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11-27-13 (2)
1505610105 REV-1500 EX`02-11"FnI enn lvania OFFICIAL USE ONLY PA Department of Revenue P� sY Bureau of Individual Taxes County Code Year File Number INHERITANCE TAX RETURN "` ""`" "I "" .. PO BOX 280601 I3 Harrisburg,PA 1'7128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ' 05/14/2013 07/17/1931 ....................._.._....................................._.._._.......--............. ........... _...._..................._......................._.._.........................__........... ........................................................................_............................... ..... Decedent's Last Name Suffix Decedent's First Name MI Barrick ' Jean E (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI .............._.......................................--._........................-......._....._....................................._._...................................... ....................,..._..........._.__.. .........................................................._.........................._..........................._..........._.............._......... ._, i ..........................................._..............._._-.._.__..........................__....,........_......- .._................_.._.........._._...................... ..........._............._........_._....... _..........__.........__......__...... _........................._................_.................................... . Spouse's Social Security Number - ° THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW CD 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 �. -- ..__.. ._._....._........................ ..... _ ._................ _......-...... _._................, ........ ........_ ...__..,.._ . ...- Nolan S. Barrick (302)482-5857 .. .... ... . .._.... ...... .. ... ...... . ...... . ....... _.. .............. - ... ... REGISTER'OF See GX�r)j,t I -Fcf Coloy o"f S1,or-f' C@+��t `'�C� �nr.r� OF WILLS USE ONLY -PA eta, First Line of Address O t t C> -..._._....................._.........................,......................_.........._..........................._.............._.........................................--............__._...................-......-.....................__.......,.....- _ c 340 Mourning Dove Drive c z' cn _ cx Second Line of Address r tU r'I F'` _..........................._.._......- ..._._._..........-......_-...._..----........................_..-......__..........._...._.........---.........._..... _........._.......__.._............., -J _......._...._.............................._..._.................-..._.............._........,..,.........................,................................_......_..._............._............_......,........................._...._..__.........i -i C�DBE FIL �t City or Post Office State . ZIP Code = ' ........................................................:...__..........._....._..._._........ .... .._......__......_ .. ;Newark DE 19711 ' r s ..---......................__._...... -._...._...._...................._......_..... .._..._..._...__.......-................_..._....................__...0.. f-, � :.................................._......._............_.._...........__._...._..._................._. o o Correspondent's e-mail address:nolan.s.barrick @dupont.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 t personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON_RESP rNSI f%CSR IL G ADDRESS J�� rnOef/n l n s IJd l;,e_ /,)✓1✓E � /v�ala✓,`' IJ C. � 7 �l' SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number ............._........................................................._.............................._......-............ Decedent's Name: Jean E. Barrick RECAPITULATION 1. Real Estate(ScheduleA). ............................................ 1. 185,000.00 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. 124,610.79 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. 692,636.65 8. Total Gross Assets(total Lines 1 through 7)............................... 8. 1,002,247.44 9. Funeral Expenses and Administrative Costs Schedule H ... 9. ' 18,258.91 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 11. Total Deductions(total Lines 9 and 10)................................. 11. 18,258.91 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 983,988.53 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ........................ 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 983,988.53 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfersunder Sec.9116 £............_............__,..._......,...._.....................,...._..................._... m...._.,..,....-..............................._........................._ ._..............__.............._...._...... (a)(4.2)X.0_ 15.' 16. Amount of Line 14 taxable -._.,_.. ....,....,.,_..,,....: .._._ ...._ ... .w....,. .:..:. . ...,.. ! _.._,, ._ ., _ _ .._........ ........... at lineal rate X.0 45 983,988.53 16, 44,279.48 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18.. 19. TAX DUE......................................................... 19.1 44,279.48 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Jean E. Barrick STREETADDRESS 68 North high Street CITY STATE ZIP Nevvville PA 17241 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 44,279.48 2. Credits/Payments A.Prior Payments 39,000.00 B.Discount 2,052.63 3. Interest Sec E)ek 61+ :F-L:-- Gop Y °f 'Cal r-/l Total Credits(A±B) (2) 41,052.63 (3) 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. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 3,226.85 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.......................................................................................... ❑ 0 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?...................................................................... ❑ N 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?........................................................:..................................................... ❑ 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? .............................................................:.......................................................... N ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on,or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000:, • The tax•rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jean E. Bard& All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' Real Estate sold 11-1-13. Please see Exhibit III for copy of settlement sheet. 185,000.00 TOTAL(Also enter on Line 1, Recapitulation.) 185,000.00 If more space is needed,use additional sheets of paper of the same size. . REV-i5o8 EX+(o8-12) INpennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jean E. Barrick Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1: Cash in bank account(Please see Exhibit IV for copy of bank statement) 91,000.94 2 Cash on-hand 100.00 3 Proceeds from sale of car lift 2,500.00 4 Proceeds from sale of cars 20,500:00 5 net proceeds from auction-sale of house contents(Please see Exhibit V for copy of auction settlement) 10,509.85 TOTAL(Also enter on Line 5, Recapitulation) $ 124,610.79 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Jean E. Barrick This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH. %OF DECD'S EXCLUSION _ TAXABLE INCWDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1• IRA account#1352-8853(Please see Exhibit VI for copy of account statement 221,535.29 100 0.00 221,535.29 and beneficiary designates) 2 Non-qualified account#4138-0842(Please see Exhibit VII copy of account 471,101.36 100 0.00 471,101.36 statement and TOD information TOTAL(Also enter on Line 7,Recapitulation) $ 692,636.65 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) Qs pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jean E. Barrick Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT -A. FUNERAL EXPENSES: 1' Please see attached Exhibit VIII funeral invoice 7,017.70 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 0.00 Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2,193.61 2. Attorney Fees: 5 GG F—X1,. It �. 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 0.00 Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: Sce EX 1„ 433.50 5. Accountant Fees: 0.00 6. Tax Return Preparer Fees: 0.00 7• Utilities and lawncare 2,004.28 Transfer Tax-real estate 1,850.00 Home owner's insurance 268.00 Estate advertising 211.44 Real estate taxes 555.90 Executors mileage reimbursement-see attached Exhibit A 3,724.48 TOTAL(Also enter on Line 9, Recapitulation) $ 18,258.91 If more space is needed,use additional sheets of paper of the same size. EXHIBIT COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND I, GLENDA FARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 5th day of June, Two Thousand and Thirteen, Letters TESTAMENTARY in common form were granted by the Register of said County, , on the estate of JEAN E BARRICK late of NEWVILLE BOROUGH (First,Middle,Last) in said county, deceased, to NOLAN S BARRICK and (First,Middle,Last) NANCY R EVANS (First,Middle,Last) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 5th day of June Two Thousand and Thirteen. File No. 2013- 00631 PA File No. 21- 13- 0631 Date of Death 511412013 S. S. # Register Of l 'Rputy NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL EXHIBIT 1. 1- COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 _ PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017913 BARRICK NOLAN S 340 MOURNING DOVE DRIVE NEWARK, DE 19711 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold __________ ________ 101 $39,000.00 ESTATE INFORMATION: SSN:. FILE NUMBER: 2113-0631 DECEDENT NAME: BARRICK JEAN E DATE OF PAYMENT: 07/19/2013 )STMARK DATE: 07/19/2013 COUNTY: CUMBERLAND DATE OF DEATH: 05/14/2013 TOTAL AMOUNT PAID: $39,000.00 REMARKS: CHECK# 108 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER EXHIBIT 1111 LEON P. HALLER ESCROW AGENT 6237 **** REAL ESTATE CLOSING**** Buyer/Borrower: SCHULLER Seller: DEC Lender. HOME FINANCE OF AMERICA, INC. 1309HFA2139 Property: 68 NORTH HIGH STREET/NEWVILLE PA 17241 / Settlement Date: November 1,2013 Disbursement Date: November 1,2013 Check Amount: $ 179,488.96 Pay To: ESTATE OF JEAN BARRICK DEC For: .: SETTLEMENT PROCEEDS LEON P:.HALLER 'a i+ .-jETRO I ,`r r ,6'2,3 7 ' ESCROW AGENT FOR r,' a` BANK <FIRST AMERICAN TITLE INSURANCE COMPANY- '4% t` t. "' '•!, ' ?I' +'' I t�' J + v' 1719 NORTH FRONT STREET 60-184 313 ' . HARRISBURG, LER68(13)PA 12102 SCHUL •I.i`, . t r ;.J• `s 'r + sl SETTLEMENT PROCEEDS ` C —One Hundred Seventy Nine Thousand Four Hundred Eighty Eight-and 96/100 — — — AMOUNT Dollars +, } DATE t $ — • � ' I i ` t, i, r � -t ' 4' jJ I ,. II ''s t .: ! itl. :' u { 1, f ) e November 1,'2013 $ ** '`179,488 96 , I ; PAY:.;: "TO THE`. :. h ;10 'oOpDERESTATE OF JEAN BARRICK DEC 126 E. KIN6'STREET' 8HIPPENSBURG, PA 17257 ',r , , �• , ,- } •, ' --v ALITH ORIZED SIGNATURE• - ': ' 8i SECURITY FEATURES INCLUDED.DETAILS ON BA6k: t8 II'00623Ti' 1:0 3 130 18461: 53 819002 611' r �tTT6NrQ,c OMB Approval No.2502-0265 A: 'Settlement Statement (HUD-1) 0"1 B. Type of Loan 1.Q FHA 2.❑ RHS 3. nX Conv.Unins. 6. File Number. 7. Loan Number: 8. Mortgage Insurance Case Number. 4.❑VA 5.Q Conv.Ins. SCHULLER68(13) 1309HFA2139 C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked"(p.o.c.)