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Home My WebLink About04-1188COUMOflWENJ3-1 OF PENNSYLVANIA DEPAR'IUEN'r OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECE S (mT. F.RST, ^.O DATE OF DEATH (MM-OD-YEAR) D,~TE OF BIRTH (MM-DO- ~Y~/) I (IF APPLICABLE) SUR~/IVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) FILE NUMBER SOCIAL SECURITY NUMBER t'lo -oH- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURI~ NUMBER w [] 1. Ohginal Retem [] 2. Supplemental Retem [] 3. Ra~ainder Retom(date~a~-tol2-,3~2) r-'] 6. De~t Died Testete (~.a~ a~w o~ w~) ~ 7. ~ Mai~i~d a ~ Trust (~ ~m~) ~ 8. T~I Numar ~ ~e ~ Sox~ ~ ~ 9. U~P~sR~ ~ 10. S~lPo~(~12~l~l~l-l~) ~ 11.E~n~un~r~c. 911~A)(~o) FIRM NAME ~LEPHONE NUMBER COMPLETE MAILING ADDRESS 1. Real Estate (&:heduie A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held C.,oq~, Partnership or Sale-proprietorship (3) 4. Mortgages & Notes Receivai~e (Schedule B) (4) 5. Ca~h, Bank Depesds & MldceNaneous Pemonal PropeR (5) (Schedule E) qTZ q 6. ~)leliy Owned PropeRty (Schedule F) (5) 7. Inter-Vivos Transfe~ & Mlecelananus Non-Probate Propeffy (7) 3 ~'~, (Schedule G or L) 8. Total Gm~s Assets (total Lines 1-7) (8) g. FunemlExpenses&AdmldletralJveCosts{ScheduleH) (9) C~ ~ ~,.,..,3.-". 10. De~s of Decedan(, Mortgage Uabililles, & Liens (Schedule I) (10) (3 11. Total Beduc~ (tetel Lldes 9 & 10) (11) 12. Net Value of Estate (Une 8 minus Li~e 11) (12) 13. Charitobto and Govemmantel Bequeets/Sec 9113 Tmste for which an eleclion to lax has no~ been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 mldus Line 13) 04) 3G~7. 8 q 3. SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousa~ tex rate, or ~ansfers under Sec. 9116 (a)(1.2) x .0 (15) 16. Amount of Line 14 taxable at lineal rote x .0 ~'~' (16) 17. Amount of Ltee 14 taxable at sibling rate . x .12 07) 18, Amount of Li~e 14 texabld at colldtetal rate x A5 (18) 19. Tax Due·· (19) ) > BE ~JRE TO AN~NER ALL GUE~rlOM~ OM REVER~E ~IDE AND RECHECK MATH < < Decedent's Complete Address: STREET~ORE~ ~ Zoo ~ ~-v,~,-~. ~v,'~,~ ,.- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Cradite/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount zip ~<~ / Total Creqits (A + B + C ) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (2) 87-7. 5. If Line 1 + Line 3 is graater than Line 2, enter the difference. This is the TAX DUE. (3) O. o-'o A. Enter the interest on the tax due. (4) (5) 9 z9 (SA) O. ~ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 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 usa 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; or .......................................................................................................................... [] d. receive the promise for life of either payments, benefits or cam? ...................................................................... [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death w~thout receiving adequate consideration? .............................................................................................................. [] 3. Did decadent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] 4. Did decadent own an Individual Retiremant 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. RE OF~_~.PEI~SO~ RES~Oh~IB~.E;OR~.,.~ ' ~-~Fl~ RETURN ADD~ESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 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 or for the use of the suwiving spouse is 3% [72 P.S, §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the usa of the surviving spouse is 0% [72 RS. §9116 (a) (1.1) (ii)]. The statute does not exemet a transfer to a surviving spouse from tax, and the statutory requirements for disdesure of assets and filing a tax return ara stfl 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 fi.om a deceased child tweaty-one years of age or younger at death to or for the usa of a natural parent, an adoptive parent, or a stepparant of the child Ls 0% [72 RS. §9116(a)(12)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2} [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% [72 P.S. §9t16(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least on parent in common with the decedent, whether by blcod or adoption. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OFINDIVIDUAL TAXES RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004776 DELLA-CROCE ANN H 25 NORTH 24TH STREET CAMP HILL, PA 17011 fold ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2104- 1188 DECEDENT NAME: HATCH JOSEPH P DATE OF PAYMENT: 12/28/2004 POSTMARK DATE: 1 2/28/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/02/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $15,725.30 TOTAL AMOUNT PAID: $15,725.30 REMARKS: SEAL CHECK//3224 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER Thi>. is ~o certit~ that the information here given is correctly copied from an original certificate of death duly filed with me as [ ocztl Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificale, $2.00 P 10685534 No. Local Registrar ocr 0 ,i 2004 Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Joseph P. Hatch Sr. ~]~. 170 94 ¥" 4-5-10 ~'. ~ [] ~D ,s~%,, ~ Bell Telephone v,,~ ~ 12~~ "'~'"~ ~Wid~ed ~ }Ell, PA 17011 ~ts~t~ ~1 · ~"'"'~7 t7d'~ .,,~,,,~.~ ~ Hill ~,,,~ ..... S,~TU.~ ]""~ate of Heaven ~metery ~.. Mechanics~rg~ PA ,~.