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HomeMy WebLinkAbout02-0445 PETITION FOR PROBATE and GRANT OF LETTERS Estate of Robert H. Griswold Social Security No. 204-03-6272 No. ~ I-O~'" c.J" 5 To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania. The Petition of the undersigned respectfully represents that: Y our Petitioners are 18 years of age or older and are the co-executors named in Article Four of the last Will of the above decedent, dated January 19,2001. Decedent was domiciled at death in Chester County, Pennsylvania, with his last address in a continuing care community at 100 Sycamore Drive, Suite 128, West Grove, PA 19390 where he had lived since February 5, 2002. However, prior thereto for many decades decedent resided in Grantham, Cumberland County, PA and, more recently, at Country Meadows, 4902 E. Trindle Road, Mechanicsburg, Cumberland County, PA. Petitioners, being all of the parties in interest and the beneficiaries of decedent's Will, desire to have the Will probated in Cumberland County. Decedent, then 86 years of age, died April 26, 2002, at Jennerville Regional Hospital, Penn Township, Chester County. Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the Will offered for probate, was not the victim of a killing and was never adjudicated incompetent. Decedent at death owned property with estimated values as follows: 1. All personal property $ 800,000.00 2. Value of real estate in Pennsylvania $ 50,000.00 The Pennsylvania real estate is mountain land situated in Tioga County near Canton, P A. WHEREFORE, petitioners respectfully request the probate of the last will presented herewith and the grant of letters testamentary thereon. ~~~~~l' Anne G. DiSabatino 1744 Flint Hill Road Landenberg, PA 19350 1lJ K ~J; David R. Griswold 622 Perry Valley Road Millerstown, PA 17062 2eZ0f Route 1, Box 1247-A Bridger, MT 59014 1. /7-~/-9 OATHS OF PERSONAL REPRESENTATIVES COMMONWEAL TH OF PENNSYL VANIA: : SS COUNTY OF CUMBERLAND Petitioners, David R. Griswold, Scott M. Griswold and Anne G. DiSabatino, swear or affirm that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioners and that as personal representatives of Robert H. Griswold, deceased, petitioners will well and truly administer the estate according to law. Sworn to or affirmed before me, J)~1Z~4 David R. Griswold this 3rd day of May, 2002 S~~&f Scott M. Griswo d . ~[;~/~~j]~ MARY C. LEWIS tl4tV d ~ iL..~t:::. Anne G. DiSabatino -- 2. No. 21-2002-445 Estate of Robert H. Griswold, Deceased DECREE OF PROBATE AND GRAND TO LETTERS AND NOW May 3rd, ,2002, in consideration of the petition set forth on the two preceding pages, satisfactory proof having been presented before me, IT IS DECREED that the instrument dated January 19, 2001, described therein be admitted to probate and filed of record as the last will of Robert H. Griswold, deceased, and Letters Testamentary are hereby granted to David R. Griswold, Scott M. Griswold, and Anne G. DiSabatino, Co-Executors. .~(!.~~ ~f1-I:A Regis of Wills ,,- ~ MARY C. LE.WIS FEES 4 fJ~4~ Probate, Letters, Etc. TOTAL $ 480.00 $ 60.00 $ 21.00 $ 5.00 $ 566.00 Attorney: S. Berne Smith Short Certificates (20) Sup. Ct. I.D. No: 07254 Renunciation 107 N. 24th Street Camp Hill, PA 17011-3602 Other JCP x-Pages (7) Phone: 717-737-6789 Filed: May 3rd, 2002 3. MAILED LE"ITERS 'ID ATTORNBY LAST WILL AND TEST AMENT OF j.1-O~- '1f/6 ROBERT H. GRISWOLD I, ROBERT H. GRISWOLD, of Hampden Township, Cumberland County, Pennsylvania, being of sound mind and disposing memory, do hereby make this Will, hereby revoking all my former Wills and Codicils: Article One: Tangible Personal Property: S 1.1 I bequeath all my tangible personal property in accordance with the terms of a personal property memorandum I may prepare. If no such memorandum is located or received by the Executor within 60 days after being appointed as such, after conducting a reasonable search for such memorandum, the Executor shall be held harmless for distributing such property as hereinafter provided. S 1.2 I bequeath such property not disposed of by such memorandum, or all of such property ifno such memorandum is located or received, to my children, per stirpes, to be divided among them in as nearly equal shares as they agree. In the event of irreconcilable disagreement among my children, they shall take alternate turns selecting individual items with the oldest child making the first selection. Any items not so selected shall be sold and the proceeds shall pass as a part of my residuary estate. S 1.3 To the extent practicable in the Executor's sole discretion, I bequeath any policies of insurance on such property to the beneficiary entitled to such property. S 1.4 I direct that the expenses of storing, packing, shipping, insuring and delivering any such property to the beneficiary entitled thereto shall be paid by the Executor as an administrative expense of my estate. Article Two: Residue: ~2.1 I bequeath and devise all the residue of my estate, of whatever nature and wherever situated, including any property over which I have a power of appointment, to be divided 1 among my children, per stirpes, subject to the provisions of ~2.2 hereinafter. My three children are: David R. Griswold of Millerstown, PA; Scott M. Griswold of Billings, MT; and Anne G. DiSabatino of Landenberg, P A. ~2.2 I give to the Trustee hereinafter named any share passing hereunder for the benefit of any Beneficiary of mine, who shall not have attained the age of twenty-two (22) years, to be held, administered and disposed of in accordance with Article Three hereof (the "Beneficiary's Trust") for the benefit of such Beneficiary. Article Three: The Beneficiary's Trust: ~3.1 The Trustee shall hold, manage, invest and reinvest the assets of the Beneficiary's Trust, collect the income thereof and: ~3.1.1 While the beneficiary of the Beneficiary's Trust (the "Beneficiary") is under eighteen (18) years of age, the Trustee shall apply to or for the benefit of the Beneficiary so much of the net income and, if the net income is insufficient, so much of the principal of the Beneficiary's Trust as the Trustee shall from time to time deem necessary or proper for the Beneficiary's health, maintenance, support and complete education, including preparatory, college and graduate education, and professional, vocational or technical training, taking into account other available funds, including the Beneficiary's assets. The Trustee shall annually accumulate any net income not so distributed and add the same to the principal of the trust property. ~3.1.2 After the Beneficiary attains eighteen (18) years of age, the Trustee shall distribute to or for the benefit of the Beneficiary the net income of the Beneficiary's Trust in quarter-annual installments, or more frequently if the Trustee deems it advisable, and so much of the principal as the Trustee shall from time to time deem necessary or proper for the Beneficiary's health, maintenance, support and complete education, including college and graduate education, and professional, vocational or technical training, and to assist the Beneficiary with reasonable wedding expenses, iri the purchase of a principal residence or in the establishment of a profession or business considered a good risk by the Trustee, taking into account other available funds, including the Beneficiary's assets. ~3.1.3 Any Beneficiary upon reaching the age of twenty-two (22) years may withdraw any or all of the principal of that Beneficiary's Trust. ~3 .1.4 If the Beneficiary dies before the complete termination of the Beneficiary's Trust, the Trustee shall distribute the property then held in trust to such persons or corporations, (including the Beneficiary's estate), in such amounts and upon such trusts, terms and condition, as the Beneficiary by last Will may appoint by 2 specific reference to this general power of appointment; provided, however, any portion of the trust property not subject to the Beneficiary's power of withdrawal immediately prior to the Beneficiary's death may only be appointed to one or more of the Beneficiary's issue, in such amounts and upon such trusts, terms and conditions as the Beneficiary by last Will may appoint by specific reference to this special power of appointment. Any property not so appointed shall be distributed to the Beneficiary's then living issue, per stirpes, or if none, in accordance with the provisions of Article Two above. Article Four: Appointment of Fiduciaries: S4.l I appoint my children, David R. Griswold, Scott M. Griswold, and Anne G. DiSabatino, as Co-Executors of this Will. If one or more of them are unable or unwilling to serve or continue to serve, for any reason whatsoever, those remaining shall continue to serve as Co- Executors or sole Executor, as the case may be. All references herein to the "Executor" shall mean my originally appointed Co-Executors or sole Executor, as the case may be. S5.2 I give my Executor the discretion and authority to name a person or persons to be the Trustee( s) of any trust which may be created under this will. Article Five: Powers of Fiduciaries: S5.l No fiduciary under this Will shall be required to give bond or other security for the faithful performance of the fiduciary's duties. S5.2 Any such fiduciary shall have the following powers, in addition to those given by law: S5.2.1 To invest in, accept and retain any real or personal property, including stock of a corporate fiduciary or its holding company, without restriction to legal investments; S5.2.2 To sell, exchange, partition or lease for any period of time any real or personal property and to give options therefor for cash or credit, with or without security; S5.2.3 To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; S5.2.4 To hold shares of stock or other securities in nominee registration 3 form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; ~5.2.5 To engage in litigation and compromise, arbitrate or abandon claims; ~5.2.6 To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributes on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; ~5.2.7 To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person affected thereby; ~5.2.8 To allocate, in the Executor's sole and absolute discretion, any portion of my exemption under Section 2631 (a) of the Internal Revenue Code to any property as to which I am the transferor, including any property transferred by me during my lifetime as to which I did not make an allocation prior to my death; ~5.2.9 To disclaim any interest I may have in any estate if the Executor deems such disclaimer to be in the best interests of my estate and the beneficiaries thereof; ~5.2.10 To terminate any trust created herein, the principal of which is or becomes too small in the Trustee's discretion to make the establishment or continuance of the trust advisable, and to make immediate distribution of the then remaining trust property to the beneficiary then entitled to the income of the trust property or, ifthere is more than one beneficiary, to the beneficiaries then entitled to the income of the trust property in proportion to their respective interests therein or, if such interests are not defined, in equal shares to such beneficiaries; provided, however, no Trustee shall participate in any decision to terminate such trust if by reason of such termination such trustee could receive a distribution of trust property from such trust as aforesaid. The receipts and releases of the distributee(s) will terminate absolutely the right of all persons who might otherwise have a future interest in the trust, whether vested or contingent, without notice to them and without the necessity of filing an account in any court; and ~5.2.11 To merge any trust created hereunder with any other trust or trusts if the terms of any such trust are then substantially similar and held for the primary benefit of the same person or persons. 4 Article Six: Provision for Taxes: ~6.1 All estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of my death to any government or subdivision thereof upon or with respect to any property subject to any such tax ("Death Taxes"), and any penalties thereon, shall be paid by the Executor as follows: ~6.1.1 Death taxes due on the value of items of Tangible Personal Property bequeathed pursuant to Article One shall be paid out of the principal of the residual portion of my estate disposed of by Article Two of this Will. ~6.1.2 Death taxes, if any, due on the value of assets such as life insurance policies, my IRAs or Annuities shall be paid out of the proceeds of those assets on a prorate basis before distribution of the balance of the accounts is made to the beneficiaries named in the life insurance policies, IRAs or Annuities. ~6.1.3 Any other death taxes due on all other assets shall be paid by the Executor out of the principal of the residual portion of my estate disposed of by Article Two of this Will. Article Seven: Provision for Debts and Expenses: ~7.1 I direct that any of my legally enforceable debts, any expenses of my last illness, funeral and burial, and any of the administrative expenses of my estate shall be paid from the principal of the residual portion of my estate disposed of by Article Two of this Will. Article Eight: Miscellaneous Provisions: ~8.1 As used in this Will, the term "Internal Revenue Code" shall mean the Internal Revenue Code of 1986, as amended from time to time, or the corresponding provision of subsequent law. ~8.2 Whenever the Fiduciary is to distribute property to or for the benefit of any beneficiary who is under (a) eighteen years of age, or (b) a legal disability or otherwise suffers from an illness or mental or physical disability that would make distribution directly to such beneficiary inappropriate (as determined in the Fiduciary's sole discretion exercised in good faith), the Fiduciary may distribute such property to the person who has custody of such beneficiary, may apply such 5 property for the benefit of such beneficiary, may distribute such property to a custodian for such beneficiary, whether then serving or selected and appointed by the Fiduciary (including the Fiduciary), under any applicable Uniform Transfers to Minors Act or Uniform Gifts to Minors Act, may distribute such property directly to such beneficiary's estate, or may distribute such property directly to such beneficiary (except if any of the conditions hereinbefore described in (b) apply), without liability on the part of the Fiduciary to see to the application of such property. This provision shall not in any way operate to suspend such beneficiary's absolute ownership of such property or to prevent the absolute vesting thereof in such beneficiary. S8.3 Except as otherwise may be provided in this Will, until the property is distributed to and received by any beneficiary hereunder, the principal sums thus held for any beneficiary, respectively, and the income thereof shall not be subject to or liable for any contracts, debts, engagements, liabilities or torts of such beneficiary now or hereafter made, contracted, incurred or committed, but shall be absolutely free from the same, and such beneficiary shall have no power to sell, assign or encumber all or any part of the principal sums or such beneficiary's interest therein, respectively, or the income thereof, or to anticipate the income. S8.4 If any beneficiary hereunder should die within thirty (30) days after me or within thirty (30) days after any other person the survival of whom determines his rights hereunder, then such beneficiary shall be deemed to have predeceased me or such other person for all purposes hereunder. IN WITNESS WHEREOF, I, ROBERT H. GRISWOLD, have hereunto set my hand and seal to this, my last Will, typewritten on eight (8) sheets of paper, including the self-proving attestation clause and signatures of witnesses, this I q 13. day of J A N (A /l 0.. 7 , 2001. @tJJl> Jj (SEAL) ROBERT H. GRISWOLD Signed, sealed, published and declared by the above named ROBERT H. GRISWOLD as and for his last Will, in the presence of us and each of us, who, at his request and in his presence and 6 in the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year last above written. 9tu- ~~ Residing at J8/2.. f'f"I n~7 jJ A , v'~ !7ELf.fY-ltJI cs f3'-<(~(;.. (/1 J7()so ~!.h((fA. 7n -~ Residing at cJ "/J j? /1(1 / ,< O-~ /~ I Residing at 10 () /Jt..L~(v PIH.....= LJ A~. (0/....... }1.(6 { ;/In p II n ;1.. } -'7 () () I , I '-'- (. / T I , 10 7 A J 2..-3f./} Jr- /V. C' n n (' /1, '- '- / f>R 17(}/f COMMONWEALTH OF PENNSYLVANIA: SS. COUNTY OF CUMBERLAND We, ROBERT H. GRISWOLD, the testator, and J~5\ ICon fl. L/1,IJ~ JO~IV )1 r/</,JfON , and . (' /3 r'" "J_ c;: fl. /o.J L- ..) P-"7 I T If , the witnesses, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each 7 subscribing witness in the hearing and sight of the testator signed the Will as a witness and that to the best of his or her knowledge the testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. (j)jj}J=!/ ROBERT H. GRISWOLD 9"-+- ~ Witness J~(k 1n~ ~% tJ~ A-Y I Witness Witness Subscribed, sworn to and acknowledged before me by ROBERT H. GRISWOLD, the testator, and subscribed and sworn to before me by :)(;5"5"1 CA- (7 L;1/VG JOj1jJ /l //<:. IN] (l tJ and S' /;J.F I? N.: ~f7 /711 , the witnesses, this -n /9 day of J ./1/V ~{l~ A '7' / , 2001. rJ)OAA~ 7. (jJ lta~ Notary Public My Commission expires: 9/ j 'il / ;;20Cli SEAL MOTAIlIAL SEAl _ L...... *"MrPUaIC 1IMWt00lWP.. a-. Ate COllIm MY COIIIlSSIOfI mws sm. II _ 8 210 Grondview Avenue Camp Hill, PA 17011 717-761.7171 ;L\ / SHERIDAN FRITZ 17258 Oregon Pike, Suite 205 lancaster, PA 17601 717-560-8375 January 24, 2003 P A Department of Revenue Bureau ofIndividual Taxes Inheritance Tax Division - EXT Dept. 280601 Harrisburg, PAl 7128-060 1 Re: Estate of Robert H. Griswold File 2~02-00445 PA File No. 21-02-0445 DOD 4-26-2002 S.S. # 204-03-6272 n .....::.;,~.. u~~O \f' Q tr nO'3 \\\\ 'J~\>\ 7- be 'l Dear Sir or Madam: Please accept this letter as our request for a six month extension of time to file the Pennsylvania Inheritance Tax Retum for the referenced taxpayer. Due to ullforseell circumstances a complete and accurate return can not be filed by the original due date of January 27,2003. Every effort will be made to file the retum as soon as possible. A copy of the extension request file with the Internal Revenue Service is enclosed for your records. A deposit of$38,000 was made within the discount period however based upon our preliminary tax calculation an additional payment of$5,000 is enclosed with this extension request. Please contact our office if additional information is required. V~'o~ Melvin A. Phillips, CPA Application for Extension of Time To File a Return andlor Pay U.S. Estate (and Generation-Skipping Transfer) Taxes Department of the Treasury D 6 NA Internal Revenue Se",ce For filers of Fo 706 706-A, 706- ,or 70 - (circle only one) Note: Use Form 2758 to request an extension for Forms 706-GS(D) and 706-GSrn ~i'4 Identification Form 4768 (Rev. August 2001) OMS No. 1545-0181 Decedent's first name and middle initial ROBERT H. Decedent's last name GRISWOLD Date of death 04 /2 6/2 0 02 Name of executor Name of application filer (if other than the executor) Decedent's social security number 204-03-6272 Estate tax return due date ANNE G. DISABATINO Address of executor (Number, street, and room or suite no.) 1744 FLINT HILL ROAD City, state. and ZIP code LANDENBERG, PA 19350 ~\eitf!tliN Extension of Time To File Form 706 (Sec. 60811 Automatic extension. If you are applying for an automatic 6-month extension of time to file Form 706, check here (see instructions): . . . . . . . .. ~ [Xl Additional extension. If you are an executor out of the country applying for an extension of time to file in excess of 6 months, check here. . . .. ~ 0 You must attach a statement explaining in detail why it was impossible or impractical to file Form 706 by the due I Extension date requested date. See the instructions. Enter the extension date requested. . Extension for cause. If you have not filed a request for an automatic 6-month extension and the time for filing such a request has passed. check here .... ~ D 01/27/2003 I Domicile of decedent (county, state, and ZIP code) PENNSYLVANIA You must attach a written statement explaining in detail why you were unable to request an automatic extension, Extension date requested why it was impossible or impractical to file Form 706 by the due date, and why you should be granted an extension at this time. See the instructions. Enter the extension date requested. 