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Home My WebLink About01-0666 Register'of Wills of ~G.wn~nPIUI>f .' ~\A\M ~~~\..~I~ ~ '~~()unty, Pennsylvania PETI116t~lPORGRANT'~OF llt=trrERS John1<och No. 21-01-666 Estate of also known, as. ,: ~,:,: . Decease(l. Social Security No 1 72 - 0 1 - 1 6 0 5 Pelitioner(s), who islare 18 years or age or older, appIy)ies) for: (COMPLETE "A" OR "B" BELOW:) o A Probate and Grant of Letters and aver that Petitioner(s) is/are the execut Decedent, dated and codicil( s) dates named in the Last Will ofthe State refevant circumstances, e.g~ renunciation, death or executor, etc Except as follows, Decedent did not marry, was not divorced and aid not have a child born or adopted after execution of the documents offered for probate; was not the victim of a kining and was never adjudicated Incapacitated: lKI B. Grant of Letters of Administration (c.t.a.. d.b.n.c.la.: pendente lite, durante absentia; durante minorilate) Petitioner(s) after a proper search xasJhave ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I Elizabeth Koch stoner Dauahter -- 651 Candlewvck Road Lancaster, PA 17610 John w. Koch Son 2697 Chestnut Road - Elizabethtown, PA 17022 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumber land County, Pennsylvania, with hislher last family or principal residence at 811 Tuscarora Bld9." (Messiah Villaqe). Mechanicsburq. 17055 (list street. number and municipality) Decedent,then 87 yearsofaQ~died May 21 2001 at Messiah Village, Upper Allen Townshi , -' (location) Cumberland Cty., PA Decedent at death owned property with estimated values as follows: (if domiciled in P A AD personal property ....................-.................... (if not domiCiled in PA Personal property in Pennsylvania .................... (if not domiciled in PA Personal property in County .............................. Value of real estate in Pennsylvania ........................................................................................ Total ................. .............. ...................... ......................... ......... .............................. $ 300,000.00 $ $ $ $ 300,000.00 Real Estate situated as follows: Wherefor, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriale form to the undersigned: Signature Typed or printed name and residence Elizabeth Koch Stoner 651 Candlewyck Rd., Lancaster, PA 17610 John W. Koch 2697 Chestnut Rd. Elizabethtown PA 17022 RW-1 / L-~.t../- I 7~"i"~t-~'" i'?'!f~' r~~'''''''.'"'>i. .~. ,,J.: .:....'... .:': 1.,;.t..-,.. ,..l,;;~-'o,,"~.~..,;;::~. ;;,_:.; '. - :....' :'i... .'. . ~)d ~,:./J''':';~:~- i';.'.: , ~~, , . '. ";16l,.'atl:Jtof~ersQnal:Represen~tive,:~:"; =: ,.'L ;_.L_v~l '_....<, ~ ., ~ . Commonwealth of Pennsylvania' . County of .... ....---....-- ~" The Petitioner(s) above-named swear(s)'andaffinn(s) that the statements in the foregoing Petition are true"" and correct to the best of the knowledge and belief,?f Petitioner{ an hat, as personal representative(s) of the Decedent, Petitioner(s) will well and truly admlillStedhe est rdi g to I Sworn to and affinned and subscribed before me this 9th day of JULY o20.Q.L 77?7c? 7JJ<I/M///~ ~ J, ~ AJ Lv - KOc.J'A DECREE OF REGISTER Estate of John Koch Deceased No. 21-01-666 also known as Social Security No: 172-01-1605 Date of Death: May 21, 2001 AND NOW, JULY 16 , 2~, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters 0 Testamentary (a of Administration ((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate) are hereby granted to Elizabeth KochStoner and John W. Koch in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... $ 270.00 ~-ro/<h.;~b/~e4.dl RegIster Wills , Renunciation . ...... ................... Short Certificates(s) ............... $ $ $ $ $ $ $ $ 15.00 Extra Pages ( ) ............... I. T.R. ................. ............... ...... JCP Fee ................................. 5.00 Attorney: 1.0. No: Carl G. Wass, Esquire Inventory ....... ................... ...... 07268 Other .. ...... ............. .......... ....... Address: 3631 North Front Street Harrisburq, PA 17110 (717) 232-7661 JULY 9, 2001 TOTAL ..... .......................$. 290.00 Telephone: DATE FILED: HIO).805 REV 9/H6 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7422097 No. 21-01-666 t?-Pc)-P I Date H.OS a3Rn 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH 'ElPAlNt IN MANENT 0Cl( _ Sf< '! TN l ~'lf ~M8EA ~ECURIN f.U"'BER .. Male L...! 72 - 01 - ~EO#(lEAJ.".O't.'f:.':loty,..,..,ot-..,ooe ,'>l,,,.!........1f'l~~ Sol.M'I OAlE OF OEAfH ,Mere. ~ ......, .. May 21, 2001 NAME OF OECEDENT ,f,u' MOJle, ...., I. John Koch AGE Il~. 8or1fIoav. uNOEA 1 yEM - Doya 87 v... weJER 1 DR' taft!...... 1IIRTHPl.ACE:C.r, oIfl(J ~.:JI fc'eqnCOUNl'vl '1. . COUNTYOFDERH Cumberland ... ICINO OF IUSlNESS/INOUSTAV DECEOENT'S AI. OCCUPOl1ON l~~~~:::~ parking lots " Dl1s~ness owner . llECEOENT"SlIMlNG_SStso-. ~_.z"c-t 811 Tuscarora B Building ... Mechanicsburg, PA 17055 r:RHEJr1 NME .,..... MIOcIe. L.aIIJ to Heinrich Koch ..-rilli~~h K. Stoner OECEOEHT'S 1lCTUAI. RESIDENCE ............ on_..... Cumberland .",. I ~ METHOD OF llISPOSlTlOH Y "19 , 2001 LICE~ NU~R u144u4-L _g; ~O ___0 _0 0lIw_ . _OF' _ AC!Hl All SUCH as QIdiac Of ,..,.,MOrt ..,.... anodt or hHtt lallufe 4'..iv.l/, V"<'.<!""'.'.,oJ C,// C ,././1';".// DuE tOtOA AS A CONSE6f.E1ICE Clf'o l :. .. DuE tOtOA AlIA CONSEQUEIICE Clf'o DuE lOtOA All ACONSEOUENa Clf'o _AU1'Ol'SY'_ MANNER OIF DEAlH --.a1'RlCfl1O B" OF CAUSE -.. -... 0 DERH? - 0 --- 0 ....0 ...0 - 0 Could naI be ctM~ 0 OATE O#IH.iURY lMor1lh o.y. ~l ,.... e~l"nI L.J :=..,0 t:... EOUCAlION <om c-.. 114or~.1 RACE . AmencM....... 8IiIctl. Whl.. .. .-, Whi te 10. MARITAl STATUS........ ~M.iIf_.W~. _,5<>0<'>1 widower SUlMvINQ SPOuSE il -.. ~ "'-"" IWNlI "'" - ....tn. -' "c.129 _.~w.dift II. Lower Allen .,.. - Curwensville, PA "c1. Inc. 3125 Walnut St. ORE_ _.Cloy. -. 2311. . .... CASlO AEFE_O 10 MEDICAl. E........eAiCORONER' .... 0 HoE' NAUE AHOAOORESSOF FACiLITY ~etrick Fun. Home, LICENSE NUM8EA .PA ... . Afclto....nato 1irUr4f~ : ClNM and dedi I 16/,,<, PART I: 00............__..-..... ...,..,....in.. ....."........ ift """ I. 'flWE 0#- lKJuAY IMJVAV 1t1 WORK' DESCRIBE HOW' IN.NRY ~O. .... 