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals. D. Name and Address of Borrower: E. Name and Address of Seller. F. Name and Address of Lender. HORST K.SCHULLER ESTATE OF JEAN BARRICK DEC HOME FINANCE OF AMERICA,INC. 76 CUMBERLAND ROAD 126 E.KING STREET 521 PLYMOUTH ROAD STE 112 LEMOYNE,PA 17013 SHIPPENSBURG,PA 17257 PLYMOUTH MEETING,PA 19462 G. Property Location: H. Settlement Agent: 23-2386065 I. Settlement Date: 68 NORTH HIGH STREET LEON HALLER ESCROW AGENT NEWVILLE,PA 17241 1719 N FRONT ST/717 234 4178 November 1,2013 CUMBERLAND County,Pennsylvania HARRISBURG,PA 17102 Ph. Place of Settlement: 1719 N FRONT ST/717 234 4178 HARRISBURG,PA 17102 J. Summary of Borrower's transaction K. Summary of Seller's transaction 100. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller. 101. Contract sales price 185 000,00 401. Contract sales price 185,000.00 102. Personal property 402. Personal property 103. Settlement Charges to Borrower Line 1400 5,688.64 403. 104. 404. 105. 405. Adjustments for items paid by Seller in advance Adjustments for items paid by Seller in advance 106. LOCAL/CO Taxes 11/02/13 to 01/01/14 120.85 406. LOCAL/CO Taxes 11/02/13 to 01/01/14 120.85 107. SCHOOLTaxes 11/02/13 to 07/01/14 1,315.31 407. SCHOOLTaxes 11/02/13 to 07/01/14 1,315.31 108. Assessments to 408. Assessments to 109. 409. 110. 410. 111. 411. 112. 412. 120. Gross Amount Due from Borrower 192,124.80 420. Gross Amount Due to Seller 186,436.16 200. Amounts Paid by or in Behalf of Borrower 500. Reductions in Amount Due Seller: 201. De osit oreamest mo hey 10,000.00 501. Excess deposit see instructions 202. Principal amount of new loans 138 750.00 502. Settlement charges to Seller Line 1400 7,023.91 203. Existing loans taken subject to 503. Existing loans taken subject to 204. 504. Payoff First Mortgage 205. 505. Payoff Second Mortgage 206. 506. 207. 507. (Deposit disb.as proceeds) 208. 508. 209. 509. Adjustments for Items unpaid by Seller Adjustments for items unpaid by Seller 210. LOCAUCO Taxes to 510. LOCAL/CO Taxes to 211. SCHOOLTaxes to 511. SCHOOLTaxes to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515, 216. 516. 217. 517, 218. 518. 219. 519. 220, Total Paid by/for Borrower 148,750.00 520. Total Reduction Amount Due Seller 7,023.91 300. Cash at Settlement from/to Borrower 600. Cash at settlement to/from Seller 301. Gross amount due from Borrower line 120 192 124.80 601. Gross amount due to Seller line 420 186 436.16 302. Less amount paid by/for Borrower(line 220) 148,750.00) 602. Less reductions due Seller line 520) ( 7,023.91 303. Cash X❑ From 1:1 To Borrower 43,374.80 603. Cash El To From Seller 179,412.25 •Pald outside of closing y borrowrer(B),seler(S),lender(L),arlhird-party(T) The undersigned hereby acknowledge receipt of a completed copy of this statement&any attachments referred to herein Borrower 962L !I "AL91 Seller n-<; HORST K.SCHULLER ESTATE OF JEAN BARRIC 4AD BY NOLAN S.BARRICK,CO-EXECUTOR 1� The Public Reporting Burden forlhis collection of Information Is esllmatedat35minules per responsefor collecting,reviewing,and reporting the data.This agency may not collect this information,and you are notrequlred to complete this form,unless Itdisplays a currently validOMBcontrol number.No confidentiality is assured;this disclosure Is mandatory.This Is designed to provide the parties to a RESPA covered transaction with Information during the seltlementprocess. Page 1 of 3 HUD-1 (SCHULLER68(13).PFD/SCHUL LER68(13)/13) L. Settlement Charges 700. tl Real Estate Broker Fees:; Paid From Paid From Division of commission(line 700)as follows: Borrower's Seller's 701.$ to Funds at Funds at 702.$ to Settlement Settlement 703.Commission paid at settlement 704. 705. 800:dtenis Payable in Connection With Loan,'' 801.Ourori ination charge $ 495.00 from GFE#1 802.Your credit or charge(points)for the specific interest rate chosen from GFE#2 803,Your ad usted origination charges from GFE#A 495.00 804.AP Pra isal fee to UNITED STATES APPRAISAL from GFE#3 P.O,C. 415.00 B* 805.Credit Report to EQUIFAX MORTGAGE SERVICES from GFE#3 P.O.C.$13,00 B* 806.Tax service to from GFE#3 807.Flood certification to from GFE#3 808.APPRAISAL REINSPEC to UNITED STATES APPRAISAL from GFE#3 100.00 809• from GFE#3 810, from GFE#3 811. (from GFE#3) 900.Items Required.by Lender to Be Paid in:Advance 901.Daily interest charges from 11/01/13 to 12/01/13 30 @ $12.354450/da from GFE#10 375.90 902.Mortgage insurance premium for months to (from GFE#3) 903.Homeowner's insurance for 1.0 years to ERIE INSURANCE (from GFE#11) P.O.C.$507.00(B)* 904. (from GFE#11) 905. (from GFE#11) 10006 Researves:De osited With L6nder 1001.Initial deposit for your escrow account (from GFE#9) 1,162.74 1002.Homeowner's insurance 3.000 months @ $ 42.25 per month $ 126.75 1003,Mortgage insurance months @ $ per month $ 1004.Pro e rty taxes $ 1,749.49 LOCAL/CO Taxes 11.000 months @ $ 66.65 per month SCHOOLTaxes 6.000 months @ $ 169.39 per month 1005. 1006. months @ $ per month $ 1007. months @ $ per month $ 1008. $ 1009. AGGREGATE ADJUSTMENT $ -713.50 1100.Titie.Charges 1101. Title services and lender's title insurance (from GFE#4) 1,320.00 1102. Settlement or closing fee $ 1103. Owner's title insurance to FIRST AMERICAN TITLE INSURANCE COMPANY (from GFE#5) 230.00 1104. Lender's title insurance to FIRST AMERICAN TITLE INSURANCE COMPANY $ 1,245.00 1105. Lender's title policy limit $ 138,750.00 1106. Owner's title policy limit $ 185,000.00 1107. Agent's portion of the total title insurance premium to LEON HALLER ESCROW AGENT $ 1,126.25 1108. Underwriter's portion of the total title insurance premium to FIRST AMERICAN TITLE INSURANCE COMPAI$ 348.75 1109. $ 1110. $ 1111. $ 1112. $ 1113. $ 1200 GoVernment Recording>and Transfer Charges 1201.Government recording charges to Recorder's Office from GFE#7 155.00 1202.Deed $ 68.00 Mortgage $ 87.00 Releases $ Other $ 1203.Transfertaxes to RECORDER (from GFE#8) 1,850.00 1204.City/County tax/stamps $ 1,850.00 $ 1205.State tax/stamps $ 11850.00 $ 1,850.00 1206. 1207. 1.1300.:Additional-SettleniehtChargL,g 1301.Required services that you can shop for (from GFE#6) 1302. $ 1303. $ 1304. $ 1305. See addit'I disb.exhibit to $ 5,173.91 1400.Total Settlement Charges(enter on lines 103;Section.J and 502,Section K) - .5,688.64. 77,023:91. "PaIdoutsideofclosing by borrower(B),seler(S),lendegQ,orINrd-parly(T) By signing page 1 of this statement,the signatories acknowledge receipt of a completed copy of page 2&3 of this three page statement. LEON HALLER ESC OW AGENT,Settlement Agent Page 2 of 3 HUD-1 (SCHUL LER68(13).PFD/SCHULLER68(13)/13) Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1 Charges That Cannot Increase HUD-1 Line Number Our origination charge # 801 495.00 495.00 Your adjusted origination charges # 803 495.00 495.00 Tra nsfe r taxes #1203 3,700.00 1,850.00 Charges That in Total Cannot Increase More than 10% Good Faith Estimate HUD-1 Government recording charges #1201 270.00 155.00 Appraisalfee # 804 415.00 415.00 Credit report # 805 13.00 13.00 APPRAISAL REINSPECTION # 808 125.00 100.00 Total 823.00 683.00 Increase between GFE and HUD-1 Charges $ -140.00 or 17.01°/ Charges That Can Change Good Faith Estimate HUD-1 Initial deposit for your escrow account #1001 1,070.95 1,162.74 Daily interest charges # 901 $ 12.354450/day 375.78 375.90 Homeowner's insurance # 903 507.00 507.00 Title services and lender's title insurance #1101 515.50 1,320.00 Owners title insurance to FIRST AMERICAN TITLE INSURANCE #1103 1,325.00 230.00 # 0.00 Loan Terms Your initial loan amount is $138,750.00 Your loan term is 15.00 years Your initial interest rate Is 3.2500% Your initial monthly amount owed for principal,interest and $974.95 includes any mortgage insurance is Q Principal Q Interest ❑ Mortgage Insurance Can your Interest rate rise? ❑X No ❑ Yes,it can rise to a maximum of_ %. The first change will be on_ and can change again every_months after . Every change date,your interest rate can increase or decrease by_ %. Over the life of the loan,your interest rate is guaranteed to never be lower than_ %or higher than_ %. Even if you make payments on time,can your loan balance rise? ❑X No ❑ Yes,it can rise to a maximum of$_ _ Even If you make payments on time,can your monthly ❑X No ❑ Yes,the first increase can be on_ and the monthly amount owed for principal,Interest,and mortgage insurance rise? amount owed can rise to$_ _ The maximum it can ever rise to is$_ _ Does your loan have a prepayment penalty? ❑X No ❑ Yes,your maximum prepayment penalty is$_ _ Does your loan have a balloon payment? ❑X No ❑ Yes,you have a balloon payment of$_ _ due in_years on Total monthly amount owed including escrow account payments ❑ You do not have a monthly escrow payment for items,such as property taxes and homeowners insurance. You must pay these items directly you rself. X❑ You have an additional monthly escrow payment of$278.29 that results in a total initial monthly amount owed of$1,253.24. This includes principal,interest,any mortgage insurance and any items checked below: ❑X Property taxes 0 Homeowner's insurance ❑ Flood insurance ❑ El ❑ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. Page 3 of 3 HUD-1 (SCHULLER68(13).PFDISCHULLER68(13)/13) HUD-1 Attachment Borrower(s):HORST K. SCHULLER Sellegs): ESTATE OF JEAN BARRICK DEC 76 CUMBERLAND ROAD 126 E. KING STREET LEMOYNE, PA 17013 SHIPPENSBURG, PA 17257 Lender: HOME FINANCE OF AMERICA, INC. Settlement Agent:LEON HALLER ESCROW AGENT Place of Settlement: 1719 N FRONT ST1717 234 4178 HARRISBURG, PA 17102 Settlement Date: November 1, 2013 Property Location: 68 NORTH HIGH STREET NEWVILLE, PA 17241 CUMBERLAND County, Pennsylvania Additional Disbursements Payee/Description Note/Ref No. Borrower Seller LEON HALLER ESCROW AGENT 5,000.00 TAX ESCROW PURCELL KRUG & HALLER 10.00 TAX CERT REIMBURSEMENT LEON HALLER ESCROW AGENT 25.00 ESCROW CHARGE BOROUGH OF NEWVILLE W&S AUTHORITY 138.91 FINAL WATER-SEWER 0384 Total Additional Disbursements shown on Line 1305 $ 0.00 $ 5,173.91 Adjusted Origination Charge Details Origination Charge ORIGINATION CHARGE 495.00 to HOME FINANCE OF AMERICA, INC. Total $ 495.00 Origination Credit/Charge(points) for the specific interest rate chosen Total $ Adjusted Origination Charges $ 495.00 Reserves Deposited with Lender Homeowner's Insurance 126.75 3.000 at 42.25 per month LOCAL/CO Taxes 733.15 11.000 at 66.65 per month SC HOOLTaxes 1,016.34 6.000 at 169.39 per month AGGREGATE ADJUSTMENT -713.50 Total $ 1,162.74 Title Services and Lender's Title Insurance Details BORROWER SELLER CLOSING PROTECTION LETTER 75.00 to LEON HALLER ESCROW AGENT Lender's title insurance 1,245.00 to FIRST AMERICAN TITLE INSURANCE COMPANY WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can Include a fine and imprisonment For details see: Title 18 U.S.Code Section 1001 and Section 1010. (SCHULLER68(13).PFD/SCHULLER68(13)/13) HUD-1 Attachment - Continued Total $ 1,320.00 $ 0.00 Owner's Title Insurance BORROWER SELLER Owner's Policy Premium 230.00 to FIRST AMERICAN TITLE INSURANCE COMPANY Total $ 230.00 $ 0.00 Lender's Title Insurance BORROWER SELLER "fees also shown above In Title Services and Lender's Title Insurance Details Lender's Policy Premium 1,095.00 to FIRST AMERICAN TITLE INSURANCE COMPANY Lender's Endorsement Charges 150.00 Endorsement Endorsement Charge ALTA Endorsement 100 50.00 ALTA Endorsement 300 50.00 ALTA Endorsement 8.1/900 50.00 Total $ 1,245.00 $ 0.00 WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can