The URL can be used to link to this page

Home My WebLink About01-18-13 (2)J REV-1500 Ex (D2-"' PA Department of Revenue Pennsylvania Bureau of Individual Taxes °°'"'"'N}pi RF2M` PO 80X.280601 INH Harrisburg, PA 17128-0801 F 1505610143 OFFICIAL USE ONLY County Code Vear File Number TAX RETURN 21 12 0497 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Decedent's Last Name Suffix Decedent's First Name MI ICOTZMOYER JOANNE Y (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ICOT ZMOYER ROY F Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Re[urn ~ 2. Supplemental Return ~ 3. Peomao tl2r 3e82' (Dale of Dealh ^ 4. Limited Estate ~ qa Future Interest Compromise ~ 5. Federal Estale Tax Return Requiretl dale W tleaN seer 2-12A2) I : I g Decetlem °ied iestete ~ ~J f Wil 7_ fD~er~r~aNmai~~jo se)a Living Tlvat 1 e. Total Numtler of Safe Deposit Boxes p (Attach Copy o 9. Litigation Proceeds Received ~ 10. y~°~~nPpi~3i ~~en~t~De~~a oeatn ~ 11,Election to tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone,t,Jymber PATRICIA R BROWN ESQ 715 249 ~33~ m ~o ~`~ First Line of Address 354 ALEXANDER SPRING RO Second Line of Address City or Poat Office CARLISLE ~TFft pq wlL~s use~I~,i ~ y r- F-• n rn r ;,= rn ~ :ra c~ Y'N7e ~=i ." 'D -S ~ . <-~ C7 .. C7 ~~ 1'" Frl C? ~" neTF cll.'RDI State ZIP Code PA 17015 Correspondent's e-mail address: N""'^"lWa-'"'•-"""°a"°° llnsderueencoaneet entl mmplee Detclare~on of pre~pemer~o8ler than Me pereolnal re~premseniatlve Is based on al In~fortnatio^~of which preparerthas any knowleCge.bellN, SIGNATURE F ERSON RESPONSIBLE F R FILING/ RETURN/ DATE ~,(,~, (~ ~ nSalr~Cn Kendra K. Heinbaugh ~~ /5--~3 ADDRESS 483 Crossroad School Road Carlisle PA 77015 SIGNATUy~pF PREPARER OT,HE/R ~THAN REPRESENTATIVE DATE ~/~- tV l -d`~, ,,,, . ~- Patricia R. Brown Esq. / _ ~ ,S _ /_ g 354 Alexander Spring Road Suite 1 Carlisle PA Side 1 L 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number oeceaenr:Name, Kotrmoyer, Joanne Y. RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 38 , 311.11 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits R Miscellaneous Personal Property (Schedule E) ............... 5. 8 , 2 94.7 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 2 , 18 9.02 7. Inter-Vivos Transfers 8 Miscellaneous t~oq Probate Property (Schedule G) a Separate Billing Requested............ 7. 30 , 570.27 8. Total Gross Assets (total Lines 1 through 7) ........................................................ 8. 7 9 , 3 65.10 9. Funeral Expenses and Administrative Costs (Schedule H) .................................... 9. 13 , 896.40 10. Debts of Decedent, Mortgage Liabilities and liens (Schedule I) ............................ 10. 7 5 . ~ 0 11. Total Deductions (total Lines 9 and 10) ................................................................ 11. 13 , 971.40 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 65 , 393.70 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subjeet to Tax (Line 12 minus Line 13) ............................................... 14. 65 , 393.7 0 TAX COMPUTATION • SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 52 , 688.55 15. 0.00 (a)(1.2) X .00 16. Amount of Line 14 taxable 12 , 705.15 16. 571.73 at lineal rate X .045 17. Amount of Line 14laxable 0 • ~ ~ 17. 0 • ~ ~ at sibling rate X .12 18. Amount of Line 14 taxable 0.00 18. ~ . 00 at collateral rate X .15 19 571.73 19. TAX DUE ............................................................................................................... . . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 t)aradnnYs Complete Address: File Number 21-12-0497 DECEDENT'S NAME Kotrmoyer, Joanne Y. STREETADDRESS 348 McAllister Church Road CITY Carlisle STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 571.73 2. Credits/Payments A. Prior Payments 198.00 B. Discount 10.42 Total Credits (A + B) (2) 208.42 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Cheek box on Page 2, Line 20 to request a refund 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 363.31 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 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 :.................................. x x c. retain a reversionary interest; or ............................................................................................................. . d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^x If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x 4. Did decedent own an individual retirement account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ^x ^ 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 t, 1994 and before Jan. t, 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 January 1, 1995, the lax 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. Rav-1507 E%~ IB-9a) SCHEDULE B STOCKS 8r BONDS COMMONWEALTH OFPENNSVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF All property IoinOy-ovme0 wiM right of survivormhip must be tlleclosstl on Schetluls F. FILE NUMBER ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Allied Irish Bank, common stock -this stock was sold on 0.00 April 13, 2011 before decedent's death ;therefore, Item III F) of the Will is adeemed 2 2,296.288 shares of Forward Income & Growth Allocation - 14.8904492 34,192.73 Institutional - Orrstown Bank Account No. 11012005480 3 91 shares of Franklin