENNS RUN RD MECHANICSBURG PA 17050-8231 ii~il„~Illiul~~i~l~illlu"~i,i,ii,li~ll,iriill,~iiilii,,,~~i~ AMA Insurance Agency, Inc. To: MARTHA WARNER (7997493) Master No. Date Description 7997493 04/24/12 REFUND DUE TO Death TOTALS: Check Number: 183878 Date: April 24, 2012 Certificate No. Paid Amount 9500668256 $1.57 $1.57 Card Services P.O. Box 8801 Wilmington, DE 19899-8801 MB 01 000350 91681 B 3 A Martha ~ Warner 101 Penns Run Rd Mechanicsburg PA 17050-8231 'i'~'I~II~~t~i~~ n ~~ll~~~~~I~~{I'I~li~~l~~~~~~~llti~~~l~s " I~I~I~ May 18, 2012 Account Ending In 8444 Dear Martha L Warner, This is in reference to your Bb's Visa`Il account. We have processed a credit balance refund on the above referenced account. Enclosed is a credit balance refund check in the amount o ~31.05.~ If you need further assistance or have questions or concerns, please contact your Relationship Manager at www.BarclaycardUS.com or 1-866-483-0678. Thank you for choosing Bb's Visas . We appreciate your business. Sincerely, Card Services lV O O CO V ~ed ~.t.~~e ~ ~ ~-I'~e-ran `~ ~ i~~;t Department of the Treasury Internal Revenue Service IRS Philadelphia, PA 19255-0049 254124.252613.0906.018 1 AT 0.374 640 I~~I~~~II~~{ili,~i,i{I,~~~I~~~~~~~I~~II~~~III{li~,iilliii,i,il„~ . JAMES E & MARTHA L WARNEP, # ~:,, t~ MICHAEL R WARNER EXEC 17 PHEASANT ST MECHANICSBURG PA 17050-3145 :54124 Changes to your 2010 Form 1040 refund due: ~~.oo As a result of your recent audit, we changed your 2010 Form 1040. Please see your copy of the audit report for a detailed explanation of the changes. Notice CP21. Tax Year 201 Notice date October 15, 2012 Social Security number 188-20-8998 To contact us 1-800-829-8374 Your Cal{er ID 551873 Page 1 of 2 Summary Decrease in tax 5-8.00 Refund due $8.00 .~ As a result, you are due a refund of $8.00. v::~(~~LL, ~ ~~ ~ ~ .' ~ / What you need to do If you agree with the changes we made • If you haven't already received a refund for $8.00, you should receive it within 2-3 weeks as long as you don't owe other tax or debt we're required to collect. Continued on back ... JAMES E & MARTHA L WARNER MICHAEL R WARNER EXEC 1 i PHEASANT ST IRS MECHANICSBURG PA 17050-3145 ,~ ,- If your address has changed, please call 1-800-829-8374 or visit www.irs.gov. ~ 'I (I I ^ Please check here if you've included any correspondence. Write your Social Security . ~ ,II number (188-20-8998), the tax year (2010), and the form number (1040) on any Contact information correspondence. !~ a.m. ~ a.m. !~ p.m. ~ ! p.m. Primary phone Best time to call Secondary phone Best time to call INTERNAL REVENUE SERVICE PHILADELPHIA, PA 19255-OC~49 ~iuliu~~niu~nlo~illlll~~iliillli~lll~l,n~lllll~llllull~~l~ Notice CP21 E Social Security number 18E-20-8998 Notice date October 15, 2012 188208998 FL WARN 30 0 201012 BUREAU OF INDIVIDUAL TAXES PO BOX 280431 HARRISBURG PA 17128-0431 THIS IS N4T A BILL If you have any questions, refer to this information: JAMES E ESTATE WARNER MICHAEL R WARNER 101 PENNS RD MECHANICSBURG PA 17050 TAX ID NUMBER: DLN: Tax Period: pennsylvan~a ~: . ~r DEPARTMENT OF REVENUE REV-364 C (D7-11) DOCEXEC OCT 24 2012 188-20-8998 091300127124 2009 This notice is not a bill; however it reflects changes made to your tax return. If you have a question concerning this notice, please call: (717)787-8201 8:00 am to 4:00 pm. Or write to: PA Department of Revenue PO Box 280431 Harrisburg PA 17128-0431 Please include a copy of this notice with your inquiry and a detailed explanation of your questions or concerns. We request that you correct any errors to your name, address or SSN. PZ^a~^ in~l::de a daytime t~l~~hone number with area code so we may contact you if necessary. Date of Notice: TAX ID NUMBER: 188-20-8998 THE F IGURES SHOWN BELOW REPRESENT AMOUNTS AS ORIGINA LLY REPORTED ON YO UR 2009 TAX RETURN OR AS ADJUSTED BY THE DEPART MENT. ORIGINAL OR ADJUSTED AMOUNTS lA. GROSS COMPENSATION .......................... 6,000 1B. SCHEDULE UE EXPENSES ........................ 0 1C. COMPENSATION ................................ 6,000 2. INTEREST (SCHEDULE A) ....................... 492 3. DIVIDENDS (SCHEDULE B) ...................... 258 4. NET INCOME OR LOSS .......................... 0 5. TAXABLE SALE - GAIN OR LOSS ................. 0 5A. CAPITAL GAIN EXCLUSION ...................... 0 6. RENTS, ROYALTIES, PATENTS, COPYRIGHTS....... 10,265 7. ESTATES AND TRUSTS (SCHEDULE J) ............. 0 8. GAMBLING AND LOTTERY WINNINGS ............... 0 9. GROSS TAXABLE INCOME CARD LINES 1C,2-5,6-8). 17,015 10. OTWER DEDUCTIONSCMEDICAL, HEALTH, TUITION).N 0 11. NET PA TAXABLE INCOMECLINE 9 MINUS LINE 10). 17,015 12. TAX LIABILITY (MULTIPLY LINE 11 BY .03070).. 522 13. TAX WITHHELD (FROM W2'S) .................... 184 14. CREDIT FROM PREVIOUS TAX YEAR ............... 0 158:16 ESTIMATED TAX & EXTENSION PAYMENTS.......... 600 17. TAX WITHHELD AS REPORTED ON NRK-1........... 0 18. TOTAL CREDITS (ADD LINES 14-17) ............. 600 19B. NUMBER OF DEPENDENTS ........................ 0 21. TAX FORGIVENESS CREDIT ...................... 0 22. RESIDENT CREDIT (SCHEDULE G) ................ 0 23. CREDITS (SCHEDULE OC) ....................... 0 24. TOTAL CREDITS (ADD LINES 13,18,21-23)...... 784 25. TAX DUE CLINE 12 MINUS 24) .................. 0 26. PENALTIES AND INTEREST ...................... 28. OVERPAYMENT CLINE 24 MINUS 12) .............. 262 29. REFUNDED .................................... 100 30. CREDITED TO NEXT YEARS ESTIMATED TAX........ 162 31-35 .TOTAL DONATIONS CLINES 31-35)............ 0 TAX DU E C-) OR OVERPAYMENT C+) 262.00 + - PR EVIOUS REFUND 162.00 - + IN TEREST OWED TO YOU 8.19 + TOTAL CALCULATED OVERPAYMENT 108.19 CASH REFUND CTO BE ISSUED IN 3 TO 4 WEEKS) 108.19 THE DEPARTMENT HAS RECEIVED YOUR INQUIRY/CORRESPONDENCE CONCERNING THE ADJUSTMENT TO YOUR INCOME TAX RETURN. BASED ON THE INFORMATION PROVIDED, WE HAVE ADJUSTED YOUR RETURN. SEE THE REVERSE SIDE FOR ADDITIONAL INFORMATION AND INTEREST RATES so.Dt~edt~-I~e. ~> ~~ °1 REV-i5o9 EX+ (oi-io) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Martha L. Warner 2012-00231 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ~ ADDRESS I RELATIONSHIP TO DECEDENT A. None JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °f° OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. TOTAL (Also enter on Line 6, Recapitulation) I $ 0.00 If more space is needed, use additional sheets of paper of the same size. ~ pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Martha L. Warner 2012-00231 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 NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIQNSH[P TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (!F APPLICABLE] TAXABLE VALUE The following accounts are payable on death to the Martha L. Warner Family Revocable trust UAD 4117197; values per valuation letters attached 1 660.499 shs. Invesco Van Kampen American Franchise Fund Class A @ 8,256.24 100 8,256.24 $12.50Ish.; Invesco TOD account #1001213559 2 Lincoln Financial Group, annuity contract #92-2098626; custodial IRA 199,292.89 100 199,292.89 3 Merrill Lynch Money Market account #872-71944; custodial IRA 16,698.19 100 16,698.19 4 Vanguard Prime Money Market account #0030-88053588876; inherited IRA 16,167.32 100 16,167.32 Accrued interest to date of death 0.23 100 0.23 5 Vanguard traditional IRA #88049478628; specific funds listed below: 5,141.92 100 5,141.92 218.712 shs. Wellesley Income Fund @$23.51/sh. 1,357.975 shs. Windsor II Fund @ $27.55/sh. 37,412.21 100 37,412.21 447.778 shs. Primecap Fund @ $66.631sh. 29,835.45 100 29,835.45 335.009 shs. European Stock Index Fund @ $56.17Ish. 18,817.46 100 18,817.48 186.346 shs. REIT Index Fund @ $87.75 sh. 16,351.86 100 16,351.8E 416.9 shs. Total Stock Market Index Fund @$33.95/sh. 14,153.75 100 14,153.7 154.284 shs. Index 500 Fund @ $124.641sh. 19,229.96 100 19,229.9E 1,997.510 shs. Prime Money Market @ $1/sh. 1,977.51 100 1,977.51 Accrued interest to date of death 0.03 100 0.0~ Janney Montgomery Scott traditional IRA account #4003-4517; securities as 6 follows: Cash 454.43 100 454.4: 18 shs. Abbott Labs (ABT-NYSE) com. stock at $54.97/sh. 989.46 100 989.4E Accrued dividends to date of death 8.64 100 8.6~ TOTAL (Also enter on Line 7, Recapitulation) $ I 384,787.55 If more space is needed, use additional sheets of paper of the same size. ~ pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT __ ESTATE OF FILE NUMBER Martha L. Warner 2012-00231 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 NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE; TAXABLE VALUE Schedule G continued Item 6, Janney Montgomery Scott IRA account #4003-4517 9 shs. Chevron Corp. (CVX-NYSE) com. stock @ $106.0475/sh. 954.43 100 954.43 15 shs. Coca Cola Co. (KO-NYSE) com. stock @ $68.515/sh 1,027.73 100 1,027.73 11 shs. Colgage Palmolive Co. (CL-NYSE) com. stock @$91.58/sh. 1,007.38 100 1,007.38 Accrued dividendes to date of death 6.38 100 6.38 14 shs. Conocophillips (COP-NYSE) com. stock @ $73.26Ish. 1,025.64 100 1,025.64 20 shs. DuPont EI DeNemours (DD-NYSE) com. stock @ $50.321250/sh. 1,006.43 100 1,006.43 19 shs. Emerson Electric Co. (EMR-NYSE) com. stock @ $51.5/sh. 978.50 100 978.50 10 shs. Five Star Quality Care Inc. (FVE-NYSE) com. stock @ $3.785/sh. 37.85 100 37.85 15 shs. General Motors Co. (GM-NYSE) com. stock @ $25.225/sh. 378.38 100 378.3 100 shs. Healthcare Realty Tr. (HR-NYSE) com. stock @ $20.935Ish. 2,093.50 100 2,093.5C 17 shs. Honeywell International Inc. (HON-NYSE) com. stock @ $59.7025/sh. 1.014.94 100 1,014.94 37 shs. Intel Corp. (INTC-NASDAQ) com. stock @ $26.64Ish. 985.68 100 985.6E Accrued dividends to date of death 7.77 100 7.77 141 shs. Istar Finl Inc. (SFI-NYSE) com. stock @ $7.11sh. 1,001.10 100 1,001.1C 26 shs. Kraft Foods Inc. (KFT-NYSE) CI. A stock @ $38.47/sh. 1,000.22 100 1,000.2 12 shs. Lockheed Martin Corp. (LMT-NYSE) com. stock @ $88.1051sh. 1,057.26 100 1,057.2E 10 shs. McDonalds Corp. (MCD-NYSE) com. stock @ $99.295Ish. 992.95 100 992.9: 38 shs. Molex Inc. (MOLX-NASDAQ) com. stock @ $27.1625/sh. 1,032.18 100 1,032.11: TOTAL (Also enter on Line 7, Recapitulation) $ I 15,608.32 If more space is needed, use additional sheets of paper of the same size, ~ pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Martha L. Warner 2012-00231 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 NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDEPiT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE Schedule G. continued Item 6, Janney Montgomery Scott IRA account #4003-4517 34 shs. Republic Services Inc. (RSG-NYSE) com. stock @ $30.271sh. 1,029.18 100 1,029.18 26 shs. Sanof (SNY-NYSE) sponsored ADR @ $37.14/sh. 965.64 100 965.64 100 shs. Senior Housing PPtys Tr. (SNH -NYSE} sh. ben. int. @ $22.6351sh. 2,263.50 100 2,263.50 16 shs. Snap On Inc. (SNA-NYSE) com. stock @ $61.79/sh. 988.64 100 988.64 8 shs. Union Pacific Corp. (UNP-NYSE} com. stock @ $112.81sh. 902.40 100 902.40 13 shs. United Parcel Service Inc. (UPS-NYSE) Class B stock @ $76.935/sh. 1,000.16 100 1,000.16 16 shs. Walmart Stores Inc. (WMT-NYSE) com. stock @ $62.015Ish. 992.24 100 992.24 1,515.84 shs. Federated Equity Funds (SVAIX-NASDAQ) @ $4.8Ish. 7,276.03 100 7,276.03 640.168 shs. Yacktman Fund (YACKX-NASDAQ) @ $18.25/sh. 11,683.07 100 11,683.07 $7,000 General Motors Acceptance Corp. bond dtd. 07/2/2004 due 6,496.03 100 6,496.0? 0711512019, 6.25% @ 92.800400% Accrued interest to date of death 35.24 100 35.24 $4,000 General Motors Acceptance Corp, bond dtd. 11130/2004 due 3,740.32 100 3,740.3 11115/2024, 7% at 93.50800% Accrued interest to date of death 22.56 100 22.5E 600 shs. General Electric Cap Corp. (GEC-NYSE) Pines 6.1 %, 32 @ 15,426.00 100 15,426.00 $25.711sh. Accrued interest to date of death 228.75 100 228.70 125 shs. GMAC Inc. (GJM-NYSE) SR NT 7.35 @ $23.4251sh. 2,928.13 100 2,928.1` 980.438 shs. Fidelity Salem Street Trust mutual fund (FIPIX-NASDAQ) @ 12,716.28 100 12,716.2E $12.97/sh. 1,637.243 shs. Franklin Custodian Funds (FUSAX-NASDAQ) @ $6.95/sh. 11,378.84 100 11,378.8 TOTAL (Also enter on Line 7, Recapitulation) $ I 80,073.01 If more space is needed, use additional sheets of paper of the same size. ~ pennsylvania SCHEDULE G DEPARTMENT Of REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT - __ ESTATE OF FILE NUMBER Martha L. Warner 2012-00231 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 NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, -HEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE Schedule G continued Item 6, Janney Montgomery Scott IRA account #4003-4517 553.888 shs. Global Opportunities Bond Fund (GOBIX-NASDAQ) @ 6,192.47 100 6,192.47 $11.181sh. 510.36 shs. Hartford Mutual Funds (HIPIX-NASDAQ) @ $12.241sh. 6,246.81 100 6,246.81 749.839 shs. Loomis Sayles Funds II (LSIIX-NASDAQ) Invt. Grd. Bd. Y @ 8,283.01 100 9,283.01 $12.38/sh. 602.709 shs. Loomis Sayles Funds II Strat. Inc. Fd. Y (NEZYX-NASDAQ) @ 8,076.80 100 9,076.80 $15.061sh. 1,372.883 shs. Pimco Funds Total Rtn. Fd. P (PTTPX-NASDAQ) @ 15,266.46 100 15,266.46 $11.121sh. 516.024 shs. Pimpco Funds GNMA Fd. P (PPGNX-NASDAQ) @ $11.82/sh. 6,099.40 100 6.099.40 569.177 shs. Principal Funds Inc. Glob. Dvrsinc. P (PGDPX-NASDAQ) @ 7,564.36 100 7,564.36 $13.29Ish. 157.621 shs. First Eagle Funds Inc. Global Fd. CI I (SGIIX-NASDAQ) @ 7,576.84 100 7,576.84 $48.07/sh. 229.169 shs. First Eagle Funds Inc. Gold Fund CI I (FGGIX-NASDAQ) @ 7,154.66 100 7,154.66 $31.221sh. 279.468 shs. Permanent Portfolio Fund Perm. Portfolio (PRPFX-NASDAQ) @ 13,679.96 100 13,679.9E $48.95/sh. 312.892 shs. Thornburg Investment Trust Inv. Incm. Bld. I (TIBIX-NASDAQ} 5,841.69 100 5,841.69 @ $18.671sh. 137 shs. Enterprise Products Partners L.P. (EPD-NYSE) @ $50.7051sh. 6,946.59 100 6,946.59 33 shs. Sysco Corp. com. stock (SYY-NYSE) @ $29.202500Ish. 963.68 100 963.6E 674.762 Oppenheimer US Gov't Trust CI Y (OUSYX-NASDAQ} mutual fund 6,551.94 100 6,551.94 @ $9.71Ish. 108,444.67 TOTAL (Also enter on Line 7, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. ,~I~~ Invesco April 17, 2012 MICHAEL R WARNER 101 PENNS RUN ROAD MECHANICSBURG PA 17050 Correspondence ID: 00763327 Dear Michael R. Warner: Thank you for doing business with Invescos"'. We recently received the enclosed request regarding Martha L. Warner's Transfer on Death (TOD) account number 1001213559. As of February 14, 2012, the Invesco Van Kampen American Franchise Fund - Class A (1733) in this account had a balance of 660.499 shares with a market value of $8,256.24 at $12.50 per share at net asset value. Our funds are priced daily and the value of the account is subject to change. Additionally, because Martha L. Warner was invested in a mutual fund which doesn't pay interest, we are unable to provide the accrued interest information as requested. Dividend information can be located on the account statements and Form 1099-D1V statements. Please reference the Correspondence ID listed above on any future inquiries regarding this request. If you have any questions regarding the above information, please call one of our Client Services Representatives toll free at 1-800-959-4246 from 7:00 a.M. to 6:00 P.tv-. Central Time. We will be glad to answer any questions you may have. Sincerely, `~.. ~ . Tabitha A. Jones Correspondence Representative Enclosure(s): Copy of Request ~ Lincoln Financial Group March 28, 2012 DENISE DOUBLES DENISE.DOUBLES@ML.COM RE: Contract # 922098626 Martha Warner -Deceased Dear Denise: This letter serves as confirmation of the account value on the date of death for Mr. Ms. Martha Warner. The value as of February 14, 2012 was $ 199,292.89. If you have additional questions, please contact our office at our toll free number of 1-800-454-6265 extension *8200. Sincerely, Jerica Mickens Annuity Claims Department 8~t113f ~`L lb ~3? R~:B ~t3-~94-565$ -> 717 795 b:357' i~err ~ 1 l Lynrlt Fage ~2 .. u ^ L " ~~ ., ~' n ~: -~, ~ to 'c,; .~ C.' c. -' 9 ~ ~ ~ ~. (n~ a .`~~ m - T ~~ .o a r~ ~. ~ ~ ~ ~' ~ ~ »~ ~~ v '1T ~"1 Tr '` N ~-~ ~~ ~o ~ w ~_ ~ ~ ~ .~ b r,. O f^ r~ i ~ ' rr '~. i' ~ O' '~` ~. ~ 4~ .~ ~ ~ ~ ~ o J' ~ l~ ~1 ~ 1 ~' ~ ~ ~. ~~ 3 ~~: "~ C7 CJ ~+ p) f~ ~~ Ji ~+ 7 U1 C`±4' ~„ t3' ~ ~~ O n; ~ m ~ ~ dry ~ ~ ~,,~^ r~~I C ~' m s ~ fem. LAP R: ~ 9 ~~ ~ x ,. ~ =. ~qq~ w ~' ) 3 L ~' ~ ~- ~ ~, 4'. ~~ m T ~ ~ ti ~ Cu -y ~ rp ~~ a ~} ~; ~ ~ ~ ~ ~ ~ ~ _7 0 SQL' =i q~j ~J r3 Q 4. ~~ ~ ~ -3 u, ~' ` y ~ ~ C' ~ ~ , W ~ ~~ CaC}+ ~ cq g S; ~^ t` cv m `~~ ~i ~ a ~3 .3. h R; Yy' O S Z' !%C~' ti .~ c ~ b ~r u. t~it ~i 1 ~. s ro ~. A• r -~ *r t o ~ '' ~. t ~a. sfl ~; ;~. ~~ ~ ~1> ~, h, ~~, ~i .fi a u~ O ~ ~~ V ~~. ~~~ ~ ~ ~. ~~~ ~ ~o ~~~ c~ ~ ~~ ~. CD ~- ~~ i ~~ ~~ ~~ ~. ,~~ 1y /1] ~. ~ ~. y~ ~~ t~ (fl 0 ,~ ~~ ~~ ~~ ~~ P ~ ~r ~s+ V 3~ m ~~ (D ~~ p A b ~~ i ~ 9 ~~ a _ ~ :~ x~ ~~-.l~G ~C7~0 ~' ~ "! br ~~ ~,, ; ~ •:, a ~ ~ tDi :~~ ~ ~ i Sl'S ~ f ~`~• ~ tt~ ~ .. CGyq O T ~' ~ ~1 ~r ~ i ~~ ~ ~ ~ t~ ~s ~ c: ;~ ~ ' • • I 7~ ` ~ : / ~ .+ ~ ~ 3r ~ t ~ ~ ~ c ~; t ~ 3 1 i ` ~~ ~~ ' ~ ~ (< ~i ! ~ ~ ~ ~ t ~ I ~ ~ i ~ ~I } i f {'J1 en Q ~~ i(~y ~~ Icy ~. G , I~ i I ~i i i f~ ~; ~f cy ~ 'c~ {7i ; rGti 'JC ~ ~ C ~~ ~~ s ~=~ n~ (~ L' ® ~ ~ o, ~ ~~ ~ ~ C] C ~t ~ ~ #f~ . ; a~ ; rn ~ ~ Q! ~ ~ ;:.~. ry i,C :Cd ~ cTJ ~` u a ~. a ~ ~ ro ,f~~, ~; ~,~ ~ ~,~ G f M1J I N ~ ~ ~ c• m ~ ~ ~ ~ ~ ~~ ~ ~,U~ i 9 ~ ~ b N ~ o m ~' ?~ rn ~ N L '"'*1 ~ ~. v~ Qy n ~ ?t a ~. ~ ~.. ~. +e .~. s~r,~.-~ G, t+~ a W . ~~ April 18, 2012 MICHAEL R WARNER 101 PENNS RUN RD MECHANICSBURG PA 17050 Re: Estate of Martha L. Warner Dear Mr. Warner: P.O. Box 2600 Valley Forge, PA 19482-2600 www.vanguard.com We are responding to the letter we received requesting a valuation of Martha L. Warner's Vanguard accounts as of February 14, 2012. The information requested is included on the enclosed account value reports. If you have any questions about a transfer or a transition of assets, please call us at 888-237-9045. Specialists are available on business days from 8 a.m. to 8 p.m., Eastern time. Sincerely, Transition Team Vanguard atb Enclosure(s): ** Martha L. Warner -Traditional IRA Report ~~` I'Vlartha L. ~'varner -inherited IRA Report 52032791 Martha L Warner BENEF James E Warner 17 Pheasant St Mechanicsburg, PA 17050-3145 Martha LWarner -Inherited IRA Account value summary ~. ~. Page > 1 of 1 ~. ~!~ -T- ~"" ~la.n~u~r+~"~ Report fo 02/1412012 Voyager Services: 800-284-7245 Total report value: $16,167.55 (Total report value includes any accrued dividends.) Name Fund & ,'account ~ Date 'Price Per ! ! Accrued Number Opened Shares ~ Share Value'' ~ Dividends Prime Money Mkt Fund ~ 0030-88053588876 11/1812011 16,167.320 ~ $1 00 '!, $16,167.32 $0.23 Totals $16,167.32 $0.23 Doesn't include accrued dividends. 0587713408 04/18/2012 08:40:14 Martha L Warner 17 Pheasant St Mechanicsburg, PA 17050-3145 ~•:~~ T ,T - Report fo 02/14/2012 Voyager Services: 800-284-7245 Page > 1 of 1 Total report value: $142,920.15 (Total report value includes any accrued dividends.) Martha LWarner -Traditional IRA Account value summary PJanie Wellesley Income Fund Inv Windsor II Fund Inv PRIMECAP Fund Investor European Stock Index Adm REIT Index Fund Adm Total Stock Mkt Idx Adm 500 Index Fund Adm Prime Money Mkt Fund Fund & Account Date ~ Price Per Number ! Opened Shares Share Value* 0027-88049478628 j 12/29/2011 218.712 $23.51 I $5,141.92 0073-88049478628 ~ 12/29/2011 ~ 1,357.975 ~ $27.55 ~ $37,412.21 i 0059-88049478628 12/29/2011 ; 447.778 I $66.63 '% $29,835.45 0579-88049478628 ~ 12/29/2011 ~ 335.009 ~ $56.17 j $18,817.46 5123-88049478628 ~ 12/29/2011 !, 186.346 $87.75 ~ $16,351.86 0585-88049478628 ; 12129/2011 ~ 416.900 ~ ~ $33.95 $14,153.75 ~ i ~,ccruad Dividends 0540-88049478628 ` 12/29/2011: 154.284 $124.64 $19,229.96 ~ - 0030-88049478628 ~ 0411 2/20 1 1 ~ 1,977.510 ~ $1.00 ~ $1,977.51 i $0.03 - - ----_ __~__-_._._ _~----- ------------ ------- -----i--~__ - --.. ~__-.. _._ -- ~._ --------.~._._------_.__-- . .Totals $142,920.12 $0.03 'Doesn't include accrued dividends. 0696168008 04/18/2012 08:40:00 ~'e.~'~edu-,Q~e (~~ Tf~rn J~' Estate Valuation Date of Death: 02/14/2012 Estate of: Martha Warner Valuation Date: 02/14/2012 Account: 4003-4517 Processing Date: 03/28/2012 Report Type: Date of Death Number of Securities: 47 File ID: Martha Warner - 4003-4517 - DOD 2-14-12 Shares Security Mean &/or Div & Int Security or Par Description High/Ask Low/Bid Adj'ments Accruals Value 1) 454.43 Cash (CASH) 454.43 2) 18 ABBOTT LABS (002824100; ABT) COM New York Stock Exchange 02/14/2012 55.20000 54.74000 H/L 54.970000 989.46 0.48 E Ol/11 R 01/13 P 02/15/12 8.64 3) 9 CHEVRON CORP NEW (166764100; CVX) COM New York Stock Exchange 02/14/2012 106.53000 105.56500 H/L 106.047500 954.43 4) 15 COCA COLA CO (191216100; KO) COM New York Stock Exchange 02/14/2012 68.93000 68.10000 H/L 68.515000 1,027.73 5) 11 COLGATE PALMOLIVE CO (194162103; CL) COM New York Stock Exchange 02/14/2012 91.91000 91.25000 H/L 91.580000 1,007.38 0.58 E 01/20 R 01/24 P 02/15/12 6.38 6) 14 CONOCOPHILLIPS (208250104; COP) COM New York Stock Exchange 02/14/2012 73.91000 72.61000 H/L 73.260000 1,025.64 Page 1 This report was produced _..