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Home My WebLink About12-07-12 (2)REV-1500 EX (d2-",IF° PA Department of Revenue Bureau of Individual Taxes PO BOX 260601 Harrisburg, PA 17128-O60t ENTER DECEDENT INFORMATION BELOW 1505611186 INHERITANCE TAX RETURN Social Security Number Date of Death Decedent's Last Name FELDMAN OFFICIAL USE ONLY County Code Year File Number MMDDVI'YV Dale Of Binh MMDD1'V1'V 01071912 Suffix Decedent's First Name RENEE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW MI R MI ^ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) ^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust - 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ^ ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death 1 95 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) - ) Between 12-31-91 and 1- CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DAVID A. PHILLIPS, CPA n; o ,~ ~ rn ~E ER OF wlCCa USTfrQtl to -p n (!t ?O t'^x~ ~v First Line of Address n ~ ~ -J ~ ~ 5006 E. TRINDLE RD. ~ 7c ° "'~ ca o n; --~ " `~1 Second Line of Address ~ C r, .;: >;O SUITE 200 -~ , ~ ~ ^' ~'- m ~ ~ ~ C DATE D City or Post Offce Ode Stale ZIP MECHANICSBURG PA 17050 Correspondent'se-mailadtlress: DPHILLIPSna WFDCPA COM Untler penalties of perjury, I tleclare that I have examined this return, inUuding accompanying schedules end statements, and to the best of my knovAedge end belief, it is true, correct and c~ete. Declaration of preparar other than the personal representative is based on ell information of which preparer has any knovAetlge. Side 1 I 1505611186 1505611186 J twasn~ zooo ~uu0 ~ TRiiNDLE RD ~~jTE 2QQ,~QFC'HANI~SBURC,PA 17050 PLEASE USE ORIGINAL FORM ONLY 1505611286 REV-1500 EX (FI) Decedent's Social Security Number 283-09-2289 Decede is Na RENEE R FELDMAN RECAPITULATION 1. Real Estate (Schedule A) 1 2. Stocks and Bonds (Schedule B) . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , ... 3. 4. Mortgages and Notes Receivable (Schedule D) 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) g, 9. Funeral Expenses and Administrative Costs (Schedule H). 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 11. Total Deductions (total Lines 9 and 10) , . 1 t. 12. Net Value of Estate (Line 8 minus Line 11) . 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . 14. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 _ 15. i6. Amount of Line t4 taxable at lineal rate X .0 9.~ 354,886. 1 s. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611286 r wasae zooo 1505611286 4, 768. 12,692. 382,146. 9,161. 20,559. 29,720. 369,886. 15,000. 15,970. 15,970. REV-1500 EX (FI) Page 3 File Number 21-12-0416 Decetlent's com tet:e f+aareaa: DECEDENTS NAME STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Cretlits/Payments A. Prior Payments 1 5 ~- B. Discount 789- (1) 15 970. Total Credits (A + B) (2) 15 789. 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII In box on Page 2, Llne 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: X a. retain the use or income of the property transferred X b. retain the right to tlesignate 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 O ^ without receiving adequate consideration? ..... ............. .... .. . ? ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which ^ contains a beneficiary designation? .. .... .. .... .. .... . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)J. For dates of tleath 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 tloes 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 imposetl on the net value of transfers from a deceased chiltl 21 years of age or younger at tleath to or (or the use of a natural parent, an atloptive 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 notetl in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is tlefinetl, untler Section 9102, as an individual who has at least one parent in common with the decedent, whether Dy blood or adoption. 1 W 46] 1 1.000 REV-153 EX ~ Q-11) ~enns~lvania F3ART ENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS 8 BONDS FILE NUMBER Renee R Feldman 21-'_2-0916 All property Jointly owned with right of survivorship must be tlisclosetl on Schedule F. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1. 352 shares of Manulife Financial Corporation common stock at $13.595 per 4,768 share. Value is based on the value reported on the NYSE. Ticker symbol: MFC TOTAL (Also enter on Line 2, Recapitulation) $ 9 , 7 68 iwasss 2.00o If more space is needed, insert adtlilional sheets of the same size REV-t 506 EXt (t t-10) Pennsylvania DEPPFtTMEM OF REVENUE INHERITANCE TPX RETURN RESIDEM DECEDENT SCHEDULE E CASH, BANK DEPOSITS, Sr MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Renee R Feldman 21-12-0416 Include the proceeds of litigation and the date the proceeds were received by the estate. nit nrooerty iolntly owned with right of survivorship must be dleclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. t. PNC Sank, Checking Account, #50-8025-5769, DOD value TO7AL (Also enter on line 5, Recapi t w46AO tooa If more space is neetled, use adtlitional sheets N paper of the same size. VALUE AT DATE OF DEATH 12,692 12,69 REV-1510 EX i (tl0-09) pennsylvania DEPARTMENT OF REVENUE INHF RITANCE TAX RETURN Renee R SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY -12-0916 This schedule must be completetl and filetl if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY M AND DATE OF DEATH o /o OF DECD'S EXCLUSION TAXABLE ITEM IIiAWE Tf NVAE OF TETRPIbFEREE, TNEIR REIATIONSHPTO DECEOE r e VALUE OF ASSET INTEREST IF APPUCAe~E VALUE NUMBS nT . Te pATE OFTRasFER. ATrOCHACOPV Or rrE DEED roR REU ES 100 000 3 ? 000 , t. Cash gift *_o son, Bruce, 05/17/11 40,000 , 2. Cash gift to daughter, Laurie J. Lyon, 100 3 000 37,600 O5/17/ll 90,000 000 90 3. Cash gift to son, Bruce, 11/25/11 40,000 100 , 9. Cash gift tc daughter, Laczie J. Lyon, 000 90 li/25/;1 90,000 160 , 5. T_ntervivos trust established on 06/09/00, PNC Bank, N.A., Trustee, Account number 16-27-027-3111902. See attached 03/3C/12 (DOD) statement 965 226 for date of death values 226,965 100 , 6. Manulife Financial Corporation, 563 uncashed dividend checks 563 100 6 7. Verizon. refund 6 100 61 8. 2011 Federal income tax refund 61 100 551 9. 2011 PA income tax refund 551 100 TOTAL (Also enter on line 7, Recapitulation) S 382, 19 6 If more space is neetletl, use atl tlilional sheets W paper of the same size. 1 W46AF 1.000 REVnsrr Ex. iao-os) pennsylvania DEPARTMENLOF REVENUE INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Renee R Feldman _ 21-12-09i6 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: ~. Funeral Costs (Hetrick-Bitner Funeral Home, Inc.) 2. Funeral Luncheon (Cornerstone Culinary Kitchen) 3. Yahrzeit Plaque (Temple Ohev Sholom) B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s)of Personal Representative(s~ruce A. Feldman Street Address 119 Pin Oak Drive City New Cumberland State PA Veer(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach e>~lanation.) ri..:.......r AMOUNT 3,082 1,472 250 e,.ver nan.e« City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: ~. Publish Estate Notice -- Cumberland Law Journal 1 Wd6AG 1.000 Zlp '_7070 TOTAL (Also enter on Line 9, Recapll If more space is needetl, use additional sheets of paper of the same size. 282 3,500 500 75 9,161 RE~.,S,ZEx,„z-°e, SCHEDULE pennsylvania DEanRTMENr DF REVENUE DEBTS OF DECEDENT, i"nEaiTnNCET^xRETUR" MORTGAGE LIABILITIES 8r LIENS RESIDENT DEDE DENT FILE NUMBER ESTA TE OF 21-12-0416 Renee R Feldman Report debts incurred by the decedent prior to death that remainetl unpaitl at the date of tleath, Including unreimbursed medical expenses. VALUE AT DATE 17EM NUMBER DESCRIPTION OF DEATH 1. Value of two checks issued by decedent prior to death but cashed after the decedent's death: Blinded Veterans Association, Ck. No. 2522, dated 03/08/12 50 Diamond Pharmacy, Ck. No. 2527, dated 03/27/12 56 2. Country Meadows Associates, Paid by Estate check number 101 339 3. Country Meadows at Home, Paid by Estate check number 102 8,430 9. Country Meadows Associates, Paid by Estate check number 103 56 5. Diamond Pharmacy, Paid by Estate check number 104 171 6. Mutual of America, Refund 03/30/12 deposit to decedent's ckinq. acct. 13 7. Advance received from Bruce A. Feldman, son, 03/22/12 5,000 8. Advance received from David A. Lyon, son-in-law, 03/26/12 5,000 9. Repayment of Veterans Affairs pension for month in which death occurred, March 2012 1'449 TOTAL (Also enter on Cue 10 Recapitulation) S 2 0 , 5 ~wnsnr+ i.