0 ...0 II. PlACE OF INJURY - ~ hc)mel, fa,.", Slf.eI.lactOrt. orr.c. ~ttcl$pel:.'h,1 _. -. ... cun.....o-.c. 0l'WJ cnet -ClUtTFYING ,,"VSlClANIP'hrte..nCtllIltyonqC&IMdONll\ ""'*' .1'ICllf'. Dt'vSIC..tnhHC:-Clr1Ol.InCeddeollh ana can'*"ed !Itwt'l ;!JI ,.........t"" tnowIMp. ..th occurncf........ c~.) and manner _ .uted. . . . . ~ Z .. o .. u .. o ~ ~ 2 < z OPllOHOUNClHQ AHOCl.ftTIFYINQ PH'SlClAN~ tx1lr O)l':.f\Ol,j(oC'l\Q lJNWI.and C"'I~ IO';.....~ 01 ,Jf!dlf'll T... __ of My knowtlMt-. death OCC"'rM ........ ~I.. and pleca. and due to ItMI uuNCa) i1nc11 manNl'.. 'UIIIId.. 'IIEDlCAl. EXAM'NEIlICOAONEA On eN blai' of ...,,"n.Uon and/or inv."....,.. tn m, op."tOn. oj..th OCtu,," at lhe lima, dala, and place. ...nd due 10 the c...,sel'lJ.nd "'ailnet' .. ,.aled.. ... AIEGIS TAAA S SICNArVRE AHe NU'-"B[R ;i~ tL?:t'.d?.:.G lOCAl'ION (Slr_ Cot,f1'o.n Slat.. ,... SIGNATUR AIW TITLE OF CEAf1fIER g JIb .-w.. ,/ <, /.~. .:.---.;;; lICENSE N OER DAlE SIGHah~, 0.. ...1 ~"1 ]H~..:~~~;__':!.... .......,/ ~__ Jld. ., ..,.,: ~ ~ ,"'#"s~; N"'~E .-.Nu t,c.C'AESSOF PEAo;c)N WHQCQMPlfTEO CAUSE 06' DEATH IIlP.fTlZTlT,peQfP'lnl Tc-......;/r-,. ~ G v..;....,.-k~,'J._... ;J. ~, ,-._/" ,7.1 . "...,7" '.... _. _ /(. ..t.- .:-:>: /~,: ,12 ----IO...'EFll.f.- _2~_--_ ':_~"-"""# /- / / E ----- . CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: John Koch Date of Death: Ma y 2 1, 20 0 1 Will No. Adm. No. 2001-00666 To the Register: I certify that notice of estate administration 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 July 18, 2001 : Name Address Elizabeth Koch stoner, 651 Candlewyck Road, Lancaster, PA 17601 John W. Koch, 2697 Chestnut Road, Elizabethtown, PA 17022 Notice has now been given to all persons entitled thereto under Rule 5.6a) except: No exceptions. Date: August 13, 2001 ~.~~ (Signature) Name: Carl G. Wass, Esquire CALDWELL & KEARNS Address: 3631 North Front street Harrisburg, PA 17110 Telephone {l1 '1 232 - 7 6 61 Capacity: x Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT W ASS CARL G 3631 NORTH FRONT ST. HARRISBURG, PA 17110 -------- fold ESTATE INFORMATION: SSN: 172-01-1605 FILE NUMBER: 21-2001- 0666 DECEDENT NAME: KOCH JOHN DATE OF PAYMENT: 08/21/2001 POSTMARK DATE: 08/20/2001 COUNTY: CUMBERLAND DATE OF DEATH: OS/21/2001 NO. CD 000179 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $14,000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ELIZABETH K STONER C/O CARL G WASS ESQUIRE CHECK# 4099 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $14,000.00 MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-0666 ACN 01147337 DATE 10-10-2001 REY-1543 EX AFP eD9-DU> EST. OF JOHN KOCH S.S. NO. 172-01-1605 DATE OF DEATH 05-21-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IXJ CERTIF. ~~ DORIS FISHEL 101 W LISBURN RD PO BOX 43 BOWMANSDALE PA 17008 RE"IT PAY"ENT AND FOR"S TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If yOU feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be enswereD by cal~ing (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31500206206 Date 02-01-2001 Established x .00 50.000 .00 .15 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x Tax NOTE: If tax payments are made within three (3) months of the decedent.s date of, death, you may deduct a 5X discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s representative. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART [!] TAX RETURN - COMPUTATION lINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax S. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rate, please state your relationship to decedent: OF 1 2 3 4 S 6 7 8 x x PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on line S of Tax Computation) perjury, I declare that the facts now ledge and belief. I have reported above ~e true, corre~t~~d HOME (1ft?) tR? 7- Lllfjl./ WORK ( ) TELEPHONE NUMBER nATF COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8060l HARRISBURG, PA l71Z8-060l '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-0666 ACN 01147328 DATE 10-10-2001 REY-1545 EX AFP 109-001 ~~ DORIS FISHEL 101 W LISBURN RD PO BOX 43 BOWMANSDALE PA 17008 REMIT PAYMENT AND REGISTER OF WILLS CUMBERLAND CO COURT CARLISLE, PA 17013 TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST !Xl CERTIF. FORMS TO: EST. OF JOHN KOCH S.S. NO. 172-01-1605 DATE OF DEATH 05-21-2001 COUNTY CUMBERLAND HOUSE PNC BANK has p"Dvided the Depa..t.ent with the infD...atiDn listed belDw which has been used in calculating the pDtential tax due. Thei.. ..ecD..ds indicate that at the death Df the abDve decedent, YDU we..e a jDint Dwne../beneficia..y Df this accDunt. If YDU feel this info...ation is inco....ect, please obtain w..itten co....ection f..o. the financial institution, attach a copy to this fo... and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the Co..onwealth Df Pennsylvania. QuestiDns .ey ba answe..ed b~ ~Glling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31000190407 Date 07-07-2000 Established x .00 100.00 .00 .15 .00 TAXPAYER RESPONSE To insu..e p..ope.. c..edit to you.. accDunt, two [Z) copies Df this notice .ust acco.pany you.. pay.ent to the Registe.. Df Wills. Make check payable to: "Registe.. of Wills, Agent". Account Balance Percent Taxable ABount Subject to Tax Rate Potential Tax Due x NOTE: If tax pay.ents a..e .ade within th..ee (3) .onths of the decedent.s date of death, you .ay deduct a 5~ discount of the tax due. Any inhe..itance tax due will beco.e delinquent nine (9) .onths afte.. the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. c=l The above info...ation and tax due is co....ect. 1. You .ay chDose to ..e.it pay.ent tD the Registe.. of Wills with two copies of this notice to obtain a discDunt 0" avoid inte..est, D" you .ay check bDx "A" and ..etu..n this notice tD the Registe.. of Wills and an official asses~ent will be issued by the PA Depa..t.ent of Revenue. c=l The above asset has been 0.. will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance Tax ..etu..n to be filed by the decedent's ..ep..esentative. c=l The above info...ation is inco....ect and/o.. debts and deductions we..e paid by you. You .ust co.plete PART ~ and/o.. PART ~ below. x If you indicate a different tax rate, please