Gold Metals Fund - Orretawn Bank 33.0814266 3,008.59 Account No.4N2734826 4 33 shares of Wells Fargo & Company - (previously Wachovia 33.63 1,109.79 Corporation) TOTAL (Also enter on Line 2, Recapitulation) 36,311.11 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule B (Rev. 6-98) Rev-1509 EX+ (11-10) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF (FILE NUMBER Kofzmoyer Joanne Y 21-12-0497 Inclutle the proceeds a(bllganon end the date the proceeds were reteivetl Dy the estate. All propsrry lolntlyawmd with Ms right o/ survlvorahip must bs dlaelosad on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Wells Fargo & Company -check dated 3/30/2012 3.30 2 Comerstone Federal Credit Union, Certificate of Deposit Account No. 77656-10 1,496.76 Accrued interest on Item 2 through date of death 0.34 3 Cornerstone Federal Credit Union, Savings Account No. 77856-01 1,113.62 Accrued interest on Item 3 through date of death 0.15 4 Orrstown Bank, 50+ Interest Checking Account No. 106001781 121.68 5 Orrstown Bank, Brokerage Money Market Account No. 4N2734828 184.12 6 Orrstown Bank, US Government Money Account No. 11012005480 558.34 7 1997 Chrysler -VIN 51025047302K0 2,551.00 8 Antique dishes, vases and pitchers 100.00 9 Antique oak curved-glass china cabinet 300.00 10 Cash found in safe deposit box - 324 paper money, 510 half dollar coins, 53 silver dollars, 33 40.00 dimes 11 Jewelry - as per Item III A) of the Will -14k white gold ring 3500; 10k yellow gold ring 3500; 1,025.00 costume jewelry 325 12 Oil paintings 250.00 13 Capital Blue Cross -refund of unused premium 550.39 TOTAL (Also enter on Line 5, Recapitulation) I 8,294.70 (K more space is needeq additional pages of the same size) Copyright (c) 2070 form sottware only The Lackner Group, Inc. Fonn PA-1500 Schedule E (Rev. i t-10) _ _ ~..--- Rev-1 bOB EX~ (0110) SCHEDULE F COMMONWEALTH OF PENNeYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT OEGEOENT ESTATE OF ',Joanne M en saes/ wes SURVIVING JOINT TENANT(S) NAME A. Kendra K. Heinbaugh B. C. JOINTLY OWNED PROPERTY: M wlVlln one year of me aeee°sm's °a~e m ADDRESS 493 Crossroad School Rd. Carlisle, PA 17015 Daughter ITEM NUMBER LETTER FOR JOIN TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTRUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH ALUE OF ASSE °~ OF DECD'S INTEREST DATE OF DEATH DECE ENTS MTEREST 1 A 1N993 1- 51,000 U.S. Series EE Savings Bond - 1,341.20 50.000°k 670.60 #M48432247EE;dated 1N993;Joanne Kotzmoyer or Kendra Heinbaugh 2 A 1/1993 1- E500 U.S. Series EE Savings Bond - 670.60 50.000% 335.30 #D31259299EE; dated 1N993; Joanne Kotzmoyer or Kendra Heinbaugh 3 A 111993 3 - 5200 U.S. Series EE Savings Bond - 804.72 50.000°h 402.36 R93845577EE;R93845579EE;R93845580EE; all dated 1/1993; Joanne Kotzmoyer or Kendra Heinbaugh 4 A 07/21/2011 22.75 Franklin Gold Metals Fund, Orrstown 752.18 100.000% 752.18 Bank Brokerage Money Market Account No. 4N2734800 5 A 07/21/2011 Orrstown Bank Brokerage Money Market 28.58 100.000°k 28.58 Account No.4N2734800 (FILE NUMBER 21-12-0497 must be roportstl on schedule G. RELATIONSHIP TO DECEDENT TOTAL (Also enter on Line 6, Recapitulation) I 2,189.02 (tt more space is needed, atlditional pages of the same size) Copyright (c) 2010 farm software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 01-10) Rav-1570 EX+(08-00) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY COMMONWEALTH OFPENNSVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Y. NUMBER This schetlule must be wmpletetl and tiletl if the answer to Rny of questions 1 through 4 an page Three o<the REV-0500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE OATENOF TRANSFRERSATfACF1TA COPYEOF THE DEED ~OR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST ( EXCLUSION IF APPLICABLE) TAXABLE VALUE 1 Cornerstone Federal Credit Union, Certificate of 15,362.66 100.000°k 15,382.86 Deposit Account No. 77656-30 -Equal Beneficiaries are Roy E. Kotzmoyer, husband, and Kendra K. Heinbaugh, daughter 2 Orrstown Bank, IRA Account No. 4N2738462 -Roy F. 15,187.41 100.000% 15,187.41 Kotzmoyer, husband, beneficiary TOTAL (Also enter on Line 7, Recapitulation) I 30,570.27 (If more space is needed, additional pages or the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 08-09) REV-1151 EX+nO-09) COMry]Ory1y~OF p$ RLVgNIA SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Kotzmoyer, Joanne Y. 21-12-0497 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. ~ FUNERAL EXPENSES: See continuation schedule(s) attached B. I ADMINISTRATIVE COSTS: t. Personal Representative's Commissions Name of Personal Representative(s) 9,253.74 Street Address City State Zio Year(s) Commission Paid 2. Attorney's Fees Salzmann Hughes, P.C. 3,425.00 3. Family Exemption: (If decedent's address is nol the same as claimant's, attach explanation) Claimant Roy F. KOtimOyer street Address 348 McAllister Church Road City Carlisle state PA Zio 17015 Relationship of Claimant to Decedent SpOUSe 4. Probate Fees 262 50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Casts 955.16 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 13,896.40 Copyright (c) 2009 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule H (Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER _ Kotzmoyer, Joanne Y. 21-12-0497 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hoffman-Roth Funeral