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HomeMy WebLinkAbout04-1178 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Janet E. Beshore No. ,~ l- ~ - I I'-~7 also known as Janet Esther Beshore , Deceased Social Security No. 170-32-3241 late of West Pennsboro Township, Cumberland County, PA Petitioner(s), who is/are 18 years of age or older apply(les) for: COMPLETE "A" OR 'B" BELOW:) [] A. Probate and Grant of Letters and aver that Petitioner is the executor named in the Last Will of the Decedent, dated December 15, 1992 and Codicil dated April 17, 2003 State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: [] B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendenta lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the fe4iewing spouse (if any) and heirs: Name Relationship Residenc ~.~..~ (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Co Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 801 Hanover Street, Carlisle, West Pennsboro Township, Cumberland County, PA 17013 Decedent, then 9._~2 years of age, died December 21, 2004, at Church of God Home, West Pennsboro Township, Cumberland County, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ....................................................................... $ 550,000 (If not domiciled in PA) Personal property in Pennsylvania ............................................ $. (If not domiciled in PA) Personal property in County ...................................................... $. Value of real estate in Pennsylvania ................................................................................................... $ Total ................................................................................................................. $ 550 000 Real Estate s tuated as fo ows: NONE Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: .,'x;'~ ~._.' .Signature~ Stewart Typed orE.printedBeshorename and residence I 46 Nottingham Drive, Mechanicsburg, PA 17050 Form RW-1 Page 1 of 2 (Dauphin County - Rev. 9/92) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland before me this ~d:L-~ day of The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly admini~.ter the estate according to law. Sworn to and affirmed and subscribed , ~ ~=, Estate of Janet E. Beshore, Deceased also known as Janet Esther Beshore DECREE OF REGISTER No. Social Security No.: 170-32-3241 Date of Death December 21,2004 AND NOW, '~J~ 0_0 ~,¥--,~¢' r--~ ,200Z, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [] Testamentary [] of Administration are hereby granted to Stewart E. Beshore in the above estate and that the instrument(s), if any, dated Will dated December 15, 1992 and Codicil dated April 17, 2003 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................. $. ~.~. 0(,,~ Short Certificate(s) ............... Renunciation ........................ Affidavit ( ) ......................... Extra Pages ( ~ .................. Codicil .................................. JCP Fee ............................... Inventory & Tax Forms Other .................................... TOTAL .................... $ Attorney: I.D. No.: Address: Telephone: DATE FILED: Jeffrey A. Ernico, Esquire 07981 3401 North Front Street Harrisburg, PA 17110-0950 717-232-5000 Fonm RW-1 Page 2 of 2 (Dauphin County - Rev. 9/92) 413437vl his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permane%t filing. WARNING: It ia ille§al to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ? 108 3495 No. Local Registrar COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDE CERTIFICATE OF DEATH pp , ~r3ko BESHORE.004/DIANE December 3, 1992 LAST WILL AND TESTAMENT OF JANET E. BESHORE I, JANET E. BESHORE, presently of Lem~ .~ ._ of Cumberland, Commonwealth of Pennsylvania, bei~}~]f ~und mind and disposing memory, realizing the uncertai~-nof ~hi~ life, but with confidence in God and trust in His ~n, my ~rd and Savior, Jesus Christ, who died for my sins upon the cross, and rose again to justify me and give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, revoking any and all previous Wills and Codicils, and hereby will and dispose of all of the property which I own at my death in the following manner: As Executor of this my Will I name and nominate my son, Stewart E. Beshore, presently of Lancaster, Pennsylva- nia; if he shall for any reason fail or be unable to serve as Executor, either before or during his service as Executor, then I name my daughter, Mari]yn A. Crossley, as Executor. II. I direct that my debts and the expenses of my last illness and funeral shall be paid by my Executor as soon after my decease as may be convenient. III. Ail of my automobiles, household and personal ef- fects and other tangible personalty of like nature, together BESHORE.004/DIANE December 3, 1992 with insurance thereon, I give children as shall survive me, may determine, or, tor may decide. to my equally, to be divided among should they be unable to agree, to such of my them as they as my Execu- Harrisburg, Pennsylvania. VI. I give, devise and bequeath, all the rest, residue and remainder of my estate, real and personal and m~xed, in- cluding any property over which I may have any power of ap- pointment, in equal shares unto my children, Donald S. Beshore, Stewart E. Beshore, Marilyn A. Crossley, and Delma C. Chapman. In the event that any of my said children shall predecease me, leaving issue to survive him or her, the share of said child shall be given unto his or her issue, per stirpes; provided, however, that the subshare for my grand- son, Gregory R. Chapman, shall be held in trust as hereinafter provided. In the event that any of my children shall prede- I give and begueath the sum of Five Thousand ($5,000.00) Dollars to Bethesda Mission, of 611 Reilly Street, IV. I give and bequeath the sum of Two Thousand Five Hundred ($2,500.00) Dollars to my nephew, William Weigel, and the sum of Two Thousand Five Hundred ($2,500.00) Dollars, to my said nephew's wife, Martha Weigel, both presently of Lemoyne, Pennsylvania. BESHORE.004/DIANE December 3, 1992 cease me leaving no issue to survive him or her, the share of any such child shall be given unto my surviving children and their issue, per stirpes, in accordance with the provi- sions contained hereinabove. VII. In the event that my daughter, Delma C. Chapman, shall fail to survive me and I shall be survived by Gregory R. Chapman, her son, the share for my grandson, Gregory R. Chapman, shall be given, in trust, to Janelle Taylor (herein referred to as Trustee), as Trustee of a Trust for the benefit of my grandson, Gregory R. Chapman; and my said Trustee shall hold, invest and reinvest, collect the income therefrom, pay all taxes and other charges that may be made against the said Estate, and distribute the income and principal thereof as follows: A. During the period of said trust for said benefi- ciary, my said Trustee shall apply so much of the principal and income of the said trust as is, in the sole discretion of my said Trustee, necessary for the benefit, support, maintenance, and education of said beneficiary. Provided, however, my Trustee is directed to accumulate and add to principal the entire net income of the trust fund if, in the opin- ion of my Trustee, the expenditure of income or principal is not required to meet the needs of my said grandson for the following purposes: spending money, additional food, clothing, health services not provided by others, radios, record players, television sets, camping, vacations, athletic con- tests, movies, trips and money to purchase appropri- ate gifts for relatives and friends. My Trustee is under no obligation to expend principal for such needs, but if he, in his sole discretion, does de- cide to do so, he shall, under no circumstances, pay or reimburse any amounts to the state of Pennsylva- nia or to any other state or to any subdivision for any purpose, including the care, support, mainte- BESHORE.004/DIANE December 3, 1992 nance and education of my said grandson. My Trustee is further directed, in making any distribution to my said grandson, to consider the advisability of making such distributing in light of amounts to which my grandson may be entitled from any governmen- tal agency, including, but not limited to Social Security Administration Benefits, Veterans Adminis- tration Benefits, Medicaid (Medical Assistance) and Supplemental Social Security Income (SSI) benefits. B. Upon the death of my grandson, Gregory R. Chapman, the then remaining principal and undistribu- ted income of this Trust shall be distributed to the then-living issue of Delma C. Chapman, per stirpes. C. No principal or income payable or to become payable under any trust created by this Will shall be subject to anticipation or assignment by any beneficiary thereof or to attachment by or to the interference or control of any creditor of any bene- ficiary, or be taken or reached by any legal or equitable process in satisfaction of any debt or liability of such beneficiary prior to its actual receipt by the beneficiary. Provided, further, moreover, that in the event it is determined by a court that the existence of the trust renders my grandson, Gregory R. Chapman, ineligible to receive Supplemental Social Security Income Benefits, Medi- caid, or similar governmental benefits, or if the Trustee, in her sole discretion, determines that notwithstanding this spendthrift trust provision, this trust may be subject to garnishment, attach- ment, execution or bankruptcy proceedings by a credi- tor of my grandson, Gregory R. Chapman, my Trustee shall terminate the trust and distribute the remain- ing principal and accrued income in accordance with the provisions for distribution upon the death of my said grandson, Gregory R. Chapman, contained in the foregoing subparagraph of this, my Will. D. It is my express desire and intention to design the trust created for my grandson, Gregory R. Chapman, to be primarily for his benefit, to assure that he will have a friend, advocate or protector of his legal rights, to ensure that he will receive the services that will assist him in developing his maximum potential and in achieving a reasonable degree of normalcy and happiness, to supplement his earnings and governmental benefits, if any, and not to pay for his lodging, food, medical, dental and hospital expenses when he could otherwise claim 4 BESHORE . 004/DIA~E December 3, 1992 these from another source. In this regard, I direct my Trustee to perform certain special functions, which may be compensable to my Trustee, to assure satisfactory completion of my designs and intentions in this my Will. Specifically, I direct my Trustee to take the following action: 1. To assist my said grandson in obtain- ing Social Security Administration Bene- fits, Veterans' Administration Benefits, Medicaid, (Medical Assistance) and supple- mental Social Security Income Benefits and to collect, expend, and account separately for all such governmental assistance bene- fits. Trustee shall not co-mingle any such benefits with the trust fund; nor shall Trustee co-mingle any of my said grandson's own assets and income with said trust fund. 2. To personally visit my said grandson at his residence at least quarterly and preferably once or twice a month to in- spect his living conditions, to inquire of the staff and especially of my grandson regarding his treatment by the care provid- er (f any); to let my grandson know that he has a friend or advocate; to see that he has spending money for things he wants; to know that he is receiving education, work training, and social and recreational programs. 3. To make an annual evaluation of my said grandson including: (a) Physical and dental examination by an independent physician and dentist. (b) Education and training program. (c) Work opportunity and earnings. (d) Recreation, leisure time and social needs. (e) Appropriateness of existing resi- dential and program services. (f) Laws relating to various govern- mental financial assistance and benefits program; unless my said grandson has a 5 BESHORE.004/DIANE December 3, 1992 tion to powers: reasonable chance of earning sufficient income to support himself, it is essential that these benefits be retained. (g) Legal rights including free pub- lic education, habilitation and treatment which meet constitutional minimal stan- dards, a minimum or fair wage for work performed, privacy, the right to vote and freedom to marry. (h) My Trustee should base the annual evaluation on contacts with my said grand- son, the staff and volunteer members of the State and Local Association of Retard- ed Citizens for his area and other compe- tent professionals. VIII. I give to my Trustee the following powers, in addi- and not in limitation of common law and statutory ao To retain any property, real or personal which Trust- ee may receive as Trustee, even though such property (by reason of its character, amount, proportion to the total trust estate or otherwise) would not be considered appropriate for a fiduciary apart from this provision. To sell, exchange, give options upon, partition or otherwise dispose of any property which Trustee may hold from time to time, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such terms and such considerations as Trustee shall see fit, and to transfer and convey the same free of all trust. To invest and reinvest the trust estate from time to time in any property, real or personal, including securities of domestic and foreign corporations and investment trusts, bonds, preferred stocks, common stocks (whether fiduciary or non-fiduciary), mortgag- es, mortgage participations, even though such invest- ment (by reason of its character, amount, proportion to the total trust estate, or otherwise) would not be considered appropriate for a fiduciary apart from this provision. 