1'~"~;I~j~r Extension of Time To File Form 706-A, 706-0, or 706-NA (Sec. 6081) "",a,.".'!._.,: j You must attach your written statement to explain in detail why it is impossible or impractical to file Extension date requested a reasonably complete return by the due date of the return. r:-R"r-t'LVqr Extension of Time To Pay (Sec. 6161) " . OI..i,'. ",,~ )' ;,':, ", '::-~ ~-';;:; You must attach your written statement to explain in detail why it is impossible or impractical to pay Extension date requested the full amount of the estate (or GST) tax by the return due date. If the taxes cannot be determined because the size of the gross estate is unascertainable, check here ~D and enter "-0-" or other appropriate amount on Part V, line 3. You must attach an explanation. [J?>ij;~l Payment To Accompany Extension Request '.'Cl.\;.' 1 Amount of estate and GST taxes estimated to be due ............................. . 1 0.00 2 Amount of cash shortage (complete Part IV) ............'........................ . 2 3 !3alance due (subtract line 2 from line 1) (see instructions) ......................... . 3 0.00 Signature and Verification If filed by executor - Under penalties of perjury, I declare that I am an executor of the estate of the above-nam ed decedent and that to the best of my knowledge and belief, the statements made herein and attached are true and correct. Executor's signature Title Date If filed ~ someone other than the executor - Under penalties of perjury, [ declare that to the best of my knowledge and belief, the statements made herein and attached are true and correct, that I am authorized by an executor to file this application, and that I am (check box(es) that applies): o A member in good standing of the bar of the highest court of (specify jurisdiction) ... ~ A certified public accountant duly qualified to practice in (specify jurisdiction) ~ Pennsyl vania o A person enrolled to practice before the Internal Revenue Service. D ,A duly authorized agent holding a p_ower of attorrl (The power of attorney need not be submitted unless requested.) ~ O~fuS,i) -;;/;~(h'>3 partY'l, Notice to Applicant - To be completed by the Internal Revenue Service 1 The application for extension of time to file (Part II or III) is: D Approved D Not approved because 2 The application for extension of time to pay (Part IV) is: D Approved 0 Not approved because D Other o Other Internal Revenue Service official Date Internal Revenue Service official Date For Privacy Act and Paperwork Reduction Act Notice, see page 4, ISA STF FED5253F Form 4768 (Rev. 8-2001) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SMITH S BERNE ESQ 107 N 24TH ST CAMP HILL, PA 17011-3602 _n__n_ fold ESTATE INFORMATION: SSN: 204-03-6272 FILE NUMBER: 2102-0445 DECEDENT NAME: GRISWOLD ROBERT H DATE OF PAYMENT: 02/12/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/26/2002 NO. CD 002159 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,000,00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: DAVID R GRISWOLD C/O BERNE SMITH ESQUIRE CHECK# 504 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $5,000.00 DONNA M. OTTO DEPUTY REGISTER OF WILLS /"}-6/- l' ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 February 11, 2003 Telephone (717) 787-3930 FAX (717) 772-0412 Mr Melvin A. Phillips, CPA. 210 Grandview Avenue Camp Hill, Pa.17011 Re: Estate of Robert H. Griswold File Number 2102-0445 Dear Mr Phillips: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before July 26,2003. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. (/ /~I Sil'}t;~,~# / Ii i / _' ~:. // I I /j I J -.......,- y.t;' ., / _ I;' l/,. ,1 4'; . J. t ,. /~' '-'?1~/'-~~'~-+i;1'--( .:'///./ /~:J/_// -At{ /' .... I~ v ~v .......\,.,'.;.t/'",./'..- ...........................-"--/ Jeffrey Hollenbush, Supervisor Document Processing Unit Inheritance Tax Division COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SMITH S BERNE ESQ 107 N 24TH ST CAMP HILL, PA 17011-3602 -------- fold ESTATE INFORMATION: SSN: 204-03-6272 FILE NUMBER: 2102-0445 DECEDENT NAME: GRISWOLD ROBERT H DATE OF PAYMENT: 03/31/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/26/2002 NO. CD 002359 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $9.29 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: BERNE S SMITH ESQUIRE CHECK# 512 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $9.29 DONNA M. OTTO DEPUTY REGISTER OF WILLS a/-o~-"'I./i/S S. BERNE SMITH Attorney-at-Law 107 N. 24th Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 '02 h}\Y -3 !\!.: :(12 , ... May 3, 2002 In re: Estate of Robert H. Griswold, died April 26, 2002 (Social Security #204-03-6272) P A File: File: 145003 .1. ~.I Cl II, Mary C. Lewis, Register of Wills Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Dear Ms. Lewis: Accompanying this letter is a Petition for Probate and Grant of Letters Testamentary in the Estate of Robert H. Griswold, who died testate April 26, 2002. Attached to the petition are the following: 1. The original and one copy of the Will of Robert H. Griswold. 2. The Estate Information Sheet for the P A Department of Revenue. 3. Death Certificate for Robert H. Griswold. 4. The Will is a self-proving Will. We believe that this covers everything that is required. We ask that we be provided with twenty (20) short certificates. Please send them and the actual letters testamentary to the undersign when they are prepared. Because we will be hand delivering all of the above materials to you, we will be prepared to pay the fees by check at that time. Thank you for your attention to this matter. If anything further is required, please advise. Sincerely yours, /~~~ . S. Berne Smith Enclosures: cc: Anne G. DiSabatino, Co-Executor David R. Griswold, Co-Executor Scott M. Griswold, Co-Executor BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN S B SMITH 107 N 24TH ST CAMP HILL DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-12-2003 GRISWOLD 04-26-2002 21 02-0445 CUMBERLAND 201 Allount Rellitted PA 170ll - REY-485 EX AFP [01-05) ROBERT H MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ REV =483--E,C--AFP--Cor:.oii-----..-Noffc.f-oF--uETE-RHiNATicrti-AN-u-AS-SEssMENy----------------------- -- --- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF GRISWOLD ROBERT H FILE NO.21 02-0445 ACN 201 DATE 05-12-2003 ESTATE TAX DETERMINATION .00 1. Credit For State Death Taxes as Verified 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 43.009.29 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 5. Pennsylvania Estate Tax Due 43.009.29 .00 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID PO ::;;ft' :::J ~_ 0---: (j) ("', ..,-. . , fl' ~). ..' I,. ,,'.... '"tr ~,'~::,:' "';. ,.'O, .~ ,,,,"'1' :xl irP~ ((J 0 ;,'~" "'.., ;:;+ 52 I..!;,,; j "' Ct. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 .IF PAID AFTER THIS DATE. SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) /'}-6/- 9 ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ReCOIdc'Cl Re~jlE~e Ct DATE of ;1I3 ESTATE OF DATE OF DEATH FILE NUMBER A10 :4EOUNTY 'iCN 05-12-2003 GRISWOLD 04-26-2002 21 02-0445 CUMBERLAND 101 S B SMITH 107 N 24TH ST CAMP HILL .03 MAY 16 *' REV-1S47 EX AFP (0l~03) ROBERT H Amount Remitted PA 170 ]d(~"l Lr~,- v.v f\. CUmberlOna MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GRISWOLD ROBERT H FILE NO. 21 02-0445 ACN 101 DATE 05-12-2003 T AX RETURN WAS: (X) ACCEPTED AS F I LED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stacks and Bands (Schedule B) 3. Closely Held Stack/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) (1) (2) (3) (4) (5) (6) (7) 36,500.00 124,850.08 .00 .00 57,887.67 .00 813,476.98 (8) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 23,142.67 9. 10. 11. 12. 13. 14. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) Debts/Mortgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Return (9) (10) 9.365.61 (11) (12) (13) (14) Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 1,032,714.73 3?~D8 ?8 1,000,206.45 .00 1,000,206.45 NOTE: If an assess.ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of Akh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS. (15) .00 X 00 .00 (16) 1,000,206.45 X 045 = 45,009.29 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19)= 45,009.29 . PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-18-2002 CDOO1432 2,000.00 38,000.00 02-12-2003 CD002159 .00 5,000.00 03-31-2003 CD002359 .00 9.29 BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-01-2003 TOTAL TAX CREDIT 45,009.29 BALANCE OF TAX DUE .00 INTEREST AND PEN. 11.73 TOTAL DUE 11. 73 * IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN *1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) S. BERNE SMITH Attorney-at-Law 107 N. 24th Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 April 10, 2003 In re: Estate of Robert H. Griswold, DOD 4-26-2002; SS# 204-03-6272 P A File # 21-2002-0445 My File: 145003 Donna Otto, Acting Register of Wills Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Dear Ms. Otto: Enclosed is my check in the amount of $11.73 to pay the total due on the Notice of Inheritance Tax Appraisement for the above Estate of Robert H. Griswold. The remittance slip is also enclosed. If you have any questions, please call me. Thank you for your attention to this matter. /Je~As) S. Berne Smith Enclosure: cc: Anne G. DiSabatino, Executrix Melvin A. Phillips, CPA 0'1 -- ...- (j N EL '::,'1 '-! C> N ~ ::c (,:. C"J '-.) ->'. roO: a:: l"'l P (1) :...g ,_ r- ():, ::; 06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SMITH S BERNE ESQ 107 N 24TH ST CAMP HILL, PA 17011-3602 ___~n__ fold ESTATE INFORMATION: SSN: 204-03-6272 FILE NUMBER: 2102-0445 DECEDENT NAME: GRISWOLD ROBERT H DATE OF PAYMENT: OS/20/2003 POSTMARK DATE: 05/19/2003 COUNTY: CUMBERLAND DATE OF DEATH: 04/26/2002 NO. CD 002588 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $11.73 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: S BERNE SMITH ESQUIRE CHECK# 421 SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS $11.73 DONNA M. OTTO DEPUTY REGISTER OF WILLS ",1'1-61- 9 v BUREAU Of INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-16D7 EX AFP <Dl-D51 .03 JU"l 20 'UAt* EStATE OF DATE OF DEATH f,~L~ i~UMBER edUN# ACN 06-09-2003 GRISWOLD 04-26-2002 21 02-0445 CUMBERLAND 101 ROBERT H Rec~'r-';:- Rce' S B SMITH 107 N 24TH ST CAMP HILL Allount Rellitted PA 17011 , . MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYll8nt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R'EV=i6o"7-EiCAFP--foY:oiY-----...--iNiiERITANc'f-iAx-sTjffEiiE-Ni-cfF"-Accouiif--.-..--------------------- ESTATE OF GRISWOLD ROBERT H FILE NO. 21 02-0445 ACN 101 DATE 06-09-2003 THIS STATEHENT IS PROVIDED TO ADVISE Of THE CURRENT STATUS Of THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY Of THE PRINCIPAL TAX DUE. APPLICATION Of ALL PAYHENTS. THE CURRENT BALANCE. AND. If APPLICABLE, A PROJECTED INTEREST fIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-12-2003 P R I NCI PAL TAX DU E : .............,.............................."'.,.."'........"',.................,."'.."'....'"...,........."'....,..............................................."'.......,... ....................."''''.......... 45.009.29 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-18-2002 CDOO1432 2.000.00 38.000.00 02-12-2003 CD002159 .00 5.000.00 03-31-2003 CD002359 .00 9.29 05-19-2003 CD002588 11. 73- 11.73 TOTAL TAX CREDIT 45.009.29 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 l( If PAID AfTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION Of ADDITIONAL INTEREST. ( If TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. If TOTAL DUE IS REfLECTED AS A "CREDIT"" (CR). YOU HAY BE DUE A REfUND. SEE REVERSE SIDE OF THIS fORH fOR INSTRUCTIONS. ) ( d-. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Robert H. Griswold Date of Death: April 26, 2002 File No. 2002-0445 P A File No.21-02-0445 To the Register: I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 13,2002: Name Address Anne G. DiSabation 1744 Flint Hill Road Landenberg, PA 19350 David R. Griswold 622 Perry Valley Road Millerstown, PA 17062 Scott M. Griswold Route 1, Box 1247-A Bridger, MT 59014 Notice has now been given to all persons entitled under Rule 5.6 (a) except: None. Date: May 13, 2002. Signature:~ if.>---~ Name: S. Berne Smith Address: 107 N. 24th Street Camp Hill, PA 17011-3602 Telephone: 717-737-6789 Capacity: Personal Representative X Counsel for Personal Representative r'""'\,- .... J'< ~ . :":.:;,: '. d f'...' :r:::: -..< '-"r; --J S. BERNE SMITH Attorney-at-Law 107 N. 24th Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717)737-6783 July 18, 2002 In re: Estate of Robert H. Griswold, DOD 4-26-2002; SS# 204-03-6272 PA File # 21-2002-0445 My File: 145003 CERTIFIED MAIL, RETURNED RECEIPT REQUESTED Mary C. Lewis, Register of Wills Courthouse 1 Courthouse Square Carlisle, P A 17013-3387 Dear Ms. Lewis: ~ I am attorney for the Executors of the Estate of Robert H. Griswold. On behalf of the Executors enclosed is Estate check No. 104 in the amount of Thirty-Eight Thousand Dollars ($38,000.00) made payable to Register of Wills, Agent, as a prepayment of the P A Inheritance Tax. Please send the receipt to the undersigned. Thank you for your attention to this matter. ~S;;::~l S. Berne Smith Enclosure: cc: Anne G. DiSabatino, Executrix David R. Griswold, Executor Scott M. Griswold, Executor C""-~ ~, ...J;. '--"'.1 P COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV"1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SMITH S BERNE ESQ 107 N 24TH ST CAMP HILL, PA 17011-3602 -------- fold ESTATE INFORMATION: SSN: 204-03-6272 FILE NUMBER: 2102-0445 DECEDENT NAME: GRISWOLD ROBERT H DATE OF PAYMENT: 07/19/2002 POSTMARK DATE: 07/18/2002 COUNTY: CUMBERLAND DATE OF DEATH: 04/26/2002 NO. CD 001432 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $ 38, 000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ANNE G DISABATINO C/O S BERNE SMITH ESQUIRE CHECK#104 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $38,000.00 MARY C. LEWIS REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 ~ oK VV" Name of Decedent: ROBERT H. GRISWOLD Date of Death: April 26, 2002 Will No. 2002-0445 Admin. No. 21-02-0445 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes _X_ No 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: Not applicable. 3. lfthe answer to No.1 is Yes, state the following: A. Did the personal representative file a final account with the Court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account is: Not applicable. C. interest? Yes X Did the personal representative state an account informally to the parties in No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attacked to this report. Date: October 24, 2003 ~4 IJ~ 4-S(< Signature S. Berne Smith. Esq. Name (Please type or print) Address: 107 N. 24th Street Camp Hill, PA 17011-3602 Telephone No. 717-737-6789 Capacity: Personal Representative _X_Counsel for personal representative E --- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF ROBERT H. GRISWOLD, DECEASED ORPHANS' COURT DIVISION No. 21-02-0445 F AMIL Y AGREEMENT filed on behalf of ANNE G. DISABATINO, DAVID R. GRISWOLD AND SCOTT M. GRISWOLD, CO- EXECUTORS !"-". ' I '-.i -...1 Counsel of Record for this Party: S. Berne Smith, Esquire P A LD. #07254 l07 N. 24th Street Camp Hill, P A 17011-3602 (717) 737-6789 FAMILY AGREEMENT THIS AGREEMENT by and between ANNE G. DISABATINO, DAVID R. GRISWOLD and SCOTT M. GRISWOLD, individually and as Co-Executors of the Estate of Robert H. Griswold, Deceased, WITNESSETH WHEREAS, Robert H. Griswold, died April 26, 2002, having left his Last Will and Testament dated January 19,2001, which was duly admitted to probate by the Register of Wills of Cumberland County at the above number and term May 3, 2002; and WHEREAS, Anne G. DiSabatino, David R. Griswold and Scott M. Griswold have been dilly appointed as Co-Executors ofthe Estate of Robert H. Griswold, Deceased; and WHEREAS, the parties in interest under the Last Will and Testament of Robert H. Griswold, Deceased, are: N Addr R I f h. Sh ame ess e a IOns IP are 1. Anne G. DiSabatino 1744 Flint Hill Road Daughter 1/3 of Landenberg, PA 19350 Residue 2. David R. Griswold 622 Perry Valley Road Son 1/3 of Millerstown, P A 17062 Residue 3. Scott M. Griswold Route 1, Box 1247-A Son 1/3 of Bridger, MT 59014 Residue WHEREAS, Robert H. Griswold, Deceased, was not survived by a spouse; and WHEREAS, there were no specific bequests; and WHEREAS, each of the residuary beneficiary parties to this Agreement having been kept apprised of the estate's probate and non-probate assets, receipts and disbursements, they have determined that no further Accounting, informal or formal, is necessary; and WHEREAS, it is the desire of the parties to this Agreement that final distribution of the estate be accomplished without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, it being the desire of the parties to avoid the expense, delay and publicity of a formal accounting; and WHEREAS, the parties to this Agreement each acknowledge to have received their one third share of the residue of the estate; NOW, THEREFORE, WITNESSETH, in consideration of the mutual promises, covenants and agreements recited herein the parties do agree as follows: 1. Each of the parties to this Agreement does hereby release and forever discharge the other parties from any and all liability which may from time to time arise in connection with their service as Co-Executors of the Estate of Robert H. Griswold, Deceased. The parties do further agree to indemnify and hold harmless each other from any and all liability which may arise against the estate from creditors or other claimants. 