°o° If more space is neetled, insert additional sheets of the same size. REV-t5t3 EX+(01-t 0) Pennsylvania DEPARTMEM OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT OF: R I 1. t. 2 3 4 SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include ouln9M spousal tlistributions and transfers under Sec. 9116 (a) (1.2).] Bruce A. Feldman 119 Pin Oak Dr. New Cumberland, PA 17070 Laurie J. Lyon 102 Woodside Dr. Mechanicsburg, PA 17055 Amanda R. Piro 12 Amherst Drive Camp Y.ill, PA 17011 Jennifer L. Feldman 815 18th Street South, Apt. 606 Arlington, VA 22202 FILE NUMBER: 21-012-0916 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do NOt List Trustee(s) OF ESTATE Son Daughter Granddaughter Granddaughter 50 50 10,000 10,000 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH to OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN'. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: t Temple Ohev Sholom 2935 North Front Street Harrisburg, PA 17110 2. Blinded Veterans Association 477 H Street, NW Washington, DC 20001 PARTII- more space ISTRIBUTIONS ON LINE 13 OF REV-1500 use adtlitional sheets of paper of the same 10,000 5,000 15,0 1 W66AI 1.000 WILL OF RENEE R.FELDMAN I, RENEE R. FELDMAN, currently of Mechanicsburg, Pennsylvania, declare this to be my will and hereby revoke all prior wills and codicils made by me. ARTICLE I Tangible Personal Property I bequeath such items of my tangible personal property as are specifically itemized on the list, if any, in my handwriting, signed and dated by meat the end thereof, and attached to this, my will, to the persons named thereon to receive such items. I bequeath to my children, Bruce A. Feldman and Laurie J. Lyon, such items of my remaining tangible personal property not used in business or for the production of income, including without limitation furniture, furnishings, clothing, jewelry, objects of art and decoration, and the like, and any motor vehicles which I own, together with the insurance thereon, as they each may choose, and any disparity among them shall be equaled by such payments among them as may be necessary. Any remaining personalty not so distributed shall be sold by my executor, and the proceeds shall be added to the residue of my estate. ARTICLE II Specific Charitable Cash Legacies A. Temple Ohev Sholom. I give to the Temple Ohev Sholom, which currently maintains its temple at 2345 North Front Street, Harrisburg, Pennsylvania, or the succession organization thereto, the sum of Ten Thousand Dollars ($10 000.00), provided such organization is at the time of distribution a charitable or religious organization, to which contributions are deductible under section 2055 of the Internal Revenue Code of 1986, as amended, or any successor section thereto. B. Blinded Veterans Association. I give the sum of Five ~ housand Dollars ($5,000 00) to the Blinded Veterans Association which presently maintains its principal office in Washington, D.C.: for the general use of such organization, provided such organization is at the time of distribution a charitable organizatipn to _ which contributions are deductible under section 2055 of the Internal Revenode T of 1986, as amended, or any successor section thereto. ~- T ~ ,~ ;; ~~h~ I _'~ c r. `_,-j _ ^~~ _ : TI Y v .. ~J (~ T C ARTICLE III Powers of Appointment I declare that I do not by this Will intend to exercise any power of appointment. ARTICLE IV Specific Cash Bequests A. Individual. I give the following individuals such sums, subject however, to terms of the Descendants' Separate Trusts as set forth in Article V hereunder whereby the father of each such individual named below shall serve as Trustee of his child's separate trust. If the father of such named individuals is unable or unwilling to serve as Trustee, then the mother of such named individuals shall serve as Trustee. I give to my granddaughter, Jennifer L. Feldman, the sum of Ten Thousand Dollars ($10 000.00 ,subject to the terms of the Descendants' Separate Trusts. 2. I give to my cranddaughter, Amanda R. Piro, the sum of Ten Thousand Dollars ($10 000.00 ,subject to the terms of the Descendants' Separate Trusts. B. Survivorship. Any Beneficiary hereunder who dies within sixty (60) days following the date of my death shall be deemed to have predeceased me for all purposes of this Article. ARTICLE V Descendants' Separate Trusts Property that is to be held in the Descendants' Separate Trusts for the individuals named in Article IV above shall be held under this Article and all references to the "Descendants' Separate Trusts" shall be to the trusts held under this Article. Each Beneficiary's share shall be held as a separate trust. A. During Beneficiary's Life. The following provisions shall apply during the Beneficiary's life: The Trustee shall distribute to the Beneficiary the net income of the trust at least annually. The Trustee shall distribute to the Beneficiary as much of the principal of the trust as the Trustee may from time to time determine, for the Beneficiary's health, education, support in his or her accustomed manner of living, or maintenance. 2- The Beneficiary may withdraw all the principal at any time after attaining age thirty (30). Prier to that, at any time after attaining age twenty-five (25), the Beneficiary shall have the right to withdraw one-half of the then fair market value of the trust assets. B. Upon Beneficiary's Death. Upon the Beneficiary's death, the property then held in his or her trust shall be distributed to such one or more persons out of a class composed of the Beneficiary's descendants, and surviving spouses of the Beneficiary's descendants on such terms as the Beneficiary may appoint by a Will specifically referring to this power of appointment, or in default of appointment or insofar as an appointment is not effective; to the Beneficiary's descendants then living, per stirpes, subject to the terms of the trusts under this Article, or if there are no descendants of the Beneficiary then living; to my descendants then living, per stirpes, subject, however, to the terms of the trusts under this Article. ARTICLE VI Residue I bequeath, devise and appoint all the rest of my property, of whatever nature and wherever situated, including property over which I have a power of appointment into two separate and equal shares to be distributed outright to Bruce A. Feldman and Laurie J. Lyon, per stirpes, subject, however, to the terms of the Descendants' Separate Trusts in the case beneficiary other than a child of mine. ARTICLE VII Spendthrift Clause No interest of any beneficiary hereunder shall be subject to anticipation, pledge, assignment, sate or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his