Home & Crematory, Inc. -funeral services H-A Other Administrative Costs 2 Kendra Heinbaugh -reimbursement for 2 short certificates 3 Orrstown Bank -service fee 4 Orrstown Bank -service fee 5 Orrstown Bank -service fee 6 Register of Wills -filing fees 7 Register of Wills -two short certificates 8 Salzmann Hughes, P.C. -reimbursement for payment to The Sentinel for legal advertising 9 Salzmann Hughes, P.C. -reimbursement for 5 shoR certificates 10 Salzmann Hughes, P.C. -reimbursement for 5 short certificates reimbursement for payment to Cumberland Law Journal far legal advertising 11 Salzmann Hughes, P.C. -closing costs and final fees for income tax preparation, postage and miscellaneous contingencies in order to administer the estate H-B7 9,253.74 9,253.74 8.00 36.46 36.62 40.92 30.00 8.00 200.16 20.00 75.00 500.00 955.16 Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-7500 Schedule H (Rev. 6-98) Rev-1917 EX+ (17-09) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS COMMONWEALTHOF PENNSYLVANIA ~NHERITgNCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kotzmoyer, Joanne Y. 21-12-0497 Rspert tlelNe ir¢umtl by the tlecatlent prior to tlsaM that remalnetl unpeltl et the date o<tleaM, Inclutlinp unrelmbunetl matllol expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cornerstone VISA -payment 70.00 2 Deborah W. Piper, Tax Collector - 2012 per capita tax 5.00 TOTAL (Also enter on Line 10, Recapitulation) I 75.00 (K more space is needed, atltlitional pages of the same size) Copyright (c) 2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1b1I EX+101-10) SCHEDULE J comr~v ~g4rt~D .e~.81i~y.~ygNIA BENEFICIARIES ESTATE OF Kotzmoyer, Joanne Y. FILE NUMBER 77 _~ 7 1fA0'1 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY DECEDENT (yyords) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Roy F. Kotzmoyer Spouse Schedule G -all 52 888.55 348 McAllister Church Rd. Entire Residue , Carlisle, PA 17015 2 Kendra K. Heinbau9h Daughter Sch F -all items 12 665.15 493 Crossroad School Rd. Items per Item III , Carlisle, PA 17015 A) thru G) of the Will 3 Derek N. Heinbaugh Grandson Items per Item IV 40 00 493 Crossroad School Rd. A) B) of the Will . Carlisle, PA 17015 NOTE: ITEM IV A) of the will wasn t paid due to the fact that the only IRA went to named husband as beneficiary and didn't refer to grandson. Total 85,393.70 Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 cover sheet as a r o riate. II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTA L OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 covFa CHFFT Copyright (c) 2010 form software only The LacknerGroup, Inc. Form PA-1500 Schedule J (Rev. 01-10) ., ~ n _ ' F J T, ~ ~ T ~ n ~ ,_ _ _ n ~. LAST WILL AND TESTAMENT '~-'~-~ r~< ~-„ v _ ~ _ ~ - - , . OF n ~ ~~ o ~ Tl C~ JOANNE Y. KOTZMOYER I, JOANNE Y. KOTZMOYER, of 348 McAllister Church Road, West Pennsboro, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding do make, publish and declare this to be my Last Will and Testament. I hereby revoke all previous Wills and Codicils at any time heretofore made by me. ITEM I I order and direct my Executor, hereinafrer named, to pay my debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. ITEM II I direct my Executor to arrange for a funeral in conformity with my station in life to be followed by the interment of my remains in my burial plot in Westminster Gardens at "Garden of Christis", Lot 68-A (space 3 or 4). I also own Lot 69-B to be given to my daughter, KENDRA K. HF,INBATIGH. My Executor is further directed to purchase, erect and inscribe a suitable marker for my grave. ITEM III I hereby give and bequeath to my daughter, KENDRA K. HEINBAUGH, per stirpes, the following items: C~K A) All of myjewelry, including my diamond ring, wedding band andjewelry boxes owned by me or in my possession at the time of my death. B) All of my oil paintings. C) My antique oak curved-glass china cabinet. D) All of my antique dishes, vases and pitchers. E) All of my shares of common stock of Wachovia Corporation, its successors and/or assigns. F) All of my shares of common stocks of Allied Irish Bank, PLC, its successors and/or assigns. G) All of my US EE Savings Bonds. ITEM IV I hereby give and bequeath the following items to my grandson, DEREK N. HEINBAUGH: A) The sum of Five Thousand ($5,000.00) Dollars from my IRA account. B) All the coins and money in my safety deposit box. ITEM V I give, devise and bequeath all of the remainder of my property, of every kind and description (including lapsed legacies and devises) wherever situate and whether acquired before or afrer the execution of this Will to my husband, ROY F. KOTZMOYER, if he survives me, or if he predeceases me, then to my daughter, KENDRA K. HEINBAUGH, and to her issue, then living, per stirpes. z ~ ~~ ITEM VI If my grandson, DEREK N. HEINBAUGH, is less than twenty-one (21) years of age at the time of my death, I hereby direct that portion of my property in which he will share, wherever situate and whether acquired before or after the execution of this Will, be placed in trust to his mother, KENDRA K. HEINBAUGH, of Cazlisle, Pennsylvania, with the following conditions and provisions: A. Trustee shall hold the principal of this trust for the benefit of my grandchild (beneficiary) and shall distribute the principal and income in such proportions as Trustee