~-L ,~. Myers-Hamer m~ 1903 Mkt St. ~, PA 17011 b,,. /" ~- o-{ REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERI'Y COMMONWEAL]Y1 OF t~ENNSYLVANIA INHERITANCE TAX RETURN REStDENT DECEDENT Ifldude the p~oceeds of I~igation and the date the proceeds were received by the estate. All p~opefty jointly-owned with dgM o~ survivorship mum be disclosed on Schedule F. FILE NUMBER ITEM NUMBER VALUE AT DATE OF DEATH TOTAL (Nso enter on line 5, Recapitulation) $ C/~"7 Z. ~. ~D (If mmu sgace ~s needed, insal additional shee~ of the same size) Account Register JOSEPH P. HATCH SR *** (No. ***030) Another account: S1 - SAVINGS (S 1)S2 - HOLIDAY CLUB (S 2)S4 - CHECKING (S 4)VISA GOLD (L 1 S1 - SAVINGS (S 1) September, 2004 Eft~'ttv~ Endln Check No, Date Transaction D~crlption Amount Balanc~ 9130/2004 DIVIDEND 1.00 040901 040930 1.00 D 21.66 $4,356.97 26421.63 S4 - CHECKING (S 4) Effectlw Endln Check No. Dab Transaction Dem:Hptlon Amount Balanc~ 3031036030 9/30/200~ DIRECT DEPOSIT 785 $2,436.03 US TREASURY 303 SOC SEC 1305 9/28/200~ DRAFT PAID -53' $1,651.03 TRACE # 013034871-000527030 9783397101 9/27/200~ PREAUTHORIZED WITHDRAWAL -3.4( $1,704.03 VERIZON PAYMENT 3231174060 9/13/200~ PREAUTHORIZED WITHDRAWAL -42.92 $1,707.4g UGI UTILITIES UGI BILL 1008096660 9/8/200~ PREAUTHORIZED WITHDRAWAL -34.1E $1,750.41 PAWC PAYMENT 1230959590 9/7/200~ PREAUTHORIZED WITHDRAWAL -60.5~ $1,784.59 PP ELEC BILL 3000009547 9/7/200~ PREAUTHORIZED WITHDRAWAL -42.2Z $1,845.13 COMCAST CENTRAL CENTRAL PA 3031036030 9/3/200~ DIRECT DEPOSIT 78{ $1,887.37 US TREASURY 303 SOC SEC 1304 9/1/200~ DRAFT PAID -30(: $1,102.37 TRACE # 011100463-000527030 Den Den Den Den Sub-Tetal Kitchen Kitchen Kitchen 8ub-Telal Dining Room 8ub-Tolal Living Room Living Room Living Room Living Room Living Room Master Bedroom Master Bedroom Master Bedroom Master Bedroom Master Bedroom Spare Bedroom Spare Bedroom Spare Bedroom Bedroom 2 Bedroom 3 Bedroom 4 Bedroom 5 Sub-Ta~al TV Couch Electric Chair Rocker Dinette Set Microwave Dishes, Pots & Pans Table & Chairs Sofa Rocking Chair Tables End Tables Chest Bed Dresser Armoir Night Stand Lamp Bed Dresser Night Stand Beds Dresser Vanity Night Stand $ $ $ $ $ $ $ $ $ $ $ 1 $ 1 1 $ 1 $ 1 $ $ 1 $ 1 $ 1 $ 1 $ 1 $ $ 1 $ 1 1 $ 2 $ 1 1 $ 2 $ 304,62 121.85 152,31 76.16 106, 62 30,46 152.31 28~:39 304.62 121.85 76.16 60.92 91.39 152.31 152.31 106.62 106.62 45.69 22.85 106.62 152,31 45.69 182.77 121,85 91.39 45.69 441 .~ 2,932.00 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G iNTER-VIVOS TRANSFERS & /VIISC. NOH-PROBATE PROPERTY RLE NUMBER schedule must be cemp~eted and filed if the answer to any of questions 1 through 4 GA the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRN~ THE~ RBA~ION~p TO OECEOENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAYJ~LE ~IUMBEF 'm~ ~TE o~ m~/~Tr~c~ a Co~ c~ *m~ ~la~ ~ ~_ ast~ VALUE OF ASSET INTEREST ~AP~ VALUE TOTAL (Nso enter on line 7' Recapitulation) $ 3 (o 7. (If mom space is needed, insert ad~onal sheets of the same size) EV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF -~S¢r "~. l_~.)rC.~. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ~ebts of decedent must be mlx~t~ on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 5. 6. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Pers~al Repms~tatlve's Comn~ Yea~s) Commission Paid: Attorney Fees Family Exemp~on: (ff decedent's address is not Ihe same as ~ls, ~ ~) Claimant C~y State __Zip Relatiomhip of Claimam t~ Decedent Probate Fees ~s Fees T~x Re~um Pr~are~s Fees TOTAL (Also enter on line 9, Recapitula~on) $ ~.~'3,,~'. oW (ff mom space is needed, inset additional shee~ of Ihe sa~e size) Myers-Harner Funeral Home, Inc. 1903 MARKET STREET · PO BOX 291 CAMP HILL, PENNSYLVANIA 17011 Robert, H Harner, Superwsor Phone: (717)737 996i STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED explain in writing belo,~ For the Service of ~Jo.~L'zl~l~ ~. ]"fl/~"¢clT~ 5~., Date of Death C~a~o: ,'4ZVaZ Id. De~z~-C',~,~c~-. ,~6'/V. ~y~-sF A. CHARGE FOR SERVICES SELECTED: 1 PROFESSION?,I. ',ERX ICE~ Scrx'iccs of Fuller2~ I)Jrt ti!ir ~;taff ~]~ ~* Embalming tor hmeral cercmo~l~ local SUB-TOTAl OF AUTOMOTIXE EQUIPMENT TOTAL OF PROFESSIONAL SERVICES FACILITIES ~.ND AldTOMOTIVE EQ[ [PMENT B. CHARGE FOR MERCHANDISE SELECTED: ,I)c crip~ionJ ~0~ ~ D s 1o~70- Other clothing SUB-TOTAl. OF FACILITIES/EQUIPMENT A2 3 AL [OMOTI\E EQ!'IPMENT Local Local (Description) Outer burtat container/~k/'~} 6$L,t~ (Description) Acknowledgemenl cards Register book{s) Mere ry fiflders Prayer cards Temporary grave marker Burial clothing TOTAL MERCHANDISE SEI, ECTED B S signsbeow alaecfiaroe fl"'"~'l~jJ~,,~'. - .... i~ ' '~1 ~'[UlI1/ ~m:~JJ~ (][[}xI lagrccmhc tl}and,,o~,r ahc,a,hanv eesewho THE JOSEPH P. HATCH~ SR. FAMILY REVOCABLE TRUST THIS TRUST ,AGREEMENT is executed in triplicate on this ~ day of ~-~-~ , 1994, by and between JOSEPH P. HATCH, SR., now of 2~07 Harvard Avenue, Camp Hill, Cumberland County, Pennsylvania 17011 {herein called "Settlor") and JOSEPH P. HATCH, SR., now of 2007 Harvard Avenue, Camp Hill, cumberland County, Pennsylvania 17011 (herein called "Trustee"). ARTICLE I. PARTIES, PERSONAL DATA AND TABLE OF CONTENTS 1.01. Parties and Personal Data. The Settlor is a widower, his wife, HELEN S. HATCH, having passed away March 28, 1993. The Settlor's children are JOSEPH P. HATCH, JR. and ANN H. DELLA-CROCE. Throughout this Trust Agreement: (a) JOSEPH P. HATCH, SR. will be referred to as the Settlor; (b} JOSEPH P. HATCH, JR. and ANN H. DELLA-CROCE will be referred to as the children of the Settlor or the Settlor's children; and (c) the word "issue" will include Settlor's children as well as Settlor's other descendants. 1.02. Table of Contents. PAGE ARTICLE I. PARTIES, PERSONAL DATA AND TABLE OF CONTENTS 1.01 Parties and Personal Data .................. 1 1.02 Table of Contents .......................... 1 ARTICLE II. TRUST ESTATE 2.01 Transfer to Trust .......................... 2 2.02 Additional Transfers to Trust .............. 3 ARTICLE III. LIFE INSURANCE POLICIES 3.01 Transfers of Life Insurance to Trust ....... 3 3.02 Payment of Premiums ........................ 3 3.03 Rights in the Life Insurance Reserved to Settlor ................................. 4 3.04 Duties of Trustee Regarding the Life Insurance .................................. 4 ARTICLE IV. DISTRIBUTIONS FROM TRUST 4.01 Distributions During Settlor's Life ........ 