state your relationship to decedent: PART [!] TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. ABount Subject to Tax S. Debts and Deductions 6. ABount Taxable 7. Tax Rate 8. Tax Due TAX ON JOINT/TRUST ACCOUNTS OF 1 2 3 4 S 6 7 8 x PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line S of Tax Computation) I $ Under penalties of perjury, I declare that the facts I cOBplete to the best of BY knowledge and belief. TAYPj,Z~~TIIRJ: ~~J have reported above ~e true, correct and HOME (tIf 17) fe <=( 7 -t{ I j -cJ WORK ( ) TELEPHONE NUMBER DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8060l HARRISBURG, PA l71Z8-060l '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0666 01147333 10-10-2001 REY-1545 EX AFP 109-001 EST. OF JOHN KOCH S.S. NO. 172-01-1605 DATE OF DEATH 05-21-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS D CHECKING o TRUST [X] CERTIF. ~~ DORIS FISHEL 101 W LISBURN RD PO BOX 43 BOWMANSDALE PA 17008 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has providad the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered hy ~~!!ing (717) 187-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31800207864 Date 04-03-2001 Established x .00 50.000 .00 .15 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice must aCCOBpany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Account Balance Percent Taxable A.ount Subject to Tax Rate Potential Tax Due x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5X discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. [J The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s representative. [J The above information is incorrect and/or debts and deductions were paid by you. You Bust complete PART ~ and/or PART ~ below. x If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. A.ount Subject to Tax 4 S. Debts and Deductions S 6. A.ount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS x PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line S of Tax Co.putationJ Under penalties of perjury, I declare that the facts I co.plete to the best of .y knowledge and belief. DcrM/~ T4YP4VF~ ~T~NATUR have reported above a~ tr~ correct and HOME ( '117 ) ~ Y L -- '-/1 J 7) WORK ( ) TELEPHONE NUMBER DATE 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 W ASS CARL G 3631 NORTH FRONT ST. HARRISBURG, PA 17110 nn____ fold ESTATE INFORMATION: SSN: 172-01-1605 FILE NUMBER: 21-2001- 0666 DECEDENT NAME: KOCH JOHN DATE OF PAYMENT: 11/13/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: OS/21/2001 NO. CD 000513 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,939.97 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ELIZABETH K STONER C/O CARL G WASS ESQUIRE CHECK# 41 00 SEAL INITIALS: PB RECEIVED BY: $4,939.97 MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS REV_l500EX+(6-00} Ifc.-;;(Lf</ - I REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 1712B-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ Z W C W U W C Koch John DATE OF DEA,TH (MM-OO-Year} DATE OF BIRTH (MM-OD-Year) OS/21/2001 02/23/1914 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Ul :. "'-'" u"'''' Ul"-U :rOO U"'--' "-'" "- '" o 1. Original Return o 4. Umited Estate 06. DecedentDiedTestate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of llealh alter 12.12.82) [R] 7. Decedent Maintained a Living Trust (Attach copy ofTrusl) D 10. Spousal Poverty Credit [date of death between 12.31.91 and 1-1-95) I- Z Ul o Z o "- '" Ul '" '" o u ~ESPONjjE~AND C NEt :u TAX- COMPLETE MAILING ADDRESS 3631 North Front Street 'ION MUST 8 NAME Carl G. Wass Es uire FIRM NAME (If A"I<ab~) CALDWELL & KEARNS P.C. TELEPHONE NUMBER 717 232-7661 Harrisbur z o ~ ...J :J ~ ii: <C U w 0:: 1. Real Estate (SchoOule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (SchoOule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (7) (SchoOule G or L) B. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Unes 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11} OFFICIAL USE ONLY FILE NUMBER 21-010666 ""CciUNTYCODE ----vE-AR- - - 'NmiBER- - SOCIAL SECURITY NUMBER 172-01-1605 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~EGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (dateofdeathpriorto 12-13.82) o 5. Federal Estate Tax Return Required Q.. 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach &h 0) .NSHOULD TE PA 17110 OFFICIAL USE ONLY '.-1 13. Charitable and Governmental BeQuests/Sec 9113 Trusts for which all election to tax has not been made (Schedule J) 14. Net Value Subjectto Tax (Une 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ :J Q. :;; o u ~ I- 15. Amount of Line 14 taxable at tile spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X 0_(15) 326,171.94 X .04.5 (16) X .12 (17) 33,081.52 X .15 (IB) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 82,655.55 \ 63,331.33 \ 228,475.20 I I I _J (B) 374,462.08 9,221.79 5,986.83 (11) (12) (13) 15,208.62 359,253.46 (14) 359,253.46 14,677.74 4,962.23 19,639.97 AI.L QUEST~ .~~ >>~1!!"011Il o d t' C I t Add ece en s omPle e ress: . , STREET ADDRESS 811 Messiah Villaqe CITY I STATE I ZIP Mechanicsbur9 PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 19,639.97 14 000.00 700 00 3. InteresVPenalty if applicable D.lnterest E. Penalty Total Credits (A + B +C) (2) 14,700.00 TotallnteresVPenalty (D + E) (3) 4. If Une 2 is 9reater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund (4) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 4,939.97 0.00 4,939.97 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; .....................,........ ........................................... [R] 0 b. retain the right to designate who shall use the property transferred or its income; """""""""""""'''''''''''''' 00 0 c. retain a reversionary interest; or ................. ............... .............." .............. ...............,. .................. 0 [Xl d. receive the promise for life of either payments, benefits or care? ......................... ................. [R] 0 2. If death occurred afler December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.......,............. ........................... ... ........... .............................. 