~rr_ith__E _tateVal, a product of Estate Valuations ~ Pricing Systems, Inc. anne Montgomery~S~cot~t LLC assumes no responsibility for accuracy or completeness of the infori~iation provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. S'ehedu.l~. G, ~-1~ ~ Date of Death: 02/14/2012 Estate of: Martha Warner Valuation Date : 02/14/2012 Account: 4003-4517 Processing Dat e: 03/28/2012 Report Type: Date of Death Numbe r of Securities: 47 File ID: Martha Warner - 4003 -4517 - DOD 2-1,4-12 Shares Security Mean &/or Div & Int Security or Par Description High/Ask Low/Bid Adj'ments Accruals Value 7) 20 DU PONT E I DE NEMOURS & CO (263534109; DD) COM New York Stock Exchange 02/14/2012 50.48250 49.34000 H/L 49.911250 0.410000 E 02/13 R 02/15 P 03/14+10.410000 50.321250 1,006.43 8) 19 EMERSON ELEC CO (291011104; EMR) COM New York Stock Exchange 02/14/2012 52.89000 50.11000 H/L 51.500000 978.50 9) 10 FIVE STAR QUALITY CARE INC (33832D106; FVE) COM NYSE AMEX Equities 02/14/2012 3.85000 3.72000 H/L 3.785000 37.85 10) 15 GENERAL MTRS CO (37045V100; GM) COM New York Stock Exchange 02/14/2012 25.45000 25.00000 H/L 25.225000 378.38 11) 100 HEALTHCARE RLTY TR (421946104; HR) COM New York Stock Exchange 02/14/2012 20.88000 20.39000 H/L 20.635000 0.300000 E 02/14 R 02/16 P 03/01+10.300000 20.935000 2,093.50 12) 17 HONEYWELL INTL INC (438516106; HON) COM New York Stock Exchange 02/14/2012 60.09000 59.31500 H/L 59.702500 1,014.94 Page 2 This report was produced with Estateval, a product of Estate Valuations & Pricing Systems, Inc. ,Tanney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. Date of Death: 02/14/2012 Estate of: Martha Warner Valuation Date : 02/14/2012 Acco unt: 4003-4517 Processing Dat e: 03/28/2012 Report Type: Date of Death Number of Securities: 47 File ID: Martha Warner - 4003-4517 - DOD 2-14-12 Shares Security Mean &/or Div & Int Security or Par Description High/Ask Low/Bid Adj'ments Accruals Value 13) 37 INTEL CORP (458140100; INTC) COM The NASDAQ Stock Market LLC 02/14/2012 26.78000 26.50000 H/L 26.640000 985.68 0.21 E 02/03 R 02/07 P 03/01/12 7.77 14) 141 ISTAR FINL INC (450310101; SFI) COM New York Stock Exchange 02/14/2012 7.23000 6.97000 H/L 7.100000 1,001.10 15) 26 KRAFT FOODS INC (50075N104; KFT) CL A New York Stock Exchange 02/14/2012 38.61000 38.33000 H/L 38.470000 1,000.22 16) 12 LOCKHEED MARTIN CORP (539830109; LMT) COM New York Stock Exchange 02/14/2012 88.55000 87.66000 H/L 88.105000 1,057.26 17) 10 MCDONALDS CORP (580135101; MCD) COM New York Stock Exchange 02/14/2012 99.64000 98.95000 H/L 99.295000 992.95 18) 38 MOLEX INC (608554101; MOLX) COM The NASDAQ Stock Market LLC 02/14/2012 27.41000 26.91500 H/L 27.162500 1,032.18 Page 3 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. Janney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. Date of Death: 02/14/2012 Estate of: Martha Warner Valuation Date: 02/14/2012 Account: 4003-4517 Processing Date : 03/28/2012 Report Type: Date of Death Number of Securities: 47 File ID: Martha Warner - 4003 -4517 - DOD 2-14-12 Shares Security Mean &/or Div & Int Security or Par Description High/Ask Low/Bid Adj'ments Accruals Value 19) 34 REPUBLIC SVCS INC (760759100; RSG) COM New York Stock Exchange 02/14/2012 30.49000 30.05000 H/L 30.270000 1,029.18 20) 26 SANOFI (80105N105; SNY) SPONSORED ADR New York Stock Exchange 02/14/2012 37.40000 36.88000 H/L 37.140000 965.64 21) 100 SENIOR HSG PPTYS TR (81721M109; SNH) SH BEN INT New York Stock Exchange 02/14/2012 22.85000 22.42000 H/L 22.635000 2,263.50 22) 16 SNAP ON INC (833034101; SNA) COM New York Stock Exchange 02/14/2012 62.13000 61.45000 H/L 61.790000 988.64 23) 8 UNION PAC CORP (907818108; UNP) COM New York Stock Exchange 02/14/2012 113.72000 111.88000 H/L 112.800000 902.40 24) 13 UNITED PARCEL SERVICE INC (91131 2106; UPS) CL B New York Stock Exchange 02/14/2012 77.22000 76.65000 H/L 76.935000 1,000.16 Page 4 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. Janney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. Date of Death: 02/14/2012 Estate of: Martha Warner Valuation Date: 02/14/2012 Account: 4003-4517 Processing Date: 03/28/2012 Report Type: Date of Death Number of Securities: 47 File ID: Martha Warner - 4003-4517 - DOD 2-14-12 Shares Security Mean &/or Div & Int Security or Par Description High/Ask Low/Bid Adj'ments Accruals Value 25) 16 WAL MART STORES INC (931142103; WMT) COM New York Stock Exchange 02/14/2012 62.24000 61.79000 H/L 62.015000 992.24 26) 1515.84 FEDERATED EQUITY FDS (314172560; SVAIX) STRG VAL DV INST Mutual Fund (as quoted by NASDAQ) 02/14/2012 4.80000 Mkt 4.800000 7,276.03 27) 640.168 YACKTMAN FD INC (984281105; YACKX) COM Mutual Fund (as quoted by NASDAQ) 02/14/2012 18.25000 Mkt 18.250000 11,683.07 28) 7000 GENERAL MOTORS ACCEPTANCE CORP (3704AONW8) Financial Times Interactive Data DTD: 07/27/2004 Mat: 07/15/2019 6.250 02/14/2012 92.80040 Mkt 92.800400 6,496.03 Int: 01/15/2012 to 02/14/2012 35.24 29) 4000 GENERAL MOTORS ACCEPTANCE CORP (3704AOUC4) Financial Times Interactive Data DTD: 11/30/2004 Mat: 11/15/2024 70 02/14/2012 93.50800 Mkt 93.508000 3,740.32 Int: 01/15/2012 to 02/14/2012 22.56 30) 600 GENERAL ELEC CAP CORP (369622519; GEC) PINES 6.10 32 New York Stock Exchange 02/14/2012 2 5.77000 25.65000 H/L 25.710000 15,426.00 0.38125 E 02/10 R 02/14 P 02/15/12 228.75 Page 5 . This report was produced with Estateval, a product of Estate Valuations & Pricing Systems, Inc. Janney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. Date of Death: 02/14/2012 Estate of: Martha Warner Valuation Date: 02/14/2012 Account: 4003-4517 Processing Date: 03/28/2012 Report Type: Date of Death Number of Securities: 47 File ID: Martha Warner - 4003-4517 - DOD 2-1.4-12 Shares Security Mean &/or Div & Int Security or Par Description High/Ask Low/Bid Adj'ments Accruals Value 31) 125 GMAC INC (361860301; GJM) SR NT 7.35 New York Stock Exchange 02/14/2012 23.55000 23.30000 H/L 23.425000 2,928.13 32) 980.438 FIDELITY SALEM STREET TRUST (316146810; FIPIX) ADV INFL INSTL Mutual Fund (as quoted by NASDAQ) 02/14/2012 12.97000 Mkt 12.970000 12,716.28 33) 1637.243 FRANKLIN CUSTODIAN FDS INC (353496821; FUSAX) US GOV ADVISOR Mutual Fund (as quoted by NASDAQ) 02/14/2012 6.95000 Mkt 6.950000 11,378.84 34) 553.888 GLOBAL OPPORTUNITIES BD FD (GOBIX) LM BW GW OPPT I Mutual Fund (as quoted by NASDAQ) 02/14/2012 11.18000 Mkt 11.180000 6,192.4 35) 510.36 HARTFORD MU'T FDS INC (HIPIX) INFLATN PLUS I Mutual Fund (as quoted by NASDAQ) 02/14/2012 12.24000 Mkt 12.240000 6,246.8] 36) 749.839 LOOMIS SAYLES FDS II (543487136; LSIIX) INVT GRD BD Y Mutual Fund (as quoted by NASDAQ) 02/14/2012 12.38000 Mkt 12.380000 9,283.0- Page 6 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. Janney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. Date of Death: 02/14/2012 Estate of: Martha Warner Valuation Date: 02/14/2012 Account: 4003-4517 Processing Date: 03/28/2012 Report Type: Date of Death Number of Securities: 47 File ID: Martha Warner - 4003-4517 - DOD 2-14-12 Shares Security Mean &/or Div & Int Security or Par Description High/Ask Low/Bid Adj'ments Accruals Value 37) 602.709 LOOMIS SAYLES FDS II (NEZYX) STRAT INC FD Y Mutual Fund (as quoted by NASDAQ) 02/14/2012 15.06000 Mkt 15.060000 9,076.80 38) 1372.883 PIMCO FDS (72201M552; PTTPX) TOTAL RTN FD P Mutual Fund (as quoted by NASDAQ) 02/14/2012 11.12000 Mkt 11.120000 15,266.46 39) 516.024 PIMCO FDS (PPGNX} GNMA FD P Mutual Fund (as quoted by NASDAQ) 02/14/2012 11.82000 Mkt 11.820000 6,099.40 40) 569.177 PRINCIPAL FDS INC (PGDPX) GLOB DVRSINC P Mutual Fund (as quoted by NASDAQ) 02/14/2012 13.29000 Mkt 13.290000 7,564.36 41) 157.621 FIRST EAGLE FDS INC (32008F606; SGIIX) GLOBAL FD CL I Mutual Fund (as quoted by NASDAQ) 02/14/2012 48.07000 Mkt 48.070000 7,576.84 42) 229.169 FIRST EAGLE FDS INC (FEGIX) GOLD FD CL I Mutual Fund (as quoted by NASDAQ) 02/14/2012 31.22000 Mkt 31.220000 7,154.66 Page 7 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. Janney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. Date of Death: 02/14/2012 Estate of: Martha Warner Valuation Date: 02/14/2012 Account: 4003-4517 Processing Date: 03/28/2012 Report Type: Date of Death Number of Securities: 47 File ID: Martha Warner - 4003-4517 - DOD 2-14-12 Shares Security Mean &/or Div & Int Security or Par Description High/Ask Low/Bid Adj'ments Accruals Value 43) 279.468 PERMANENT PORTFOLIO FD INC (714199106; PRPFX) PERM PORTFOLIO Mutual Fund (as quoted by NASDAQ) 02/14/2012 48.95000 Mkt 48.950000 13,679.96 44) 312.892 THORNBURG INVT TR (885215467; TIBIX) INV INCM BLD I Mutual Fund (as quoted by NASDAQ) 02/14/2012 18.67000 Mkt 18.670000 5,841.69 45) 137 ENTERPRISE PRODS PARTNERS L P (293792107; EPD) COM New York Stock Exchange 02/14/2012 50.94000 50.47000 H/L 50.705000 6,946.59 46) 33 SYSCO CORP (871829107; SYY) COM New York Stock Exchange 02/14/2012 29.33000 29.07500 H/L 29.202500 963.68 47) 674.762 OPPENHEIMER U S GOVT TR (OUSYX) CL Y Mutual Fund values reported to NASDAQ 02/14/2012 9.71000 Mkt 9.710000 6,551.94 Total Value: Total Accrual: Total. $205,578.53 $205,269.19 $309.34 Page 8 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. Janney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS _ ___ _ ESTATE OF FILE NUMBER Martha L. Warner 2012-00231 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; 1' Myers-Buehrig Funeral Home - prefessional services, embalming, casket, obituary notices, & misc. exp. 12,133.00 B. 1, ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) _Michael_R. Warner Street Address 101 Penns Run Road city Mechanicsburg ___ __ _____ __ Year(s) Commission Paid: nla 2, Attorney Fees: C~cete5 ~e.~~ru.ne,r ~{~-r~ •F ~1,1.15~ - Q.(~'I,I.Q,Q '~ ~:t "~" ~5{'fi~t1a~,~ 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.} Claimant Street Address 4 5 b 7. 8. 9. 10. 11. 12 City ________ State _____ ZIP _ Relationship of Claimant to Decedent _ __ ____ Probate Fees: ~~ g A.cld.i-I~f~a,Q Shor+ Ce~l-iii e~t~e S Accountant Fees: Tax Return Preparer Fees: Cumberland Law Journal -estate notice Patriot News -legal advertisement Michael R. Warner - reimb. for postage, tax id. #s, notary fees, death certifs., & misc. costs Deluxe checks -cost for estate checks Central Penn Appraisals -appraisal fee for two properties Additional administrative costs listed on attachment TOTAL (Also enter on Line 9, Recapitulation) I $ 0.00 1,500.00 0.00 463.50 0.00 0.00 75.00 109.52 588.89 62.54 700.00 7,028.73 22,661.18 State PA ZIp 17050 If more space is needed, use additional sheets of paper of the same size. Schedule H continued Administrative Costs Martha L. Warner Estate 12. Maintenance expenses for 17 Pheasant Street, Mechanicsburg, PA post date of death through November 7, 2012: PPL -electric United Water Silver Spring Township Authority -sewer Pennwaste -trash Lawnscapes -lawn maintenance Nationwide -homeowners insurance Debra Basehore Wiest, Tax Collector - 2012/2013 school taxes Debra Basehore Wiest, Tax Collector - 2012 real estate taxes Bonnie K. Miller, Treasurer - 2012 real estate taxes for 116 Linden Drive, Camp Hill, PA Settlement Costs for 116 Linden Drive, Camp Hill, PA per attached Settlement Statement Real estate transfer tax 2012/2013 School taxes Integrity Bank Wire fee Lower Alien Township 3rd quarter sewer & trash File No. 2012-00231 $ 287.14 88.92 318.00 82.55 435.14 213.33 1,446.18 491.20 707.08 1, 300.00 1, 530.24 20.00 108.95 Total additional administration expenses $7,028.73 STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED t;hargc•s are clnly for those. items that you selected or that are required. If we are required by law or b} a cemetery- or crematory to use any items, «-e will explain the reason in writing below. If ycnt selected a funeral that may rec{wire embalming, such as a Funeral viewing, you may hay=~ to pay for embalming. You do not have to pay for emhalm- ing you slid not approve if yclu selected arrangements such as direct cremation or immediate burial. If we charged for embalming, we will explain why below. For the Service of Date of Death Charge to: ~iallle Address City State A. CHARGE. FOR SERVICES SELECTED: i. PIZt)P[~,SSIONr11.51?ItvIC:I:S 5et~~ices of Funeral Dircrtol~ ,staff ...... 5 I?nlhalming ..................... Other preparation of body SLIB-TOTAL OF PROFESSIONAL SERVICES ..........A1 5 ?. !:~\(:(1.1'1'IF.ti r1V1) tiER1'1C:fa Use of t:u~ ilitic•s and srrt~ices ti~lr vii°~eing (Visitation~~tiake) ......... $ t`sr ~>f facilities and sen~iccs tilt func°r.r) cerenu>nv ............ 5 lise o- facilities and sen~ires fc>r :~Ienlorial tien~icc ............... S t'se <~- equipnu~nt and services for graveside service ............. Other use ul~ I~acilitirs ..............................y SUB-TOTAL OF FACII.ITIES/EQUIPMENT ..........._~2 S ~. AI``COhIC)']1\I 1?Qltlt"~tl'.NT Vehicle to transfer i~nelins to funeral Home Local ......................... ~• IICalsc' (Casliet CU:IChI Linxxisine Local .........................ti 1'am111' cal' Loral 5 Flower car or floral disposition Loral ........................y Lead car; rlel,l;y car Local .........................7 Car tin- pallbrlrers Loral ......... . ............... '+ Out of town transponation .......... S SUB-TOTAL OF AUTOMOTIVE EQUII'MENT .........A3 S TOTAL OF PROFESSIONAL SERVICES, FACII.ITIES AND AUTOMOTIVE EQUIPMENT ................. .................~ 5 B. CHARGE FOR IViERCHAi'~IDISE SELECTED: gasket ......:........ ...... `~~ 1lksrriptionl _ ' ~ ... Other Kerr ptarle ................. S i l iesrripti~m) ______ ______ Outer burial rontau~er ...' ... .....~.. S (Dc~rription t __ ~_ .,,.t,,,,,,,,i.,,~.~,•,,,..,,~ , ,~,t~ c Other clothing Cremation urn ................... 5 (Description ) OTHER ~ ' ~ ,~ S S TOTAL MERCHANDISE SELECTED .................I3 S C. SPECIAL CHARGES: For,~•arding of remains to S tFuneril Homej Receiving of remains 5-c'lm S l I'urleral I Iome ) Immediate Burial ............... .. S Direct Cremation ............... .. S 5 SUB-TOTAL OF SPECIAL CHARGES ................C `± D. CASH ADVANCED Opening Grave ................ ..:+ Cenletery Equipment .. . ......... .. w ~~ - Lot and Deed ................. .. 5~ Newspaper :~oticerLocal .' .` .. .. ..:~ 1• j:J r pLI I~cc~ s 1 per ~iotices-Out-of-tom n ..:. .. 5 Telephone ~~ Telegrams .......... .. :airfare ...................... .. S___-_--- Cfertryt`~~iass (.)ffering ............ .. 5_ Pallbearers .............. ,-:... .. $ '.-- Certified Copies of the Death ~.. .... .. Certificate .................... .. S Police Escort .................. .. ~+ _ Flowers ...................... .. S ti<iult Ser~~ice Charge ............. .. S ti 5` _. S~ SUB-TOTAL OF ADVANCES ...... ................. D S 2. Z ~ ~~ \X~e charge you for our sen•ices in obtaining: (apecifj~ cash advances tba~t urn ma~rke~l-rrp) • SUMMARY OF CHARGES A. Professional Sen~icrs, Facilities and ~,,jl ,-,~ . • G~ ,~,. Equipment, and _lutonx>tivc Equipment ................... ~; .. I3. b4erchandise ... ~ _"~j'~-, CUS~{`" ~•~]~~it~ ~ ~~f ~'y~ ~- - ~ ~ ...... ........ C. Special Charges .. S D. Cash Ad~-ances .................. ~ ~ 2-~ ,. TOTAL OF ALL SECTIONS . ' PAII) AT TIME OF OR PRIOR TO ARRANGEMENTS ........ ......... J~(,~~ Q ......... 5 U CE DUE ....................... ......... S A. l.t1A1(tr~ rvn a~nvt~,>na ~na,r,~.1<^lv: 1. PKOfI:SSIOtiAL SI'.R~'ICf?S Services of funeral Director,~'Staff ...... Embaluling ..................... ~+ Other preparation of bod}' ........................... ...s SUB--TOTAL OF PROFESSIONAL SERVICES ..........Al 5 ?. I:~~CI1,I'(~II:S ~1tiD SEK~~'ICES I'se of t.u~i{ities anti services fir , ~~ieu~ing (~'isitaticn;~C'ahe) ...... ... ti t'se of facilities and sell~iccs f~c,r funeral cerentom~ ........ ... ~ _ l se cif f~ICilities and ser~'ices liar \1enu~rial Sen~ire ............ ... S l'se of ec{uipntent and services f~n~ graveside srrvice .......... ... S C)ther use of I~tcilities ..............................s SUB-TOTAL OF FACII.ITIES/EQUIPMENT ...........:~? S Cremation urn .................. . S .- (Description O"I1IEK <; ~; 5 TOTAL MERCHANDISE SELECTED .. ...............ti w _-_-- C. SPECIAL CHARGES: Fortivarding of relz~ains to f Furn°ra1 Dome) Receiving of remain, frcmt w ---~ ~- (Funeral Home) Irnmediate Burial ................ . S_ -- 1)irect Cremation ................ . S.- ~. At~~"1~O~~10"I~Iti EO!`IP:tii?NT Vehule to transfer tc~nains to Funeral Home Lcx'af ......................... ti Hearse (Casket Coach) Local .........................5 Limousine Lrlcal ......................... ti I'am111" lal' Local .........................~ Ffower car c,Ir floral disposition Local .........................5 Lead car clergy car Local .........................w Car for pallbearers Local ......................... Out of town tr<tnsponation .. , ....... S -- ~' StTB-TOTAL OF AUTOMOTIVE EQUII'NiENT .........A3 TOTAL OF PROFESSIONAL SERVICES, FACII.I'I'IES AND AUTOMOTIVE EQUII'MENT ...................................A S B. CHARGE F!DR MERCHANDISE SELECTED: Casket ......::.. ' ............... S tDescription) __ Other Receptacle ................. S (Description) ____ Outer burial containe-• ...... ....... S ' t Description) ;~ckno«Icdgement cards ..... ....... ti Register hI x~k(s t ............ ...... 5 _ \iemut~' folders ............ ...... ti Prayer cards .............. ...... ti Temporary grave marker ..... ....... 5 Ilurial clothing ............ ....... S SUB-TOTAL OF SPECIAL CHARGES ................t; S D. cASx ADVANCED opet,;ng Grave ................ .. Cemetery Equipment ............ .. S ~~ Lot and lleecl ................. .. 5_.~___._ Ne~~spapel Notices-Local ..` .. .. n .. S f ~`~ .... Nees a ~c r Notict.s-Out-of-tow p' } ' .. S Telephone ~ "I"elegrams .......... ...' ~.. Airfare ...................... .. 5.~,--- Clergy;`tiiass Offering ............ . S ~ : ~ ^' , Certified Copies of tl?e Death ...... .. 5~_'w,_ Certificate .................... .. 5 __.__ Police Escort ......... . ........ .. ~~~-- I~lo~~~ers ...................... .. :; ~ . Vault Service Charge ............. ..:± S C . S - ~, ~ ~ _ SUB-TOTAL OF ADVANCES ...... ................. D ~ -~ ~ 2 ~ ~~ ~X%e charge you for our services in obtaining: (sperify cash adaances that are rrurrk~er!-te~i) 5L:fMMARY OF CHARGES A. Professional Services, Facilities and Equipment. and Aummotive ~- I:yutl~ment ................. `'------ _ _ _ ~C~`I~. CU'St- I~. yerchandise .................... y __ C. Special Charges .................. S f 2 ~ 3 3 D. Cash Advances .................. S_ TOTAL OF ALL SECTIONS • .. ~ ~' PAID AT TIME OF OR PRIOR TO ~~Q~~ ARRANGEMENTS ........ .......... ~ ....... .. CE DUE ......................... ....... S REASON FOR EMBALMING It any (aw, eemeterv, or cremator' requirements have required the. purchase of an~~ of the items listed ahcave, the law or requirement is explained blow. l agree that 1 have examined the items of goods and ser~rices selected above and found them to be correct and according to the arrangements 1 have requested. I acknowledge receipt of a copti~ of this Statement of Funeral Goods and. Services Selected. 1 represent that I have sufficient funds available for payment oI the cash price for the goods ,,, tn<I services selected. 1 afro a;;reu to make payment of S ~r~~tthin' ' ~ ~dat:b ,f att,rl ~drto~thle inn ~aid~halan~c lh~~s;u~nin~~ tth ax~yo~r else ~~'ho cla ~ signs below. A l.tte ch.u,~;e of _ pc~r month amounting to pc.r year vill E pp I f, >' from the date of this agreement. I will also pay to the Funeral Director all reasonable costs patd by the I'uner'al Director to collect :unounts I rnve undo [htti tgreement. hhose costs may include attorneys' fees, court costs and other costs. Any additional services or merchandise ordered or requested after the date of thls agreement will he cnnsidered pall of this agreement and the cost thereof will he reflected on the final bill or statement. (Sral 1 _ ------ ------- - (Purchaser) lI)atc) i tical I (Purchaser) Prna~c(~~;n~k; F:nSrral t)irectur~ ,1sx>ri.rti~,n form - C00 Revised 1/04 (Licensed Funeral Director) ~~1{ITt: Fun*~r~! I)irrc~u; 1'I[L[.O~' Funrril Dirca~x I'Itil~ Cusumicr Gates, Halbruner, Hatch ~ Guise, PC 1013 Mumma Road Suite #100 Lemoyne, PA 17043 (717) 731-9600 Federal l . D. 20-4304745 nvva~cE Martha L. Wamer, Estate of c/o Michael R. & Renee Wamer 101 Penns Run Road Mechanicsburg, PA 17050 Estate Administration Invoice Date April 12, 2012 Period Ending March 31, '2012 Invoice No. 63239 ~ `~: i~ _~~ -~ ~.~ ~ ~ ~ ~, v ~, ~,- PAYMENT DUE UPON RECEIPT OF STATEMENT All overdue accounts will be assessed finance charges of 1.5% per month. We now accept the following credit cards for payment: Discover, Mastercard & Visa. Professional Fees 3/5/2012 CAH Office conference with Michael and Renee. Research regarding processing of IRA claims payable to Trust. Prepared e-mail regarding estate administration and taxation of IRA plan distribution. 3/7/2012 TLH E-mail correspondence with Renee with Estate Notice, Beneficiary Notice, Trust Notice and addresses fior publication notices in the Patriot News and Cumberland Law Journal. 