shall determine, for his health, maintenance, support, business endeavors and education, including college, graduate level or professional education after considering the beneficiary's age, aptitudes, interests, abilities anc: needs. Education shall be defined broadly to include trade school and other similar training. In the event the income of this Trust shall be insufficient to provide the beneficiary with adequate maintenance, support, welfare or education, the Trustee may invade the principal of the Trust for this purpose. The Trustee, in exercising her discretionary authority with respect to the payment of income or principal of the Trust estate to my beneficiary, shall take into consideration any income or other resources available from sources outside of this Trust that may be known to the Trustee. The determination of the Trustee with respect to the necessity of making ';~K payment out of income or principal to my beneficiary shall be conclusive on all persons however interested in the Trust. B. If the beneficiary should die, without issue, before attaining the age of distribution, all unapplied principal and income shall become part of my residuary estate. C. The beneficiary of this Trust shall not have any right to alienate, encumber or hypothecate his interest in the principal or income of the Trust in any manner, nor shall his interest be subject to claims of his creditors or liable to attachment, execution or other process of law. D. In order to carry out the purposes of this Trust established by this Will, the Trustee, in addition to all other powers granted by this Will, or by law, shall have the following powers over the Trust estate, subject to any limitation specified elsewhere in this Will: To retain any property, real or personal, received by the Trust estate for as long as the Trustee considers it advisable. 2. To spend funds for the maintenance and repair of real property. 3. To sell at public or private sale, exchange or lease for a period of time, any real or personal property and give options for sale of the lease. ' aK 4. To execute and deliver any deeds, assignments or other instruments as may be necessary to carry out the provisions of this Trust. 5. To borrow money and to mortgage or pledge any real or personal property. 6. The Trustee shall maintain accurate records and accounts showing receipts and disbursements of principal and income no less frequently than annually. The Trustee shall receive fair and reasonable compensation for administration of this Trust, not to exceed five (5%) percent of amrual income. 7. To distribute property in kind. 8. To do all other acts that are in her judgment necessary or desirable for the proper management, investment and distribution of the Trust estate. E. The Trust estate for the beneficiary shall be administered until said beneficiary is twenty-one (21) years of age, at which time the Trust will terminate and Trustee shall distribute the remaining principal and accumulated interest to the beneficiary. ITEM VII I direct that the personal property listed in the Memorandum (Directive) attached to my Will be distributed by my Executor as indicated therein. qK ITEM VIII In the event that ROY F. KOTZMOYER and I should die simultaneously or under circumstances as to render it impossible to determine who predeceased the other, or within thirty (30) days of each other as the result of a common accident, I shall be deemed to have survived him, and all the provisions of this Will shall take effect as though I had survived my husband. ITEM IX I hereby nominate, constitute and appoint my husband, ROY F. KOTZMOYER, as Executor of this my Last Will and Testament. In the event of his renunciation, death, resignation or inability to act For any reason whatsoever, I nominate, constitute and appoint my daughter, KENDRA K. HEINBAUGH, as Alternate Executrix of this my Last Will and Testament. ITEM X I hereby direct that no Executor or other Fiduciary named or appointed by this Will shall be required to post any bond or give any security of any type for any purpose whatsoever, nor be liable for failure to file any report, accounting or inventory, in any jurisdiction in which he or she may be called upon to act, insofar as I am able by law to do. ITEM XI I authorize my Executor in his discretion to sell, with or without notice, at either public or private sale, and to lease any property belonging to my estate, subject only to such confirmation of Court as may be required by law, for such prices and on such terms and conditions as he deems best, and to make distribution hereunder either in case or kind, as he may deem wise. 6 ~K p , IN WITNESS WHEREOF, I hereunto set my hand and seal to this, this / ~L day of (`,.