0 [KJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...."........... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........ ................................................................... . ........................ 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pre parer other than the personal representative i on all information of which preparer has any knowledge. SIGNA TVRE OF PERSON RESPONSIBLE FI TV ~ X'~ ADDR S 651 Candlewyck R Lancaster SIGNATURE OF PRE PARER OT ER THA tdu DATE /J.g.ol PA 17601 DATE ~OO\ PA 17110 For dates of death on or afler July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or tor the use of the surviving spouse is 3% [72 P.S. S91 16 (a) (1.1) (i)l. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)l. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or afler July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(I.2)]. The tax rate imposed on the net value offransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 PS. 99116(a)(I)J. The tax rate imposed on the nef value of transfers to or tor the use of the decedent's siblings Is 12% 172 P.S. 99116(a)(1.3)J. A sibling is detined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508EX"(1-97)_~_ ,.~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Koch John FILE NUMBER 21 01 0666 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. OESCRIPTION 1994 Cadillac DeVille, 4-door sedan, value per Kelley Blue Book, Serial No. 1 G6KD52B3RU237986 (Exh. #1) VALUE AT OATE OF DEATH 8,790.00 Misc. personal property located at Messiah Village, Independent Living Unit No. 811. Estimated. 2,000.00 Guaranteed refund from Messiah Village, per Agreement, and Addendum B attached. (Exh. #2) 23,900.00 Messiah Village, Residents' Investment Club, 550 shares @ $27.05 (Exh.#3) 14,877.50 2,667 shares, common stock, ePlans, Inc. Accompanying corporate information indicates, alternatively, no vaiue & some value; and, indicates also no market for sale, trade or exchange exists. Estimated @$1.00/share (Exh. #4) PNC Bank, Certificate of Deposit #31800182872 (Exh. #5, item on p. 5 thereof) 2,667.00 1,709.74 IRS income tax refund for 2000 4,000.00 AF&L Insurance Co. - Long term care benefits received after death 13,700.00 Conseco Sr. Health Ins. Co. - Benefits received after death 9,500.00 AF&L Ins. Co. - Premium refund 268.18 Conseco Sr. Health Ins. Co. - Premium refund 360.48 Blue Cross/Blue Shield - Premium refund 200.95 Travelers - Ins. premium refunds 328.00 Verizon - Credit balance refunded 5.70 Pa. income tax refund - 2000 348.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 82655.55 REV.'50SEX+(1'97l~~ . .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL V-OWNED PROPERTY ESTATE OF Koch John If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G. FILE NUMBER 21 01 0666 SURVIVING JOINT TENANT{S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Doris Fishel Box 43, Bowmansdale, PA 17008 Friend B Lloyd Fishel Box 43, Bowmansdale, PA 17008 Friend c Elizabeth Koch Stoner 651 Candlewyck Road, Lancaster, PA 17601 Daughter JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH HEM FOR JD1NT MADE Include name of financial institution and bank account number or similar iderltifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed forjoinUy-held realeslale VALUE OF ASSET INTEREST DECEDENTS INTEREST 1 A. 7/7/00 PNC Bank, Certificate of Deposit #31000190407 1,060.96 100. 1,060.96 (Exh. #5, page 1) 2. A.B. 211101 PNC Bank, Certificate of Deposit #31500206206 1,014.81 100. 1,014.81 (Exh. #5, page 4) 3. A.B. 4/3/01 PNC Bank, Certificate of Deposit #31800207864 1,005.75 100. 1,005.75 (Exh. #5, page 4) 4. C. 10/4/99 PNC Bank, Certificate of Deposit #31200166982 1,104.74 50. 552.37 (Exh. #5, page 3) 5. C. 3/7/00 PNC Bank, Certificate of Deposit #31800179761 1,082.05 50. 541.03 (Exh. #5, page 5) 6. C. 8/8/00 PNC Bank, Certificate of Deposit #31000195318 1,053.86 100. 1,053.86 7. C. 8/18/00 PNC Bank, Certificate of Deposit #31800197266 5,259.71 100. 5,259.71 8. C. 9/5/00 PNC Bank, Certificate of Deposit #31700198146 1,046.42 100. 1,046.42 9. C. 10/26/0 PNC Bank, Certificate of Deposit #31500201468 1,036.54 100. 1,036.54 10. C. 11/7/00 PNC Bank, Certificate of Deposit #31400203075 2,067.70 100. 2,067.70 TOTAL (Also enter on line 6, Recapitulation) $ 63331.33 (If more space is needed, insert additional sheets of the same size) Koch, John Continuation of REV-1500 Inheritance Tax Return Resident Decedent 21 01 0666 PaQe 1 Schedule F-1 - Jointly Owned Property SURVIVING J01N1 TENANT(S) NAME D. John W. Koch ADDRESS RELATIONSHIP TO DECEDENT 2697 Chestnut Road, Elizabethlown, PA 17022 Son Continuation of REV-1500 Inheritance Tax Return Resident Decedent Koch, John 21 01 0666 PaQe 2 Schedule F-2 - Jointly-Owned Property lETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed forjointly-l1eld real estate, VALUE OF ASSET INTEREST DECEDENT'S INTEREST 11. C. 11/27/0 PNC Bank, Certificate of Deposit #31600203348 1,030.35 100. 1,030.35 12. C. 1/4/01 PNC Bank, Certificate of Deposit #1500205267 1,021.88 100. 1,021.88 13. C. 2/1/01 PNC Bank, Certificate of Deposit #3130207022 1,014.81 100. 1,014.81 14. C. 6/12/00 PNC Bank, Certificate of Deposit #31100161705 1,110.49 100. 1,110.49 15. C. 6/12/00 PNC Bank, Certificate of Deposit #31800161896 1,093.14 100. 1,093.14 16. C. 6/12/00 PNC Bank, Certificate of Deposit #31400163722 1,092.55 100. 1,092.55 17. C. 6/12/00 PNC Bank, Certificate of Deposit #31700183396 1,071.91 100. 1,071.91 18. C. 6/12/00 PNC Bank, Certificate of Deposit #31600189606 1,065.09 100. 1,065.09 19. C. 6/12/00 PNC Bank, Certificate of Deposit #31000189687 1,063.31 100. 1,063.31 20. C. 6/12/00 PNC Bank, Certificate of Deposit #31300180809 6,492.34 100. 6,492.34 21. C. 10/12/0 PNC Bank, Certificate of Deposit #31600200466 1,039.04 100. 1,039.04 22. C. 6/12/00 PNC Bank Checking Account #5070099811 13,482.62 100. 13,482.62 23. D. 6/29/00 PNC Bank, Certificate of Deposit #31600190896 1,062.53 100. 1,062.53 24. D. 8/18/00 PNC Bank, Certificate of Deposit #31900198118 5,259.71 100. 5,259.71 25. D. 8/29/00 PNC Bank, Certificate of Deposit #31800197969 1,047.70 100. 