6 BESHOPE.004/DIANE December 3, 1992 Fe To make loans, secured or unsecured, in such amounts, upon such terms, at such rates of interest, to such persons, firms or corporations as Trustee shall think fit. In dividing into separate trusts or shares or in distributing same, to divide or distribute in cash, in kind or partly in cash and partly in kind, as Trustee thinks fit. For purposes of division or distribution, to value the trust estate and any part thereof, reasonably and in good faith, and such valuation shall be conclusive upon all parties. To whatever extent division or distribution is made in kind, my Trustee shall, so far as Trustee finds practicable, allocate to the respective beneficia- ries approximately proportionate amounts of each kind of security or other property in the trust estate. To use his discretion to elect the most propitious settlement option with regard to any qualified em- ployee benefit plans available to me at my death so long as such election shall be in accordance with the Plan's Administrative Committee or Administrator as the case may be. To borrow money without liability on the part of the lenders to see to the application thereof, and to mortgage or pledge any real or personal property. IX. My Executor shall pay out of the residue of my es- tate, as an expense of administration, all estate, inheritance and succession taxes, and interest and penalties thereon, which may be due and payable by reason of my death with re- spect to any property included in my gross estate for tax purposes, whether or not passing under this Will and any Codi- cil hereto, shall be borne by the principal of my residuary estate passing under this, my Will. I further authorize my Executor to prepay taxes on future and remainder interests if deemed advisable. 7 BESHORE.004/DIANE December 3, 1992 I direct that no bond or other security be required of my said Executor or Trustee in any jurisdiction in which they or either of them may act. IN WITNESS W~EREOF, I have hereunto set my hand and seal this /~ day of .~~, 1992, to this My Last Will and Testament typewritten on eleven (11) sheets of paper (including witnesses' signatures). (SEAL) 8 BESHORE.004/DIANE December 3, 1992 On the /~ day of ~¢~¢~ , 1992, JANET E. BESHORE declared unto us, the undersigned, that the forego- ing instrument was her Last Will and Testament, and she re- quested us to act as witnesses to the same and to her signa- ture thereon. She thereupon signed this Will in our pres- ence, we all being present at the same time, and we now, on the same date, at her request and in her presence and in the presence of each other, hereunto subscribe our names as wit- nesses. And each of us declares that he believes this Testatrix to be of sound mind and memory. Address BESHORE.004/DIANE December 3, 1992 COMMONWEALTH OF PENNSYLVANIA: cOUNTY OF SS. I, JANET E. BESHORE, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified accord- ing to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. J~%/gET E. BESHORE Sworn or affirmed to and acknowledged before me, by JANET E. BESHORE, the Testatrix, this {~ day of b~\~ , 1992. Notary Public (SEAL) My Commission Expires: 10 BESHORE.004/DIANE December 3, 1992 COMMONWEALTH OF PENNSYLVANIA: SS. and J witnesses whose names are signed to the foregoing instrument, being duly qualified ac- cording to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by '~[%~_ this /%+~ day of Notary Public (SEAL) My Commission Expires: , 1992. 11 CODICIL TO LAST WILL AND TESTAMENT OF JANET E. BESHORE I, JANET E. BESHORE, presently of Lemoyne, Cumberland County, Commonwealth of Pennsylvania, being of sound mind and disposing memory, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross, and rose again to justify me and give me eternal life, do hereby make, publish and declare this to be my Codicil amending my Last Will and Testament dated December 15, 1992 and revoking all previous Codicils, as follows: o ~ ~ r.~ Paragraph IV of my said Last Will and Testament is hereby~etToked, Cahd'"-"~ or~ in its place and stead the following paragraph shall be inserted: I give and bequeath the following: The sum of Ten Thousand Dollars ($10,000) to each of the following grandchildren who shall survive me: Beverly Beshore- Strohm, Diane Beshore-Strohm, Steven Crossley, Deborah Sloan, Craig Beshore, Brad Beshore, and Janell Suzanne Taylor. The sum of Ten Thousand Dollars ($10,000) to my daughter, Delma C. Chapman, if she survives me, or my granddaughter, Janell Suzanne Taylor, if my said daughter does not survive me, with the hope and desire that the recipient of such gift and bequest manage and distribute said funds for the benefit and best interest of my grandson, Gregory R. Chapman, as deemed appropriate by the said recipient; provided, however, my the foregoing gift or bequest shall be ntfll and void if my grandson, Gregory R. Chapman, shall not survive me. The sum of Ten Thousand Dollars ($I0,000) to my daughter, Marilyn Crossley, if she survives me, or her husband, David Crossley, if my said daughter does not survive me, with the hope and desire that the recipient of such gift and bequest manage and distribute said funds for the benefit and best interest of my granddaughter, Tammy Laird, as deemed appropriate by the said recipient; provided, however, my the foregoing gift or bequest shall be null and void if my granddaughter, Tammy Laird, shall not survive me. The sum of Two Thousand Five Hundred Dollars ($2,500), to my nephew, William Weigel, and the sum of Two Thousand Five Hundred Dollars ($2,500) to my said nephew's wife, Martha Weigel, both presently of Lemoyne, Pennsylvania. II. In all other respects I hereby confirm and ratify my Last Will and Testament dated December 15, 1992. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /7Y4 day of J~ttY/'t~ ,2003, to this my Codicil to my Last Will and Testament typewritten on two (2) sheets of paper (including witnesses' signatures). I IIqET E. BESHOKE -2- On the [-]~ day of ~9/'b~ , 2003, JANET E. BESHORE, declared unto us, the undersigned, that the foregoing instrument was the Codicil to her Last Will and Testament, and she requested us to act as witnesses to the same and to her signature thereon. She thereupon signed this Codicil in our presence, we all being present at the same time, and we now, on the same date, at her request and in her presence and in the presence of each other, hereunto subscribe our names as witnesses. And each of us declares that he believes this Testatrix to be of sound mind and memory. Address ~ \ Address COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF : We, JANET E. BESHORE,_Testatrix, /~tYtg/r-O ,ft~a.t/~-4' , -ff~r~z', Z~-/~ ce and ~/e~e'.~..~ ?c o , the witnesses, whose names are signed to the foregoing instrumerft, being qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as the Codicil to her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Codicil as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 years of age or older, of sound mind and under no constraint or undue J~,IET E. B'[iS~-ORE - Witness Subscribed, sworn to and acknowledged before me by JANET E. BESHO~RE, testatrix, and subscribed and sworn to .be_fore me by /r~,~_~_/, ff~ ff,,:~ , .ffz~.~,z ,-1L.~, ~' Joq... and this 17r~ day of ~r, / ,2003. Notary Public (SEAL) Notarial Seal [ Melisa M. Lucas, Notary Public C ty of Harrisburg, Dauphin County My Commission Expires Oct. 13, 2003 M ember, Pennsylvania Association of Notaries :321697 _1 CERTIFICATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Janet E. Beshore. a!k!a Janet Esther Beshore Date of Death: December 21. 2004 o c:~~o > ~~; F;l ",:./.i;:;( -~iE~(~ Will No. Admin. No. 21-04-1178 2004-01178 To the Register: ,-..> = C~~ c.n I certify that notice of estate administration required by Rule 5.6(~af the --;: Orphans' Court Rules was served on or mailed to the following beneficiaries of thl'tc above-captioned estate on Januarv 21. 2005 : Name Address William B. Weigel 230 Walton Street. Lemoyne. PA 17043 Martha J. Weigel 230 Walton Street. Lemovne. PA 17043 Bethesda Mission 611 Reily Street. Harrisburg. PA 17102 Stewart E. Beshore 46 Nottingham Drive. Mechanicsburg. PA 17050 Marilyn A. Crosslev 3009 Lisburn Road. Mechanicsburg. PA 17055 Delma C. Chapman 1009 Hillview Lane. Hershey. PA 17033 Deborah S. Sloan 2236 Greene Forest Drive. Marvville. TN 37803 Craig A. Beshore 212 Pickering Circle. Marvville. TN 37803 Brad L. Beshore 340 Ross Springs Drive. Marvville. TN 37803 Steven D. Crossley 945 16th Street. New Cumberland. PA 17070 Janelle S. (Tavlor) Paul 403 Sharon Avenue. Mechanicsburg. PA 17055 Beverly Beshore-Strohm 80 Sunnyside Drive. Carlisle. PA 17013 Diane Beshore-Strohm 4 Summer Wind. Cromwell. CT 06416 l>- (- :;:;~. :;;r: N .V -ry _1."'. '~.~ -n .J n"' ,'~) ;-) _:C'f-, Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE. ~I, Date: January ~. 2005 Jeffrev A. Ernico. Esauire Name 3401 North Front Street fIarrisburlZ. PA 17110 Address (717) 232-5000 Telephone Capacity: _ Personal Representative lL Counsel for Personal Representative 413655vl ,__,c.,,-:--;-;_~7.: ".~(".c.:-~,.,.......~ A"_,,r--"'- j i! ; Ii \ \ i~!,t;; 'N "~, \1 "'" ! II - \ \\~, :.~! ~,~ 111 ~.~1,.'11,or,. ~\:; ~, _ ,.t-. -f l"'" ,"<> _ \. ~..., ~\i) I; ,)... .~ ~.~..~0~ . ~~. :; , ), j4.J - 6, to ~ ) -.:J ~ (L \\Y. -s. I \.\I~~ Q) rJl :> o € ~ jQ) j 0 ~ (II 0 '5 -::~ ??i};C') _ '-' C "C"""" "r,...njQ)O -:. VI ~ 0 fJJ t- :=:....::=:(.)';j~ - Q):::>' 0 ::C:::>''O.c<!. :.--c:~c.. " (II 0 (II j "u......-COal ~~~~0~ " ~ -~ g O~ ~ =(50::0 '-' _ ru \S) "" ::r .0 ('- rn ru \S) Cl Cl Cl Cl Jl "" "" ::r Cl Cl {'- III i:l .. z 0 r/l 0 \0 '" ~ ~ ~ '" 0 .-- 0 '" ~ '" !; :\0 '>\l:l31'J i 0 J \;; 0 .. 'i " c: '" ~ ~ 0 " .lI u 0 " .. r,ClJl III '" D- 8\ fJl ~ 1;; '" 0 ci SO .7\ VA :t III 'v fl'-'" ~ Z Z '" 0 '" \< o. " iii 0 0 D- III III I- Z III f,j '" l- i< ... .. ~ '" \Ii 0 .. '" ~ :t t D- .. ~ - - --:; -; --:; --: - - ~ --:; --:; :::: - """ :::: ..:: --:; - - ~ - - -; - ,,, " '" ,,, 0' ~l ,'I ,'f' \'1 ~. ", 1,.. \" ",' --.--...-.-. ~-- -,---_.- 1:: t - - METTE. EVANS & WOODSIDE A PROFESSIONAl, CORPORATION ATTORNEYS AT LAW JEFFREY A. ERNICO 3401 NORTH FRONT STREET P.O. BOX 5950 HARRISBURG, PA 17110.0950 DIRECT DIAL (717) 231-5206 IRS NO. 23-1985005 EMAIL ADDRESS jaernico@mette.com TELEPHONE (717) 232-5000 FAX (717) 236-1816 http://www.mette.com March 17, 2005 VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 c::> -"r-"1 Re: Estate of Janet E. Beshore File No. 21-04-1178 r...:} C) CJl Dear Ms. Strasbaugh: Enclosed is an estate check in the amount of $24,500 payable to "Register of Wills, Agent," representing a prepayment of Pennsylvania Inheritance Tax in the above-referenced estate. Please issue a receipt for this payment and forward it to my attention at the above address. Thank you for your assistance. Very truly yours, (~^~c~S: \( 'Y\o~ Lisa J. Kn de Paralegal to frey A. Emico UK: Enclosure 419607vl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ERNICO JEFFREY A POBOX 5950 HARRISBURG, PA 17110-0950 n_un_ fold ESTATE INFORMATION: SSN: 170-32-3241 FILE NUMBER: 2104-1178 DECEDENT NAME: BESHORE JANET E DATE OF PAYMENT: 03/18/2005 POSTMARK DATE: 03/17/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/21/2004 NO. CD 005094 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $24,500.00 I I I I I I I I TOTAL AMOUNT PAID: $24,500.00 REMARKS: CHECK# 515 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS ,. T~ t.'C.t'C.\V" ~1\\V.~\'C.'l;'i'C.\\ ,tq.. ." -->.\.....-~"."'""'~,,: '- ",~ - ....' --..;~.:r~ ~_ ~~?-,:;'2v~' ...! i1S50~iAGf 1: ~.",- _ ".,__?:\~;.:_?!'\ii - . - - l~ ="""')" 'c'" ,~I, x 0 ~ :1' ~I:::'" u_\~ ,~~ ;.o~67")"---'----_._-" I ~1II111 ;i-;=:.i.J ,"'r.~("') ;Il~F;; :!I03~ o -n ~ ~ -< iIl~'-.'.~ In r .:J:JC ~, 7002 3150 0006 7726 7029 First Class Mail UeW ssel~ ~SJ!:I METrE, EVANS & WOODSIDE A PROFESSIONAL CORPORATION AT'fORNEYS AT LAW 3401 NORTH FRONT STREET P.O. BOX 6960 HARRISBURG, PA 17110.Q950 TO: GLENDA F AHNER STRASBAUGH REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE PA 17013 '" ~ ~ ~...... .~ METTE. EVANS & WOODSIDE A PROFESSIONAl, CORPORATION ATTORNEYS AT LAW JEFFREY A. ERNICO 3401 NORTH FRONT STREET P.O. BOX :5950 HARRISBURG, PA 17110-0950 DIRECT DIAL (717) 231-5206 IRS NO. 23-1985005 EMAIL ADDRESS jaernico@mette.com TELEPHONE (717) 232-5000 FAX (717) 236-1816 http://www.mette.com May 13, 2005 Via Certified Mail Return ReceifJt Requested Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 -",';. c-, ('::;"1 Reo' Estate of Janet E. Beshore File No. 21-04-1178 Dear Ms. Strasbaugh: Enclosed for filing are the following documents: I. The original and one (I) copy of an Inventory; 2. The original and one (I) copy of Rev-I 500, Pennsylvania Inheritance Tax Return, plus a copy of the cover page; 3. A check payable to "Register of Wills, Agent" in the amount of$723.31 in payment of the Inheritance Tax owed; 4. Our check in the amount of$30.00 in payment of your filing fees; and 5. A postage prepaid envelope for return mail. Please file the Inventory and Inheritance Tax Return. Please return a date-stamped copy of the Inventory and the cover page of the Inheritance Tax Return, along with your receipt for the Inheritance Tax payment, to my attention in the enclosed envelope. May 13, 2005 Page 2 Please do not hesitate to call with any questions. Thank you for your assistance. Very truly yours, C3v'G,u \lCV\o'~ Lisa J. Kno e Paralegal to Je Frey A. Emico UK: Enclosures 424272v1 0"1 c. Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Janet E. Beshore No. 21-04-1178 also known as Janet Esther Beshore Date of Death December 21, 2004 late of West Pennsboro Township, Cumberland County, Pennsylvania , Deceased Social Security No. 170-32-3241 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. IlWe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Jeffrey A. Ernico, Esquire Personal Representative: Stewart E. Beshore ~~2\~~ 1.0. No.: 07981 Telephone: 3401 N. Front St., PO Box 5950, Harrisburg, PA 17110 (717) 232-5000 Dated: S-\\-oS, Address DESCRIPTION C2 IA S:~ c)t8LUE <" .',:'~ =n -,""C) -'. REAL PROPERTY: ".I:T] C"\ None PERSONAL PROPERTY: 1. 2,000 shares of common stock in A 0 Smith Corp. at $28.93 per share 57,8~.00 2. 4,000 shares of common stock in Conexant Systems, Inc. at $2.01 per share 8,040.00 3. 400 shares of preferred stock in Health Care PPTY 7.1% Ser F at $25.30 per share 10,120.00 4. 400 units of Morgan Stanley Capital Trust V, 5.75%, Due 07/15/2033, at $24.50 per unit 9,800.00 5. 3,700 shares of common stock in Rockwell Automation, Inc. at $48.97 per share 181,189.00 FormRrN-7(DauphlnCounty)-Rev.9IlI2 v- 6. 3,700 shares of common stock in Rockwell Collins, Inc. at $39.96 per share 147,852.00 7. 1,600 shares of common stock in Skyworks Solutions, Inc. at $9.99 per share 15,984.00 8. 1,200 shares of common stock in UGI Corporation New at $41.09 per share 49,308.00 9. Church of God Home, Inc. Residents Fund 20.00 10. 70,000 units of First Bank Puerto Rico Certificate of Deposit, 5.75%, Due 11/07/2019 11. M&T Bank Checking Account #15263754 12. Morgan Stanley Money Market Account #410037122024 70,014.00 13. Refund - 2004 federal personal income tax 1,125.52 43,823.91 741.00 TOTAL 595,877.43 (Attach Add"io"al Sheets If Necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. 418973v1 FOOTlRIN.1(Oaup/linCounty)-Rw.9J92 REV-1500 EX (6-00} OFFlClAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~L --'14- 1178 ___ I- Z W o w ld o DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Beshore Janet DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 12/21/2004 12/29/1911 (IF APPUCABLE)SURVlVlNG SPOUSE'S NAME (LAST, fiRST, AND MIDDLE INITIAL) N/A [iJ 1. Original Return D 4. Limited Estate E COUNTY CODE YEAR SOC~LSECUR\TYNUMBER 170-32-3241 TKISRENRN MUST BE FILEt) 'N DUPLICATE WITH THE NUMBER REGISTER OF WILLS SOC~l SECURllY NUMBER W I- ",<CUI ,,0:'" wo." :E:~O Ua.af 0. <C [X] 6. D9. Decedent Died Testate (Attach copyofWII) o 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death attar 12-12-82) D 5. Federal Estate Tax Return Required [X] 7. Decedent Maintained a living Trust (Attach copy of Trust) L B. Total Number of Safe Deposit Bo)(.es o 10. Spousal Poverty Credit (dale cfdaath batween 12-31.91 8,.,1-1.il5) 0 11. Election to tax under Sec. 9113(A)(AtIa~h$~hOl litigation Proceeds Received THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE'DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z w Q Z o .. .. ll! It: 8 Jeffre A. Ernico Es ire FIRM NAME (If Applicable) METTE EVANS & WOODSIDE TELEPHONE NUMBER 3401 N. Front St., P.O. Box 5950 Harrisburg, PA 17110-0950 717-232-5000 -'1:) 4. Mortgages & Notes ReceNable (Schetlule 0) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sd'ledule E) Z 6. JO Owned Property (Schedule F) 0 i= Separate Billing Requested ~ 7. Inter-Vivos Transfers & Miscellaneous Non~Probale Property ~ (Schedule G or l) a: .. Total Gran MUla (total Lines 1-1) c( 0 W 9. Funeral Expenses & Administrative Costs (Schedule H) a: (4) (5) 0.00 480,153.00 0.00 0.00 115 , 724.43 0.00 '"'''':''' 1. Real Estate (Schedule A) (1) ON~~:'::~ ,::~/"! 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) O"~ (6) -' (7) 27,638.71 (9) (8) 39,895.99 1.113.90 623,516.14 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) (10) 12. Net Value of Estats (line 8 minus Line 11) 13. Charitable and Governmental BeC\uestsfSec 911'3 Trusts for which an e\ec\ioo total!. has not been made (Schedule J) (12) 41,009.89 582,506.25 5,000.00 11. Total Deductions (Iotal lines 9 & 10) (11) (13) 14. Net Vlllue Subject to Tax (Line 12 minus Line 13) SEE INSTRUC'TIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 0.00 z rate, or transfers under Sec. 9116 (a)(1.2) 0 ;:: 16. Amount of Line 14 taxable allineal rate 572 , 506.21 <C I- ::> 0.00 0. 17. Amount of Line 14 taxable at Sibling rate :Ii 0 5,000.00 " I.. Amount of Line 14 taxable at collateral rale >< <C Tax Due I- 19. (14) 577,506.25 , .0 L-(15) , .0 45 (16) x .12 (17) x .15 (18) (19) 0.00 25,762.78 0.00 750.00 26,512.78 20. o CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO AtilSWER ALL QUESTIONS ON REVERSE SIDE AtilDRECHECK MATH < < 3W46451,OOO \)'-.. Decedent's C6mplet~ Address: SlREET ADDRESS 801 Hanover Street Cumberland CITY 1STA1E TZlP Carlisle PA 17013- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 26,512.78 0.00 24.500.00 1,289.47 Total Credits (A + B + C) (2) 25,789.47 3. Interest/Penalty ~ applicable D. Interest E. Penalty 0.00 0.00 TotallnterestlPenalty (0 + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 723.31 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Pa able to: REGISTER OF WILLS, AGENT (58) 723.31 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . D []g b. retain the right to designate who shall use the property transferred or its income; . D []I C. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . D [1a d. receive the promise for life of either payments, benefits or care? . . . . . . . . . D [j 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . " D []I 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D [J:g 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. [XJ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. r declare that I have examined this reltJm, including accompanying schedules and statements, and to the best or my knowledge and belief. it is tllJe, correct and complete. Declaration 01 preparer other than the personal repr&S.8l'\tative is besed on all k\lorma\ion of whiCh preparer ho any \mowledge SIGNATURE OF PERSON RESPONSIBLE F FILING RETURN DATE -\ \-as Stewart E. Beshore AOORE S 46 Nottingham Drive SIGNATURE OF PREPARER OTHER THAN REPRESE~ Jeffre A. Ernico, Es ire~- ADDRESS 3401 N. Front St., Harrisburg, PA 17110-0950 -ot,UllIl!PI ~_ ~".~006i~;'~~ -~\j' "'" For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to erfor the use of the surviving spouse Is 3% [72 P.S. ~ 9916 (a) (1.1) (;)]. Mechanicsburg, PA 17050 DATE 5 \:;L OS' For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 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 retum are still appUcable even if the $urv\'II\ng 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 twenty-one years of age or younger at death to or for the use 0 or a stepparent of the child is 0% 172 P.S. 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%, except as noted in 72 P. (lRPl) The tax fate impo$8d em the I'oet value oftrans1erS to crior the use of the decedenrs siblings is 12% (72 P.S. ~ 9116(a)(1.3)]. A sibling i individual who has at least one parent in common with the decedent, 'htlether by blood or adoption. 3W46461.000 REV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Janet E. BAshore 21 D4 1178 All property jointly~owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1.2,000 Shares A 0 Smith Corp. shares @ $28.93 DESCRIPTION VALUE AT DATE OF DEATH common stock; 2000 per share 57,860.00 2 4,000 Shares Conexant Systems, Inc. common stock; 4,000 shares @ $2.01 per share 8,040.00 3 400 Shares Health Care PPTY 7.1% Ser F preferred stock; 400 shares @ $25.30 per share 10,120.00 4 400 Par Morgan Stanley Capital Trust V; 5.75%, DUE 07/15/2033; 400 units @ $24.50 per unit 9,800.00 5 3,700 Shares Rockwell Automation, Inc. common stock; 3,700 shares @ $48.97 per share 181,189.00 6 3,700 Shares Rockwell Collins, Inc. common stock; 3,700 shares @ $39.96 per share 147,852.00 7 1,600 Shares Skyworks Solutions, Inc. common stock; 1,600 shares @ $9.99 per share 15,984.00 8 1,200 Shares UGI Corporation New common stock; 1,200 shares @ $41.09 per share 49,308.00 3W46961.000 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 480,153.00 REV-t508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RElURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS. & MISC. PERSONAL PROPERTY ESTATE OF Janet E. Beshore FILE NUMBER 21 04 1178 Include the proceeds of litigation and the date the proceeds "Were received by the estate. All property jolntly-owned with the rlaht of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Church of God Home, Inc. Residents Fund - personal cash account 20.00 2 70,000 Par First Bank Puerto Rico Certificate of Deposit, 5.75% DUE 11/07/2019 70,014.00 3 M&T Bank Checking Account #15263754 Interest accrued to 12/21/2004 1,125.51 0.01 4 Morgan Stanley Money Market Account #410 037122 024 43,823.91 5 Refund - 2004 federal personal income taxes 741.00 3W46AD 1.000 TOTAL 'Also enter on line 5 Recaoitulation) $ (If more space is needed, insert additional sheets afthe same siz.e) 115,724.43 REV-1510 EX + (6-98) SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janet E. Beshore FILE NUMBER 21 04 1178 ITEM NUMBE 1. DATE OF DEATH VALUE OF ASSET % OF DECO'S INTEREST This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY N:ll.a: T\-E~OFT\-ETRIItlSFiOREE, 1HEIR RELA110NS)11P 10 DfCEDEN'T AND Tl-E DAT€ OF l'RAi'SFER_ ATTACHACOPV OF THE DEED FOR REAL ESTA1E TAXABLE VALUE Janet E. Beshore Revocable Trust, under Agreement dated March 11, 1994, Delma C. Chapman, Trustee Trust assets held under investment account with Legg Mason, Account #363-01417-15, which consisted of the following: 27,638.71 100.0000 409.303 shares of Legg Mason Value Trust mutual fund at $64.00 per share, totaling $26,195.39 1,443.32 shares of Legg Mason Cash Reserve Trust (money market) @ $1.00 per share, totaling $1,443.32 TOTAL VALUE OF TRUST ASSETS $27,638.71 See attached correspondence from Legg Mason TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3W46AF 1.000 EXCLUSION (IF APPUCABLEI 0.00 27,638.71 27 638.71 REV-1511 EX + (12-99) COMMONVVEAL lH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janet E. Beshore SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 04 1178 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1- Funeral Luncheon 368.50 2 Neill Funeral Home 2,508.70 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 20,875.00 Name of Personal Representative(s) Stewart E. Beshore Social Security Number(s) I EIN Number of Personal Representative(s) Street Address 46 Nottinqham Drive City Mechanicsburq State PA Zip 17050 Year(s) Commission Paid: 2. Attorney Fees 15,000.00 3. Family Exemption: (If decedent's address \s not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 509.50 5. Accountant's Fees 315.00 6. Tax Return Preparer's Fees 7. 