1.40 @ 210.00/hr 294.00 0.50 @ 125.00/hr 62.50 Sub-total Fees: 356.50 Current Over 30 356.50 0.00 Over 60 Over 90 o.o0 0.00 PLEASE VISIT OUR WEBSITE AT WWW.GATESLAWFIRM.COM Total Current Billing: 356.50 Previous Balance Due: 0.00 Tota I Now Due : 35fi.50 Gates, Halbruner, Hatch & Guise, PC 1013 Mumma Road Suite #100 Lemoyne, PA 17043 (717) 731-9600 Federal LD. 20-4304745 INVOICE Martha L. Warner, Estate of c/o Michael R. & Renee Warner 101 Penns Run Road Mechanicsburg, PA 17050 Estate Administration Inwice Date May 10, 2012 Period Ending April 30, 2012 Inwice No. 63594 PAYMENT DUE UPON RECEIPT OF STATEMENT All overdue accounts will be assessed finance charges of 1.5% per month. We now accept the fallowing credit cards for payment: Disco~r, Mastercard & Visa. Professional Fees 4/26/2012 CAH E-mail with Phillip Miles office regarding IRA distribution taxation. Payments 4/26/2012 Payment #1018 Current 42.00 0.20 @ 210.00/hr 42.00 Sub-total Fees: 42.00 356.50 Sub-total Payments: 356.50 Total Current Billing: 42.00 Previous Balance Due: 0.00 Tota 1 Now Due : 42.00 Over 30 Over 60 Over 90 0.00 0.00 0.00 PLEASE VISIT OUR WEBSITE AT WWW.GATESLAWFIRM.COM ;, ;` ,~. ~ r, ,t _.. ;,,' ~~ `fin ~ _ f' ~ !! ;, ,,;,, Gates, ~albru~er, i-iat~h ~ Guise, PC 7 013 tiff umma Road Suite #'~ 00 Lemoyne, PA. '!7043 ~7'i 7) 73'i -9600 Federal 1. D. 20-X1304745 ~~~~~CE Martha L. Warner, Estate of c/o Michael R. & Renee Warner 101 Penns Run Road Mechanicsburg, PA 17050 Estate Administration Invoice Dare August 6, 2012 Period Endirg Jul_! 31, 2012 Invoice No. 64475 PAYMENT DUE l1PC~t~ RECEIPT OF STATEMENT Al! overdue accounts will be assessed f~~ance charges of 1.5% per month. We now accept the following credi` yards for payment: Discover, Mastercard & Visa. Professional Fees 6/26/2012 CAH Reviewed and responded to a-mail. 0.30 @ 210.00/hr 6/27/2012 TLH Preparation of drafit Receipt and Release :Agreement for 0.30 @ 125.00/hr Renee. E-mail correspondence ~r.~ith Renee v~ii~h Receipt and Release Agreement. 7/18/2012 TLH Preparation of DPW letter. E-mail corrES~~ondence with 0.30 @ 125.00/hr Renee regarding DPV`J letter. Sub-total Fees: Payments 7/24/2012 Payment Trust appiicaticn. 1,014.99 63.00 37.50 37.50 138.00 Sub-total Payments: 1,014.99 Page: 2 Gates, Halbr±~ner, Hatyh 8~ Guise, PC Estate Administration Yotal Current Billing: 138.00 Previous Balance Due: 0.00 Tota I Now Due : 138.00 Current Over 30 Over 60 Over 90 38.00 0.00 0.00 0.00 PLEASE VISiT OUR',~JE~3SETE A~T' ~r,~1~r''~.N.GATESLAWFIRM.COiVI Gates, Ha~bruner, Hatch ~ Gusse, PC 1013 Mumma Road Suite #100 Lemoyne, PA 17043 (717) 731-9600 Federal I.D. 20-4304745 ~rvvo~c~ Martha L. Warner, Estate of c/o Michael R. & Renee Warner 101 Penns Run Road Mechanicsburg, PA 17050 Estate Administration inwice Date September 10, 2012 Period Ending August 31, 2012 inwice No. G4740 PAYMENT DUE UPON RECEIPT OF STATEMENT All overdue accounts will be assessed finance charges of 1.5% per month. We now accept the following credit cards for payment: Discover, Mastercard & Visa. Professional Fees 8/30/2012 CAH Reviewed a-mails and prepared response with suggestions on processing of IRA accounts. Payments 8/14/2012 Payment #1047 138.00 Sub-total Payments: 138.00 ~~~~~ ~.. i Total Current Billing: 63.00 Previous Balance Due: 0.00 Tota I Now Due : 63.00 Current Over 30 Over GO Over 90 G3.00 0.00 0.00 0.00 PLEASE VISIT OUR WEBSITE AT WWW.GATESLAWFIRM.COM 0.30 @ 210.00/hr 63.00 Sub-total Fees: G3.00 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sc{care Carlisle, PA 17613 WARNER MARTHA L Estate File No.: 2012-00231 Receipt Date: 2/22/2012 Receipt Time: 12:00:57 Receipt No.: 1068852 Paid By Remarks: RENEE E WARNER HMW ------------------------ Receipt Distrib ution ------ ------- -------- --- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 360.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 28.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN Check# 1745 Total Received......... 431.50 ~~ ~~ _`~-'-~ .~ ~, 3 ~+ 5'er~e ~", RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse S uare Carlisle, PA 1713 WARNER MARTHA L Receipt Date: 4/09/2012 Receipt Time: 12:50:20 Receipt No. 1069424 Estate File No.: 2012-00231 Paid By Remarks: MICHAEL R WARNER CJ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 16.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 1007 $16.00 Total Received......... $16.00 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 WARNER MARTHA L Receipt Date: 6/01/2012 Receipt Time: 15:36:23 Receipt No.: 1070099 Estate File No.: 2012-00231 Paid By Remarks: MICHAEL R WARNER HMW ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 16.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 1025 $16.00 Total Received......... $16.00 __ N, L~; ~,a I i ._~-_ ~_ _ CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (717) 249-2663 April 13, 2012 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication far Cumberland County and the legs! ne~rrspaper for publication of legal notices. TO: Michael R. Warner, Executor RE: Martha L. Warner Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: March 30, April 6, and April 13, 2012 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due Becky H. Morgenthal, Executive Director $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 SC~eo~.c,c-~~ ~~ ~~ervt a ~ The Patri®t-mews Cc~. 20w0 Technology 1=l~wy Suite 300 IUlechanicsburg, PA 17050 Inquiries - 717-255-8213 WARNER 101 PENNS RUN ROAD MECHANICSBURG PA 17050 STA~o EME~"~" ALL CHARGES ARE NET A;;C~I_# NAME AD ORDER # DATE EDITION ADDTL. INFO. TYPE OF CHARGE AMOUNT 84578 WARNER 0002200531 03/30/12 METRO WEST BASIC AD CHARGE $34.84 84578 WARNER 0002200531 04/06/12 METRO WEST BASIC AD CHARGE $34.84 84578 WARNER 0002200531 04/13!12 METRO WEST BASIC AD CHARGE $34.84 AFFIDAVIT CHARGE TOTAL: This is not an invoice. Please do not remit payment from this Statement. An invoice will be generated at the end of the month. --Thank you. NOTE: This Statement replaces the Order Confirmation which we previously sent with Proofs of Publication $5.00 $109.52 s~,P~-I~ ~, s+~ t3 g XFINITY Connect XFINITY Connect Page 1 of 1 reneewarnerCgDCOmcast.ne - - Font Size - US-TAX-ID-NUMBER.COM Customer Receipt/Purchase Confirmation From :Customer Support <AGENT@US-TAX-ID-NUMBER.COM> Fri, Jun 29, 2012 08:26 PM Subject : US-TAX-ID-NUMBER.COM Customer Receipt/Purchase Confirmation To :Michael Wamer <reneewarner@comcast.net> ~,Y ~ ~" ~r~ .J C~t,/r sly ~ ~l Thank you for your order! li'I~ Sf` Merchant: US-TAX-ID-NUMBER.COM Billing Information Shipping Information Michael Warner 101 Penns Run Road Mechanicsburg, PA 17050 reneewarner@comcast. net Total: US $99.00 Date~me: 29-Jun-2012 04:26:01 PM ET Transaction ID: 4476380016 A© 2012 Business Filing Services LLC http://web.mail.comcast.net/zimbra/h/printmessage?id=6$2174&tz=America/New__ York&... 11 /6/2012 XF1N1"TY Connect XFINITY Connect Page 1 of 1 reneewarner@comcast.ne Font Size - Your Tax ID Number (EIN) application has been approved. From :agent@us-tax-id-number.com Subject :Your Tax ID Number (EIN) application has been approved. To : reneewarner@comcast.net Fri, Jun 29, 2012 11:12 PM Thank you for using .Included is your Federal Tax ID Number (EIN), for you to print and keep with your file. LEGAL NAME: ZACHARY J WARNER SUPPLEMENTAL NEEDS TR IRS FEDERAL TAX ID NUMBER (EIN): 45-7018980 A confirmation letter will be mailed to you. This letter will be the applicant's official IRS notice and will contain important information regarding the EIN. Please allow up to four (4) weeks for the letter to arrive by mail. This EIN is your permanent number and can be used immediately for most of your business needs, including: • Opening a bank account • Applying for business licenses • Filing a tax return by mail. However, it will take up to two weeks before your EIN becomes part of the IRS's permanent records. You must wait until this occurs before you can: • File an electronic return • Make an electronic payment • Pass an IRS Taxpayer Identification Number (TIN) matching program. Feel Free to contact us if you have any questions or concerns, and good luck with your new business! PH 877 567 2995 ext. 1901 FAX 877 693 2117 © 2012 Business Filing Services LLC http://web. mai 1.comcast.net/zimbra/h/printmessage`?id=682240&tz=AmericalNew___York~.... 11 /6/2012 Payment Due Date New Balance Past Due Amount Minimum Payment U8,09„2 52,078.20 50.00 $25.00 CHASE 1:~ Account number: 4640 1820 1936 6289 Make your check payable to: . Chase Card Services. Please write amount enclosed. New addressor e-mail? Print on back. 4640182019366289000025D00020782DODDOOOD00000005 2!535 BEX 9 /9412 C MRS RENEE E WARNER MICHAEL R WARNER 101 PENNS RUN RD MECHANICSBURG PA 17050-8231 ~rir~~~rr~~~~nu~rr~i~~rn~r~~~n~r~n~~~ni~~~~~nut~~u~r~~ ~~'111'1~1""I1~~11~1~~~~1111111~11~1'i'I'~Iill'~'Il~~~~irlilll CARDMEMBER SERVICE PO BOX 15153 WILMINGTON DE 19886-5153 5000 l6D 28 18 2 20 ir9366 289 L amazon.eom~ Manage your account online: Customer Service Additional contact ~/ www.chase.coml~nazon 1-888-247-4080 information on back ACCOUNT SUMMARY Account Number: 4640 1820 1936 6289 Previous Balance 54,203.42 Payment. Credits -54.243.65 Purchases +52.118.43 Cash Advances 50.00 Balance Transfers 50.00 Fees Charged 50.00 tnterest Charged 50.00 New Balance 52.078.20 Opening!Closing Date Credit Access line Available Credit Cash Access Line Available for Cash 06/13!12 - 07/12/12 S 15.500 S 13,421 53,100 53.100 PAYMENT INFORMATION New Balance 52,078.20 Payment Due Date 08!09/12 Minimum Payment Due 525.00 Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee of up to 535.00 and your APR's will be subject to increase to a maximum Penalty APR of 29.99°%. Minimum Payment Warning: If you make only the minimum payment each period, you will pay more in interest and it will take you longer to pay off your balance. For example: I(you make no You will pay off the And you will end up additional charges balance shown on paying an estimated using this card and this statement in total of... each month you about... pay... Only the minimum 10 years 53.333 payment S6g 3 years 52,460 (Savings=5873) If you would like information about credit counseling services, cau 1-866-797-2885. AMAZON REWARDS CARD POINTS SUMMARY Previous Month's Points Balance 8.028 Instantly redeem on Amazon.com through Shop + 3x points on Amazon.com purchases 0 with Points. Or choose other options such as + 2x points on gas, dining. and Rx purchases 1,384 cash back. travel, and more. For more + Points earned on all other Visa purchases 1.387 information visit wvrw.chase.comfamazon or call = Remaining points balance 10.799 1-888-247-4080. Unlimited Points. You earn points for every dollar you spend on your Amazon.com Rewards Visa Card. Earn 3 points on Amazon.com purchases, 2 points on everyday purchases such as gas, dining, and drug store purchases. and 1 point on all other purchases. There are no earning caps and points never expire. For complete program details. please refer to your Rewards Rules and Regulations. ACCOUNT ACTIVITY Date of Transaction Merchant Name or Transaction Description S Amount PAYMENTS AND OTHER CREDITS 06/29 MARSHALL5 #834 MECHANICSBURG PA -40.23 07!09 Payment -Thank You -4,203.42 PURCHASE5 06/1d KWIK FILL MECHANICSBURG PA 33.00 06119 THE PEPPERMILL RESTA 888-4774510 PA 18.25 06t20 GIANT 6005 MECHANICSBURG PA 67.75 O6i20 TURKEY HILL #294 MECHANICSBURG PA 26.19 06!21 ERAWAN THAI CUISINE PH1LA PA 40.34 06/21 CHICKIE 8 PETE'S PHILADELPHIA PA 19.44 06!20 WEGMANS #45 tv1ECHANICSBURG PA 77.89 06/21 THE CLLG PHYSN OF PHILLA PHILADELPHIA PA 50.00 p6/22 MTA MVM RFTH AVENUE 718-330-1234 NY 29.00 06/22 MASATO 212-9729638 NY 13.61 06!22 BURGER KING #13110 NEW YORK NY 14.86 06122 MANHATTAN CHILI CO NEW YORK NY 31.95 UOUOCD7 FI533:135 C 2 000 Y 9 12 12'07'12 Page 1 ot2 Uo23& htAt:!A 2?535 19410000020002153501 (1441 Statement Date: 06;13112 - 07!12/12 Account Number: 4640 1820 1936 6289 Page 2 of 2 ACCOUNT ACTIVITY CONTINUED Date of Transaction Merchant Name or Transaction Description S Amount 06122 JAMBA JUICE #608 NEW YORK NY 25.15 06/22 MTA MVM FIFTH AVENUE 718-330-1234 NY 29.00 06/22 MAPLE SHADE CITGO MAPLE SHADE NJ 13.88 06/23 NOM WAH DIM SUM PARLOR. I NEW YORK NY 50.39 06/23 RICE TO RICHES NEW YORK NY 9.50 06124 VALOR PARKING LLC NEW YORK NY 43.00 06/23 MTA MVM 34TH STREET-PEN 718-330-1234 NY 2.50 06?23 PANINI 8 COb1PANY BREAD 1 NEW YORK NY 25.04 06123 WESTWAY DINER NEW YORK NY 47.22 06/25 TURKEY HILL #294 MECHANICSBURG PA 22.17 06/24 CHEVYS 2950 NEW YORK NY 78.95 06126 COMCAST OF CENTRAL PA 800-COMCAST PA 207.59 06x24 MTA MVM 42ND ST-GRAND C 718-330-1234 NY 2.50 06/24 MTA MVM 42ND STREET & 8 718-330-1234 NY 2.50 06!26 GIANT 6005 MECHANICSBURG PA 55.05 06126 IGNITE 214-8004500 TX 24.95 06!28 BOILING SPRINGS TAVERN BOILING SPRIN PA 18.53 06/30 US-TAX-ID-NUMBER.COM 877-567-2995 OH 99.00 06129 MARSHALLS #834 MEC ANICSBURG PA 30.23 06/30 REDBOX "DVDRESERVATION 866-733-2693 IL 2.54 06/29 MARSHALLS #834 MECHANICSBURG PA 40.23 07/01 GIANT 6005 MECHANICSBURG PA 91.79 07101 FLAGSHIP CINEMAS MECHA MECHANICSBURG PA 14.00 07/02 A.H. REIFF LANDSCAPE SUP CARLISLE PA 33.39 07!02 A.H. REIFF LANDSCAPE SUP CARLISLE PA 11.13 07102 A.N. REIFF LANDSCAPE SUP CARLISLE PA 2226 07103 WAL-MART #1886 MECHANICSBUR PA 65.25 07/03 TURKEY HILL #294 MECHANICSBURG PA 25.88 07/03 WAL-MART #1886 MECHANICSBUR PA 26.93 07!03 PARTY CITY #399 TRENTON NJ 15.79 07105 WAL-MART #1886 MECHANICSBUR PA 46.62 07/05 GIANT 6005 MECHANICSBURG PA 132.14 07!05 TURKEY HILL #0268 069 MECHANICSBURG PA 21.00 07!06 HAIR CUTTERY #3571 MECHANICSBURG PA 31.65 07!06 CVS PHARMACY #5991 tv1ECHANICSBURG PA 34.73 07!07 GIANT 6005 MECHANICSBURG PA 137.98 07/07 TACO BELL 244100244129 MECHANICSBURG PA 15.49 07108 FIVE GUYS MECHANIC MERCHANiCSBUR PA 23.26 07/09 WAL-MART #1886 MECHANIC58UR PA 15.86 07/10 NEW FOREST CHINESE RESTA MECHANICSBURG PA 15.20 07110 AAA CENTRAL PENN-R CAMP HILL PA 37.70 07!10 AAA CENTRAL PENN-R CAMP HILL PA 22.70 07111 GIANT 6005 MECHANICSBURG PA 25.48 2012 Totals Year-to-Date Total fees charged in 2012 50.00 Total interest charged in 2012 S0.00 Year-to-date totals reflect all charges minus any refunds applied to your account. INTEREST CHARGES Your Annual Percentage Rate (APR) is the annual interest rate on your account. Annual Balance Balance Percentage 5ubjeci To Interest Type Rate {APR) Interest Rate Charges PURCHASES Purchases 11.24°,'° iv) -0- -0- CASH ADVANCES Cash Advances 19.24°1° (v) -0- -0- BALANCE TRANSFERS Balance Transfers 11.24°~b (v) -0- -0- (v) -Variable Rate 30 Days in Billing Period Please see Information About Your Account section for the Calculation of Balance Subject to Interest Rate. Annual Renewal Notice. Hovr to Avoid Interest on Purchases. and other important information. as applicable. 0000001 FIS33J35 C 2 Ou0 Y 9 72 72~07/S2 Page 2 of 2 0623E 1dA h9A 2'535 79410000020002153502 ~` r n C~ DEPARTMENT OF THE TREASURY ~Y 1.i~.~J INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 `p ~` MARTHA L WARNER FAMILY RVOC TR UAD 4-17-97 ._ ..___ ~-~i~I-CHAEi; R AARNER TTEE 101 PENNS RUN RD MECHANICSBURG, PA 17050 Date of this notice: 03-12-2012 Employer Identification Number: 45-6807508 Form: SS-4 Number of this notice: CP 575 B For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER ..~r~nU tj~>> for applying for an Employer Identification Number (EIN) . We assigned you EIN 45-6807508. This EIN will identify your estate or trust. If you are not the applicant, please contact the individual who is handling the estate or trust for you. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 1041 04/15/2013 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year), see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue). Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. o~e~ed-cc.le ~, Ste n~ l3 9 Payment Due Date Ne4v Balance Past Due Amount Minimum Payment 05!09112 S3.572.02 50.00 $35.00 CHASE 1.~ Account number: 4640 1820 1936 6289 • Make your check payable to: Chase Card Services. Please write amount enclosed. New address or a-mail? Print on back. 46401820193662890000350000357202D00000000000004 33x23 BEX J 70372 C MRS RENEE E WARNER MICHAEL R WARNER 101 PENNS RUN RD MECHANICSBURG PA 17050-8231 ~ni~~~nt~~~un~~~r~~ni~u~ur~r~n~~un~~~~uun~~u~r~) II~11~1~~1111~~1~~~1~~111'iltl~l'~~~~"I~IiI'~~~'~I'~'~II'il"ii' CARDMEh16ER SERVICE PO 80X 15153 WILMINGTON DE 19886-5153 5000 L60 28 i8 2 20 19366 289 ~ am azon.eom ~ Manage your account online: Customer Service Additional contact ~~/~ ~y4v_w.chase comiamaz~n 1-888-247-4080 information on back ACCOUNT SUMMARY Account Number: 4640 1820 1936 6289 Previous Balance 51.748.93 Payment. Credits -51,748.93 Purchases +53.572.02 Cash Advances 50.00 Balance Transfers 50.00 Fees Charged 50.00 Interest Charged 50.00 New Balance $3.572.02 OpeningiClosing Date Crodit Access Line Available Credit Cash Access Line Available for Cash 03!13112 - 04;12!12 S 15.500 511,927 53.100 53.100 PAYMENT INFORMATION New Balance 53.572.02 Payment Due Date 05!09112 Minimum Payment Due S35.00 late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee of up to 535.00 and your APR's will be subject to increase to a maximum Penalty APR of 29.99°,'0. Minimum Payment Warning: If you make only the minimum payment each period.. you will pay more in interest and it will take you longer to pay off your balance. For example: If you make no You will pay oft the And you will end up additional charges balance shown on paying an estimated using this card and this statement in total of... each month you about... Pay... Only the minimum 15 years S6,258 payment 5117 3 years 54,228 (Savings=52,030) If you would like information about credit counseling services, call 1-866-797-2885. AMAZON REWARDS CARD POINTS SUMMARY Previous Month's Points Balance 17.159 Instantly redeem on Amazon.com through Shop + 3x points on Amazon.com purchases 0 with Points. Or choose other options such as + 2x points on gas, dining, and Rx purchases 807 cash back. travel, and more. For more + Points earned on all other Visa purchases 3.169 information visit vrww.chase.com/amazon or call - Points redeemed this period 5.615 1-888-247-4080. = Remaining points balance 15.520 Unlimited Points. You earn points for every dollar you spend on your Amazon.com Rewards Visa Card. Earn 3 points on Amazon.com purchases, 2 points on everyday purchases such as gas, dining, and drug store purchases, and 1 point on all other purchases. There are no earning caps and points never expire. For complete program details. please refer to your Rewards Rules and Regulahons. ACCOUNT ACTIVITY Date of Transaction Merchant Name or Transaction Description S Amount PAYMENTS AND OTHER CREDITS 04109 Payment -Thank You -1.748.93 PURCHASES 0311 ASI BUSINESS CONSULTIN 000-0000000 NY 65. 0 03!14 MCDONALD'S F15988 MECHANICSBURG PA '~ 5.93 03115 CHIPOTLE 1340 HARRISBURG PA 20.51 03!14 STAPLES 00106435 MECHANICSBURG PA 8.16 03/15 TRINDLE MINI MART MECHANICSBURG PA 10.01 03/17 GIANT 6005 MECHANICSBURG PA 88.77 03116 DOUBLETRKEDEALS 717-569-5100 PA 50.00 03116 CHICK-FIL-A #02167 MECHANICSBURG PA 18.42 03116 GIANT 6005 h1ECHANICSBURG PA 112.78 03!17 BJ WHOLESALE #0025 CAh1P HILL PA 21.18 03115 ALFRED ANGELO #49 HARRISBURG PA 147.34 03115 ALFRED ANGELO #49 HARRISBURG PA 269.00 000000.7 FIS33335 C 2 000 Y 9 12 12;'04!72 Page t o72 On236 t.1A MA 33x23 70310f7000200D33423Dt l( 0347 INS153fi1 Statement Date: 03!13!12 - 04/12/12 Account Number: 4640 1820 1936 6289 Page 2 of 2 ACCOUNT ACTIVITY CONTINUED Date of Transaction Merchant Name or Transaction Description S Amount 03116 HAPPY GARDEN MECHANICSBURG PA 10.18 03/18 GIANT 6005 MECHANICSBURG PA 20.05 03118 TURKEY HILL #294 MECHANICSBURG PA 33.50 03(21 VZWRLSS'APOCC VISE 800-922-0204 NJ 186.72 03/21 THE PEPPERMILL RESTA 888-4774510 PA 15.94 03!22 C GOODHART AND COMPANY LEMOYNE PA 686.24 03123 GIANT 6005 MECHANICSBURG PA 147.12 03/23 REDBOX 'DVD RENTAL OAKBRKTERRACE IL 1.27 03!25 REDBOX 'DVDRESERVATION 866-733-2693 IL 1.27 03,25 TURKEY HILL #294 MECHANICSBURG PA 36.30 03/27 COtv1CAST OF CENTRAL PA 800-COMCAST PA 208.10 03!26 IGNITE 214-8004500 TX 24.95 03128 TFA 'CIRQUE DU SOLEIL: 800-653-8000 NY 469.80 03128 CAMP HILL DENTIST CAMP HILL PA 120.54 03!30 HAPPY GARDEN MECHANICSBURG PA 19.77 03131 WAL-Iv1ART #1886 MECHANICSBUR PA 24.14 04!01 TACO BELL 244100244129 MECHANICSBURG PA 19.81 04/02 GIANT 6005 MECHANICSBURG PA 244..86 04/02 HAIR CUTTERY #3571 MECHANICSBURG PA 18.00 04104 TURKEY HILL #294 MECHANICSBURG PA 64.25 04!06 THE RESTAURANT STORE #5 CAMP HILL PA 38.99 04!07 GIANT 6005 MECHANICSBURG PA 36.03 04;06 TURKEY HILL #294 MECHANICSBURG PA 36.00 04;07 WAL-MART #1886 MECHANICSBUR PA 91.17 04106 STAPLES 00106435 MECHANICSBURG PA 15.87 04108 WALMART.COM 8009666546 8009666546 AR 15.90 04/06 MICHAELS #2754 CAMP HILL PA 70.78 04107 OLLIES BARGAIN OUTLET 003 MECHANICSBURG PA 80.47 04/09 AC MOORE STR 82 IvtECHANICSBURG PA 16.90 2012 Totals Year-to-Date Total fees charged in 2012 S0.00 Total interest charged in 2012 _ S0.00 Year-to-date totals reflect ail charges minus any refunds applied to your account. INTEREST CHARGES Your Annual Percentage Rate (APR) is the annual interest rate on your account. Annual Balance Balance Percentage Subject To Interest Type Rate (APR) Interest Rate Charges PURCHASES Purchases 11.24°0 (v} -0- -0- CASH ADVANCES Cash Advances 19.24°'° (v) -0- -0- BALANCE TRANSFERS Balance Transfers 11.24% (v) -0- -0- (v) =Variable Rate 31 Days in Billing Period Please see Information About Your Account section for the Calculation of Balance Subject to Interest Rate. Annual Renewal Notice How to Avoid Interest on Purchases. and other important information. as applicable. LREWARDS ACTIVITY I Date of Transaction Merchant Name or Transaction Description S Amount Rewards PURCHASES AND REDEMPTIONS 03125 AMAZON.COM AMZN.COMlBILLWA 46.16 4.fi16 03/27 AMAZON.COM AMZN.COM!BILLWA 9.99 999 (1(100004 rIS33335 C 2 0001 Y 9 12 ~~U4%12 Page 2 of 2 06236 f.tA RiA 33423 10370000020(Hi3342302 XFINITY Connect Page 1 oI~ 2 XFjNj-~-y Co111'tect reneewarner@comcast.ne - Font Size - Fw: Federal Tax ID -EIN Application Successfully Assigned From :Michael Warner <wcccpc@verizon.net> Subject : Fw: Federal Tax ID -EIN Application Successfully Assigned To :Renee Warner <reneewarner@comcast.net> -----Original Message ----- _ ) ~ `'~ From: ~~~%l To: Sent: Thursday, February 23, 2012 2:43 PM Subject: Federal Tax ID -EIN Application Successfully Assigned r+C)$'t:~i~~{.91~t9~7a~ ji 1"'+:s~l~' W:.?:' 3?