2. Each party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon their respective heirs, successors, administrators, and assigns. 3. This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. Dated as of {?cT~ 2..."1 ,2003. WITNESS: 7j;LIk~ , I ~ dI' ~. Anne G. DiS~atino, 1hdividually and as Co-Executor of the Estate of Robert H. Griswold, Deceased. WITNESS: :1tIr f.vW'M~/dU' D~f<GL'~ David R. Griswold, indivi ually and as Co-Executor of the Estate of Robert H. Griswold, Deceased !2:L~~ :2~~~ Scott M. Griswol, individually d as Co-Executor of the Estate of Robert H. Griswold, Deceased of ~.dWs COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN *' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 REV-75' EX AFP (01-0U .04 FEB 20 All :21 02-24-2004 GRISWOLD 04-26-2002 21 02-0445 CUMBERLAND 202 ROBERT H S B SMITH 107 N 24TI:I,ST CAMP HILL L,;S,it< PA ii 11 Ul9?urt Cwnbenand CO., PA Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR FILES ...... REY=736-EX--AFP--cOr:.-02'j-----.-.-Noffc'E--oF--JiETERMINAfIOtrANJi-AssEssMENY----------------------- ----- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF GRISWOLD ROBERT H FILE NO.2l 02-0445 ACN 202 DATE 02-24-2004 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 43,009.29 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 43,009.29 5. Pennsylvania Estate Tax Due .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ":"IlII COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 260601 HARRISBURG. PA 17126-0601 ~\'q -r REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 2002 _00445 __ YEAR. NUMBER REV-1500 EX (6-00) \'\ OFFICIAl.. USE ONLY FILE NUrJeER 21 OJl.NT'YCODE I- Z w Q w 1;3 Q DECEDENTS NME (lAST, FIRST. AND MIDDLE INITIAL) GRISWOLD, ROBERT H DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DO-YEAR) 04/26/2002 08/30/1915 (IF APPLICABLE) SURVNlNG SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 204-03-6272 TlIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOC~SECURnYNUMBER D [XJ ~ 00 1. Original Return D 2. Supplemental Return ",~IIlD D (.) fo 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) w 00 "" rvl 1 5: f~ L6J 6. Decedent Died Testate (Attach o:py of Will) l.AJ 7. Decedent Maintained a Living Trust (Attach ccpy of Trust) _ 8. Total Number of Safe Deposit Boxes ~ D 9. litigation Proceeds Received D 10. Spousal Poverty Credit (d81e 01 death between 12-31-91 ard1-1~) D 11. Election to tax under Sec. 9113(A)(AttaehSdlO) _ SECTION I/IUST BE COMPLETEQ. ALL CORIlESPON CONFIDENTIAL TAX otU.lA IQNSHOULDBE DIRECTED TO: NAME CQMPlElE M.<\IUNG ADDRESS 3. Remainder Return (date of dealh prior to 12-13-82) 5. Federal Estate Tax Retum Required !Z w Q Z l( i 8 FIRM NAME (If Applicable) TELEPHONE NUMBER 1. Real Estate (Schedule A) 36,500.00 124,850.08 0.00 0.00 57,887.67 0.00 OFFClAl USE ONLY (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or SoIe-Proprietorship (3) z o ~ :l t: 0.. <C l..l W a: 4. Mortgages & Notes Reeeivable (Schedule OJ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule Fl D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or l) 813,476.98 (4) (5) (6) 8. Total Gross Assets (total Lines 1-7) (8) 23,142.67 9,365.61 1,032,714.73 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) 32,508.28 1,000,206.45 0.00 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABlE RATES '5. Amount of Line 14 taxable at the spousal tax 0.00 z rate, or transfers under Sec. 9116 (a)(1.2) 0 ~ 16. Amount of Line 14 taxable at lineal rate 1,000,206.45 ::> 0.00 .. 17. Amount of Line 14 taxable at sibling rate :IE 0 0.00 U 16. Amount of Line 14 taxable at collateral rate ~ Tax Due I- 19. (14) 1,000,206.45 x.OO_(15) 0.00 x ,045-- (16) 45,009.29 0.00 0.00 45,009.29 x .12 (17) x.15 (18) (19) 20. o CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 2W4645 1.000 ~CflEqKlI1A"!'~: <;:'!-~'i" , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 February 11, 2003 Telephone (717) 787-3930 FAX (717) 772-0412 Mr Melvin A. Phillips, CPA. 210 Grandview Avenue Camp Hill, Pa.17011 Re: Estate of Robert H. Griswold File Number 2102-0445 Dear Mr Phillips: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before July 26,2003. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely,. _ ..;" ///;1 'j ;J " ~ ' "j(-<~/"'I/ ~~ / r J1 ../ ... ;J"'/ /j-;:"' /? ~,../ ;~<../IC.//'JJ_-Pt-./ ~ Jeffrey Hollenbush, Supervisor Document Processing Unit Inheritance Tax Division 1 Decedent's Com lete Address: SlREET ADDRESS 100 SYCAMORE DRIVE CITY WEST GROVE Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Cradtt B. Prior Payments C. Discount STATE PA ZIP 19390 (1) 45,009.29 0.00 43,000.00 2,000.00 Total Credtts (A + B + C) (2) 45,000.00 3. InteresUPenalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnteresUPenatty (0 + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 9.29 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Pa able to: REGlSTEROFW1I..LS,AGENT (5B) 9.29 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . D 00 b. retain the right to designate who shall use the property transferred or its income: . D 00 c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . 0 00 d. receive the promise for life of either payments, benefIts or care? . . . . . . . . . D 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . , . . . . . . . . . . . . . . , . . . . . . ., [X] 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 00 4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property which contains a beneficiary designation? . . . . , . . . . . . . . . . . . . . . . . . . . , . . , , ,. 0 [Z] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEOULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare Itlatl tlave eKamined this ret\Jm, Indud.,g accompanying schedule5 and statements, and 10 ttle best of my knowledge and belief, it is true, correct .md complete DeclaraHon of preparer other than the personal representati~ is based on all information of ....niGh proparer has any kncrwledge SIGNATU OF PERSON RESPONSIBLE F FILING RETURN I ' ~ ~ ;;c~ 3 SIGNATU~ 'f PREP~ER.~AN REPRESENTATIVE ~ K. N-.u.... eRA ADDRESS ran VJ.QW ve ue Camp Hill, PA 17011 ,~A ~~r:' c DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~ 9916 (al (1.1) (il]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use otthe surviving spouse is 0% (72 P.S. S 9116 (a) (1.1) (Ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stili 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 twenty-one yealll 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% (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%, except as noted in 72 P.S. 9 9116(1.2) [72 P.S. 99116(a)(1)]. The tax rate Imposed on the net value of transfers to or ror the use of the decedent's siblings Is 12% (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, 'o'ktBther by blood or adoption. W46461.000 Estate of: ROBERT H GRISWOLD 204-03-6272 CO-EXECUTOR DAVID R GRISWOLD 622 PERRY VALLEY ROAD MILLERSTOWN, PA 17062 SCOTT M GRISWOLD ROUTE 1, BOX 1247-A BRIDGER, MT 59014 REV-1502EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF GRISWOLD, ROBERT H FILE NUMBER 21-2002-00445 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 a1 which property would be exchanged between a willing buyer and a wllling seller, neither being compelled to buy or sell, both havIng reasonable knowledge of1he relevan1 facts. Real property which is jolntly.owned with right of survivorship must be disclosed on Schedule F. NGU'~ER DESCRIPTION 1. Land known as RD Canton, Ward Township, PA 17724, 65 Acres (See appraisal attached) VALUE AT DATE OF DEATH 36,500.00 2Wo46952.0oo TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 36 500.00 REY-l504 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP ESTATE OF GRISWOLD, ROBERT H FILE NUMBER 21-2002-00445 Schedule C-t or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole.proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. DESCRIPTlON VALUE AT DATE OF DEATH ITEM NUMBER 1. 2W46972.000 TOTAL (Also enter on line 3, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 0.00 REV-1507 EX.. 1'-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRISWOLD, ROBERT H SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER 21-2002-00445 All property joinUy-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT OATE OF DEATH 1. TOTAL (Also enter on line 4, Recapitulation) $ 0.00 2W46AC 2.000 (If more space Is needed, insert additional sheets of same size) , REV.15GB EX~ (1-97) COMMJN'vVEAL TH OF PENNSYLVANIA INI-IERfTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF GRISWOLD, ROBERT H FILE NUMBER 21-2002-00445 Include the proceeds of litigation and the dale the proceeds 'N8f8 received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Citizens Bank, Account Number 112-412-5624 Checking, Robert H Griswold) (Personal Interest VALUE AT DATE OF DEATH 37,694.27 2 Citizens Bank, Account Number 31-A30711-C (Certificate of Deposit, Robert H. Griswold) 1,002.08 3 Cash on Hand at Date of Death 354.00 4 Traveler t s Checks 200.00 5 Personal property Located at 100 Sycamore Drive, West Grove, PA (See attached listing and appraisal) 4,360.00 6 1997 Ford Crown Victoria Sedan LXI 28,652 Miles - See Attached Appraisal 9,500.00 7 McNees Wallace - Retirement Income Receivable 1,888.32 8 United States Treasury-2002 Form 1040 Refund 2,889.00 2W46AD2.000 TOTAL {Also enter on line 5 Rer..qnitulation\ $ (If more space is needed, insert additional sheets of the same size) 57,887.67 REV-l&l9 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRISWOLD, ROBERT H SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21-2002-00445 If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. c. JOINTL y-oWNED PROPERTY: <mER DATE DESCRIPTION Of PROPERTY %OF DATE OF DEATH ITEM FORJOINT MADE Include na~~~:,nancial insUlulion and bank account number or DAlE OF DEATH DECO'S VAlUE OF NUMBER T""'" JOINT similar ldenll in nulTtler. Attach deed for JOInllv-held real estate. VAlUE OF ASSET INTEREST DECEDENrS ImEREST 1. TOTAL (Also enter on line 6 Recanitulation\ $ 0.00 2W46AE 2.000 (If more space Is needed, insert additional sheets of same size) REV-1510 EX+ (1-97) COMMONWEAL TIi OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRISWOLD, ROBERT H SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-2002-00445 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ceSCRIPllON OF PROPERTY %OF ITEM IN:::l..UDE TI-E t.w.JE OF TI-ETRMISFEREE, TI-EIR RELATIONSHIP TO DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE NUMBEF DECEDENT ANO THE DATE OF TRANSFER ATTACH A COPY OF THE VALUE OF ASSET ~F APPUCABLE\ DEED FOR REAl.. ESTATE INTEREST 1. Various securities transferred 711,010.99 100.00 0.00 711,010.99 to Hershey Trust Company, trus tee, Robert H. Griswold T/U/A (#25-6564387) for the benefit of Robert Griswold on October 29,1996 (see copy of trust agreement attached) . See Statement G-1 for a copy of the computation of the amount included. 2 IRA - Citizens Bank A/C# 4,465.99 100.00 0.00 4,465.99 00313-001266 3 14 GIFTS TO 14 RECIPIENTS OF 98,000.00 100.00 0.00 98,000.00 $7,000 EACH TOTAL (Also enter on line 7, Recapitulation) $ 813,476.98 (If more space is needed, insert additional sheets of same size.) 2W46AF 2.000 REV.1511 EX + {1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONVVEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRISWOLD, ROBERT H FILE NUMBER 21-2002-00445 Debts of decedent must be re..orted on Schedule I. ITEM NUMBER OESCRIPTlON AMOUNT A. FUNERAL EXPENSES: 1. Musselman's Funeral Home, Inc. - Funeral Charges 7,931. 95 2 Evans Cemetary Memorials-Engraving of Monument 100.00 3 Harding's Restaurant-Funeral Dinner 1,032.72 B. ADMINISIRATNE COSTS: 1. Personal Representative's COmmissions 0.00 Name of Personal Representative{s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Name: 9,250.00 3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 0.00 5. Accountant's Fees Name: 4,000.00 6. Tax Return Preparer's Fees 0.00 7. Appraisal - Land-Tioga County Property 250.00 8 Register of Wills-Filing fee 566.00 9 Bank charges 12.00 TOTAL (Also enter on line 9, Recapitulation) $ 23,142.67 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) REV-1512 EX+ (1-g7} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRISWOLD, ROBERT H SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2002-00445 Include unreimbursed medical expenses. ITEM NUMBER OESCRIPTlON AMOUNT 2,508.40 1. NCS Heal th Care, Pharmacy Bill 2 SpaceMart Self-Storage - Desk Storage 55.12 3 Verizon Wireless - Telephone 11.59 4 NCS HealthCare - Pharmacy Bill 121. 17 5 Verizon Wireless - Telphone 2.86 6 SpaceMart Self-Storage - Desk Storage 55.12 7 State Farm Insurance Company - Auto Update 44.63 8 Ann R. Dorsey - Real Estate Taxes, Tioga County property 739.89 9 Hershey Trust - Service charge 16.45 10 Hershey Trust - Service Charge 9.54 11 Hershey Trust - Service Charge 4.02 12 PA Dept. of Revenue - 1st Quarter PA-40 Estimate for 2002 70.00 13 Jenner's Pond - Retirement Home 3,870.00 14 Verizon - Telephone 51.82 15 Brown, Schultz, Sheridan & Fritz - Accounting Fees 1,660.00 16 Med-Trans, Inc. - Medical Transportation 55.00 17 PA Department of Revenue 90.00 2W46AH2,OOO TOTAL (Also enter on line 10, Recaoitulation) $ (If more space is needed, insert additional sheets of the same size) 9,365.61 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX REruRN RESIDENT DECEDENT ESTATE OF GRISWOLD ROBERT H NUMBER I. 1. NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfers under Sec. 9116 (al (1.2)] GRISWOLD, DAVID R 622 PERRY VALLEY ROAD MILLERSTOWN, PA 17062 FILE NUMBER 21-2002-00445 RELATIONSHIP TO OECEDENT Do Not List Trustee(s) SON DAUGHTER SON AMOUNT OR SHARE OF ESTATE 333,402.15 333,402.15 333,402.15 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON- TAXABUE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 2W46A11,OOO 2 DISABATINO, ANNE G 1744 FLINT HILL ROAD LANDENBERG, PA 19350 3 GRISWOLD, SCOTT M ROUTE 1, BOX 1247-A BRIDGER, MT 59014 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II_ ENTER TOTAL NON-TAXABLE DISlRIBUTlONS ON LINE 13 OF REV-1500 COVER SHEET (If more space IS needed, Insert additional sheets of the same SlZ6) $ 0.00 REV-1514 EX'" (1-97) SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on Rev-1500 Cover Sheet COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRISWOLD, ROBERT H FILE NUMBER 21-2002-00445 This schedule is to be used for all single Ine, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single Ine calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. o Will 0 Intervivos Deed of Trust 0 Other NAME(S) OF LIFE TENANT S NEAREST AGE AT DATE OF BIRTH DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE Term of Years Term of Years Term of Years 1. Value of fund from which life estate is payable 2. Actuarial factor per app~iate table Interest table rate- U 3112% 0 6% 0 10% 3. Value of life estate (Line 1 multiplied by Line 2) Term of Years $ o Variable Rate % $ NEAREST AGE AT DATE OF BIRTH DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE NAME(S) OF ANNUITANT S Term of Years Term of Years Term of Years 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26)[] Monthly (12) o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) OOther ( ) 3. Amount of payout per period $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate 0 31/2% D 6% D 10% DVariableRate % 6. Adjustment Factor (see instructions) 7. Value of annuity. If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 $ Term of Years NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13,15.16 and 17. (If more space is needed, insert additional sheets of the same size) 2W46AJ 1.000 . . REV.16U EX+ (1-97) SCHEDULE 0 COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN RESIDENT DECEDENT (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER GRISWOLD, ROBERT H 21-2002-00445 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual, A, S, By-pass, Unified Credit, etc.) If a trust or similar arrangement meels the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed in Schedule 0, and b. The value of lhe trust or similar arrangement is entered in ~ole or in parl as an asset on Schedule 0, then the transferor's personal representative may specifically idenllfy the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction rlthe trust or similar arrangement. The numerator of Ihis fraction is equal to the amounl of the trusl or similar arranClement included as a taxable asset on Schedule o. The denominator is eCluallo the lolal value of the trusl or similar arranClemen1. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's survivina SDouse under a Section 9113(A) trust or similar arrannement. CESCRlPTlON VALUE Part A Total $ 0.00 PART B: Enter the descnntion and value of all interests included in Part A for which the Section 9113 A election to tax is beina made. DESCRIPTION VALUE Part B Total $ 0.00 (If more space is needed, insert additional sheets of the same size) 2W48E21,OOO ESTATE OF ROBERT H. GRISWOLD 204-03-6272 FORM REV-1500EX LIST OF ATTACHMENTS CERTIFIED COpy OF WILL SCHEDULE A - REAL ESTATE APPRAISAL SCHEDULE E - APPRAISAL OF CONTENTS OF RESIDENCE SCHEDULE E - APPRAISAL OF AUTOMOBILE SCHEDULE G - V ALUA TION OF TRUST SCHEDULE G - TRUST AGREEMENT LAST WILL AND TEST AMENT OF ROBERT H. GRISWOLD I, ROBERT H. GRISWOLD, of Hampden Township, Cwnberland COWlly, Pennsylvania, being of sound mind and disposing memory, do hereby make this Will, hereby revoking all my fonner Wills and Codicils: Article One: Tangible Personal Property: S 1.1 I bequeath all my tangible personal property in accordance with the terms of a personal property memorandum I may prepare. lfno such memorandum is located or received by the Executor within 60 days after being appointed as such. after conducting a reasonable search for such memorandum, the Executor shall be held harmless for distributing such property as hereinafter provided. S J.2 I bequeath such property not disposed of by such memorandum, or all of such properly if no such memorandum is located or received, to my children, per stirpes. to be divided among them in as nearly equal shares as they agree. In the event of lITeconcilable disagreement among my children, they shall take alternate turns selecting individual items with the oldest child making the first selection. Any items not so selected shall be sold and the proceeds shall pass as a pan of my residuary estate S 1.3 To the extent practicable in the Executor's sole discretion, I bequeath any policies of insurance on such property to the beneficiary entitled to such property S 1.4 I direct that the expenses of storing, packing, shipping, insuring and delivering any such property to the beneficiary entitled thereto shall be paid by the Executor as an admmistrative expense of my estate. Article Two: Residue: !i2 I I bequeath and devise all the residue of my estate, of whatever nature and wherever situated, including any property over which I have a power of appointment, to be divided among my children, per stirpes, subject to the provisions of !i2.2 hereinafter. My three children are: David R. Griswold of Millerstown, PA; Scott M. Griswold of Billings, MT; and Anne G. DiSabatino of Landenberg, P A. !i22 1 give to the Trustee hereinafter named any share passing hereunder for the benefit of any Beneficiary of mine, who shall not have attained the age of twenty-two (22) years, to be held, administered and disposed of in accordance with Article Three hereof (the "Beneficiary's Trust") for the benefit of such Beneficiary. Article Three: The Beneficiary's Trust: !i3.1 The Trustee shall hold, manage, invest and reinvest the assets of the Beneficiary's Trust, collect the income thereof and: !i3.1.1 While the beneficiary of the Beneficiary's Trust (the "Beneficiary") is under eighteen (18) years of age, the Trustee shall apply to or for the benefit of the Beneficiary so much of the net income and, if the net income is insufficient, so much of the principal of the Beneficiary's Trust as the Trustee shall from time to time deem necessary or proper for the Beneficiary's health, maintenance, support and complete education, including preparatory, college and graduate education, and professional, vocational or technical training, taking into account other available funds, including the Beneficiary's assets. The Trustee shall annually accumulate any net income not so distributed and add the same to the principal of the trust property. 