1 Cumberland Law Journal Advertisement of estate notice 75.00 2 Morgan Stanley Annual account service fee 100.00 Total from continuation schedules 144.29 TOTAL (Also enter on line 9, Recapitulation) $ 39 895.99 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: Janet E. Beshore 170-32-3241 Schedule H Part 7 (Page 2) 3 The Sentinel Advertisement of estate notice 144.29 Total (Carry forward to main schedule) 144.29 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janet E. Beshore SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 04 1178 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Continuing Care Rx Pharmacy bill 261.73 2 Continuing Care Rx Pharmacy bill 3.29 3 Holy Spirit Hospital 50.88 4 PA Department of Revenue Estimated payment for 4th Qtr. PA personal income tax 700.00 5 PA Department of Revenue Balance of 2004 PA personal income taxes 98.00 3W46AH2.00Q TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additionaJ sheets of the same size) 1 113.90 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janet E Beshore FILE NUMBER 21 04 1178 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (0) (1.2)] Brad L. Beshore 340 Ross Springs Drive Maryville, TN 37803 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE NUMBER I General Bequests: 10,000.00 8.33333% Residue: 40,208.84 Grandson 50,208.84 2 Craig A. Beshore 212 Pickering Circle Maryville, TN 37803 General Bequests: 10,000.00 8.33333% Residue: 40,208.84 Grandson 50,208.84 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET II NON.TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Bethesda ~ssion 5,000.00 3W46A11.000 TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET (If more space IS needed, Insert additional sheets of the same size) $ 5 000.00 Estate of: Janet E. Beshore 170-32-3241 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 3 Stewart E. Beshore 46 Nottingham Drive Mechanicsburg, PA 17050 25% Residue: 120,626.56 Son 120,626.56 4 Beverly Beshore-Strohm 80 Sunnyside Drive Carlisle, PA 17013 General Bequests: 10,000.00 Granddaughter 10,000.00 5 Diane Beshore-Strohm 4 Summer Wind Cromwell, CT 06416 General Bequests: 10,000.00 Granddaughter 10,000.00 6 Delma C. Chapman 1009 Hillview Lane Hershey, PA 17033 General Bequests: 10,000.00 25% Residue: 120,626.56 Daughter 130,626.56 7 Marilyn A. Crossley 3009 Lisburn Road Mechanicsburg, PA 17055 General Bequests: 10,000.00 25% Residue: 120,626.56 Daughter 130,626.56 8 Steven D. Crossley 945 16th Street New Cumberland, PA 17070 General Bequests: 10,000.00 Grandson 10,000.00 9 Janelle S. Paul 403 Sharon Avenue Mechanicsburg, PA 17055 General Bequests: 10,000.00 Granddaughter 10,000.00 Estate of: Janet E. Beshore 170-32-3241 Schedule J Part 1 (Page 3) Item No. Description Relation Amount 10 Deborah S. Sloan 2236 Greene Forest Drive Maryv~lle, TN 37803 General Bequests: 10,000.00 8.333333% Res~due: 40,208.85 Granddaughter 50,208.85 11 Martha J. We~ge1 230 Walton Street Lemoyne, PA 17043 General Bequests: 2,500.00 Niece 2,500.00 12 Will~am B. We~gel 230 Walton Street Lemoyne, PA 17043 General Bequests: 2,500.00 Nephew 2,500.00 BESHORE.004/DIANE December 3, 1992 LAST WILL AND TESTAMENT OF JANET E. BESHORE I, JANET E. BESHORE, presently of Lemoyne, County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and disposing memory, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross, and rose again to justify me and give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, reVOking any and all previous Wills and Codicils, and hereby will and dispose of all of the property which I own at my death in the following manner: I. As Executor of this my Will I name and nominate my son, Stewart E. Beshore, presently of Lancaster, pennsyl va- nia; if he shall for any reason fail or be unable to serve as Executor, either before or during his service as Executor, then I name my daughter, Marilyn A. Crossley, as Executor. IT. I direct that my debts and the expenses of my last illness and funeral shall be paid by my Executor as soon after my decease as may be convenient. III. All of my automobiles, household and personal ef- fects and other tangible personalty of like nature, together , BESHORE.004/DIANE December 3, 1992 with insurance thereon, I give to my equally, to such of my children as shall survive me, to be divided among them as they may determine, or, should they be unable to agree, as my Execu- tor may decide. IV. I give and bequeath the sum of Two Thousand Five Hundred ($2,500.00) Dollars to my nephew, William Weigel, and the sum of Two Thousand Five Hundred ($2,500.00) Dollars, to my said nephew's wife, Martha Weigel, both presently of Lemoyne, Pennsylvania. V. I give and bequeath the sum of Five Thousand ($5,OOO.OO) Dollars to Bethesda Mission, of 611 Reilly Street, Harrisburg, Pennsylvania. VI. I give, devise and bequeath, all the rest, residue and remainder of my estate, real and personal and mixed, in- cluding any property over which I may have any power of ap- pointment, in equal shares unto my children, Donald S. Beshore, Stewart E. Beshore, Marilyn A. Crossley, and Delma C. Chapman. In the event that any of my said children shall predecease me, leaving issue to survive him or her, the share of said child shall be giver unto his or her issue, per stirpes; provided, however, that the subshare for my grand- son, Gregory R. Chapman, shall be held in trust as hereinafter provided. In the event that any of my children shall prede- ~ BESHORE.004/DIANE December 3, 1992 cease me leaving no issue to survive him or her, the share of any such child shall be given unto my surviving children and their issue, per stirpes, in accordance with the provi- sions contained hereinabove. VII. In the event that my daughter, Delma C. Chapman, shall fail to survive me and I shall be survived by Gregory R. Chapman, her son, the share for my grandson, Gregory R. Chapman, shall be given, in trust, to Janelle Taylor (herein referred to as Trustee), as Trustee of a Trust for the benefit of my grandson, Gregory R. Chapman; and my said Trustee shall hold, invest and reinvest, collect the income therefrom, pay all taxes and other charges that may be made against the said Estate, and distribute the income and principal thereof as follows: A. During the period of said trust for said benefi- ciary, my said Trustee shall apply so much of the principal and income of the said trust as is, in the sole discretion of my said Trustee, necessary for the benefit, support, maintenance, and education of said beneficiary. Provided, however, my Trustee is directed to accumulate and add to principal the entire net income of the trust fund if, in the opin- ion of my Trustee, the expenditure of income or principal is not required to meet the needs of my said grandson for the following purposes: spending money, additional food, clothing, health services not provided by others, radios, record players, television sets, camping, vacations, athletic con- tests, movies, trips and money to purchase appropri- ate gifts for relatives and friends. My Trustee is under no obligation to expend principal for such needs, but if he, in his sole discretion, does de- cide to do so, he shall, under no circumstances, pay or reimburse any amounts to the state of Pennsylva- nia or to any other state or to any subdivision for any purpose, including the care, support, mainte- ~ BESHORE.004/DIANE December 3, 1992 nance and education of my said grandson. My Trustee is further directed, in making any distribution to my said grandson, to consider the advisability of making such distributing in light of amounts to which my grandson may be entitled from any governmen- tal agency, including, but not limited to Social Securi ty Administration Benefits, Veterans Adminis- tration Benefits, Medicaid (Medical Assistance) and Supplemental Social Security Income (SSI) benefits. B. Upon the death of my grandson, Gregory R. Chapman, the then remaining principal and undistribu- ted income of this Trust shall be distributed to the then-living issue of Delma C. Chapman, per stirpes. C. No principal or income payable or to become payable under any trust created by this Will shall be subject to anticipation or assignment by any beneficiary thereof or to attachment by or to the interference or control of any creditor of any bene- ficiary, or be taken or reached by any legal or equitable process in satisfaction of any debt or liabili ty of such beneficiary prior to its actual receipt by the beneficiary. Provided, further, moreover, that in the event it is determined by a court that the existence of the trust renders my grandson, Gregory R. Chapman, ineligible to receive Supplemental Social Security Income Benefits, Medi- caid, or similar governmental benefits, or if the Trustee, in her sole discretion, determines that notwithstanding this spendthrift trust provision, this trust may be subject to garnishment, attach- ment, execution or bankruptcy proceedings by a credi- tor of my grandson, Gregory R. Chapman, my Trustee shall terminate the trust and distribute the remain- ing principal and accrued income in accordance with the provisions for distribution upon the death of my said grandson, Gregory R. Chapman, contained in the foregoing subparagraph of this, my Will. D. It is my express desire and intention to design the trust created for my grandson, Gregory R. Chapman, to be primarily for his benefit, to assure that he will have a friend, advocate or protector of his legal rights, to ensure that he will receive the services that will assist him in developing his maximum potential and in achieving a reasonable degree of normalcy and happiness, to supplement his earnings and governmental benefits, if any, and not to pay for his lodging, food, medical, dental and hospital expenses when he could otherwise claim . BESHORE.004/DIANE December 3, 1992 these from another source. In this regard, I direct my Trustee to perform certain special functions, which may be compensable to my Trustee, to assure satisfactory completion of my designs and intentions in this my Will. Specifically, I direct my Trustee to take the following action: 1. To assist my said grandson in obtain- ing Social Security Administration Bene- fits, Veterans' Administration Benefits, Medicaid, (Medical Assistance) and supple- mental Social Security Income Benefits and to collect, expend, and account separately for all such governmental assistance bene- fits. Trustee shall not co-mingle any such benefits with the trust fund; nor shall Trustee co-mingle any of my said grandson's own assets and income with said trust fund. 2. To personally visit my said grandson at his residence at least quarterly and preferably once or twice a month to in- spect his living conditions, to inquire of the staff and especially of my grandson regarding his treatment by the care provid- er (f any); to let my grandson know that he has a friend or advocate; to see that he has spending money for things he wants; to know that he is receiving education, work training, and social and recreational programs. 3. To make an annual evaluation of my said grandson including: (a) Physical and dental examination by an independent physician and dentist. (b) Education and training program. (c) Work opportunity and earnings. (d) Recreation, social needs. leisure time and (e) Appropriateness of existing resi- dential and program services. (f) Laws relating to various govern- mental financial assistance and benefits program; unless my said grandson has a BESHORE.004/DIANE December 3, 1992 reasonable chance of earning sufficient income to support himself, it is essential that these benefits be retained. (g) Legal rights including free pub- lic education, habilitation and treatment which meet constitutional minimal stan- dards, a minimum or fair wage for work performed, privacy, the right to vote and freedom to marry. (h) My Trustee should base the annual evaluation on contacts with my said grand- son, the staff and volunteer members of the State and Local Association of Retard- ed Citizens for his area and other compe- tent professionals. VIII. I give to my Trustee the following powers, in addi- tion to and not in limitation of common law and statutory power s : A. To retain any property, real or personal which Trust- ee may receive as Trustee, even though such property (by reason of its character, amount, proportion to the total trust estate or otherwise) would not be considered appropriate for a fiduciary apart from this provision. B. To sell, exchange, give options upon, partition or otherwise dispose of any property which Trustee may hold from time to time, at public or private sale or otherwise, for cash or other consideration or on credi t, and upon such terms and such considerations as Trustee shall see fit, and to transfer and convey the same free of all trust. C. To invest and reinvest the trust estate from time to time in any property, real or personal, including securities of domestic and foreign corporations and investment trusts, bonds, preferred stocks, common stocks (whether fiduciary or non-fiduciary), mortgag- es, mortgage participations, even though such invest- ment (by reason of its character, amount, proportion to the total trust estate, or otherwise) would not be considered appropriate for a fiduciary apart from this provision. BESHORE.004/DIANE December 3, 1992 D. To make loans, secured or unsecured, in such amounts, upon such terms, at such rates of interest, to such persons, firms or corporations as Trustee shall think fit. E. In dividing into separate trusts or shares or in distributing same, to divide or distribute in cash, in kind or partly in cash and partly in kind, as Trustee thinks fit. For purposes of division or distribution, to value the trust estate and any part thereof, reasonably and in good faith, and such valuation shall be conclusive upon all parties. To whatever extent division or distribution is made in kind, my Trustee shall, so far as Trustee finds practicable, allocate to the respective beneficia- ries approximately proportionate amounts of each kind of security or other property in the trust estate. F. To use his discretion to elect the most propitious settlement option with regard to any qualified em- ployee benefit plans available to me at my death so long as such election shall be in accordance with the Plan's Administrative Committee or Administrator as the case may be. G. To borrow money without liability on the part of the lenders to see to the application thereof, and to mortgage or pledge any real or personal property. IX. My Executor shall payout of the residue of my es- tate, as an expense of administration, all estate, inheritance and succession taxes, and interest and penalties thereon, which may be due and payable by reason of my death with re- spect to any property included in my gross estate for tax purposes, whether or not passing under this will and any Codi- cil hereto, shall be borne by the principal of my residuary esta te passing under this, my will. I further authorize my Executor to prepay taxes on future and remainder interests if deemed advisable. ., BESHORE.004/DIANE December 3, 1992 x. I direct that no bond or other security be required of my said Executor or Trustee in any jurisdiction in which they or either of them may act. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /6 day Of..L();;U:.R/ryJ:'.e.J1" 1992, to this My Last Will and Testament typewritten on eleven (11) sheets of paper (including witnesses' signatures). /J )r: CL/707P.r--C.A!:i~~'d..a.... (SEAL) JANET E. BESHORE o BESHORE.004/DIANE December 3, 1992 On the .r~ Ie> day of Q"e,,~lx<- , 1992, JANET E. BESHORE declared unto us, the undersigned, that the forego- ing instrument was her Last Will and Testament, and she re- quested us to act as witnesses to the same and to her signa- ture thereon. She thereupon signed this Will in our pres- ence, we all being present at the same time, and we now, on the same date, at her request and in her presence and in the presence of each other, hereunto subscribe our names as wit- nesses. And each of us declares that he believes this Testatrix to be of sound mind and memory. . C '-'-, \ ) \' ('\ " ,: - c'-X'1G\"cCl~ "-~\ ~ 0\S:\ '~,0 < , "h7rO~~ ~ . ~ \n,C' -- c.0"'~'>l:" N-<..) <., Ii \ Address \1 '-_.J d~ ,9,4 Cldress / I ')0 :3 r -ff'~' / jJ,'W0c !-kif; pit /701/ . ~ Addresf n BESHORE.004/DIANE December 3, 1992 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF \)cc c\?"-,',,, ss. I, JANET E. BESHORE, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified accord- ing to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~'/)"7.o ;:t: &~. R""-<2k~ J ET E. BESHORE Sworn or affirmed to and acknowledged before me, by JANET E. BESHORE, the Testatrix, this IS''' day of U ({'''''oJ," r ~ l~h !i., I DtJZ:-;;,{ Notary Public , 1992. (SEAL) My Commission Expires: . ! Nolaiiai iWdi li"da O. WOleI\:lI. ~ My~=Od.4,1993 10 BE3HORE.004/DIANE December 3, 1992 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF 0Ch?h: ~ ss. We :?'(i, \)~cG. '0\ ,"~ ,.1: , ) rA.N If' E' L ./3 (i)v..J rJ the rr!UI'YA N-';' (). C~Y#7?Ci"l wi tnesses whose names are and signed to the foregoing instrument, being duly qualified ac- cording to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last will and Testament: that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed: that each of us in the hearing and sight of the Testatrix signed the will as witnesses: and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. ~ ........~ \ ~,-_/ \<::' '~ ';' '(\,;,~~\\j:'<_" ,'" C>.\\, \'-" ~ , cnrJjhd0. C1~ -f":Z ;I fJu~ Sworn or affirmed to and subscribed to be fore me bY~\( bu" \\\ r<--. ,.,.\\', ;7lClEJ U. r{'/ 6.() 1ia./';?7/{/1 and ~ O</V \ C e this Is;l~ day of l:Jcce ,~, l'l?_" =~ ~.&,' .J:i~ ,,) /. (;:;,.;>1 Notary Public (SEAL) My Commission Expires: L /3 COJJrJ , , 1992. NclariaI Se&I l.ind8 D. WIlIIeriGI<. NalIUY P\JlIC HanIslUll, IJlIIVin QlJnly MyC"n..~.ElqiIa0a.4,1993 11 CODICIL TO LAST WILL AND TESTAMENT OF JANET E. BESHORE I, JANET E. BESHORE, presently of Lemoyne, Cumberland County, Commonwealth of Pennsylvania, being of sound mind and disposing memory, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross, and rose again to justify me and give me eternal life, do hereby make, publish and declare this to be my Codicil amending my Last Will and Testament dated December 15, 1992 and revoking all previous Codicils, as follows: I. Paragraph IV of my said Last Will and Testament is hereby revoked, and in its place and stead the following paragraph shall be inserted: I give and bequeath the following: A. The sum of Ten Thousand Dollars ($10,000) to each of the following grandchildren who shall survive me: Beverly Beshore- Strohm, Diane Beshore-Strohm, Steven Crossley, Deborah Sloan, Craig Beshore, Brad Beshore, and Janell Suzanne Taylor. B. The sum of Ten Thousand Dollars ($10,000) to my daughter, Delma C. Chapman, if she survives me, or my granddaughter, Janell Suzanne Taylor, if my said daughter does not survive me, with the hope and desire that the recipient of such gift and bequest manage and distribute said funds for the benefit and best interest of my grandson, Gregory R. Chapman, as deemed appropriate by the said recipient; provided, however, my the foregoing gift or bequest shall be null and void if my grandson, Gregory R. Chapman, shall not survive me. C. The sum of Ten Thousand Dollars ($10,000) to my daughter, Marilyn Crossley, if she survives me, or her husband, David Crossley, if my said daughter does not survive me, with the hope and desire that the recipient of such gift and bequest manage and distribute said funds for the benefit and best interest of my granddaughter, Tammy Laird, as deemed appropriate by the said recipient; provided, however, my the foregoing gift or bequest shall be null and void if my granddaughter, Tammy Laird, shall not survive me. D. The sum of Two Thousand Five Hundred Dollars ($2,500), to my nephew, William Weigel, and the sum of Two Thousand Five Hundred Dollars ($2,500) to my said nephew's wife, Martha Weigel, both presently of Lemoyne, Pennsylvania. II. In all other respects I hereby confirm and ratify my Last Will and Testament dated December 15, 1992. IN WITNESS WHEREOF, I have hereunto set my hand and seal this nf/l day of Ilpr~ ,2003, to this my Codicil to my Last Will and Testament typewritten on two (2) sheets of paper (including witnesses' signatures). Jtr~ -t-E..:r:5~A~~.. (SEAL) J ET E. BESHORE -2- On the 11'\1., day of 8p~ ,2003, JANET E. BESHORE, declared unto us, the undersigned, that the foregoing instrument was the Codicil to her Last Will and Testament, and she requested us to act as witnesses to the same and to her signature thereon. She thereupon signed this Codicil in our presence, we all being present at the same time, and we now, on the same date, at her request and in her presence and in the presence of each other, hereunto subscribe our names as witnesses. And each of us ;;:~~;::t~ ~:~triX <0 b, Of_~e;Ory ~~ ~-l\ Zit;tz,v.) > fA Address <:t ' Address / COMMONWEALTH OF PENNSYLVANIA COUNTY OF .Da 4Ft; 11 We, JANET E. BESHORE, Testatrix, menta; .:r I.1d.{ , S~C( rf E, Ees~ r-e and Jer:r;:;r'# 2;-,-, 7 CD, the witnesses, whose names are signed to the foregoing instrume t, being qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as the Codicil to her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Codicil as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 years of age or older, of sound mind and under no constraint or undue ~~nce. .fh."" r-t;:;J9..A ~.... /1[,_ JJ\NET E. BtSHORE Witness ___________ ------- ~ fC -::=-- . \..1\- ~ . ~ ~ J--~...~.~~.~~_ . ness Witness SS: Subscribed, sworn to and acknowledged before me by JANET E. BESHORE, testat~ and subscribed and sworn tq efore me by h%/7 ;,4". I is,,, Ic. ,S-/e0Ci. + ~( &fI{O,?", and ve ,eo ~ G-r /c,c> this 17th. day of Iff" / ,2003. cn;;z)~ L,,~ Notary Public (SEAL) Notarial Seal Melisa M. Lucas. Notary Public City of Harrisburg. Dauphin County My Commission Expires Oct. 13, 2003 Member, PennsvlvamaAssoclatlonot Notanes 32]697 _I , BESHORE. 0 ~ ,LVIN M' ch 11, 1994 TRUST AGREEMENT THIS Beshore, a hereinafter hereinafter TRUST AGREEMENT is entered into by Janet E. resident of Cumberland County, Pennsylvania, referred to as Settlor, and Delma C. Chapman, referred to as Trustee. ARTICLE I. TRUST ESTATE 1.01. Transfer to Trust. The Settlor herewith delivers to the Trustee those assets and the life insur- ance policies, hereinafter referred to as the "Policies", described in the attached Schedule A. Such assets and Policies and all property hereafter subject to this Trust shall constitute the Trust Estate, and shall be held, managed, administered, and distributed by the Trustee as hereinafter provided. i I 'I !I II I I II !I II I, I 1.02. Status of Trustee. The Settlor has caused or shall cause the Trustee to be named primary beneficiary of the Policies, and constitutes Trustee custodian of the Policies during the life of the Settlor and Trustee of both the right to receive the Policy proceeds and the proceeds themselves when received. 1.03. Addi tional Property. Any individual may add to this Trust, whether before or after the death of the Settlor, by naming the Trustee beneficiary of additional life insurance policies or by transferring to the Trustee other property acceptable to the Trustee, either by gift, assignment, bequest, or devise, and, if so added, such right to receive additional policy proceeds, and such proceeds when received, and such other property, on re- ceipt 'and acceptance by the Trustee shall become part of the Trust Estate. ARTICLE II. REVOCATION OF TRUST 2.01. Revocation During Lifetime. During the life of the Settlor, this Trust may be amended, altered, re- voked, or terminated, in whole or in part, or any provi- sion hereof, by an instrument in writing signed by the Settlor and delivered to the Trustee; provided, however, that the Trust may not be amended to change the obliga- -1- " . BESHORE. 0 \LVIN ~.ch 11, 1994 tions, duties, or rights of the Trustee without the writ- ten consent of the Trustee to such amendment. 2.02. Settlor's Duties on Revocation. If the entire Trust is revoked by the Settlor, the Trustee shall payor transfer to the Settlor all of the Trust Estate and shall execute and deliver to the Settlor all instruments which are necessary or appropriate to release all inter- ests of the Trustee in the Trust Estate. ARTICLE III. PREMIUMS I I II I I I i I (' I II I I I I 3.01. Payment. Notwi thstanding any general grant of power to pay premiums, in no event shall the Trustee have a duty to pay, or be liable for the nonpayment of, any premium or assessment on any policy held by it hereun- der, whether or not this Trust shall have become irrevoca- ble and whether or not the Trustee shall have become the owner of the policy. 3.02. Information. The Trustee shall not have any duty to keep itself informed, or to inform others, with respect to the payment of any premium or assessment. ARTICLE IV. DISTRIBUTION DURING LIFETIME OF SETTLOR 4.01. Net Income to Settlor. At least annually during the life of the Settlor, the Trustee shall pay all the net income from the Trust Estate, unless otherwise directed by the Settlor in writing, first toward any premi- um or assessment on any policy held by it hereunder, and, out of any residue, thereafter, pay the Settlor or apply said residue for the benefit of the Settlor. 4.02. Principal Payments. Trustee shal payout to the Settlor so much of the principal of the Trust Estate as Settlor may direct from time to time. 4.03. Incompetency. If the Settlor becomes inca- pacitated through illness, age, or other cause, then such portion of the net income or principal of the Trust Estate shall be applied towards the support, care, and benefit of -2- II , BESHORE. O. ,LVIN li ch 11, 1994 i " " I: " ,I ii the Settlor, as the Trustee, in his discretion, shall determine without regard to the other means of support of Settlor or his said family. ARTICLE V. DISTRIBUTION AFTER THE DEATH OF THE SETTLOR 5.01. Distribution on Death of Settlor. On the death of Settlor, the income and principal of the Trust Estate shall continue to be held, in trust, by Settlor's Trustee for the benefit of Settlor's grandson, Gregory R. Chapman, and the Trustee shall hold, invest and reinvest, collect the income therefrom, pay all taxes and other charges that may be made against the said Trust Estate, and distribute the income and principal thereof as follows: A. During the period of said trust for said benefi- ciary, Trustee shall apply so much of the principal and income of the said trust as is, in the sole discretion of the Trustee, necessary for the benefit, support, mainte- nance, and education of said beneficiary. Provided, howev- er, Trustee is directed to accumulate and add to principal the entire net income of the trust fund if, in the opinion of Trustee, the expenditure of income or principal is not required to meet the needs of Settlor' s grandson for the following purposes: spending money, additional food, cloth- ing, health services not provided by others, radios, record players, television sets, camping, vacations, ath- letic contests, movies, trips and money to purchase appro- priate gifts for relatives and friends. Trustee is under no obligation to expend principal for such needs, but if he, in his sole discretion, does dec ide to do so, he shall, under no circumstances, payor reimburse any amounts to the state of Pennsylvania or to any other state or to any subdivision for any purpose, including the care, support, maintenance and education of Settlor's grandson. Trustee is further directed, in making any distribution to my said grandson, to consider the advisability of making such distribution in light of amounts to which Settlor's grandson may be entitled from any governmental agency, including, but not limited to Social Security Administra- tion Benefits, Veterans Administration Benefits, Medicaid (Medical Assistance) and Supplemental Social Security Income (881) Benefits. -3- !1 ,BESHORE.O ~LVIN :ch 11, 1994 B. Upon the death of Settlor's grandson, Gregory R. Chapman, the then remaining principal and undistributed income of this Trust shall be distributed to the then-liv- ing issue of Delma C. Chapman, per stirpes, provided that if said issue be under the age of forty (40) years, Trustee shall apply the income and principal of their respective shares, in Trustee I s sole discretion for the benefit, maintenance and education of such issue without the intervention of a guardian. Upon attaining the age of forty (40) years, the Trustee shall distribute the balance of the share of any such beneficiary