Include a fine and imprisonment For details see: Title 18 U.S.Code Section 1001 and Section 1010. (SCHULLER68(13).PFD/SCHULLER68(1,3)/13) FTPA-25(REV.101:}5) s T x x s r SETTLEMENT ESCROW AGREEMENT �..r DATE: APPLICATION NO.: SETTLEMENT AGENT ("COMPANY'): T EON uAT ER Rgf-RM AGENT _ The undersigned parties have requested that the Company hold in escrow the sum of $ 9000-00 (the "funds") from the proceeds of the settlement of the property described in the above application number. These funds are to be retained without interest by the Company on the following terms and conditions: Fimds to be returned to Seller upon receipt of proof of filing of Pennsylvania inheritance Tax Returns and payment of monies,if any, due to be paid with the return. I 1 The funds ar e e p to b aid to ESTATE OF JEAN E. BARRICK .DFCF,ASEDt , upon satisfaction of the above terms and conditions and after receipt by the Company of written conhr- oration from all parties hereto. In the event costs or expenses, including attorneys fees, are incurred by Company because of litigation j or otherwise, arising out of the holding of the funds; the Company shall be entitled to reimburse itself out of the funds for any such costs and expenses, inclusive of attorneys fees. If the Company is unable for any reason to reimburse itself out of the funds, the undersigned parties do hereby jointly and sever- ally agree to indemnify the Company for any and all costs and expenses, including attorneys fees, that the Company may sustain arising out of any acts taken by the Company in good faith pursuant to this Agreement. It is understood and agreed that in the event of a dispute, the Company, may in its absolute discretion, pay the funds into Court and allow the Court to determine the proper disposition of the funds or con- tinue to hold the funds pending receipt by Company of uniform written direction from all parties hereto. The Company, acting as escrow agent, shall not be liable for any error of judgment or for any act taken or omitted to be taken in good faith or in reliance on any written notice, certificate or other documents believed by it in good faith to be genuine and to be signed or submitted by an authorized signatory. The liability of Company hereunder, acting as escrow agent, shall be limited to matters involving the gross negligence or willful misconduct of Company. A charge of`$25.00 for the first six months shall be made for funds held in escrow by the Company; and a minimum charge of$25.00 shall be made for every year beyond the initial six month period in which the funds are held. i In consideration of the completion of settlement, the undersigned do consent and agree to the terms and conditions hereof. SELLER BUYER/MORTGAGOR / J�, Address. 1 6 E. Address: Telephone: `�! " ✓�' Telephone: Accepted on behalf of th6 mpany By: Address:J f Telephone: z � r SUBSTITUTE FORM 1099-S PROCEEDS FROM REAL ESTATE TRANSACTIONS FOR THE TAX YEAR: 2013 OMB No. 1545-0997 SETTLEMENT AGENT/FILER'S NAME AND ADDRESS Filer's Federal Tax ID Number: 23-2386065 LEON HALLER ESCROW AGENT File Number: SCHULLER68(13) 1719 N FRONT ST/717 234 4178 HARRISBURG, PA 17102 SELLER/TRANSFEROR'S NAME AND ADDRESS Transferor's Federal Tax ID Number: ESTATE OF JEAN BARRICK DEC 126 E. KING STREET SHIPPENSBURG, PA 17257 1)Date of Closing: 2)Gross Proceeds: 4)X here if property or services received: 5)Buyer's part of real estate tax: November 1,2013 185000.00 1436.16 3)Address or Legal Description: 68 NORTH HIGH STREET/NEWVILLE PA 17241 THIS IS IMPORTANT TAX INFORMATION AND IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE. IF YOU ARE REQUIRED TO FILE A RETURN,A NEGLIGENCE PENALTY OR OTHER SANCTION MAY BE IMPOSED ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE IRS DETERMINES THAT IT HAS NOT BEEN REPORTED. YOU ARE REQUIRED BY LAW TO PROVIDE LEON HALLER ESCROW AGENT WITH YOUR CORRECT FEDERAL TAX IDENTIFICATION NUMBER. IF YOU DO NOT PROVIDE LEON HALLER ESCROW AGENT WITH YOUR CORRECT FEDERAL TAX IDENTIFICATION NUMBER,YOU MAYBE SUBJECT TO CIVIL OR CRIMINAL PENALTIES IMPOSED BY LAW. UNDER PENALTIES OF PERJURY, I CERTIFY THAT THE NUMBER SHOWN ABOVE ON THIS STATEMENT IS MY CORRECT FEDERAL TAX IDENTIFICATION NUMBER. I ACKNOWLEDGE RECEIPT OF A COPY OF THIS STAT ME'N_T. / 6 ESTATE OF JEAN BARRICK DEC �47 Date Instructions for Transferoro�G � You MUST enter your Federal Tax Identification Number above. Sign and return a copy of this form immediately to LEON HALLER ESCROW AGENT. For sales orexchanges of certain real estate,the person responsible for closing a real estate transaction must report the real estate proceeds to the Internal Revenue Service and must fumish this statement to you.To determine if you have to report the sale or exchange of your main home on your tax return,see the 2013 Schedule D(Form 1040)instructions.If the real estate was not your main home,report the transaction on Form 4797,Sales of Business Property,Form 6252,Installment Sale Income,and/or Schedule D(Form 1040),Capital Gains and Losses. You may have to recapture(pay back)all or part of a Federal mortgage subsidy if all the following apply: • You received a loan provided from the proceeds of a qualified mortgage bond or you received a mortgage credit certificate. • Your original mortgage loan was provided after 1990,and • You sold or disposed of your home at a gain during the first 9 years after you received the Federal mortgage subsidy. This will increase yourtax. See Form 8828,Recapture of Federal Mortgage Subsidy,and Pub.523,Selling Your Home. If you have already paid the real estate tax for the period that includes the sale date,subtract the amount in box 5 from the amount already paid to determine yourdeductible real estate tax.But if you have already deducted the real estate tax in a prior year,generally report this amount as income on the"Other income"line of Form 1040.For more information,see Pub.523. For Paperwork Reduction Act Notice,see the 2013 Instructions for Forms 1099, 1098,5498,and W-G2. Department of the Treasury-Internal Revenue Service (SCHULLER68(13).PFD/SCHULLER68(13)/14) EXHIBIT IV Account# 111163 Statement Date 05/31/13 Page 1 of 3 JEAN E BARRICK See insert for important 68 N HIGH 'ST information about managing your account. NEWVILLE PA 17241 Hurry! Ends soon. DON'T MISS OUT ON THE HOME EQUITY LOAN YOU CAN ACTUALLY AFFORD! Surprisingly low payments with a low fixed rate and longer term. Stop by an office or visit acnb.com/lowpayments. Equal Housing Lender. Member FDIC. Esteem Checking Account Summary# 111163 Beginning Balance on 04/30/13 $89,853.09 + Deposits&Other Credits $1,664.00 -Withdrawals& Other Debits $520.02 -Service Charges $0.00 + Interest Paid $3.87 Ending Balance on 05/31/13 $91,000.94 Days in Statement Period 31 Account Activity Date Description Deposits/Credits Checks/Debits Balance 04/30/13 BEGINNING BALANCE $89,853.09 05/03/13 SSA TREAS 310 XXSOC SEC $1,664.00 $91,517.09 JEAN E BARRICK 05/08/13 CHECK#4337 $59.00 $91,458.09 05/13/13 LIFELINE SYSTEMS DIRECT PAY $40.87 $91,417.22 2618764 05/17/13 CHECK#4340 $74.48 $91,342.74 05/17/13 CHECK#4341 $69.95 $91,272.79 05/21/13 Centuryl-ink BILL PYMT $84.03 $91,188.76 SERIAL NUMBER:4342 0000000000000313348162 05/21/13 SUBURBANPROPANE2 CHECK PYMT $132.90 $91,055.86 SERIAL NUMBER:4343 2113 05/21/13 CHECK#4344 $58.79 $90,997.07 05/31/13 INTEREST PAYMENT $3.87 $91,000.94 EXHIBIT V . .. . JON Eh & 1VIAA i ill L-v V%- -t .avl�ks-) Darryl Jones, Newville, PA. SETTLEMENT STATEMENT yam) SALE NAME* PAI c k DATE OF SALE: ADVERTISING EXPENSES: Lancaster Farmin The Guide News Chronicle Valley Times Franklin Shopper_ h Sentinel Merchandiser Other Other Sale Flyer. Copies_ -< Total Advertising Cost: F Total of Bidder Numbers Total of Sale_ 4r? S C Advertising Cost . 48 Auctioneer's % g � Tent Rental Portable Toilet Rental Misc. Charge Misc. Charg Net Sale {after xpenses} Thank you for the opportunity to work with you'and your family RIONES & 1VIAKIllr tAU Darryl Jones, Newville, PA. SETTLEMENT STATEMENT � C. SALE NAME: P11 DATE OF* SALE: �1 ADVERTISING EXPENSES: Lancaster Farming_. The Guide_ News Chronicle y Valley Times Franklin Shopper= j.�.� Sentinel Merchandiser Other Other Sale Flyer Copies Total Advertising Cost:, / ,�(\ • r �1 _ Total of Bidder Numbers_ Total of Sale 1 R5 �-) . ')C) Advertising Cost 1 LIM . 1-7 Auctioneer"s % .. ,'I C��J• Ck� ___.� 'Vent Rental Portable Toilet Rental Misc. Charge wu ; Misc. Charge Misc. '' • Net Sale lafter expenses) Thank you for the opportunity to work with you and your fancily EXHIBIT VI O_ N d co C T x ILi;i 0 C) O C¢°3 c�:a910 rj - m vmo��oLt1; M MI a_ '�o I ° % M E y N E N'.N; p E« Q N C I o m • I CD C m ° ° U U J m m « C ow m U A Z O CO m O M�. 'O O CL �`C C L a).�tO lo 1 « ar o � c C cos �! �i yl ? c c CD y oa V = Q �i y!.mI C Cc! t6: r0 'O L€ Ql'!1 i N f6' >-Q fL0; j QJ:•u j a m — p` 0 iL O' O =3 ;LL c'fl c0"-Uy U m Ql= y U> N y m O N» '✓ ?'m O C H C m C cu `) m N t4 O 0. N J U: u mar E > '¢ C Q Q' 0 y Q p. :Zi "� p C U ° > O C -o! t9; a' rn LIE < lie M! i� - O ci U = O O 00-� � � O O ' O m �O c =nU `O m n m c'.0 w � amo� y U a ° > a) CD c ar U N O X _ ( EjU 6' U Gam] N_2.0 N ni LL _ Q d a..J C . ! O.. ! C m dCLO.. 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U N 6 O V icd N = U i ❑.is.dU N d LOJ > ddcu CL) rXp � m '1 vr �.�?'�'�.�c U m w 7 V Q `— w in La m cc C �. . .,.' . . ............_. ...... ...... El ;T; pO � � t58Dr825' oi c dvEc`od O O U o o S ry uP. SZi S N: 3 an d E �? o �.:$ � c 8'o'N 0 .o:o o N d O O L O L � �"�� ..r... .',..... .. i d DO V f6 d 7 d A N m o v v v v v a v.v'v m : 'O Q.m- d LLLLLL 9LLLLLL_ � �,; aT = T Q� C7� dOfa !a; a m a a a a a a a s �� d x = o m o m a f y Ia co Ea" jc;y �3 .0 voo � `o > y� E'S �� .d-, y O.° in o to;9 a•°i . - -,. . ti . � � . .j '' V p N r O V d N O. T O d `7 d y=f0 O 7 Ia d a.V U V U V >) C Ql N U m•O to mVZ.. w D :.e o © U U- H X N = N O =C N 0 d O V.N II ZIn d '> 0O w T C .O Z{ �c c„ 25 "3 c� t� aa > Jc c d 'amECL m ° tD rn si ° f' a W 7 °• m m d c_^— d C rncnU f6 O O_O Ol ) 4S' t L; 'z' OE �� m OUNdyO000 :3 3 i � E cUN d T•o T��=°•-0LOi 0 acgE m y i I c:, c C c c c c' C C c'c c c c c- i •- O x m d Q_L C C d t4 T O1 d i 0 0 0 010 0,0 0;0 0 0 0 0 0 Q �?,E� _. Tca� d_ 3 8p. aci d c of c°� aTi c7n"-o >I n N: �+ n N O M M M n m ry ^. L'? x•- d m �� O MLLE =y N O d W y m d pj d d O d rn o ~ o � c°� a9ia=ia mc °mcvaOc N > C x d E 0 fn O7 U m CD ry U I.r N M 'M bj by Zi O y (.7 >-0 O O f i QUl-E_ :_L�L_� ii H m E m o m J c WACHOVIA FIRST CLEARING, LLC IRA ENROLLMENT SECETPJTTES & CHANGE OF BENEFICIARY FORM Use this form to establish an IRA account Do not use Ws Sub Firm a BR Code FA Code Account a forth for an Education Savings Account It the them is a 19IDie ' and wants to obtain checkwriting privileges,in addition to this 001 WY WY82 1352 - 8853 form.also complete the IRA Checkwrding Application CLIENT INFORMATION Note.,DO NOT use this form for Education Savings Account(use 556447) IJ Enrollment please check appropriate box.Do not check more than ONE.If rollover,attach Rollover form. C Regular IRA ❑ Roth IRA 0 Inherited IRA 0 SEP IRA D SAR-SEP IRA(can not be a new plan) f Beneficiary Change E3 SIMPLE IRA If SIMPLE IRA,also complete the Employer Information Sheet for SIMPLE IRAs Name Date of Birth: Jean E. Barrick 07 17 1931 68e1N AighaStbeaP.O Sax) Ep 2 0 2006 Sou2058 umyNum24 - 0363 City Slate Zip Newville PA 17241 Designation of Beneficiary(ies)—Acceptable Beneficiaries are an Individual,estate,trust or organization. If there Is no named beneficlary or no remaining beneficiary then such amount shall be payable In accordance with the FCC Self-Direcled IRA document. If one of the beneficiaries in the same category should predecease the owner or disclaim benefits under this IRA,then such amount shall be payable to the sole remaining beneficiary. PRIMARY BENEFICIARY:I designate the following to share equally In my account balance unless otherwise Indicated_ NAME E ADDRESS RELATIONSHIP DATE OF BIR R.aurne SOC SEC NO RwV4vd %OF BENEFITS ham' a> . .d.J -_a_ .15_7 aJ 2 0.4n ev_ rsi_ _oJ _ _i!