93.1.2 Afterthe Beneficiary attains eighteen (18) years of age, the Trustee shall distribute to or for the benefit of the Beneficiary the net income of the Beneficiary's Trust in quarter-annual installments, or more frequently if the Trustee deems it advisable, and so much of the principal as the Trustee shall from time to time deem necessary or proper for the Beneficiary's health, maintenance, support and complete education, including college and graduate education, and professional, vocational or technical training, and to assist the Beneficiary with reasonable wedding expenses, in the purchase of a principal residence or in the establishment of a profession or business considered a good risk by the Trustee, taking into account other available funds, including the Beneficiary's assets. 93.1.3 Any Beneficiary upon reaching the age of twenty-two (22) years may withdraw any or all of the principal of that Beneficiary's Trust. 931.4 If the Beneficiary dies before the complete termination of the Beneficiary's Trust, the Trustee shall distribute the property then held in trust to such persons or corporations, (including the Beneficiary's estate), in such amounts and upon such trusts, terms and condition, as the Beneficiary by last Will may appoint by 2 specific reference to this general power of appointment; provided, however, any portion of the trust property not subject to the Beneficiary's power of withdrawal immediately prior to the Beneficiary's death may only be appointed to one or more of the Beneficiary's issue, in such amounts and upon such trusts, terms and conditions as the Beneficiary by last Will may appoint by specific reference to this special power of appointment. Any property not so appointed shall be distributed to the Beneficiary's then living issue, per stirpes, or if none, in accordance with the provisions of Article Two above. Article Four: Appointment of Fiduciaries: 94.J [appoint my children, David R. Griswold, ScOll M Griswold, and Anne G. DISabatino, as Co-Executors of this Will If one or more of them are unable or unwilling to serve or continue to serve, for any reason whatsoever, those remaining shall continue to serve as Co- Executors or sole Executor, as the case may be. All references herein to the "Executor" shall mean my originally appointed Co-Executors or sole Executor, as the case may be. 911.2 I give my Executor the discretion and authority to name a person or persons to be the Trustee(s) of any trust which may be created under this will. Article Five: Powers of Fiduciaries: 95.1 No fiduciary under this Will shall be required to give bond or other secunty for the faithful performance of the fiduciary's duties. 95.2 Any such fiduciary shall have the following powers, in addition to those given by law 95.2.] To invest in, accept and retain any real or personal property, including stock of a corporate fiduciary or its holding company, without restriction to legal investments; 95.2.2 To sell, exchange, partition or lease for any period of time any real or personal property and to give options therefor for cash or credit, with or without securi ty; 95.2.3 To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; 95.24 To hold shares of stock or other securities in nominee registration 3 fonn, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; ~5.2.5 To engage in litigation and compromise, arbitrate or abandon claims; ~5.2.6 To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributes on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; ~5.2.7 To make elections, decisions, concessions and settlements m connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person affected thereby; ~5.2.8 To allocate, in the Executor's sole and absolute discretion, any portion of my exemption under Section 2631 (a) of the Internal Revenue Code to any property as to which I am the transferor, including any property transferred by me during my lifetime as to which I did not make an allocation prior 10 my death; 95.2.9 To disclaim any interest [ may have in any estate if the Executor deems such disclaimer to be in the best interests of my estate and the beneficiaries thereof; ~5.2.1 0 To terminate any trust created herein, the principal of wnich is or becomes too smail in the Trustee's discretion to make the establishment or continuance of the trust advisable, and to make immediate distribution of the then remaining trust property to the beneficiary then entitled to the income of the trust property or, if there is more than one beneficiary, to the beneficiaries then entitled to the income of the trust property in proportion to their respective interests therein or, if such interests are not defined, in equal shares to such beneficiaries; provided, however, no Trustee shall participate in any decision to terminate such trust if by reason of such termination such trustee could receive a distribution of trust property from such trust as aforesaid. The receipts and releases of the distributee(s) will terminate absolutely the right of all persons who might otherwise have a future interest in the trust, whether vested or contingent, without notice to them and without the necessity of filing an account in any court; and 95.2.11 To merge any trust created hereunder with any other trust or trusts if the terms of any such trust are then substantially similar and held for the primary benefit of the same person or persons. 4 Article Six: Provision for Taxes: 96.1 All estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of my death to any government or subdivision thereof upon or with respect to any property subject to any such tax ("Death Taxes"), and any penalties thereon, shall be paId by the Executor as follows: 96.1.1 Death taxes due on the value of items of Tangible Personal Property bequeathed pursuant to Article One shall be paid out of the principal of the residual portion of my estate disposed of by Article Two of this Will. 96.1.2 Death taxes, if any, due on the value of assets such as life insurance policies, my IRAs or Annuities shall be paid out of the proceeds of those assets on a prorate basis before distribution of the balance of the accounts is made to the beneficiaries named in the life insurance policIes, lRAs or Annuities. 96.1.3 Any other death taxes due on all other assets shall be paid by the Executor out of the principal of the residual portion of my estate disposed of by Article Two of this Will Article Seven: Provision for Debts and Expenses: 971 I direct that any of my legally enforceable debts, any expenses of my last illness, funeral and burial, and any of the administrative expenses of my estate shall be paid from the principal of the residual portion of my estate disposed of by Article Two of this Will. Article Eight: Miscellaneous Provisions: 981 As used in this Will, the term "Internal Revenue Code" shall mean the Intemal Revenue Code of 1986, as amended from time to time, or the corresponding provision of sllbsequent law 98.2 Whenever the Fiduciary is to distribute property to or for the benefit of any beneficiary who is under (a) eighteen years of age, or (b) a legal disability or otherwise suffers from an illness or mental or physical disability that would make distribution directly to such beneficiary inappropriate (as determined in the Fiduciary's sole discretion exercised in good faith), the Fiduciary may distribute such property to the person who has custody of such beneficiary, may apply such 5 property for the benefit of such beneficiary, may distribute such property to a custodian for such beneficiary, whether then serving or selected and appointed by the Fiduciary (including the Fiduciary), under any applicable Uniform Transfers to Minors Act or Uniform Gifts to Minors Act, may distribute such property directly to such beneficiary's estate, or may distribute such propeny directly to such beneficiary (except if any of the conditions hereinbefore described in (b) apply), without liability on the part of the Fiduciary to see to the application of such propeny This provision shall nol in any way operate to suspend such beneficiary's absolute ownership of such property or to prevent the absolute vesting thereof in such beneficiary ~83 Except as otherWise may be provided In thiS Will, until the property is distnbuted to and received by any beneficiary hereunder, the principal sums thus held for any beneficiary, respectively, and the income thereof shall not be subject to or liable for any contracts, debts, engagements, liabilities or torts of such beneficialY now or hereafter made, contracted, incurred or committed, but shall be absolutely free from the same, and such beneficiary shall have no power [0 sell, assign or encumber all or any part of the principal sums or such beneficiary's interest therein, respectively, or the income thereof, or to anticipate the income. ~84 Ifany beneficiary hereunder should die within thirty (30) days after me or wlthlfl thll1y (30) days after any other person the survival of whom determines his rights hereunder, then such benefiCIary shall be deemed to have predeceased me or such other person for all purposes hereunder IN WITNESS WHEREOF, I, ROBERT H. GRJSWOLD, have hereunto set my hand and seal to this, my last Will, typewriuen on eight (8) sheets of paper, including the self-proving 11. f attestation clause and signatures of witnesses, this /0 - day of v Il A' <, fl "7 , 200 I. WJ ltJ J1 (SEAL) ROBERT H, GRISWOLD Signed, sealed, published and declared by the above named ROBERT H. GRISWOLD as and for his last Will, in the presence of us and each of us, who. at his request and in hIS presence and 6 In the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year last above written. 9cu- {)AIU1~ Residing at ]811.. ?f'ln"~7 P;;.. ",'1..- tJ c; t... II '~,J, < j d r.l I' (,... ;'/) / 7 ().> ,. ~ihfl/A 7h -~ Residing at I iJ () (J /J t.. L ..: IV J"I ;1 '- ...~ W /'/'" Ie /,~ /.." /01 n 1$ -<---...- /J...........( I Residing at C 11n/, /f/~c r.f1 /700/ I /l J' / U I IV 2-'( - r. c . 'TnI' Ii" c f~/f / 7C' /1 COMMONWEALTH OF PENNSYL VANIA SS COUNTY OF CUMBERLAND We, ROBERT H, GRlSWOLD. the testator, and .....1(;-)\ ic:.f'1 f7 [/1/'0..1..-: JOlf/V ;1rl<'I'...:..rl~;V , and \ . 13 L~ I' /V c' J ; ? , r If , the witnesses, whose names are signed to the anached or foregOing instrument, being first duly sworn, do hereby declare to the underSigned authority that the testator signed and executed the instrument as his last Will; lhatthe testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each 7 subscribing witness in the hearing and sight of the testator signed the Will as a witness and that to the best of his or her knowledge the testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence Ci&Jljkt=J/ ROBERT H, GRISWOLD 9a-CY~ Witness )~(tA- ~~ . / t5~~ /! ______j ( , Witness Witness Subscribed, sworn to and acknowledged before me by ROBERT H. GRISWOLD, the testator, and subscribed J~5'J-'C/1 n !../I;voE and sworn to before J()~tJ /I''''-''J(','V me by and day of (' ;;;: 1'< N,' Jr" 7 ), , the witnesses, this n / "7 - J/?"""",t/JAy / , 2001. r/ ;i (/ ( (t' ;() OAA ~ . U.{; )'vt~<Vv~ Notary Public My Commission expires: <i/I F/7Cl.Y--1 SEAL IIOIAlllAL SEAl. IrJlISl L DflJ.IIAII. IlIlIAI'r MlIC ICAIIPIOfIlllP.. CUIIIOINIO rotIllTl flY COIlM~S1OII Dl'IRl$ $[n. II. 2004 8 A & D Al'praisals and Insurance Certified Appraiser Al Stoltzfus PO. Box 72 9/ Princeton St., Wellsboro, PA 16901 Office: 570-724-2539 Fax: 570-724-7164 Ii II I A&D Appraisals and Insurance 2002-204 File No. 2002-204 APPRAISAL. OF ~i ~"! " ,", Y"" " ,) ':.; ;~:~ .'^< ~~::~ ;:'- b~ ;,~ :'J Land Appraisal Report ~ lS ij: L.OCATEDAT: ;~ Y.1 , RD Canton Ward Town5hip, PA 17724 '1 " FOR: i, ~ i j ~ , David Griswold 622 Perry Valley Road MiIlerstown, PA 17062 BORROWER: Robert Griswold Estate AS OF: April 22, 2002 BY: Alvin J Stoltzfus, certified GRA GA-000810-L d1 t'.':"I"-::~:" if~, flr}? ,-, 0': t~.:; ~... ~."'f ;Vs ~Z: ! 1:1',"('\' ~;",~, ; :t::.<F: ','''-,'~ . 1 :::::.;:'~ "'" .':,;:i' 2002-204 Fi. No 2002-204 -I A&D Appraisals and Insurance May 20, 2002 DaVid Griswold 622 Perry Valley Road Millerstown, PA 17062 File Number. 2002-204 ,~' f Dear David, In accordance with your request, I have personally inspected and appraised the real property at: R D Canton Ward Township, PA 17724 . The purpose of this appraisal is to estimate the market value of the subject property, as vacant. The property rights appraised are the fee simple interest in the site. ,~ d i.j ,~~ ,. ~',.. '1;;" ~~I , ">.j ,~; Ji 0' J '~ In my opinion, the estimated lTlarket value of the property as of April 22. 2002 is: $36,500 Thirty-Six Thousand Five Hundred Dollars The attached report contains the description, analysis and supportive data for the conclusions, final estimate of value, descriptive photographs, limiting conditions and appropriate certifications, .; i'l ;q t: i: i i 1 fI ~ ; , Respectfuny Submitted, tl/~ AlVin J. Stoltzfus, Certified GRA GA-000810-L 2002-204 LAND APPRAISAL REPORT Fie No 2002-204 .';' ,p :~'.<~ ',:~ ';t~ ~q ~ , -:'i ::'.:~ .',1 ,,'j ':') ProDel"lY Address RD Canton I Cb Ward Township Counlv liona l...... [)nailllion See Deed Book 231 Pane 363 OwnerlOtnlD.llnt Robert Griswold Estate M Referef1ce 37 PL04 020 ., Sill. PrioB S 1 Dale of5i11e 8130143 Property Righls. Appraised loanc:n--sIconc8ssionslobepaidbv__S None Known ~ FMSimpI. RE. TaxK$ 1084.56 Tax-Year 2002 HOAWo N/A leashold lenw!Oieni David Griswold Condominium (HUDlVA) 622 Perry Vallev Road Millerstown PA 17062 I PUD Scurce LOCATION ~ Urbiin W Suburban ~ Rural NEIGHBORHOOD ANALYSIS Good....,,..__ BUILT UP 8 ()yer 75% W 25-75% 1KI Under 25% E~m.nl Stablity 0 (KI 0 ~ GROWTH RATE Rapid (KJ ~able 0 Slow Conurtiel108lo E"l'ioYlMnl 0 ~ B PROPERTY VALUES ltla1la$ing (R) Slabl& 0 [;le(jning ConvenilH1ce to Shopping 0 X DEMANOISUPPL y 0 Shorlage ~ In Balance CJ ()yer Supply. Convenience to Schoofs 0 X MARKETING TIME nUnder3Mos IXt3-6Wos. t IOver6Mos AdequaeyofPublicTransportahon ~ @ ~x B : PRESENT LAND USe,.. LAND USE CHANGE PREDOMINANT 5N1EFAMLYHC4.JSN:; ReaealionFaci~in l.CJ . Single Famiy ~ Not Ulely (R) OCCUPANCY PRICE AGE Adequacy of Fac:ilies B . ,~,..iy _ Ukoly 0 Owo. 00 ~OOO) On) '10""" Compot."y 0 0 .. Muth.Faml~ _ Inpl'OO!S$ 0 Tenal1 0 35 low 1 Proted:ionlromD<<rimentalCond B 00 0 0 Comll'eraal _ To. Vacant land is Vacant (0-5%) ~ 140 High 75 Pdice & Fn Pr~edion 00 0 0 ,."'."'" wooded and """.(...'5%) 0 .......... Gonn-.,..of'IO"..... 0 0 0 0 v"". 85% aoricuttural. 75 _ .......,....-, 14 rxi 14 14 Note: Race or the racial composihon of the neighborhood are nol considered reliable appraisal factors. COMMENTS.Subiect is located in a verv rural nelohborhood with PennsYlvania State Forest surroundino it Within 2 miles of Bradford Countv on the eastern edoe of Tiooa County, Verv nice location with a mixture of residential and seasonal dwellinas 5I:al. PA lAnsus T rarJ 9905 Zi> Code 17724 LENDER DISCRETIONARY USE ..._ SN/A o.t. MorIgageAmcM.ant $ Mortgage Type Disccunl Points and Ot'* Concessions Paid by SeIer $ ..':! t-~i Dimensions See attached deed descrintion Topography Sliaht orade to rollina S~eAtea 65 Acres Com&rlol No Size Tvnical for Area loningClassification ResidentlallAQricuttural Zoning~iance Yes Shape Rectanoular HIGHEST & BEST USE: Ptewnl Use Recreational Other Use Residential CKainage Aooears Adeauate UTILITIES Public Other SITE IMPROVEMENTS Type PubliC Prrtate View Tvnical EJed:rdy 0 None S1~ Gravel ~ ROB- Landscaping TVDical Gas 0 None CurblGuflllf None Oriv_a~ Gravel Water 0 None Sidewalle: None ~parent EaserNnts Usual Rd and Utilities Sanilal')' Sewer Cd None Street lights None FEIAA. Flood Hazard Yes. _ No "'C'" StormSe_ I I None AI.w None FEMA"Macl7ooe 422101 0004B 711187 Comnwnts (Apparent adnl'se easements. encroachrTllnls, special assessmllnls, $Iide areas., e1c.): Wooded land with some nice mature trees on an easy access maintaIned aravel road. No other adverse conditions soecial assessments encroachments or easements as per visual inspection :) i:~ ~,~.. ;_tl '.~ :,~ :f <) r~" unU"'9Md ~.. 'HitU I~'ee ,eceM IIln or p,a,e.lin ",011 ,,,'"ltl. Inf ,'U4"'lle to tubjecl .n~ nu ta~",de'U I~.n In Ih m.'kellnal,,,.. nl dutr,p""n ,ntlud.. I Oatia, 'OJUlI",~nl, <tll~cllnll ....UI .ea~loon la 111018 lIe.., 01 ,i9n'fjtlnl ..,illian b~l.ee" 1ft. ,ubl.cl I~d CQ"pe,,~j, pro,"'i... II'. .iV"iljc,"' It_rn ,n lilt C"rnp""bll p'ape,!I''' ,up...;o' 10_ 0' ma'e fuorUle !~.". Ihe sU~lect p,opor'y. a """u$ (-) 'diU'!"'""! I' "'lOt. tnus "~u~'nv Ihl 'ndical~~ .,Iue o! ,ublec'. ,I. siVn'f,clnl de'" in l~. cornpl,,~le Is ,n!..;o' to. o' In. I.."..~I~ l~l" I~, .lIb,HI ~rope'l~ I plY' (i) .dlu.\mtnl II mldt, lnu. 1"~"I"n, lftt Indicaled ..Ju. 01 I~. lubjecl ,( ITEM SUBJECT COMPARABLE NO_ 1 COMPARABLE NO_ 2 CO/6lARABLE NO.3 RD Canton RD#1 Rt 349 Rt 49 Off Tioga Street Addless Ward T ownshin Westfield PA '6950 Nelson PA 16940 Morris Run PA 16939 Pro.m.I:vloSubiec1 36.38 miles 26.09 miles 6,98 mites SaI.,poo. 1 1 S 33 000 S 26 900 1 33900 Pricel Acre S III 1 550 III S 37781 III 1 565.381ll DataSovroe Public Records MLSlPublic Records MLS/Public Records MLS/Public Records - VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION 1,.- DESCRlPTlON "-lS.....n..