or her interest, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my fiduciaries for any liability of such beneficiary, whether such liability arises from his or her debts, contracts, torts, or other engagements of any type. ARTICLE VIII Facility of Payment for Minors or Incompetents Any amounts or assets which are payable or distributable to a minor or incompetent hereunder may, at the discretion of my fiduciaries, be paid or distributed to the parent or guardian of such minor or incompetent, to the person with whom such minor or incompetent resides, or directly to such minor or incompetent, or may be applied for the use or benefit of such minor or incompetent. -3- ARTICLE IX Powers A. Fiduciary Powers. In addition to such other powers and duties as may be granted elsewhere herein or which may be granted by law, my fiduciaries hereunder shall have the following powers and duties. without the necessity of notice to or consent of any court: To retain all or any part of my property, real or personal, in the form in which it may be held at the time of its receipt, notwithstanding that said property may not be of a character authorized by law. To invest and reinvest any funds held hereunder in any property, real or personal, including, but not by way of limitation, bonds, preferred stocks, common stocks and other securities of domestic or foreign corporations or investment trusts, mortgages or mortgage participations, mutual funds with or without sales or redemption charges, and common trust funds, even though such property would not be considered appropriate or legal for a fiduciary apart from this provision. To sell, convey, exchange, partition, give options to buy or lease upon, or otherwise dispose of any property, real or personal, at the time held by them, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such terms and for such price as they may determine, and to convey such property free of all trusts. 4. To borrow money from any person, including any fiduciary hereunder, for any purpose in connection with the administration hereof, to execute promissory notes or other obligations for amounts so borrowed, to secure the payments of such amounts by mortgages or pledges of any property, real or personal, which may be held hereunder. 5. To make loans, secured or unsecured, in such amounts, upon such terms, at such rates of interest, and to such persons, firms, or corporations as they may deem advisable. To renew or extend the time for payment of any obligation, secured or unsecured, payable to or by them as fiduciaries, for as long a period or periods of time and on such terms, as they may determine, and to adjust, settle, and arbitrate claims or demands in favor of or against them. 7. In dividing or distributing any property real or personal included herein to divide or distribute in cash, in kind, or partly in cash and partly in_kind. 4- 8. V`/ithout limitation of cowers elsewhere granted therein, to hold, manage and develop any real estate ~,vhich may be held by them at any time, to mortgage any such property in such amounts and on such terms as they may deem advisable, to lease any such property for such term or terms and upon such conditions and rentals as they may deem advisable, whether or not the term of any such lease shall exceed the period permitted by law or the probable period of retention under this instrument; to make repairs, replacements and improvements, structural or otherwise, in connection with any such property, to abandon any such property which they may deem to be worthless or not of sufficient value to warrant keeping or protecting, and to permit any such property to be lost by tax sale or any other proceedings. 9. To employ such brokers, banks, custodians, investment counsel, attorneys, and other agents, and to delegate to them such duties, rights and powers as they may determine, and for such periods as they think fit. 10. To register any securities at any time in their own names, in their names as fiduciary, or in the names of nominees, with or without indicating the trust character of the securities so registered. 11. With respect to any securities forming a part of the trust, to vote upon any proposition or election at any meeting of the corporation issuing such securities, and to grant proxies, discretionary or otherwise, to vote at any such meeting; to join or become a party to any reorganization, readjustment, merger, voting trust, consolidation or exchange, and to deposit any such securities with any committee, depository, trustee or otherwise, and to pay out of the assets held hereunder, any fees, expenses and assessments incurred in connection therewith, to exercise conversion, subscription or other rights, and to receive or hold any new securities issued as a result of any such reorganization, readjustment, merger, voting trust, consolidation, exchange or exercise of conversion, subscription or other rights and generally to take all action with respect to any such securities as could be taken by the absolute owner thereof. 12. To exercise all elections which they may have with respect to income, gift, estate, inheritance and other taxes, including without limitation execution of joint income tax returns, election to deduct expenses in computing one tax or another, election to split gifts, and election to pay or to defer payment of any tax, in all events without their being bound to require contribution from any other person. B. Exoneration from Security. No Executor shall be required to give bond or other security in any jurisdiction and, if despite this exoneration a bond is nonetheless required from it, no sureties shall be required. 5- ARTICLE X Taxes I direct that all estate, inheritance, and succession taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed. other than generation-skipping taxes, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration, and all other property includible in my taxable estate for federal or state tax purposes, whether or not passing under this will, shall be free and clear thereof; provided, however, that my executor may in the discretion of my executor request that any portion or all of said taxes (to be paid out of the principal of my general estate) shall instead be paid out of the principal of any trust established by me or my husband, to the extent expressly authorized under the terms of said trust. ARTICLE XI Fiduciaries I appoint as executor hereunder my son, Bruce A. Feldman. If he should be unable or unwilling to serve or to complete the administration of my estate, then my daughter, Laurie J. Lyon, shall serve in his place. My executor shall serve as guardian of the property of any minor beneficiaries hereunder, under any instrument of trust executed by me, under any policies of insurance on my life, and in any other situation in which the power to make such appointment exists under the laws of Pennsylvania. No individual fiduciary shall be liable for the acts, omissions or defaults of any agent appointed and retained with due care or of any co-fiduciary. No fiduciary named herein shall be required to furnish bond or other security for the proper performance of duties hereunder. IN WITNESS WHEREOF, I, RENEE R. FELDMAN, herewith set my hand to this, my last Will, typewritten on seven (7) sheets of paper including the self-proving attestation clause and signatures of witnesses, this F day of January, 2010. ~ , _~~._~.::,_ ~`~ -~l4~ni~~w (SEAL) RENEE R. FELDMAN Witnessed: ~ . i ,_ ~, ~~ residing at ~c~InM~ ~'~~i ~~ , _ ~ )~ ~jc~'1~c~"Y Ct ~1, l_~~( 7._G `~. residing at )~ ~-l.c,lC-(~ fC-~~.1;7~ ~ I .