_.L _ U. _.�. .ls�l rl�� 4 -- e IL IF Q Check this box of additional beneficiaries are named on a separate signed page using the same format as above. Complete only if trust is named as beneficiary: The Trustees) serving at my death under the Agreement of Trust executed on ._ _— by me as grantor and as Trustee(s) to be held as part of such Trust and administered and distributed In accordance with its provisions as amended to the time of my death. CONTINGENT BENEFICIARY:I designate the following to share equally in my account balance(unless otherwise Indlcated)If no pnmary beneficiary is Irving at the time of my death. NAME ADDRESS RELATIONSHIP �D'A'TEOFBIRTH .wi.ut SOC SEC NO tilsvp1pblel, %OFBENEFITS 2 I f 1 1 4. IF j Complete only if trust Is named as beneficiary: The Trustees) serving at my death under the Agreement of Trust executed on I by me as grantor and ___ - _—__=as.Trustee(s) to be held as part of such Trust and administered and distributed In accordance with its provisions as amended to the time of my death SPOUSAL CONSENT-FOR USE IN COMMUNITY OR MARITAL PROPERTY JURISDICTIONS(including but nor limited to AZ.CA,ID,LA.NV.NM, TX, WA,WI,or PR)-IF MARRIED. (Note that in Alaska,community property rules may be adopted by agreement signed by the married couple) I am the spouse of the IRA accountholder named above. I acknowledge that I have received a fair and reasonable disclosure of my spouse's property and financial obligations I hereby agree and consent to the naming of the primary beneficiary set toM above,and along with my agreement and consent.do hereby bammute to my spouse all my community property interest in the IRA described above that I may have I acknowledge my community property interest in the IRA account and voluntarily elect to relinquish my rights to the cDmmunity property interest in the IRA account. I also acknowledge and agree that I shall have no claim whatsoever against the astDdian for any payment to my spouse's named benefiClary(es). X' SIGNATURE OF SPOUSE DATE Wachovia Secutihes Is the trade name used by two separate.registered broker-dealers and ran-bank afilates of Wachovia Corporation providing certain retail securities brokerage serm Wactiovia Securities.LLC,member NYSEISIPC,and Wachovia Securities Financial Network,LLC,member NASDISIPC.Accounts carried by First Clearing,LLC,member NYSEISIPC. 550401(Rw 12)Page+of 2 Copy f-Now Account Copy 2-Branch Copy 3-Client L ti Sub Firm it BR Code I FA Code I Account a 001 WY WY82 1352 — 8853 ARBITRATION. Arbitration Disclosures: This Agreement contains a predispute arbitration clause.By signing an arbitration agreement,the parties agree as follows: f All of the parties to this Agreement are giving up the right to sue each other In court, including the right to a trial by jury, -except as provided by the rules of the arbitration forum in which the claim is filed. • Arbitration awards are generally final and binding;a party's ability to reverse or modify an arbitration award Is very limited. • The ability of the parties to obtain documents,witness statements and other discovery is generally more limited in arbitration than in court proceedings. The arbitrators do not have to explain the reason(s)for their award. The panel of arbitrators typically will include a minority of arbitrators who were or are affiliated with the securities industry. • The rules of some arbitration forums may impose time limits for bringing a claim in arbitration. In some cases,a claim that is ineligible for arbitration may be brought in court • The rules of the arbitration forum in which the claim is filed,and any amendments thereto,shalt be Incorporated into this Agreement. No person shall bring a putative or certified class action to arbitration,nor seek to enforce any pre-dispute arbitration agreement against any person who has initiated in court a putative class action;or who is a member of a putative class who has not opted out of the class with respect to any claims encompassed by the putative class action until: (1) the class certification is denied;or (11) the class is decertified;or (ill) the client is excluded from the class by the court. Such forbearance to enforce an agreement to arbitrate shall not constitute a waiver of any rights under this Agreement except to the extent stated herein. Arbitration Provision: It Is agreed that all controversies or disputes which may arise between you and WSLLC including controversies or disputes with WSLLC's clearing agent (collectively, "us") concerning any transaction or the Construction, performance or breach of this Agreement or any other agreement between us,whether entered into prior to,on,or subsequent to the date of this Agreement, Including any controversy concerning whether an issue is arbitrable, shall be determined by arbitration conducted before,and only before,an arbitration panel set up by either the National Association of Securities Dealers,Inc.("NASD")or the New York Stock Exchange, Inc. ("NYSE")in accordance with their respective arbitration procedures.Any of us may Initiate arbitration by filing a written claim with the NASD or the NYSE.Any arbitration under this Agreement will be conducted pursuant to the Federal Arbitration Act and the Laws of the Commonwealth of Virginia. I,the undersigned,acknowledge I have received,read,understand,adopt and agree to be bound by the terms of this Agreement as well as the accompanying First Clearing,LLC("FCC")Self-Directed individual Retirement Account Disclosure Statement&Individual Retirement Account Custodial Agreement(for the type of IRA I have selected above),and the Wachovia Securities General Account Agreement and Disclosure Document, which are hereby incorporated into this Agreement. i certify that my social security number shown on this form is correct. I acknowledge that there are fees for this account and agree to pay such fees. Wachovia Securities, LLC and Wachovia Securities Financial Network, LLC are separate broker-dealer affiliates of Wachovia Corporation (each ui these broker-deaieis will be referred to hereinafter individually as W33"), As separate wrpuratiuns neither Is rasponsibie for the obligations of the other.Stocks,bonds,mutual funds,and other securities bought and sold through WS,are not deposits of any bank and are not insured or otherwise protected by the Federal Deposit Insurance Corporation ("FDIC"), or any other government agency: are not an obligation of any bank or any affiliate of WS;are not endorsed or guaranteed by Wachovia Corporation,WS,or any bank or any affiliate of WS. and involve investment risk including possible loss of principal.CDs purchased through WS are FDIC insured up to$100,000 in the event of the failure of the issuing bank.Neither form of insurance protects against declines in the market value of the CDs to the extent a secondary trading market exists Administrative fees and charges assessed by Wachovia Securities,LLC or First Clearing LLC on your IRA may diminish the overall account return and could negatively impact any tax deferral benefits.Such fees and Charges may particularly impact those accounts with smaller retirement savings balances. It is important that you review all applicable fees and charges relative to your account prior to establishing a First Clearing,LLC as Custodian IRA By signing below,I acknowledge that i have read and understand the foregoing. THIS AGREEMENT CONTAINS A PREDISPUTE ARBITRATION CLAUSE LOCATED ON PAGE 2 UNDER THE HEADER "ARBITRATION," AND BY REFERENCE, ON PAGE S, PARAGRAPH S OF THE WACHOVIA SECURITIES GENERAL ACCOUNT AGREEMENT AND DISCLOSURE DOCUMENT. SIGNATURE X f ,� s DATE `rj J It j (Home Office USE ONLY)APPROVAL OF ACCOUNT«THE FOREGOING APPLICATION IS HEREBY APPROVED BY I AUTHORIZED SIGNATURE DATE S%40i(Rev 12)Page 2 nit Copy 1-New Account Copy 2.Branch Copy 3•Client '! ' Sub Fttm p SR Code FA Code Accoum Y 001 WY WY82 1352 — 88S3 ARBITRATION. Arbitration Disclosures: This Agreement contains a predispute arbitration clause.By signing an arbitration agreement the parties agree as follows: • All of the parties to this Agreement are giving up the right to sue each other In court, including the right to a trial by Jury, except as provided by the rules of the arbitration forum in which the claim is filed. • Arbitration awards are generally final and binding;a party's ability to reverse or modify an arbitration award Is very limited. • The ability of the parties to obtain documents,witness statements and other discovery is generally more limited In arbitration than In court proceedings. • The arbitrators do not have to explain the reason(s)for their award. • The panel of arbitrators typically will Include a minority of arbitrators who were or are affiliated with the securities industry. • The rules of some arbitration forums may Impose time limits for bringing a claim In arbitration. In some cases,a claim that is Ineligible for arbitratlon may be brought In court. The rules of the arbitration forum In which the claim is filed, and any amendments thereto,shall be incorporated into this Agrcemont. No person,shall bring a putative or certified class action to arbitration,nor seek to enforce any pre-dispute arbitration agreement against any person who has Initiated in court a putative class action;or who is a member of a putative class who has not opted out of the class with respect to any claims encompassed by the putative class action until: (1) the class certification is denied;or (1I) the class is decertified;or (Ili) the client is excluded from the class by the court Such forbearance to enforce an agreement to arbitrate shall not constitute a waiver of any rights under this Agreement except to the extent stated herein. Arbitration Provision: It Is agreed that all controversies or disputes which may arise between you and WSLLC Including controversies or disputes with WSLLC's clearing agent (collectively, "us") concerning any transaction or the construction, performance or breach of this Agreement or any other agreement between us,whether entered into prior to,on,or subsequent to the date of this Agreement, including any controversy concerning whether an Issue Is arbitrable,shall be determined by arbitration conducted before, and only before,an arbitration panel set up by either the National Association of Securities Dealers,Inc.("NASD") or the New York Stock Exchange, Inc. ("NYSE")in accordance with their respective arbitration procedures.Any of us may Initiate arbitration by filing a written claim with the NASD or the NYSE.Any arbitration under this Agreement will be conducted pursuant to the Federal Arbitration Act and the Laws of the Commonwealth of Virginia. 