~~ ~"" '~_~(.`'F` ~;: §?! z tint;.- ~` EIN Assigned: 45-6771372 Legal Name: MARTHA L WARNER ESTATE Mon, Feb 27, 2012 05:42 PM 1:A PLEASE REPLYA if you have not filed your Articles of Incorporation for your new Company and we can assist you with all of your state level filings and certifications as well. Additional Information About Your Federal Tax ID Number JEIN /TIN When Can You Use Your EIN? This EIN is your permanent number and can be used immediately for most of your business needs, including: Opening a bank account Applying for business licenses Filing a tax return by mail. However, it will take up to two weeks before your EIN becomes part of the IRS's permanent records. You must wait until this occurs before you can: File an electronic return Make an electronic payment Pass an IRS Taxpayer Identification Number (TTN) matching program. Thank you. Customer Service Headquarters Contact: Email: CS@Federal-Tax-Identification.com Toll Free: (866) 781-8833 Fax: (866) 422-2894 Billing Company Headquarters Contact: Email: Toll Free: (800) 541-3907 Fax: (480) 449-8801 CONFIDENTIALITY NOTICE: This email and any attachments are for the exclusive and confidential use of the intended recipient. If you are not the intended recipient, please do not read, distribute or take action in reliance upon this message. If you have received this in S'ehedu~e ~-, rt=-~~ ~ 9 http://web.mail.comcast.net/zimbralh printmessage?id=593284&tz=America/New_ York&... 11 /6/2012 Payment Due Date New Balance Past Due Amount Minimum Payment 04/09!12 51.748.93 50.00 525.00 CHASE Ci Account number: 4640 1820 1936 6289 Make your check payable to: . Chase Card Services. Please write amount enclosed. New address or a-mail? Print on back. 46401820193662890000250DD0174893DDOOODDOOOD0002 2283D BEX 4 07212 C MRS RENEE E WARNER A4ICHAEL R WARNER 101 PENNS RUN RD b1ECHANiCSBURG PA 17050-8231 Irrrlll~~~lll,~r~l~i~ll~r~lrrl~~rl~l~~ll~~rrlill~„rr~ilr~lrll Inlllllllurrllh~~~lll~lmlllrlll~llrli~~l,lnl,llllnirl~ CARDMEMBER SERVICE PO BOX 15153 WILMINGTON DE 19886-5153 5000 L60 28 i8 2 20 19 366 289 1 am azon•VOI 1 ~ • Manage your account online: Customer Service Additional contact ~~/~ www.chase,comlamaz_on 1-888-247-4080 information on back ACCOUNT SUMMARY Account Number: 4640 1820 1936 6289 Previous Balance S2,125.86 Payment. Credits -S2.125.86 Purchases +51.748.93 Cash Advances 50.00 Balance Transfers 50.00 Fees Charged 50.00 Interest Charged 50.00 Ne~v Balance 51,748.93 OpernnglClosing Date Credit Access Line Available Credit Cash Access Line Available for Cash 02113/12 - 03!12/12 S15.500 513,751 53,100 53.100 PAYMENT INFORMATION New Balance 51.748.93 Payment Due Date 04/09/12 Minimum Payment Due S25.00 Late Payment Warning: if we do not receive your minimum payment by the date listed above, you may have to pay a late fee of up to S35.00 and your APR's will be subject to increase to a maximum Penalty APR of 29.99°,~~. Minimum Payment Warning: If you make only the minimum payment each period. you will pay more in interest and it will take you longer to pay off your balance. For example: If you make no You will pay oN the And you will end up additional charges balance shown on paying an estimated using this card and this statement in total of... each month you about.. pay... Only the minimum 9 years 52.682 payment S58 3 years S2,070 (Savings=S612j If you would like information about credit counseling services, can 1-866-797-2885. AMAZON REWARDS CARD POINTS SUMMARY Previous Month's Points Balance 14.977 Instantly redeem on Amazon.com through Shop + 3x points on Amazon.com purchases 0 with Points. Or choose other options such as + 2x points on gas. dining, and Rx purchases 864 cash back. travel, and more. For more + Points earned on all other Visa purchases 1.318 information visit www.chase.com/amazon or call = Remaining points balance 17.159 1-888-247-4080. Unlimited Points. You earn points for every dollar you spend on your Amazon. di i com Rewards Visa Card. Earn 3 points on and 1 point on all other store purchases nd dru n ng. Amazon.corn purchases. 2 points on everyday purchases such as gas, lete F , g a please refer to your Reevards Rules ram details ro or comp purchases. There are no earning caps and paints never expire. , p g and Regulations. ACCOUNT ACTIVITY Date of Transaction Merchant Name or Transaction Description S Amount PAYMENTS AND OTHER CREDITS 03109 Payment -Thank You -2.125.86 PURCHASES 02/13 GIANT 6005 iv1ECHANICSBURG PA 138.12 02!14 CHICK-FIL-A #02167 MECHANICSBURG PA 25.92 02115 THE PEPPERMILL RESTA 888-4774510 PA 25.37 02116 EVERGREEN RESTAURANT BUFF MECHANICSBURG PA 27.80 02!17 GIANT 6005 MECHANICSBURG PA 86.65 02/21 VZWRLSS'APOCC VISE 800-922-0204 NJ 186'72 02121 TURKEY HILL #294 MECHANICSBURG PA 30.94 02121 OFFICE MAX MECHANICSBURG PA 33.43 02/21 WEGMANS #45 MECHANICSBURG PA 16.63 02123 TURKEY HILL #294 MECHANICSBURG PA 71.01 02/24 THE HERSHEY PANTRY INC HERSHEY PA 14.82 02/24 CVS PHARMACY #5991 MECHANICSBURG PA 38.15 02124 GIANT 6005 MECHANICSBURG PA 51,94 GOtT;001 F153i335L2 O(i0 Y' 9 72 1203`12 Page7a(2 Oo23i; l~1Ar,1A22830 07210006020002283001 \( 0417 Statement Date: 02!13!12 - 03!12/12 Account Number: 4640 1820 1936 6289 Page 2 of 2 (ACCOUNT ACTIVITY (CONTINUED) I Date of Transaction Merchant Name or Transaction Description 5 Amount 02/26 REDBOX 'DVDRESERVATION 866-733-2693 IL 1.27 02125 CHIPOTLE 1340 HARRISBURG PA 1579 02;26 PY GARDEN tv1ECHANICSBURG PA 41.45 02/23 ECSuite.com 'Incorporate 888-73664 150.00 IGNITE 214-8004500 TX 24.95 02/28 COMCAST OF CENTRAL PA 800-COMCAST PA 270.21 02!28 RED LOBSTER US00001958 MECHANICSBURG PA 25.19 03,01 TURKEY HILL #294 MECHANICSBURG PA 32.80 03/01 Best Buy 00014787 h1ECHANICSBURG PA 12999 03/01 WEGMANS #d5 MECHANICSBURG PA 53.10 03103 GIANT 6005 MECHANICSBURG PA 9.00 03x03 FIRE MTN #2465 MECHANICSBURG PA 15.03 03x04 WENDYSt130 025 MECHANICSBURG PA 17.30 03!05 WAL-MART #1886 MECHANICSBUR PA 166.54 03/09 VALVE SOFTWARE 425-8899642 4VA 31.93 03109 THE PEPPERMILL RESTA 888-4774510 PA 16.88 2012 Totals Year-to-Date Total fees charged in 2012 50.00 Total interest charged in 2012 50.00 Year-to-date totals reflect all charges minus any refunds applied to your account. INTEREST CHARGES Your Annual Percentage Rate (APR) is the annual interest rate on your account. Annual Balance Balance Percentage Subject To Interest Type Rate (APR) Interest Rate Charges PURCHASES Purchases 11.24°ia (vj -0- -0- CASH ADVANCES Cash advances 19.24°~ (v) -0- -0- BALANCE TRANSFERS Balance transfers 11.24°0 (v) -0- -0- (vj =Variable Rate 29 Days in Billing Period Please see Information About Your Account section for the Calculation of Balance Subject to Interest Rate. Annual Renewal Notice How to Avoid Interest on Purchases, and other important information. as applicable. 0000001 F1533335 C 2 GUU Y 9 72 7'2.0372 Page 2 012 OS238 A1A hiA 22830 U72100000200U2283002 AAA. co m 3433 TRINDLE ROAD CAMP HILL, PA, 17011 Tel: 717 761-8347 26 JUL 2012 15:01 Receipt 02WS-4398-58/CG2 AAA CENTRAL PENN RECEIPT MICHAEL R WARNER 438 195 816443000 1 BA 101 PENNS RUN RD Mem Since: 1983 MECHANICSBURG, PA 717 796-7615 17050-8231 Reference Description Amount Domestic ----------------- ------------------------------------ ------ -------- 1. SUN 1395252 NOTARY FEES (NF) 1 ~ 2.00 US 2.00 Total 2.00 MC Payment 2.00 CLUB M/CARD: XXXXXXXXXXXX9296 Cardholder: WARNER/MICHAEL R AUTHORIZATION: 060650 REF #: 178180092995 711088 PURCHASE $2.00 DATE/TIME: 26 JUL 12 03:02pm SIGNATURE I AGREE TO PAY ABOVE TOTAL AMOUNT ACCORDING TO CARD ISSUER AGREEMENT -------------------- 1. SUN NOTARY FEES DON'T MISS OUT! Join the 1,000's of members who have saved hundred's of dollars on their Auto & Home Insurance. Call or visit your local AAA Central Penn Office for a free quote. Do you Show your Membership Card at the following locations: Tanger Outlets, New York & Co., Payless Shoes, Lenscrafters, NAPA, Reebok Outlet Stores If you do, your savings will be 10~ or more. Go to AAA.com for a complete listing. S~ed~~-!e ?~~ z+~ t3 ~ VitalChek Order Receipt VitalChek Order Receipt Purchase Date: Friday, June 01, 2012 Payment Method: Visa XXXX X~;XX X)CXX 6289 Agency: Pennsylvania Vital Records Ship to: Michael Warner 101 Penns Run Road Mechanicsburg, PA 17050 Shipping Method: Regular Mail Estimated Processing Time: 25 - 30 business days Page 1 of 1 Order Number: 29514729 Pin: 457594 Item Record Ordered Qty Price Extra Copies Total 1 Death: Martha Louise Wamer 5 $9.00 $36.00 $45.00 Agency Expedite Fee: $0.00 Processing: $10.00 Shipping: $0.00 Tax: $0.00 Total: $55.00 Estimated Processing Tirne: Estimated processing time may vary according to the resources and workloads of the agency. VitalChek has no control over these variations or the amount of time an agency requires to process an order. For these reasons, we do not guarantee processing times. Shipping is not included in processing times. Order Status Information: Check the status of your order at any time by clicking on the'My Order' tab at www.vitalchek.com, or by calling 866-203-2777 for automated order status information. Please be advised that if the order has already been transmitted to the government agency, we will not be able to cancel or make changes to the order. If you have any additional questions or would like to a-mail VitalChek about this order, please visit https://VitalChek-solutions.custhelp.com Shipping Information: If your order is being shippEsd via an express service, you may receive a tracking number by e-mail once the order is processecl and in transit. You may also be required to sign for the delivery of your certificate. Now that you've ordered your most important identity document, click here to protect it. We appreciate your business and look forward to assisting you in the future. Sincerely, VitalChek Customer Service https://VitalChek-solutions.custhelp.com https://www.vitalchek.com/rf;ceipt.aspx ~X:n~i° tT~ ~~'~~ ~ 9 6/1/2012 AAA.com 3433 TRINDLE ROAD CAMP HILL, PA, 17011 Tel: 717 761-8347 __ 07 MAR 2012 11:39 AAA CENTRAL PENN Receipt 02WS-4278-25/GU2 RECEIPT MICHAEL R WARNER 438 195 816443000 1 BA 101 PENNS RL7N RD Mem Since: 1983 MECHANICSBUI2G, PA 717 796-7615 17050-8231 Reference Description Amount Domestic ----------------- ------------------------------------- ------ -------- 1. SUN 1344524 NOTARY FEES (NF) 1 @ 2.00 US 2.00 Total 2.00 C Payment 2.00 1. SUN NOTARY FEES DON'T MISS O17T! Join the 1,000's of members who have saved hundred's of dollars on their Auto & Home Insurance. Call or visit your local AAA Central Penn Office for a free quote. Do you ;Show your Membership Card at the following locations: Tanger Outlets, New York & Co., Payless Shoes, Lenscrafters, NAPA, Reebok Outlet Stores If you do, your savings will be 10~ or more. Go to AAA.com for a complete listing. ~. ~eh~.1~ 1-~; ~'+en~ 139 __ __ NEW KINGSTOWN PO NEW KINGSTOWN, Pennsylvania 170729800 ? ~ 99 4 m ~ 11:36:43 AM 87 (800)~75 7 04/16/2012 el ,~/~' -- - Sa 1 es Receipt -- -- - ~ ~1 ~ Product Sale Unit Final ~~j Description Qty Price Price ~ OfficeMax #3 ~FORD CT 06176 HAR Zone-3 First-Class $1.30 8416 CARLISLE PIKE SUI1~ 50 00 Large Env MECHA~rICSBURG, PA 2.10 oz. ~717~ 766-~v6;:s Expected Delivery: Wed 04/18/12 ___ ___ -- Return Rcpt (Green Card) $2.35 -- --J"-- -----~------------- Certi f i ed X2.95 -------~ Label #: 7011157000004792u886 h L Issue PVI: ---- $6.60 ~i L~. 1 HARRISBURG PA 17129 :61.10 $4 8827806680~1 Zane-1 First-Class ,in Blk NP Ink ~6 Ttl x$10.00) Large Env 20805032895421 1.40 oz. Expected Delivery: Tue 04/17/12 Coupon promo Discount LimYtOU1PA~ X31.99 Return Rcpt (Green Card> 35 $2 Certified $2.95 7 29 $2 Label #: 7011157000004792 08 9 --- - . 026CJ000~'S f 4 1 Issue PVI : . 4o $6 Glue S t i u~, ~ i caF'~ea ~ i ~~0 ~ $7.29 070330417557 HARRISBURG PA 17129 $1.10 ical Pencil .5mm 24C h Zone-1 First-Class an Mec Large Env 1.80 oz. TOTAL SAVINGS ($10.00) Expected Delivery: T~ ~r4i17/12 Return Rcpt (Green ~' _,~ d) .62.35 Certifiied $2.95 $41.57 Label #: 70111150000229715453 $~ 49 SubTotal Issue PVI: __ __ __ $6 40 Tax 6.000% $44.06 TOTAL HARRISBURG PA 17129 :61.30 $44.06 Zone-1 First-Class Large Env , JISA ,,,~ ,r~~-~~,;~~,;~;~X~~,;~189 2.30 oz. -----"= , Cam ;~r-!~i~er ' ~~ 06C Authorization 1)21 Issue PVI: $1.30 XXXXX3105 HARRISBURG PA 17129 $1.10 MaxPerks Number Zone-1 First-Class Large Env hiaxperks Qualified Purchase Balance as 1.90 oz. $31.54 Issue PVI: :61.10 Total: 21.80 Paid by: Debit Card $21.80 Account #: XxXXXXXXXXXX2132 Approval #: 512859 Transaction #: 668 23 903111615 Receipt#: 000732 ~'~~, stamps at usps . cumi sP~t~,p car ca 1 1 ~~04 . Go ~ra us+ ~-, ~ ~~ir/r:l i ckr~shi p {ah~ Copy of race i pt CAST ~. ~ ~ to RENEE~JARIdERC~COM 86449556 0039 00003 03008 8.56/ 29J AM 11. 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Expected Delivery: Thu 03/08/12 Insurance $5.95 Insurance Amount $350.00 Label #: VI680476954US Issue PVI : ~~ ~-~~'" ^ ~~--~5 80 ~~~ $13.45 aid by: sbit Card $13.45 Account #: XXh:,~:XXXXXXX2132 Approval #: 392253 Transaction #: 400 23 9031;1.615 Receipt: 001637 ` Save this receipt as evidence of ~surance. For information regarding ~rnestic insurance, visit our website at >ps.com/insurance/postoffice.htm ,der stamps at usps.com/shop or call -800-Stamp24. Go to usps.com/ciicknship ~ print shipping labels with postage. ~r other information call 1-800-ASK-LISPS. 't your mail when and where you want it th a secure Post Office Box. Siyn up for• box online at usps.com/poboxes. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~x~~~~~~~ 11#: 1000203134845 ark: 03 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER Go to: https://postalexperience.com/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS 7KIr~Y(YCyCSCYtYC~YC~7flKYC~~C~~Yf~YC~Yt~~~YCYt7k~ycx~kYCYC~ Customer Copy J~^ U~ ~~ ~~ NEW KINGSTOWN PO NEW KINGSTOWN, Pennsylvania 170729800 4134870072 -0099 03/31/2012 (800)275-8777 10:2 3:57 AM Sales Receipt -- -- Product Sale Unit Final Description Qty Price Price GETTYSBURG PR 17325 $1.90 Zone-1 First-Class Large Env 6.00 oz. Issue PVI: $1.90 DAVIDSOiV Py`~ 28036 `£2.10 Zone-4 First-Class Large Env 6.20 oz. T~~ue PVI: $2.10 HAf;n:i`~BURG PA 17128 $0.65 Zane-1 First-Class Letter 1.40 oz. Expected Delivery: Man 04/02/12 Return Rcpt (Green Gard) X2.35 Certified $2.95 Label #: 701115700000479274b5 Issue PVI: $5.95 CINCINNATI OH 45999 $1.90 Zane-4 First-class Large Env 5.90 oz. Expected Delivery: Mon 04/02/12 Return Rcpt (Green Card> ,2.35 Certified $2.95 Label #: 70111570000047927458 Issue PVI: :7.20 HARRISBURG PA 17128 6.50 Zone-1 First-Class Large Env 8.10 oz. Expected Delivery: Mon 04/02/12 Return Rcpt (Green Car•d> $2.35 Certified $2.95 Label #: 70111570000047927434 Issue PVI: $7.80 HARRISBURG PA 17108 $5.30 Zone-1 Priority Mail 1 lb. 1.10 oz. Expected Delivery: Man 04/02!12 Return Rcpt (Green Card) :2.35 Certified $2.95 Lahei #: 70111570000047927441 Issue PVI: $10.60 Tatai: Paid by: Debit Card Account #: Al~prova 1 # Transaction # 23 903111615 Receipt#: $35.5 $35.55 XXXXXXXXXXXX213? 325995 494 000544 Sel~~du.d~e l~; .~..e,,, (~9 ~r~ar ~t~mn~ at i r~t~~ r:nm/~hnn nr ral 1 Page 1 of 1 .. ,:..~ -a (.`~i t, .... ~ ~. ...f d d IRVJIC ~e~tE'l~i.G(.~ ~e. f~ ~ ~~-~m B~ U' http://www.deluxe.com/shopdeluxe/checkout/printpage jsp 8/9/2012 http://www.deluxe.com/shopdeluxe/checkoudprintpage jsi ofr`uxs err, at.j.r.'R, Shipping Details Shipping Address Shipping Method Michael Warner Standard 101 PENNS RUN RD, MECHANICSBURG. PA 17050-8231 USA {717) 796-7615 Payment Summary Direct Debit Billing Amount: $31.27 Order Details: Order #: 27420685 Product Name Quantity The Traveller, Business Size Portable Checks 50 Item: 59000N Price $29.50 Total $29.50 Sub Total: $29.50 Tax $1.77 Shipping: $0.00 Order Total: 531.27 You Saved: r"1 TRUSTe~ tai 2011 Deluxe Enterprise Operations. All Rights Reserved. c~ d ea.~-tee v ' ~ ~~ ~' u 1 ~ 2/27/2012 1:37 Pty 1 of 1 PA 17011 { f~~1' r ~ ~~~~tbl' _1~~-t S ~~.5 DATES Shiremanstown , ~ ~4 ~ ~ ~ t `~ ~ '` i ~ i~ I P f ~ e,r~i 0~"f7c-~- tit r' Invoice Date: 04/10/2012 Telephone Number: 717-737-4600 Fax Number: 717-737-9123 Due Date: REFERENCE Tt): Internal Order #: Lender Case #: Michael R. Warner Client File #: 5315 E Trindle Rd FHANA Case #: Mechanicsburg, PA 17050 Main File # on form: LINDENDR116 Other File # on form: E-Mail: Telephone Number: 717-766-5406 Fax Number: Federal Tax tD: 25-1733269 Aftemate Number. 717-421-8792 Employer ID: RESIDENTIAL APPRAISAL SUMMARY REPORT DESCRIPTION Lender: Michael R. Warner Client: Michael R. Warner Purchaser/Borrower: NIA Property Address: 116 Linden Dr City: Camp HiA County: Cumberland State: PA Zip: 17011 Legal Description: Deed Book 0031 S, Page 00911, LOT 9, SEC A, PB 6, PG 49 FEES AMOUNT Residential Appraisal Summary Report 350.00 Zl~~ ~ I . r~'v'- ~, ,,(, t ~°' ~ V ;J SUBTOTAL 350.00 PAYMENTS ~ AMOUNT Check #: Date: Description: Check #: Date: Description: Check #: Date: Description: . ~n~,.vA,. D,o ~..I- , ~~n., 12 - ~ SUBTOTAL DATES Shiremanstown, PA 17011 Invoice Date: 04/10/2012 Telephone Number: 717-737-4600 Fax Number: 717-737-9123 Due Date: REFERENCE T0: Internal Order #: Lender Case #: Michael R. Warner Client File #: 5315 E Trindle Rd FHA/VA Case #: Mechanicsburg, PA 17050 Main F;ie # on form: PHEASANTST17 Other File # on form: E-Mail: ReneeWarner@comcast.net Telephone Number: 717-766-5406 Fax Number: Federal Tax iD: 25-1733269 Alternate Number: 717-421-8792 Employer ID: RESIDENTIAL APPRAISAL SUMMARY REPORT DESCRIPTION Lender: Michael R. Warner Client: Michael R. Warner purchaserl6orrower: N/A Property Address: 17 Pheasant St City: Mechanicsburg County: Cumberland State: PA Zip: 17050 Legal Description: Deed Book 00272, P age 04697, LOT 133, PH 5, PB 61, PG 67 FEES AMOUNT Residential Appraisal Summary Report 350.00 ~~ ~' ~ ~ t ; ,, ~ { .F,~~ , r`' ~ ~ \ ~ ~1 SUBTOTAL ~ 350.00 PAYMENTS AMOUNT Check #: Date: Description: Check #: Date: Description: Check #: Date: Description: ~~ ~, ~ ,~ .. I e .l i 7--~.~ ,~~ i~ - I SUBTOTAL Questions? Please O contact us by Mar 29. 1-800-DIAL-PPL (1-800-342-5775} ~,. ~,~~:~r~z: ~~~„~~,~~ M-F: Sam to 5pm Visit us online at Page 1 ~ pplelectric.com * r~ i' ~ ~ ~• 46650-82024 Mar 29, 2012 $424.37 Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Mar 8, 2012 $275.87 MARTHA WARNER Charges: 17 PHEASANT ST Total Stream Energy PA Charges $98.02 MECHANICSBURG, PA 17050 Total PPL Electric Utilities Charges $50.48 Meter: 46307273 Your next meter reading is on or about Apr 5, 2012. Total Charges $424.37 This section helps you understand your year-to-year Amount Due By Mar 29, 2012 _ ~` _ $424.37 electric use by month. Meter readings are actual unless Account Balance $424.37 otherwise noted. , ~rj ~ ~:~' 2011 2012 PPL Electric Utilities' price to compare far your rate is 6.935 cents ~~ _ effective 3/1/2012 to 5/31/2012. For a list of supplier offers, visit 15o papowerswitch.com or www.oca.state.pa.us. ~ ~ g~ .c 125 3 ~ ! Your Messa a Center ~C 1oa t- o I • This bill includes a previous balance. If you have paid _ _ 75 ~' ~ ~ this amount, please accept our thanks and pay only the °- so ~ - current charges. Q 25 ~ ~~ ~ _-{ i .- ~ ~ ~ ~~ ~ ~ ~ • With paperless billing, you can receive and pay your The process is free PPL Electric Utilities bills online o . , ~,_ ~_ , ; , . quick, convenient and secure. To learn more or sign up, ~ F M a M ~ ~ A s o N p visit pplelectric.com. Months • Information about appliance energy use and tips on saving energy are available through the Energy Library ' ~ on our Web site, pplelectric.com. ~ "~ • Clean the coils on the back or bottom of your Mar 2012 30 1143 38 37F refrigerator every 3 months. Dust covered coils waste energy. Mar 2011 32 2364 74 35F • a Payment Methods = Mar 7 Actual 56830 ~ Online at: ©By phone: 1-800-342-5775 Feb 6 Actual 55687 pplelectric.com or call BiIlMatrix (service fee applies} at 1-800-672-2413 to pay using Visa, 30 Days kWh Billed 1143 MasterCard, Discover or debit card. , ®By Mail: Correspondence should be sent to: ~ 1046 Apr 2011- Mar 2012 12552 2 North 9th Street Customer Services _ CPC-GENN1 827 Hausman Road Apr 2010 -Mar 2011 22066 1839 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Qther important information on the back of this bill --~ Questions? Please Visit us online at Page 1 contact us by Apr 16. ~ pplelectric.com 1-800-DIAL-PPL ~ r ~ - j o (1-E00-342-5775} 46650-82024 Apr 16, 2012 $25.28 f,PL Elc~c4r•ir_ utiiuia~ M-F: Sam to 5pm !, =. Your Electric Usage Profile Service to: MARTHA WARNER-ESTATE 17 PHEASANT ST MECHANICSBURG, PA 17050 Meter: 46307273 This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. ~' 2011 ®2012 iso s izs 3 loo ~ 75 `a ~ 50 oc Q 25 Months .. •. ~. Mar 2012 16 173 11 54F Mar 2011 29 1513 52 42F •~ .. .