~ -s- GCNiN1ONWEALTH OF PENNSYLVANLa S S'. COUNTY OF Ji`t'v~ t-F l fv' RENEE R. FELDMAN (the testatrix), yC~.V ci ~ 1 Llirt~~=>, SK and jr~,^~k L-1c~ .i rJ:~-(l ~K- (the witnesses), whose names are signed to the foregoing instrument, being first duly sworn, each hereby declares to the undersigned authority that the testatrix signed and executed the instrument as her last will in the presence of the witnesses and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of his or her knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. WITNESS: aAP ~ \~~ TESTATRIX: RENEE R. FELDMAN WITNESS: U Subscribed, sworn to and acknowledged before me by RENEE R. FELDMAN, the testatrix, and subscribed and sworn to before me by ~av <1 ~I _ LlUei-f'as, ~~ and ~~~'YKIGC~ l C~<< a1ea~- ,the witnesses, this.~i`,_ day of JC~~~~~t ~ , 201~'~ I ~~.. ~ --~ Notary Public `~ (SEAL) COMMONWEALTH OF PENNSYLVANIA Notarial Seal Ur,Ca M. Eshelman, Notary Public i dty cA Harrlsbury, Dauphin Counry ~ My Commission Expires OG. 19, 2013 7 - ~~ AMENDED AND RESTATED ~0 ~~ FELDMAN REVOCABLE TRUST AGREEMENT f~ THIS IS AN AMENDMENT TO A CERTAIN AGREEMENT OF TRUST dated this ~ ~- day of June, 2000, by and between Renee R. Feldman ("Settlor") and PNC Bank, N.A. ("Trustee"). WHEREAS, on June 20, 1977, Leon Feldman and Renee R. Feldman, as Settlors, entered into a certain Funded Revocable Trust Agreement with Cumberland County National Bank and Trust Company (now PNC Bank, N.A.) acting as Trustee; WHEREAS, on June 15, 1988, Leon Feldman executed a Revocable Agreement of Trust which was intended to amend the June 20, 1977, Funded Revocable Agreement of Trust; WHEREAS, on January 4, 1996, Renee R. Feldman consented to the June 15, 1988, Revocable Agreement of Trust WHEREAS, Renee R. Feldman wishes to exercise her power of amendment reserved expressly in Paragraph 2 of the June 15, 1988 Revocable Agreement of Trust and modify and amend the Trust in the manner hereinafter set forth; and WHEREAS, the Trustee agrees to continue holding the initial trust principal, and such additional property as may be placed in trust hereunder (whether during lifetime or by testa- mentary act) subject to the terms and conditions of this Agreement set forth below. ARTICLE I Trust Name This Agreement of Trust may be referred to as the FELDMAN REVOCABLE TRUST. ARTICLE II Principal and Income Distributions A. During the Life of Renee R. Feldman. The Trustee shall pay to or for the benefit of Renee R. Feldman, during her lifetime, such sums from the income or principal of the trust as she may from time request, or as may be requested by the holder of a Power of Attorney given by her. B. Upon the Death of Renee R. Feldman. Following the death of Renee R. Feldman, the total property held in trust shall be divided into two separate and equal trusts, one for the benefit of each of the children of Leon Feldman and Renee R. Feldman, namely, Bruce A. Feldman and Laurie J. Lyon, as set forth under Article IV. If either Bruce or Laurie is not then living, his or her share shall be distributed equally among those of his or her children who are then living or, if there are no such children, such share shall be distributed to the other child of Leon Feldman and Renee R. Feldman, or, if he or she is not then living, shall be distributed equally among those of his or her children who are then living, provided, however, that any property passing to Bruce or Laurie as a result of the operation of this sentence shall be added to and administered as part of the trust created for his or her benefit hereunder. If both Laurie and Bruce have died without leaving children who survive Leon and Renee, the property shall be distributed as set forth in Article IV. Any amounts distributable to the children of Bruce or Laurie shall be held in trust for them under terms similar to those of Article III below, but with IIIB not being applicable until age 30, and with the survivor of Bruce or Laurie as Trustee, or if he or she is unwilling or unable to so serve, the surviving parent shall act as Trustee. ARTICLE III Bruce A. Feldman and Laurie J. Lyon Separate Trusts A. Income and Principal Distributions. There shall be paid to Laurie and Bruce from their respective separate trusts the net income in each year plus such portions of the principal as may from time to time be necessary for their support, education, and to meet needs of an emergency nature such as those arising from serious illness or accident, taking into account such other sources of support as may be available. B. Rights of Withdrawal. Bruce and Laurie shall each have a right in each year to withdraw all the principal of his or her trust at any time as requested in writing. C. Upon the Death of Bruce or Laurie. If either Bruce or Laurie should die before requesting the entire amount held in his or her separate trust, the amount in the trust, if any, at the time of death shall be divided equally among those of his or her children who survive him or her. If there are no such children, said property shall pass to the other child of Settlor or, if he or she is not then living, equally among those of his or her children who are then living, provided, however, that any property passing to Bruce or Laurie as a result of the operation of this sentence shall be added to and administered as part of the trust created for his or her benefit hereunder. If both Laurie and Bruce have died without leaving children who survive Leon and Renee, the property shall be distributed as indicated in Article V. Any amounts distributable to the children of Bruce or Laurie shall be held intrust for them under the terms of this Article, but with IIIB not being applicable until age 30, and with the survivor of Bruce and Laurie as Trustee, or, if her or she is unwilling or unable to so serve, the surviving parent shall act as Trustee. ARTICLE IV Takers of Last Resort If Laurie and Bruce should both die without leaving children who survive them, the balance of such property held in trust at the death of the last to die shall be distributed as follows: -2- One Hundred Thousand Dollars ($100,000.00) shall be distributed to the Ohev Sholom Temple, currently located at 234 North Front Street, Harrisburg, Pennsylvania. Fifty Thousand Dollars ($50,000.00) shall be distributed to Messiah Village, currently located at 100 Mt. Allen Drive, Mechanicsburg, Pennsylvania. 3. One Hundred Thousand Dollars ($100,000.00) to my son-in-law, David R. Lyon, if he survives me. 4. One Hundred Thousand Dollars ($100,000.00) to my daughter-in-law, Gail M. Feldman, if she survives me. The remainder hereof shall be distributed in equal shares, among the survivors of Eugene Goodman, foster brother of Renee R. Feldman, and Gertrude Eileen Feld, foster sister of Renee R. Feldman. ARTICLE V Payments to Minors Whenever income or principal becomes for any reason distributable to a person under twenty-one (21) years of age (described herein as the "Minor" regardless of the actual legal age of majority), a Trustee shall be appointed as the Trustee hereunder and they may make distributions in any way in which such Trustee deem appropriate, including (but not limited to) those enumerated in this Article: A. Distribution to Trust. The Trustees may hold the property in a separate trust for the Minor until the Minor attains twenty-one (21) years of age. The Trustees may distribute to the Minor as much of the net income and/or principal of the trust as the Trustees may from time to time determine, for any purpose, annually adding to principal any undistributed net income. When the Minor reaches