-f DESCRIPTION .r_IIMI<5t1Ni"ll . SalesOl"FlnanctJg None Known None Known None Known Concessions None Known None Known None known Oat, of Salemme 8130/43 4/9/2001 5/812001 4/3012001 . location Rural/Good Rural/Avo +4 000 RurallAvg +4 000 RuraVAva +4 000 SitelV," 65 Acres/Ava 60 AcreslAvo : "'2500 7120 Acres/B/Av": +7000 59, 96 Acr~AvQ +2 500 Seotic System None Perc : -2000 None Priw/Perc : -2000 Well None None SDrino -'000 Public -2000 : N8IAdi./lotall Xl-. I t- '$ 4500 Xl. I. '$ 10DOolfxl. I~~ ~ I ~ ~ of Subi~ ,..,.: $ 37 500 Nit $ 36 900 Net Commttnts of Sales Comparison: These comDarables are considered to be the best available at the time of inspection. adiusted for includina: acreaae location well and sPntic. il. :1 Is 2500 36400 Maior differences were Comments and Conditions of Appraisal: See Limitina Conditions. Final Reconciliation: Sublect property is vacant land only Income Approach does not applv. The three comparables chosen represent the . averaae market data available usina MLS and Dublic records. I ('M:)ESTIMATETHE MARKET VALUE,AS OEFINED,OFTHESUBJECT PROPERTY AS OF ADril22 2002 tobeS 36500 . I (We) certify t!MIl to the besl 0' ~(our) knowledge and belief, the facts and data used herein are true and cOlTed, lhat 1 (we) personally Inspected the sub/ed: property andlnSPeded~IICO s s .:'th . Ihall(wI)hannoundlSdosNll'ltnsl Pl'eMnlororosoedrweln-rn .. , ~ ASSIStant to tl1,e, Cet:tilied Rea) Estate Appra,ser '00"""") r , ...::{;001 rI..{)(l~li/.J OOid 00_0,"'" AFof"i" I c::t....~f..... r.....f........ r.:D" (if.......:.........,,\....., _ . f\H~fi~~ ~~~~i1l'\ . \!'~~: '~~~ h\i;'; t'.>:i. .":rr"~ ~~'; ;p'l ~\,<j ~!.<;?:> . . .~c,:,\ t"::';,> 'j"'" ??~~,.-. !:~.,{;~.; ~':F~i ,t) ~,] 1'-X:;~ t?: ~i.'.">;. ,; '.-';,;, .' .~. h:i;;d . .'~~-~l ~.:;f!'> ~" . i;;~ l.;-). f;;,:L \1"..."'. ~~~:.l~e~ ~~.'t,:::,:: f~ ~,: ;::.~:~;)~ ~ ,..,;. 'i,!.... ~~~\~ "",.,\, ,'.<"ifl ~,:.,,~~, .,..q;~r 'r.l-~""~-~,' ~:w"'>t:H 2002 -20' Fi. No. 2002-204 DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing at title from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well informed or well advised, and each acting in what he considers his own best interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment is made in terms of cash in U.S dollars or in terms of financial arrangements comparable thereto; and (5) the price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions. granted by anyone associated with the sale ~ *Adjustments to the com parables must be made for special or creative financing Of sales concessions No adjustments are necessary for those costs which are normally paid by sellers as a result of tradition Of law in a market area; these costs are readily identifiable since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in the property or transaction, Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession but the dollar amount of any adjustment should approximate the market's reaction to the financing Of concassions based on the Appraiser's judgment. , '1' ~ ~I~...'.. ~ . , . ~.: ,~ STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION CONTINGENT AND LIMITING CONDITIONS: The appraiser's certification that appears in the appraisal report is subject to the following conditions: 1. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised or the title to it. The appraiser assumes that the title is good and marketable and, therefore, will not render any opinions about the title. The property is appraised on the basis of it being under responsible ownership. b: , p 2. The appraiser has provided a sketch in the appraisal report to show approximate dimensions of the improvements and the sketch is included only to assist the reader of the report in visualizing the property and understanding the appraiser's determination of its sIZe. 3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted in the appraisal report whether the subject site is located in an identified Special Flood Hazard Area. Because the app-aiser is not a surveyOf, he Of she makes no guarantees, express IX implied, regarding this determination. i~ n ." ..'-J', 4 The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do so have been made beforehand, 5. The appraiser has estimated the value of the land in the cost approach at its highest and best use and the improvements at their contributory value. These separate valuations of the land and improvements must not be used in conjunction with any other appraisal and are invalid if they are so used I,~ :~1 f~ ~~ ,! " 6. The appraiser has noted in the appraisal report any adverse conditions (such as, needed repairs, deprecialion, the presence of hazardous wastes, toxic substances, etc. ) observed during the inspection of the subject property or that he or she became aware of during the normal research involved in performing the appraisal. Unless otherwise stated in the appraisal report, the appraiser has no knowledge of any hidden or unapparent conditions of the property or adverse environmental conditions (including the presence of hazardous wastes, toxic substances, etc ) that would make the property more or less valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, express or implied, regarding the condition of the property. The appraiser will not be responsible for any such conditions thaI do exist or for any engineering or testing that might be required 10 discover whether such conditions exist. Because the appraiser is not an expert in the fteld of environmental hazards, the appraisal report must not be considered as an environmental assessment of the property. !-i ) j ~ :1 ;1 \~ I 1 I ~ 7, The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he or she considers to be reliable and beheves them to be true and correct. The appraiser does not assume responsibility for the accuracy of such items that were firnished by other parties. 8. The appraiser will not disclose the contents of the appraisal report except as provided for in the Uniform Standards of Professional Appraisal Practice. 9. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory completion, repairs, ex alterations on the assumption that completion of the imp-ovemenls will be performed in a workmanlike manner. 10. The appraiser must provide his or her prior written consent before the lenderJclient specified in the appraisal report can distribute the appraisal report (including conclusions about the property value, the appraiser's idenlity and professional designations, and references to any professional appraisal organizations or the firm with which Ihe appraiser is associated) to anyone other than the borrower; the mortgagee or its successors and assigns; the mortgage insurer; consultants; professional appraisal organizations; any state or federally approved financial institution; or any department, agency, or instrumentality of the United States or any state or the District of Columbia; except that the lender/clienl may distribute the property description section of the report only to data collection or reporting service(s) without having to obtain the appraiser's prior written consent. The appraiser's written consent and approval must also be obtained before the appraisal can be conveyed by anyone to the public through advertising, public relations, news, sales, or other media. L'.,_ \:.. I ! ~ ~I ~ ~ "1 !il :~~~ ;.~.j t'~ ~l .:"1 "'t !a , II::) l' f. "'/: ;l f{ "~'I ;:! , J :! ~( " ~, '~ ~ ., ~ ~ ~ 2002-204 'lo No. 2002-204 APPRAJSERS CERTIFICATION: The Appra~", certifies and agr." lI1at; 1. I have researched the subject market area and have selected a minimum of three recent sales of properties most sImilar and proximate to the subject property for consideration in the sales comparison analysis and have made a dollar adjustrMnt when appropriate to reflect the market reaction to those items of significant variation. If a significant item in a comparable property is superior to . or more favorable than, the sub,eel property, I have made a negative adJustment to reduce the adjusted sales price ot the comparable and, it a significant item in a comparable property is inferior to, or less favorable than the sublect property, I have made a positive adjustment to increase the adjusted sales price of the comparable 2. r have taken into consideration the factors that have an impact on value in my development of the estimate of market value in the appraisal report. I have not knowingly withheld any sIgnificant information from the appraisal report and I believe, to the best of my knowledge, that all statements and information in the appraisal report are true and correct. 3. I stated in the appraisal report only my own personal, unbiased, and professional analysis, opinions, and conclusions, which are subject only to tne contingent and Limiting Conditions specffied in this form 4. r have no present or prospective interest in the property that is the subject to this report, and I have no present Of prospective personal interest or bias with respect to the participants in the transaction. I did not base, either partially or completely, my analysis and/or the estimate of market value in the appraisal report on the race, color, religion, sex, handicap, familial status, or national origin of either the prospective owners or occupants 0' the subject property or of the present owners or occupants of the properties in the vicinity of the subject property 5_ I have no present or contemplated future interest in the subject property, and neither my current or future employment nor my compensation for perfOl'ming this appraisal is contingent on the appraised value of the p-operty. 6. J was not reqUired to report a predetermined value or direction in value that favors the cause 01 the chent or any related party, the amount of the value estimate, the attainment of a specific result, or the occurrence of a subsequent event in order to receive my compensation andlor employment for performing the appraisal. I did not base the appraisal report on a requested minimum valuation, a specific valuatIon, a the need to approve a specdic mortgage loan. 7. I performed this appraisal in conformity with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal FoundatIOn and that were In place as of the effectIVe date 01 thiS appraisal, with the exception of the departure provision of those Standards. which does not apply. I acknowledge that an eslimate of a reasonable time for exposure in the open market is a condition in the definition of market value and the estimate I developed is consistent with the marketing tIme noted in the neighbcfhood section of this report, unless I have otherwise stated in the reconciliatIon section 8. I have personally inspected the subject property and the exterior of all properties listed as comparables in the appraisal report. I further certify that r have noted any apparent or known adverse conditions in the subject improvements, on the SUbJBct site, or on any site within the immediate vicinity of the subject property of which I am aware and have made adjustments for these adverse conditions in my analysis 01 the property value to the extent that I had market evidence to support them. I have also commented about the effect of the adverse conditions on the marketability of the subject p-operty. 9. I personally prepared all conclusions and opinions about the real estate that were set forth in the appraisal report. If 1 relied on significant professional assIstance from any individual or indiVIduals in the performance of the appraisal or the preparatIon of the appraisal report, 1 have named such individual(s) and disclosed the specific tasks performed by them in the reconciliation section of this appraisal report. I certify that any individual so named is qualified to perform the tasks_ 'have not authorized anyone 10 make a change to any ilem in the report; thereklfe, if an unauthorized change is made to the appraisal report, f will take no responsib~ity tor it. SUPERVISORY APPRAISER'S CERTIFICATION: If a supervisory appraiser SIgned the appraisal report, he Of she certifies and agrees that: I directly supervise the appraiser who prepared the appraisal report, have reviewed the appraisal report, agree with the statements and conclusions of the appraiser, agree to be bound by the appraiser's certifications numbered 4 through 7 above, and am taking full responsibility for the appraisal and the appraisal report. ADDRESS OF PROPERTY APPRAISED: 65 Acres, Ward Township, PA APPRAISER: StgnatLr';~ Name AIViOC~!;.:ed GRA Date Signed: Mav 20, 2002 S1ale Certification #: GA.000B10.L Q' State license 'M: Stale: PA Expiration Date of Certification or License: June 30, 2003 Assistant to the Certified Real Estate Appraiser S'gnah.. ,,"f ).lY)J'I. I'CJQi }J{J/W Name: Susan M Owens, Assistan to the Certified GRA Date Signed: May 20.2002 State CertifICation 'M: Assistant to the Certified or State Ucense II: Real Estate Appraiser State: PA Expiration Date of Certification or license' o Did 00 Did Notlnsped Property ~.1it.; il,,m tJJ~i ~!1;;.' [:.><." Mt~~;\ "~'N.l: lI't.~t t.:1_:~ :1 r;;o,'i;j tl1i'B~,..-.: Ii;,,;:, ~'t:;.)Jt,:~ ,~". ~~t t;;{:,\~ ~:, ";~>i ~l\l " f!~~t t.,--., ~(,. f,~:,) ~'~h'; .~tt~1 Il'.'~"" >t'" ~It:!.j.~ .~. '.'~"bi J:liA~ h' ;OJ L~ ~'~}$~ ~;:l"~~ ",."'i!<,t, i~'.'-".-'I..if1i :'il. ~il<<1; I':~' ' \; .' ""c."_ .'~ -rill -;-;::ii/, ~.:!;;::' '"',....!~ ~l"..'.~:"',..~0~~ . '0:,;"'.' ",jrr:'\ f~&~ r~"';jil~ t;i':'~',\r ,.,.,....~~..'c~. II;:{".~ , " ;:,\i l!.:~.'",. ~/j:l;';lli:<< '1""'''''''.1 ~'r> -':-:.' i ~t~f~(,;? ~"a"' h' f:'!~ti-: ~~.J.':- ,;; k'" ,,' ,*r;ltjt f:,'..~k, f~,rd Property Address: RD Canton City: Ward Township Lender: David Griswold Slate: PA ~;' ;~i ~, .:i :~ )}, !j [.1 () ,;:\ ~-b '"l , h 1.:1 1<'1 :J \~ 1----- ---..------.- I I I .-.- -------.--------.----.-.-l I I , :; .;i :.~ .-....... ..._~........ Case No : 2002-204 Zip: 17724 FRONT VIEW OF SUBJECT PROPERTY Appraised Date' April 22, 2002 Appraised Value: $ 36.500 REAR VIEW OF SUBJECT PROPERTY STREET SCENE f.ifi;:: f~ ;~ '~ :'.1 ~ ?'1 "'d f~l ~ ,~~ iJ! .:r, ~ ~t (, ::,:~ t) ',"., ':l , \ q 'j 1j i ~~ ~1 ',< ~'j l , ~ , . ~hD"leS ... \eS SillY the Par\( Aaaocletlon bo abla to hold the {'raaent OfUI ..Y Orl.... .nd .xlt ov.r the landa cr II.Vi.Alrer .dJolnlng t.hltl drlva on the South, then the above cIau... to be nu 1 IneS "Ol~ .. thlll object ct thlll chu.e 1_ to .......... the Sl'l"Jthe PaT'll Aaa01:h'!.lI;Jn of 01'\'.a1 drlv' IN'" llulir lInd. Incll..l:Unl' thh p1rc.l to Mdn Strut ~rln6 the "e'k of the IhIHJIE:leS Fair. 1'o.ll doled 1s I>~". 1n 1'\1I'.,,.n,,a to I ".rt"ll' lot "olltToct bB'!..""" u,a pIn tl". hereto of the flrBt an" aecond part: b~Rrln; date tl'\e ;o,Otli ""Y or July. A.t'. 1926. ~t ~~nr;. pIOn of the uma pIece or Illnd f1onvay.d to nld erontoro by "'lnnle L. ChI'''' et a1. by da"d cloted .l\lf.U!lt 18th, 1126. 'toc"th.r ..lth 1\11 .nll 111nf'''1Illr tile tano"",nta, "erecl1t......nt. Bnd oppurt~n.nC"B t,o tho SA"" belonf.lnr" cr In e"1"'1'1l 1l!'p"',.tR.lnlfl/', Bnd tl,e rav,rllon nnrt lev"ulonll, r~","lnder and remllnd,u8, rent8, ls.uea and l'roflts th..r"ot. AHn /',[.SO, all th.. elltrd.." dOlt, tJtle, In- tereat, provorty, chi'" lInd d"",IInrl .'h"t.coever, batt, In 1... und ",,"lty, of' tll.. .~1d p"ftlt-a of tha fir at pol"t, of, In, to or (lllt or tns allJd pr...,l"ll lJno:l IIvp.ry pllrt .nl! pBrcel ther.of, TO t,.ve lInd to Iiold thf 11810:1 premhu. WItt, all (lrd all\{f,\I1Ior the I>p}}\,rt'lll>tt"ll, unto ti,l' aAld plrt) of tile alleond rt'l"t, It~ B\leettlaOr" heIr, aflll aa,l!,na. to Bill! for Ibe onl,. IlJ'ol~r uao 1ot\<3 "Dllr.=f or \.ho 1I1\1d pllrt, 01 tne ...cond port, ita ."cc.u9C1r' hrllrl Rnd 19ldr:ns forever AND tho .a1d Orvlll.. L, SchMltacha" and )lartllll f., SCIH.nt..cl'llr, 1.1. w1la, for tI'e",,"1v.o, their 11.11'8, ex"cutot". IIn<'l e,mlnl"trl \ OT!, do by th8aa pt'IIannh, cov~n.l\t, gr.nt /lnrl .sr"" to and wIth tha .~1 d party of the second prl rt, It.. "ucc.....or8 ~,,,1 1'.. olld ..al;',n8, \J1,t:. tnsy ths "n16 OrvIlle [.. Schllnbachar .nll ~lR1'tlla~. SehltnbllChel, h1a ..U", the1.r heir.., III nn~ lllnlO'.uln. tha hel'IIIeSJ tRII"'nt. ."d pr_l.eB hordn n~ov,,-dOacriblltd IInd gro nt..d, or I1llntloned "nd Int. nd.ed t' ao t.o b.., "Ith tha a,..purteni\nCaB, Ullt.O the aflld part,. of the aeeon" pBrt, ito "neceB80r8 l'e1r nnrl "aall',r>~, "l'p1tl11t \'0' ...td partlea of' the nr~\, par't 1:81" tha1r helr~, an<'! .(!"lnst /ill e~ every ether person or persOl1l1, ""'omsoav",r, lU'lllU", claimIng or to clB1.. th~, BR."e or nny parti U-.r-uot, ''''611 llnd 1/111, by these rraOlln\'~, \1'M1RM'T ANP FORT:vr:A f'EI'TlID. ] IN WITNESS 'WERrOF', O.e 1l01<1 pllrtJn ol Ii,e I1rsl plrt h"va hereuntc. let tl,elr t\!,nds ond! aBrh, the dB,. ,nd ye..r f1.r.t ol.ove "rltt..n. Orville L. SCIDnb"Cher(S..al~ SJr-ned. atlnlecl ond clellvared In Ulll pre.ence ot LIe: l,nrU'lI A. Sch"nh9,I,er(S~all state of l'ennly}vRnla, J os, J TIO(lJI COlJ)lT'i, On tha eJ@lteenth clay of Augullt In t.he 16.r one thollllll1ld nJne huntlr"d Ind t......nty-.lx l;>t.fore ...... tile .,,1'8cr1ber, " J'llltlco ot tt.e peBce 1n and ter lIlld county III'ld lItDte CRn,,, n,,, above-nan'lld ORVILLE L. SCHANBAC1rER IInd ~l~R'T)lA A. ZCllfltlEAClIEA, l.1a "UII, llnrl ..cknowled(ed the .Love Jndanturt to be tt.elr act ..fill Deed, llnd they de!lrad tbe .Dme ",Ir,ht bB ncoI'dad B~ Buct, 'll'ITtl'tSS ",y hlnd,. notarhl !:,-al. c.t1.l("llevt" J.'P. My COlTllfll,ulon E)lJ11r..a lit. "ondoy In J..n. 1932 JustleaSe"l Reeol'd..d S..pl<lmber 20, 19<1:'i ~ HUff#lWll/ilfmlfflillfHIl/flR'UiUIIfIfIlHfOll , , ~ D,"~O : II count)- of TiOf.a II , , II TO II , , II Robllrt orl'tlQM II , , IWfH N, IIlHfNflUUlIlHlnHllIUlllllfflfllllflNIIlI1 farty-three, bet..aen the Coont! of Tlof:.l' , 1n tba Stl 0 ot I'ennllllven!o, by 1ts floud of co.onty COII\I'II'slonart, oral1tor, ^ N D Rollart Or14wolu, of Canton. \ T.rrs DEED ....d.. the 30th dBY cr A\lf!;'-'at, In the yellZ" of our tord. Ol'\~ tbouaond nJne hun~red atld Erll1ltord Count,', penna;: IVllnlll, Grllnttl8' WITNESSETH, That In.eon.!Olc!erlltlon of 11tty {t,!jO.OOI DOnars, in httnd r-1d, tl,,, rertlJpt _her..of 111 hereby 8c)o:no"1'd"ad, the satd gt"nL'ltar do.e hereby j;J"unt orrl convey to th" an1d , the I i grpntee~ 'h1s'hel".~ -auI2fl.:3" All tbet eert81n lot, trset, or p'a-~-celot land sltUFlte In .<"~_' ..At. t~tM ~_~"".r- ,Town3hip of ;-ierr, 1rI the CC'unty cf TIcS:;', ern st~te of peMs:;'lvanla, described as follows: founced on the Ncrth by hn~s of F'l~llo YJ11ffln ~r.d Ira Enter; on ~he Ee~t e.r.d Soutt: by If.nc"s ot Harry [rown, an:;! on U.e Jl'eEt by lands of E:nr.:e. Kr.1ffln And Jar-:es Kniffin, containing: "i ., ~ ~ 65 acrea, and being tr.e :!lee prerrlses sold to the COlnlr.l~slone:rs or T:oga Tre&surer of said County, At a tu ::ale held on -he 12tt- Cf:.Y of I:eceuber, ence to ccuntJ' 'I'ree:I1Jrerl s teed acknowledged In open CC'll't on tt-.e 6th day county J by the i ~932, a s by refe r. I I of Fetruar y, 19;>':>, '~:' u 11'111 &p~e8r by reference to Sheriff's Deed Book 2, at pege 459, and also ty refe:-ence to i , Beok 1, at pa::e IDS of Record of Tre.?_surer's Seles kept In the coumlsslaners Of nee of Tioga county, and wticl": soid Deed toes been lost andhss nev r been recorded; that the ri,!ff.t of :e-: de'''Pt ion of said land exph'ed on tbe 12th day of December, 19~4, and that the ri,j",t of e- deJ"".ption of said lerd was r.ot exercised prior to its expirction. 