5 4.02 Settlor's Special Power of Appointment ..... 5 4.03 Termination and Distribution of Trust ...... 5 ARTICLE V. POWERS OF TRUSTEE 5.01 General Powers ............................. 6 5.02 Voting by Trustee .......................... 9 ARTICLE VI. SPENDTHRIFT PROVISION 6.01 General Provisions ......................... 9 ARTICLE VII. CONSTRUCTION OF TRUST 7.01 Choice of Law .............................. 9 7.02 Code ....................................... 9 7.03 Other Terms ................................ 9 7.04 Captions and Table of Contents ............ 10 7.05 Situs of Trust ............................ 10 ARTICLE VIII. COMPENSATION OF TRUSTEE AND APPOINTMENT OF SUCCESSOR TRUSTEE 8.01 Compensation .............................. 10 8.02 Removal of Trustee ........................ 10 8.03 Successor Trustee ......................... 10 ARTICLE IX. PERPETUITIES CLAUSE 9.01 General Provisions ........................ 11 ARTICLE X. REVOCATION AND AMENDMENTS 10.01 Reservation of Powers .................... 11 10.02 Effect of Settlor's Incapacity ........... 11 A. If Settlor Incapacitated ......... 11 B. Settlor's Retained General Power of Appointment ............. 11 C. Definition of Incapacity ......... 12 (1) Admission of Incapacity ..... 12 (2) Medical Certification of Lack of Capacity ............ 12 (3) Powers Personal to Settlor..12 ARTICLE XI. ACQUISITION OF UNITED STATES TREASURY BONDS ELIGIBLE FOR TAX PAYMENT; PAYMENT OF TAXES, FUNERAL EXPENSES, AND EXPENSES OF ADMINISTRATION 11.01 Acquisition of Bonds ..................... 13 11.02 Payment of United States Estate Tax By Bond Redemption ................... 13 11.03 Payment of Death Taxes and Other Estate Settlement Costs .................. 13 ARTICLE II. TRUST ESTATE 2.01. Transfer to Trust. Settlor does hereby assign, transfer and deliver to the Trustee and its successors and assigns the property described in Schedule "A" attached hereto and made a part hereof, or as Schedule "A" may be amended. As further evidence of such assignment, the Settlor has executed or will execute or cause to be executed such other instruments as may be 2 required for the purposes of completing the assignment or transfer of title to such property to the Trustee. The Trustee accepts such transfer and assignment to itself as Trustee, and the Trustee undertakes to hold, manage, invest and reinvest the assets of this Trust, and to distribute the income and principal of the Trust in accordance with the provisions of this Agreement. 2.02. Additional Transfers to Trust. The Settlor, and any other person, with the consent of the Trustee, shall have the right at any time to make additions to the corpus of this Trust or any shares thereof hereby established. All such additions shall be held, controlled, and distributed by the Trustee in accordance with the terms and conditions of this Agreement. ARTICLE III. LIFE INSURANCE POLICIES 3.01. Transfers of Life Insurance to Trust. If any insurance policies are transferred into this Trust, the Trustee shall be vested with all right, title, and interest in and to the transferred policies of insurance, and are authorized and empowered to exercise and enjoy, for the purposes of the Trust herein created and as absolute owner of such policies of insurance, all the options, benefits, rights and privileges under such policies, including the right to borrow upon and to pledge them for a loan or loans. The Trustee takes all rights, title, and interest in and to such insurance policies subject to any prior split-dollar life insurance agreement which may be in effect at the time of the transfer. The insurance companies which have issued such policies are hereby authorized and directed to recognize the Trustee as absolute owner of such policies of insurance and as fully entitled to all options, rights, privileges, and interests under such policies, and any receipts, releases, and other instruments executed by the Trustee in connection with such policies shall be binding and conclusive upon the insurance companies and upon all persons interested in this Trust. 3.02. Payment of Premiums. It is the intention of the Settlor to pay any and all premiums, assessments or other charges necessary to keep each policy included in the Trust in force unless such premiums shall be paid by the insured thereunder (where the insured is someone other than the Settlor) or in some other manner, but the Settlor shall be under no duty in this respect and shall incur no liability to the beneficiaries of the Trust or to any other person if the Settlor shall permit any such policy to lapse for nonpayment of premiums, assessments or charges, or otherwise permit any such policy to become uncollectible. The Trustee shall be under no obligation to pay the premiums which may become due and payable under the provisions of any policy of insurance which may be transferred or assigned to this Trust, or to make certain that such premiums are paid by the transferor of 3 such policy, or to notify any persons of the nonpayment of such premiums, and the Trustee shall be under no responsibility or liability of any kind in case such premiums are not paid, except that the Trustee shall apply any dividends received by the Trustee on such policies to the payment of premiums thereon. Upon notice at any time during the continuance of this Trust that the premiums due upon such policies are in default, or that premiums which will become due will not be paid, either by the transferor or by any other person, the Trustee, within its sole discretion, may apply any cash values attributable to such policy to the purchase of paid-up insurance or of extended insurance, or may borrow upon such policy for the payment of premiums due thereon, or may accept the cash values of such policy upon its forfeiture. In the event that the Trustee receives the cash value of such policy upon its forfeiture for nonpayment of premiums, the amount received shall be added to the corpus of this Trust, and shall be administered according to the terms of this Agreement. If the insured under such policies of insurance, becomes totally and permanently disabled within the meaning of any policies and because thereof the payment of premiums, or any of them, shall, during the pendency of such disability, be waived, the Trustee, upon receipt of such knowledge, shall promptly notify the insurance company which has issued such policies, and shall take any and all steps necessary to make such waiver of premium provision effective. 