1,047.70 SUBTOTALSCHEDULEF~ 37,947.47 Continuation of REV-1500 Inheritance Tax Return Resident Decedent Koch, John 21 01 0666 PaQe 3 Schedule F-2 - Jointly-Owned Property LETTER DATE DESCRIPTION OF PROPERTY %0' DATE OF DEATH ITEM FOR JOINT MADE lnclude name of financial institution al'ld bank account number or similar idsI11ifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 26. D. 10/31/0 PNC Bank, Certificate of Deposit #31700201145 2,070.15 100. 2,070.15 27. D. 11/27/0 PNC Bank, Certificate of Deposit #31500203388 1,030.35 100. 1,030.35 28. D. 1/1/01 PNC Bank, Certificate of Deposit #31500205268 1,021.88 100. 1,021.88 (NOTE: All of above accounts set forth on Exh. #5.) 29. C. 6/6/00 Morgan Stanley Dean Witter Account #410-013716-022: a. 66 shares Cons Envirowaste Ind. Inc. @ .0885 5.84 100. 5.84 b. 4 shares Avaya Inc. @ 15.990 63.96 100. 63.96 c. 100 shares Nextel Communications @ 19.750 1,975.00 100. 1,975.00 d. 50 shares Atlantis Group Inc. @ .0105 0.53 100. 0.53 e. 300 shares Bethlehem Steel Corp. @ 3.790 1,137.00 100. 1,137.00 f. 100 shares Dell Computer Corp. @25.840 2,584.00 100. 2,584.00 g. 100 shares Rite Aid Corp. @ 8.560 856.00 100. 856.00 (ITEM No. 29 set forth on Exh. #6.) SUBTOTALSCHEDULEF~ 10,744.71 GRAND TOTAL SCHEDULE F-2 $ 63,331.33 REV':'OO"'"'97I,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RES\DENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Koch John FILE NUMBER 21 01 0666 This schedule must be completed and filed jf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF TI-lE TRANSFEREE,THEIRRELATIONSHIPTODECEDENIAND THE DATE OF TR;\JIJSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE NUMBER ATTACH A COPV OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) 1. Irrevocable Trust Agreement with Dean Witter Reynolds, Inc. ("Trustee"), dated June 26,1997 -- with 5 subsequent Amendments. Transfer of assets, in Trust, made June 26, 1997. (Agt. and 5 Amend., attached. (Exh. #7) Value reported as of end of 2nd Quarter - precise date of 228,475.20 100. 0.00 228,475.20 death value not available. (Exh. #8) TOTAL (Also enter on line 7, Recapitulation) $ 228475.20 (If more space is needed, insert additional sheets of the same size) """"",.".,". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Koch ,John 21 01 0666 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hetrick Funeral Home - Balance due after credit for prepaid funeral expense 469.60 2. West Shore Country Club - Funeral luncheon 528.66 B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~s) I EIN Number of Personal Representative{s) Street Address City State Zip YeaTts) Commission Paid: 2. Attorney Fees Caldwell & Kearns, P.C. 7,590.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ClaImant Street Address City State lip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills, Cumberland County 290.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal, legal advertising 75.00 8. The Patriot News, legal advertising 118.53 9. Register of Wills - RESERVED - Final Accounting and/or Receipts and Releases 150.00 TOTAL (Also enter on line 9, Recapitulation) $ 9221.79 (It more space is needed, insert additional sheets 01 the same size) """"".".''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE- TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Koch. John FILE NUMBER 21 01 0666 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 162.42 1. Wesl Shore Country Ciub - final fee/expense payment 2. Messiah Village - rental payment for residential unit 1,391.54 3. Messiah Village - final payment for nursing care expense 3,712.50 4. R. Myers, DMD - dental bill 580.00 5. Mellon - gasoline and prescription drug expenses paid 81.49 6. Exxon - gasoline credit card debt 36.00 7. PP&L - final electric bill 22.88 TOTAL (Also enter on line 10. Recapitulation) $ (If more space IS needed, insert additional sheets of the same size) 5986.83 REV-15jJEX.(j-9n~_ "~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Knr.h .Inl In ?1 01 ORRR RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Ust Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Doris Fishel Friend $10,000 (plus joint Box 43 accounts - $2,071.24) Bowmansdale, PA 17008 2. Lloyd Fishel Friend $10,000 (plus joint Box 43 accounts - $1,010.28) Bowmansdale, PA 17008 3. Julie Hoyt Granddaughter $10,000 70 Houston Road Gronton, CT 06340 4. Amy Allen Granddaughter $10,000 2697 Chestnut Road Elizabethtown, PA 17022 5. Deborah Koch Granddaughter $10,000 408 Highlawn Avenue Elizabethtown, PA 17022 6. David Michael Stoner Grandson $10,000 120 Fox Hollow Avon, CT 06001 7. Christopher Todd Stoner Grandson $10,000 1267 Lafayette Street, Apt. 403 Denver, CO 80218 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A SPOUSAL OISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Koch, John 21 01 0666 PaQe 4 Schedule J . Beneficiaries. 1 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. Michael Shawn Stoner Grandson $10,000 651 Candlewyck Road Lancaster, PA 17601 9. Angela Camplese Friend $10,000 P. O. Box 12053 Harrisburg, PA 17108 10. John W. Koch Son 1/2 Residue 2697 Chestnut Road Elizabethtown, PA 17022 11. Elizabeth Koch Stoner Daughter $10,000 plus 651 Candlewyck Road 112 Residue Lancaster, PA 17601 Kelley Blue Book Used Car Values - StIller...... . /ebb.com - guiding the car buyer My c"e v..... New C. Pricino UMd Car ReI:lIiI Buy . ..... Car Buy . Used Car Sell TOOl< Car MOf:Or(;yd* Financino Ineur_ LemOn ChIld< wamtn\iell "<<Hfllries Car Reviews Car Previ_ Decisitln GuidCl8 Advice Aboul kbb Home Page 1 of2 Nl:W rONTENT f"l::tD6AC~ WIUh.....KoCnloolo_? TII"IID BkJeBa"k Click on the image above to visit this advertiser Blue Book Private Party Report Pennsylvania' July 30. 2001 "~--- 1994 Cadillac DeVille Sedan 40 ftlj\UlUsed Car Financino Quote Insurance Quote Warranty Quote Pre-Purchase Insoection pg-y-mentS:-<tJ~jJl<ltor Engine: V8 4.9 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 50,000 Equipment Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control AM/fM Stereo Cassette Dual Air Bags ABS (4-Wheel) Leather Dual Power Seats Imitation Conv Alloy Wheels Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. The paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. In states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left. A clean title history. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Most recent model cars owned by consumers fall into this category. Private Party Value $8,790 Private Party value represents what you might expect to pay for a used car when purchasing from a private party. It may also represent the value you might expect to receive when selling your own used car to another private EXHIBIT 1#1 http://www.kbb.comlkblki.dlllkw.kc.urr?kbb.P A;2167 49& I 7055;lux;p&752;Cadillac; I 994%;... 7/3010 I Kelley Blue Book Used Car Values Page 2 of2 party . GLUE OODK VALUE FEE06ACK Copyright <9 2001 by Kelley Blue Book Co., All Rights Reserved. Jul-Aug 2001 Edition. The Information In tnis report was printed from the Kelley Blue Book Web site (www.kbb.com) and Is intended for the personal use of the customer only and may not be sold or transmitted to another party. We assume no responsibility for errors or omlsslons.{v.01070) http://www.kbb.com/kb/ki.dlllkw.kc.urr?kbb.P A;216749& 17055;lux;p&752;Cadillac; 1994%;... 7/30/01 o ~ f\) o o f\) <.D 00 ~~~~0A1'H tf a c:o-puRtJ8ser oIh8r then your spOuse is listed "end yOu W8nt1h8'. be.1I;st8d BS__..Join( Tenan18'Mlh'R!rIltof SurvIvorshrp" (Onde8th)~~:.,~, ~,:,1ilIe goeato 9tMVIYingowner.) CHECK HERE O.;OlherwiSe.ItMi~ wi~-~_lssOed as "Tenants In ComrnOn~ (On death of one oWnet, lnlereStilf" ~Dwner goes 10 hisIher hails or estate). 'tstUeNoATt: -+-- IFNOUEN.CHECK 1ST UENHOUlER SIGN IN PRESENCE (IF r, nCT '.RY STREeT em STA'" ZIP 'ANANC\AllNSTTT\1TlON NUMBER 2ND UEN DATE: "'0 UENHOlDER STREfT mY , , ADDENDUM B MESSIAH VILLAGE INDEPENDENT LNING RESIDENCE AGREEMENf TRANSFER TO UNIT WITH LOWER ACQUISITION FEE This Addendum represents the written understanding between MESSIAH VILLAGE ("Village") and f!; ~ ("Resident"), whether singular or plural, dated this L day of ~ .l~ The parties agree to the transfer arrangement described below: 1. Resident desires a transfer of hislher right of occupancy from independent living unit at '0'3 8" ~ J~to independent living unit at Y' 1/ ~ ~ The transfer date is 58- ~ /7 tA..-, (99'1 . 2. Refund due to Resident because of transfer to unit with lower Acquisition Fee is Od $ Z.357 X>< 3. The alljusted Acquisition Fee and guaranteed refund amount are $ 00 $ cl-..~, <100 M- ( ~ -' %)respectively, and supercede the eel '1-6-' t, O(J 1<:" and . Acquisition Fee and guaranteed refund amount contained in the aforementioned Agreement or attachments to Agreement. Any language or conditions contained in the aforementioned Agreement remain unchanged except: the Acquisition Fee, the guaranteed refund amount and the reference to the particular unit occupied. WITNESS: L \:~ rt{esid~t: \~: /~_/(J-/97T CJ</H~.d~/ Resident: Date:_ ~{A1' Y '4(~d Rev.8/lm MESSIAH VILLAGE . ( . By:~O'~Date: /.).-/()-/77,Y EXHIBIT 112 DEPOSIT AI<<lR'l'IZATION N~"D - ,<' "'. ~ '- nna: ~o...,.? =s-~.?'r --, I c. _~ c. HOUSB TYPE AND I: C ~"r!::< ~ ......,'11._ .~ftmIZ C' "- r .,..... ~ .......,.m~..........~ ED: ~ ,.... ,,' ""._, 'l'EllM or AKlRTIZATION: ) 0 !:J IYl 0 '1 T~ S RATE or AKlRTIZATION: KSN'l'BLr AKlR'l'IZATION: ,Y.>7'i/mo. ';137. (,S '1i~ ~ 1711 ~jk di<- J~-17-1Y9; .Jl~o-'" AMORTIZATION BBGDlRING DATE: J...", I, j~9~ AMORTIZATION ENDING DATE: Sef Jo,""8 REFUND: 5 31 g 1.) " J ~Q/iwr:-#13S1; ~u~: #..?3J9t\'J~~ '- FISCAL YEAR-END DATES AMOUNT BALANCE /:/1:;"0;''' ():J {, I TO' .".. 0" .- 0, 937!-'5 /2 "0 S7.3';;. 7 (, I TO 1) o. ;/ ~r;:u(' '1/~i:3'),I[' ,; ./ 7 , TO , 10 3, 1101 cg::.a~ ,/ -?::... 7 t- . ! ,~TO ). ~3 q O"~ 31> .'3'f 7 (, 1'13 TO )> '1'7 ')qll 7 ~ ~S 7 ~ I '" TO 3., 9r i7 g~(p.51 7 TO' 1 3, S-lo5'; Jf . "3~ " ~, 7 , I q~ TO 34 .' llr3 2.~ .lD ., -; I.. I nTO :;?" 9E 3'1,070.0'( '7 ~ / l;: TO 3=' ~s ;. 'g 13.0'1 '1.2>7 GO q. FIN.\L UNAMORTIZED AMOUNT: DATE PAID: 93, i~).'o o - " I ~ ~.5D.)- I 'il nUl.- , 7f)3~~.!J? I 5"l073<;" I '17 pl. /,'b ( " S!~ 5"2. ....1, J . 2,'>'3,7.5:" I /4 o{,5',:ZO I -' '6/3,0'-' , - 0 - ~~jah Cuntinuing Care Retirement Seroices-Founded 1896 September 4, 2001 Carl G. Wass Caldwell & Kearns 3631 North Front Street Harrisburg, P A 1711 0-1533 Dear Mr. Wass: Enclosed please find a refund check payable to the estate of John Koch in the amount of $23,900.00. This is the amount of the refund due from the apartment at 811 Tuscarora Building, Messiah Village in which he resided. If you have any questions regarding the refund, please call me at (717)790-8220. Sincerely, ~~~ Steven C. Moles Assistant Director of Fiscal Services cc: Elizabeth Stoner 100 Mt. Allen Drive. Box 2015. Mechanicsburg. PA 17055-2015 (717) 697-4666 . Fax (717) 790-8200 . www.messiahvillage.com EnhancingUi MESSIAH VILLAGE 100 Mr. ALLEN DR.., PO BOX 2015 MECHANICSBURG, PA 17055-2015 INVOICE OA TE INVOICE NUMBER CHECK NO. 62039 007543 COMMENTS 0&/2&/2001 AUGI2R101 23,900.00 23,900.00 REF DUE APT 8111USCARORA TACH AND RETAIN n"ns STATEMENT. :: ATTACHED CHECK IS IN PAYMENT ITEMS DESCRIBED ABOVE. 23,900.00 60-1273/313 100 MT. ALLEN DRIVE PO BOX 2015 MECHANICSBURG, PA 17055 (717) 697-4666 PNC BANK, N.A. SQUTHCENTRAl. PA ,1,,'..23900 DOu.AR8 AND 00 CENTS 'OF JOHN KOCH >.:;." nOD!; 2D :lqno 1:0:110:110 27:181: 5070 W 108 10 !;nO 381R..-MIl1I MESSIAH RESIDENTS INVESTMENT CLUB MESSIAH VILLAGE POBOXIOO MEClIANlCSBURG. fA 17055 JIID.e 19,2001 Mrs.. Eli:?abeth Stoner 651 Candlewyck Rd. LljJ1G~e{,Pa.17601 RE:. John KOGh Esta1e Dell{ MI]!.. StQ!le{:. We shme with you. the los.s. of John andhis. gmcious spirit He was. the first president of the Investment Club and probably prime mover in its organization. I was pleased to speak with you a1 his funeral... It was. a very meaningful tribute to his life. I mentioned at the funeral that we would be advising you. of his. investment in the Club. John has purchased 550 shares in the Club. At the close of the trading day on whicl1 he died the value of our investments. was. $27.05 per share. His. equity is therefore $14,877.50. " . . '.::"... :,:.' '-,' ,"',," ,': ,< ,',. .' ,.:,....