twenty-one (21) years of age, the Trustees shall distribute the property to the Minor, if then living, or otherwise: 1. to the Minor's descendants surviving the Minor, per stirpes, or in default thereof; 2. if the Minor was a grandchild or more remote descendant of the Settlor, to the descendants then living, per stirpes, of the Minor's nearest ancestor who was a descendant of the Settlor with issue then living, or in default thereof or if the Minor was a child of the Settlor; 3. to the Settlor's descendants then living, per stirpes. B. Distribution to Custodian. The Trustees may distribute the property to a custodian under any state's version of the Uniform Transfers (or Gifts) to Minors Act, including a 3- B. Distribution to Custodian. The Trustees may distribute the property to a custodian under any state's version of the Uniform Transfers (or Gifts) to Minors Act, including a custodian selected by the Trustees. The Trustees may select any age for termination of the custodianship permitted under the Act, giving due consideration to selecting twenty-one (21) years of age if that is permitted. C. Distribution to Donee of a Power During Minority. The Trustees may actually distribute the property to anyone serving as Trustee under this Agreement, in a manner so that it then vests in the Minor, to hold the same as donee of a power during minority, such donee to have all the powers of a Trustee under this Agreement (including the power to apply the property for the Minor) and to be compensated as if the property were a separate trust, but with no duty to account to any court periodically or otherwise. D. Distribution to a Guardian of a Minor's Property. The Trustees may distribute the property to a guardian of the Minor's property. E. Distribution to a Minor's Parent. The Trustees may distribute the property to a parent of the Minor even if the parent does not assume any formal fiduciary capacity concerning the property. Distributions shall be made to a parent of a beneficiary only if the parent either is a descendant of the Settlor or was married to a descendant of the Settlor at the date of death of the descendant of the Settlor who was the spouse of the parent to receive the distribution. F. Distribution Directly to a Minor. The Trustees may distribute the property directly to the Minor if the Minor has attained fourteen (14) years of age and has the practical capacity to own the type and amount of property in question. G. Exoneration of Fiduciary for Distributions for Minor. The Trustees shall be free from any responsibility for the subsequent disposition of the property if it is distributed in one of the ways specified in this Article. ARTICLE VI Spendthrift Trust A. No Assignment. No interest in the trust shall be subject to the beneficiary's liabilities or creditor claims, assignment or anticipation. B. Protection from Creditors. If the Trustees shall determine that a beneficiary would not benefit as greatly from any outright distribution of trust income or principal because of the availability of the distribution to the beneficiary's creditors, the Trustees shall instead expend those amounts for the benefit of the beneficiary. This direction is intended to enable the Trustees to give the beneficiary the maximum possible benefit and enjoyment of all of the trust income and principal to which the beneficiary is entitled. -4- ARTICLE VII Payment of Death Taxes A. All from Residue. All estate, inheritance, legacy, succession, generation-skipping, or other wealth transfer taxes that result from the death of the Settlor's wife, imposed by any domestic or foreign taxing authority with respect to all property taxable by reason of the Settlor's death, together with interest and penalties on those taxes, shall be charged against and paid without apportionment out of the residue of the Trust Fund as an administration expense. B. Apportionment Prevails Over Abatement. If payment of taxes from the residue of the trust fund in accordance with the foregoing exhausts the residue of the trust fund, the balance of tax due shall be paid in accordance with the rules of tax apportionment rather than the rules of abatement. ARTICLE VIII Trustees A. Trustee Appointments. A Trustee who is a party to this Agreement or who is appointed in this Article shall serve as Trustee of each trust under this Agreement except where this Article or some other provision of this Agreement specifically provides otherwise. B. Additional Provisions Regarding Changes in Fiduciaries. Any Trustee may resign at any time without court approval and whether or not a successor has been appointed. 2. If the office of Trustee of a trust is vacant, and no successor takes office pursuant to any other provision of this Agreement, an individual or corporation with fiduciary powers may be appointed as Trustee by the Settlor's adult descendants then living and competent. C. Governing Law and Trustee Powers. The interpretation and operation of the trust shall be governed by the laws of the Commonwealth of Pennsylvania. The Trustee may, without prior authority from any court, exercise all powers conferred by this Agreement or by common law or by any fiduciary powers act or other statute of Pennsylvania or any other jurisdiction whose law applies to the Trust. The Trustee shall have absolute discretion in exercising these powers. Except as specifically limited by this Agreement, these powers shall extend to all property held by the Trustee until actual distribution of the property. The powers of the Trustee shall include the following: 1. The Trustee may determine what property is covered by general descriptions contained in this Agreement. 5- The Trustee may make any election available under the tax laws in such manner as the Trustees shall determine. The Trustee may retain and or sell any property originally owned by the Settlors, and invest and reinvest in all forms of real and personal property. 4. The Trustee may compromise claims or debts and abandon or demolish any property which the Trustee shall determine to be of little or no value. 5. The Trustee may apply to the use of any individual, any property, whether principal or income, that otherwise would or could be distributed directly to such individual. 6. The Trustee may consolidate any trust for a descendant with another trust having identical terms and the same trustee (whether or not under this Agreement) and administer the two as one trust, provided that each portion of the consolidated trust shall terminate and vest in possession no later than the date required for the separate trust from which it came. The Trustee may accept or decline to accept additions from any source. D. Exoneration From Security. No Trustee shall be required to give bond or other security in any jurisdiction, and if despite this exoneration a bond is nevertheless required, no sureties shall be required. ARTICLE IX Definitions and Miscellaneous Provisions The following definitions and miscellaneous provisions shall apply under this Agreement: A. Minor and Adult. Whether an individual is a minor or an adult shall be determined under the laws of the individual's domicile at the time in question, except in cases when this Agreement has specifically defined "Minor" to mean a person under twenty-one (21) years of age. B. Per Stirpes. Property that is to be divided among an individual's surviving or then living descendants "per stirpes" shall be divided into as many equal shares as there are children of the individual who are then living or who have died leaving surviving or then-living descendants. A share allocated to a deceased