3.03. Rights in the Life Insurance Reserved to Settlor. The following rights, exercisable without the consent of the Trustee or the beneficiaries of the Trust, are expressly reserved by the Settlor during the Settlor's lifetime with respect to each policy included in the Trust insuring the Settlor's life and owned by the Settlor and made payable to the Trustee hereunder: {i) to exercise all options, elections, rights and privileges accorded to the Settlor under the terms of any such policy, {ii) to obtain all or any part of the loan value of any such policy, (iii) to use any such policy as collateral for a loan, (iv) to sell, assign or pledge any such policy, {v) to receive any dividends, distributive shares of surplus earnings, disability benefits, surrender values or the proceeds of matured endowments, (vi) to change the named beneficiary to whom the proceeds of such policy are payable on the insured's death, and (vii) to convert any or all policies into other forms of insurance or annuities or to permit the same to lapse. The Trustee agrees to execute any and all instruments that may be necessary to permit the exercise of any such right by the Settlor, without liability to anyone for so doing. Upon the maturity of any life insurance policy included in the Trust, whether at the insured's death or at any other time, the Trustee shall collect the proceeds thereof. 3.04. Duties of Trustee Regarding the Life Insurance. The Trustee shall be under no obligation or duty whatsoever except with respect to the safekeeping of such policies of insurance and the 4 duty to receive such sums as may be paid to it, in accordance with the requirements of this Trust, by the companies issuing such policies, and to hold, manage and disburse such proceeds subject to the terms of this Agreement. Upon the death of the insured, the Trustee shall make reasonable efforts to carry out the provisions of this Agreement, including the maintenance or defense of any suit, provided, however, the Trustee shall be under no duty to maintain or enter into any litigation unless its expenses, including counsel fees and costs, have been advanced or guaranteed in an amount and in a manner reasonably satisfactory to it. The Trustee may repay any advances made by it or reimburse itself for any such fees and costs from any corpus or income of this Trust. ARTICLE IV. DISTRIBUTIONS FROM TRUST 4.01. Distributions During Settlor's Life. The Trustee shall pay to, or apply for the benefit of, the Settlor: (1) so much of or all of the income and so much of or all of the principal as the Trustee deems desirable for the most comfortable care, support, maintenance, welfare, education, happiness, luxuries and any needs arising from illness, accidents or other emergencies of the Settlor; and, (2) so much of or all of the income and so much of or all of the principal as the Settlor shall request. 4.02. Settlor's Special Power of Appointment. The Settlor shall have the power at any time, exercisable by instrument or instruments in writing delivered to the Trustee during the Settlor's life specifically referring to this Subparagraph 4.02, to appoint all or any portion of the principal and any accumulated and accrued income of this Trust, except any policies of insurance on the life of the Settlor. Any appointment made under this Subparagraph 4.02 may be upon any terms and conditions {including further trusts, the beneficiaries of which are only Settlor's issue) to or for the benefit of any one or more of the Settlor's issue and spouses of the Settlor's issue. However, no such appointment may be made to the estate, the creditors, nor the creditors of the estate of Settlor, nor to anyone other than the Settlor's issue and spouses of the Settlor's issue, nor may any general powers of appointment be created by the exercise of the special power of appointment created herein. 4.03. Termination and Distribution of Trust. Upon the Settlor's death, this Trust shall terminate. Upon termination, the remaining Trust Estate shall be divided into separate and equal shares, and one such share shall be distributed, absolutely, to each of Settlor's children, JOSEPH P. HATCH, JR. and ANN H. DELLA- CROCE, or to the then-living issue of any predeceased child, per stirpes; provided, that if either of Settlor's children predecease the termination of this Trust without leaving issue, then the remaining Trust Estate shall be distributed, absolutely, to Settlor's other child, per stirpes. 