1,the undersigned,acknowledge I have received,read,understand,adopt and agree to be bound by the terms of this Agreement as well as the accompanying First Clearing,LLC("FCC')Self-Directed Individual Retirement Account Disclosure Statement&Individual Retirement Account Custodial Agreement(for the type of IRA I have selected above), and the.Wachovia Securities General Account Agreement and Disclosure Document, which are hereby incorporated into this Agreement. I certify that my social security number shown on-this form is correct I acknowledge that there are fees for this account and agree to pay such fees. Wachovia Securities, LLC and Wachovia Securities Financial Network, LLC are separate broker-dealer affiliates of Wachovia Corporation (each ui ihese broker-dealers will be referred to hereinafter individuaGy as Wino). As separate corporations neither is responsiWa for the obligations of the other.Stocks,bonds,mutual funds,and other securities bought and sold through WS,are not deposits of any bank and are not insured or otherwise protected by the Federal Deposit Insurance Corporation ("FDIC"). or any other government agency; are not an obligation of any bank or any affiliate of WS;are not endorsed or guaranteed by Wachovia Corporation,WS,or any bank or any affiliate of WS, and involve investment risk including possible loss of principal.CDs purchased through WS are FDIC insured up to$100,000 in the event of the failure of the issuing bank. Neither form of insurance protects agalnst declines in the market value of the CDs to the extent a secondary trading market exists.Administrative fees and charges assessed by Wachovia Securities,LLC or First Clearing LLC on your IRA may diminish the overall account return and could negatively impact any tax deferral benefits.Such fees and charges may particularly impact those accounts with smaller retirement savings balances. It is important that you review all applicable fees and charges relative to your account prior to establishing a First Clearing,LLC as Custodian IRA.By signing below,I acknowledge that I have read and understand the foregoing. THIS AGREEMENT CONTAINS A PREDISPUTE ARBITRATION CLAUSE LOCATED ON PAGE 2 UNDER THE HEADER "ARBITRATION," AND BY REFERENCE, ON PAGE 1, PARAGRAPH 5 OF THE WACHOVIA SECURITIES GENERAL ACCOUNT AGREEMENT AND DISCLOSURE DOCUMENT. SIGNATURE J( u DATE S (Home Once USE ONLY)APPROVAL OF ACCOUNT-THE FOREGOING APPLICATION IS HEREBY APPROVED BY AUTHORIZED SIGNATURE DATE 55a4o1(Rev 121 Page 2 or 2 Copy 1-New Account Copy 2-Branch Copy 3•Client 1 S�J7 L EXHIBIT VII U 7 T 0 co Q TO tKp °a p `7 O O a)•- s cn c°i t 0 N i �vwi°c uyU v mom cu O- °0 Co o j 01i ' �3 O O, a .G c; j CU Zd O 7 U U d O U C � M.2 N C iz (11.r lO� ! V1i�i N c a N' N > N O Qi� j O� cn M1 a) ovrQ @ �lLltllir0 >RQ= rncons N!L ca cn u_ O 0 LL 7 a d U 3 a m T•—°�>0 x W C O r fu:W t lJf:• QJ M i 7 > C U C C O a U C t11' N rn m 7 J al 0 Yi— Y;�i U: o c ° > oc n , a OiQ � C �Qm CL LL pNj Q m 0l2 Qs c o m= o O m a T m QyL c d 7 O Qf� :3 10! `n c�rv:°S auili 'Zj= �:�' ! FLU" d'(C Y V a '� a1 O X ',.N� E � IDi > a U O y E C ((S ru . L U W N_ Y C Q} UN` Oi aCi y CL�wiay0 ID O O u V i cQ U' a) 0 o ao) 0 O j yco w O� L @ >' Q j, c c y T... O' er` Nn. d EO� o °- Ear a� ti E ° > N i f`D i.yam i O U m 7 n U C.0.. 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T= t0 �' ii1 > fN•J.n N foy ro•1 h In tin tNn In N �1 rn P;-r S+ P _il -H o g U x N U N O c6 LL C N N �1 M +It o R O Z>- CO o'iNI.. ::�, n .°M1 °�' - :F. o f co�� y m L y v, a°i d Rt y�.m J- 0 I I- Cf 1- c6 `y 0 E L CD o v y y¢ is c °m c y �� m r1i C I ; + �+ +1 �v C�1 p_ p OcXO v E c°�Y o c o °a H f V`N- �N' U Z G r L ID m U 3 _....p �YZ��ii F- m E m o ca c WACHOVIA SECURITIES Transfer on Death Kit Services to TOD Accounts Easing Transitions 556442(Rev 04) Page 1 d 8 413 gr-00a WACHOVIA SECURITIES TERMS AND CONDITIONS REGISTRATION OF ACCOUNTS IN BENEFICIARY FORM TRANSFER ON DEATH(TOD)DIRECTION The following Terms and Conditions shall govern any Transfer on Death(TOD)Account established through Wachovla Securities LLC,Wachovla Securities Financial Network LLC and First Clearing,LLC("FCC")(herein collectively referred to as'WS"). SECTION 1 DEFINITIONS 2 06 Revocation by WdL A sole Amount Owner or the last sumving In these Temis and Conditions and the related Applicalwn for Registration Account Owner may revoke a Beneficiary designation.effective upon the Death of Account In Beneficiary Form Transfer on Death(TOO)Drection,capitalized of the Account Owner,by specifically,describing the revocation in such Amount terms shall have the meanings set forth below. Owner's valid last will and testament However,the terms of the revocation are Throughout this.Agreement,you'your;and'the undersigned'refer to not binding on us unless,prior to reregrstrabon or distribution,we have received the person(s)whose srpnature(s)appear(s)below and at others who are legally written notice from any claimant to any interest in the Recount objecting to obligated on this Account.We;'our.' ours'and-us;refer to WS and FCC, disributon by us of the Account pursuant to the terms of the Application and their subsidiaries and affiliates,their officers,directors,agents,and employees these Terms and Conditions If a Beneficiary designation is revoked, the .10 1 'Account"shall mean a Transfer on Death Account established by Percentage of the Account for which no Beneficiary is designated shall be the Account Owner through WS which contains TOO-Eligible Securities. distributed to the Estate of this Account Owner, 102."Account Owner" shall mean the one or more persons whose 2.07.Account Fees.Amount fees,d any,shat be due and payable,n the names are identined es ttx owners of the A xxx nt amounts and an the dates established by us Any fees owed to us and remaining 1.03 "Act" shat) mean the Virginia statutes relating to non-probate of TO shag be deduced from t the Account or pad from then our sole of the sale transfers at death and transfer on death security registration,as now eidsting and of or to an ree Securities r the Account as selected by ua n our tide dismetion hereafter emended. prior to arty rcreglstrebon a distributor 1 :mended. shaft refer to Ina most recent WS Application for 2.08. Interest of Beneficiaries.The designation of Beneficiaries n the Application ties no effect on ownership of the Amount or the TOD-Eligible Securi. Registration of Account in Beneficiary Form Transfer on Death(TOD)Direction bes until the Death of the Account Owner.The Beneficiaries have no rights can the received and accepted by us Account or the T00-Eligible Securities unlit such Death of the Account Owner. 1.05"Beneficiary"shag refer to the one or more Primary Beneficiaries of During the time period between the Death of the Account Owner and Contingent Beneficiaries reregistratiom or distribution pursuant to the provision of Section 4 below,all then 106 'Contingent Beneficiary"shat mean the one or more persons or living Beneficiaries hold their Interests as tenants in common We shag not have envies designated to receive the TOD-Eligibta Securities in the Account which any Ladisy In Connection with any interest,dividends or other amounts paid in would otherwise be passed to a Primary Beneficiary who dies before the Death of respect of the TOD-Eligible Secaibea after the Death of the Account Owner but the Account Owner prior to the receipt of all information required pursuant to Section 4 01 1.07."Death of the Account Owner"shall mean the death of the sole SECTION 3 BENEFICIARIES Account Owner or the last survivor of multiple Account Owners 3.01.Beneficiaries.With the exception of a custodian under the Uniform 108 "Estate of the Account Owner"shall mean to estate of the aole Gdts to Minors Ad,any individual or envy may be designated as a Primary Account Owner or of the last survivor of multiple Account Owners. Beneficiary or a Contingent Beneficiary. 109 'WS"shell mean Wachovie Securities together with its successors 3 02 Primary Beneficiaries The Application shag designate one or more and assigns Primary Beneficiaries to wham the TOD-Eligible Securities in the Amount shelf be 1.10. "Primary Beneficiary" shall mean the one or more persons or distributed upon the Death of the Account Owner.The Application may designate entities designated to receive the TOO-Ekgible Securities in the Account upon the the percentage of the Amount each Primary Beneficiary a to receive.If the Death of the Account Owner Application does not designate percentages for the Primary Beneficiaries,the 1 11 "Repreuntatiw of the Estate or the Account Owner'shed mean Primary Beneficiaries shall share equally If the Application designates percent. the duly appointed domicigary executor,administrator or personar representative ages and the alai of ee percentages ere more than one hundred percent Of the sole Amount Owneror of the last surHwr a1 mubipb Accourri Owners. (100%). the Primary Beneficiaries shill share pro refs In proportion to the 1.12"Terms and Conditions"smell mean these WS Transfer en Death designated percentage each If the Application designates percentages and the (TOO)Teens and Conditions Co di ninny be hall m ad byes W time to time total of the percentages is less than one hundred percent(100%),the percentage of the Amount for which no Beneficiary Is designated shag be distributed to the 1 13."TOD-Eligible Security"shelf mean any security or cash balance Estate of the Accost Owner. contained in the,Account for which Transfer On Death registration is allowed 3.03 Contingent Beneficiaries.The Application may designate one or under the provisions of these Terins and Conditions and the AM All TOD-Eligible more Cbnbngent Benefcanes to whom the TOD-Eligible Securities VA be Securities held in the Account must be registered in steal name,and any asset distributed if a Primary Beneficiary des or does rat exist an the Death of the ne(d In registered form by us for an Account Owner orwhich cannot be registered Amount Owner. The Account Owner Is not required to name Contngent in street name his not considered a TOD-Eggible Security Notwithstanding the Beneficiaries previous sentences, the following Items are llgt considered TOD Eligible 3.04.Designation of Beinefictarles.The designation of arty Beneficiary Securities: limited partnership Interests, cerufied shares of mutual fund shall include the name,current address,date of birth,taxpayer identification companies•commodities,precious metals.annuities,We insurance policies,and number of the Beneficiary and relationship to the Amount Owner. 