child of the individual shall be divided further among such deceased child's surviving orthen-living descendants in the same manner. -6- ARTICLE X Revocability of Trust 8~ Rights Reserved Renee R. Feldman reserves the following rights, each of which may be exercised whenever and as often as she may wish: A. Amend or Revoke. The right by an acknowledged instrument in writing to revoke or amend this Agreement or any trust hereunder. B. Remove and Appoint Trustees. The right to remove any trustee and appoint substitute, additional or successor trustees. C. Approve Investment Decisions. The right to approve the Trustee's investment decisions, and her approval shall bind all other beneficiaries. D. Approve Trustee's Conduct. The right from time to time to approve of the Trustee's conduct (whether in connection with an accounting by the Trustee or without an accounting), and her approval shall bind all other beneficiaries. E. Insurance Policies. All rights she may have as the owner of any insurance policies payable to the Trustees. IN WITNESS WHEREOF, Renee R. Feldman and the Trustee have signed this Agreement, effective the day and year first above written and executed by each of them on the dates set forth below. WITNESS: n I\\ SETTLOR: -~~ ~.(d-,-a.~... RENEE R. FELDMAN ATTEST: c..T'~`UK.t.. _ RSS ~ V ALE D~S1,4 TRUSTEE: PNC BANK, N.A. byG~C-~ > -7- COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF ~J~U P F4 r ~ I HEREBY CERTIFY that on this ___[-day of ~ ~ N ~ , 2000, before me, the subscriber, a Notary Public in and for the Commonwealth of Pennsylvania, personally appeared the Trustee, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the foregoing instrument, and acknowledged that the foregoing instrument was executed by RENEE R. FELDMAN, as Settlor, for the purposes therein contained. WITNESS my hand and notarial seal, ~,~ 8-2 ~ . Notary Public (SEAL) NOTARIAL SEAL Carol P.. Koppenhaver, Notary Public Harrisburg, PA Dauphin Gounry My Commission expires March 6, 2004 -8- COMMONWEALTH OF PENNSYLVANIA pEPAPTMENT OF flEVENUE BUREAU OF INDIVIDUAL TAXES pEPL 280601 HARRISBURG. PA 1]t 28-Ofi01 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FELDMAN BRUCE A 119 PIN OAK DRIVE NEW CUMBERLAND, PA 17070 ACN ASSESSMENT CONTROL NUMBER rota ESTATE INFORMATION: SSN: 283-09-2289 FILE NUMBER: 2112-0416 DECEDENT NAME: FELDMAN RENEE R DATE OF PAYMENT: 06/26/2012 POSTMARK DATE: 06/26/2012 COUNTY: CUMBERLAND DATE OF DEATH: 03/30/2012 REV-1162 EX111-961 NO. CD 016171 AMOUNT 101 ~ S 15,000.00 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK#114 INITIALS: HEA RECEIVED BY: S 15, 000.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER MFC Historical Prices ~ Manulife Financial Corporation Stock -Yahoo! Finance New Uaer9 Reg'.e:er Sign In Eelp Upgratle to Sahr IE8 Search HOME INVESTING NEWS PERSONAL FINANCE MY PORTFOLIOS EXCLUSIVES - - - r ~ Mnn,J "15. 2C1.^... 'A.JfiaM FDT-JS P:.ark scgsa in.5 hz -nd Z?mans ,.....av.__._..:~ Dow 17.26 % Nasdaq i 1.76 "~°MFCEOR I AT aeTRAOen MFC Manulife Flnanclal Corporation (MFC)- Nvse Add to Portfolio "xe , 5s 10.30 10.29(2.74%) 1036AM ED7-Nastlaq Real Time Pnm Historical Prices see Dau aange C• Daily Smrt oem: Mar * 30 2072 E9. Jan 1.2010 (- Weekly Errs oea: Mar + 30 2012 r Monthly (- Dividends Only S7~.P %. Pdces _. _ _... _... Dale Open High Low Close Mer 30, 2012 13.61 13 77 13.48 13.55 ' Close prim aQUntatl for tlivitlentla and splits. Get Nmrodul Pdcas for: GO First ~ Previous 1 Next ~ Las1 ..... .... ........... .... ... Volume Adl Close' 3,803,800 73.41 First ~ Previous ~ Next ~ Last !~IDOwnload to Spreadsheet Currency in USD/. /! •',... .;,~. Cie-. u'in., ~.. ~'>< ,;~. ^.epyepht ^. v'.1 vapor. laa .+ll nylne reserves r-:rvacy r'mmy - wam oar eda - rmms m sen!ce - coc;nOb:•'~r v,;ay -sera =aeenarx-Yahoo! -ABC News Network Ouotes (or NYSE. Nastlaq and NY9EAmex am Real-lima and sourced iron NasddV LSa~. Sale when av611ab1e If not available OIDn NLS gpela$wiu appear tlBl5yetl from prima!y cs']mg soarer. 5~'e rlsp delay l..e or prnnr ex hVnres. Ouplas and ether _nfnrmallnr suppietl by I de nd rn prm tlr s de --btl r i Ih Vahr Finan Van r p e O t s pd r^d a t y. ba: vnll be w'nod ml ade c5 minmes c nactivily QooW$ era tlelayed at east l~ rdmJ:cs f II 10'ratloa Fovltletl vs tp I ma tonal pup s /. not mle d U l d =y pu p s s w advice !Jeehar YaCw' tier any of inCependrnl previdera la Lade iW any' in!cnnaLpnal erro!s, inrompleteoess, cr tl~ a; S or to am aq'pns taken n!ebance en n urmal en conEl _c Yere~n. Uy access ng the J w siL. you e e not In red: b Ic ,he nip m on fo nd 14eroin. Funtlamema, op epany data p ,u detl by Capital ID. 1 sc cal mart data and flatly ul da~es p-ovgaa q- Cc^Ir~.^,dity Systems, inc. 'CSry. Irl=rnal aa. histcncal coati data. deiq eptla:es, funtl sum!narj_ h:ntl pehcrmance. tlrAd^nc dale anG Mpmincstar Intlex data pmmded by Mprc ncsLar Ire. ~ ~:%,v! /3~YP ~, 7D r ~' /3.,~ v y~ x 3 Sz Jas. _ `Y.7c /~ v Mall MYYI YGnco'. _..... .~aarCt~ Web ..., Page 1 of 1 6/25/2012 089510184 UPRR],___ .. ~ ..:.24 ?~r3 C/0 UPRR, LLC P C Box 2262 Neev York NY 10116 000042 089510184 FELDMAN--LEON-D000 LEON FELDMAN 4833 E TRINDLE RD MECHANICSSUR6 PA 17050-3652 Substitute Form W-9: By signing belovu I certify under 1 penalties of perjury that O the Tax ID number Ilsted below is accurate (li) '. am not subject to backup avRhholding and (iii) I am a U S. citrzen or other U S. perscn a. ^ Shareholder(s) is deceased. Reissue shares as indicated in the box to the right. Replace any shares not enclosed and replace any uncashed dividend checks ;less processng tee antl surety bontl premium if ceNficates are lost) b. ~ Sell all the shares and replace any uncashed dividend checks (Less processing tees antl surety bontl premium if cerlifcates are lost). 2 Soc. Sec# orTaxlD#- Date of 31dh. S-,gnahre. Name: Medallion Signature Guarantee Necessary (See Reverse OSA #2) -.SHARES HELD BY YOU: U'NEA' H' D H K 352.0000 562.57 Dear Recipient. Unclaimed Property Recovery and Reporting LLC ("UPRR"J has been retained by Manulife Financial Corporation ("Manulife") to contact the surviving joint tenant, relatives or heirs of shareholders who. based upon Social Security records, are deceased. Any uncashed dividend checks and/or the shares associated wRh the decedents account should be re-issued into the name of the survivor(s) or heir(s). Possibly, the shares are lost and need to be replaced. Participation in the services provided by UFRR is voluntary and you will be charged a fee as described below with a portion of that fee being paid to BNY Mellon. To utilize UPRR's services you should complete and sign this authorization form and return it, along with any stock certificates that may be in your possession along with the appropriate documentation as referenced in the enclosure entitled InsVUCtions Por the T2nsfer o/Ownership. You should expect to receive the preperty approximately 45 days after returning this letter; a business reply envelope is provided for your convenience. If you do not respond to this mailing or contact BNY Melton, the property may be subject to escheatment to the appropriate state as required under the applicable unclaimed property laws. Information on how to prevent escheatment can be obtained at www.unclaimed.org. O to ions Choose program option 2a above if you wish to change the account registration Enclose the certifcate(s) you have along with this signed authorization form and applicable documentation (see enclosed. InstrucLons for the T2nsfer of Ownership). Be sure to complete the information in the "Transfer Instructions Box" above. and complete the