5 ARTICLE V. POWERS OF TRUSTEE 5.01. General Powers. In addition to such other powers and duties as may have been granted elsewhere in this Trust, but subject to any limitations contained elsewhere in this Trust, the Trustee shall have the following powers and duties: A. In the management, care and disposition of this Trust, the Trustee shall have the power to do all things and to execute such deeds, instruments, or other documents, as may be deemed necessary and proper, including the following powers, all of which may be exercised without order of or report to any court: (1) To sell, exchange, or otherwise dispose of any property, real, personal or mixed, at any time held or acquired hereunder, at public or private sale, for cash or on terms, without advertisement, including the right to lease for any term notwithstanding the period of the Trust, and to grant options, including an option for a period beyond the duration of the Trust. (2) To invest all monies in such stocks, bonds, securities, investment companies or trust shares, mortgages, notes, choses in action, real estate, improvements thereon, and other property as the Trustee may deem best, without regard to any law now or hereafter in force limiting investments of fiduciaries; except that the Trustee may not invest in any stock or securities issued by the corporate Trustee or issued by a parent or affiliate company of such Trustee. (3) To retain for investment any property deposited with the Trustee hereunder; except that the Trustee may not retain for investment any stock or securities in the corporate Trustee or in a parent or affiliate company of such Trustee. (4) To vote in person or by proxy any corporate stock or other security and to agree to take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security held by this Trust. (5) TO use lawyers, real estate brokers, accountants and other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. (6) To compromise, settle or adjust any claim or demand by or against the Trust and to agree to any rescission or modification of any contract or agreement affecting the Trust. 6 (7) To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging, pledging or conveying any property of the Trust, including the power to borrow from the Trustee (in the Trustee's individual capacity) at a reasonable rate of interest. (8) To retain and carry on any business in which the Trust may acquire any interest, to acquire additional interests in any such business, to agree to the liquidation in kind of any corporation in which the Trust may have any interest and to carry on the business thereof, to join with other owners in adopting any form of management for any business or property in which the Trust may have an interest, to become or remain a partner, general or limited, in regard to any such business or property and to hold the stock or other securities as an investment, and to employ agents and confer on them authority to manage and operate the business, property or corporation, without liability for the acts of any such agent or for any loss, liability or indebtedness of such business if the management is selected or retained with reasonable care. (9) To register any stock, bond or other security in the name of a nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that the stock, bond or other security is a trust asset and the Trustee shall be responsible for the acts of the nominee. (10) To merge this Trust with any other trust created in my Will or otherwise, with similar provisions and purposes and the same beneficiary or beneficiaries, but only to the extent that the merger of the trusts will not cause the imposition of gift tax, estate tax, or generation-skipping tax, federal or otherwise. B. Whenever the Trustee is directed to distribute any trust principal in fee simple to a person who is then under twenty-one (21) years of age, the Trustee shall be authorized to hold such property in trust for such person until he becomes twenty-one (21) years of age, and in the meantime shall use such part of the income and the principal of the Trust as the Trustee may deem necessary to provide for the proper support and education of such person in the standard of living to which he has become accustomed. If such person should die before becoming twenty-one (21) years of age, the property then remaining in trust shall be distributed to the personal representative of such person's estate. C. In making distributions from the Trust to or for the benefit of any minor or other person under a legal disability, the Trustee need not require the appointment of a guardian, but shall be authorized to pay or deliver the distribution to the custodian 7 of such person, to pay or deliver the distribution to such person without the intervention of a guardian, to pay or deliver the distribution to the legal guardian of such person if a guardian has already been appointed, or to use the distribution for the benefit of such person. D. In the distribution of the Trust and any division into separate trusts and shares, the Trustee shall be authorized to make the distribution and division in money or in kind or in both, regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Trustee shall be binding and conclusive on all persons taking hereunder. The Trustee may, in making such distribution or division, allot undivided interests in the same property to several trusts or shares. E. If at any time after Settlor's death the total fair market value of the assets of any trust established or to be established hereunder is so small that the Trustee's annual fee for administering the trust would be equal to or less than the minimum annual fee set forth in the Trustee's regularly published fee schedule then, in effect, the Trustee in its discretion shall be authorized to terminate such trust or to decide not to establish such trust, and in such event the property then held in or to be distributed to such trust shall be distributed to the persons who are then or would be entitled to the income of such trust. If the amount of income to be received by such persons is to be determined in the discretion of the Trustee, then the Trustee shall distribute the property among such of the persons to whom the Trustee is authorized to distribute income, and in such proportions, as the Trustee in its discretion shall determine. F. The Trustee shall be authorized to lend or borrow, including the right to lend to or borrow from the Settlor's estate, at an adequate rate of interest and with adequate security and upon such terms and conditions as the Trustee shall deem fair and equitable. G. The Trustee shall be authorized