- ., Mar 23 Actual 57003 - Mar 7 Actual 56830 16 Days kWh Billed 173 • ~ • Apr 2011- Mar 2012 i 11212 ~ . 934 Apr 2010 -Mar 2011 22219 1852 Billing Summary (Billing details on back) Balance as of Mar 26, 2012 $0.00 Charges: Total Stream Energy PA Charges $14.84 Total PPL Electric Utilities Charges $10.44 Total Charges $25.28 Amount Due By Apr i6, 2012 $5.28 Account Balance $25 28. PPL Electric Utilities' price to compare for your rate is 6.935 cents per kWh effective 3/1/2012 to 5/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center , With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. Before digging around your home or property, you should always call the state's One Call notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Call system. Be safe and call 811 before you dig. Payment Methods -~ ~`jv1~ 0 0 a Online at: ©By phone: 1-800-342-5775 pplelectric.com or call BIIIMatrix (service fee applies} at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mail: 2 North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Hausman Road Allentown, PA 18104-9392 Other important information on the back of this bill -~ 1 F M A M J J A S O N D Meter: 46307273 Your next meter reading is on or about 1ul 6, 2012. This section helps you understand your electric use by month. Meter readings are actual unless otherwise noted. This graph shows the average number of kWh you used each day. You used 0 kWh in 22 days, or an average of 0 kWh a day. The average daily temperature for your area last month was 68F. 3 0 ~, a a 2012 J F M A M J J A S O N D Months Total Charges $6.78 Amount Due By Jun 27, 2012 $6.78 Account Balance $6.78 PPL Electric Utilities' price to compare for your rate is 7.993 cents per kWh effective 6/1/2012 to 8/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. ~(03z, -' Your Message Center / Z~ /~ ~ • Thank you for the opportunity to serve you. Our goal is to provide a level of service that ensures you are very satisfied. We have established your account without a deposit. Payment of your bill each month by the "Due Date" ensures that we will not charge you a deposit. Please call us if you have any questions. • This bill covers a shorter period than usual. • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. • Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. • • ~ e t ~ • Jun 6 Actual 57189 Pay ment Methods May 15 Actual 57189 ~ Online at: ©By phone: 1-800-342-5775 pplelectric.com or call BillMatrix (service fee applies) 22 Days kWh Billed 0 at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mail: Correspondence should be sent to: 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill ~ Questions? Please Visit us online at Page 1 ® contact us by Jul 27. ~ pplelectric.com , 1-800-DIAL-PPL ~ ° ° ~ ~ ' (1-800-342-5775) 46650-82033 Jul 27, 2012 $2056 SQL ~!~ r.?rlc t.aiis~i~~ ~ M-F: Sam t0 5pm Your Electric Usaae Profile Service to: MARTHA WARNER-ESTATE 17 PHEASANT ST MECHANICSBURG, PA 17050 Meter: 46307273 Your next meter reading is on or about Aug 6, 2012. This section helps you understand your electric use by month. Meter readings are actual unless otherwise noted. This graph shows the average number of kWh you used each day. You used 94 kWh in 30 days, or an average of 3 kWh a day. The average daily temperature for your area last month was 74F. Y ca 0 ~, a Q ~ 20~ 2 6 5 4 3 z 1 0 J F M A M J J A S 0 N D Billing Summary (Billing details on back Balance as of 1u1 6, 2012 $0.00 Charges: Total PPL Electric Utilities Charges $20.56 Total Charges $20.56 Amount Due By 1ul 27, 2012 20.56 Account Balance ~ _~~ $20.~ PPL Electric Utilities' price to compare for your rate is 7.993 cents per kWh effective 6/1/2012 to 8/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or Sign up, visit pplelectric.com. • Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. • Before digging around your home or property, you should always call the state's One Call notification system to locate any underground utility lines. You can do this by simply dia{ing 811, which will connect you to the One Call system. Be safe and call 811 before you dig. ,~ 7/71~E ~L 0 v 0 0 Months •. •• o- s Jul 6 Actual 57283 Payment Methods Jun 6 Actual 57189 ~ Online at: ~ By phone: 1-8Q0-342-5775 pplelectric.com or call Bi1lMatrix (service fee applies) 30 Days kWh Billed 94 at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. By Mail: 2 North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Hausman Road Allentown, PA 18104-9392 Other important information on the back of this bill -~ Questions? Please 27 A b Visit us online at com l lectric ~ Page 1 . y ug contact us 1-800-DIAL-PPL . pp e ~ ~ ~ ~ . - r (1-E00-342-5775) 46650-82033 Aug 27, 2012 $27.41 r,-~ x-~,~~-~,r,~- ~.,~~:~~,~~ M-F: Sam to 5pm Your Electric Usage Profile Billing Summary {Billing details on back) _ Service to: _ Balance as of Aug 6, 2012 $0.00 MARTHA WARNER-ESTATE Charges: 17 PHEASANT ST Total PPL Electric Utilities Charges $27.41 MECHANICSBURG, PA 17050 Meter: 46307273 Your next meter reading is on or about Sep 5, 2012 This section helps you understand your electric use by month. Meter readings are actual unless otherwise noted. This graph shows the average number of kWh you used each day. You used 151 kWh in 31 days, or an average of 4 kWh a day. The average daily temperature for your area last month was 77F. 2012 r 3 0 L ~, a Q 1 F M A M J J A S O N D Months ® • ~ A Aug 6 R , Actual 57434 Jul 6 Actual 57283 31 Days kWh Billed 151 Total Charges $27.41 Amount Due By Aug 27, 2012 $27.41 Account Balance $27.41 PPL Electric Utilities' price to compare for your rate is 7.993 cents per kWh effective 6/1/2012 to 8/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. Before digging around your home or property, you should always call the state's One Call notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Call system. Be safe and call 811 before you dig. Payment Methods `J~, Online at: ~ By phone: 1-800-342-5775 _ U ppielectric.com or call BillMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. By Mail: Z North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Hausman Road Allentown, PA 18104-9392 a 0 0 Other important information on the back of this bill -~ MARTHA WARNER-ESTATE 17 PHEASANT ST MECHANICSBURG, PA 17050 Meter: 46307273 Your next meter reading is on or about Oct 5, 2012. This section helps you understand your electric use by month. Meter readings are actual unless otherwise noted. This graph shows the average number of kWh you used each day. You used 183 kWh in 30 days, or an average of 6 kWh a day. The average daily temperature for your area last month was 73F. T ~D 0 L v a 7 Q 2012 J F M A M J J A S d N b Charges: Total PPL Electric Utilities Charges $31.23 ~~~~(Z, Total Charges $31.23 ~ ~ 7~~', Amount Due By Sep 26, 2012 31.23 Account Balance ~ $31.23 PPL Electric Utilities' price to compare for your rate is 7.907 cents per kWh effective 9/1/2012 to 12/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. • Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. • Before digging around your home or property, you should always call the state's One Call notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Call system. Be safe and call 811 before you dig. Months :. ~ ~ .e Sep 5 Actual 57617 Payment Methods Aug 6 Actual 57434 ~ Online at: a By phone: 1-800-342-5775 30 Days kWh Billed 183 PPlelectric.com at 1-800-672-2413sto payfus g Visas MasterCard, Discover or debit card. By Mail: 2 North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Hausman Road Allentown, PA 18104-9392 Other important information on the back of this bill -~ Questions? Please Visit us online at Page 1 O contact us by Oct 26. ~ pplelectric.com ~ ~ o ~ ~ s 1-800-DIAL-PPL (1-800-342-5775) 46650-82033 Oct 26, 2012 $27.38 ~~L ~;~:~r;~ ~t;;;z;~,, M-F: Sam to 5pm Your Electric Usage Profile Service to: MARTHA WARNER-ESTATE 17 PHEASANT ST MECHANICSBURG, PA 17050 Meter: 46307273 Your next meter reading is on or about Nov 5, 2012 This section helps you understand your electric use by month. Meter readings are actual unless otherwise noted. This graph shows the average number of kWh you used each day. You used 152 kWh in 30 days, or an average of 5 kWh a day. The average daily temperature for your area last month was 64F. a D L v a d ~ 20~ 2 J F M A M J J A S 0 N D Billing Summary (Billing details on back) Balance as of pct 5, 2012 $0.00 Charges: Total PPL Electric Utilities Charges $27.38 Total Charges $27.38 mount Due By oct 26, 2012 $27.38 Account Balance `~ $27.38 PPL Electric Utilities' price to compare for your rate is 7.907 cents per kWh effective 9/1/2012 to 11/30/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, ppieiectric.com. Before digging around your home or property, you should always call the state's One Cal{ notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Call system. Be safe and call 811 before you dig. Months •. •~ a • _ Oct S Actual 57769 Payment Methods Sep 5 Actual 57617 ~ Online at: ©By phone: 1-800-342-5775 ppletectric.com or call BiIlMatrix (service fee applies) 30 Days kWh Billed 152 at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. By Mail: 2 North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Hausman Road Allentown, PA 18104-9392 0 0 m d Q Clther important information on the back of this bill ~ United Water Pennsylvania Customer Service Center G'~~ ~ - 8189 Adams Drive ~~~~ ~ U N ITE D UtlATE R Hummelstown, PA 17436 '"ate. Telephone: 717-564-3662 www.unitedwater.com USAGE HISTORY Monthly usage in Thousands of Gallons 4 3 z 0 3 3 3 3 3 z z z Billing Date: 04/02/12 Account Number: 00207901620000 Previous Balance $0.00 Payments Through 04/02/12 $0.00 Balance Forward $0.00 Current Charges Due 04/23/2012 $11.08 TOTAL AMOUNT DUE $11.08 '"°` „°` ~'°y '°° ",~ 'e" "" ~"°" "" ,°" ~~° ,~°~ "~~ ~n J~~t sut~rnit paument. YoJ.~ are enrolled in E-PAY. Next meter reading date: on or about 05/01/2012 *PAY BY 04/30/2012 TO AVOID A 1.5% LATE PAYMENT CHARGE SERVICE TO' MARTHA WARNER SERVICE ADDRESS' 17 PHEASANT ST MECHANICSBURG PA Meter Number Service Days of Meter Reading Unit of Fram To Service Previous Present Usage Measure Reading Type Rate 64036432 03/01 /12 04/02/12 32 0335 0335 0 MGl ACTUAL W07 EQUIVALENT TO 0 GALLONS SERVICE CHARGES $11.00 DISTRIBUTION SYSTEM IMPROVEMEN $0.08 TOTAL CURRENT CHARGES $11.08 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION IMPORTANT MESSAGES Your consumption is based on an actual reading of your water meter. YOUR ACCOUNT NUMBER HAS CHANGED. THANK YOU FOR YOUR PATIENCE WHILE WE UPGRADE OUR COMPUTER SYSTEM TO SERVE YOU BETTER. PLEASE READ THE ENCLOSED INSERT FOR MORE INFORMATION. Save a stamp and go paperless today! log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling: Approximate state tax included on this bill $0.44. ~' ~~r 0 0 o z~;ns~:ui PI EASE DETACH HERE AND RETURN THE BOTTOM PORTION WITH YOUR PAYMENT IN THE RETURN F S'eG~Pdu.l e ~1, r~w- (3 ~ ~. USAGE HISTORY Monthly usage in Thousands of Gallons ~, 3 z ~, 3 3 3 3 3 -- z z ~ - Z -- ~~ -~, ~ T I ~ ' ~ Oilling Date: 05/01 /12 Account Number: 00207901620000 Previous Balance $11.08 Payments Through 05/01 /12 THANK rou $11.08CR Balance Forward $0.00 Current Charges Due 05/21 /2012 $11.09 TOTAL AMOUNT DUE __ _.__ ___ $11.09 --_.T-_- _ _ -_ ____ ____ ...~- ADr Moy Jun Jul SeV Jcl Nov Uec ]an Fed Mor Apr Flay / Next meter reading date: on or about 06/01/Z012 *PAY BY 05/29/201 Z TO AVOID A 1.5% LATE PAYME CHARGE SERVICE TO: MARTHA WARNER SERVICE ADDRESS: 17 PHEASANT ST MECHANICSBURG PA Meter Nu mber Service ~jj From To ._.__^~__. 1 Days of Meter Reading Service Previous Present ---___-.---____-- ----------- Unit of Usage Measure Reading Type ------____.-~ __._..__._______..._ ____~~____~_______~ Rate ~ ___~~_ ____-- - ___._ 64036432 _- --__....._ ___._________ 04/02/12 . ___ 05/01 /1 Z Z9 0335 0335 0 MGL /\CTUAI. EQUIVALENT TO 0 GALLONS W07 SERVICE CHARGES $11.00 DISTRIBUTION SYSTEM IMPROVEMEN $0.08 STATE TAX ADJUSTMENT SURCHARGE $0.01 TOTAL. CURRENT CHARGES $11.09 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION _ ___ ___ _ _1MPORTANT_ MESSAGES Your consumption is based on an actual reading of your water meter. YOUR ACCOUNT NUMBER HAS CHANGED. THANK YOU FOR YOUR PATIENCE WHILE WE UPGRADE OUR COMPUTER SYSTEM TO SERVE YOU BETTER. PLEASE READ THE ENCLOSED INSERT FOR MORE INFORMATION. Save a stamp and go paperless today! log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling. Approximate state tax included on this bill $0.44. _~ :~..,~~. ~ PLEASE. DETACH_H[RE AND RETURN Tf1E BOTTOM PORTION WITH YOUR PAYMENT IN THE RETURN ENVELOPE PROVt 002 ....................... . 5-l r v=) UNITED WATER USAGE HISTORY Monthly usage in Thousands of Gallons ~, ° United-Water Pennsylvania Customer Service Center 8189 Adams Drive Hummelstown, PA 17036 Telephone: 717-564-3662 Billing Date: 06/01 /12 Account Number: 00207901620000 Preuious Balance $11.09 Payments Through 06/01 /12 THANK roU $11.09CR Balance Forward $0.00 Current Charges Due 06/21/2012 $11.09 TC}TAL AMtJUNT DUE $11.09 hi~y Tun lul SeV Oc[ Nnv Dec Tan Feb Mnr Api May )ur, Next meter reading date: on or about 07/02/201 Z *PAY BY 06/26/201 Z TO AVOID A 1.5% LATE PAYMENT CHARGE SERVICE T0: MARTHA WARNER SERVICE ADDRESS: 17 PHEASANT ST MECHANICSBURG PA Meter Number _~ Service .pays of Meter Reading Unit of From To Service Preuious Present Usage Measure Reading Type Rate 64036432 05/01 /12 06/01 /12 31 0335 0335 0 MGl ACT~IA~ W07 EQUIVALENT TD 0 GALLONS SERVICE CHARGES $11.00 DISTRIBUTION SYSTEM IMPROVEMEN $0.08 STATE TAX ADJUSTMENT SURCHARGE $0.01 TOTAL CURRENT CHARGES $11.09 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION IMPORTANT MESSAGES Your consumption is based on an actual reading of your water meter. YOUR ACCOUNT NUMBER HAS CHANGED. THANK YOU FOR YOUR PATIENCE WHILE WE UPGRADE OUR COMPUTER SYSTEM TO SERVE YOU BETTER. PLEASE READ THE ENCLOSED INSERT FOR MORE INFORMATION. Save a stamp and go paperless today! log on to wuu~,u.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling. Effective April 1, 2012 UWPA's Distribution System Improvement Charge (DSIC) surcharge was increased from 0.00% to 0.77%. Notice of this approved surcharge uuas inadvertently omitted from your April bill. We apologize for the ouers~ght and thank you for your understanding Approximate state tax included on this bill $0.44. s,%~ UNITED WATER USAGE HISTORY Monthly usage in Thousands of Gallons 4 3 z 0 3 3 3 3 z z )un Jul Sep Oct Nov D r Jor. Feb Mar Apr May Jun Jut Next meter rending date: on or about 08/01/Z012 United Water Pennsylvania Customer Service Center 8189 Adams Drive Hummelstown, PA 17036 Telephone: 717-564-3662 Billing Date: 07/02/12 Account Number: 00207901620000. Previous Balance $11.09 Payments Through 07/02/12 THANK YOU $11.09CR Balance Foruvard $0.00 Current Charges Due 07/23/Z012 $11.12 TOTAL. AMOUNT DUE $11.1 Z *PAY BY 07/30/201 Z TO AVOID A 1.5% LATE PAYMENT CHARGE SERVICE TO: MARTHA WARNER SERVICE ADDRESS: 17 PHEASANT ST MECHANICSBURG PA Meter Number Service Days of Meter Reading Unit of From _To Service Previous Present Usage Measure Reading Type Rate 64036432 06/01/12 07/02/12 31 0335 0335 0 MGl ACTUAL W07 EQUIVALENT TO 0 GALLONS SERVICE CHARGES $11.00 DISTRIBUTION SYSTEM IMPROVEMEN $0.11 ~ (~ 5 STATE TAX ADJUSTMENT SURCHARGE $0.01 TOTAL CURRENT CHARGES $11.1 Z SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION IMPORTANT MESSAGES Your consumption is based on an actual reading of your water meter. YOUR ACCOUNT NUMBER HAS CHANGED. THANK YOU FOR YOUR PATIENCE WHILE WE UPGRADE OUR COMPUTER SYSTEM TO SERVE YOU BETTER. PLEASE READ THE ENCLOSED INSERT FOR MORE INFORMATION. Save a stamp and go paperless today! log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling. Effective 7uly 1, 2012 UWPA's Distribution System Improvement Charge (DSIC) surcharge increased from 0.77% to 1.02%. Approximate state tax included on this bill $0.44. J9491 000400 400 1 1 0 3500 1 0 0 0 1 ~J~~` U N 1 T E D 1NAT E ~t ,~ rwa. USAGE HISTORY Monthly usage in Thousands of Gallons 4 3 z ° 3 3 3 z United tNater Pennsylvania Customer Service Center $7 89 Adams Drive Hummelstown, PA 17036 Telephone: 717-564-3662 Billing Date: 08/01 /12 Account Number: 00207901620000. Previous Balance $11.12 Payments Through 08/01/12 THANK YOU $11.12CR Balance Forward $0.00 Current Charges Due 08/21/2012 $11.12 TOTAE AMOUNT DUE $11.12 lul Sep Ocl Nnv Dec Ion feb Mar Apr May ]un lui Aug Next meter reading date: on or about 09/04/2012 *PAY BY 08/27/2012 TO AVOID A 1.5% LATE PAYMENT CHARGE SERVICE TO: MARTHA WARNER SERVICE ADDRESS: 17 PHEASANT ST MECHANICSBURG PA Meter Number' _ Service ~ pays of T Meter Reading i Unit of From To Spree Previous Present Usage Measure Reading Type Rate 64036432 07/02/12 08/01/12 30 0335 0335 0 MGl ACTUAL W07 EQUIVALENT TO D GALLONS SERVICE CHARGES $11.00 Q DISTRIBUTION SYSTEM IMPROVEMEN $0.11 't~j~ ~O STATE TAX ADJUSTMENT SURCHARGE $0.01 TOTAL CURRENT CHARGES $11.12 ~ $'~l ~ ?-' SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION IMPORTANT MESSAGES Your consumption is based on an actual reading of your water meter. Save a stamp and go paperless today! log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling. Effective July 1, 2012 UWPA's Distribution System Improvement Charge (DSIC) surcharge increased from 0.77% to 1.02%. Approximate state tax included on this bill $0.44. n 0 o Re 30949 PLEASE DETACH HERE AND RETURN THE BOTTOM PORTION WITH YOUR PAYMENT IN THE RETURN ENVELOPE _PROViDED. _ _ _ _002. ~~ UNITED WATER USAGE HISTORY Monthly usage in Thousands of Gallons ~, 3 z 1 0 3 3 I ® ~ ® ® 0 0 0 0 0 0 0 0 o I united Water Pennsylvania Customer Service Center 8189 Adams Drive Hummelstown, PA 17036 Telephone: 717-564-3662 www.unitedwater.com Billing Date: 10/01 /12 Account Number: 00207901620000. Previous Balance $11.1 Z Payments Through 10/01 /12 THANK YOU $11.12CR Balance Forward $0.00 Current Charges Due 10/22/2012 $11.18 TOTAL AMOUNT DUE $11.'18 Oct Nou Dec Inn feb Mur Apr May tun lul Auq Sep U[t Next meter reading date: on or about 11/01/2012 *PAY BY 10/29/Z012 TO AVOID A 1.5% LATE PAYMENT CHARGE SERVICE T0: MARTHA WARNER SERVICE ADDRESS: 17 PHEASANT ST MECHANICSBURG PA Meter Number Service Days of Meter-Redding ~~ _ _ Unit of from To Service Previous Present Usage Measure Reading Type Rate __ _ _ l~_~l_---_~ --- - ~-_------ --~--- --_ --- - -- 64036432 09/04/12 10/01 /12 Z7 0335 0335 0 MGl ACTUAL W07 EQUIVALENT TO 0 GALLONS SERVICE CHARGES $11.00 DISTRIBUTION SYSTEM IMPROVEMEN $0.17 STATE TAX ADJUSTMENT SURCHARGE $0.01 TOTAL CURRENT CHARGES $11.18 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INfORMATiON IMPORTANT MESSAGES Your consumption is based on an actual reading of your water meter. Effective October 1, 2012 the Distribution System Improvement Charge (DSIC) was increased from 1.02% to 1.5Z%. This charge funds the replacement of water distribution facilities in Pennsylvania. Save a stamp and go paperless today! Log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling; Approximate state tax included on this bill $0.44. ~,%',~ UNITED WATER USAGE HISTORY Monthly usage in Thousands of Gallons 4 3 3 3 3 z z ° Scy Oct Nou Dec Jan Feb Mor Apr May tun )ul Aug Sep Next meter reading date: on or about 10/01/2012 United Water Pennsylvania ~~ .Customer Service Center 81$9 Adams Driue Hummelstown, PA 1.7036 Telephone: 7'17-564-3662 www.unrtedwater.com ~..m.~,.~,,....,,.~..~,. ~,....® - Billing Date: 09/04/1 Z Account Number: OOZ 07901620000. Previous Balance $11.12. Payments Through 09/04/12 THANK YOU $11.12CR Balance Forward $0.00" . Current Charges Due 09/24/201 Z $11.12 TOTAL AMOUNT DUE $11.12 -'~ ~ ,; ~ -~ ~ c, ~ Ct` `~ *PAY BY 10/01 /201 Z TO AVOID A 1.5% LATE PAYMENT CHARGE SERVICE TO: MARTHA WARNER 5ERVICE ADDRESS: 17 PHEASANT ST MECHANICSBURG PA Meter Number Service Days of .Meter Reading Unit of Fram To Service previous Present Usage Measure Reading Type Rate 64036432 08/01 /12 09/04/12 34 0335 0335 0 MGl ACTUAL. W07 EQUIVALENT TO 0 GALLONS SERVICE CHARGES $11.00 DISTRIBUTION SYSTEM IMPROVEMEN $0.11 STATE TAX ADJUSTMENT SURCHARGE $0.01 TOTAL CURRENT CHARGES $11.12 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION I~--- IMPORTANT MESSAGES Your consumption is based on an actual reading of your crater meter. Saue a stamp and go paperless today! Log on to urww.umtedwater.com or call Customer Seruice to find out more information and to enroll in eBilling. Effective July 1, 2012 UWPA's Distribution System Improvement Charge (DSIC) surcharge increased from 0.77% to 1.02%. Approximate state tax included on this bill $0.44. 