~C/Lb-'tJ-~L , 2003. (SEAL) J ANNE Y. KOT OYE Signed, sealed, published and declared by the above-named Testatrix, JOANNE Y. KOTZMOYER, as and for her Last Will and Testament, in the presence of us, who thereupon at her request, in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANLA SS. COUNTY OF CUMBERLAND ~ We, JOANNE Y. KOTZMOYER, PATRICIA R. BROWN, and VALERIE F. GSELL, the testatrix acrd witnesses, respectively, whose names are signed to the attached or foregoing instrument, being duly sworn do hereby declare to the undersigned authority that the testatrix signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; and thaC each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge, the testatrix was at that time 18 or more yeazs of age, of sound mind and under no constraint or undue influence. ( SEAL) J ANNE Y. KO Z O ~~ ,• ~ ~'Y`-^^~-+~ (SEAL) Witness ~~'CFi~~-_~C"~-t,e ~_~~ (SEAL) Witness SUBSCRIBED, sworn to, and acknowledged before me by JOANNE Y. KOTZMOYER, the testatrix and subscribed and sworn to before me by PATRICIA dR. BROWN and Vifl errs (-- C~~rf (i ,the w(i/t//n/)esses,~-own the day of //t.Li~u-z/ , 2003. Notary Public N~ NOT N11' Shareowner Services S H A R E O W N E R P.O. Box 358333 Pittsburgh, PA 15252-8333 000326 SERVICES December 17, 2012 SALZMANN HUGHES, P.C ATTN KENDRA K HEINBAUGH 354 ALEXANDER SPRING ROAS, SUITE 1 CARLISLE, PA 17015 Re: Estate of Joanne Y Kotzmoyer Dear Sir or Madam: Company '' ALLIED IRISH BANKS Name PLC fAccount fKOTZMOYERJOANY0000 KeY Control 201212140002195 Number Telephone rl 800-522 6645 Number We recently received an inquiry regarding the above referenced account. Please find below the High, Low and Closing price per share of the above stock on the following date. Date High Price Low Price Closing Price April 11, 2012 $0.91 $0.85 $0.90 The enclosed account transcript will provide you with the information requested. Specifically, this transcript provides: • Account Profile that offers a general account status. • Account Certificate Listing that outlines debit/credit of certificates. • Account Payment List, which details cumulative dividend payments. • Dividend Reinvestment Account Summary that details shares purchased with distributions. We hope you find this information helpful. As a reminder, you may access our Investor ServiceDirectr"" website at ia~ww.cpushureownerservices.com or call our automated voice response system at the above number for account information and to initiate certain transactions. You may also speak with one of our Customer Service Representatives who are available during normal business hours. Sincerely, Shareowner Services Page 1 of 3 . _ ,...._ .v.,.~~,,,.,,~Ma, Shareholder: JOANNE Y KOTZMOYER 348 MCALLISTER CHURCH ROAD CARLISLE PA 1 701 5-9 577 Our Control Number: 101212140002195 _~ s. 01922880 - ALLIEB IRISH BANKS PLC • • ' • 9207 CERTIFICATE HISTORY (From :2011 To: 2012) Th¢re ar¢ no certificakes for this account. BOOK ENTRY HISTORY (From :2011 To: 2011 J Final Cast Basta for your covered shares will tre provided on your year end Form 1099-8. PLAN TYPE : IRO01 3 ha ~M~„ y t i ~~~'y. °e(tg~{y ' ` a 5 H'1r~ ~ N ~ti ie e ~' ~, ,y S d4 B~a d$f J'4 b& h.~A gy~~h i $ } I 'M6{ ~e % fr 't J•"'~"A A ~ N ~e?AA ~ G k A,„~ SF%as. ` ® r4 .7+„ ~~s !~*k~-x~."~ I" V?}i y~gy 9 "p r P'°4" t~.''+ I . rA~„ %f!`n °Y m .~ g b.Rn ~S'x_ ~ , ~ °,~ a. .°°f~ #.. ~w:i, ~ t, ~ ,~ ~v..C . a' rz,A .:§re. 6 ad~EAt R...r.~Ar..n P 9 .e Ce nd ~3 y ~ ,'S4n N/A - 01/01/2012 Balance ForwaN .0000 .0000000 .00. .00 .DO .00 0001003776 - 04/13/2011 Sale 42.0000 4.1256160 173.28 10.00 159.08 .00 0001002787 - 03/25/2011 Transfer Credit 42.0000 .0000000 .00 .00 .00 .00 6001002787 N 03251201 t EXCH .:14.2000 '. 0 0000 •OOi : 0001002787 N D325201t-:. EXCH 284000 , 0.0000 '_ ; . :. • 002 0001002787 N 03/25201L' CIL ~" .6000 '.0.0000 • 001 0001002787 N '. 03252015. SEL 13.6000 0.6000 • 001 _ _ 0001002787 ~ N 0325/2011 SEL ~ 28 4000 ! 0.0000 -002 , N/A - 01/01/2011 Balance Forward .0000 .0000000 .00' .00 .00 .00 `Denotes adjusted acqulsltloNholding date andlor price as a result of Corporate Action events, reelasalfication of return of capital, transfers, andlor gigs PAYMENT HISTORY (Prom 2011 To: 2012 ( ~ ~ ' ~' ~'sM ~~"~ f~ ~~~ a 9 i ~ ff~`7 ~d "u ~ s~'7B~keS* y. "? z' ;i~~a ~~~': ( ~ w L €t ..ry~+~~ 5°"~~i9 ~°sdtlk+.~ y~., j ~w e ~ ~~i~iey~ ° Y •g'S " ~ ~•n • ~[ a g txe d?a 4 ; 4~ Aa @ 4 T tl ' 4 ~~ , , ~ k 8." p 1'~ ~ ~ y $ y ry ~ s s~ 3a A A 4~. a. „~ J 8 .~ tS n : rte ~ .n~9 ti afi..0. d ~. i ` e , e qv *_' rv: Dividend Reinvestment 04/13/2011 '. 7598411 PAID on 04/26/2011 159.08 0000000110040 0000000000 0.0000 Page 2 of 3 YEAR TO GATE ACCOUNT SUMMARY Note: For Security reasons, we era replacing the first five digits of your Social Security member with "" ""'(asterisks) on correspondence that ws send to you. C/N denotes covered (C) and non-covered (N) shares. Covered shares are e quity securities purchased on January 7, 2017 and later. Purchases within a divitlend reinvestment plan ate covered as of January 7, 2012. Non•covsretl Shares ate equity eecurities purchased before January 1, 2071, or shares received upon transfer where cost bads has not been providetl. TransType Description TransType Description BKXC Book Transfer to Other Cusip I BOOK Book Transfer CA/DIL Corporate Action cash in lieu CDEP Cereficate Deposit sale CHRS Chadtable Sale CRPL/CRTR Certificate Replacement CSBY Cash Purchase I DEMU Corporate Action Demulualization DRPP Dividend ReinvesMent I ESCH Escheated to State ISOS Incentive Stack Op0ons I ISS Issuance MRSU Management Restricted Stock I RPU Restricted Performance Units Unit SCDV Scrip Dividend I SDIV Stock Dividend SEL Sell I SPIN BDln og STK Stock Dividend5plit ~ TRAN Transfer Page 3 of 3 Forward Funds Web System ATradik'ort oflnzceJJerue Page 1 of 2 Date Range mntNO.11012005480 VNE Y KOTZMOYER MCCALLISTER CHURCH RO LISLE, PA 17015 From: 44/11/20121 ~~c To: O6/07/2012~~ r SeFDates Transaction Detail 8 Retum to Menus ' The cost basis Is only being calculated and reported on covered shares. Any shares acquired prior to January 1, 2012 are not considered covered shares and are not Included In this Flgure. Trade Date rensactlon Description Share Price sis Co Basis Amoun Ba Method OANNEY KOTZMOYER Forward US Government Mone -Instltutional 04-12-2012 Innin Balance 558.340 1.0 .0 558.34 04-16-2.012 Fee Redem tlon -36.460 1.0 - 36.46 0.5=15-2012 Fee Redem tlon -36.620 1.00 - 36.62 D - - 12 Dividend Reinvest .030 1.00 ,01 06=0g_2p12 Redem on -985.270 1.OD - 48527 06-07-2D12 mfln Balance .00 1.00 .OD .00 Forward Lnoo me & Growth Altocstion-Institutlona l 04-1i-2012 Innin Balance 2 296.28 14.8 .00 34 192.7 0 - - Dividend Reinvest 3.38 16.D very a Cost 50.97 06- -2012 Dividend Reinvest 5.414 39.7 very a Cast 79.59 06- -2012 Redem Non -2 305.08 14.6 35 395.5 very a Cast - 33 654.2 06-07-2012 ndln Balanre .000 14.6 .D .OD https://www.fonvardrk.comlFFWeb/changeViewData.do7fromDat~04°/a2F11 %2F2012&to... 6/8/2012 CORNERSTONE F e d e r a l Credit U n i o n P.O. Box 1181, 5 Eastgate Drive, Carlisle, PA 17015 Telephone (717) 249-1661 FAX (717) 249-8208 Member founded -Service based voww.cornerstonefcu.coop July 27, 2012 Salzmann Hughes P.C. Attorneys at Law 354 Alexander Spring Road, Suite 1 Carlisle, PA 17015 RE: The Estate of Joanne Y. Kotzmoyer Dear Patricia: At the time of her death, Joanne Y. Kotzmoyer was a single owner of account 77656 and joint owner of 7656. Listed below is the information you have requested in your letter dated June 29, 2012: Account Type of Date DOD Accrued Number Account Ooen Balance Interest 7656-01 Savings 06/15/2000 $1190.69 $0.89 7656-09 Savings 09/23/2009 $0.00 (Closed 8/1/2011) Closing Balance: $545.19 7656-13 CD 12/27/2000 $5479.58 $12.28 77656-01 Savings 01/04/2001 $1113.62 $ .15 77656-10 CD 06/15/2000 $1496.76 $ .34 77656-30 IRA CD 06/16/2000 $15285.19 $97.67 Joanne wasjoint with Roy F. Kotzmoyer on account 7656 (includingthe two savings accounts and the CD). There were no changes in ownership within the past year prior to death. If you require any further information, please call me at 717-249-1661 ext 240. Sincere r I 1 l/1't~~~ Elaine Bentz Financial Service Administrator MEMBER SAVINGS ACCOUNTS FEDERALLY INSURED TO $2$O,OOO BY THE NATIONAL CREDIT UNION ADMINISTRATION TRADITIONAL IRA TRUST APPLICATION PACKET -CUT (FORM 2300) ~R -~~y- CUT CJredit Union Plan Number - !credit union will complete) IRA Owner's Social Securi~ Number i' 'IRA Owner's Birth Date IMolDaylYrl - required for processing) 1(.~ ~~, Account Number IRA Owner's Name (First, Initial,'Lastl J1 i j. ~ {{ x Street Address Apt # .Mailing Atddress iF Different From Street Address City, State, ZIP instruct the credit union to invest this IRA in the following investment: PRIMARY BENEFICIARY(IES) F % Neme and Social Security p Mailing Address )include ZIP code) ~0 ~:y f~ . .[t.]i.YLJ~ Y~ `1)l i'I~~Li>Ti'%i r.nt'> iC)i / ~) _ 5~ k A/:7 hit ~ ~/'Y' //~14 f ~~~ ~n .J f r ~~ ~~ ivl; % column MUST to ta/ 100% )see reverse side Jor comp/ere instructions! SECONDARY BENEFICIARY(IES) % column MUST Iota/ 100% )see reverse side /or comp/ete ins tructionsl Relationship Birth Date h 1~i CONSENT OF SPOUSE - 1 consent to [he designation of beneficiary on this form, and I agree to convert this IRA into the separate property of my - spouse [o be distributed as shown on this form following my spouse's death. I understand that by signing this consent, - I am giving up both my current community/marital property rights in this IRA and my community/marital property rights in any future convibutions to this IRA. I further understand that I may not revoke this consent in the future. However, this consent will be automatically revoked if my spouse amends this designation of beneficiary during my lifetime. -X' {,,. Signature of IRA Owner's Spouse Date lMO/Day/Yr) IRA OWNER'S SIGNATURE - I acknowledge receipt of the "Credit Union Traditional IRA Disclosure Statement," which includes a financial projection tablo-~ I also accept the terms ar~d conditions of the "Credit Union Traditional IRA Trust Agreement." IR wner s Signature ~ Date (Mo/DaylVrl v . k ACCEPTgMCE QF TRUSTEE (tpi credit union use only! ~redlt union hereby establishes a traditional IRA for~the above IRA wner under the terms of the [tio'ne41RA ?rust Agreement' ~ , ~, "~ Union Name . Authorized Credi( nion'9fgnatpr r~" ". ~ - r p,.,, ~ y +' , ! -~- Unbn Mail(ngAddrass (include street address; ci ,state and ZlP code! Date (MdlDay]Yr) . #80008 WHITE-ADMINISTRATOR COPY CANARY-CREDIT UNION COPY PINK-OWNER COPY 2300-CUT m tooa ruN4 co.,d~a r..,,~~r, i..~ )Rev. 4!981 Holdings by Investor orrst:own k __. _ - - ------------ -- - - - Joanne Y Kotzmo er - - - -" - - - -- Y Bradley Gerlach Combined Account Portfolio 348 Mcallister Church Road =. -°--- ~ Date: 04/11/2012 - Carlisle, PA 17015 ~ Created: 05/17/2012 ~ `~ .