to the beneficiary. C. No principal or income payable or to become pay- able under any trust created by this Trust shall be sub- ject to anticipation or assignment by any beneficiary thereof or to attachment by or to the interference or control of any creditor or any beneficiary, or be taken or reached by any legal or equitable process in satisfaction of any debt or liability of such beneficiary prior to its actual receipt by the beneficiary. Provided, further, moreover, that in the event it is determined by a court that the existence of the trust renders Settlor's grand- son, Gregory R. Chapman, ineligible to receive Supplemen- tal Social Security Income Benefits, Medicaid, or similar governmental benefits, or if the Trustee, in his sole discretion, determines that notwithstanding this spend- thrift trust provision, this trust may be subject to gar- nishment, attachment, execution or bankruptcy proceedings by a creditor of Settlor's grandson, Gregory R. Chapman, Trustee shall terminate the trust and distribute the re- maining principal and accrued income to the then-living issue of Delma C. Chapman, per stirpes, subject to the provisions of Subparagraph 5.01 B. above. D. It is Settlor I s express desire and intention to design' the trust created for Settlor I s grandson, Gregory R. Chapman, to be primarily for his benefit, to assure that he will have a friend, advocate or protector of his legal rights, to ensure that he will receive the services that will assist him in developing his maximum potential and in achieving a reasonable degree of normalcy and happi- ness, to supplement his earnings and governmental bene- fits, if any, and not to pay for his lodging, food, medi- cal, dental and hospital expenses when he could otherwise claim these from another source. In this regard, Trustee is to perform certain special functions, which may be -4- 'I .BESHORE.O. ,LVIN 11 ch 11, 1994 compensable to Trustee, to assure satisfactory completion of Settlor's designs and intentions in this Trust. Trust- ee shall take the following action: i' .i 1. To assist Settlor's grandson in obtaining Social Security Administration Benefits, Veter- ans' Administration Benefits, Medicaid (Medical Assistance) and supplemental Social Security Income Benefits and to collect, expend, and account separately for all such governmental assistance benefits. Trustee shall not co-min- gle any such benefits with the trust fund; nor shall Trustee co-mingle any of Settlor's grand- son's own assets and income with said trust fund. 2. To personally visit Settlor's grandson at his residence at least quarterly and preferably once or twice a month to inspect his living conditions, to inquire of the staff and especial- ly of Settlor's grandson regarding his treatment by the care provider (if any); to let Settlor's grandson know that he has a friend or advocate; to see that he has spending money for things he wants; to know that he is receiving education, work training, and social and recreational pro- grams. 3. To make an annual evaluation of Settlor 's grandson, including: (a) Physical and dental examination by an independent physician and dentist. (b) Education and training program. (c) Work opportunity and earnings. (d) Recreation, leisure time and social needs. (e) Appropriateness of existing residen- tial and program services. (f) Laws relating to various governmental financial assistance and benefits program; unless Settlor's grandson has a reasonable -5- BESHORE.O~LVIN r ':ch 11, 1994 chance of earning sufficient income to support himself, it is essential that these benefits be retained. (g) Legal rights including free public education, habilitation and treatment which meet constitutional minimal standards, a minimum or fair wage for work performed, privacy, the right to vote and freedom to marry. (h) Trustee should base the annual evalua- tion on contracts with Settlor I s grandson, the staff and volunteer members of the State and Local Association of Retarded Citizens for his area and other competent professionals. ARTICLE VI. POWERS OF TRUSTEE 6.01. Description of Powers. In out the purposes of this Trust Agreement, addition to all other powers granted by the following powers and discretion: order to carry the Trustee, in law, shall have I II I i (I) Retain Assets. To continue to hold any and all property received by the Trustee or subsequently added to the Trust Estate or acquired pursuant to proper authori- ty, including shares of Trustee's own stock and stock in any corporation controlling, controlled by, or under com- mon control with the Trustee, if and as long as the Trust- ee, in exercising reasonable prudence, discretion, and intelligence, considers that the retention is in the best interests of the Trust. (2) Investments. To invest and reinvest in every kind of property, real, personal, or mixed, and every kind of investment, specifically including, but not by way of limitation, corporate obligations of every kind, and stocks, preferred or common, which men of prudence, discre- tion, and intelligence acquire for their own accounts. -6- II !I !I . BESHORE. 0: .LVIN N ch 11, 1994 . I I I II I , (3) Management of Securities. To exercise, re- specting securities held in the Trust Estate, all the rights, powers, and privileges of an owner, including, but not limited to, the power to vote, give proxies, and to pay assessments and other sums deemed by the Trustee neces- sary for the protection of the Trust Estate; to partici- pate in voting trusts, pooling agreements, foreclosures, reorganizations, consolidations, mergers, and liquida- tions, and in connection therewith to deposit securities with and transfer title to any protective or other commit- tee under such terms as the Trustee may deem advisable; to exercise or sell stock subscription or conversion rights; to accept and retain as an investment any securities or other property received through the exercise of any of the foregoing powers, regardless of any limitations elsewhere in this instrument relative to investments by the Trustee. (4) Form of Ownership of Trust Property. securities or other Trust property in the name Trustee as Trustee under this Trust Agreement or Trustee's own name or in the name of a nominee or conditions where ownership will pass by delivery. To hold of the in the in such (5) Business Interests. To continue and operate, to sell or to liquidate, as the Trustee deems advisable at the risk of the Trust Estate, any business or partnership interests received by the Trust Estate. (6) Sell and Exchange. To sell for cash or upon such terms and conditions (as to creditor otherwise) as the Trustee may deem appropriate, at public or private sale, to exchange, and to convey any property of the Trust Estate. (7) Division of Trust Estate. On any division of the Trust Estate into separate shares or Trusts, to appor- tion and allocate the assets of the Trust Estate in cash or in kind, or partly in cash and partly in kind, or in undivided interests in the manner deemed advisable in the discretion of the Trustee; after any division of the Trust Estate, the Trustee may make joint investments with funds from some or all of the several shares of Trusts, but the -7- . BESHORE. 0 ~LVIN =ch 11, 1994 Trustee shall keep separate accounts for each share or Trust. (8) Abandonment of Trust Assets. To abandon any Trust asset or interest therein in the discretion of the Trustee. (9) tion of a sition of Option. To grant an option involving disposi- Trust asset and to take an option for the acqui- any asset by the Trust Estate. ( 10) ty of the extending Lease. To lease any real or personal proper- Trust Estate for any purpose for terms within or beyond the duration of the Trust. (11) Property Management. To manage, control, improve, and repair real and personal property belonging to the Trust Estate. (12) Development of Property. To partition, di- vide, subdivide, assign, develop, and improve any Trust property; to engage in representations before public real estate authorities; to adjust boundaries or to adjust differences in valuation on exchange or partition by giv- ing or receiving consideration; and to dedicate land or easements to public use with or without consideration. (13) Repair, Alter, Demolish, and Erect. To make ordinary and extraordinary repairs and alterations in buildings or other Trust property, to demolish any improve- ments, to raze party walls or buildings, and to erect new party walls or buildings as the Trustee deems advisable. (14) Borrowing and Encumbering. To borrow money for any Trust purpose from any person, firm, or corpora- tion, including one acting as Trustee hereunder, on the terms and conditions deemed appropriate by the Trustee and to obligate the Trust Estate for repayment; to encumber the Trust Estate or any of its property by mortgage, deed of Trust, pledge, or otherwise, using whatever procedures to consummate the transaction deemed advisable by the -8- 'I . BESHORE. O. ,LVIN N ch 11, 1994 Trustee; to replace, renew, and extend any encumbrance and to pay loans or other obligations of the Trust Estate deemed advisable by the Trustee. (15) Natural Resources. To enter into oil, gas, liquid or gaseous hydrocarbon, sulphur, metal and any and all other natural resource leases on terms deemed advis- able by the Trustee, and to enter into any pooling, utili- zation, repressurizations, community, and other types of agreements relating to the exploration, development, opera- tion, and conservation of properties containing minerals or other natural resources; to drill, mine, and otherwise operate for the development of oil, gas, and other miner- als; to contract for the installation and operation of absorption and repressuring plants; and to install and maintain pipelines. I I i , I I I II I I I I I I II I I II , ! (16) Insurance. To procure and carry at the ex- pense of the Trust Estate insurance of the kinds, forms, and amounts deemed advisable by the Trustee to protect the Trust Estate and the Trustee against any hazard. (17) Enforcement of Hypothecations. To enforce any mortgage or other real or personal property security interest held by the Trust Estate and to purchase at any sale thereunder any property subject to any such hypothecation. (18) Extending Time of Payment of Obligations. To extend the time of payment of any note or other obligation held in the Trust Estate, including accrued or future interests, in the discretion of the Trustee. (19) Adjustment of Claim. To compromise, submit to arbitration, release with or without consideration, or otherwise adjust claims in favor of or against the Trust Estate. (20) expense of Litigation. To commence or defend at the the Trust Estate any litigation affecting the -9- I' .BESHORE.O~LVIN ~ch 11, 1994 Trust or any property of the estate deemed advisable by the Trustee. (21) Administration Expenses. To assessments, compensation of the Trustee, expenses incurred in the collection, care, and protection of the Trust Estate. pay all taxes, and all other administration, (22) Employment of Attorneys, Advisers, and Other Agents. To employ any attorney, investment adviser, accountant, broker, tax specialist, or any other agent deemed necessary in the discretion of the Trustee; and to pay from the Trust Estate reasonable compensation for all services performed by any of them. (23) Loans. To make loans, secured or unsecured, in such amounts, upon such terms, at such rates of inter- est, and to such persons, firms, or corporations as Trust- ee shall think fit. (24) Distribution. On any partial or final distri- bution of the trust Estate, to apportion and allocate the assets of the Trust Estate in cash or in kind, partly in cash and partly in kind, or in undivided interests in the manner deemed advisable at the discretion of the Trustee and to sell any property deemed necessary by the Trustee to make the distribution. (25) Employee Benefit Plans. Trustee shall use its discretion to elect the most propitious settlement option with regard to any qualified employee benefit plans available to Settlor at the time of his death so long as such election shall be in accordance with the Plan's Admin- istrative Committee or Administrator, as the case may be. (26) General. To do all the acts, to take all the proceedings, and to exercise all the rights, powers and privileges which an absolute owner of the property would have, subject always to the discharge of his fiduciary obligations; the enumeration of certain powers in the -10- II , BESHORE. 0 ,LVIN Nch 11, 1994 Trust Agreement shall not limit the general or implied powers of the Trustee; the Trustee shall have all addition- al powers that may now or hereafter be conferred on him by law or that may be necessary to enable the Trustee to administer the Trust in accordance with the provisions of this Trust Agreement, subject to any limitations specified in this Trust Agreement. 