'r~s conveyance 1.s :nade pursuant to an order of U'".e Ccurt of comnon pleas of T~oga Coun~y. droted the ~Oth da:.; of AUfust, 1943, and rned to No. 142, Au~ust ~er~, 194~. This deed Conv!ys arA 1s 1ntended to convey fill the right, title, and interest of the county cf ':1oga 1n tbe prerr..lses above described. AND "he sald GI'flr: tor will Wf,RR.\h'"I' SPFCIA LLY the pr'operty hereby conv!:ye d. ;.'..:~... " "'~' f,~ l' l.. ;;: AND the uid ccunty of Tiora does hereby constitute ara appoint Harry E. Willard to ce I ,;~ ,~. ;.~" its atterne:,', for it Bnd in its name, ::\n(' as and for Its corpoI'!.:te act Me: deed tc' eckr_owledse ;',:3 this deed before any ~erson having authcrity by the :..a1ls of 'Xc COl"lIG:enwealth of I-efU'"!,s'" to take suet a.cknov:ledgements, to tre intE:nt trat ti'e same may te duly reccr<'ed. 1", nl.1 I ! IN T::S~IMONY ',',llER::::OF, the ,said county of Tiega, bj' its Board of ccunt:: Conudss!.oner.s, has caused tl:l,s deed to be stgned by Its pres1dent and Seeretcry, attested by 1ts Chief ClE:r~, and affixed hereunto tr,t;: s~al of the said county, thet the seal affixed r:a'eto 1.,s the ~eal of t:e !Ir.ld cowr:t:' of 'floga, and that it was so affixed 1:y OrGel of tile Eor.rd of ccunty Comm';' isslcners of the County of '!'logs, end that the:' slgne;d their n.:.mes l:ereto by Uke order, tt~e: ,; Ii ~~ :';') ~.~ cs~' and yep.r first etave '";''Tltten. ?<lARD OF CQUNTY Cot,U,:IfSIONERS CF '!PE CCXJNTY OF TIOGA, Earl"'; E. Willer c! Chief Gh:rk Attest: Stephen C .Kennedy Pres 1eent \ Gfflcial Seal ~obert P. Lugg Se ere t;::. ry ~i i (1 , COM~'.on'YP.LT~' CF" C~NrS:.'"~':J.._~!I.~ ) s<' ) COt'N~":'" C F ':'10CA ., 'j ~ ~ " ! I her-eby certify that on n.i!l 70th ca.y of: AUfust, in the year cd' roT Lo: c c: re ttousE<nd I nine hunC:red end forty.:.tree, 'before I:'",e, the eutscrlber, Deput:i !tecerdel' of Deeds, personallr a?peered EllI'r~' E.l'll11f,r~, tt.e attorney named in the foregoing Leed, and by virtue 01 and :n pursuance of the al1thoritjo therein cont'!::rred 'lpon l"":~lD, scknowled,-'ed tr.e said Leed to te tte set and deed of tte sa:d County of ':io(,'.::I. Utnes,s my rend end cd'f1cial seal the ea.... anc. year <i.forescI6. MDcr ed L :jer 8L, ld crnc tal Seal Lieput:: Recerder of Deeds ! tert by certi!:; that tte precise reslder;ce of 'j;e Grantee 15 Canton, eradfcrd County, Per.n- sy1Y a nle. Recorded Septcrnber 21, 194:3 LOCATION MAP BOfTower: Robert Griswold Estate Property Address: 65 Acres City: Ward Township Lender: David Griswold File No.: 2002-204 Case No : 2002.204 Zip: State: PA ,,,,.;.;.;~.:;(.,lckJ,,.,-.It::~-'I" f:f '-'j"I,I,' X'''~. """'""v_ :-,.....'i'-. >-~ . .~~'? "'1'__ '. " 'Ij' ."~.:..~, '.,..... "'-" :1 p"IeIoIt"~---- ,......_If -. --1 'I: l- I \' P.rlttsbu'g.J enev - 0\rQ If~-- ---:-~-..:- " ~ t " 0"." eh.xton I '\ _ _ - J tJ ., II' 'Hector .,,<_!,~r_J' ~, I ~lr~\,: I~~ I' I<. 1~'KeUl:ll!. lak~,,; - '. \ etnll-=-.~ . "'~. .1 / /,",j~- -1 i ~odtSll'l!;.-n ~ I , ,'0 'J...~" ". . .rI I" .- '. 't' ',' Corte, ,-- . ~ '- \ l ' ~;.....;,~t}lyrcne . ~/axc:lett I ~ _ '1ll!!ltSl!Irtv*,,' .- 'foIelkr'lSOIer1 . tfllOW ~ ,. IBracf10rd '\1 .-. J ....L....... .....Elro~...... . '-' ,,' ,.....,...."...... ."- '1 - _f"'. ..F. .Fi' Ii '< - J -~tt"': ('~ ':",':""0"'" . , ~_....__:J1!'8.:ifl!~~'- ,l.hIi--'\_~;" am~' I,! Q:'_~--~~~< I 'f \. j ....j'Y;,.'" I ,'se.ence<,~ , . . " - .... .-Van Eften __ - ~Pl8N I ~ isPDli....---)&i1 /'1' I ~~~\ ....:-., 'i ~ " "11~- .' ~ ml.. 'i Lod<W""". \ ,,' , , ~ .~'Bl:ll1on '. "" ogacenle J'. ,.J':o. lN8ve_rlY\., . sm. ' '\:'._____.- .'-)- ._" '.I'S3vre.- . 'I _ ," ~ ..' '. "" ..' ...."" , '. ....... . .,. '" I Ells! Smlt1fi~d Rome _____Sprngfeld-" ':ut.ste;r t: Moms Run PA 16939 ~..' . c\,,"~ .... "~'..:''''';: ",.J- .' ~~" T"'~~.!:3' '..)~:;.' p. '~~--'~.'~~I~~l~:~;'~\~.;~ IS,'" ~- (CI":_.,-;-,),..eroy,-~,.. _, f-' \ '::'i~"-~~ Subject 'J~'" .~ ' I, '." .:;,:, "- T926- J.-"L.-.'" .' \""W":'''Y ,'./ .;: - ....~\...... wardTownSh'PPA,:6930 :::1:=:..~t\~;-'~.~' - '~2-- ~ .~~~.' '!-.~: ~._._..,I'j', ':/~'Rt:r1 ~.,-.,""I,'/-'''. '\'" .J~;;;;'--: . ;''';''.''/ /' 'I: ( j'! ,)~BodOes, }..~~.j~vo':-:>~,,:_~~-,.. -" "'}-"~"i-t / \\o.\. f"1 J (";\~~,,;,,,,;,~^,~:,''''''''~').:'''1.' 't:~" J ~ r ) 0( ... ~'\-"""'- " ';~i /.:-~ .,- .~ NOI1hBend- - '" ~'tJers;~Mb tS ;.../- . )/,I':""VsI ',' "soneSl~ , r~\j "\~-\~""""I ~~- '}.= ~~;:{- =7;;;---/'''' "" '? """""'",' 1" ~.~"od" "-. ' -, { I~~'" ,... cni~' / :. ....;;"Sha .it ~ ''')',' .. M.:.;-.....). '",",0/(. I C';'oi:. F~''-~ .-p:..A,._~.").Arfe$F~ -~g"'T-r~'-- - --?'"-' I ~ ,t\----~ ~ \0.-" '\ ---.' .;>,"".1 ,_ fr. . ""~.':,""' "'j" ~,Sllwlller'" ~P~~~(-J' ': ,:":' ,.r_":~f~-t'A" J,.L;"f>. ,:"Y',"C J ,.1n.,,' BeechQ..., Nt' ~ .... _ ...:c...alisv. h ~ \ ..... '-'.;..<!~ ~ l - '" '.r' . , - ~ ~ ~,_~-'f.e:glevile ~ ~~~':"'~-~ ..We:$~O(l\fille \ ~ , ,---,: , ~non-7" ,~\ Ligt'tStreet':., /:..Hciww .~_ ,s"'- -j ,_'_ _..~ 1 ;.~ " ' BlooriiSbUia . '\ _ A'ylersvi!;." ~--~~ /. - sGrove e - / .~~-- _ ~,." ~"_'_-~~:'g '.-- '", __ ~..,f~-.,~-~~~,\(c~.'~a"..',-" ~.,;~ ~__:mur; f_""_', _ ~ ,Miff;;:;; "', ",'::\~:'-~I-~,:"_.....~' ".. .~=' ': " . \ .,~ .".~O:!B,. , l.I'.hrldWe,~HrwllelOfI-tl ,_ fleld;-,.... 1,\ '\:.,-'.-,..."'_. ) ,_ '.~ ..~-" ..-- "'5wengel -. ,,' ~Mlptee'" ......' .~..- NUmde / .~, _ Spr-~~/ J.cotUn ~.~e;'~-~--.;-~';:"-~pe~~Creek -_\ ~, ~-~.., \ 'y~ .. J' Centre HIIll ' -4'" ~ . ~ - ~Shemotin Dam P!l)(I1O~ -,' / T ,':. .-/,'-1 ~ ~'.....,~,. " ~~ /,"'- ~~ :: ,=, - J!:X: __ .~~rg ~_..~;. ~ IN~O;~yol1~ . ~ .Polarc!~~, ,~,,,.., SIeIer'vtreJSf " v II \.." i___".-..... ~ed Slallon -""\:amfeo " ' -;~~. -<--.Jr;-~'-'"-,_~~"",~~ . I.: ~~' '~'" {" . i -l 'Cemeron '; r' I "'7':..., Camet~_Mls '.6,nOO'ver J '.~,' ""'-\ . ~_'- i. i. I'~."'-';-' I I ,,- I j ,(-.,.;Rexvlle ~', I ' ..~.;tnes c , ". ._I~'f Comparable 4 .."'''' -'( " tru~ .0iIetl I ')""'" \. . ,LJysses_, 't.. I 810,-,,/0##1 .r .r 2~' / ~j ,c..' 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COlLATERAl(e.Id~_..-.oI>a'",-,,)PROPERTY ADDRESS David Griswold (l~al Description may be attached) 622 Perry Valley Road 65 Acres Millerstown, PA 17062 Ward Township PA 3 lENDER 10 NO I 4. LOAN IDENTIFIER r 5 AMOUNT OF FLOOD INSURANCE REQUIRED $ SECTION II A NATIONAL FLOOD INSURANCE PROGRAM INFIP\ COMMUNITY JURISDICTION 1. NFfP CommJnity ,. Counly(iIts) 3. Slate , NFfP Community N.me Number Ward Township Tioga PA 422101 00048 6 NATIONAl FLOOD INSURANCE PROGRAM INFIP\ DATA AFFECTING 6UILDlNGIM08"E HOME 1 NFIP Map Number Of ComrftJnity.Ptlnel Number 2. NFfP Map Panel El'f1!dJYel 5 NoNFfP (Carnm.tnitll name if not the same as "1<,"\ R....isecll)a\e 3 LOMM.OMR <4 Roodlonl ." UV.. .C- 711187 Oat. C FEDERAl FLOOD INSURANCE AVAIlABILITY IC"'d< all that a;;;;M 1, ~ Federal Flood In$UTanct is available (COO\lTllnily participal~ in NFfP). 00 Regulaf Program U Emefgl!ncy Program of NFlP 2. 0 Federal Flood Imlurance is not available beCav1e commmity ill not participating in lh. NFfP 3 o Building/Moble Home is in a Coaslaf Barriltr RflOl/rctlS f>Ra (CBRA) or OIIil!fWilie Proteded Area (OPA), Federal Flood Insurance may not be avaiable CBRA/CPA designation dale D. DETERMINATION IS BUILDING/MOBILE HOME IN SPECIAL FLOOD HAZARD AREA (ZONES CONTAINING THE LETTERS "A" OR "V")? DYES DNO If yes, flood Insurance is required by the Flood Disaster Protection Act of 1973. If no, flood Insurance is not reqUired by the Flood Disaster Protection Act of 1973. E COMMENTS (Opt_) This determination is based on examining the NFIP map, any Federal Management Agency reviSIOns to it, and any other information naeded to locate the building I mobile home Ofl the Nf IP map F PREPARER'S INFORMATION Name. Address, Telephone Number (If other than lender) DATE OF DETERMINATIOH May 19, 2002 N... A & 0 Appraisals and Insurance A.ddrv>>', P.O Box 72 Telephone Number: Welfsboro. PA. 16901 Date Signe<J: Mav 20 2002 FEMAform81.113,OCT98 ____llfIlIII__,IIlIO.2JUl'lI___._ A & D Appraisals and Insurance it HAROW S. HILL & SON, Auctioneers, Inc. Complete Auction Service P.O. BOll 22 Kemblesville, PA 19347 Phone (6/0) 274-8525' Fax (6/0) 255.05/9 APPRAISAL FOR THE ESTATE OF ROBERT H. GRISWOLD 6-7-02 PERSONALITY AT DATE OF DEATH 4-26-2002 W ASHST AND WINDSOR CHAIR WALNUT ROLL TOP DESK SMALL QUEEN ANNE SOFA BRASS FLOOR LAMP MARBLE TOP VICTORIAN TABLE MARBLE TOP VICTORIAN DRESSER TOBACCO JAR OCCASIONAL UPHOLSTERED CHAIR BOOKSHELF DRAWER STAND PAIR OF SAILING SHIP PICTURES @50 MAPLE DOUBLE BED MAPLE DRESSER WITH MIRROR TELEVISION 'Svb To 4-~ \ 1997 FORD CROWN VICTORIA SEDAN LX\ 28,652 MILES TOT AL APPRAISAL: $100.00 100.00 2,500.00 400.00 25.00 350.00 500.00 50.00 ]5.00 30.00 50.00 100.00 50.00 50.00 40.00 ~ "3G.O,ClO 9,500.00 13,760.00 ;:r~J /~ H. JAMES HILL, AUCTIONEER. HJHlao ESTATE OF ROBERT H. GRISWOLD ROBERT H. GRISWOLD T1U/A VALUATION CALCULATION SUMMARY ID# 204-03-6272 Stocks and Bonds Accured Interest - Stocks and Bonds Common Trust Fund Common Trust Fund Common Trust Fund Muni-Fund Accrued Interest - Muni Fund Total Valuation $250,312.13 1,885.78 45,447.35 114,402.30 143,822.42 154,958.58 182.43 . $~11 ,01 f2..!l.~= Estate Valuation Date of Death: Valuation Date: Processing Date: 04/26/2002 04/26/2002 OS/29/2002 Estate of: Robert Griswold Account: Robt Griswold 2339 Report Type: Date of Death Number of Securities: 11 File ID: griswold 2339 Shares or Par Security Description High/Ask Low/Bid Mean &/or Div & 1nt Security Adj'ments Accruals Value 1 ) 15000 AMBRIDGE PA AREA SCH DIST G.O. BDS (023362EV4) OTC DTD: 08/01/1997 Mat: 11/01/2004 4.45% 04/26/2002 104.77200 104.77200 A/B 104.772000 15,715.80 Int: 11/01/2001 to 04/26/2002 324.48 2 ) 25000 BANGOR PA AREA SCH D1ST G.O. BDS (060205EN7) OTC OTO: 04/15/1999 Mat: 03/15/2005 3.95% 04/26/2002 102.84300 102.73200 A/B 102.787500 25,696.88 Int: 03/15/2002 to 04/26/2002 112.47 3) 15000 ALLEGHENY CNTY PA G.O. BOS (0172856G7) OTC DTD: 06/01/1999 Mat: 10/01/2006 4.2% 04/26/2002 104.21100 103.96100 A/B 104.086000 15,612.90 Int: 04/01/2002 to 04/26/2002 43.75 4 ) 25000 BERKS CNTY PA G.O. BOS (084509JMl) FT 1ntr. DTD: 03/15/1999 Mat: 11/15/2006 4.1% 04/26/2002 103.89800 103.64800 A/B 103.773000 25,943.25 Int: 11/15/2001 to 04/26/2002 458.40 5) 25000 MONTOUR PITTSBRGH PA SCH OIST G.O. NOTE (614707KT3) FT Intr. DTD: 02/15/1999 Mat: 01/01/2007 4.05% 04/26/2002 102.60000 102.35000 A/B 102.475000 25,618.75 Int: 01/01/2002 to 04/26/2002 323. 44 late of Death: 'aluation Date: 'rocessing Date: 04/26/2002 04/26/2002 OS/29/2002 Estate of: Robert Griswold Account: Robt Griswold 2339 Report Type: Date of Death Number of Securities: 11 File 1D: griswold 2339 Shares or Par Security Description High/Ask Low/Bid Mean &/or Div & Int Security Adj'ments Accruals Value 7) 25000 GENERAL MCLANE SCH DIST PA REF-BDS (370291GV2) FT Intr. DTD: 10/15/1998 Mat: 10/15/2007 4.25% 04/26/2002 103.97000 103.72000 A/B 103.845000 25,961.25 Int: 04/15/2002 to 04/26/2002 32.47 8) 40000 GARNET VALLEY PA SCH DIST G.O. BDS (366268GU8) OTC DTD: 01/01/2002 Mat: 04/01/2008 4% 04/26/2002 101.65000 101.40000 A/B 101.525000 40,610.00 Int: 04/01/2002 to 04/26/2002 111.11 9) 25000 SPRINGFIELD PA SCH DIST DELAWA G.O. REF (851347HB3) OTC DTD: 11/15/2001 Mat: 03/15/2009 3.75% 04/26/2002 99.16500 98.91500 A/B 99.040000 24,760.00 Int: 03/15/2002 to 04/26/2002 106.77 10) 30000 SCRANTON PA SCH DIST G.O. REF (810827MC6) OTC DT 0: 07/15/2001 Ma t: 04/01/2009 4. 1 % 04126/2002 101.26400 101.01400 A/B 101.139000 30,341.70 Int: 04/01/2002 to 04/26/2002 85.42 11) 20000 MONROE CNTY PA G.O. BDS (610767JLO) OTC DTD: 10/01/2001 Mat: 12/15/2009 3.95% 04/26/2002 100.38300 100.13300 A/B 100.258000 20.051.60 Int: 12/15/2001 to 04/26/2002 287.47 Total Value: tal Accrual: Total: $277,837.16 :!l 25o,31~,13 $1,885.78 Page 2 his report was produced with EstateVal 2000, a product of Estate Valuations & Pricing Systems. Inc. If you have questions. please contact EVP Systems at (818) 313-6300. (Revision 6.2.1) Common Trust Fund DOD Valuation Robert H Griswold TUA # 2339 CTF Growth Equity Date of Valuation Number of days in Month of Death Day of death in month Number of units subject to valuation Common Trust Fund Valuation for month preceding death....."........".... Common Trust Fund Valuation for month end of month of death...".....". Date of death value of fund.."..... Date of death value of holding 04/26/02 30 26 725 66.6089 62.0825 62.686 $45,447.35 Common Trust Fund DOD Valuation Robert H Griswold TUA # 2339 CTF Value Equity Date of Valuation Number of days in Month of Death Day of death in month Number of units subject to valuation Common Trust Fund Valuation for month preceding death..................... Common Trust Fund Valuation for month end of month of death............. Date of death value of fund......... Date of death value of holding 04126102 30 26 422 270.2423 271.2268 271.0955 $114,402.30 Common Trust Fund DOD Valuation Robert H Griswold TUA #2339 CTF Fixed Income Date of Valuation Number of days in Month of Death Day of death in month Number of units subject to valuation Common Trust Fund Valuation for month preceding death..................... Common Trust Fund Valuation for month end of month of death............. Date of death value of fund......... Date of death value of holding 04/26/02 30 26 139 1022.9742 1036.4967 1034.6937 $143,822.42 ::E "" '" '" 11 ... '" ~ 1 0 ... a- "0 ..., " ..., C N .;: ... "" " " .Q E E ~ " z " " e ... ... <: - .... .. ... ~ '" .. 0 .0 .; .;i. ... ... ~ '" .. .. M i. ::E "' ~ N .;i. 0 .... .. '" <:> ... "' N '" N 0 .0 .. 0 c:l - ... "' <:> <:> ... "l .. N ~ M i. - "' '" ... ~ ~ N <:> - ... ... 0 0 ... ~ 0 <: '" '" -< .. .. ... .;: =- ..: - ::> p. "0 "0 .... ~ <: ... ... 0 V> '" '" 'C - '" '" v ::> ... ... - en i- '" '" :I: '" '" <( 'tl ~ ~ 1:: '0 ... ... " e- e- en .D ~ C 0 '" '.:: Cl '" .;: .!2 \) .~ ;:: c: c; ~ -; .- M " - " .:: "C M .D - '0 '0 N E 1: ~ " c ~ - II ... " " - " N " ::: ;oJ 0 z 0 .Q "' "' " - I I - 0 e !: - ~ J: :; ~ . .. N IX ~ ~ 0 :; - '" " '" " "' " "' - " 0 N ;; ..: u >: >: >: >: .., " :: ..: " - E c: " '" "l ~ >. ..: 0 " .... z '" c:I ... ... 0 ;>, " ... 0 .0 "0 .D " ~ ... 0 " "0 '" " ... "l ~ .!!! e :J:J M ;; 0 ~ " ... ~ ;;; ... <( Ii: 0 0 <: (J '" >- 1: ,nt By: HP LaserJet 3100; 717 737 6783; Jan-22-03 11 :48AM; Page 2 COpy TRUST AGRE: 'lENT TIllS TRUST AGREEMENT, made the "l q \\4 day of a c.. -t tl \., EO yo ,1996, betwecn ROBERT H. GRISWOLD of C. LLm..C..i.d_ (l YI....d. County, Pennsylvania., (herein called Settlor), and HERSHEY TRUST COMPANY, of Hershey, Pennsylvania, and its successors, (herein called Trustee), WITNESSETH THAT: 1. Trust ProoertY. The Settlor does hereby transfer and deliver to the Trustee the property listed on the schedule annexed hereto, to have and to hold the same, and any cash, securities or other propeny which the Trustee may, pursuant to any of the provisions hereof, at any time hereafter hold or acquire, all of such propeny being herein referred to as the trust estate, in truSt, tor the uses and purposes and upon the terms and conditions following: 2. Dispositive Provisions. The Trustee shall hold, manage, invest and reinvest the trust estate, and shall collect the income thereof and dispose of the net income al1d principal as follows: (a) During thc lifctime of the Settlor, the Trustee shall pay [0 or for thc use of the Settlor, in quarter annual or more frequent installments, the net income of the trust t:~tatt:. Any income not so distributed may be accumulated and invested in the same manner as the corpus of the trust estate. In addition to the income, there shaIl be raid to the Settlor or applied for his use out of the corpus, at any time and from time to time, such amounts, if any, as the Trustee in its discretion shall determine to be necessary for his maintenance, medical, dental, surgical, nursing, hospital, institutional and psychiatric care, comfort and welfare. In addition to ,nt By: HP LaserJet 3100; 717 "137 6783; Jan-22-03 11 :49AM; Page 3 such discretionary invasions of principal. the Trustee shall pay to Settlor at any time and from time to time such portion or all cfthe principal as he may request for aay purpose including gifts to others. (b) Upon the death of Settlor, to distribute the trust estate to Settlor's personal representative to be disposed ofin accordance with Settlor's will or applicable law. (c) The primary purpose and intent in creating this trust is to provide for the income beneficiary. The rightS and interests of remaindermen and/or the Senior's Estate are subordinate and incidental to that purpose. The provisions of this Agreement shall be construed liberally by the Trustee in the interest and for the benefit of the income beneficiary. 3. Additional Prooertv. The Settlor may at any time or from time to time transfer and deliver to the Trustee cash. securities and any other property to be added to the trust estate. All such property hereafter delivered and transferred to the Trustee by Settlor shall be held, administercd and disposed of by the Trustee in accordance with the provisions of this Agreement without the execution of any further instrument or declaration. 4. Accountin9-' by Trustee The Trustee may at any time render an account to the income beneficiary, whose written approval shall be final, binding and conclusive upon aJ1 persons then or thereafter interested in the trust estate. The Trustee may also at any tim.. rendeI' a judicial account of its administration. 5. Security No bond or other security shall be required of the Trustee in this or any other jurisdiction 6_ Successor Trustees. No change in name of the Trustee hereunder nor any merger of ils corporate powers with another corporation shall affect its appointment Dr powers 2 nt By: HP LaserJet 3100; 717 737 6783; Jan-22-03 11 :49AM; Page 4 hereunder. The Trustee or any of its substitutes or successors may at any time resign the trust. Whenever in this Agreement reference is made to Trustee, such reference shall be deemed to include not only the Trustee expressly named herein, but also any and all substitutes and successors at any time qualified and acting hereunder, and all rights and powers given in this Agreement to the Trustee sh.all be vested in substitute and successor uustees. 7. Pavments to Persons Under Disabilirv Whenever income or principal hereunder is to be paid to a person under legal disability, or to a person not adjudicated incompetent but who by reason of illness or mental or physical disability is unable in the opinion of the Trustee properly to administer such payments, then payment may be made (a) directly to such beneficiary; (b) to the legally appointed guardian or representative of the beneficiary; (c) to some near relative of the beneficiary to be applied for the benefit of the beneficiary; or (d) by expenditure by the Trustee directly to those furmshing property or services to the beneficiary. The receipt of any of the foregoing shall be a complere discharge to the Trustee which shall not be bound to see to the application of any such payment. 8. Situs. This Agreement and trust estate shall be governed and construed in all respects according to the laws of the Commonwealth of Pennsylvania. 