Substitute W-9 information (owner's Social Security Number., signature and date of birth). UPRR will purchase a surety bond on your behalf for the shares not ei closed and instruct BNY Mellon to send yuu a Credit Transaction Advice fur the navy shares and any uncashed dividends will be sent to you. Choose program option 2b above if you mrish to sell your shares Enclose the certificate(s) you have along with this signed authorization form and applicable documentation (see enclosed. Instructions for the T2nsfer of Om»ership). Be sure to cemplete the information m the `Transfer Instructions Box" above. and complete the Substitute W-9 information (Owner's Social Secunty Number: signature and date of birth). UPRR will purchase a surety bond on your behalf for the shares not enclosed and sell all the shares. A check for the sale proceeds and any uncashed dividends will be sent to you. Please indicate your choice above by checkino 2a or 2b. In order to cover the costs of locating you, processing all required documents, arranging for the reactivation of your account or reissuance of your shares, and/or selling your shares, a processing fee of 20% of the value of the property will be deducted from your proceeds. If you have lost some or all of your certificates, UPRR will also purchase the necessary surety bond on your behalf, at a cost of 2°/ of the current fair market value of the lost securities. The surety bond premium will be deducted from your proceeds. If you have any questions, please call UPRR at 1-80059-7145 You muse sign and enter your Tax ID # (Item i above), elect one of the two program options (Item 2 above), and sign below (Item 3). AUTHORIZATION I acknowledge and represent that I am a registered owner of the shares veith good Litle to the shares znd/or have full po~mer end authority to authorize this transaction I irrevocably appcint UPRR as my agent with respect to this transaction in accordance with my election specified above I agree that a precessing fee of 20 % is to be paiC to UPRR If I elect to sell ail my shares, ~. authorize UPRR to arrange through UPRR Securities, LLC. its broker Cealer affr.iate- to arrange for the sale cf ail such shares and to arrange to have the fee(s) due and the premwm for any necessary surety bond deducted 'rom the proceeds and a eneck for the balance sent to me- '.f I elect to receive shares, I authorize UPRR to arrange through UPRR Securities, LLC for the sale of ocly those shares necessary to satisfy the fee due and the premium for any necessary surety bona deducted. I acknowledge that my shares may be bundled mrdh shares of other shareholders mrhen sold, and that the proceeds '. receive may be based on the weighted-average price or daily pr,ce for all shares sold by UPRR on that trade date I hereby attest that a registered broker dealer does not currently employ me ..~gna ure o owner igna ure o o-owner elep~ one um er = mar a ress UPRR Securities, LLC is a registered broker~lealer member FINRA, SIPC. Interest Checking Account Statement PNC Wealth Management For qu p~rlod 03M 0/2012 M 04/10/Z012 000166 RENEE R FELDMAN 355 5 SPORTING HILL RD STE 31 MECHANIC58URG PA 17050-7702 (, T'NC~3AC~J1. Primary account nun'~be c 5 7-6025 5769 Page 1 of 4 Number of enclose rus n For 24-hour banking, a mi transaction or interest rate infonrati~ m, sign on to PNC Bank Online Banl ing at pnc.com. 'a For customer se rvi~:~ c a l l t-8H8-762-6226 Monday - Friday: 7 At t ~~ 10 PM ET Saturday & Survda~,•: f ,AM - PM ET Para servicio er esnaP cl, 1-666-HOLA-PNC. MotaM07 Please contact t s at 1-666-762-6226 ® Write to: Customer Se r: ice PO box 609 Pittsburgh PA 15230-9 ]36 Visit us at pnc.com ® TDD terminal: l-800-531-1648 For hearing impab ed , tier L+ oNy ~~ nr_~ • nui ~ Enroll in online statements today through online banking, and have access to your checking and saving statements for u ~ to 6 years. Enrol? today by visiting the Customer Service Tab in online banking. ~~„ , e,,,, , Interest Checking Account Summary Account number: 50-8025.5769 Overdraft Protection has not been established for this account. Please contact us if you would like to set up this service. Your axount is currently Opted-Out of Overdraft Coverage. To learn more, visit us online at pnc.combverdraftsolutions Renee R Feldman Balance Summary Beginning Deposits and Chocks and other Ending balance other additions tledudions balance 6,974.12 12,996.90 6,161.27 18,809.'75 Average monthly Charges balance and fees 10,526.08 3.00 Transaction Summary Checks paid/ Check Card POS Check Card/Bankeard withdrawals signed transactlons POS PIN transactions 3 0 0 Total ATM PNC Bank Olher Bank transactions ATM transactions ATM transactions p 0 0 Interest Summary Annual Percentage Number of days Average collected Interest Pald yield Earned (APVE) in Interest period balance for APYE this period 0.0]% 92 10,219.88 .OB As of 04110, a tc tai o~f a.30 in interest rues paid this year. Y ' .. ±~', Interest Checking Account Statement Fer rh. p.nea oaitono~a to osf~onou For 24-hour information, sign on to PNC Bank Online Banking RENEE R FELDMAN on pnc.com. Primary account number: 50-6025-5769 Account number: 508025-5769 -continued Page 2 of 4 ActlWty Detail Deposits and Other Additions Therewere7 DeposhsandOtherAddkions Date Amoum Desalptlon totaling S12,t1N.at1. 03/22 5,000.00 Deposit Reference No. 522116040 03/26 5,000.00 Deposit Reference No. 522719896 03/30 1,449.00 Direct Deposit - Xxva Benef US Treasury 310 XXXXX2289 10 ]0 03/30 309.25 Direct Deposit -Annuitant PA Treasury Dept XXXXXXXXX}Ot9960 03/30 12.57 Direct Deposit - Cra-Gbs Sy Mut-L Of America XXXXX0000 04/03 1,226.00 Direct Deposit - Xxsoc Sec US Treasury 310 XXXXX2289A 04/10 .08 Interest Payment Checks and SubstiluN Checks Check Date Reference Gheck Date Rererenoe number Amount paid number number Amount pe10 number 2522 50.00 04/10 085190559 2531 • 6,052.50 03/26 oes2stses 2527' 55.77 04/02 oasso7oso ` Gap in check sequence There were 3 checks IIMed totaling }e,tp37. Other Deductions There was 1 Other Dedutxion totaling Date Amount Descrlptlon :a.N. 04/10 3.00 Check Images In Stazement Fee Daily Balanoe Detail Date Balance Data Balance Date nalanr:e DMe Balance 03/10 6,974.12 03/26 10,921.62 04/02 12,636.67 04/10 13,809.75 03/22 1],974.12 03 30 12,692.44 04/03 13,862.67 A Great Month to Start Saving] Open a new free 'S' is for Savings(SM) or Statement Savings account for your child between April 1 and Apti13Q 2012, and eam a $ ]0 reward credit when the account grows to $50 by September 30, 20]2. Visit your local PNC Bank branch to Team more. • Offer available for new to bank minor child (under the age of 18) who opens a savings account from Aptil 1 - 30, 20]2. Account balance must reach $50 by September 30, 2012 to receive a S 10 account credit. The account has no monthly balance requirement or monthly service charge until the child reaches age of 18. Offer is limited to one account per minor. The S 10 reward maybe tax reportable. 