6.02. Settlement of Settlor's Estate. Subject to the provisions of paragraph 6.03 Trustee shall have the power, but not the duty, upon Settlor's death, to make such expenditures out of the principal of the Trust as Trustee may think desirable in order to facili ta te the settlement of Settlor's estate. In exercising such power, Trustee may pay, in part or in whole, any or all of the following items: the expenses of Settlor's last illness and burial, her debts, income taxes owed by her, any or all death taxes and interest and penalties thereon, and the expenses of administering Settlor's estate. Any such items may be paid directly by Trustee or else the funds for the payment thereof may be transferred by Trustee to Settlor's personal representatives; and neither such per- sonal representatives nor any beneficiary of Settlor's estate shall be required to reimburse Trustee for any fund so paid or transferred. This power may be exercised even if some or all of the beneficiaries of Settlor's estate have no interest under this Agreement. It is particularly requested that the powers herein granted be exercised liberally in favor of the prompt and convenient settlement of Settlor's estate and particularly to relieve any situa- tion that may arise as a result of there being insuffi- cient cash in the hands of Settlor's executors or adminis- trators with which to accomplish such settlement. 6.03. Special Directions. Notwithstanding any- thing to the contrary contained in this Trust Agreement. Settlor directs that all proceeds received by the Trustees hereunder from "qualified" plans exempt from federal es- tate tax under the applicable provisions of the U. S. Internal Revenue Code shall become a part of the corpus of this Trust Agreement and any of the Sub-Trusts created hereunder, free and clear of all debts, taxes or other obligations of Settlor's estate and without diversion to, or for the benefit of Settlor's estate administration. In -11- I' BESHORE.O' ~LVIN r 'ch 11, 1994' order to accomplish this purpose, Trustee is authorized to maintain such separate or special bank accounts, or other- wise identify and segregate such funds as it may deem to be necessary or appropriate to insure compliance with the direction contained in this paragraph. 6.04. Limitation on Powers. All powers given to the Trustee by this Trust Agreement are exercisable by the Trustee only in a fiduciary capacity and in accordance with the prudent man rule. 6.05. Release of Life Insurance Companies. Settlor releases the life insurance companies from any responsibility to see to the execution of the Trusts creat- ed hereunder or to the application of the proceeds of the policies. ARTICLE VII. DUTIES AND COMPENSATION OF THE TRUSTEE 7.01. Allocation of Income and Principal. The Trustee shall determine what is income and what is princi- pal of each Trust created under this Trust Agreement, and what expenses, costs, taxes, and charges of any kind what- soever shall be charged against income and what shall be charged against principal in accordance with the applica- ble statutes of the Commonwealth of Pennsylvania as they now exist and may, from time to time, be enacted, amended, or repealed. 7.02. Relations with Trustee. No one dealing with the Trustee need inquire concerning the validity of any- thing it purports to do, or need see to the application of any money paid or any property transferred to or on the order of the Trustee. 7.03. Compensation. The original Trustee hereun- der and all successor Trustees shall be entitled to reason- able compensation and, when appropriate, based on its regular schedule of fees for such services in effect at the time of the service rendered. -12- II . BESHORE. 0 \LVIN ~ 'ch 11, 1994 7.04. Bond. No bond shall be required of the orig inal Trustee hereunder or of any successor Trustees; or if a bond is required by law or court, no surety shall be required on such bond. 7.05. Resignation of Trustee and Successor Trust- ees. The Trustee may resign and discharge himself from any Trust created hereunder at any time, and on such resig- nation the Settlor may appoint a successor Trustee. If the Settlor shall then be deceased, G. DAVID BIAS, of 1100 Piney Lane, Harrisburg, Pennsylvania, shall serve as suc- cessor Trustee for any trust created hereunder. If G. David Bias is unable to serve for any reason, then a Court of competent jurisdiction shall appoint the successor. 7.06. Accounts. The Trustee shall each year ren- der an account of his administration of each Trust hereun- der to each beneficiary of this Trust to whom income of such Trust may be distributed (or such beneficiary's guard- ian). Such person's (or the guardian's) transactions stated therein or shown thereby, shall be final and bind- ing on all persons (whether in being or not) who are then or may thereafter become interested in, or entitled to share in, either the income or the principal of such Trust, provided always, however, that nothing contained in this paragraph 7.06 shall be deemed to give such person (or the guardian) acting in conjunction with the Trustee the power to alter, amend, revoke or terminate such Trust. ARTICLE VIII. CONSTRUCTION OF THE TRUST 8.0l. be governed nia. Governing Law. This Trust Agreement shall by the laws of the Commonwealth of Pennsylva- 8.02. Severability. If any part, clause, provi- sion, or condition of this Trust Agreement is held to be void, invalid, or inoperative, such voidness, invalidity, or inoperativeness shall not affect any other clause, provision, or condition hereof; but the remainder of this -13- , BESHORE. 0: ,LVIN lfch 11, 1994 Trust Agreement shall be effective although such clause, provision, or condition had not been contained herein. 8.03. Interpretive Clause. As used in this Trust Agreement, the masculine, feminine, or neuter gender, and the singular or plural number shall each be deemed to include the others whenever the context so indicates. 8.04 Notice of Events. Until the Trustee shall have received written notice of any birth, death, or other event on which the right to receive payment from the Trust Estate may depend, it shall incur no liability for dis- bursements or distributions theretofore made in good faith. 8.05 Perpetui ties. Notwi ths tanding anything here- in contained to the contrary, no Trust created hereby shall continue for more than 21 years after the death of the last survivor of the Settlor, his Wife, his children, and such descendants of the Settlor as are in being at the date of the death of the Settlor, and if at the expiration of such period any property is still held in Trust hereun- der such property shall immediately be distributed to and among the persons then receiving or entitled to have the benefit of the income therefrom in the same proportions in which they are receiving or entitled to have the benefit of such income. IN WITNESS WHEREOF, si~';1\ by the Settlor and of -t--JJ ~I.A rJ--- , 1994. this Trust Agreement has been the Trustee on this / I rh day SETTLOR O~E. ~.A~ rr'Te> J'il:"net E. Beshore llEE (I r!A /~,! /k) Del a C. Chapm n (~ d'''" , .- /7 \'., :/ /' ",' G c.;- / // , ':/ .;7 ,-_.r" ,... /1~ ~f/"' / 'E~?, 0;;., ~/ / ALTE G. -14- II . BESHORE. 0 \LVIN ~ 'ch 11, 1994 COMMONWEALTH OF PENNSYLVANIA COUNTY OF OC<"f/';{;'" ss: On this, the f~ /1-- day of ~r~ 1994, before me, a Notary Public, the undersigned officer, persona1- ly appeared Janet E, Bashore, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTAftIA1 SOl. _ A. f/IIlICO, NOTARY PUlUC IINlIItS8IJIlG. IlAUPHIN COIJIlY. PA. MY COIIMfSSIOliEXPIRES SEPl10 1994 My Commission Exp1res: I , Ii II II -15- " .BESHORE.O' ,LVIN COMMONWEALTH OF PENNSYLVANIA COUNTY OF Dcz."r,f?Ar:" On this, the :f:l:-. II day of . ~. 'ch 11, 1994 ss: ffJr/ 1994, before me, a Notary Public, the undersigned officer, personal- ly appeared Delma C. Chapman known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purpose therein contained. seal. IN WITNESS WHEREOF, I hereunto set my hand and official Public (SEAL) NOTARiAl SEAl JEFfIlfY A. ERNICO, NOTARY PUBLIC HARRISBURG, DAUPHIN COUNTY, PA. MY COMMISSION EXPIRES SEPT. 10, 1994 My Commission Expires: -16- !! . BESHORE. 0 '\.LVIN r 'ch 11, 1994' COMMONWEALTH OF PENNSYLVANIA 55: COUNTY OF .~ '> ~__ (.., ,i 1 ~ On this, // // r . /,//';;" /" /'-- , the day of 1994, before me, a Notary PUblic, the undersigned officer, personal- ly appeared G. David Bias known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. I ;1 11 II I I. Ii ,I Ii II 'I II II 'I I I , , , I ;7 J /"1 // /;//-;~.cA:?o/ " v //}/ /,/~/'" "/ __ C?,,-- t: ~ - - Notary Public (SEAL) My Commission Expires: -17- ,. i'\..' \' "t> rl:1 M&fBank 499 Mitchell Road, MilIsboro, DE 19966 Mail Code DE-MB-12 Mette, Evans & Woodside Attorneys At Law 3401 North Front Street - POBox 5950 Harrisburg, Pennsylvania 17110-0950 Phone (888) 502-4349 Fax (302) 934-2955 January 10, 2005 Re: Estate of: Janet E. Beshore Social Securitv: 170-32-3241 Date of Death: December 21, 2004 Dear Sir or Madam: Per your inquiry dated December 29, 2004, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 15263754 Ownership (Names oj) Janet E Beshore Stewart E Beshore, POA Opening Date 8/28/64 Closed 1/5/05 Balance on Date of Death $J,l25,51 $ 0.01 Accrued Interest Total $1,125.52 Please be advised, there was no safe deposit box found for the above decedent. For further account information, regarding ownership, closures andlor reimbursement offunds, etc" please call the West Shore Plaza Office # 717-255-2271. Sincerely, ~~ Records Management Account Information System Output for WILLIAM JENNINGS / A 410 037122 024 2 12/21/04 1 TOT FOR ACCT CSH REV SUMMARY 1 T.D. CASH BAL 2 S.D. CASH BAL 3 CSH AVAILABLE 4 MTHLY ACC INC JANET E BESHORE DOB 12/29/11 PLT HOME (717)766-6911 SWP=AAA/AAGS TYP CASH AAA TEFRA=O 5327=JAN04/NOV04 0=NOV04 5 MKT VAL LONG POSITIONS 550,413.00 CR 6 MKT VAL LONG OPTIONS 0.00 CR 7 MKT VAL SHORT POSITIONS 0.00 CR 8 MKT VAL SHORT OPTIONS 0.00 CR 6427=DEC03/NOV04 0.00 CR 0.00 CR 0.00 CR 0.00 CR 9 MNY MKT BAL AAGS 43,823 CR 10 MKT VAL CUSTODIAL POSIT 0 CR 11 TOTAL PENDING DB/CR 0 CR 12 TD ACCT VL(1+5+6+9+10-7-8) 594,237 CR 13 TD LONG HOLDGS VAL(5+6+10) 550,413 CR 14 TD INVESTABLE FUNDS(1+9-4) 43,823 CR -- RECAP OF RECENT ACTIVITIES CONTINUING CARE RX 1002 ACTIVE ASSETS GOVT SEC TR CHURCH OF GOD HOME 6681 ACTIVE ASSETS GOVT SEC 330 ACTIVE ASSETS GOVT SEC FIRSTBANK PR FID 5750 1054 ACTIVE ASSETS GOVT SEC VAL BELOW FOR PRICED UNREALZD GAIN/LOSS ACCT VAL Y.E. 12/03 ACCT VAL M.E. 11/04 PROJTD CASH JAN/MAR PERCENT INVESTED (13/12) DIV RE PRICE VALUE SEC TR 1.00 43,823.91 POS 1 OF 9 12/17/04 SID 550,413.00 MKT PRICE UNITS MKT VALUE 2.01 4000.000 8040 41.09 1200.000 49308 48.97 3700.000 181189 39.96 3700.000 147852 24.50 400.000 9800 25.30 400.000 10120 9.99 1600.000 15984 100.372 70000.000 70260 12/15 12/15 12/14 12/14 12/08 12/07 12/07 CHKA SLD CHKA SLD BOT CPN BOT 1. 00 TR TR *19NVO TR 1. 00 1. 00 1. 00 A 410 037122 024 .3 12/21/04 2 ASSET ALLOCATION FOR MS POSITIONS CASH + MMKT = 7% EQUITIES = 81% JANET E BESHORE BONDS = 12% OTHER = C.CUSTODIAL POSITIONS DATE ISSDT QTY/YLD SYMBL MGN PLAN NR 12/21 43,823.910 ACTIVE ASSETS GOVT O.Cash 0.00 T/D 0.00 SECURITY RTG CONEXANT SYSTEMS INC EV UGI CORPORATION NEW COM 4* ROCKWELL AUTOMATION INC E ROCKWELL COLLINS INC 0 MORGAN STAN V CUM 5750 *33JL15 N/O HEALTH CARE PPTY 7.1000% SER F N/O SKYWORKS SOLUTIONS INC N/O FIRSTBANK PR FID 5750 *19NV07 N/O Morgan Stanley Dean Witter Confidential Data - not an official statement Page 10f2 POSIT ONLY 77 ,819+ 750,896CR 595,347CR 2,946+ 92 1,002.20DB 1,002.20CR 6,681. 70DB 6,681. 70CR 330.82DB 330.82CR 1,054.50DB 0% MARGINED/ POLICY # o . 00 CSH COST SYMBOL 29955# CNXT 24101# UGI 224775# ROK 78662# COL 10000 MWO 10372 HCP.F 1753 SWKS 70000 UJ295 Wednesday, December 22, 2004 8:38 am Account Information System Output ^ Co. WILLIAM JENNINGS A 410 037122 O.Cash SECURITY A 0 SMITH CORP 12/21/04 3 JANET E BESHORE POS 9 OF 9 RTG PRICE UNITS MKT 2* 28.93 2000.000 024 END Morgan Stanley Dean Witter C01ifidential Data - not an official statement Page 2 of2 12/17/04 VALUE COST 57860 22974 SYMBOL AOS W edDesday, December 22, 2004 8:38 am FEB. -28' OS (MO.N) 13:,14 LEGG MASON CAMP HILL TEL:7177370800 G. David Bias Senior Viel! Prl!ddent - InW!stml!nts February 25, 200S Mette, 1!:vans & Woodside A<<n: Lisa J. Knode 3401 North Front Street Harrisburg, Pll.17110-09S0 Re: 1!:stltte Of Janet 1!:. Beshore Delma C. Chapman TTEE Janet E. Beshore Trust, DTD 3/11/94 LM Aeet 1#363-01417-15 Ms. Knode: Encloscd is a summllry of the Dllte Of Death Valullll oftbe Trust account for Janet E. Beshore and a copy of hcr December 2004 Statemcnt as you requested. The benefieiary is stipublted in the Trust Agreement as Gregory R. Chapman, grandson of deceased. There has been no transfer of funds Dr any loans in Mrs. Beshore's account witbin one yellr of ber dellth. Uyou have any questions please do Dot hesitate to cnU me at 737-6500, ext 3219. Sinccrely, Lydia Schiavoni Client Service Rep for G. David Bios . l..fcr;: MllHlft Wood Wllllrr .Ineorpo~'r:d P.O. :pox 81153,21" Senl. Avenlle.1~ Floor Cnmp Hili. P.-\ 11101-1813 "'.'3'-6100 SnD-4l3-l1R' ,..:'\'.731-0100 Alh1110a Iuv,ctlun I!!iilnc:. lAP!) . P. 001 PEB. -28' OS (MQN) [3;14 LEGG MASON CAMP HILL TEL:7177370800 P. 002 Henry J. pali Legg Mason Wood Walker, Inc. 02/2512005 12:02 PM Delma C ChaJ)man TTEE Janet E. Beshore Trust DTD 3/11/94 Date Of Death. 12/21/04 Holdinas: yalues 1.) 2.) 1443.32 Shs. Legg Mason Cash Reserve Trust@ 1.00 409.303 Sha. Legg Mason Value Trust @64.00 NAV Approx. Total $ 1,443.32 $ 26,195.39 $ 27,638.71 .. The foregoing Information was prepared from sources believed to be reliable but Is not guaranteed as to accuracy. It should be carefUlly reviewed and compared with your Legg Mason monthly statements. Any "uesllons should be referred to your Investment Executive orthe 61'ilnch Manllger. Page 1 of 1 NEILL Funeral Home Inc. SR"-U,"'-'i:.