9. Powers Without regard to any legal restrictions otherwise applicable to Trustees, the Trustee and its substitutes and successors are authorized and empowered in their so Ie and absolute discretion to exercise the following discretionary powers as well as any other powers conferred by law: (a) To retain, whether originally a part of the trust estate or subsequently acquired. and to purchase or otherNise acquire and to retain. any property, whether 3 ,ent ey: HP LaserJet 3100; 717 737 6783; Jan-22-03 11 :49AM; Page 5/7 or not such property is authorized for investment under the Pennsylvania Fiduciaries Investment Act of 1949 or by other law, all without diversification as to kind and amount (b) To transfer, sell, exchange, partition, lease, mongage, pledge, give options upon or otherwise dispose of any property at any time held by them, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such terms and conditions, with our without security, and for such price as they may determine. (e) To bold any part ofrhe trust estate in cash or uninvested far allY period deemed advisable, (d) To borrow money for any trust purpose, create a security interest in, Dr pledge all or part of the trust estate to secure such borrowing without incurring any persanalliability therefor. (e) To pay, extend, renew, modify or compromise, upon such terms as they may detennine, and upon such evidence as they may deem sufficient, any obligations or claim, including taxes, either in favor of or against the trust estate, (f) To register any securities at any time in their names as Trustee, or in the names of nominees, with or without indicating the trust character of the securities 50 registered. (g) With respect to any securiti~s held hereunder. to vote upon any proposition or election at any meeting of the person or entity issuing such securities, and to grant proxies, discretionary or otherwise, to vote at any such meeting, to exercise conversion, subscription or other rights, and to receive or hold any new securities issued as a result of any reorganization, readjustment, merger, voting trust, consolidation, exchange or exercise of 4 t By: HP LaserJet 3100; 717 737 6783; Jan ~""-u.J I I . .,..;;1......., J -";;, conversion, subscription or other rights and generally to take all action with respect to any such securities as could be taken by the absolute owner thereof. (h) To make allotments or distributions in kind. 10. Amendment and Revocation. Settlor may any time and from time to time amend, modifY or revoke this trust in whole or in part. 11. Attornev to Ac1cnowledlle. Hershey TruSt Company hereby appoints Robert K. Reiuel as its attorney to acknowledge this Agreement before any officer authorized to take such acknowledgement. 12. Comoensation of Trustee. Trustee shall receive compensation for its services under this Agreement at the same rate as is charged from time to time by Trustee in accordance with its published fee schedule for performing as trustee of revocable agreements of trust of approximately the same size and complexity as the within Trust. IN WITNESS WHEREOF, this Agreement has been executed hy the Settlor IIIId Trustee on the date first above mentioned. WITNESS: -/~J(/W ^ (J'-~L~../-(Lt/ Robert H. Griswold i (SEAL) ArrEST: HERSHEY TRUST COMPANY r:::2: ~ ~ Assistant Secretary B'~# Vice President and Trust Officer 5 ,nt By: HP LaserJet 3100j Cash Cash 717 737 678~; "- SCHEDULE" A" Jan-22-0311:50AMj $330,043.86 S L 100.76 Page 7 J7 ~ Form 7 0 6 United States Estate ~and Generation-Skipping Transfer Tax Return OMS No. 1545-0015 (Rev. August 2002) Estate of a citizen or resident of tlie United States (see separate Instructions). Department of the Treasury To be filed for decedents dying after December 31,2001, and before January 1, 2003. Internal Re\.9nue Sllf'o'ice For Paperwork Reduction Act Notice, see the separate Instructions. ,. Decedent's first name and middle initial (and maiden name, if any) 1b Oecedent's last name 2 Decedent's Social Security No. ROBERT H GRISWOLD 204-03-6272 ~ i 3. Legal residence (domicile) at time of death {county, state, and 3b Year domicile established I (4 Dale of birth 5 Date of death ZIP COde~r forer country) 1915 08/30/1915 04/26/2002 PENNSYL ANI ,ll .. Name of executor (see page 3 of the instructions) 6b Executor's address {number and street including apartment or suite no. or rural '" route; city, town, or post office; state; and ZIP code} c ANNE G DISABATINO ~ ~ 1744 FLINT HILL ROAD .c Executor's social security number (see page 3 ofll1e instructions) LANDENBERG, PA 19350 . u .!: 167-40-4864 . 7. Name and location of court where will was probated or estate administered ! 7b Case number ..: 1: CUMBERLAND COUNTY COURT HOUSE, CARLISLE , PA 21-2002.0445 ~ .. If decedent died testate, check here ....1 X 1 and attach a certified conv of the will. i9 If Form 4768 is attached, check here ~Ix I 8 10 If Schedule R-1 is attached check here ~ I I 1 Total gross estate less exclusion (from Part 5, Recapitulation, page 3, item 12) 1 1 028 507.91 2 Total allowable deductions (from Part 5, Recapitulation, page 3, item 23). . . 2 32 508.28 3 Taxable estate (subtract line 2 from line 1). . . . . . . . . . .. . 3 995 999.63 4 Adjusted taxable gifts (tota] taxable gifts (within the meaning of section 2503) made by the clecedent after December 31. 1976, other than gifts that are includible in decedent's gross estate (section 2001(b))). 4 0.00 5 Add lines 3 and 4 . . . . ........... . . . .. . . . ... . .. . . . 5 995,999.63 6 Tentative tax on the amount on line 5 from Table A on page 4 of the instructions . . . . .. . .... . 6 344,239.86 7 Total gift tax payable with respect to gifts made by the decedent after December 31. 1976. Include gift taxes by the decedent's spouse for such spouse's share of split gifts (section 2513) only if the decedent was the donor of these gifts and they are includible in the decedent's gross estate (see instructions). . . .. . 7 0.00 8 Gross estate tax (subtract line 7 from line 6). . . . . . . . . . . . . . . . . .. . '345 '80'0'.01 344 239.86 9 Maximum unified credit (applicable credit amount) against estate tax . . 9 10 Adjustment to unified credit (applicab]e credit amount), (This adjustment c .2 may not exceed $6,000. See page 5 of the instructions.). . . . . . . . . . . 10 0.00 jjj 11 Allowable unified credit (applicable credit amount) (subtract line 10 from line 9) 11 345.800.00 ::I . . .. . . . ... E 12 Subtract line 11 from line 8 (but do not enter less than zero) . . . . . . . .. . . . .. . .. . 12 0.00 0 (J 13 Credit for state death taxes (cannot exceed line 12). Attach credit evidence (see instructions). Figure ~i~~ ~ the credit by using the amount on line 3 less $60.000. See Table B in the instructions. , oj Enter the amount here from Table B .... x.75 ~ 13 0.00 ---------------- 1: 14 Subtract line 13 from line 12 . . . . . .... . .... . ., . . . 14 0.00 ~ .. 15 Credit for Federal gift taxes on pre-1977 gifts (section 2012) (attach ili computation) . . ...... . . . .. . ...... . .... . . . ... . 15 0.00 16 Credit for foreign death taxes (from Schedule(s) Pl. (Attach Form(s) 706-CE.). . . . . . . . . . . .. . .. . 16 0.00 17 Credit for tax on prior transfers (from Schedule Q) . 17 0.00 18 Total (add lines 15, 16. and 17). . .. . 18 0.00 19 Net estate tax (subtract line 18 from line 14) .. . 19 0.00 20 Generation.skipping transfer taxes (from Schedule R, Part 2, line 10) 20 0.00 21 Total transfer taxes (add lines 19 and 20) . . .... . .... . ',' '1' .. . 21 0.00 22 Prior payments. Explain in an attached statement . . . . . . . . . 22 0.00 Ii 23 United States Treasury bonds redeemed in payment of estate tax 23 I 0.00 24 Total (add lines 22 and 23). . . . .............. . 24 0.00 25 Balance due {or overnavment' Isubtract line 24 from line 21'. . 25 0.00 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, :::::,,:=~ ~'-""~"-'~'~-':?';~'"~"'-~~-"' c.. 210 Grandview Avenue Camp Hill, PA 17011 Address (and ZIP code) Signatu re of preparer other than executor Date JSA 2RBOOO 1.000 Form 4768 " Application for Extension of Time To File a Return andlor Pay U.S. Estate (and Generation-Skipping Transfer) Taxes Department of the Treasul)' ..ornal Rew"e S,,'''e For filers of Fo 06 706-A, 706-0, or 706-NA (circle only one) Note: Use Form 2758 to re uest an extension for Forms 706-GS D and 706-GS Identification OMS No. 1545-01 B 1 (Rev. August 2001) Decedent's last name GRISWOLD Name of application filer (if other lhan the executor) Date of death 04/26/2002 Decedent's social security number 204-03-6272 Estate tax return due date Decedent's first name and middle initial ROBERT H. Name of executor ANNE G. DISABATINO Address of executor (Number, street. and room or suite no.) 1744 FLINT HILL ROAD City, slate, and ZIP code LANDENBERG, PA 19350 f'a-rtn Extension of Time To File Form 706 Automatic extension. If you are applying for an automatic 6.month extension of time to file Form 706, check here (see instructions):. . .. .... [Xl Additional extension. If you are an executor out of the country applying for an extension of time to file in excess of 6 months, check here . . . .. ... 0 You must attach a statement explaining in detail why it was impossible or impractical to file Form 706 by the due I Extension date requested date. See the instrucUons. Enter the extension date requested. Extension for cause. If you have not filed a request for an automatic 6-month extension and the time for filing such a request has passed, check here .... ... 0 You must attach a written statement explaining in detail why you were unable to request an autcrnatic extension. Extension date requested why it was impossible or impractical to file Form 706 by the due date. and why you should be granted an extension at this time. See the instructions. Enter the extension date requested. Part III Extension of Time To File Form 706-A, 706-0, or 706-NA Sec. 6081 You must attach your written statement to explain in detail why it is impossible or impractical to file a reasonably com plete return by the due date of the return. Part'IV Extension of Time To Pay (Sec. 6161) You must attach your written statement to explain in detail why it is impossible or impractical to pay the full amount of the estate (or GST) tax by the return due date. If the taxes cannot be determined because the size of the gross estate is unascertainable, check here ~ D and enter "-0-" or other appropriate amount on Part V, line 3. You must attach an explanatio PartY Payment To Accompany Extension Request 1 Amount of estate and GST taxes estimated to be due .,............,.............., 2 Amount of cash shortage (complete Part IV) ........,....... JAN ,2-4' 2003"' . . . . . . 3 Balance due (subtract line 2 from line 1) (see instructions ...................."..,. Signature fll~~rRj.c1!.ti9Imue Servioe If filed by executor - Under penalties of perjury, I declare th"!IIllJJn~1Pl' !1#b!:e~lflfl pf the above-named decedent and that to the best of my knowledge and belief, the statements made herein and attached are true ana correct. 01/27/2003 Domicile of decedent (county, stale, and ZIP code) PENNSYLVANIA Extension date requested Extension date requested 1 2 3 0.00 0.00 Executor's signature Title Dale If filed by someone other than the executor - Under penalties of pe~ury. I declare that to the best of my knowledge and belief. the statements made heren and attached are true and correct. that I am authorized by an executor to file this application, and thai I am (check box(es) that applies): D A member in good standing of the bar of the highest court of (specify jurisdiction) ~ lliI A certified publiC accountant duly quaiified to practice in (specify jurisdiction) ~ Pennsy1 vania D A person enrolled to practice before the Internal Revenue Service. D A duly authorized agent holding a power of attorney. (The power of attorney need not be submitted unless requested,) 11t~ U.U~~. c/A /bv'/76'~S Filer's signature (other than the executor) / . I Date Notice to Applicant - To be completed by the Internal Revenue Service 1 The application fer extension of time to tHe (Part II or III) is: 2 The application fer extension of time to pay (Part IV) is: D Approved D Not apprOlled because D Approved D Not apprOlled because D Other o Other Internal Revenue Service official Date Internal Revenue Service official Date For Privacy Act and Paperwork Reduction Act Notice, see page 4. ISA $lF FED5253F Form 4768 (Rev, 8-2001) Estate of: ROBERT H GRISWOLD The following is a list of executors, not including the primary executor displayed on the first page: CO-EXECUTOR DAVID R GRISWOLD 622 PERRY VALLEY ROAD MILLERSTOWN, PA 17062 167-40-4906 SCOTT M GRISWOLD ROUTE 1, BOX 1247-A BRIDGER, MT 59014 167-40-4905 204-03-6272 Form 706 (Rev.8'{)2) E~ate~:ROBERT H GRISWOLD Part 3 - Elections by the Executor 204-03-6272 Please checIc the "Yes" or "No" box for each uestiOfJ. See If1structjoflS Yes No 1 Do u elect alternate valuation? ........ 1 2 Do you elect spedal use valuation? ........ If "Ves" au must com lete and attach Schedule A-1. 2 3 Do you elect to pay the taxes in installments as described in section 6166? ........................... If '"Yes" au must attach the additional information described on a e 9 of the instructions. 3 4 00 you erect to postpone the part of the taxes attributable to a reversionary or remainder interest as described in section 6163? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4 Part 4 - General Information (Note: Pl6ase affach the necessary supplemental clocuments. You must attach the death certificate.) (See ;nstructions on page 10.) Authorizallon to receive confidential tax information under Regs. sec. 601.504(b)(2)(i); to act as lhe estate's representative before the IRS; and to make written or oral presentations on behalf of the estate If retum prepared by an attorney, accountant, or enrolled agent for the executor: Name of representative (print or type) State Address (number, street, and room or suite no., dty, state, and ZIP code) JAMES NACE PA 210 Grandview Avenue Camp Hill, PA 17011 I declare that I am the this return for the executor. ."""'. Signature attomayl X certified PUblic accountanU enrolled agent (you must check the applicable box) for the executor and prepared I am not under suspension or disbannent from practice before the Internal Revenue Service and am qualified to practice in the state shcrtm CAF number 2605-59331R Date Telephone number 717-761-7171 1 Death certificate number and issuing authority (attach a copy of the death certificate to this return). P8206328 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS 2 Decedent's business or occupation. If retired, check here ....[XI and state decedent's former business or occupation. ATTORNEY 3 Marital status of the decedent at time of death: D Married o Widow or widower- Name. SSN, and date of death of decaased spouse ~_~<:~~_~_G.~:.~~_~~~-=~~=~~~~_~.?!~H_1_9..8_~_ --------------------------------------------------------------------------------------- Single Legally separated Divorced - Date divorce decree became final .... 4a Surviving spouse's name 4b Social security number 4c Amount received (see page 10 of the instructions) 0.00 5 Individuals (other than the surviving spouse), trusts, or other estates who receive benefits from the estate (do not include charitable benefidaries shown in Schedule 0) (see instructions). For Privacy Act Notice (applicable to individual benefidaries only), see the Instructions for Form 1040. Name of individual, (rust, or estate receiving $5,000 or more Identifying number Rel0'3!ionship 10 decedent Amount (see instructions) DAVID R GRISWOLD 167-40-4906 SON 317,038.45 ANNE G DISABATINO 167-40-4864 DAUGHTER 317,039.36 SCOTT M GRISWOLD 167-40-4905 SON 317,038.48 All unascertainable beneficiaries and those who receive less than $5 000 . .~ 0.00 Total. . . 951,116.29 Pleasachackfha "Yes" or "No" box for each auastion. Yes No 6 Does the gross estate contain any section 2044 property (qualified terminable interest property (QTIP) from a prior gift or estate) (see Dace 10 of the instructions)? . . X (continued on next page) JSA 2R80011.000 Page 2 Form 706 (Rev. 8-02) Part 4 - General Information (continued) 204-03-6272 Please check the "Yes" or "No" box for each question. 71 Have Federal gift tax retums ever been filed? .. .. . . . . . . . ... . . . . . . . . If "Yes," please attach copies of the returns, if available, and furnish the following information: 7b Period(s} covered 7c Internal Revenue office(s) where filed ................... . If you answer "Ves" to any of questions 8.16, you must attach additional Information as described In the Instructions. 8a Was there any insurance on the decedent's life that is not lnduded on the return as part of the gross estate? . . . . , . . . . . . . X b Did the decedent own any insurance on the life of another that is not induded in the gross estate? . . . , . . . . . . , . , . , . . X 9 Did the decedent at the time of death own any property as a joint tenant with right of survivorship in which (a) one or more of the other joint tenants was someone other than the decedent's spouse, and (b) less than the full value of the property is included on the return as part of the gross estate? If "Yes," you must complete and attach Sdledule E . . , , . . . . . , . . . , , . X 10 Did the decedent, at the time of death, own any interest in a partnership or unincorporated business or any stock in an inactive or closel held co ration? ............ . . . . . . . . . . . . . . . . , . . . . . . , , . , , . , , . . , . . , . . X 11 Did the decedent make any transfer described in section 2035, 2036. 2037, or 2038 (see the instructions for Sdledule G beginning on page 12 of the separate instructions)? If "Yes," you must complete and attach Schedule G. . , . . . . . . . . . , . . . X 12 Were there in existence at the time of the decedent's death: a Any trusts created by the decedent during his or her lifetime? . . . . . . , . . . . . . . . . . . . . . . . . . . . . , , . . . b Any trusts not created by the decedent under which the decedent possessed any power, beneficial interest, or trusteeship? . 13 Did the decedent ever possess. exercise, or release any general pO'Nerof appointment? If.Yes,. you must complete and attach Schedule H .. . . 14 Was the marital deduction computed under the transitional rule of Public Law 97-34, section 403{e}(3) (Economic Recovery Tax Act of 1981)? If "Yes," attach a separate computation of the marital deduction, enter the amount on item 20 of the Recapitulation, and note on item 20 "com utation attached." 15 Was the decedent, immediately before death, receiving an annuity described in the -General" paragraph of the instructions for Schedule I? If "Yes," ou must com lete and attach Schedule I . . , . . . . . . . . . , . . . . , , . . . , . , . . . . . . . . X 16 Was the decedent ever the beneficiary of a trust for which a deduction was claimed by the estate of a pre-deceased spouse under section 2056 b 7 and which is not re orted on this return? If ''Yes" attach an lanation....,..."",..... X Part 5 - Recapitulation Item Gross estate Alternate value Value at date of death number 1 Schedule A - Real Estate . 