~ PA 717-240-0803 -- - - - - -- --------- Acct Na a JOANNE Y KOTZMOYER>348 MCALLISTER CHURCH RD ---------- -~ Acct No:4N4828 - -' . CARLISLE PA 17015-9577 Rep. No:OXK Acct 7ype:lndividual Mwt Nama Tlekar Asset Type BROKERAGE MONEY MARKET M t. Nama 4 Quantity Price (t) Vslw (S) CASH BROKERAGE 1$4.12 MONEY 1.00 1$4.12 MARKET FRKLN GOLD METALS FUND CLS FKRCX NON-US STOCKS FRANKLIN/TEM PLETON 91.00 33.06 3,008.59 FUNDS June 1, 2012 JOANNE Y KOTZMOYER Salzmann Hughea PC Patrlala R grown Eeq 7a St Paul Orlve Ghanberaburg PA 17201 Shareowner Services Post Office Box 64874 St. Paul, MN 55164-08%4 www.shareowneronline.com Re: Financial Confirmation Dear Shareowner._. Account Number: 34021 81 91 7 Registration: JOANNE Y KOT2MOYER 348 MCALLISTER CHURCH RD CARLISLE PA 17015-9577 Account Creation Date: 5!27/1998 Issue Namo of Stock: Welts Fargo & Company Total Share Balance on 4!11!2012: 33.OD0 Certifirate Shares: 33.000 DRS/Book-Entry Shares:.000 Dividend Reinvestment Plan Shares: .000 Dividend Amount Paid Y'fD: $14.52 Closing Price per Share on 4/11/2012: $33.83000 Ticker Symbol for the Company is: WFC Stock Exchange: NYSE Please note that as a transfer agent, we are not directly connected to the stock market. The-above pdce is given as an- -- estimate and is not. a guarantee of s specific price. If you have any questions., please call our office toll-free at 877-840-0492. Our Shareowner Relations Specialists are available to assist you Monday through Friday, from 7 AM to 7 PM Central Time. You may also send an email to us by selecting "Contact Us" at any time while online at www.shareownoronline.com. Sincerely, Wells Fargo Shareowner Services ~IIIIIIIIIIIIIIIIIIIII~IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII~IIIIIIIIIIIIIIIIIII "ZFNC0153~48~1~1~YrriYlYlY" as ~- - 5/09/12 Joanne Y Kotzmoyer Closed Messages Ldst stmt balance: Current balance: 1=View 6=Print T=Tset Posted Check No S T/C 3/20/12 $ 334 3/20/12 P 020 3/20/12 911 C 183 3/21/12 912 C 183 3/21/12 912 C 178 3/26/12 P 020 3/28/12 C 163 3/28/12 151 9/05/12 914 C 183 _ 4/05/12 916 P 091 4/05/12 913 P 091 4/05/12 151 4/18/12 917 C 183 4/30/12 P 050 Deposit Inquiry Account number: F9=Redsply F6=Bal Inq F7=Scan Fwd F17=Top F18=Bottom F19=EDI F20, 00 Last stmt 00 Statement Control: From Debit 30.53 39.00 37.00 date: cycle: 15:41:29 106001781 1 of 1 5/06/12 5 To Credit Balance 37.00 368.30- 400.00 31.70 1.17 37.83- 74.83- 112.00 37.17 671.00 708.17 .01000000% 708.17 288.39 419.78 260.00 159.78 38.10 121.68 ,- - .000OOOOOa 121.68 ~._ 70.00 51.68 51.68 .00 Bottom =Scan Bkwd F11=Prior bal F15=EFT F16=Sort fold F22=T/C F23=Checks Orrstown Bank, 50+ Interest Checking Account No. 106001781 - owned individually by Joanne Y. Kotzmoyer Kelley Blue Book j~ls Kelley Blue Block tm Innsrta arsouaci oI~OOREIJ/I/E 899°° /~ • __ _. _ _ Ilnp 1 r__ ~ _/ '', The Name Vour Price"Tool. Only from Progressive ' r ' Q~ wM ad. Your Blue Booka Value 1997 Chrysler Concorde Style: Setlan 9D Mileage:9R59 Private Party Value Vehicle Highlights Excellent $2,801 Very Gootl $2,626 Good $2,551 Fair $2,051 Page 1 of 2 MPG: Ciry SS1Hury 24 Doors: 4 Drivetrain: FWD EPA Class: Large Cars Country of Origin: United States Man Seating: 6 Engine: V6. 3.5 Liter Transmission'. Aueomatic Botly Style: Sedan Country of Assembly: Canada Your Configured Options Our pre-selectai options, easetl on typical equipment la this or. J Options that you addN while confguring this var. Engine Comfort snd Convenience V6, 3.5 Liter Alr Conditioning Transmission Power Windows Automa[k Parer Door Lacks OrWetraln Crvise Contrd Steerlnq FlND Accessory Packages Power Steering Tilt Wheel ~ Entertainment antl Instrumentation AM/FM Stereo Ussette Sakaty antl Security Dual Air Bags Seats Power Seat Wkeela antl Tires Steel Wheels u~c nnt~ ~c~ ~ wl~~c Gci~J ~~~, v~ ~~~~ ~Llo~ l~~ ~~°° on L O ~, ~ O ~ c C Y ~ d U C Q OD .'~ C +i Ol x ro N b C v x a O 1-I v T 6 N 3J O ?4 D+ v C O .1 N_ N_ O O N N ~ N N O to . O N l0 NQ OC C as _N V_ r p . . . « « 2 ~ ~ M M M M M y N N N N N N`+ O O O O O rd Q ~ N N N N l0 0 0 0 0 0 C .. w ~ N N N N N r _ _ _ _ _ +' C 0 0 0 0 O A ~ ~ N O N O N N N O i O O d Z 0 0 0 0 0 ~ ~ ~ ~ O ~ d N N N N N l0 ~ N 1l7 u7 « 0 0 0 0 o 0 a 0 o 0 ~ p 0 0 0 0 0 R~ V V C V V __ ~ ~ ~ O O N N N (O N y aD aD a0 O ~ ~ (O (D t4 I~ ~ N N N (O M ~ v v v o o r N N N (O N w a6 a6 a6 o ~ ~ co c4 ~4 m ~ r v M C 0 0 0 0 0 O O O O O 4 0 0 0 0 0 V 0 0 0 10 0 . ` r N ~ a "' M M M M M d y 0 0 0 0 0 7 0 0 0 41 01 ~ 0 0 0 0 0 d a w w w w w E W W W W w ~ ~ 0 0 0 ~ Z I~ O n O ~ ~ ~ i 4 N N _ 4'1 1f1 Y1 0 N ~ ~ V V 10 P1 ~ cO aD aD N ~ Q/ M M M ~ (O fq 0 0 0 M O E 0 0 0 0 0 o o o o o O N N N 14 O C Hi D w d W W W W W y W W W W W' y i ~ O Z ~ N M V _ l4 - d 7 d w C w c0 H O 9 ~ O ~ > m C N~ J O ~ C y dTOV cn ~v T y N C v ~ c O O O L U Z y C N L ~ U p ~ ~ N'O C C N O ~ N L .°~~.°~ C _ dZ NwL =~aa~Oio = yN~ ~ ~ N O O w T C a N N p,r N t0 N ~ ~~Ox N z m E ~ o OEM y-4 w:m10a ~ y >, U ;a1~Ea ~ r 4 ~ c c o ~ c'm 4Z-4 10a ~y~~y Xv~~~ W~4a1md CZ~Rd L • ~~ m `° `° ,~ Din 0O p yyC_C`r 3 .O. p ~ N '~ c>> C O C N y L 2]'C 'N .y 4 C>d33w cww c y ~ ~ L O y y y mmalm Q(ny w ~ ~ ~ 3 y y y-O C O 0 0 o a Via' O N m (0 a N C Holdin s b Inv_e_s_t_or orrsrown nlc -- - __ ----- __ - - ___ -- _ _- - -- JoanneY Kotzmoyer Bradley Gerlach Combined Account Portfolio j -- Date 04/11/2012 - 't~~ 348 Mcallister Church Road Created: 05/17/2012 Carlisle, PA 17015 PA 717-240-0803 Acct Name:JOANNEY KOTZMOYER KENDRA HEINBAUGV~ JTTEIJ ~48 MCALLISTER CHURCH RD. CARLISLE PA 17015-9577 ~--`'~ ,~ Acct No:4N2734800 AcctType:Joint Rep. No:OXK 1 ~ .