to sell or purchase, at the fair market value as determined by the Trustee, any property including any property to or from Settlor's estate, or any trust created by Settlor during life or by will, even though the same person or corporation may be acting as executor of Settlor's estate or as trustee of any such other trusts and as the Trustee of this Trust. H. The Trustee shall have discretion to determine whether items should be charged or credited to income or principal or allocated between income and principal as Trustee may deem equitable and fair under all the circumstances, including the power to amortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the 8 maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal, to treat any dividend or other distribution on any investment as income or principal or to apportion the same between income and principal, to charge any expense against income or principal or apportion the same, and to provide or fail to provide a reasonable reserve against depreciation or obsolescence on any asset subject to depreciation or obsolescence, all as the Trustee may reasonably deem equitable and just under all of the circumstances. I. The Trustee is hereby authorized and empowered to purchase such insurance policies as it deems appropriate. 5.02. voting by Trustees. When the authority and power under this Trust are vested in two (2) or more Trustees or Co-Trustees, the authority and powers are to be held jointly by the Trustees or Co-Trustees. A majority of the Trustees or Co-Trustees may act on behalf of the Trust by exercising any authority or power granted under this Trust or granted by law. Any attempt by one such Trustee to act for the Trust on other than ministerial acts shall be void. The action of one such Trustee on behalf of the Trust may be validated by a subsequent ratification of the act by a majority of the Trustees or Co-Trustees. ARTICLE VI. SPENDTHRIFT PROVISION 6.01. General Provisions. No beneficiary shall have the power to anticipate, encumber or transfer his interest in the Trust Estate in any manner other than by the valid exercise of a Power of Appointment. No part of the Trust Estate shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. ARTICLE VII. CONSTRUCTION OF TRUST 7.01. Choice of Law. This Trust shall be administered and interpreted in accordance with the laws of the Conunonwealth of Pennsylvania. 7.02. Code. Unless otherwise stated, all references in this Trust to section and chapter numbers are to those of the Internal Revenue Code of 1986, as amended, or corresponding provisions of any subsequent federal tax laws applicable to this Trust. 7.03. Other Terms. Unless the context otherwise requires, the use of one or more genders in the text includes all other genders, and the use of either the singular or the plural in the 9 text includes both the singular and the plural. 7.04. Captions and Table of Contents. The underlined captions set forth in this Agreement at the beginning of the various divisions hereof and the Table of Contents appearing at the beginning of this Agreement are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their construction and application. 7.05. Situs of Trust. The Trust shall have its legal situs at Cumberland County, Pennsylvania. ARTICLE VIII. COMPENSATION OF TRUSTEE AND APPOINTMENT OF SUCCESSOR TRUSTEE 8.01. Compensation. The Trustee shall receive as its compensation for the services performed hereunder that sum of money which the Trustee normally and customarily charges for performing similar services during the time which it performs these services. 8.02. Removal of Trustee. Settlor, during Settlor's lifetime, may remove the Trustee at any time or times, with or without cause, upon thirty (30) days' written notice given to the current Trustee. Upon the Settlor's death, a majority of the current beneficiaries may remove the Trustee at any time or times, with or without cause, upon thirty (30) days' written notice given to the current Trustee. Upon removal of the Trustee, a successor Trustee shall be appointed in accordance with the terms set forth in Paragraph 8.03. 8.03. Successor Trustee. The Trustee may resign at any time upon thirty (30) days' written notice given to the Settlor if Settlor is living, or in the event of Settlor's death, upon thirty (30) days' written notice given to the current beneficiary or beneficiaries (including a beneficiary's natural or legal guardian or legal representative), hereunder. Upon the death, resignation, removal or incapacity of the Trustee, then Settlor's daughter, ANN H. DELLA-CROCE, is hereby appointed as the successor trustee. Upon the death, resignation, removal or incapacity of ANNH. DELLA-CKOCE as successor trustee hereunder, then Settlor's son, JOSEPH P. HATCH, JR., is hereby appointed as the successor trustee. Upon the death, resignation, removal or incapacity of the above-named successor trustees, then additional successor trustee(s) may be appointed by the Settlor during Settlor's lifetime, or after Settlor's death, by a majority of the current beneficiaries. Settlor prohibits the appointment of the beneficiary's or beneficiaries' natural or legal guardian or legal representative as Trustee and any attempt to do so shall be without authority under this Agreement. The successor Trustee shall be a financially sound and competent corporate Trustee. Any successor trustee thus appointed, or if the Trustee shall merge with or be consolidated 10 with another corporate fiduciary, then such corporate fiduciary, shall succeed to all the duties and to all the powers, including discretionary powers, herein granted to the Trustee. ARTICLE IX. PERPETUITIES CLAUSE 9.01. General Provisions. Notwithstanding anything to the contrary in this Trust, each disposition Settlor has made herein, legal or equitable, to the extent it can be referred in its postponement