0 n n ke s,nea, PEASE DETACH HERE AND RETURN THE BOTTOM PORTION WITH YOUR PAYMENT IN THE RETURN ENVELOPE PROVIDED. nn2 5~~~ UNITED WATER USAGE HISTORY Monthly usage in Thousands of Gallons 4 3 3 - Z z 0 0 0 0 0 0 0 0 0 0 0 United Water Pennsylvania Customer Service Center 8189 Adams Drive Hummelstown, PA 17036 Telephone: 717-564-3662 Billing Date: 11 /01 /12 Account Number: 00207901620000. Previous Balance Payments Through 11 /01 /12 THaNK rau Balance Forward $11.18 $11.18CR $0.00 Current Charges Due 11 /21 /2012 $11.18 TOTAL AMOUNT DUE $11.18 Nov Dec Ian Feb Mar Apr Nay ]un lul Auq Sep Oct Nov Next meter rending date: on or about 12/03/2012 *PAY BY 11 /27/Z01 Z TO AVOID A 1.5% LATE PAYMENT CHARGE SERVICE TO: MARTHA WARNER - - - SERVICE ADDRESS: 17 PHEASANT ST MECHANICSBURG PA Meter Number Service pays of Meter Reading Unit of From To Service previous Present Usage Measure Reading Type Rate 64036432 10/01/12 11/01/12 31 0335 0335 0 MGl ACTUAL W07 EQUIVALENT TO 0 GALLONS SERVICE CHARGES $11.00 DISTRIBUTION SYSTEM IMPROVEMEN $0.17 STATE TAX ADJUSTMENT SURCHARGE $0.01 TOTAL CURRENT CHARGES $11.18 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION __ IMPORTANT MESSAGES Your consumption is based on an actual reading of your water meter. Effective October 1, 2012 the Distribution System Improvement Charge (DSIC) was increased from 1.02% to 1.52%. This charge funds the replacement of water distribution facilities in Pennsylvania. Save a stamp and go paperless today! log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling: Approximate state tax included on this bill $0.44. 0 0 o Re ~zszz~ PLEASE DETACH_HERE AND RETURN THE_ BOTTOM PORTION WITH YOUR PAYMENT IN THE RETURN ENVELOPE ,PROVIDED. 002 Silver Spring Township Authority Silver Spring Township Authority 5 Willow Mill Park Rd., Suite #3 P 17072 h i b M ~ ~~ urg, an cs a ec 717-591-1370 t ~ ~( t ~ Statement of Account for Sewer Services ~~ .~' ~ Account Number: Due Date Before Due Date 280-280 05/02/12 $106.00 Service Address: After Due Date 17 Pheasant St $116.60 Office will be closed: Friday, Apri l 6, 2012 (Good Friday) Previous Balance: ~ $0.00 Billing Period Current Charge: $0. 00 From 01/01/2012 Other Charges: _ To: 03/31 /2012 Meter Credits: $0.00 Pay this amount before due date 106 Total Consumption: 0 Pay this amount after due date: ' $116.60. Hours: Normal business hours are from 8:OOAM-4:OOPM; however, we do close for a one (1) hour lunch Monday thru Friday, except holidays and special occassion and answering machine is availabe for after hour questions regarding your sewer bills. Payments: Payments are due at the Silver Spring Authority's office on or before the due date and are subject to the 10% penalty after due date has past. Return checks will be subject to a $40.00 NSF charge. Payments can be made by check, money order or credit cards (call for convenience fee rates). Bring your payment along with the return stub to the Silver Spring Authority offices during business hours or you may mail your payment to: 5 Willow Mill Park Rd., Suite #3, Mechanicsburg, Pa 17050. NOTICE: The Silver Spring Authority had directed that the waiver for sewer rental fees for temporarily vacated properties to be terminated. The fixed costs of operating the sewer system are continually ongoing and are paid with funds collected from the base sewer rental fee each quarter-year billing period. The sewer system stands ready to serve each connected property on a perpetual basis. Rates: The rate schedule for Silver Spring Township Authority is as follows: " Commercial -Flat Charge of $188.75 (per unit/per month). "Residential -Flat Charge of $150.00 (per unit). ~U I ~E=1~-c,~ 'e. ~/ ~~"-~~'1 `jam ' ~• Silver Spring Township Authority Silver Spring Township Authority 5 Willow Mill Park Rd., Suite #3 Mechanicsburg, Pa 17050 717-591-1370 Statement of Account for Sewer Services Account Number: 280-280 Service Address: Due Date Before Due Date 08/13/2012 $106.00 17 Pheasant St Office will be closed: HOLIDAYS: Monday, September 3, 2012 (Labor Day) After Due Date $116.60 Previous Balance: j_ $0.00; Billing Period Current Charge: I $106 .0 0 ; From 04/01/2012 Other Charges: . _ To: 06/30/2012 Meter Credits: __ ___ ! $0.00 Pay this amount before due date: ,_ $106.00 '. Total Usage: D Pay this amount after due date: _ $1.16.60 ~ ~Z I ~ ~~V i `V J ~~~ Hours: Normal business hours are from 8:OOAM-4:OOPM; however, we do close one (1) hour lunch on special occassion and answering machine available for after hour questions regarding your sewer bills. Payments Payments are due at the Silver Spring Authority office on or before the due date and are subject to a 10% penalty after due the due date h Info.: past. Return checks will be subject to a $40.00 NSF charge. Payments can be made by check, money order or credit cards (call for convenience fee rates). Bring your payment along with the retun stub to the Silver Spring Authority offices during regular business hours c you may mail your payment to: 5 Willow Mill Park Rd., Suite #3, Mechanicsburg, Pa 17050. We do have a drop-box for your conveniencf Notice: The Silver Spring Authority had directed that the waiver for sewer rental fees for temporarily vacted propertieis to be terminated. The fixec costs of operating the sewer system are continually ongoing and are paid with funds collected from the base sewer rental fee each quartet year billing period. The sewer system stands ready to serve each connected property on a perpetual basis. Rates: The rate schedule as of 04/01!12 for Silver Spring Township Authority is as follows: *Commercial Metered Customers -Minimum charge of $71.85 for your first 3,000 gallons of consumption (per unit, per month). *Commercial Non-Meter -Charge of $188.75 (per unit, per month). *Residential -Minimum charge of $106.00 for your first 9,000 gallons of consumption (per unit, per quarter). *Additional gallons charged are $6.50 per 1,000 gallons after your first 3,000 (Commercial) and 9,000 (Residential). Silver Spring Township Authority Silver Spring Township Authority 5 Willow Mill Park Rd., Suite #3 Mechanicsburg, Pa 17050 717-591-1370 Statement of Account for Sewer Services Account Number: Due Date Before Due Date 280-280 11 /07/2012 $106.00 Service Address: After Due Date 17 Pheasant St $116.60 Office will be closed: HOLIDAYS: November 22nd and 23rd (Thanksgiving), December 24th and 25th (Christmas) Previous Balance: $0.00 Billing Period ~ Current Charge: $106.00 From 07/01/2012 Other Charges: To: 09/30/2012 Meter Credits: $0.00 Pay this amount before due date: $106.00 Total Usage: 0 Pay this amount after due date: ~ $116.60 '' Hours: Normal business hours are from 8:OOAM-4:OOPM; however, we do close one (1) hour lunch on special occassion and answering machine available for after hour questions regarding your sewer bills. Payments Payments are due at the Silver Spring Authority office on or before the due date and are subject to a 10% penalty after due the due date h Info.: past. Return checks will be subject to a $40.00 NSF charge. Payments can be made by check, money order or credit cards (call for convenience fee rates). Bring your payment along with the retun stub to the Silver Spring Authority offices during regular business hours c you may mail your payment to: 5 Willow Mill Park Rd., Suite #3, Mechanicsburg, Pa 17050. We do have a drop-box for your conveniencf Notice: The Silver Spring Authority had directed that the waiver for sewer rental fees for temporarily vacted propertieis to be terminated. The fixec costs of operating the sewer system are continually ongoing and are paid with funds collected from the base sewer rental fee each quarter year billing period. The sewer system stands ready to serve each connected property on a perpetual basis. Rates: The rate schedule as of 04101/12 for Silver Spring Township Authority is as follows: *Commercial Metered Customers -Minimum charge of $71.85 for your first 3,000 gallons of consumption (per unit, per month). *Commercial Non-Meter -Charge of $188.75 (per unit, per month). *Residential -Minimum charge of $106.00 for your first 9,000 gallons of consumption (per unit, per quarter). *Additional gallons charged are $6.50 per 1,000 gallons after your first 3,000 (Commercial) and 9,000 (Residential). rt..~..- __~tr_,___...._.a _. ~....~ .. ~, .--- - ,. INVOICE Penn Waste, Inc. PO Box 3066 ^ ~ York, PA 17402 ~ www.pennwaste.com Phone (717) 767-4456 To1lFree 1-(866) 575-8720 V Fax (717j 767-4285 114401 AV 0.350 E0075X 10075 D484620801 P1072523 0001:0001 H12 I~1~~11~~1~~11111111111~~1'I'~I~I11~11~~11~~~1~11~~11~11~~11~~1~~ ~, ~ ESTATE OF MARTHA L WARNER ` 101 PENNS RUN RD MECHANICSBURG PA 17050-8231 Invoice Number: 0002051402 Page Number: 1 of 1 Date: 05/31 /2012 Customer Number: RSO44777 Site Number: 0000 Reference: Invoice Total: $44.35 Total Due: $44.35 • • - - • • • • http://pennwaste.billtrust.com - ~ ~ HPV PPP HRT Online Billing Now Available! •~ / ', ~ Receive your invoices faster ', and help save the environment by ~ enrolling in our free online service. See enrollment details above! Code Description Date Reference Quantity Amount (0001) MARTHA L WARNER 17 PHEASANT ST MECHANICSBURG, PA 01 Curbside Trash 8~ Recycling 05/31/12 1.00 43.35 32.OOGA 07/0112012-09/30/2012 I 01 Municipal Administrative Fee 05/31/12 1.00 1.00 07/01 /2012-09/30/2012 ~ ,~ i I i Current 30 - 60 Days 61 - 9o Days Over 90 Days Please visit our website at ~~+nvw.pennwaste.com $44 35 $0 00 $0 00 00 ~ $0 for holiday schedules and collection information. . . . . PLEASE DETACH AND RETURN BOTTOM PORTION WITH PAYMENT ~ehec~u Q.e. I-~, ~~n ~3 ~ ~. INVOICE ~~ Penn Waste, Inc. PO Box 3066 ^ ~ York, PA 17402 www.pennwaste.com Phone (717) 767-4456 ToIlFree 1-(866) 575-8720 V Fax (717) 767-4285 3835 1 AV 0.350 E0085X 10085 D549522571 P1183845 0001:0001 ~i~llll~ll~l~~ll~lll~l~ll'I~Ill~l~~llllf'1"'~I1~11~'I~"lI~~1~11 ESTATE OF MARTHA L WARNER 101 PENNS RUN RD MECHANICSBURG PA 17050-8231 Invoice Number: 0002185544 Page Number: 1 of 1 Date: 09/17/2012 Account Number: RSO44777 Site Number: 0000 Reference: Invoice Total: $38.20 Total Due: $38.20 • • - • • • • • http:llpennwaste.billtrust.com - • • HPV PPP HRT Online Billing Now Available! •~/ ', ~ Receive your invoices faster ', and help save the environment by ~ enrolling in our free online service. See enrollment details above! Code Description Date Reference Quantity Amount (0001) MARTHA L WARNER 17 PHEASANT ST MECHANICSBURG, PA 01 Curbside Trash & Recycling 09/17/12 1.00 37.20 32.OOGA 10/01 /2012-12/31 /2012 01 Municipal Administrative Fee 09/17/12 1.00 1.00 10/0112012-12/31 /2012 Current 30 - 60 Days 61 - 90 Days Over 90 Days Please visit our website at www.pennwaste.com 20 $38 00 $0 00 $0 $0.00 for holiday schedules and collection information. . . . PLEASE DETACH AND RETURN BOTTOM PORTION WITH PAYMENT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- LAWNSCAPES, INC 1125 East Lisburn Road Mechanicsburg, PA 17055 717-697-1833 Ref: Warner 17 Pheasant Street Michael Warner 101 Penns Run Road Mechanicsburg, PA 17050 Invoice 16971 . Account No. Date 1225 Apr-30-2012 Total Amount Due $62.67 Please return this portion with your payment. Make all checks payable to `LAWNSCAPES, INC'. 1.5% per month 18% annual charged on past due invoice DATE DESCRIPTION PRICE QTY AMOUNT Apr-13-2012 Lawn Maintenance $19.00 Apr-20-2012 Lawn Maintenance $19.00 Apr-27-2012 Lawn Maintenance $19.00 Apr-30-2012 Gas Surchage $0.75 3.00 $2.25 Weekly Gas Surchage ..~~ ~ ~~ a ,3 - '4. Sales Tax: $3.42 Sub Total: $62.67 Prepaid: $0.00 Total Amount Due $62.67 LAWNSCAPES, INC -1125 East Lisburn Road -Mechanicsburg, PA 17055 LAWNSCAPES, INC 1125 East Lisburn Road Mechanicsburg, PA 17055 717-697-1833 Ref: Warner 17 Pheasant Street Michael Warner 101 Penns Run Road Mechanicsburg, PA 17050 Invoice 17200 Account No. Date 1225 May-31-2012 Total Amount Due $81.96 Please return this portion with your payment. Make all checks payable to 'LAWNSCAPES, INC'. 1.5% per month 18% annual charged on past due invoice DATE DESCRIPTION PRICE QTY AMOUNT May-04-2012 Lawn Maintenance $19.00 May-11-2012 Lawn Maintenance $19.00 May-18-2012 Lawn Maintenance $19.00 May-25-2012 Lawn Maintenance $19.00 May-31-2012 Gas Surchage $0.35 4.00 $1.40 Weekly Gas Surchage 7~I`z (~ I ~, ~ D~ Sales Tax: $4.56 Sub Total: $81.96 Prepaid: $0.00 Total Amount Due $81.96 LAWNSCAPES, INC - 1125 East Lisburn Road -Mechanicsburg, PA 17055 LAWNSCAPES, INC 1125 East Lisburn Road Mechanicsburg, PA 17055 717-697-1833 Ref: Warner 17 Pheasant Street Michael Warner 101 Penns Run Road Mechanicsburg, PA 17050 Invoice 17432 Account No. Date 1225 Jun-30-2012 Total Amount Due $81.96 Please return this portion ~v~th ,~a;r pay^~ent. Ilrtake al: chicks payable to'LAWN~GAPES, INC'. 1.5% per month 18% annual charged on past due invoice LAWNSCAPES, INC - 1125 East Lisburn Road -Mechanicsburg, PA 17055 LAWNSCAPES, INC 1125 East Lisburn Road Mechanicsburg, PA 17055 717-697-1833 Ref: Warner 17 Pheasant Street Michael Warner 101 Penns Run Road Mechanicsburg, PA 17050 Invoice 17651 Account No. Date 1225 Jul-31-2012 Total Amount Due $20.54 Please return this po Dior with your payment. Make ati checks payable to 'LAWNSCAPES, INC'. 1.5% per month 18% annual charged on past due invoice DATE DESCRIPTION PRICE QTY AMOUNT Jul-27-2012 Lawn Maintenance $19.00 Jul-31-2012 Gas Surchage $0.40 Weekly Gas Surchage 1 `~/ ~~ ~' Sales Tax: $1.14 Sub Total: $20.54 Prepaid: $0.00 Total Amount Oue $20.54 LAWNSCAPES, INC - 1125 East Lisburn Road -Mechanicsburg, PA 17055 LAWNSCAPES, INC 1125 East Lisburn Road Mechanicsburg, PA 17055 717-697-1833 Ref: Warner 17 Pheasant Street Michael Warner 101 Penns Run Road Mechanicsburg, PA 17050 Invoice 17867 Account No. Date 1225 Aug-31-2012 Z~ ~ Total Amount Due 1 ~ $104.45 l Please return this portion with your payment. Pdake a!t checks payable to'LAWNSCAPES, INC'. 1.5% per month 18% annual charged on past due invoice DATE DESCRIPTION PRICE QTY AMOUNT Aug-03-2012 Lawn Maintenance $19.00 Aug-10-2012 Lawn Maintenance $19.00 Aug-17-2012 Lawn Maintenance $19.00 Aug-24-2012 Lawn Maintenance $19.00 Aug-31-2012 Gas Surchage $0.75 5.00 $3.75 Weekly Gas Surchage Aug-31-2012 Lawn Maintenance $19.00 Sales Tax: $5.70 Sub Total: $104.45 Prepaid: $0.00 Total Amount Due $104.45 LAWNSCAPES, INC -1125 East Lisburn Road -Mechanicsburg, PA 17055 LAWNSCAPES, INC 1125 East Lisburn Road Mechanicsburg, PA 17055 717-697-1833 Ref: Warner 17 Pheasant Street Michael Warner 101 Penns Run Road Mechanicsburg, PA 17050 invoice 18088 Account No. Date 1225 Sep-30-2012 Total Amount Due $83.56 Please return this portion with your payment. Make all checks payable to 'LAWNSCAPES, INC'. 1.5% per month 18% annual charged on past due invoice UAI t DESCRIPTION PRICE QTY AMOUNT Sep-07-2012 Lawn Maintenance $19.00 Sep-14-2012 Lawn Maintenance $19.00 Sep-21-2012 Lawn Maintenance $19.00 Sep-28-2012 Lawn Maintenance $19.00 Sep-30-2012 Gas Surchage $0.75 4.00 $3.00 Weekly Gas Surchage Sales Tax: $4.56 Sub Total: $83.56 Prepaid: $0.00 Total Amount Due $83.56 LAWNSCAPES, INC - 1125 East Lisburn Road -Mechanicsburg, PA 17055 Nationwide . On Your Side Martha L Warner 101 Penns Run Rd Mechanicsburg PA 17050-8231 For Questions Contact: JOHN T MORITZ 717.697.9469 Hearing Impaired (TT1~: 1.800.622.2421 Claims: 1.800.427.3535 Access your account online at Nationwide.com Prepared on June 19, 2012 Page 1 of 2 Your Homeowner Bill Full Remaining Balance $295.00 ,--- Minimum Monthly Installment $53.33 Should Be Received B 3, 2012 Account Number 5802035163 Sign up for convenient automatic bill payment with Nationwide Easy Sign up for convenient, pay. To learn more, ask your agent or go to Nationwide.com/account automatic bill payment with Nationwide Easy Pay. ~ l (~ 3 To learn more, ask your / agent or go to ~ ~ Z~ Nationwide.com/account Payment of $295.00 received 01 /03/12 -Thank you! 0 0 0 ~~~~ 06/19/12 Number Policy Period Additional Description Balance Installment 5837H0947480 Homeowner 01/13/12 - 01 /13113 17 PHEASANT ST ... 290.00 48.33 Installment Fee - For processing this payment 5.00 Minimum Monthly Installment $53.33 Nationwide On Your Side Martha L Warner 101 Penns Run Rd Mechanicsburg PA 17050-8231 For Questions Contact: JOHN T MORITZ 717.697.9469 Hearing Impaired (TTY): 1.800.622.2421 Claims: 1.800.421.3535 Access your account online at Nationwide.com Sign up for convenient, automatic bill payment with Nationwide Easy Pay. To learn more, ask your agent or go to Nationwide.com/account Prepared on July 20, 2012 Page 1 of 2 Your Homeowner Bitl Full Remaining Balance $246.67 --- Minimum Monthly Installment $ 3.33 f{' `j Should Be Received By ~ ugust 13, 2012 Account Number 5802035763 Go green. Sign up for paperless billing at Nationwide.com/gopaperless. Payment of $53.33 received 06/28/12 -Thank you! ti 0 o~ M 0 0 :~. 00 07!20/12 Number _ Policy Period Additional Description Balance Installment 5837H0947480 ~ Homeowner 01 /13/12 - 01 /13/13 17 PHEASANT ST ... 241.67 48.33 Installment Fee -For processing this payment 5.00 Minimum Monthly Installment $53.33 Nationwide . On Your Side Martha L Warner 101 Penns Run Rd Mechanicsburg PA 17050-8231 For Questions Contact: JOHN T MORITZ 717.697.9469 Hearing Impaired (TTY): 1.800.622.2421 C{aims: 1.800.421.3535 Access your account online at Nationwide.com Prepared on September 19, 2012 Page 1 of 2 Your Homeowner Bill Full Remaining Balance $150.00 Minimum Monthly Installment $53.33 Should Be Received By October 13, 20i 2 Account Number 5802035163 Sign up for convenient automatic bill payment with Nationwide Easy Sign up for convenient, pay. To learn more, ask your agent or go to Nationwide.com/account automatic bill payment with Nationwide Easy Pay. To learn more, ask your agent or go to Nationwide.com/account Payment of $53.34 received 09/10/12 -Thank you! a 0 ti ~o ti 0 0 0 0 o~ ao 09/19/12 Num_b_er Policy Period Additional Description Balance Installment 5837H0947480 Homeowner 01/13/12 - 01/13/13 17 PHEASANT ST ... 145.00 48.33 Installment Fee -For processing this payment _ S.uu Minimum Monthly Installment $53.33 ti Nationwide On Your Side Martha L Warner 101 Penns Run Rd Mechanicsburg PA 17050-8231 Account Number 5802035163 0 0 0 0 o~ N r For Questions Contact: JOHN T MORITZ 717.697.9469 Hearing Impaired (TTY}:1.800.622.2421 Claims: 1.800.421.3535 Access your account online at Nationwide.com Sign up for convenient, automatic bill payment with Nationwide Easy Pay. To learn more, ask your agent or go to Nationwide.com/account Prepared on August 21, 2012 Page 1 of 2 Yaur Homeowner Bill Full Remaining Balance $198.34 Minimum Monthly Installment $53.34 Should Be Received By September 13, 2012 Local farm bureau members save money! Farm Bureau members may receive special savings on several Nationwide policies and enjoy many other discounts and services. You don't have to be a farmer to join! If you're not already a member, ask your agent for details. ~~ 1 ~ Z~~ , ~ ~, ~-~ ~.~.- ~ Payment of $53.33 received 08/13/12 -Thank you! 08/21 /12 Number Policy Period Additional Description Balance Installment 5837HO947480 Homeowner 01/13/12 - 01/13/13 17 PHEASANT ST ... 193.34 48.34 Installment Fee -For processing this payment 5.00 Minimum Monthly Installment $53.34 PAYABLE TO: BILL #: 06382 = ' • • RETURN THIS PORTION WITH A PAYMENT FOR SECOND INSTALLMENT Debra Basehore Wiest, Tax Collec#or WARNER, JAMES E & MARTHA L 269 Woods Drive Mechanicsburg, PA 17050-2635 WARNER, JAMES E & MARTHA L 101 PENNS RUN RD MECHANICSBURG, PA 17050-8231 BILL #: 06382 OFFICE HOURS July -October Mon. 9 am - 12 pm, Tues. 9 am - 11 am August 22: 4 pm - 6 pm August 31: 9 am - 5 pm September 17 - 23: Closed Also open by appointment; closed holidays November 1 -December 18: Call for updated hours Phone: 717-697-1294 Please Indicate: ^ SECOND INSTALLMENT ^ SECOND INSTALLMENT WITH PENALTY • r ~ NO DISCOUNT If paid on or before 9/15/12 $491.56 If paid after 9/15/12 $540.72 PAYABLE TO: Debra Basehore Wiest, Tax Collector 269 Woods Drive Mechanicsburg, PA 17050-2635 WARNER, JAMES E & MARTHA L 101 PENNS RUN RD MECHANICSBURG, PA 17050-8231 PAYABLE TO: Debra Basehore Wiest, Tax Collector 269 Woods Drive Mechanicsburg, PA 17050-2635 BILL DATE: Property Location 7/1 /2012 38-23-0571-222 17 PHEASANT STREET WESTFIELDS LOT 133 PH 5 PB 61 PG 67 Property Location BILL DATE: 38-23-0571-222 7/1/2012 17 PHEASANT STREET WESTFIELDS LOT 133 PH 5 PB 61 PG 67 NOTICE OF PROPERTY TAX RELIEF Your enclosed tax bill includes a tax reduction for your homestead and/or farmstead property. As an eligible homestead and/or farmstead property owner, you have received tax relief through a homestead and/or farmstead exclusion which is provided under the Pennsylvania Taxpayer Relief Act, a law passed by the Pennsylvania General Assembly designed to reduce your property taxes. THIS TAX IS DUE AND PAYABLE. YOU ARE HEREBY REQUESTED TO MAKE PAYMENT THEREOF. ~' ~ ~ `.z Z~ ~~ WARNER, JAMES E 8~ MARTHA L 101 PENNS RUN RD MECHANICSBURG, PA 17050-8231 Please Indicate: ^ FINAL INSTALLMENT OFFICE HOURS July -October Mon. 9 am - 12 pm, Tues. 9 am - 11 am August 22: 4 pm - 6 pm August 31: 9 am - 5 pm September 17 - 23: Closed Also open by appointment; closed holidays November 1 -December 18: Call for updated hours Phone: 717-697-1294 ^ FINAL INSTALLMENT WITH PENALTY NO DISCOUNT If paid on or before 10/15/12 $491.55 If paid after 10/15/12 $540.70 ~ -• • ASSESSMENT $25,600 $150,300 $175,900 HOMESTEAD EXCLUSION $6,689 FARMSTEAD EXCLUSION $0 R/E TAX RATE 8.715 8.715 FULL SCHOOL R/E TAX $223.10 $1,309.86 $1,532.96 LESS HOMESTEAD CREDIT -- LESS FARMSTEAD CREDIT TAX AMOUNT DUE .. 