~\' ~ ~~ Asset Name Ticker Asset Type Mgt. Nama Quantity Prioe (S) Value ($) BROKERAGE MONEY MARKET CASH BROKERAGE 28.58 1.00 28.56 MONEY MARKET FRKLN GOLD METALS FUND CLS FKRCX NON-US STOCKS FRANKLIN(fEM 22.75 33.06 752.18 PLETON FUNDS Account Total: $780.76 Incomplete'rf presented without accompanying tlisclosure pages Page 1 of 2 Holdings bylnvestor orrstown k Joanne Y Kotzmoyer Bradley Gerlach _ Combined Account Portfolio 348 Mcallister Church Road ~ ~--'°° ~ Date 04/11/2012 r Carlisle, PA 17015 Created: 05/17/2012 '~!~ ~.> PA 717-240-0803 JoanneY Kotzmoyer ~ ~ -., . Acct Narr{e:IR~F80 JOANNE Y KOTZMOY ER PRIMEVEST F INL SVCS CUSTODIAN 348 MCALLISTER CHURCH RD CARL IS LE~'P/~ 17015-9577 ~cct No:4N2738462 Acct Type: Third Party As Custodian Retirement Account Rep. No:OXK Asset Name Tieker Asset Type Mgt. Name Quantity Price ($) Value (S) AMERICAN FUNDS CAP WORLD CWBFX INTERNATIONAL AMERICAN 199.29 20.89 4,163.11 BOND A FIXED INCOME FUNDS AMERICAN FUNDS NEW ANWPX INTERNATIONAL AMERICAN 165.60 28.97 4,797.40 PERSPECTVEA FUNDS BROKERAGE MONEY MARKET CASH BROKERAGE 682.53 1.00 682.53 MONEY MARKET WASHINGTON MUTUAL INVESTORS AWSHX US STOCKS AMERICAN 186.99 29.65 5,544.37 FUNDS Account Total: $15,187.41 MA9-29-2012(TOEJ 13:08 ORRSTOIJN BRNK (FflR)T1T249801D P. 002/003 J TRADITIONAL IRA ADOPTION AGREEMENT O PARTKI RA ~ROLLOVFJt IRA ^SPOUSALIM l^((~~_ ®^ GU IAN ~ INNERYI'ED/BENEFlCIARY IRA ~ SEP IRA (MUTUAL FVNp ONLY IRA not iuu4b10lor SFP ACCOUNTS; attach a copy of your employer's Form530E-SEP or Prototype Adoption AgraameM) ~- FOP S~IRA ONLY, PLEASE PROVIDE YOUR EMPLOYER'STA%IDENFIFlGTION NIIMBFR: p MUTUAL FUND ONLY Nooc Mutual fund ody aecauna arc anilabk for all cunodial aceoum typo ev..pt for SEP IRA. Ifyou ulcer a mutual fund aaly accoun4 you abnot wtnmingLr otLv invrstmena within your mu[tpl fund only accaant. Th Pawiopant undmanda that any idkrodt to the IMr,dl be inraml is a umnq marYa Fund dgwrde aeeeuat. er odrn ioormmmenr made available thtonpp }our 6n.nelal orpntrarLw, ualer ehe MttklNm dem othetwiw br d,arbnC the Iron below. Arty wKlr inramtmt of idle ash h mde prarunr m a ptnspeerw m«hm dRai..g dnwmnnt. chid the lattiripaatrhould obuin (mm hu ae ha fimadaLorpoiunaa~ . ^ DO NQIINVEST IDLE CASN.IThe Parfleipard mdrstards that the Custodian hastnresponsibAilyto pedA InleaeC an uninvested nth Inary IAAJ ' Frw mort sanplem infmrodon whom dte monry tiaatYet FweL IndwlWrg dwryo mrd q+rnrm, rquat a pruya+ro t,oru row unarrw ergaauwwrm ,.~.... are{ully brfomyau N.etn MARRALSTATUS: Q9nEla ®Marrlal (NOT'E Spatial eoromn may 6e requbad. See btlowJ 73eErEsw ahaEbe D®e6dagnra..... .e dtbLlRA.IFIrlcirpnremerethannneprimaryoraootio6mrtlrnrfir~~y,bu~doooc ~fj rbe pmowrt~ m whidt roeh Betref wr)' x Bmeficiuia ae mddcd. pa7mcur will be onde m nc~ ar'ririnG &ndidvT °Fr'l pa atirpea. N.pG Fu spacifx 6enefiaiary pnwkiona, plax teFa m dteapp5rabk tcaioro oFrhe PLsn aad the DiwJaure Samnwrc. rtaaw CawoFA aVF ppATpr611R aATFR BIaTR sppaLSFOIROY NONSU ADDRE56 PtaQNFA4E F C~+~IM ~ Vl-L Saars~ ~z .~e9e/-~9:oort9 5,4M~ ~~ t Y1rA-SOd ADOP PersMrtg LLC. a wMldtary al The Bad of New York Mellor C«oantion, p.awuaov~ww MemM FINRA, NYSE SIPC.TrademarHS) hebeg Io lhdr eapeeli.e mv~rs. Iherehy Jaiq,.a ALCOUNT~_ ~ d(~ ~ -1-~~ mthefimncial otywiatioa NUM6ER: C e, amu nawrrt MRy-29-2012(TUE) 13;08 ORRSTOWN BANK (FflK)7172498010 P. 003/003 MME K~QXh ~ tRNOQ hVf M TIDNSraI DA1EOFtpRfX sotNlSCLUMYRtM11ER nDWI35 ~_ ~, zf ro 14N-3p.bss~ 54mE PFnCFNTAGF /ao~ ]f you ate m.nivJ. wide in n mmmuniry pttgmyw rnarid property attu, and dt:ilnaarmmcax mlterdutt four rpoum m }our wk. pdmary Bendieary, your apace muu sign thh farm helnw. in additbn. if rcquiral iw ymN natu dm (wm mwe 6e signed U the prcxem aFs Novt aPu6 eeiualun Jte apatite uftlw ek..onamed aawot holdw.l aclmotvlalge thu 1 hm raaxired a fairand ttareorde dirdamre ofmy tpwneh ptopwty obligetionr. Due m drc impottma m sbnmgtutttn afgiving up my imane in ehia IHA.I haze been advised m yea tart pmferiamL I htwdry gtK the account halter any intact 1 hne in the funds ar proparyd4+tuitad in thb IRA and omntlM ro the Bme6eiagdwgpuionGl intBpKd ahaw.l auttme ~ rapnmbiliry for any adKne metntgtteeca thu may ttexde No rmt w legal advice was given m etc by the Cunodian. SIGNATURE OF SPOUSE ethwaeu xmw..tMwrielW wyettraMrs7 DATE: PRINT NAME I tmdeaund theeligihiliry rtqulleutata foe the type of IRAJelwtirs i make ant I ante that I qualify m woe the depadL I ItaK received a copyaf the Pershing U.C indivMtwl pmitwomt Catnodial Acmunt Plan and Didmute5taremrne I uodarond dre the «teruend wodidona whkh apply m chit IRA are mnuiatd in rhia Prnhieg ]1C Individual RWtemat CwrndLlAemnne Plot ant Dhelauro Sntnvene 3 agn:e m be bound M these tame nttd uutdidtrtm !iI elect m nnke. eolkrver unttibrtiea to rltu accaum, l henlry unify that I undmund the rdlorv rules and amditiom u thry pc++am ea thi. IRA and I haK mm the roquAemmn for wkiog a roRtew. Due ro ehe important ne contegetetttn of rollirtgover firndt ar properryT haw been ad+ited ro oonnJt with a tae pwf , .. • AB infurmaeian pm.iJed i+y w : na..td arrs4a and wy h. alieJ upon by ehe ^""_ '._ _ I atame full tagwroihtlity for aatab{'shing this IM.ttd for rollow.r tmeaaiew and will twthold the Cttnodintt liable fet wyadvtme onuequetKa drat twy wale I htaby irtereaby deaigmrc the rolovee of RteJt w odmr ptopncy>. mllaKrew3ttrimi. I hrx6yadopt nc~ Penhigl I1.C Iedividuil l4+hwnan Curtodktl plan. I AGRIIE TNA7TNI$ AGREEMENT CONTAINS A PREDISPUTE ARBffRATION CLAUSE WHICH 6 LQCAIT:D AT ARTICLE IX ON PAGE 9lN THIS AGRlEMlNT. PRINT NAME JOANNE Y M;Q'IZ6dOYFR g lawardmyour 6Me 21