8 the any and at other securities or instruments as designated by us from time to time, Beneficiary its a trust.the desgnation shag include the date of the trust agreement SECTION 2 TOD ACCOUNT (or the testators date of death and the date of the will if the trust is created under 2 01 Application and Beneficiary Designation.An Account shah be a will)and the formal name of the trust.A designation of the trustee of a trust as established by us only upon the execution of an Application.The Application shag Beneficiary shag be deemed to mciude any co-tastes,or successor trustees be executed by the Account Owner(or by all Account Owners)Individually.No acting from came to uhe.if a trustee is designated as a Beneficiary and such trust attorney in fad,guardian.conservator or other representative of an Amount Is revoked or terminated prior to the Death of lie Account Owner.the designation Owner shall be authorized to establish an Amount,revoke an Amount or change Noah be treated as If the Beneficiary were an Individual and the individual had the Beneficiary on any Amount.No Application shag be effective unfit received died prior to the Death of the Amount Owner, and accepted by us. 3 05 Change of Beneficiaries.Any change in the Beneficiaries shag be 2 02 Account Owners An Amount may be established only by an made by the Account Owner,or it there its more then one Account Owner,by ell milmdual or individuals'(no busts. corporations. partnerships, or other non- then Irving Account Owners,executing and delivering to us a new Application naluref entities) If more than one individual is named as the Account Owner. setting font the new Beneficiaries No such change shell be effective hmW the such.multiple Amount Owners shall hold the Amount wish the right of new Application Is received and accepted by us survivorship Multiple Amount Owners may hold the Accourd asjoiM tenants with 306,Beneficiaries'Designations Not Subject to Probate Rubs.The right of survivorship,as tenants by the enfrebes.or as owners of commuruy designation of Beneficiaries pursuant to the Application shall not be subject to the prop"held in survivorship forth;multiple Account Owners may not hold the laws of the Commonwealth of Virginia or any jurisdiction which provide far, Account as tenants in common - a. The inclusion as Benemaaries of Children bom to any Account Owner sorer 203 Account Registration by Account Owner.An Account shall be the date of the latest Application on file with us; registered in the narre of the Account Owner.followed by the words'TOD b The inclusion or a spouse of any Account Owner m the event that such Registration' The Beneficiary designation shag be governed by the most recent Account Owner mantes such spouse after the date of the latest Application Application accepted by,and on file with,us. on file with us,or the exclusion of a spouse of any Account Owner in the 2 04 Account Rereglstration by Beneficiaries. If the Beneficiary or event that such Account Owner and such spouse divorce after the dale of 8eneficianes desire to have the Account reregistered following the Death of the the latest Application on file with us,or Account Owner,such Beneficiary or Beneficiaries will be required to sign a INS c Dsthbuuon to the issue of any deceased Beneficiary urdess the Account Request for an Execution of an Transfer on Death(TOD)Direction and to provide Owner has provided specifk Contingent Beneficiary designations for such such other document&required by us We will not transfer an or any part of the deceased Beneficiary - - TOD-Eligible Securities to any Beneficiary until all of the procedures described In Section 4 01 have been satisfied end we have received a Request for Executron SECTION 4 REREGISTRATIONS OR DISTRIBUTIONS i of a Transfer On Death Direction from either(r)the Representative of the Estate 4 01.Proof of Death and Eligibility.Prior to reregistering the Amount or ( at the Account Owner,or(,,)gig of the Beneficiaries entilled to the TOO-Eligible distributing the TOD-Eligible Sewrubes following the Death of the Account Owner, Sectinthls. we must receive the following 2.05. Cancellation or Removal During Lib of Account Owner.An a Proof of the Death of the Account Owner(or all Account Owners in the Amount may be canceled,or securities may be removed from the Amount,at case of an Amount owned by multiple persons)in the form of■certified any time by the then living hale Account Owner or all then surviving multiple copy of the death cerWkate,a coed copy of a probate certificate or a Account Owners giving written notice to us We will not accept a revocation of a court order Indicating the date of death. I TOD designation for an Account unless the revocation is delivered to us on the form provided by us. 558442(Rev 04) Page 2 of 8 0 Wachovia Securities to A Request for Distribution of Eligible Assets from s Transfer on Death 4 06 Distribution to Minors,Incapachated Persons,Custodians and (TOO)Amount(a'Request)executed under oath In such form as we may Guardians.In the event a nominated custodian for a nnrwr under the Uniform require,by(h)all Beneficiaries or(ii)the Repmsentadw of the Estate of the Transfm to Minors Ad of any state or a nominated custodial trustee for an adult Account Owner, accompanied by a ropy of the Representative of the under the Uniform Custodial Trust Ad of any state is designated as a Beneficiary. Estate of the Account Owners letters of administration certified to a date we may distribute to such nominated custodian at custodial trustee,and the not more than sixty(80)days pnor to the date of the Request Such receipt of the distribution by such nominated custodian or custodial trustee shelf Request shag declare. constitute a full release of us for such dsinbutnon.Custodians under the Uniform (t)That the person executing the Request Ice a Beneficiary or the Representative Gifts to Minors Ac of any slate shag not be eligible to receive reregistered - Accounts at distributions from the Account If no custodian or custfodier trustee qf the Estate of the Account Owner: (2)That each person a eRUN vdw a which us to recelve a distribution is then has been nominated for any minor le incapacitated filling t adult or d the nbhranetee custodian or custodial trustee is unable or unwilling to accept the distrbution,we living or then in ainslence: may dsMbule to any duly appointed and acting custodian for such minor under (3)That them ere no known disputes as to the persons entitled to a distribution the Urvforn Transfers to Minors Ace of any sate or any duly appointed and acting from the Account or as to the amount to be distributed to each person and there custodial trustee for such incapacitated adull under the Uniform Custodial Trust are no known claims that would affect the distribution; Act Of any state,or to any duly appointed conservator or guardian for such minor (4)That we shall be vhderimfied by the person(s)signing the Request from or Inapacitated adult,and the receipt of the distnbution by such custodian. lability for any claim,loss or damage which may be created by reason of the custodial trustee,guardian or conservator shag constitute a full release of us for distribution from the Account to the Beneficiaries as requested therein,and such distribution. (5)That all persons signing the Request agree that,if all or any portion of the 4 07 No Duty to Notify.We shag have no duty to determine whether the Amount distributed is determined to belong to another, such persons shall Account Owner is still alive Upon lemming of the Death of the Account Owner. transfer the portion improperly received and all Income therefrom to the person we may;but shall not be obligated lo,notify any of the Primary Beneficiaries of entitled to t, tiro fact of their designation and the Death of the Account Owner.We shag have e. An affidavit of domicile d required,and no liability to arty Beneficiary for any loss that may occur In the Amount after the d. A waiver of inheritance axes,it required,and Death of the Account Owner pending receipt of the proof of death and eligibility of e. In the event arty Primary Beneficiary predeceased the Account Owner, the Beneficiary. proof of death of the Primary Beneficiary in the form of a certified copy of 4 08 Satisfaction of Account Dablts.In the event there is any debt the death certificate.a certified copy of a probate certificate or a court order balance in the Account at the Death of the Account Owner, TOD-Eligible indicating the date of death. Securities selected by us in our sole discretion shall be sold and the proceeds 4.02 Dispute Procedure- In the event of any dispute among the from the sale thereof used to satisfy such debit balance prior to any recegistration Beneficiaries as to entitlement to the TOD-Eligible SecvtUes,or in the event of or distribution. , any claims to any portion of the Account by the Representative of the Estate of 4 09 Activity In Account prior to Reregistrat(on or Distribution.Until Me Amount Owner, creditors of the Estate of the Account Owner, surviving all of our procedures specAed in these Terns and Conditions for reregistration or spouse of the Account Owner(including the assertion of cmhmuniy,property or distribution of the TOD-Eliglhle Securities am completed to our satisfaction,we similar rights),the Account Owners heirs or any other person claiming an interest will not permit any actinty,(such as withdrawals.purchases.sales,liquidations or in the Account other than by virtue of his,her or its designation as Beneficiary,via exchanges)in the Amount Without the written consent of(t)the Representative of may require full resolution of such disputes and claims prior to reregistenng the me Estate of the Account Owner,or(u)all persons or entities claiming any Account!or distributing any of the TOD-Eligible Securities Pending resolution of portion of the TOD-Eligible Securities We Will not be responsible for any decline any such disputes or claims,we will not permit any activity(such as withdrawals, In the value of TOD-Eligible Securities in the Account pending the completion of purchases,sales,liquidations or exchanges)in the Account without the written such procedures consent of all persons or entities claiming any potion of the TOD-Eligible SECTION 5 MISCELLANEOUS PROVISIONS Securities,and we will not be responsible for any decline in value of TOD-Eligible 5 01 Governing Law. The Application (including these Terms and Securities in the Account as a result of delays in reregistering the Account or Conditions)and all Amounts accepted by us shall be governed by the laws of the distributing the TOO-Eligible Securities. Commonwealth of Virginia.Including,without limitation,the Act.All protection of 403 Payment of Debts. Taxes and Expenses of the Estate. the Ad shalt inure to the benefit of us and our successors and assigns All Reregistrabons or dstnbutions under the Application shall be(educed on a pro provisions of these Terms and Conditions,the Application,the Act and Virginia - rain basis,or elirtdrated altogether,in the event that prior thereto we receive law shall be binding upon us,our employees,agents,successors and assigns, written notice that the assets retained in the Estate of the Account Owner are not and upon the Account Owner,the Representative of the Estate of the Account sufficient to pay such Estate of the Account Owners debts,axes and expenses Owner,the Beneficiaries,the Account Owners surviving spouse and anyone else of adrunstraton,including statutory allowance to the Amount Owners shavrving claiming through or on behalf of the Amount Owner or the Estate of the Account spouse and minor and dependent children.In such case,sufficient TOD-Elgible Owner. - Securities selected by the Representative of the Estate of the Account Owner 5 02.Effect of the Laws of Other Sate.If transfer on death registration Is shall either be sold or distributed to the Estate of the Amount Owner to allow the not permitted under the laws of the jurisdiction where the Amount Owner is Representative of the Estate of the Account Owner to pay such debts,taxes and domiciled at the time of the Death of the Account Owner.we shall distribute the expenses If,after reregistration or distribution,the Benefioary(ies)receiving the TOD-Eligible Securities pursuant to the Beneficiary designations set forth in the Account or TOD-Eligible Securities are found in any proceeding to be liable to the Application and shall have no liability to the Estate of the Account Owner or any Estate of rte Account Owner for such amounts,we shag have no liability in Beneficiary thereof unless we have received written notice of objection prior to connection with any such claim unless we have received written notice of reregistretion ordisbibuton Objection prior torereghstrabonordistribution. 