1, 0.00 ,. $1,474.67 $1,622.14 If Paid On or Before 8/31112 10/31/12 12/17/12 NO CHECKS ACCEPTED AFTER DECEMBER 17, 2012 $491.56 I $491.56 I $491.55 On or before 8/15112 On or before 9/15112 1 On or before 10/15/12 e~Cal2d.u~e ~-, .~-2n~ B I y RETURN THIS PORTION WITH A PAYMENT FOR FINAL INSTALLMENT BILL #: 06382 WARNER, JAMES E & MARTHA L Hours: See Reverse MUNICIPALITY: Silver Spring Twp. BILL N0: 06382 Phone: 717-697-1294 PROPERTY: 17 PHEASANT STREET BILL DATE: 7/1/2012 MAP CODE: 38-23-0571-222 WARNER, JAMES E 8 MARTHA L Cumberland County Pennsylvania TAX COLLECTOR COPY -RETURN WITH PAYMENT FOR PROPER CREDIT WARNER, JAMES E & MARTHA L 17 PHEASANT STREET MECHANICSBURG, PA 17050-3145 Payable To: DEBRA BASEHORE WlEST 269 WOODS DRIVE MECHANICSBURG, PA 17050-2635 PHONE (717) 697-1294 17 PHEASANT STREET Acres 0.15 WESTFIELDS LOT 133 PH 5 PB 61 PG 67 Bitl No: 6358 Bill Date: 3/1/12 Control No: 3838004651 MAP NO: 38-23-0571-222. Assessed Value: Land: 25,600 Improvement: 150,300 Total: 175,900 Discount Face Penalty County R E 1.902 $327.87 $334.56 $368.02 County Lib .143 $24.65 $25.15 $27.67 Twp/Boro 0.8045 $138.68 $141.51 $155.66 TAX AMOUNT DUE If Date Of Payment Is On $491.20 3/1/12 thru 4/30/12 $501.22 5/1/12 thru 6/30/12 $551.35 7/1/12 or Later Payable To: DEBRA BASEHORE WIEST Office Hours: MONDAY 9-12; TUESDAY 9-11 AM Bill No: 6358 269 WOODS DRIVE ALSO 4118 & 4/25,5-7 PM Bill Date: 3/1/12 MECHANICSBURG, PA 17050-2635 CALL FOR HOURS AFTER JUNE 26 Contro! No:3838004651 PHONE (717} 697-1294 MAP NO: Desc: 38-23-0571-222. 17 PHEASANT STREET Acres 0.15 WESTFIELDS LOT 133PH5 PB61 PG 67 1111111 Illli IIIII Illli IIIII IIIII IIIII lilll IIIII Illll lIli IIII $1_00 FEE FOR ADDITIONAL RECEIPTS Tax Payee WARNER, JAMES E K MARTHA L 17 PHEASANT STREET MECHANICSBURG, FA 17050-3145 Assessed Value: Land: 25,600 Improvement: 150,300 Total: 175,900 Discount Face Penalty County RE 1.902 $327.87 $334.56 $368.02 County Lib .143 $24.65 $25.15 $27.67 Twp/Boro 0.8045 $138.68 $141.51 $155.66 TAX AMOUNT DUE If Date Of Payment Is can ~$d91.20_~ $501.22 3/1/12 thru 4/30/12 5/1/12 thru 6/30/12 $551.35 7/1 /12 or Later ~~ ADDRESS CHANGES CAN BE MADE ON BACK OF BILL TAXPAYER'S COPY -KEEP THIS PORTION FOR YOUR RECORDS S'e~,edu.l,e N-, .-I~-ew~ 8 ~ ~- Cumberland County Pennsylvania TAX COLLECTOR COPY -RETURN WITH PAYMENT FOR PROPER CREDIT WARNER, JAMES E & MARTHA L 17 PHEASANT STREET MECHANICSBURG, PA 17050-3145 Payable To: BONNIE K MILLER, TREASURER 2233 GETTYSBURG ROAD CAMP HILL, PA 17011-7302 PHONE (717) 737-5671 116 LINDEN DRIVE Acres 0.18 LINDEN GARDENS LOT 9 SEC A PB 6 PG 49 Payable To: BONNIE K MILLER, TREASURER 2233 GETTYSBURG ROAD CAMP HILL, PA 17011-7302 PHONE (717) 737-5671 MAP NO: 13-23-0551-109. Desc: 116 LINDEN DRIVE Acres 0.18 ii~i~i~iniPuiniiuiwifiuiHiiuuii ~a~a~AE~E,P., Tax Payer WARNER, .JAMES E & MARTHA L 17 PHEASAt~1T STREET MECHANICSBURG, PA 17050-3145 Bill No: 5504 Bill Date: 3/1/12 Control No: 1 31 3001 683 M~4P NO: 13-23-0551-109. Assessed Value: Land: 35,700 improvement: 132,200 Total: 167,900 Discount Face Penalty County RE 1.902 $312.96 $319.35 $351.29 County Lib .143 $23.53 $24.01 $26.41 Twp/Boro 1.23 $202.39 $206.52 $227.17 Fire Srvs 0.41 $67.46 $68.84 $75.72 St Light 1 $33.28 $33.28 $33.28 Debt Svc 0.41 $67.46 $68.84 $75.72 TAX AMOUNT DUE If Date Of Payment Is On $707.08 3/1/12 thru 4130/12 $720.84 5/1/12 thru 6/30/12 $789.59 7/1!12 or Later Office Hours: MON,TUES 8 THURS 9-4 Bill No: 5504 CLOSED WED, FRt AND ALL HOLIDAYS Bill Date: 311/12 BMILLER~iLATWP.ORG Control No:1313001683 Assessed Value: Land: 35,700 Improvement: 132,200 Total: 167,900 Discount Face Penalty County RE 1.902 $312.96 $319.35 $351.29 County Lib .143 $23.53 $24.01 $26.41 Twp/Boro 1.23 $202.39 $206.52 $227.17 Fire Srvs 0.41 $67.46 $68.84 $75.72 St Light 1 $33.28 $33.28 $33.28 Debt Svc 0.41 $67.46 $68.84 $75.72 TAX AMOUNT DUE If Date Of Payment Is On ..._707.08 3/1 /12 thl'ra 4/30/12 $720.84 5J1 /12 thru 6/30/12 $789.59 7/1 /12 or Later TAXPAYER'S COPY -KEEP TNIS PORTION FOR YOUR RECORDS ~ ' ~ I ~-- ~ ~~v3 A. Settlement Statement (HUD -1 } OMB Approval No. 2502-0265 B. Type of Loan 6. File Number 1 FHA ~ 2 FmHA ~ 3 Conv. Unins. ® 7. Loan Number 215779224 4 VA ~ 5 Conv. Ins. ~ 8. Mort a e Insurance Case No. C • are shasvn here for informational purposes and are not included in the totals. D. Borrower: Michael R. Warner - 101 Penns Run Road, Mechanicsbur , PA 17050 E. Seller Estate of Martha L. Warner - F. Lender: - G. Property Address: 116 Linden Drive Cam Hill, PA 17011 Township/Municipality: Lower Allen Township Count : Cumberland Settlement Agent: Gates, Halbruner, Hatch & Guise, P.C. 1013 Mumma Road, Suite 100, H. Lemoyne, PA 17043 (717) 731-9600 Fax: (717) 731-9627 Attorne 's Name: Clifton R. Guise, Es . 1. Settlement Date 07/03/12 J. Summa of Borrower's Transactions K. Summa of Seller's Transactions too Gt•oss Amount Due From Borro«er .too Gross Amount Due To Seller lot Contract Sales Price S 130,000.00 aoi Contract Sales Price $ 130,000.00 102 Personal Pro erty 5 - -toe Personal Pro ems $ - to3 Settlement C1iarL*e~ S 2,512.00 -to? 5 - to-t $ - .tot $ - t05 S - ao5 5 - Adjustment for Items Paid by Seller in Advance Adjustment for Items Paid by Seller in Ad~•anec 106 Tottnshi Taxes from 07;'0,1_' to L''~1-12 S - -306 Townshi Tales from 0703,13 to 12'31,'12 $ - lo? C ounty Tales from 07'0 ~! 12 to I Z-`? 1. 12 $ 350.39 -to7 County Faxes from 07; 03-` 12 to 12!3 U 1? $ 350.39 los Assessment tiom 07/03; L to 1231-12 $ - .cos Assessment tiom 071031 12 to I?/31~ 12 5 - loy School Taxes from 07!03112 to U6-'30.13 $ 1,516.62 -toy School Taxes from 07 031 12 to 06130 13 5 1,516.62 tto Se~~•er from 07.03%12 to 09='3011? $ 53.79 -tto Se~~•er from 07`03112 to 09/30%12 $ 53.79 111 Trash from 0?%03~` 12 to 0930:' 12 5 52.76 t t l Trash from 07:`03r 12 to 09- 30' I Z $ 52.76 I1'_ 5 - •11'_ - ~ - 1 l 3 -t 13 - v~ - II-! -11-! - $ - t20 Gross Amount Due From Borro~rer 5 134,485.57 ago Gross Amount Due to Seller 5 131,973.57 20o Amounts Paid b~• or in Behalf of Borro~ser goo Reductions in amount Due to Seller 'oi De osits ~ - Sot De osii Held by Seller 5 - 202 Priuci al Amount of Ne~~~ Loan $ - 50_' Settlement Charges to Seller 8 86,818.53 203 Existing Loans Taken Sub'ect to S - 503 Existinn Loans Taken Sub'ect to 5 - ,o~ , _ 50.t S - 205 Credit for Pre-Distribution to Buyer 5 45,155.04 505 Credit for Prt-Distribution to Buyer $ 45,155.04 'O6 ~ - 5Q6 ~ - ,p7 50' - ~ - 20S vS - 508 - S Ad'ustments for Items IIn aid by Seller Ad~ustments for Items L'n aid by Seller 21o CitvTases from Ol'O1%12 to 07.'03`12 ~ - 51U CitvTaxes from 01-'01'12 to 07'03.'1'_ 5 - 't I C'ounri• Taxes from 01 '0 l : 12 to 07'03 12 $ - 5 t 1 County Taxes fmm 01 `01, 12 to 07'03; 12 8 - 2t2 Assessment from 01f0U12 to 07'03:12 5 - 51'_ Assessment tiom 01'01!12 to 0703,`12 $ - 213 School Taxes from 01 !01 ' 12 to 07- 03 ~ L' $ - ~ 13 School Tales from 01 %01 ' 12 to 07'03' 12 5 - 21-! from O1.0U12 to 07'03112 5W from 01'01!12 to 0~~'U3'12 8 - 21 ~ from 01'01 ~ 12 to 07; 03 ~ 12 ~ t 5 from 01.0 U 12 to 07'03' 12 5 - 'l6 ~ - 516 $ - 'I? $ - 51? 5 - 22o Total Paid by-- far Borrower $ 45,155.04 52o Total Reductions in Amount Due to Seller $ 131,973.57 30o Cush ai Settlement From/To Borrower 60o Cash at Settlement To/From Seller 301 Gross Amount Due From Borro~rer S 134,485.57 601 Gross Amount Due to Seller $ 131,973.57 302 Less Amount Paid bw'for 13orro«•er $ 45,155.04 602 Less Reductions in Amount Due to Seller 8 131,973.57 303 Cash from Borrower $ 89,330.53 603 Cash from Seller $ 0.00 S'e4~e~.~.e.r,e I~-, ~-Fe~ R ~ ~- L. SETTLE~IEIT CIL-IRGES Paid liom zoo Total Real Estate Broker Fees BormS~-er's p aid from Di~-ision of Colmnission (Line 700) as follo~cs: S I :0.000.00 (ti ~.o~a = 57,300.00 Funds at Sell er's Funds '0- 50.00 to Settlement at Settlement ?o~ SOAO to 'u? C'omniissiou Paid at Settlement S - S - 'oa to S - S - -05 Broker Fee to S - S - soo Items Pa~•able in Connection r~'ith Loan S - S - sot Ourorieinationcharee to S - rfromGFE-t) S - S0~ 1'au credo or charee amts for the s ecitic inrerest rare chosen S - i born GFE =_ 1 5 - 5 - SO? 1~our adjuaed oti~inatiou dYlr~es to S - t tium GFE =.-~1 S - S - stuA raisalFee to ~ - itirnnGFE=:) 5 - S - St15 Credit Re . ort Fee [o $ - t front GFE = ~) S - 5 - St/6 Tax Sen'ice Fer to S - Riont GFE =?j S - S - s0' Flood Detcmiination Fec to S - t,fruw GFE _+) S - S - SOS to S - f from GFE = i S - 5 - gpy to S - t front GFE ~ 1 $ - 5 - slo to S - S - 311 Io 5 - 5 - 90o Items Re wire b~• Lender to be Paid in Ad~-ance iol Interest from 07 03 12 ro at S - er da~• tuom GFE =1oi 5 - S - ~o_ i\tortgage Insurance Premium for months to ifrom GFE _?) S - S - ~~0? Flazard Insurance Premium for ~~ears S - ifrom GFE =t 1 i S - S - vw 0 S - 5 - tooo Reser~•es De osited kith Lender for: tool Initial De osit for ~•our escro5c itirnn GFE =9) S - S - ti)UZ Houleo+5'uet's htswutce 1110nt1U `(( S - er momh $ - too. ;tlongage Insurance months !~i S - er month S - low Citt• Pro ~~rn• Taxes months '?i S - er month 5 - ]tw5 Cntc Pro em Tries months <a S - er month 5 - looc School Taxes months'h S - er month S - too~ Aggregate Anah:~is Ad ustment S - itoo Title Char es t 101 Titir Sen•ices and lender's title iusunnce ifirnn GFE =-ti S - t 10_ Title Search to Ioimi Abstract C'om am- S 12.00 t ui ~ Attorne~• Fees to S - 5 - t uia Attometi• Fees to Gates. Halbruner. Hatch & Guise. P.C. S 1.000.00 S - t 105 Ownei s Title Insurance i frow GFE ~.) S - S - 1 tor> Lender's Title Insurance S - S - 1 ta7 Lender's Title Police Limit S - t los O55mer's Title Polio- Limit S - t Io9 Aeelu's ortiau of the total title iunuauce reuliuui to S 125.00 1110 L'ude»~•riter'~ onion of the total title insurance to S - IIII to 5 - 5 - It1= Io 5 - $ Ill? t0 5 ~ - izoo Go~•ernment Recordin and Transfer Charges IZoI Gorernntent Recording Fees itiowGFE ~'i S 62.00 S - 1 Zoe Deed 5 62.00 Mortgage S - Release 5 - t X03 Transfer Tas tfrow GFE =s) S I . •00.00 S 1.300.00 1_ot Cin• Cowin' tax. Siam s Deed D4ortgage S - S - 1~05 State tax Stani s Deed 114ortgaEe S - S - I_OG I_'U' 1300 Additional Settlement Char es 1;01 Tax Certification to Bonnie Ii. Miller ifrom GFE = I S 10.00 S - lsoz 2012 2013 School Taxes to Bonnie Iti. 'Miller I$etu GFE = 1 S - S l .? 30.2-1 130? hit.omin°_ t~UtgOtng L\~lle Fee f0 Inl~artt}" Baril: (from GFE = ) S 15.00 5 ~0.()C1 t3t>t 3rd Quarter Seiner & Trash to LoS~~er Allen TotS•nshi i5om GFE = i S - S I08.9~ t?at Partial Estate Distribution to Aticl><~el R. \l'anier IC'redit ou Paee t) 3~° o Share (frow GFE = i S - S - I X05 Partial Estate Distribution to James T. ~~'arner 3~°o Share tfrow GFE = i S - S -t>.15~.0~ t?o~~ Partial Estate Distribution to Deborah E. Barr 6°o Share tfrow GFE = ) S - S 7.7-JO.S6 t?o' Partial Estate Distribution to Brock ~1. ~t"arner 6°. o Share room GFE = i S - S 7,7-10.86 1?os Partial Estate Distribution to ~i<•ii-issa k. \i'arner G°i, Share rtiotuGFE = i S - S 7,7-40.36 1?0~~ Partial Estate Distribution to Kelse~• N. tiell 6°a Share (fiomGFE = t S - S 7,7-10.86 1?10 Partial Estate Distribution to Zachan~ J. ~t'amer 6°o Share ifrom GFE = r S - S 7.7-10.86 t. i l to 1 born GFE = t S - S - 1400 TOTAL SETTLE:IIE`T CHARGES 5 2,512.00 5 86,818.53 1 ha+'e caretnlh' re1'1e15'e(I the HI_'D-1 Settletneut State and to the best of ult' kuot+'ledge and belief. it is a tnte snit accwate statement of all receipts and disbmseutent taade on un account orb} ma in dli, ttau~utiou. I fiutltet certih' that I hate recei5'ed a cope of dre Hi'D-1 Settlewent SnSteuteut. Borro~~'er; $orro~cer: ~~~~~~ Date: Date `fie : el R. 1l"arner `-- - - Sell Ier: (~ Seller: '~a~l~~~ ='-'"-Late: -- Date Estate of Martha L. ti"arner The Hi'D-1 Settlewent Stateweut ~.+htcb I hate ptep;urd ii a nua and accurate account of this transaction. I bare caused or +5'ill cmue the tituils to he disbmso'd in accouLutce ;eith this ,tateutent Settlement agent: Clifton R. Guise, Esq. Date 1Caruiuu. it is a criute to kuoo'iueh' make false stateuteut to the L?nired Stairs ou this or au~• other suuilar Loon. Peualnes upon crnniction iudude a fine and impnsomnent Fer details see: Title t 3 C'_S. Ccxie Sechou 1001 and Section 1010. ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Martha L. Warner 2012-00231 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1~ Orrstown Bank checking accunt #1490007540 -checks which cleared post date of death that were written prior to date of death #171 to United Water 11.00 #172 to Koppy's Inc. 1,206.93 #173 to Lawnscapes 28.00 #174 to Ripe for Harvest 2,000.00 2. Comcast -final cable bill 6.10 3. US Treasury - 2011 Federal individual income taxes due 7,498.00 4. Pa. Dept. of Revenue - 2011 Pa. Individual income taxes due 114.00 5. Messiah Village -final nursing home charges 1,952.00 6. Verizon -final telephone bill 34.19 7. PPL -electric bill from 116112-216112 275.87 8. Verizon Wireless -final) cell phone bill 56.27 9. Barclaycard US - BJs credit card bill 7.92 10. Penn Waste -trash bill prior to death 44.35 TOTAL (Also enter on Line 10, Recapitulation) I $ 13,234.63 If more space is needed, insert additional sheets of the same size, ~~~-~~ ~ ~~~t 3/27/12 Mamba L Warner CIS' address change Last stmt balance: Current balance: Control: Posted effect _ 1/17/12 1/17/12 __ 1./1.8/12 1/18/12 _ "1/20/12 1/20/12 2/03/1.2 2/03/12 _ 2/03/12 2/03/12 _ 2/02/12 2/02/12 _ 2/08/12 2/0$/12 2/13/12 2/13/12 ~1 17 12 2/17/12 I 2/16/12 2/16/12 -- _ 2/17/12 2./17/12 Deposit Inquirer Account number: Closed I+~essages Passport AT1~/Dr Card .00 Last stmt date: .00 Statement cycle: -- C H E C K S -- _ Batch Segv.ence S rc T/C Amotxrit 0010 0120003700 P 091 450.00 0030 0020006000 P 091 121.87 0010 0010011800 P 091 44.24 0012 2534012549 C 183 512.99 0010 0120015300 P 091 4,950.00 0010 0100003600 P 091 106.00 0010 0310001000 P 091 951.00 5398 0019077297 C X83 4_ 0010 0210011400 P 091 ~ 11.00 0010 0020001200 P 091 1, 206_..-83 0010 0120014600 P 091 28.00 J_ 2./14/12 2/14/12 0010 0300016300 P 091 _ 2/14/I2 2/14/12 0100 0040011800 P 090 3,000.00 1,000.00 F7=Scan forward F8=Scan backwards F17=Top F18=Bottom F20=Show Payee 171 173 ~1,~~~, S , OS i r ~ 17 4 ~-~ G~ 177 Bot tom F22=T/C 1.3:31:59 1.49000 754 I of 1 3/12/12 63 Serial 162 163 164 165 166 167 169 170 4 ~,01 1 1~~~~T Account Num 09547 205171-03-9 Billing Date 01 /281 Total Amount Due $88.28 Auto Pay 02125/12 Page 1 o f 2 Contact us: www.comcast.com ~ 717-540-8900 _ _ _ _ __ __ _ _ _ _ __ _ __ _ _ _ M WARNER Previous Balance 89.54 F rvice ~ Payment- 01125/12-thank you -$9.54 17 PHEASANT ST ECHANICSBURG PA 17050-3145 ~ New Charges -see below 88.28 Total Amount Due $88.28 News from Comcast Auto Pay 02/25/12 Comcast has all the speed you need to do everything you want on the Internet -- faster, including our Performance Starter tier, with speeds up to 6 Mbps, far $49.95 per month Thank you for your prompt payment. You are enrolled in the Comcast Auto Pay Program. The amount due which will be deducted from your bank account or will be applied to your credit card may include charges incurred or credits issued after the statement prepared date. Details of any charges or credits posted after the statement date will appear on your next bill. The amount due will be debited from your account on the 25th. Hearing/Speech Impaired Call 711 XFINITY TV 81.88 Taxes, Surcharges & Fees 6.39 Total New Charges $88.28 ,~,""~"~ ~D ~~~~v 3 m m ~, 0 0 nrr~rCZ•n T~.,,oc F ta~rncr n~/n~/7n11 040 Department of the Treasury-Internal Revenue Service (99) le in this space ite or sta t i d O ~° U.S. Indlvtdual Income Tax Return OMB No. . p wr o no y- n 1545-0074 IRS Usa For the year Jan.1-Oec. 31, 2011, or other tax year beginning , 2011, ending , 20 See separate instructions. Your first name and initial Last name Your soda! securtty number ;y James E Warner -- ~ CLy ~~~Lf,f ~ ~~ -.}i";. ~S -'c~~~~' ~ 3 1 188-20-8998 If a joint return, spouse's first name and initial Last name Spouse's social security number Martha L Warner ~- ~-~eCeaS~c1 z l~ Z. 211-18-1230 Home address (number and street). if you have a P.O. box, ses instructions. Apt. no. ~ Make sure the SSN(s) above and on line 6c are correct. 17 Pheasant Street City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Preslderrtial Election Campaign Mechanicsburg PA 17 0 5 0 check here it you, or Your spouse if firing l~~ty' waM ~ to go to this fund. checking Forei n rovince%oun Foreign country name 9 P tY Foreign postal code a box below will not change your tax or refund. ~ You ~ Spouse Filing Status 1 ^ Stngle 4 U Head of household (with qualifying person). (See instructions.) ff 2 ®Married filing jointly (even if only one had income) the qualifying person is a child but not your dependent, enter this Check only one 3 ^ Married filing separately. Enter spouse's SSN above child's name here. - box. and ful! name here. - 5 ~ Qualifying widow(er) with dependent child 6a ®Yoursetf. If someone can claim you as a dependent, do not check box 6a . 1 Boxes checked Exemptions J on Sa and 6b 2 b ®S ouse No. of children If more than four dependents, see instructions and check here - ^ c Dependents' (2) Dependents (3) Dependents l4) / if cfiifd under age 17 qualifying for child tax credit (1) First name Last name social security number relationship to you (see instructions) -- ^ d Total number of exemptions claimed Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 8a Taxable interest. Attach Schedule Brf required L 8b b Tax-exempt interest. Do not include on line 8a Attach Form(s) W-2 here. Also ga ordinary dividends. Attach Schedule B if required d i id L gb I 3 2 8.` attach Forms b s en v Qualified d W-2G and 10 Taxable refunds, credits, or offsets of state and local inco me taxes 1099-R if taut 11 Alimony received was withheld. ~ 2 Business income or (loss). Attach Schedule C or C-EZ 13 Capital gain or (toss}. Attach Schedule D if required. If not required, check here - If you did not 14 Other gains or (losses). Attach Form 4797. get a W-2, 15a IRA distributions 15a 4 2 2~2 5 7 . b Taxable amount $OLI,OV~R see instructions. ROLLOVE R 16a Pensions and annuities 16a - 212 , 8 6 6 . b Taxable amount 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E Enclose, but do 18 Farm income or (loss}. Attach Schedule F . not attach, any payment_ Also, 19 Unemployment compensation . . please use 20a Social security benefits ~ 20a ~ 2 8 , 6 6 0 . f ~ b Taxable amount Form 1040-V. 21 Other income. last type and amount 22 Combine the amounts in the far right column for lines 7 through 21. This is your total income - 23 Educator expenses 23 Adjusted 24 Certain business expenses of reservists, performing artists, and GiCOSS fee-basis government officials. Attach Form 2106 or 2106-EZ 24 Income 25 Health savings account deduction. Attach Form 8889 25 26 Moving expenses. Attach Farm 3903 26 27 Deductible part of self-employment tax. Attach Schedule SE 27 28 Sel#-employed SEP, SIMPLE, and qual~ed plans 28 29 Self-employed health insurance deduction 29 30 Penalty on early withdrawal of savings . 30 31 a Alimony paid b Recipient's SSN - 31 a 32 IRA deduction 32 33 Student loan interest deduction . 33 34 Tuition and fees. Attach Fom18917 . 34 35 Domestic production activities deduction. Attach Form 8903 on 6c who: • lived with you • did not t'rve with you due to divorce ~ separation (see instructions) Dependents on 6c not entered above 7 8a ea 10 11 12 13 14 15b 16b 17 18 is 21 22 36 Add lines 23 through 35 36 37 Subtract line 36 from line 22. This is your adjusted gross income - 37 For Disetosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. gpA REV oti2ut2 TTw Add numbers on a lines above - 1, 154 . 124. 328. 74. 81. 51, 602 . 26, 026. 10 044. 24 361. 113.794. 113, 7 94 . ~ Form ~ ~0 (2011) ;';~f0 (2011) ax and ~ Amount from line 37 {adjusted gross income) . 39a You were bom before January 2, 1947, ^ Blind. 1 Total boxes Check ® <t Credits ' ~ J if: ®Spouse was bom before January 2, 1947, ^ Blind. checked - 39a 2 d d b If your spouse itemizes on a separate return or you were adual-status alien, check here- 39b^ ar stan Deduction 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) for- •People who 41 Subtract line 40 from tine 38 - check any 42 Exemptions. Multiply $3,700 by the number on line 6d . box on line 39a or 39b or 43 Taxable income. Subtract fine 42 from line 41. if tine 42 is more than line 41, enter -0- who can be claimed as a 44 Tax (see instructions). Check if any from: a ^ Form(s} 8814 b ^ Form 4972 c ^ 962 election dependent, 45 Alternative minimum tax (see instructions}. Attach Form 6251 see instructions. 46 Add lines 44 and 45 - • All others: 47 Foreign tax credit. Attach Form 1116 if required . 