- The policy of the club indicates that in the case of deatq orri:slgnation the Club shall refund the shares Within three mo~ths. This will allow tinie to liquidate sufficient holdings to make an appropriate s.etUement. I have advised oUr officers. and members to prepare for this settlement appropriately. If you have any questions or suggestions kindly advise. Sincerely Elbert N.. Smith T reasW:\lr PS:. At our meeting yesterd.ay the Club expres.sed appreciation for yourfather's interest and involvement. They felt it would be appropriate to extend an . Invitation for you and John to become members.. 'AUgela'Camplese ma{discnss this fuJ1hC?r; wilh you. ,- ~ ... I : _ '.,: J , ' -. ," .. . " . -., . '.- -: !:. ',' ; '. :...! .i ~ ; , " :! ~;;.: .~ -:;, ; - ; '::-. '.":) !<,~; . -,""'1'," ';, ' }, :' .', !.~ ~':'1 ;pr. ;i_:"';T'-~ r' " '.',- ",(.'-.: ,'~,".", . ;,,' ~: EXHIBIT #3 " :':'<-~ ~:, ',;-i.. 'i.''':';'''".,,'' " .,.) .. REMOVE DOCUMENT ALONG THIS PERFORATION .. DO NOT ACCEPT UNLESS BLUE AND GREEN l"lK ARE PRESENT. THE BACK OF THIS DOCur,'ENT CONTAiNS A HEAT SENSITIVE SECURITY STRiP. "",C ,,/ ',--I~ ''":;--'/ '~"-'<'f,^"-."Yl~"'9I~YI0:: "-VI~"""j~",Y """0;-"",Y /'-t~' ,/"j~ /'-,''-...'' Yr""V'r~"~""'''- "-/,~' ''iCZ "t '["/- 1'1' /,1" /? !'I // 1I"~/11 //' II ~/ 11/'-'" /'/ Ii /'/ 11,//<11//11/ /'/ II // I' //' "" ,-, ,7/ ,>',,~1' ..... 1,-;..--; //, // //.' //; ......;..., , /J" /...... ;/"1 l//",: // //' //<, .. 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""-':<-""".y.,.,..'- _,....""v._..~, _~.~v. eP/~ .. ._~~ __ _ --.;r ePlans lac. 2 Fox Chase Drive P.O. Ilox 915 Ifdey, Pennsylvania 17033 lelepho,,: 717053401183 fuoimle: 717-534..,8\3 wehsite:eplansinuom August 29,2001 Carl G, Wass, Esq. Caldwell & Kearns 3631 North Front Street Harrisburg, PA 17110:1533 Re: Estate of John Koch Dear Mr, Wass: This correspondence is in reply to your inquiry of July 18,2001, relative to the value of ePlans inc. (formerly Plansoft Corporation) common stock. John and Esther Koch purchased 2,667 shares of ePlans common stock on July 29, 1996 at a price of $3.75 per share. The most recent sales of ePlans common stock occurred on December 30 and December 31,1998 at which time 1,000 and 1,000 shares, respectively, were sold at a price per share of $5.00. ePlans is a development stage company and has not generated income from operations. ePlans is proceeding with the development of its PlanMagic@ 401(k) software and expects to complete same in the fourth quarter, 2001. We attach a copy of our most recent financial statements and notes to financials. Very truly yours, EPLANS INC. &r. ~"~ll-'( - Raymond C. Hedger, Jr. President RCH:JMH Enclosures EXHIBIT #-4 EPLANS INC. (A DEVELOPMENT STAGE CORPORATION) . BALANCE SHEETS ASSETS December 31, 2000 1999 1998 CURRENT ASSETS: Cash $ 2,385 $ 24,090 $ 10,525 Grant receivable 0 47,000 0 Total Current Assets 2,385 71,090 10,525 PROPERTY AND EQUIPMENT: Furniture and equipment 31,045 29,688 28,250 Accumulated depreciation (29,229) (28,538) (23,542) Total Property and Equipment 1,816 1,150 4,708 Total Assets $ 4,201 $ 72,240 $ 15,233 LIABILITIES AND STOCKHOLDERS' EQUITY (DEFICIT) CURRENT LIABILITIES: Payroll taxes payable Trade accounts payable Current portion of long term debt Total Corrent Liabilities $ 1,304 $ 3,001 $ 86 2,400 0 0 9,078 10,404 9,997 12,782 13,405 10,083 200,180 168,436 149,593 167,500 149,500 131,500 36,314 41,614 39,890 1,063,403 851,856 644,426 170,000 125,000 0 1,637,397 1,336,406 965,409 1,650,179 1,349,811 975,492 OTHER LIABILITIES: Amounts due to officers Note payable to shareholder Notes payable to banks Compensation payable Loan payable Total Other Liabilities Total Liabilities STOCKHOLDERS' EQUITY (DEFICm: Common stock, par value $.01 per share, authorized 100,000,000 shares, issued and outstanding 886,198 (2000),886,198 (1999) and 884,198 (1998) Preferred stock, par value $.01 per share, authorized, issued and outstanding 10,000 Additional paid-in capital (common stock) Deficit accumulated during the development stage Total Stockholders' Equity (Deficit) Total Liabilities and Stockholders' Equity 8,862 8,862 8,842 100 100 100 271,799 271,799 266,819 (1,926,739) (1,558,332) (1,236,020) (1,645,978) ( 1,277.571) (960,259) $ 4,201 $ 72,240 $ 15,233 See accompanying notes. eP/~ .. --... ~ __ _ --;r ePlans lnc. 2 FoxOlase Drive 10. Box 9IS Henhey,P.,nsyIvonio 17033 Ieiephone: 717.534.1183 locsimile:717.S34-'1313 website:eplllftsinc.(om September 12, 2001 Carl G. Wass, Esq. Caldwell & Kearns 3631 North Front Street Harrisburg, PA 17110-1533 Re: Estate of John Koch Dear Mr. Wass: We regret that ePlans inc. is neither in a position to reacquire its shares from the estate of John Koch nor recommend a potential purchaser therefor. However, ePlans would recognize any distribution of its shares from the Koch estate and would issue new certificates (with customary securities transfer restrictions) as appropriate. Very truly yours, EPLANS INC. ~ -4.P~( ~ Raymond C. Hedger, Jr. President RCH:JMH ALG-28-2001 00:54 PN:BfN< elF DEPARTI'ENT QPNCBAN< Decedellt Reportillg Fintside Center P7-PFSC-4-F 500 Finrt Avenue Pittsburgh. PA 15219-3128 August 27, 2001 Carl G. Wass 3631 North Front Street Harrisburg, PA 17110-1533 RE: Estate of John Koch, Deceased SSN: 172-01-1605 DOD: 5/21/2001 Dear Mr. WllSS: 412 70S I'Il1l57 P.01/05 ISCP Please find the date of death balances you bave requested listed below. CERTIFICATES OF DEPOSIT #31000190407 JOHN KOCH DORIS FISHEL DOD Balance: $1,058.20 + $2.76 accrued interest #31000195318 JOHN KOCH ELIZABETH STONER DOD Balance: $1,051.35 + $2.51 accrued interest #31800197266 JOHN KOCH ELIZABE'rn STONER DOD Balance: $5,256.81 + $2.90 aoorued interest Page 1 of5 A member of The PNC Financi., Services Group Otle PNC Plaza 249 Fifth AV(:nut' Pirtsbut'gh ~ns.vNania 15222 210) EXHIBIT #5 Established 07/0712000 Established 08/08/2000 Established 08/1812000 RUG-28-2001 08:54 FM:mi'I< CI F DEPffiTl'ENT QPNCBAN< #31700198146 JOHN KOCH ELIZABETH STONER DOD Balance: $1,043.49 + $2.93 accrued interest #31500201468 JOHN KOCH ELIZABETH STONER DOD Balance: $1,032.07 + $4.47 accrued interest #31400203075 JOHN KOCH ELIZABETH STONER DOD Balance: $2,062.78 + $4.92 accrued interest #31600203348 JOHN KOCH ELIZABETH STONER DOD Balance: $1,026.15 + $4.20 accrued interest #1500205267 JOHN KOCH ELIZABElH STONER DOD Balance: $1,019.16 + $2.72 accrued interest #3130207022 JOHN KOCH ELIZABETH STONER DOD Balance: $1,012.10 + $2.71 accrued interest #31100161705 JOHN KOCH ELIZABETH STONER DOD Balance: $1,104.73 + $5.76 accrued interest Page 2 of5 A ..