1 DAP-FELDR ~~~~~~~~~ Gifts Made Outright to an Individual 34 NOTE: Onry complete Forma Sa and/or 35 it in 2011: • You made piib of cash or marketable securities to an individual that exceeded $13,000; a • You mods gMle of hard-to-value assets (weh sa eloselY-held stodtl to an individual of arty amount; or • You made any transfero to a trust (including paying premiums on a Iffe insurmee policy that wee transferred to a life insurance trust). Yw should include all gifts made to each individual during the year, including gifts la his a her birMday, holiday, anniversary, graduation. etc. In addition, please include any gitb You made for atlueabonal or medical ezpensea. You can exclude amounts paid directly to a rtualiying educational organiaadon for tuition. You can also exclude amounts paid direetty to health care provitlers if the expenses relate to noneleedve mediosl expenws. N yw made any loans with an interest rata Mlow the muket rate of interest, please provide details below. H your most recent gift taz return was not prepared by us, please include a copy. For gifts other than each, please Include a copy of any appraisal(s) of assets. M no appraisal is available, please describe how the value was determined. For each gift matls outright to an individual during the year, please Provide the following iMormatlon: Gift 7: Person giving the gift ~ Taxpayer ~ Spouse ....................... Name of person receiving the gift ....... ... L~~"~ Q ~' L.~p~ Address of person . . .. . . . .................. . Vour relationship to Me person (e.g., son, granddaughter or fiend) . . . . ......... . Ape of the person S } Date(s)ofgift(s) .................. (MO/Da/Vr) S 1 7011 t l1'ZSI'TOtI Descdptbn and amount of assets gfltetl (e.g., $13,000 in cash or 500 shares of ABC stock) , ... , $~}Or00p.o0 t >~4Qa0 Cost basis of assets giftetl d other than cash .......... Value of assets Biked it other than cwh ............ . O Joint Gift 2: Taxpayer ................ Person giving the gift ....... Name Of person receiving the gilt $R-~'~ ~ ' Address of person ..... 1\rl ~Iw1 D Vour relationship to the parson SO f• 1 (e.g., son, granddaughter or friend) . . . . . . . . ....... Age or me person ................... ....... bfl Date(s) of Bit(s) (MO/l')a/Vtj .................. Description and amount of assets gittetl (e.g., $13,000 in cash or SOD shares of ABC stock) , , , Cost basis of assets Biked z other than cash ....... . Value of assets gifted k other than rash ......... . 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Please contact us for additional options. ~:- otinnni rn+_ intxa79o+_inn_NUUUUnI nn7 nnncno Country Meadows At Home STATEMENT PO Box 3060 Hershey, PA 17033 Phone: (888) 7542220 Fax: (717)520-4760 www.countrymeadowsathome.com Renee Feldman ~` ~\\ ,z ~ ~' . ` Cam"" `~^ `~.•~. ~, 03/27/2012 Balance forward 6,576.00 04/08/2012 tNV #11975. 1,854.00 8,430.00 c~ ~~ ~~~ ~~ 1.30 DAYS 31-60 DAYS 61-90 DAYS OVER 90 DAYS CURRENT PAST DUE PAST DUE PAST DUE PAST DUE AMOUNT DUE 1.854.00 6.576.00 0.~ Terms: Due Within 14 Days Of Receipt. You may pay htr~//countNmeadows billingdoc.net//countNmeadows billingdoc.net or by phone toll free MAKE CHECKS PAYABLE TO: At $~ Country Meadows At Home PO Box 3060 Hershey, PA 17033 fit "'AST' ~r u~~)ur~~)u r~nr~~~m ru~~ur~~ur~~( ~nr~~~ur~~~unr~~ur~~nr~~r~~nu~~u~~n u~~n~~uun~~~ RENEE FELDMAN Country Meadows Retirement Communities C/O BRUCE FELDMAN P.O. Box 3060 119 PIN OAK DRIVE HERSHEY, PA 170333060 NEW CUMBERLAND PA 17070 Page 1 of 2 Account #: 01871 Country Meadows Retirement Communities Feldman, Renee asxseeoooms J Please check box if above address is incorrect and indicate change(s) on reverse sitle. At ~,~ ome. Personal Croe Services Date: 04!10/2012 Client Name: Feldman, Renee Account#: 01871 Page #: 1 PI Fr}~Cf nf?')~.}l, ~l~AF?ISM, R,PTTr1~~CT1:~1(J/TH~Vf1~~~v9X44F46? 0.00 0.00 $8,430.00 ard, American Express or Discover On Line at Statement Gate: Act Nom- 04!10/2012 01871 ArtaraR Due: Amoiait Encbsed: Chedt Number. sa,43o.0o Bi'r3a.x~o lCz Robert L. Haar From: Bruce Feldman (brucebaf@hotmail.com] Sent: Wednesday, October 31 2012 10:33 AM To: Robert L. Haar Subject: RE: VETERANS AFFAIRS REQUEST FOR REPAYMENT Bob: The VA informs me the estate only owes one month of benefits as we suspected, $1,449• I will mail a check to the VA in this amount today, so the Inhentance tax return can be completed. ey the way, Jennifer located the $10,000 check and will deposit it this weekend. Thank you. Bruce From: rhaarCawfdcoa.com To: brucebafC~hotmail coin Subject: RE: VETERANS AFFAIRS REQUEST FOR REPAYMENT Date: Thu, 25 Oct 2012 17:50:37 +0000 Bruce, Again, thank you for the prompt reply. I will defer the completion of the inheritance tax return until I hear from you about the resolution of the matter with the Department of Veterans Affairs. Bob Robert L. Haar, CPA Waggoner, Frutiger & Daub LLP Certified Public Accountants (717) 506-1222 Fax (717) 506-1223 Please be advised that, based on current IRS rules and standards, the advice contained herein is not intended to be used, nor can it be used, for the avoidance of any tax penalty that the IRS should assess related to this matter. Notice: This email transmission, including any attachments, may contain information that may be confidential and privileged. This message is intended for a specific individual and purpose, and its unintended use is prohibited by law. If you are not the intended recipient you may not disseminate, distribute or copy this email. Please notify the sender immediately by email if you have received this email by mistake and delete this email from Your system. If you are not the intended recipient you are notified that disclosing, copying, distributing or taking any action in reliance on the contents of this information is strictly prohibited. Please notify the sender by replying to this email or by calling Waggoner Frutiger & Dauh at 717.506.1222 and deleting the erroneous transmission from your system without copying it. Thank YOU. Iilll 111111 IIIII IIIII IIIII VIII IIIII VIII I~il NIII IIIII11111111111 1111111111111111 IIII IIII IIIII VIII IIII III II VIII VIII VIII VIII III II IIIII IIII IIII DEPARTMENT OF VETERANS AFFAIRS p Debt Management Center Bishop Henry Whipple Federal Building P.O. Box 11930 St. Paul, MN 55 1 1 1-0930 AUGUST 22, 201 2 Flee Number: 03330682 REPRESENTATIVE OF THE ESTATE OF: payee Number: 10 RENEE FELDHAN person Entitled: R FELD 4833E TRINDLE RD Deduction Code: 30 MECHANICSBURG PA 17050-3552 E-Mail Address: dmc.ops@va.gov We are sorry to learn of the death of the beneficiary and wish to express our sympathy. WHAT YOU SHOULD KNOW Beneficiaries are not entitled to benefits for the month in which death occurred. Any checks received after the date of death or any monies that were electronically deposited in a bank account after the date of death should be returned. Instructions for returning the funds can be found on t$he back aeahool If you0are the spouseoof the deceased, you may betentitled t ethe benefit forthe of month of death. HOW DO YOU KNOW IF A SPOUSE IS ENTITLED? lease call ]-800-827-1000. To obtain information regarding the surviving spouse benefit, p Heazing impaired should call 1-800-829-4833. LEGISLATIVE CHANGE On Tune 30, 2008 and October 10, 2008, the President signed laws providing equitable debt relief for members of the Armed Forces who die on active duty and for veterans who die as a result of injuries incurred or aggravated in the line of duty while serving in combat theaters of operations or other hostile incidents after September 11, 2001. Contact us for more information WHERE DO YOU CALL IF YOU HAVE QUESTIONS REGARDING THIS LETTER? You should contact the VA Debt Management Center at 1-800-827-0648._ Chief, Operations Division _ _ FOR PROPER CREDIT TO YOUR ACCOUNT, PLEASE DETACH AND RETURN W/TN YOUR PAYMENT _ _ 2D>,223s PAYMENT REMITTANCE r103330682103D1827060512D427 x103330682 1030 18270605120427 0289800 6 AMOUNT ENCLOSED ENTER YOUR CURRENT ADDRESS BELOW ONIV If THE ONE ABOVE IS INCORRECT. • FILE N0. ~ 03330682 PLEASE INCLUDE YOUR ZIP CODE. PAYEE N0. ~ 1D S YOOR :EIEPMONE NO. PERSON ENTITLED ~ R FELD UncWde Area eeae) DEDUCTION CODE - 3D Please include this number on our check or mone order. R 9-51:, UEC 2009