1 36.500.00 2 Schedule B - Stocks and Bonds. 2 124 850.08 3 Schedule C - Mortgages, Notes, and Cash. 3 39 250.35 4 Schedule D - Insurance on the Decedent's Life (attach Form(s) 712) 4 93,793.18 5 Schedule E - Jointly Owned Property (attach Fonn(s) 712 for life insurance), 5 0.00 6 Schedule F - Other Miscellaneous Property (attach Form(s) 712 for life insurance). 6 18,637.32 7 Schedule G - Transfers During Decedent's Ufe (attach Form(s) 712 for life insurance) 7 711,010.99 8 Schedule H - Powers of Appointment. 8 0.00 9 Schedule I - Annuities 9 4,465.99 10 Total gross estate (add items 1 throuQh 9). 10 1,028,507.91 11 Schedule U - Qualified Conservation Easement Exclusion 11 0.00 12 Total gross estate less exclusion (subtract item 11 from item 10). Enter here and on line 1 of Part 2 - Tax Computation . . . 12 1,028,507.91 Item number Deductions Amount 13 Schedule J - Funeral Expenses and Expenses Incurred in Administering Property Subject to Claims 13 23,142.67 14 Schedule K - Debts of the Decedent 14 9,365.61 15 Schedule K - Mortgages and Liens 15 0.00 16 Total of items 13 through 15 . 16 32,508.28 17 Allowable amount of deductions from item 16 (see the instructions for item 17 of the Recapitulation) 17 32,508.28 18 Schedule L - Net Losses During Administration 18 0.00 19 Schedule L - Expenses Incurred in Administering Property Not Subject to Claims 19 0.00 20 Schedule M - Bequests, etc., to Surviving Spouse 20 0.00 21 Schedule 0 - Charitable, Public, and Similar Gifts and Bequests 21 0.00 22 Schedule T - Qualified Familv-Owned Business Interest Deduction 22 0.00 23 Total allowable deductions (add items 17 throuah 22). Enter here and on line 2 of lhe Tax Computation , 23 32,508.28 Page 3 JSA 2R80021.oo0 Form 706 (Rev. 8-02) Estate of: ROBERT H GRISWOLD 204-03-6272 SCHEDULE A - Real Estate o For jointly owned property that must be disclosed on Schedule E, see the instructions on the reverse side of Schedule E. o Real estate that is part of a sole proprietorship should be shown on Schedule F. o Real estate that is included in the gross estate under section 2035, 2036, 2037, or 2038 should be shown on Schedule G. o Real estate that is included in the gross estate under section 2041 should be shown on Schedule H. o If vou elect section 2032A valuation. vou must comolete Schedule A and Schedule A-I. Item number Description Alternate valuation date Alternate varue Value at date of death 1 Land known as RD Canton, Ward Township, PA 17724, 65 Acres (See appraisal attached) 36,500.00 Total from continuation schedules or additional sheets attached to this schedule 0.00 TOTAL. (Also enter on Part 5 Recaoitulation. naoe 3 at item 1.\ . . . . . . . . . 36,500.00 (If more space is needed, attach the continuation scheduie from the end of this package or additional sheets of the same size.) (See the instructions on the reverse side.) JSA 2MaOO.,000 Schedule A - Page 4 Form 706 (Rev. 8-02) Estate of: ROBERT H GRISWOLD 204-03-6272 SCHEDULE B - Stocks and Bonds (For jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.) Item Description including face amount of bonds or number of shares and par number value where needed for identification Gi\18 9-digit CUSIP number. CUSIP number Unit value Alternate valuation date Alternate value Value at date of death See Schedule attached Total from continuation schedules (or add~ional sheets) attached to this schedule. . 124,850.08 TOTAL. (Also enter on Part 5, Recapitulation, page 3, at .em 2.) .. . . . . . . . . . 124,850.08 (If more space is needed, attach the continuation schedule from the end of this package or add~ionai sheets of the same size.) (The instructions to Schedule B are in the separate instructions.) Schedule B - Page 12 JSA 2MB008 1.000 Estate of: ROBERT H GRISWOLD It.... No. Description 1 243 shares Delaware Tax Free PA Fund A Class Common Stock Dividend Accrued on Item 1 from January 22, 2002 to April 22, 2002 2 400 shares TUpperware Common Stock 3 2,400 shares General Electric Common Stock 4 300 shares Equity Investors Fund 1st Exchange Series AT&T 5 5 uni ts Penn IMIT 7 Interest Accrued on item 5 6 500 shares Solomon Bros. Fund, Inc. Common Stock 7 GNMA Certificate - Pool #007617X Schedule B -- Stocks and Bonds Unit Val. CUSIP 7.85 23.55 899896104 31.5 369604103 91.96 662.31 11.725 795477108 TOTAL. (Carry forward to main schedule) Al terna te Val. Date Alternate Value Page 2 204-03-6272 Value at Date of Death 1,907.55 30.86 9,420.00 75,600.00 27,588.00 3,311.55 16.05 5,862.50 1,113.57 124,850.08 Form 706 (Rev. 8-02) Estate of: ROBERT H GRISWOLD 204-03-6272 SCHEDULE C - Mortgages, Notes, and Cash (For Jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.) Item number Description Alternate valuation date Alternate value Value at date of death 1 Citizens Bank, Account Number 112-412-5624 (Pereonal Interest Checking, Robert H Griswold) 37,694.27 2 Citizens Bank, Account NUlllber 31-A30711-C (Certificate of Deposit, Robert H. Griswold) 1,002.08 3 Cash on Hand at Date of Death 354.00 4 Traveler's Checks 200.00 Total from continuation schedules 'or additional sheets) attached to this schedule. 0.00 TOTAL. (Also enter on Part 5 Recanitulalion naoe 3 al ilem 3.\ . . . , . . . . . . 39,250.35 (If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.) (See the 'Instructions on the reverse skie.) JSA 2MacO.'.000 Schedule C . Page 13 Form 706 (Rev. 8-02) Estate of: ROBERT H GRISWOLD 204-03-6272 SCHEDULE D - Insurance on the Decedent's Life You must list all policies on the life of the decedent and attach a Fonm 712 for each policy Item number 1 ~ssachusetts Mutual Life Insurance Company. Polity Number 0685172; Beneficiary Anne G. DiSabatino, David R. Griswold, & Scott M. Griswold. See Form 712 attached to this return. Description Alternate valuation date Alternate value Value at date of death 1,020.74 2 State Farm Insurance Companies. Policy Number LF 0031-3539; Beneficiary Anne G. DiSabatino, David R. Griswold & Scott M. Griswold. See Form 712 attached to this return. 17,996.92 3 State Farm Insurance Companies. Policy Number LF 0049-8269; Beneficiary Anne G. DiSabatino, David R. Griswold & Scott M. Griswold. See Form 712 attached to this return. 17,451.03 4 United States Government - Department of Veterans Affairs. Polity Number V 321 04 65; Beneficiary Anne DiSabatino, David Griswold & Scott Griswold. See Form 712 attached to this return. 12,053.13 5 The Prudential Insurance Company of America. Policy number 21 194 033; Beneficiary Anne E. DiSabatino, David R. Griswold & Scott M. Griswold. See Form 712 attached to this return. 45,271.36 Total from continuation schedules 'or additional sheets' attached to this schedule. 0.00 TOTAL. 'Also enter on Part 5 Recanitulation none 3 at ~em 4.\ . . . . . . . . . . 93,793.18 (If more space is needed, attach the continuation schedule from the end of this package or add~icnal sheets of the same size.) (See the instructions on the reverse side.) Schedule D - Page 15 JSA 2M8010 1.000 Form 708 (Rev. 8-021 Estate of: ROBERT H GRISWOLD 204-03-6272 SCHEDULE E - Jointly Owned Property (If you elect section 2032A valuation, you must complete Schedule E and Schedule A-l.) PART 1.. Qualified Joint Interests - Interests Held by the Decedent and His or Her Spouse as the Only Joint Tenants (Section 2040(b)(2)) Item Description Alternate Alternate value Value at date of death number For securities, give CUSIP number. valuation date Total from continuation schedules (or additional sheets) attached to this schedule 0.00 1a Totals " . . . .... . .............. . . 11a 0.00 1b Amounts included in oross estate (one-haW of line 1 a). . . . ........ . , 11b 0.00 PART 2. - All Other Joint Interests 2a State the name and address of each surviving co-tenant. If there are more than three surviving co-tenants, list the additional co-tenants on an attached sheet. Name Address (number and street, city, state, and ZIP code) A. B. C. Item c:nler u.escnptlon Percentage Includible Includible value at number letter for (including alternate valuation date if any) For includible alternate value date of death co-tenant securities, give CUSI? number. Total from continuation schedules (or additional sheets) attached to this schedule 0.00 2b Total other ioint interests .......................... . 2b 0.00 3 Total includible joint interests (add lines 1 band 2b). Also enter on Part 5, Recanitulation naoe 3 at item 5 . . , . . . . . . . . . . . . . . . . . . . . 3 0.00 (If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.) (See the instructions on the reverse side.) Schedule E - Page 17 JSA 2MBOll 1.000 . Form 706 (Rev. 8-02) Estate of: ROBERT H GRI SWOLD 204 -03- 6272 SCHEDULE F - Other Miscellaneous Property Not Reportable Under Any Other Schedule (For jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.) (If you elect section 2032A valuation, you must complete Schedule F and Schedule A-I.) 1 Did the decedent at the time at death own any articles at artistic or collectible value in excess of $3,000 or any Ve. No collections whose artistic or collectible value combined at date of death exceeded $10,000? . . . . . . . . . . . ... . .t's ~ If "Ves," submit full details on this schedule and attach appraisals. 2 Has the decedent's estate, spouse, or any other person, received (or will receive) any bonus or award as a resun of the decedent's employment or death? ...................... . ............... . ... . X If "Ves," submit full details on this schedule. 1.< :<t' 3 Did the decedent at the time of death have, or have access to, a safe deposit box? . .............. . . .... X If "Ves," state location, and if held in joint names of decedent and another, state name and relationship of joint depositor. If any of the contents of the safe deposit box are omitted from the schedules in this return, explain fully why omitted. Item Description Alternate Alternate value Value at date of death number For securities, give CUSIP number. valuation date 1 Personal property Located at 100 Sycamore 4,360.00 Drive, West Grove, PA (See attached listing and appraisal) 2 1997 Ford Crown Victoria Sedan LXI 28,652 9,500.00 Miles - See Attached Appraisal 3 McNees Wallace - Retirement Income 1,888.32 Receivable 4 United States Treasury-2002 Form 1040 2,889.00 Refund Total from continuation schedules (or addttional sheets) attached to this schedule. 0.00 TOTAL. (Also enter on Part 5, Recapitulation, page 3, at nem 6.) . . . . . . . . . . 18,637.32 .. (If more space is needed. attach the continuation schedule from the end of thiS package or additional sheets of the same sIZe.) (See the instructions on the reverse side.) JSA 2M80121.000 Schedule F - Page 19 Form 706 fRev. 8-()2) Estate of: ROBERT H GRISWOLD SCHEDULE G - Transfers During Decedent's Life 204-03-6272 flf "ou elect section 2032A valuation vou must comnlete Schedule G and Schedule A-t.) Item Description Alternate Alternate value number For securities. aive CUSIP number. valuation date Value at date of death A. Gift tax paid by the decedent or the estate for all gifts made by the decedent or his or her spouse within 3 years before the decedent's death (section 2035(b)). . . . . . . . . . . . . . . X X X X X 0.00 B. Transfers includible under section 2035(a}, 2036, 2037, or 2038: See Sohedule attaohed Total from continuation schedules lor additional sheets' attached to this schedule. 711,010.99 TOTAL. IAiso enter on Part 5, Recaoitulation. nane 3, at item 7.) ......... . 711,010.99 SCHEDULE H - Powers of Appointment (Include "5 and 5 lapsing" powers (section 2041 (b)(2)) held by the decedent.) Iff vou elecf section 2032A valuation, vou must comDlete Schedule H and Schedule A- U Item Description Alternate Alternate value Value at date of death number valuation date Total from continuation schedules (or additional sheets' attached to this schedule . 0.00 TOTAL. (Also enter on Part 5 Recaoitulation, nane 3 at .em 8. \ ... . . . . . . . 0.00 (If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.) (The instructions to Schedules G and H are in the separate instructions.) JSA 2MB0132.000 Schedules G and H " Page 21 Estate of: ROBERT H GRISWOLD Schedule G -- Transfers During Decedent's Life It.... No. Description 1 Various securities transferred to Hershey Trust Company, trustee, Robert H. Griswold T/U/A (#25-6564387) for the benefit of Robert Griswold on October 29,1996 (see copy of trust agreement attached). See Statement G-l for a copy of the computation of the amount included. Uni t Val. CUSIP Al terna te Val. Date Alternate Value TOTAL. (Carry forward to main schedule) . . . . . . Page 2 204-03-6272 Value at Date of Death 711,010.99 711,010.99 . Form 706 (Rev. 6-021 Estate of: ROBERT H GRISWOLD 204-03-6272 SCHEDULE I - Annuities Note: Generally, no exclusion is a/lowed for the estates of decedents dvina after December 31, 1984 (see paae 14 of the instructions. A Are you excluding from the decedent's gross estate the value of a lump-sum distribution described in section 2039(1)(2) Ves No (as in effect before its repeal by the Deficn Reduction Act of 1984)? . . . . . . . . , . , . , . . . . . . . . . . . . . . X If "Yes," vou must attach the information reQuired bv the instructions. i:. Item Description number Show the entire value of the annuity before any exclusions. 1 IRA - Citizens Bank A/c# 00313-001266 Alternate valuation date Includible alternate value Includible value at date of death 4,465.99 Total from continuation schedules (or additional sheets) attached to this schedule. 0.00 TOTAL. (Also enter on Part 5 Recaoitulation oaoe 3 at item 9.\ ...,...... 4,465.99 (If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.) (The instructions to Schedule 1 are in the separate instructions.) Schedule I - Page 22 JSA 2M80143.000 ~ Form 706 (Rev. 6-02) Estate of: ROBERT H GRISWOLD 204-03-6272 SCHEDULE J - Funeral Expenses and Expenses Incurred in Administering Property Subject to Claims Note: Do not list on this schedule expenses of administering property not subject to claims. For those expenses, see the instructions for Schedule L. If executors' commissions, attorney fees, etc., are claimed and allowed as a deduction for estate tax purposes, they are not allowable as a deduction in computing the taxable income of the estate for Federal income tax purposes. They are allowable as an income tax deduction on Form 1041 if a waiver is filed to waive the deduction on Form 706 isee the Form 1041 instructions). Item number A Funeral expenses: 1 ~usselman's Funeral Home, Inc. - Funeral Charges Description Expense amount Total amount 7,931.95 2 Evans Cemetary Memorials-Engraving of Monument 100.00 Total funeral expenses .......". ...,......,.... ~ _______9_,_0_6_4_._6)_ B. Administration expenses: 1 Executors' commissions - amount estimated/4lg~gd "PQn/p~irl {~trike out the words that do not apply.) _ _ _ _ _ __ _ _ _ _0_,_0_0_ 2 Attorney fees - amount estimatedia~reea "~eA'~.id. (Strike out the words that do not apply.) . . n_____~L~~q,:..q,q, 3 Accountant fees - amount estimated/:is,wwd lI~Q".lpai<l. (Strike out the words that do not apply.) n _____~Lq,q,q,'--q,q, 4 Miscellaneous expenses: 4 Appraisal - Land-Tioga County Property Expense amount 250.00 5 Register of Wills-Filing fee 566.00 6 Bank charges 12.00 Total miscellaneous expenses from continuation schedules (or addnional sheets) attached to this schedule . . . Total miscellaneous emenses .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .... 0.00 828.00 TOTAL. (Also enter on Part 5 Recanitulation nane 3 at nem 13.). ~ 23 142.67 (If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.) (See the instructions on the reverse side.) JSA 2M8D15 3.000 Schedule J - Page 23 .. Estate of: ROBERT H GRISWOLD Page 2 204-03-6272 Schedule J, Part A -- Funeral Expenses Item No. Description 3 Harding's Restaurant-Funeral Dinner Amount 1,032.72 TOTAL. (Carry forward to main schedule) . 1,032.72 Form 706 IRev. 8-02) Estate of: ROBERT H GRISWOLD 204-03-6272 SCHEDULE K - Debts of the Decedent, and Mortgages and Liens Item Debts of the Decedent - Creditor and nature of claim, and Amount unpaid to date Amount in contest Amount claimed as number allowable death taxes a deduction 1 NCS Health Care, Pharmacy Bill 0.00 0.00 2,508.40 2 SpaceMart Self-Storage - Desk Storage 0.00 0.00 55.12 3 Verizon Wireless - Telephone 0.00 0.00 11.59 4 ~CS HealthCare - Pharmacy Bill 0.00 0.00 121.17 5 ~erizon Wireless - Telphone 0.00 0.00 2.86 6 SpaceMart Self-Storage - Desk Storage 0.00 0.00 55.12 7 State Farm Insurance Company - Auto 0.00 0.00 44.63 Jpda te 8 'Inn R. Dorsey - Real Estate Taxes, 0.00 0.00 739.89 Tioga County property 9 Hershey Trust - Service charge 0.00 0.00 16.45 Total from continuation schedules (or additional sheets\ attached to this schedule .............. . 5,810.38 TOTAL. (Also enter on Part 5 Recaoitulation DaDe 3 at item 14.\ . . . . . ........... . . . . . . . . 9,365.61 Item Mortgages and Liens - Description Amount number Total from continuation schedules (or additional sheets' attached to this schedule. 0.00 ............. . TOTAL. (Also enter on Part 5 Recanitulation naoe 3 at item 15.'. . . . . . . . . . . . ........... . 0.00 (If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.) (The instructions to Schedule K are in the separate instructions.) Schedule K - Page 25 JSA 2MS0164.000 .. Page 204-03-6272 2 Estate of: ROBERT H GRISWOLD Schedule K, Part 1 -- Debts of the Decedent Item Amount unpaid Amount Deduction No. Description to date i.n contest amount 10 Hershey Trust - Service Charge 0.00 0.00 9.54 11 Hershey Trust - Service Charge 0.00 0.00 4.02 12 PA Dept. of Revenue - 1st Quarter 0.00 0.00 70.00 PA-40 Esti.mate for 2002 13 Jenner's Pond - Retirement Home 0.00 0.00 3,870.00 14 Verizon - Telephone 0.00 0.00 51.82 15 Brown, Schultz, Sheri.dan & Fritz - 0.00 0.00 1,660.00 Accounting Fees 16 Med-Trans, Inc. - Medi.cal 0.00 0.00 55.00 Transportation 17 PA Department of Revenue 0.00 0.00 90.00 TOTAL. (Carry forward to mai.n schedule) . . 5,810.38 ...... t .. Form 706 (Rev. 8-02) Estate of: ROBERT H GRISWOLD 204-03-6272 SCHEDULE L - Net Losses During Administration and Expenses Incurred in Administering Property Not Subject to Claims Item Net losses during administration Amount number {Note: Do not deduct losses claimed on a Federal income tax return.> Total from continuation schedules (or additional sheets\ attached to this schedule. ............. . 0.00 TOTAL. (Also enter on Pert 5 Recaoitulation. oaoe 3 at item 18.1. . . . . . . . . . . ...... . ..... . 0.00 Item Expenses incurred in administering property not subject to Amount number claims flndicate whether estimated anreed unon or naid,) Total from continuation schedules (or additional sheets) attached to this schedule. . . . . . ........ . 0.00 TOTAL. (Also enter on Part 5 Recanitulation nane 3 alttem 19.\. . . . . . . . . . . . . . . ........ . 0.00 (If more space is needed, attach the continuation schedule from the end of this package or addITional sheets of the same size.) Schedule L - Page 26 (The instructions to Schedule L are in the separate instructions.)