5.03 Indemnification. Account Owner, for him or herself, for me 404 Distribution of TOD-Eligible Securities,Subject to Sections 2.06 Representative of the Estate of the Amount Owner and for the Estate of the above and 408 below,upon receipt of proof of Death of the Account Owner, Account Owner,agrees to indemnity and hold us harmless from any and an eligibility of Benefcianes and such other evidence and documents as we may claims of creditors of Account Owner,the Estate of to Account Owner,the require pursuant to Section 4 01 above, and subsequent to satisfaction of Beneficiaries,the Account Owners surviving spouse or anyone daumng through Sections 4 02 and 4.03 above,a applicable,we will cause the Amount to be Or on behalf of the Account Owner orthe Estate of the Amount Owner reregistered in the names of,or each TOD-Eligible Security In the Account to be 5.04.Agreement to Arbitrate Disputes.An Accounts sham be subject to distributed to,the Primary Beneficiaries in the percentages specified In the most the requirement that disputes be subject to arbitration,as set forth in any other recent Application an file with us.If any Primary Beneficiary dies before the Death documents executed by the Amount Owner relating to the Amount of fie Account Owner,the portion of the Account which that Primary Benefidary 5 05 Other Agreements not Revoked.The Application shag be subject to would have been entitled to receive shaft, if the Account Owner has so (jive terms of at other agreements which the Amount Owners have executed with _ designated, be distributed to the Contingent Seneficary(nes)who survive the regard to the Account Death of the Account Owner.If One or more Of such Contingent Beneficiaries dies 5 O6 Number.Wherever the context of the Application or these Terms and before the Death of the Amount Owner.the portion of the Account which the deceased Contingent Beneficiary(es)would have been entitled to receive shell Conditions Indicates,the plural shalt be read as the singular,and the singular as be distributed to the Estate of the Amount Owner If the Amount Owner has not the plural designated any Contingent Beneficiary for a deceased Primary Beneficiary,the 5.07.Captions.The captions of sections in these Terms and Conditions or portion of the Amount which the deceased Primary Beneficiary would have been the Application acv Included for convenience any and shag not be considered entitled to receive shall be distributed to enter the other surviving Primary pan of,or in aid to,the construction of these Tema and Conditions or line Beneficiaries or to the Estate of the Account Owner,according to the choice Application rade in the Account Owners Application.Arrangements for the distribution of _ 508 Counterpart Signatures.The Application may be executed in arty TOD-Eligible Secunties to Primary or Contingent Beneficiaries other than in the number of counterparts,each one of which shag be deemed to be an original. form set forth in our form of Application may be used if these other arrangements 5 09 Amendment. These Tema and Conditions and the form of the am clearly communicated to us in wnbng with the Account Owners Application.ff Application may be amended by us from time to time without the consent of Ito the time of Death of the Amount Owner,or the Death of a Beneficiary or either of Account Owner.Each Account Owner shall be furnished a copy of any such them cannot be detennned. and if cannot be established that a Primary amendment Beneficiary figs 6urvrved the Account Owner or that a Contingent Beneficiary has 5.10.Assjgnmant The Application and any Accounts may be assigned by survived a Pasty Beneficiary,it will be deemed that the Beneficiary laded to us to any affiliated entity without the prior consent of the Amount Owner. survive 405 Fractional Shares. In the event that mudupte Benefioanes are 5/1 No.w make o representations s Eations as to or Taxation.In ss of he designated,the Benefloanes may,by letter of instructions delivered to us,direcr the Application.des,we make no representations es to the ng the Account t the the allocation of fractional shares of TOD-Eligible Securities among themselves Beneficiary deegnaudns or the lax consequences s of holdup the Account and If no such Instructions have been received at the time the proof of death and owner of Ac the Account or distributing seek tone legal orioth Securities r counsel l The Assent other required evidence is received,we shag men all fractional shams seated by Owner a Account Owners should seek such legal or other counsel as he,she e allocating the TOD-Eligubfe Securhbes pm rats in the proportions specified in the they deem, these Ta mms and all legal end tax issues related h T way to the Application, These Temps and Conditions,the Account and the T06EIigiDle Application and shall distribute the proceeds (alter deducting normal sales Securities commissions and expenses)in the percentages specified 556442(Rev D4) Page 3 of 8 0 Wadhovis Securities WACHOVIA SECURITIES Sub Firm k 13R Code FA Code Account Number APPLICATION FOR REGISTRATION OF ACCOUNT IN BENEFICIARY FORM TRANSFER ON DEATH(TOD)DIRECTION --� Account Owner(S)Name I Account Owner Address City,State ZIP Li — —� --- -- 1— !F You are applying for registration of your Account If you are married and live in a community in beneficiary form thereby assigning ownership of the property jurisdiction, you understand that if you Account on your death to your beneficlary(les)named designate a beneficiary who is not your spouse, your below You direct Wachovia Securities ("WS') to spouse must approve your designation of beneficiary transfer all TOO-Eligible Securities held by WS in this by signing this forin.Community property jurisdictions Account in accordance with this direction and the are as follows: Arizona, California, Idaho, Louisiana, Terms and Conditions included with this Application. Nevada,New Mexico,Texas,Washington,Wisconsin, and Puerto Rico. Note that in Alaska, community You release WS and their agents and property rules may be adopted by agreement signed representatives from all claims, demands, suits, by the married couple actions,liabilities and responsibilities whatsoever and agree to Indemnify them From any and all liabilities, IF YOU ARE MARRIED AND LIVE IN A cost or expense whatsoever including attomey's fees, COMMUNITY PROPERTY JURISDICTION, YOU for acting in good faith in accordance with the UNDERSTAND THAT A SUBSEQUENT MARRIAGE. Instructions and the privileges selected herein. You PRIOR TO YOUR DEATH MAKES THIS further certify that you received and read the Terms DESIGNATION OF BENEFICIARY INEFFECTIVE and Conditions included with and made a part of this AND YOU UNDERSTAND THAT ANY SPOUSE TO Application. All terms of this Application and the WHOM YOU ARE MARRIED AFTER YOU MAKE Terms and Conditions shall be binding upon your THIS DESIGNATION MUST CONSENT TO YOUR heirs,representatives and assigns. DESIGNATION.Also see page four. IF YOU ARE MARRIED AT THE TIME OF YOUR DEATH; AND LIVE IN A COMMUNITY PROPERTY JURISDICTION,AND IF WS HAS NOT ACCEPTED AN APPLICATION, INCLUDING THE APPROPRIATE SPOUSAL CONSENT, YOU UNDERSTAND THAT THIS DESIGNATION OF BENEFICIARY IS INEFFECTIVE AND THAT ALL TOD - ELIGIBLE SECURITIES WILL BE DISTRIBUTED TO YOUR ESTATE. Wachovia Securities is the trade name used by two separate, registered broker-dealers and non-bank affiliates of Wachovia Corporation providing certain retail securities brokerage services:Wachovia Securities,LLC,member NYSEISIPC,and Wachovia Securities Financial Network,LLC,member NASD/SIPC.Accounts carried by First Clearing,LLC,member NYSE/SIPC. 556442(Rev 04) Page 4 of 8 p,t of 4 �{� WACHOVIA sub F rm# BR fade FA Code Am3unt Number SECURITIES APPLICATION FOR REGISTRATION OF ACCOUNT IN BENEFICIARY FORM TRANSFER ON DEATH(TOD)DIRECTION PRIMARY BENEFICIARY DESIGNATION At the Death of the Account Owner all TOD-Eligible Securities in the Account shalt be transferred to the fallowing Primary Beneficiaries who sum".the(last surviving)Account Owner.Unless different percentages are indicated below,the TOD-Eligible Securities in the Account shall j be divided equally among the Primary Beneficiaries.The percentages designated below must add up to 100%. YOU MUST CHECK ONE BELOW. If any Primary Beneficiary listed below is not Living or in existence at the Death of the Account Owner or disclaims the TOD-Eligible Securities,,that Primary Beneficiary's share shall be distributed as follows: ❑ Distribute the TOD-Ellgible Securities to the remaining Primary Beneficiary(ies) pro rata, t e.. proportionate to the designated percentages. ��The TOD-Eligible Securities should be distributed to the specific Contingent Beneficiary(ies)designated on the following page(s). ❑ The TOD-Eligible Securities will become pail of the estate and be processed through probate. Relationship to Client Bonefidary Mama Social Security Number or Tax ID Number `Bindicliry Phone Number Designated Percentage eenenclaryAddrees City,State LP Beneficiary BMWs or Trust Dots 1g/e ?c *-fTa._tktt'r,�_r_� Jacksbur �j Relationship to Client Beneficiary Nam SoUslSocurttylkluNiberorTs a ID Number Beneficiary Phone Number s _ a!�.__ J1i1an.�Sarfr'ek i l 31r _l1_$77 J Designated Psrcerage Beneficiary Address Cby,state Zip BenMclary Blithdats or Trust Data a gib R0, &x—/16,,7z�_ W _ Relationship to client Beneficiary Name social Security Number or Tax ID Number Beneficiary Phone Number Designated Percentage Beneficiary Address City,state j ZIP Beneficiary BlHhate or Trust Date - Relationship to Client Benefciary Name Social security Number or Taa ID Number Bom lciary Phone Number a �_ __ __ _ 0001 F]DIE � Designated Percentage Banoficlary Address City,State ZIP Beneficiary Btreulate or Trust Daa Relationship to Client Beneficiary Name Social Security Number or Tex ID Number Beneficiary Phone Number _ i00000C1C��QC�- Deslgated Percentage Beneficiary Address cry,state ZIP Beneficiary BlMats or Trust Date Relationship to Client Beneficiary Nam Social Security Number or Tax RJ Number Denefklary Phone Number —1 010301— 1 6 10 IF-5101010 Designated Percentage Bmefictary Address city,State ZIP Beneficiary Blrthdate or Trust Data Relationship to Client Benenclary Name Social Socudry Number or Tax to Number Beneficiary Phone Number Designated Percentage Beneficiary Address city,state ZIP Beneficiary Blrthdate or Trust Dots I_ 1dd - -Relationship to Cllerd Beneficiary Nara Social Security Number or Tax to Number Beneticlsry Phons Number Dealgnatsd Pernrhga Beneficiary Address city,State ZIP Senenciary Birthdats or Trust Date 556442(Rev 04) Page 5 d 8 p,2 of 4 { r WACHOVrA Sub Flrtn# BR Code FA Code Account Number SECURITIES CCU L�_ _ APPLICATION FOR REGISTRATION OF ACCOUNT IN BENEFICIARY FORM TRANSFER ON DEATH(TOO)DIRECTION CONTINGENT . • Beneficiary Nana Social Security yNNumber �po..rr Tax IV Number eaml chry PPhone Number to Primary Benenelary Numberlsl 117 ierJI v /5_1-5_ JO Beneficiary Address City,$Me 23P Beneficiary Bldndata or Trust Dab Dnlgnated Percentage of Primary 8enelclary Share V D 0 _ ?