of becoming a vested interest to a duration measured by some life or lives in being at the time of Settlor's death is definitely to vest in interest, although not necessarily in possession, not later than twenty-one (21) years after such lives (and any period of gestation involved); or, to the extent it cannot be referred in any such postponement to such lives, is to so vest not later than twenty-one (21) years from the time of Settlor's death. ARTICLE X. REVOCATION AND AMENDMENTS 10.01. Reservation of Powers. The Settlor expressly reserves the powers to: {i) revoke this Agreement by an instrument in writing delivered to the Trustee while the Settlor is alive, (ii) to alter, amend or modify this Agreement at any time or from time to time by an instrument or instruments in writing delivered to the Trustee while the Settlor is alive, but no such alteration, amendment or modification shall increase the duties nor change the basis for compensation of the Trustee without their written consent, and (iii) withdraw from this Trust any life insurance policy or other property forming a part of this Trust, which property or the proceeds therefrom was added to this Trust by Settlor. Any such withdrawal by the Settlor shall be considered a revocation of this Trust solely with respect to the policy or other property withdrawn. 10.02. Effect of Settlor's Incapacity. A. If Settlor Incapacitated. If at the time of any attempted exercise of (a) powers reserved to the Settlor or (b) any other powers to demand and receive the principal of this Trust (if any are granted in this Agreement), the Settlor is incapacitated (as defined below in subparagraph (C)), through illness, age or other cause, then the Trustee shall disregard any instructions from the Settlor which have the effect of remaking, altering, amending or modifying this Agreement in whole or in part or enabling the Settlor to withdraw from the Trust any life insurance policy or any other property forming a part of this Trust. B. Settlor's Retained General Power of Appointment. Notwithstanding the above provisions, the Settlor shall always have 11 the right to exercise a general Dower of appointment, by a will, specifically referring to the reservation of this general power of appointment in this subparagraph (B), to appoint all of the Trust property to the estate of the Settlor, the creditors of the Settlor, or the creditors of the Settlor's estate. C. Definition of Incapacity. For purposes of this Trust, the Settlor or a Trustee shall be deemed to have become incapacitated upon the happening of either one of the following events: (1) Admission of Incapacity. Delivery, by hand, or by mail to the Trustee then serving, of a written instrument from the Settlor or a Trustee declaring that said person no longer considers that he or she should possess the power (as Settlor) to exercise any of the powers reserved by the Settlor in this Article X or any other powers to demand and receive the principal of this Trust, except the general power of appointment reserved above in subparagraph 10.02(B), or the power (as Trustee) to continue to serve as Trustee, or (2) Medical Certification of Lack of Capacity. Delivery, by hand or by mail, to the Trustee then serving, of written instruments by two physicians licensed to practice medicine, one of whom must be a board certified psychiatrist and the other of whom must be a board certified internist, that the Settlor or a Trustee no longer has the capacity, as a result of illness, age or other cause: (i} in the case of the Settlor, to exercise any powers reserved by the Settlor over the Trust under the terms of this Article X or any other powers to demand and receive the principal of this Trust, except that notwithstanding any other provision to the contrary, the reserved general power of appointment of the Settlor, as set forth in subparagraph 10.02(B) above, shall always be exercisable by the Settlor or {ii) in the case of a Trustee, to continue to serve as a Trustee. (3) Powers Personal to Settlor. The powers reserved by and to the Settlor in this Article X shall be personal to the Settlor and shall not be exercisable by any conservator, committee, guardian or like fiduciary, except a valid Power of Attorney, nor shall they be assignable to nor extend to the executor or administrator of the Settlor's estate, nor to any beneficiary named herein. Upon the death of the Settlor, this Trust shall be deemed irrevocable. 12 ARTICLE XI. ACQUISITION OF UNITED STATES TREASURY BONDS ELIGIBLE FOR TAX PAYMENT; PAYMENT OF TAXES, FUNERAL EXPENSES, AND EXPENSES OF ADMINISTRATION 11.01. Acquisition of Bonds. The Trustee may, at any time, without the prior approval or direction of the Settlor and whether or not the Settlor is able to manage his own affairs, acquire United States Treasury Bonds selling at a discount, which bonds are redeemable at their par value plus accrued interest thereon for the purposes of applying the proceeds to the payment of the United States estate tax on the Settlor's estate; and the Trustee may borrow from any lender, including itself, with or without security, to so acquire these bonds. 