47 Single or Marred filing 48 Credit for child and dependent care expenses. Attach Form 2441 48 separately, $5,800 49 Education credits from Form 8863, line 23 ~ Married filing 50 Retirement savings contributions credit. Attach Form 8880 50 jointly or Qual~fyin 51 Child tax credit (see instructions) 51 widow(er}, 52 Residential energy credits. Attach Form 5695 52 $11,600 53 Other credits from Form: a ^ 3800 b ^ 8801 c ^ 53 Head of household, 54 Add lines 47 through 53_ These are your total credits . $8,500 55 Subtract line 54 from line 46. If line 54 is mare than line 46, enter -0- - Other ~ Self-employment tax. Attach Schedule SE 57 Unreported social security and Medicare tax from Form: a ^ 4137 b ^ 8919 Taxes 58 Additional tax on IRAs, other qualfied retirement plans, etc. Attach Form 5329 'rf required 59a Household employment taxes from Schedule H b First-time homebuyer credit repayment. Attach Form 5405 if required 60 Other taxes. Enter code(s) from instructions 61 Add lines 55 throu h 60. This is our total tax - 62 Federal income tax withheld from Forms W-2 and 1099 62 Payments 63 2011 estimated tax payments and amount applied from 2010 return 63 7 , $ 3 2 - ~ tf you have a 64 Earned income credit (EIC} - - 64a qualifying child, attach l EIC d h S a b Nontaxable combat pay election 64b Attach Form 8812 65 Additional child tax credit 65 e . u c e . 66 American opportunity credit from Form 8863, line 14 66 67 First-time homebuyer credit from Form 5405, line 10 . t37 aid with request for extension to file 68 Amount ~ p 69 Excess social security and tier 1 RRTA tax withheld 69 70 Credit for federal tax on fuels. Attach Form 4136 70 71 Credits from Form: a ^ 2439 b ^ 8839 c ^ 8801 d ^ 8885 71 ?2 Add tines 62, 63, 64a, and 65 through 71 _ These are your total p ayme nts - - Refund 73 If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid 74a Amount of line 73 you want refunded to you. if Form 8888 is attached, check here - ^ i Direct deposit? - b Routing number ~ X ~, X ~. X j X i~_X~ X X ~ X i - c Type: ^ Checking ^ Savings see - d Account number i X 1 X i X j X i X~ X 1 X i X 1 X i X~ X i X~ X M X i X i X{ X i instructions. 75 Amount of line 73 you want applied to your 2012 estimated tax - (75 Amount 7s You Owe 77 Third Party Designee Sign Here Page ~ 113 , 7 9 4~- 40 13, 900 . 41 99, 894 . 42 7, 400 . 43 92, 4 94 . 44 15, 330 . 45 0 . 46 15, 330. 54 55 56 57 59a 59b 60 61 72 73 74a Subtract line 72 from line 61 For details on how to pay, see instructions - 76 15,330. 15,330. 7.832 . 7,498. Amount you owe. • Estimated tax ena see instructions ~ Do you want to allow another person to discuss this return with the IRS (see instructions)? ^ Yes. Complete below. ®No Designee's Phone Personal identification name - no. - number (PIN) - Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, con-ect, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signatur I Date Your occupation Daytime phone number Joint return? See L f ~rd ~ ~a ~) ~~ ~ ~ (,~•-'7~ ( J instructions. _ ~ ~~~ ~aNi't-L ~-~~~ . Keep a copy for Spouse's signature. If a joint return, both must sign. Date Spouse's occupation If the IRS sent you an Identity Protection your records. -, Paid Preparer Use Only PrintlType preparer's name ~ Preparer's signature Date Firm's EIN - PIN, enter it here flee inst. PTIN Check ^ if self-employed Film's name - SELF P Firm'c arlr~rtacc - REV 02/22/12 T7W Form 1 U4U (2011) __ J 1,1007,1,005 PA-40 ~O 1 ~ co$-11) (FI) Pennsylvania Income Tax Return PA Department of Revenue, Harrisburg, PA 17129 OFFICIAL USE ONLY PLEASE PRINT IN BLACK INK. ENTER ONE LETTER OR NUMBER IN EACH BOX. FILL IN OVALS COMPLETELY. . Your Social Security Number 211-18-1230 Last Name Warner Your First Name Martha Spouse's First Name Spouse's Social Security Number (ifi filing jointly) ~ Extension. see the instructions. Spouse's Last Name -Only if different from Last Name above First Line of Address 17 Pheasant Street Second Line of Address City or Post Office Mechanicsburg Daytime Telephone Number Suffix MI L OVERSEAS MAIL. - MI See Foreign AddresslnsWdions in PA-40 booklet. Suffix State ZIP Code PA '! 7050 School Code 21160 I Amended Return. See the instructions. Residency Status. Fill in only one oval. R Pennsylvania Resident N Nonresident P Part-Year Resident from /2011 to /2011 Filing Status. Fill in only one oval. S Single J Married, Filing Jointly ® M Married, Filing Separately F Final Return. Indicate reason: D Deceased. Date of death /2011 Identification Label Change. Fill in this oval if the label is not completely correct. Discard the incorrect label. Fill in this oval if you did not file a 2011) PA tax return. Farmers. Fill in this oval if at least two-thirds of your gross income is from farming. Name of school district where you Lived on 12/31/2011: Cumberland Val Your occupation Spouse's occupation homemaker 1 a. Gross Compensation. Do not include exempt income, such as combat zone pay and qualifying retirement benefits. See the instructions . ............................. 1 a. 1 b. Unreimbursed Employee Business Expenses . ................................. 1 b. 1 c. Net Compensation. Subtract Line 1 b from Line 1 a ............................... 1 c. 2. Interest Income. Complete PA Schedule A if required . .......................... 2. 92.00 3. Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required... 3. '4'~~ • ~~ 4. Net Income or Lass from the Operation of a Business, Profession or Farm. ... LOS 4. 5. Net Gain or Loss from the Saie, Exchange or Disposition of Property. ........ Loss 5 6. joss Net Income or Loss from Rents, Royalties, Patents or Copyrights............ 6. 9,205.0 7. Estate or Trust Income. Complete and submit PA Schedule J . .................... 7. 8. Gambling and Lottery Winnings. Complete and submit PA Schedule T. ............. 8. 9. Total PA Taxable Income. Add only the positive income amounts from Lines 1c, 2, 3, 00 9 706 9 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6 ............... . . ~ 10. Other Deductions. Enter the appropriate code for the type of deduction. See the instructions for additional infomlatian. ........................ 10. 11. Adjusted PA Taxable Income. Subtract Line 10 from Line 9 . ..................... 11. 9,706.00 Side 1 EC OFFICIAL USE ONlY FC 0053 ],1,00110053 1,1,0017, ~A~4® ~0" (08-11) (FI) 1,10021,0051, Social Secure Number (shown first) ty 211-18-1230 Name(s) i ................. 12. 298.00 12. PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307).... . .~ ........................... 13. 13. Total PA Tax Withheld- See the instructions. ...... . ................ 14. 89.00 14. Credit from your 2010 PA Income Tax return . ................ . 95.00 15. 2011 Estimated Installment Payments. Fill in oval if including Form REV-4598. 15. ......... 16. 16. 2011 Extension Payment ........................................ . 17. Nonresident Tax Withheld from your PA Schedules} NRK-1. (Nonresidents only) .... 17. 18. 184.00 18. Total Estimated Payments and Credits. Add Lines 14, 15, 16 and 17 . ........... . Tax Forgiveness Credit, submit PA Schedule SP Dependents, Part B, Line 2, 19a. Filing Status: Unmarried or Married Deceased 19b. PA Schedule SP....... • . Separated 20. Total Eligibility Income from Part C, Line 11, PA Schedule SP. . ................ 21. 21. Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP. . 22. Resident Credit. Submit your PA Schedule(s) G-R with your PA Schedule(s) G-S, G-L, andlor Rl(-1 .................................... 22. - . 23. 23. Total Other Credits. Submit your PA Schedule OC ................ . . • - - - - - - - 24. 24. TOTAL PAYMENTS and CREDITS. Add Lines 13, 18, 21, 22 and 23.......... - • - 25. USE TAX. Add amount. See the instructions . ................................. 25. 26. TAX DUE. If the total of Line 12 and Line 25 is more than Line 24, 26• 1 ~ ~.00 enter the difference here . ............................................... . 27. Pena{ties and Interest. See the instructions for additional information. Fill in oval if including Form REV 1630/REV-1630A .... - . 27. 28. TOTAL PAYMENT DUE. See the instructions .................................. 28. 1 14.00 29. OVERPAYMENT. If Line 24 is more than the total of Line 12, Line 25 and Line 27 29 enter the difference here .......................... • • • • The total of Lines 30 through 36 must equal Line 29. 30. Refund -Amount of Line 29 you want as a check mailed to you......... F2EFUND 30. 31. Credit -Amount of Line 29 you want as a credit to your 2012 estimated account. .... 31. 32. Amount of Line 29 you want to donate to the Wild Resource Conservation Fund.... 32. 33. Amount of Line 29 you want to donate to the Military Family Relief 33. Assistance Program. ................................... 34. Amount of Line 29 you want to donate to the Governor Robert P. Casey Memorial 34. Organ and Tissue Donation Awareness Trust Fund . ....................... . 35. Amount of Line 29 you want to donate to the Juvenile (Type 1) Diabetes Cure 35. Research Fund ...... ............................ 36. 36. Amount of Line 29 you want to donate to the PA Breast Cancer Coalition's Refunds For Breast and Cervical Cancer Research Fund . ................... . ....... . SIGNATURE(S). Under penalties of perjury,l(we) declare that 1(we) have examined this return, Including all accompanying schedules and statements, and to the best of my taurl belief. they are true, correct, and complete. Out Preoarer's PTIN Your Signature Spouse's Signature, if feting jointly Date E-File Opt See the instructions. `'~ ~ bl ~~ Preparer's Name and Telephone Number FEIN PLEASE DO NOT CALL ABOUT YOUR REFUND UNTIL EIGHT WEEKS AFTER YOU FILE. Side 2 L 110021051 110021,0051 J ~vle.ssi a 1-~ 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 MICHAEL WARNER 101 PENNS RUN ROAD MECHANICSBURG, PA 17055 Form PB-O1 RESIDENT # UNIT STMT. DATE 121121 028 W 02/29/2012 RESIDENT S Mrs. MARTHA L. WARNER TOTAL AMOUNT DUE $1,921.00 DATE DUE 03/31/2012 DATE DESGRtPT10N RATE Days/ iJni~s + ~ CHARGES CREDITS DA! ANGE Balance Forward 31.00 02/29/2012 PAYMENT RECEIVED -THANK YOU!!! 31.00 0.00 x:~x Nursing Care :~:xx 02/01/201.2 DAILY PHONE CHARGE (WAGNER) 1.00 13.00 13.00 13.00 02/13/2012 RM/ BRD -NURSING -SEMI-PVT 314.00 6.00 1,884.00 1,897.00 02/08-02/13 02/13/2012 AIR MATTRESS 02/08-02/13 4.00 6.00 24.00 1,921.00 ~ ~~ ~~ .v ;~ RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOT L AMOUNT DUE 121121 1,921.00 0.00 0.00 0.00 0.00 $1,921.00 RESIDENT NAME Mrs. MARTHA L. WARNER N!A Pa~o~ Please make check payable to Messiah Village. A 1 `% finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you'. If you have any questions or concerns about ,your bill, please address them directly to Fiscal Services at 790-8220. Thank You! ~Vie.ssiati 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 MICHAEL WARNER 101 PENNS RUN ROAD MECHANICSBURG, PA 17055 Form PB-O t RESIDENT # UNIT STMT. DATE 121121 028 W O1 /31 /2012 RESIDENT S Mrs. MARTHA L. WARNER TOTAL AMOUNT DUE $31.00 DATE DUE 02/29/2012 DATE DESCRIPTION RATE Days/ ~ CHARGES Units CREDITS BALANCE Balance Forward 951.00 01/31/2012 PAYMENT RECEIVED -THANK YOU!!! 951.00 0.00 ~xx Nursing Care YYY 01/01/2012 DAILY PHONE CHARGE (WARNER) 1.00 31.00 31.OU 31.00 ~(Z1~~~" f~" Ir RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 121121 31.00 0.00 0.00 0.00 0.00 $31.00 RESIDENT NAME Mrs. MARTHA L. WARNER N/A PB-~~ Please make check payable to Messiah Village. A 1'% finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! s~r~,,~ s, ~,, s saF' . ,~,,.. ~. 1 'y~~,y .~1~ t ~, s + ~ ,, t i 'zi , s ~^~t ~-,°_ k k;Y x '~,~ '~r'- ,n> - ° c~t~~ •t ~ q k 3"- h..~~~~~. 4.:~~~~~~ ;~ ''tl ~~y~ r t~~''`+ ~ •y .i~ 'r 7 5t. S- „'~ - ~ ~ - ~r _ - Account Nwnber Due Date Amount Due 717 766-6314 422 74Y 3/19/12 $34.19 ~r+~r-_ on _ _ _ Account Information t~~ veri~©n,com ~/iqp ~ B7/IP~+ ":4craount C1%zgts Statement Date: 3/7/12 .9~Pa.1~ '~Pep~~lae ~ ,, ~~~ MARTHA WARNER Phone: 717-766-6314 6o gteen today - Go Paper Frye ~ ~refiz~n.co-~Imy~ierz4rr Account Summary Previous Balance VBrI2t7n NeWS ~ - _. __._..;_T__ _ No Payment Received Don't Move Without Verizon! Balance Forward Call 1-888-416-9691 before you move. We'll help set up your N, Internet and Phone for your new New Charges address. You can be up and running in no time! DON'T WAIT! And be sure to ask it FiOS is available in your Current Activity area. Service availability varies. Taxes, Fees and Other Charges We Want You to Stay With Us Total New Charges You are a valued customer & we want to deliver the Amount Due very best service & value to you. Call us at 1-888-240-8929 to find out about the new ways Final Bill Verizon can save you money. We appreciate being your provider, and we would like to keep you with us longer by improving your Verizon experience. Get More, Save More Call 1-888-251-7944 to ensure you're getting the best Verizon services at the best value -from phone, Internet and N, to money saving bundles, international plans, and tun add-ons. Together we'll Lind ways to save you even more. $51.70 $.00 x',51.70 -$10.46 -$7.05 -517.51 $34.19 /' 3/ZZ/~ Z Questions about your bill or service? View your bills in detail at verizon.com or call 1-800-VERIZON (1-800-837-4966). Enter your ten digit number 717-766-6314. Use 422 if asked for the three digits following your account number. Customers with disabilities can reach us by TTY at 1-800-974-6006. .~.'~C? ~e~dcc.P ~e .~, ~~-,e ~ ~ O Questions? Please ` contact us by Feb 24. 1-800-DIAL-PPL (1-800-342-5775 ) ~~ ~r~,~crrc ~arnrtr~.~ M-F: Sam to 5pm Visit us online at Page 1 pplelectric.com ~ ~ * ~ 46650-82024 Auto Pay Your Electric Usage Profile Service to: MARTHA WARNER 17 PHEASANT ST MECHANICSBURG, PA 17050 Meter: 46307273 Your next meter reading is on or about Mar 7, 2012. This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. 2011 ®2012 150 ~ 125 100 0 75 i;, a 50 oG a 25 e. ~~ Feb 2012 31 Months 1016 ~• • 33 35F Feb 2011 29 3769 130 26F • ~ Feb 6 • Actual t 55687 Jan 6 Actual 54671 31 Days kWh Billed 1016 ~ . • Mar 2011- Feb 2012 1 13773 x • 1148 Mar 2010 -Feb 2011 22817 1901 ~f~t_ p?l+v~c4rtt~, tltllikj~r„ AT 01 05199fi 307758191 At'3DGT ~111111~~~11~1111i1~11~I1~~l~~~l~~~l~l~~~~~~l~~li~ll~f~l~llllil~l MARTHA WARNER 17 PHEASANT ST MECHANICSBURG, PA 17050-3145 Billing Summary {Billing details on back) Balance as of Feb 8, 2012 $0.00 Charges: Total PPL Electric Utilities Charges $42.78 Total Stream Energy PA Charges $233.09 Total Charges ,,1~-_-._ti _ .. $275.87 utomatic Bill Payment o Feb 29, 2012 ~ $275.87 Account Balance '`°~--------..w----d.--~.-~----~' $275.87 PPL Electric Utilities' price to compare far your rate is 7.769 cents per kWh effective 12/1/2011 to 2/29/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn mere or sign up, visit pplelectric.com. information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. Before digging around your home or property, you should always call the state's One Cafl notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Call system. Be safe and call 811 before you dig. Payment Methods Online at: ~ By phone:1-800-342-5775 pplelectric.com or call BiIlMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. By Mail: 2 North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Hausman Road Allentown, PA 18104-9392 Other important information on the back of this bill ~ 0 r--~~~~~ PPL ELECTRIC UTILITIES 2 NORTH 9TH STREET CPC-GENN1 ALLENTOWN, PA 18101-1175 ~li~~~l~~ll~~~~i~l~i~~~l~l~~ll~ll~l~l~l~~ll~l~~~ll~~~l~l~~~i~~~~~ 1 9?00002758770000275870 4665082024 S~CI~~'G~P,C~I ~ ,~~ Z7~°r~ 7 J F M A M J J A S 0 N D PPL Electric Utilities 827 Hausman Road Allentown, PA 18104-9392 Tel. 800.342.5775 Fax 484.634.3484 www.pplelectric.com MARTHA WARNER 17 PHEASANT ST MECHANICSBURG February 24, 2012 PA 17050 ~ ,s ~ ; ~ ~ i ~o• ^.. ~1~; '~~ `rr~ Sili ~iccount #: 46550-32024 ABP Plan Rer>c;:ove Date: 02/24/12 For: 17 PHEASANT ST Due Date: 02/29/12 MECHANICSBURG Balance Due: 5.87i' ~~- PA 17050 Dear Martha Warner: As you requested, we removed your account from our Automatic Bill Payment Plan on the date shown above. Your current bill WILL NOT be automatically withdrawn from your bank account. You can pay your bill either on-line by signing up at www.pplelectric.com or mail your payment to: PPL Electric Utilities Cash Processing Center - GENN 1 2 N. 9th Street Allentown, PA 18101 I{ you cannot pay the account balance by the due date, please_call us at 1-800-342-5775 to make other arrangements. Sincerely, PPL Electric Utilities ~~~ ~~ ~~ V abprem t .doc_071962_1630350 very ` onwireJess Po BoX 4003 Manage Your Account & View Your Usage Details Account Number Date Due ACWORTH, GA 30101 ~. ; ` _ . - Invoice Number 669993726Q 60000506 01 AT 0.371 "AUTO T2 0 1223 17050-314517 E PHIL2304 ~Il~illll~~l~l~i~~~~ilill~li~~~~li~~lill~~l~~~~i~i~~~li~~~lii~il~ MARTHA L WARNER 17 PHEASANT 5T MECHANICSBURG, PA 17050-3145 i Verizon Wireless has chosen to offer ~~ wireless emergency alerts within portions of its service area. See last '~, page of bill for more details. i _ _ (see back for details) No Payment Received Adjustments Credit Balance Monthly Access Charges Usage Charges $48.80 $.00 -$149.23 -- -_ _- - - -$100.43 -$16.55 Voice $22.95 Verizon Wireless' Surcharges and Other Charges & Credits $141.44 Taxes, Governmental Surcharges & Fees $8.86 Total Gurrent Charges $156.70 Total Charges Due by March 18, 2012 $56.27 Pay from Wireless Pay on the Web Questions: ,_ ~ Y r ,. • - - - _ Payment Due Date - -- March 16, 2012 ~ ~=Minimum Payment Due ~7 GG ~ ' Pre~~ious Balance X512.9° '' Statement Balance S7.`~2 Customer News Visa Signature® Statement Page 1 of 4 Primary Account (Number Ending in: 8x44 Questions? Call 1-866 483-~~678 ..YOUR ZU71 ANNUAL SUIIAMARY_- statement Billing Period: 01/ZOl1 Z - CZ/i 9/1 Z ! ril.'il•~i.BarclaycardUS cam STATEMENT IS NOUN AVAILABLE Account Summary Activity Summary `Your:Z(311 Annual Summary Statement is rtow,available ©niir~e. To view your Annual Summary ', 'Statement, lag into' wwwBarclaycardUS.com and click on 'Statements'. From the statement period dr©p-down box, select '2fl11 Annual Summary` to view, download and: punt your statement. f Minimum Payment Due $7.92 Previous Balance $512.99 Payment Due Date 03/16/12 -Payments $1,190.18 Statement End Date 02/19/12 + Purchases $685.11 Revolving Line $19,500.00 -Other Credits $0.00 Available Revolving Line $19,492.08 + Balance Transfers $0.00 Cash Credit Line $7,800.00 + Cash Advances $0.00 Available Cash Line $7,800.00 + Fees $0.00 Past Due Amount $0.00 + Interest $0.00 Overlimit Amount $0.00 Statement Balance $7.92 It s that easy. Payment Information -__ ___ - ENlt3Y THE CONVENIENCE `Statement Balance - __ --- _--_ ____ - _----- $7.92 Nave you logg>ad into your acc©unt ~I Minimum Payment Due $7.92 at vuww.$arclaycardUS.com yet?-You ~ Payment Due Date 3/16/2012 can-.view up-to~date'account activity, ', Late Payment Warning: If we do not receive your minimum payment by the date dovvriioad transactions, make '; listed above, you may have to pay a late fee of up to $35.00 and your APRs may be payments end even transfer 'increased up to the Penalty APR of 30.24%. - -_ - _ balances 24 hflurs a day, 7 days a _-- _ _ -- _ _ - ___ __ - -_ _ - - - - - --_ . _ _ week's Reward Summary 2,182 0 690 0 690 0 0 2, 872 i 5,000 Detach hi?rE, P18a~^ ^^"!'^ '~"'t"' ^""'~t^ `^ "~„'~ Services" and inclu''~ ~~'^ ^°""'-"` '^"^^ ^ '^ the enclosed envelcRe. Please allow 7-1U days for U.S. Postal Service delivery ---~ ~e~ecCu_le .~, Sty, g MARTHA L WARNER 17 PHEASANT ST MECHANICSBURG, PA 17050 29 -Feb i 29 -Feb Penn Waste, Inc. P O Box 3066 York, PA 17402 www.pennwaste.com Phone (717) 767-4456 Fax (717) 767-4285 (0001) MARTHA L WARNER 17 PHEASANT ST, MECHANICSBURG PA Serv #001 Curbside Trash & Recycling 32.00 Curbside Trash & Recycling O1Apr12-307un12 Municipal Administrative Fee O1Apr12-307un12 r i 3 ?~,~ Z l t INVOICE 0002028863 1 - Feb-29-12 RS 44777 0 • ® , $44.35 ~ ~ 1.00 ~ $43.35 i 1.00 i $1.00 ~,~1' eGQ.u.E-~ Z, ~t2 n~ to REV-1513 EX+ (O1-1Q) ~ pennsylvania SCHEDULE 17 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Martha L. Warner 2012-00231 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) _ OF ESTATE I I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under 1. 2. 3. 4. 5 ~ 6 7 >~ II 1. 1. Sec. 9116 (a) (1.2).] Michael R. Wamer, 101 Penns Run Road, Mechanicsburg, PA 17050 son James T. Warner, P.O. Box 2236; Davidson, NC 28036 son Brock M. Wamer, 101 Penns Run Road; Mechanicsburg, PA 17050 grandson Marissa K. Hiester (formerly Warner), 4112 Beechwood Ln., Apt. J, Harrisburg; PA 17112 granddaughter Kelsey N. Nell, (formerly Warner), 399 Bermudian Creek Road, East Berlin, PA 17325 granddaughter Intrust for Zachary J. Warner, Michael R. Warner, Trustee, 101 Penns Run Rd., Mechanicsburg, PA 17050 grandson Deborah E. Barr, 4008 Cherokee Avenue, Camp Hill, PA 17011 friend ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE, NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 326,508.11 326, 508.11 55,972.83 55,972.83 55,972.82 55,972.82 55,972.82 •lAT~~ Ar w•nT r* r~ITrn TnrAl Alnr,l TAVAOI C f1TCTl1TQIITTn AIC nAl I TAIC ,~ nc oc~~_t Cnn rn~rGO cuFGT It If more space is needed, use additional sheets of paper of the same size.