_/ .qg_ BenMOlary Name Social Security Nurrider or - _ Tu10 Nu—mberr BenMelary Phone Number to aonell lary Number(s) A�kj eenedciary Address City,State Zip Beneficiary elrthdate or Trust Date Designated Pa eemage of neneu re Primary �, Bery$h. .so % ass- FR�n1clirl Dr 4slxf__ _ /04 I� /Beneficiary Name �r SSolciaall Security umber�ror-r Tax ID Number Benefklary phone Nupmberp BeminparylePrintery Ir+r 1 Beneficiary Address City,Site LP Beneficiary B1rWda11 or Trust Date Designated Percentage of Primary Beneficiary Shan ,�� Ln , RE j-, Q J Beneficiary N.me Social security Number or Tax IV Number Beneficiary Phone Number Bene�nciaiary Nuberrts slxac L. arr__ck. Daslgnated Percentage of Primary Bmeflclary Address City,State LP Beneficiary Blrthda%or Trust Date ///�� y B.nefielary Share % .Ur !✓vA I 1 Bene}lclary None Social Sect' Number or Tax ID Number Beneficiary Phone Number gem to Primary sans Benafkiw Nambertsl Beneficiary Addms City,state zip Bensfclary BlMdate or Trust Deb Dsallimited Percentage at Primary BansDclary Share J L _ % ^_Bmofielary Name Soci all Seumy Number or Tax 10 Number Benenciary Phone Number n � � u1 `I Benefelary Num D rJ D J LJ Beneficiary Address City,State LP Beneficiary Birihdate or Trust Date Designated Percentage of Primary �-�—� Irr-�II Beneficiary Nacre Social Security Number or Tax ID Number Beneficlary Phone Number eminperd Beneficiary N umbarls y — _ E7 n 1 LJ be 017 J • Beneficiary Address city,State 21P Beneficiary elrthdate or Trust Date DeNpnalad Percentage of Primary I�j I�I� I Beneficiary Shan�(% —J 1 I E 1_— --I _ Beneficlary Name Social Security__NuNNuu1ImJJberloorr T'aliiirx to Number tNuummber JJJ Beneficiary Phone Number B Contingent Numbor(s) E _ ____ I I—I C+J I_J 1-J L J I_J 0 Benefciary Addrets city,State ZBP Benefkhry Bir data or Trust Date Beneficiary Shanmap•of Prima% � J rumor I J If all designated Primary and Contingent Beneficiaries: (1)are not living or in existence at the Death of the Account Owner;or(ii)properly disclaim the TOD-Eligible Securities,the TOD-Eligible Securities in(he Account will be distributed to the Estate of the Account Owner, 556442(Rev 04) Page 6 of a P.3 Of 4 `..> WACHOVIA SECURITIES APPLICATION FOR REGISTRATION OF ACCOUNT IN BENEFICIARY FORM TRANSFER ON DEATH(TOD)DIRECTION INFORMATION ACCOUNT i i Sub Firm K� BR Code � FA Code � Aecourd Number ' 00 �- Original Application for Registration in Beneficiary Form D Change for Registration In Beneficiary Form IMPORTANT:Some of the securities shown on your account statement may not be eligible for TOD registration.Please refer to the definition of"TOD-Ellglble Security"In the Terms and Conditions.Securities not eligible for TOD registration will be distributed to your heirs through normal probate or estate settlement procedures.Because of the complex legal and tax ramifications involved,we cannot advise whether a TOD registration Is or is not an appropriate component of an Individual client's tax and estate planning. The ability to register securities accounts In TOD forth Is created by state law and not all states have enacted or recognize such laws.CLIENTS SHOULD ALWAYS CONSULT WITH THEIR OWN LEGAL AND TAX ADVISORS BEFORE ELECTING OR REVOKING A TOD ACCOU T REGISTRATION. i 7A G Account r Signature Date Account Owner Signature Date SPOUSAL If Account Owner lives In a community property Jurisdiction,this section must be completed by the spouse of the Account Owner if the spouse Is not a joint tenant of this Account and is not named as the solo beneficiary of the Account assets.The undersigned hereby declares thalANshe is the spouse of the Account Owner noted above and consents to any designation of beneficlanes made whatsoever and whensoever by the Account Owner for this TOD Registration and agrees not to make any claim against the Seneficlary(ies)or against us as a result of any distribution to said Beneficiary(ies)pursuant to this Application.This consent shall apply to all TOD-Eligible Securities in the Account at the Death of the Account Owner.This consent shall be revocable by the undersigned by executing a letter of authorization which is signed by the Account Owner and the spouse and filing the same with us prior to the Death of the Account Owner, Name of Spouse(Please type or print) Address of Spouse , Signature of Spouse Date City,State ZIP 1—J — REQUIRED NOTARIZATION OF SPOUSE'S SIGNATURE State County Subscribed and sworn to before me This Day of Year (Signature of Notary Public) My Commission Expires ACCEPTED BY / Branch Man ig re Date_! �T� Wachovia Securities is the trade name used by two separate, registered broker-dealers and non-bank affiliates of Wachovia Corporation providing certain retail securities brokerage services:Wachovia Securities, I.I.C. member NYSEISIPC,and Wachovia Securities Financial Network,LLC,member NASDISIPC.Accounts tamed by First Clearing,LLC,member NYSEISIPC. O 556442(Rev a4) Page 7 of a p 4 of 4 WACHOVTA SECURITIES ' Riverfront Plaza 901 East Byrd Street Richmond,VA 23219 f Wachovia Securities is the trade name used by two separate, registered broker-dealers and non-bank affiliates of Wachovia Corporation providing certain retail securities brokerage services-Wachovia Securities, LLC,member NYSE/SIPC, and Wachovia Securities Financial Network,LLC,member NASD/SIPC.Accounts carried by First Clearing.LLC,member NYSEJSTPC. 556442(Rev 04) Page a d 8 EXHIBIT . VIII /J c'l" Woe 15 Big Spring Avenue NEWVILLE, PENNSYLVANIA 17241 -HARLES EGGER, Supervisor 717-776-3414 FRANK C. EGGER, Funeral Director May 21, 2013 Funeral bill for Jean E. Barrick Date of Service May 18, 2013 Professional services $4,375.00 Spencer 20 gauge casket $1,575.00 Cemetery Opening $680.00 15 Death Certificates $6.00 a piece $90.00 Valley Times Star obituary $50.00 Sentinel Obituary $247.70 Total $7,017.70 3'� EXHIBIT IX WEIGLE&ASSOCIATES, PG Attorneys-at-Law 126 East King Street Shippensburg,PA 17257-1397 Phone:(717)532-7388 Fax-(717)532-5289 Jean E.Barrick Estate September 23,2013 c/o Nolan Barrick 340 Mourning Dove Drive . Newark.,DE 19711 File#: 10445A Inv #:: 12879 DATE DESCRIPTION HOURS AMOUNT . Jul-18-13 E-n&to and from Nolan-begin work on 1.25 218.75 cover letter and documents Aug-0643 Review Nolan's email and Nancy's e-mail.in 0.25 4175 preparation for telephone conference call Aug-07-13 Conference call regarding Agreement of Sale, 0.50 87.50 Disclosure forms Aug-07-13 Researched property deed,subdivision plan 0.50 0.00 and tracts(Paralegal time)(nn charge) Aug-08-13 Review subdivision plans:(no charge) 0.25 0.00 Aug-13-13 Review email from Nolan with attachments 0.25 43.75 . Sep-06-13 Final preparation for public sale 0.25 43.75 Sep-07-13 Attend settlement 0.50 87.50 Sep-0943 Begin work on drafts of Deed and Power of 0.75 131.25 Attorney-instructions to staff Sep-10-13 'Work on Power of Attorney-e-mails to and 0.50 87.50 from Nolan-instructions to staff Sep-11-13 Continue to work on Deed,Powers ofAttorney 0.50 87.50 -prepare letter to PA DPW-instructions to staff Totals 5.50 $831.25 DISBURSEMENTS Disbursements Receipts Sep-11-13 Cost to Post Office-certified mailing cost to 6.11 Dept.of Public Welfare 116A, WEIGLE &ASSOCIATES, PC" Attorneys-at-Law 126 East King Street Shippensburg,PA 17257-1397 Phone:(717) 532-7388 Fax:(717) 532-5289 Jean E. Barrick Estate October 23,2013 C/o Nolan Barrick, Co-Executor 340 Mourning Dove Drive Newark,DE 19711 File#: 10445A Inv #: 12952 DATE DESCRIPTION HOURS AMOUNT Sep-12-13 Message from Mr. Schuller-message from PA 0.50 87.50 DPW- several a-mails Sep-13-13 Several a-mails - call to Darlene at PA DPW 0.25 43.75 Sep-16-13 -Call from Tom Vandabecker of Home Finance 0.25 43.75 of America- instructions to staff-e-mail to clients Sep-17-13 Calls to and'from Tom of Home Finance 0.25 43.75 Sep 723-13 Review e-mail from Nolan,-finalize drafts of 0.75 131.25 items to e-mail to-clients - instructions to staff Sep-24-13 Several a-mails - call to Sharon Dunn 0.25- 43.75 Sep-25-13 Prepare letter to Sharon.Dunn 0.25 43.75 Sep-30-13 Several e-mails -call to Sharon Dunn(no 0.25 0.00 charge) Oct-01-13 Several a-mails - call to Sharon Dunn(no 0.25 0.00 charge) Oct-02-13 Numerous a-mails and calls in preparation for 0.25 43.75 settlement Oct-03-13 Numerous a-mails in preparation for 0.75 131.25 settlement Oct-04-13 Several calls to Sharon Dunn regarding escrow 0:75 131.25 proposal- call from client numerous a-mails in preparation for settlement Oct-07-13 Numerous e-mail's regarding settlement- 0.75 131.25 review escrow agreement- call to Sharon- call to client Oct-10-13 Several a-mails regarding settlement issues (no 0.25 0.00 charge) 3,�L Invoice#: Oct-11-13 Several a-mails (no charge) 0.25 0.00 Oct-14-13 Several a-mails regarding settlement 0.25 43.75 Oct-16-13 Several a-mails (no charge). 0.25 0.00 Oct-19-13 Review numerous a-mails regarding status of 0.25 43.75 settlement Totals 6.75 $962.50 Sep 30/13 fee payment $837.36 Total Fees & Disbursements $962.50 Previous Balance $837.36 Previous Payments $837.36 Balance Due Now $962.50 WEIGLE &ASSOCIATES, P.C. Attorneys-at-Law 126 East King Street Shippensburg, PA 17257-1397 Phone:(717) 532-7388 Fax:(717) 532-5289 Jean E. Barrick Estate November 5, 2013 c/o Nolan Barrick, Co-Executor 340 Mourning Dove Drive Newark, DE 19711 File#: 10445A Inv #: 12978 DATE DESCRIPTION HOURS . AMOUNT Oct-21-13 Returned Tom Vandabetters call (no charge) 0.25 0.00 Oct-22-13 Several a-mails (no charge) 0.25 0.00 Oct-23-13 Review numerous a-mails regarding settlement 0.25 43.75 status Oct-28-13 Several e-mails and telephone messages 0.25 0.00 regarding settlement (no charge) Nov-01-13 Finalize preparation of various items for 2.00 350.00 settlement and a-mails - attend settlement Totals 3.00 $393.75 Oct 28/13 fee payment $962.50 Total Fees & Disbursements $393.75 Previous Balance $962.50 Previous Payments $962.50 Balance Due Now $393.75 �� /"8-i3 Invoice#: PAYMENT IS DUE UPON RECEIPT OF THIS BILL. PLEASE MAKE CHECK PAYABLE TO "WEIGLE&ASSOCIATES, P.C.".A VISA OR MASTERCARD MAY BE USED TO MAKE PAYMENT. WE THANK YOU FOR YOUR CONFIDENCE PLACED IN OUR FIRM. A billing fee of ten dollars ($10.00)per monthly.statement will be charged after thirty (30) days. EXHIBIT X A U RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date : 6/05/2013 Cumberland County - Register Of Wills Receipt Time : 08 : 15 : 59 One Courthouse Square Receipt No. : 1074404 Carlisle, PA 17613 BARRICK JEAN E Estate File No. : 2013-00631 Paid By Remarks : NOLAN S BARRICK CJ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 310 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 50 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 3410 $433 . 50 Total Received. . . . . . . . $433 . 50 EXHIBIT Xl - JEAN E. BARRICK ESTATE " Co — executors mileage at IRS standard 2013 rates Nolan S. Barrick and Nancy R. Evans are co-executors of the Jean E. Barrick Estate. ( Please see Exhibit I for short certificate and Death certificate) Addresses: Estate: 68 North High Street, Newville PA 17241 Nolan S. Barrick residence: 340 Mourning Dove Drive, Newark, DE 19711 (115 miles to estate) Nancy R. Evans residence: 205 Franklin Drive, Blacksburg,VA 24060 (297 miles to estate) Eight trips to Newville to prepare estate for auction of contents and real estate and to meet with lawyer were made between May 14, 2013 and November 1, 2013 sale of real estate by both executors. 56.5 cents per mile—IRS standard mileage rates Nolan S. Barrick. 8 trips.X 230 miles X 56.5 cents = $1,039.60 Nancy R. Evans 8 trips X 594 miles X 56.5 cents =$2,684.88 Total $3,724 48.