\ S. I3.ES,tID,'U: MI~. MarilYR Crossley 3000 Lisburn Rd Mecha"iG5bUl9, rA 17055 Services For: Janet E Beshore Complete Traditional Service Burial ................... $ Hairdresser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y33 628 DH FINCH ................................ 10 Gauge Galvanized Steel. . . . . . . . . . . . . . . . . . . . . . . . . . Clothing- Pink Gown ............................... Memorial Packages - Bridge of Faith ................... Flowers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cemetery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Death Certificates 6 @ $2.00 .... . . . . . . . . . . . . . . . . . . . . Honorarium! Marcia Haller .. . . . . . . . . . . . . . . . . . . . . . . . . . Honorarium! Carl Peterson .......................... Patriot News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Discount 2: Family Paid on PN ....................... PN Discount 1 Trust PN to AN ....................... Total Funeral Charges $ Adjustments (Payments) $ Balance Due on Account 3401 Market Street Camp Hill, PA - 17011-4428 tel 717 737-8726 fax 717 737-1859 Robert J. Pramik, Supervisor 3501 Derry Street Harrisburg, PA - 17111-1817 tel 717 564-2633 fax 717 561-9918 Stephen]. Wilsback, Supervisor December 23, 2004 Ref No.: 1002776/ C04-102 3,845.00 75.00 4,745.00 2,095.00 165.00 180.00 386.90 1,490.00 12.00 300.00 300.00 115.80 (5,400.00) (5,801.00) $2,508.70 0.00 Member of ALDERWOODS GROUP COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOIVIDUAL TAXES OEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ERNICO JEFFREY A POBOX 5950 HARRISBURG, PA 17110-0950 n_n___ told ESTATE INFORMATION: SSN: 170-32-3241 FILE NUMBER: 2104-1178 DECEDENT NAME: BESHORE JANET E DATE OF PAYMENT: 05/16/2005 POSTMARK DATE: 05/13/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/21/2004 NO. CD 005327 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $723.31 I I I I I I I I TOTAL AMOUNT PAID: $723.31 REMARKS: CHECK#518 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL ~q;>p' (':CF!('E ~RAISEKENT, ALLOWANCE OR DISALLOWANCE INHERIUNCE lAX DIVISION . _\....Vl..)'-U '-"v - .....!OF DEDUCTIONS AND ASSESSI1ENT OF TAX PO BOX 280601 ~ HARRISBURG PA 17128-D601 ' DATE ESTATE OF DATE OF DEATH FILE NUMBER CDUNTY ACN 08-22-2005 BESHORE 12-21-2004 21 04-1178 CUMBERLAND 101 APPEAL DATE: 10-21-2005 (See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LONER PORTION FOR YOUR RECORDS +- REV:is47-EX-AFP-C03:0si-NOTicE-OF-iNHERiTANCE-TAX-APPRAiSEMENT:-ALLOWANCE-OR--------------- DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JANET E FILE NO. 21 04-1178 ACN 101 Zn0:; "'ur: '".Vo. tJlJl'r, .....-...' II: 25 '"'I E:""':I l,",_ ,',;'\ n:"',~:'\."I,';-:: ,"'- JEFFREY A ~iWtClJ.ESll METTE HAL']' PO BOX 5950 HBG ., Ii)"; PA 17110 ESTATE OF BESHORE DATE 08-22-2005 TAX RETURN liAS: I X) ACCEPTED AS FILEO RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..I Estate ISchedule A) 2. Stocks and Bonds ISchedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule DJ 5. Cash/8W\k DepositsIHisc. Personal Property (Schedule E) 6. ~olntly Owned Property (Schedule f) 7. Transfers (Schedule S) 8. Total Assets I ) C_ED III (2) (3) (4) IS) (6) 17l .00 480.153.00 .00 .00 115.724.43 .00 27,638.71 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Hort~age Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitabl./GoYer~ental Bequests; Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estat. Subiect to Tax I~ an assessment was issued previously, lines 14, 15 and/or 16, 17. 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. ~t of Line l~ at Spousal rate (15) 16. A.ount of Line 14 taxable at Lineal/Class A rate (16) 17. A~nt of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Coll.teral/Class B rate (18) 19. Principal Tax Due T X NOTE: . DATE 03-17-2005 05-13-2005 NUIlBER CD005094 CD005327 INTEREST/PEN PAID 1-) 1,289.47 .00 ~. IF PAID AFTER DATE INDICATEO, SEE REVERSE FOR CALCULATION OF AOOITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTEO AS A "CREDIr' ICR), YDU KAY BE DUE A REFUND. SEE REVEK~ ~Tni:' nil=' TUTe, ~....... .."'... ....---..------- (9) 110) 39,895.99 1.113.90 I1ll 112) 113) 114) .00 572,506.21 .00 5,000.00 x 00 = X 045 = X 12 = X 15 = 119)= AKOUNT PAlO 24,500.00 723.31 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE '* REY-1547 EX AFP (06-05) JANET E NOTE: To insure proper credit to your account~ sub.l t the upper portion of this for_ with your tax pa".."t. 623,516.14 41.009 89 582.506.25 5,000.00 577 ,506 .25 .00 25,762.78 .00 750.00 26,512.78 26,512.78 .00 .00 .00 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF THE ESTATE IS NOT COMPLETED, FILE A 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: JANET E. BESHORE. a!kJa Janet Esther Beshore Date of Death: December 21. 2004 Will No. 2004-01178 Admin. No. 21-04-1178 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate. 1. State whether administration of the estate is complete: Yes IZI No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No IZI b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes IZI No 0 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: \~\ 6 \ \ f),GOb Jeffrev A. Ernico. Esquire. Atty. LD. #07981 Name (Please type or print) t_.. , C,' 3401 North Front Street. P.O. Box 5950 Address L_ Harrisburg. PA 17110-0950 ('.J 1 (717) 232-5000 Telephone Capacity: o Personal Representative IZI Counsel for Personal Representative 437991vl t1 ~t: 1505610105 REV-1500 Ex t°2_'1'tF`' ~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY or=»,„E„~ ~~ A County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX z8o6oi ~ , a ~ ~ i "~ ~( Harrisburg, PA 1'7128-o6oi RESIDENT DECEDENT (~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 179-38-2120 11 /13/2010 04/12/1951 Decedent's Last Name Suffix Decedent's First Name MI AMSPACHER THOMAS E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI AMSPACHER TERESA M Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust __ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number FIONA K. FADNESS, ESQ. (717) 991-1382 First Line of Address 301 SOUTH HANOVER ST Second Line of Address City or Post Office CARLISLE State ZIP Code PA 17257 REGISTER OF WILLS USE ONLY r > n :_~ .. w.. - ;7 ~ 1 -t' ~r7 DATA ~~ED ' "' r. ' ly4 ,~ ~. l'r L.'> (_} --; , Correspondent's a-mail address: FKLESOUIRE@AOL.COM Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. FOR FILING RETURN ADDRESS 16 SCRAFFORD ST, SHIPPENSBURG, PA 17257 OF PREPARE~OT}-1~2 THAN REPRESENTATIVE DATE P.UURCJJ 301 SOUTH HANOVER ST, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: THOMAS E AMSPACHER 179-38-2120 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. 110,148.30 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 110,148.30 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 23,374.68 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 1,369.42 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 24,744.10 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 85,404.20 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 85,404.20 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 85,40420 (a)(1.2) X .0 0 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ 1g. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. TAX DUE ....................................................... ..19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME THOMAS E AMSPACHER - -- STREETADDRESS 16 SCRAFFORD STREET --- _ __ clrY SHIPPENSBURG ,STATE I Zlp PA 17257 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ___ ---- _- B. Discount __ 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) Total Cretlits (A + g) (2) (3} (4'~ (5) 0.00 0.00 0.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred ......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income ........................................... ^ c. retain a reversionary interest ............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, ditl decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ...................................................................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1.2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death tc or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-i5o8 EX+ (iI-io) ~~i pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: THOMAS E AMSPACHER SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY FILE NUMBER: 21-10-1178 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. Ir more space is needed, use additional sheets of paper of the same size. RF~/-15ll EX+ ~ 1'~I-h' Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER THOMAS E AMSPACHER 21-10-1178 Decedent's debts must be reported on Schedule I. ITEM - NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: I' FOGELSANGER-BRICKER FUNERAL HOME -FUNERAL SERVICES 10,646.93 2 SHULL-KOONTZ -HEADSTONE/GRAVE MARKER 3,341.0() 3 SPRING HILL CEMETERY ASSOCIATION -GRAVE LOT WITH PERPETUAL CARE 1,450.0() 4 VET'S CANTEEN ASSOCIATION -FUNERAL RECEPTION 519.7!i B. 1. z. 3. 4. 5. 6. 7. 8 s ADMINISTRATIVE COSTS: Personal Representative Commissions; Name(s) of Personal Representative(s) Street Address __ City _ State ZIP ', Year(s) Commission Paid: Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant TERESA M. AMSPACHER -- Street Address 16 SCRAFFORD STREET City SHIPPENSBURG __ _ __ _ _ State PA ZIP 17257 Relationship of Claimant to Decedent SPOUSE Probate Fees: Accountant Fees: Tax Return Preparer Fees: INHERITANCE TAX FILING FEES THE SENTINEL -ADVERTISING CUMBERLAND LAW JOURNAL -ADVERTISING 3,275.OC 3,500.00 314.50 15.00 212.50 100.00 TOTAL (Also enter on Line 9, Recapitulation) $ 23,374.68 If more space is needed, use additional sheets of paper of the same size. RE'/-15iZ rX- ~ G;4; pennsylvania !i7 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER THOMAS E AMSPACHER 21-10-1178 _ Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. !t more space is needed, insert additional sheets of the same size. REV-1513 EX+ {01-10) Pennsylvania ~..~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: THOMAS E AMSPACHER 21-10-1178 _ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1~ TERESA AMSPACHER, 16 SCRAFFORD ST, SHIPPENSBURG, SPOUSE 100% PA, 17257 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON L[NES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. I~ RENUNCIATION OF INHERITANCE TO: ESTATE OF THOMAS E. AMSPACHER I, Jennifer Kyner, the undersigned, being an heir of the Estate of Thomas E. Amspacher, deceased, hereby disclaims my right to receive any property from the Estate of Thomas E. Amspacher, whether by Will or intestate succession and further states as follows: L I have been fully advised of my rights to certain property of the Estate of Thomas E. Amspacher and waive and disclaim my right to same voluntarily and without duress or undue influence. This disclaimer applies to all real and personal property I would have received. 2. The undersigned acknowledges that the administrator of the Estate will rely on this Renunciation of Inheritance in distributing the property and assets of the Estate. 3. This Renunciation of Inheritance shall be binding upon the undersigned, and his or her heirs, executors, administrators, legal representatives and assigns. ~~ 1l Date Commonwealth of Pennsylvania SS: County of ~~~~~ Witness On this ~~~ day of S , 2011, before me, the undersigned officer, personally appeared Jennifer Kyner, own to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein. contained. In Witness Whereof, I hereunto set my hand and official. seal a o -_ x:;~ OOMMONWEALTH F PENNSYLVANIA ? ~ rte- ~.~ NOTARIAL SERI. DEBORAti V'dARREN, Notay Public - `' rn - - cr>~~~- rv -_~ burfl Twp., Cumb6rtand Coum,~ ~ rrsrt~slan Exptr~ Npvember 8, 2©12 C ~ ~ ,-~ _ -, ' -~ o My y 1 1 ~ __ ~, . ~~ .. c__ .-_ ~; ~,~ C i. - r RENUNCIATION OF INHERITANCE TO: ESTATE OF THOMAS E. AMSPACHER I, Erik Amspacher, the undersigned, being an heir of the Estate of Thomas E. Amspacher, deceased, hereby disclaims my right to receive any property from the Estate of Thomas E. Amspacher, whether by Will or intestate succession and further states as follows: 1. I have been fully advised of my rights to certain property of the Estate of Thomas E. Amspacher and waive and disclaim my right to same voluntarily and without duress or undue influence. This disclaimer applies to all real and personal property I would have received. 2. The undersigned acknowledges that the administrator of the Estate will rely on this Renunciation of Inheritance in distributing the property and assets of the Estate. 3. This Renunciation of Inheritance shall be binding upon the undersigned, and his or her heirs, executors, administrators, legal representatives and assigns. `? ~-~ ~ Date Commonwealth of Pennsylvania SS: County of ~!(,~~ On this( ~~~day of ~i~.~--fir , 2011, before me, the undersigned officer, personally appeared Erik Amspacher, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. In Witness Whereof, I hereunto set my hand and official seal COMMONWEALTw (~F ~l=NNSYLVANIA Notarial Seal -a STEVEN D. BRENNEMAN, Notary Public -~- West Manchester Twp., York County ,,_ ^ My Commission Expires April 8, 2013 ~Cj -- _ _t=T _ - ' "" ~- - -' 'n rte- y. 3 _ .- -- "~ . n~ . _., ,.~ ,; ,z? -- -1 :~, ~.~~ r, .,; ,