11.02. Payment of United States Estate Tax by Bond Redemption. The Settlor directs that any United States Treasury Bonds which may be redeemed at their par value plus accrued interest thereon for the purpose of applying the proceeds to the payment of the United States estate tax imposed on the Settlor's estate, and which are held by the Trustee, shall, to the extent of the amount determined to be required for payment of the estate tax, be distributed to the legal representative of the Settlor's estate to be used by the legal representative ahead of any other assets and to the fullest extent possible to pay the estate tax. 11.03. Payment of Death Taxes and Other Estate Settlement Costs. After the Trustee has complied with paragraph 11.02, above, and ascertained from the legal representative that all such bonds have been redeemed in payment of the United States estate tax, the Trustee shall also ascertain from the legal representative whether the legal representative has sufficient assets to pay the remaining legacy, succession, inheritance, transfer, estate and other death taxes or duties (except the additional estate tax imposed by Section 2032(c), or corresponding provisions of the Internal Revenue Code of 1986 applicable to the Settlor's estate and imposing the tax), levied or assessed against the Settlor's estate (including all interest and penalties thereon), all of which taxes, interest and penalties are hereinafter referred to as the death taxes, interest and penalties. If the legal representative advises the Trustee that insufficient funds exist to pay all the death taxes, interest and penalties, the Trustee shall then pay to the legal representative from the trust property, an amount equal to all the death taxes, interest and penalties in excess of the funds available to the legal representative for this purposes, which payments are to be made without apportionment. In making the payments, the Trustee shall use only those assets or their proceeds which are includable in the Settlor's gross estate for purposes of the United States estate tax. If the Settlor's legal representative advises the Trustee that there are sufficient funds available to pay the death taxes, interest and penalties, then the Trustee may nonetheless pay to the legal representative from the 13 trust property, all or any portion, as the Trustee in its sole discretion deems advisable and in the best interests of the Settlor's beneficiaries named in this Trust, of (a) any such death taxes, interest and penalties, whether or not on property held in or payable to the Trust, said payments to be made without apportionment, (b) the Settlor's funeral expenses, (c) claims and other debts of the Settlor, whether allowed against the Settlor's estate or not, (d) expenses of administering the Settlor's estate, and, (e) bequests under any will or codicil executed by the Settlor. In making any such payments, other than to satisfy bequests under any will or codicil executed by the Settlor, the Trustee shall use only those assets or their proceeds which are includable in the Settlor's gross estate for purposes of the United States estate tax. IN WITNESS WHEREOF, the Settlor and Trustee have hereunto set their hands and seals as of the day and year first written above. WITNESS: COMMONWEALTH OF PENNSYLVANIA : : SS: On this, the~nJ day of~ , 1994, before me, a Notary Public, the undersigned offlder, personally appeared JOSEPH P. HATCH, SR., known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Trust Agreement, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official Seal. My Commission Expires: ~ Linda Lee Sale~, ! Shir?~own Bom, Curnbe~a~ Count~ 14 ! My Cornmissk)n Expires Oct 9,1995 Momber, p~nnsylvania As.soc~on o[ Notades The foregoing Trust Agreement was delivered, and is hereby acceDted, at Lemoyne, Pennsylvania, on ~/~ ~"~'~, 1994. ? WITNESS ~SEPH~. HATCH, SR., TKUSTEE 15 SCHEDULE REFERRED TO IN THE ANNEXED FROM JOSEPH P. HATCH, SR., SETTLOR TO JOSEPH P. HATCH, SR., TRUSTEE PROPERTY DESCRIPTION: ................................ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162 EX(11-96) NO. CD 004776 DELLA-CROCE ANN H 25 NORTH 24TH STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: FILE NUMBER: 2104- 1188 DECEDENT NAME: HATCH JOSEPH P DATE OF PAYMENT: 12/28/2004 POSTMARK DATE: 12/28/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/02/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 915,725.30 TOTAL AMOUNT PAID: $15,725.30 REMARKS: SEAL CHECK//3224 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES DEPT280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004776 DELLA-CROCE ANN H 25 NORTH 24TH STREET CAMP HILL, PA 17011 fold ESTATE INFORMATION: SSN: FILE NUMBER: 2104-1188 DECEDENT NAME: HATCH JOSEPH P DATE OF PAYMENT: 12/28/2004 POSTMARK DATE: 12/28/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/02/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $15,725.30 REMARKS: TOTAL AMOUNT PAID: 5,725.30 SEAL CHECK# 3224 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WlLLS BUREAU OF INDIVIDUAL. TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX I') .'- DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-04-2005 HATCH 10-02-2004 21 04-1188 CUMBERLAND 101 ANN H DELLACROCE 25 N 24TH ST CAMP HILL '* REV-1547 EX AFP (03-05) JOSEPH P PA 17011 Allount R_i Hed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ IUV--m~"Yf.~.m~'1m1.'tMft'1!t.W.!JII.ftAW,Um't.m.lWAlTftMMf~."tCr.'W'~M!r.~Yr.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HATCH JOSEPH P FILE NO. 21 04-1188 ACN 101 DATE 04-04-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED I~ an assessment was issued previDusly, lines 14, 15 and/Dr 16, 17, 18 and 19 will reflect ~igures that include the tDtal D~ ALL returns assessed tD date. ASSESSMENT OF TAX: 15. A.ount of Line 14 at Spousal rate (15) 16. AlIOunt of Line 14 taxable at lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rat. (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due AX TS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 9.725.00 .00 367.653.00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governll8ntal Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 9.535.00 .00 (11) (2) (3) (14) NOTE: .00 X 367.843.00 X .00 X .00 X + INTEREST/PEN PAID (-) 827.65 AHOUNT PAID 15.725.30 DATE 12-28-2004 NUHBER CD004776 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 377.378.00 9.535.00 367.843.00 .00 367.843.00 00 = 045 = 12 = 15 = .00 16.552.94 .00 .00 16.552.94 (9)= 16.552.95 .01CR .00 .01CR . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ~~V