-, of The PHe Hllancial ScrvittS Group Onr PNC Plan ~49 Fifth Avenue Pittsburgh Pennsylvania 15222 2701 412 70S 00S7 P . 02/l!l5 Established 09/05/2000 Established 10/26/2000 Established 1110712000 Established 11/2712000 Established 01104/200 1 Established 02l0l/2oo 1 Established 0611212000 AUG-28-2001 08:54 PN:BANK CI F DEPARTMENT aPNCBAN< #31800161896 JOHN KOCH ELIZABETH STONER DOD Balance: $1,091.18 + $1.96 acaued interest #31400163722 JOHN KOCH ELIZABETH STONER DOD Balance: $1,092.18 + $0.37 acaued interest #31700183396 JOHN KOCH ELIZABETH STONER OOD Balance: $1,071.65 + $0.26 accrued interest #31600189606 JOHN KOCH ELIZABETH STONER DOD Balance: $1,064.10 + $0.99 accrued interest #31000189687 JOHN KOCH EUZABElH STONER DOD Balance: SI,058.97 + $4.34 accrued interest #31%00166982 JOHN KOCH ELIZABETH K STONER DOD Balance: $1,100.97 + $3.44 acaued interest #31300180809 JOHN KOCH ELIZABETII K STONER DOD Balance: $6,476.05 + $16.29 accrued interest Page 3 of5 A membtt of The me f'mandal Servi<es Group One PNe Pla:a 249 Fifth AvtnlJ~ Pittsburgh Ptnnsytvania '\ 5222 2701 412 70S 0l1S7 P . e3/05 Established 06/12/2000 Established 06/12/2000 Established 06/12/2000 Established 06/12/2000 Established 06/12/2000 Established 10/04/1999 Established 06/1212000 ALG--28-2001 1218:54 FtCBfN< elF DEPARTI'EHT aPNCBAN< #31500206206 JOHN KOCH DORIS FISHEL LLOYD FISHEL DOD Balance: $1,012.10 + $2.71 accrued interest #31800207864 JOHN KOCH DORIS FISHEL LLOYD FISHEL DOD Balance: $1,003.63 + $2.12 accrued interest #31600190896 JOHN KOCH JOHN W KOCH DOD Balance: $1,058.19 + $4.34 accrued interest #31900198118 JOHN KOCH JOHN W KOCH DOD Balance: 55,256.81 + $2.90 accrued interest #31800197969 JOHN KOCH D JOHN W KOCH DOD Balance $1,043.66 + $4.04 accrued interest #31700201145 JOHN KOCH JOHN W KOCH DOD Balance: $2,062.77 + $7.38 accrued interest #31500203388 JOHN KOCH JOHN W KOCH DOD Balance: $1,026.1 S + $4.20 accrued interest Page 4 of5 A __, of The PNC fin_nO_. Sc..ittS &roup One PNC Plaza 249 Fifth Avenue Pittsburgn P1::nnsytvani~ lSJ,., 1.10) 412 70S l!e57 P. 04/05 Established 0210112001 Established 04/03/200 I Established 06/2912000 Established 08/1812000 Established 08129/2000 Established 10/31/2000 Established 11/27/2000 fU3-28-2001 08: 54 FN::BANK CI F DEPARTl'ENT 412 70S 0ffi7 P.05/05 (!)PNCBAN< #31500205268 Established 01/0112001 JOHN KOCH JOHN W KOCH DOD Balance: $1,019.16 + $2.72 accrued interest #31800179761 Established 03/0712000 EUZABETII K STONER JOHN KOCH DOD Balance: $1,079.34 + $2.71 accrued interest #31600200466 Established 10/12/2000 EUZABETH K STONER JOHN KOCH DOD Balance: $1,037.42 + $1.62 accrued interest #3180018287Z Established 04/1112000 JOHN KOCH DOD Balance: $1,706.67 + $3.07 accrued interest CHECKING ACCOUNT #5070099811 Established 06/1212000 JOHN KOCH ELIZABETH STONER DOD Balance: $13,481.91 + SO.71 accrued interest Our offiee only provides elate of death balances for IRA's, CD's, CheckiDg and Savings accounts. We do m FInancial Transactions or Statement Orden. For Further information please caD 1-800-4-BANKER or your local PNC Brandt and ask to speak with a Financial Services Representative. Sincerely, ~~ Rachelle Sciullo 1-800-762-1775 Page 5 of5 ^ """"bet of The I'tlC FInandal Servi... Group On. PNC Plaza 249 Fifth A..nue Pittsburgh I'<nnsvlv:lnia 15222 2707 TOTf'l. P.05 4rh & Walnut Streets P.O. Box 12053 Harrisburg,. PA 17108 MorganStanley toU-f,.. 800 676 0673 phone 717 255 6666 Caldwell & Kearns Attorneys At Law Attn: Carl G. Wass 363 I North Front Street Harrisburg, PA. 17110-1533 August 6, 2001 RE: John Koch & Elizabeth K. Stoner Morgan Stanley Account 410-013716-022 Dear Sir, As of May 21,2001 John Koch and Elizabeth K. Stoner had the following in their account: Shares Name Hif!h Low Value OS/24/01 - 0.087 0.087 0.087 66 Cons Envirowaste Ind Inc 05/03/01 - 0.090 0.090 0.090 4 A vaya Inc 16.350 15.140 15.990 100 Nextel Communications Inc CL A 19.750 18.320 19.750 50 Atlantis Group Inc 07/1 I/OI - 0.020 0.020 0.020 04/26/01 - 0.001 0.001 0.001 50 Lucent Technologies 9.940 9.550 9.900 300 Bethleham Steel Corp 3.890 3.500 3.790 100 Dell Computer Corp 25.990 24.190 25.840 100 Rite Aid Corp 8.640 8.150 8.560 EXHIBIT (16 4th & Walnut Streets P.O. Box 12053 . Harrnbu<g. PA 17108 "l MorganStanley toll-free 800 676 0673 phone 717 255 6666 Depending on the dates you choose for Cons Envirowaste Ind Inc and Atlantis Group the value of account will change. Upon that detennination, you may add up the amounts in value column to get your account value. Sincerely, Angela Camplese Vice President Financial Advisor 4th & Walnut Streets PO. Box 12053 Harrisburg. PA 17108 ""l MorganStanley toll.free 800 676 0673 phone 717 2556666 Carl Wass, Esquire Caldwell & Kearns 3631 North Front Street Harrisburg, PA 17110-1533 September 10, 2001 RE: Account of John Koch and Elizabeth Stoner Dear Carl: As requested, I have researched the opening date of the above referenced account. Unfortunately the documents were executed on June 6, 2000. I also checked my calendar to determine if I met with John and he expressed his intent to add Elizabeth to his account prior to May 2 I, 2000 and found nothing. The documents indicate on June 6, 2000 John added Elizabeth to his account and the assets were transferred into joint name on June 14, 2000. I hope this clarifies any gray area concerning these dates. Please do not hesitate to call if you have any additional questions or concerns. Angela Camplese, Vice President, Financial Advisor AMC:csp Attachments IPORTANT TAX NOTICE ust be Signed and Returned Immediately!! JStitute FornI W.I/l ~ar Client, On August 5, 1983. The Interest and Dividend Tax Compliance Act of 1983 was signed into law. This law has serious Iplications for accounts opened with Dean Witter Reynolds, Inc. on or after January 1. 1984. The Backup Withholding section of the law requires the withholding of 31 % of Dividends, Interest and Gross Proceeds of ,Ies of securttles for any account which has not filed a signed Form W-9 or a substitute form with us regardless of whether Social Security or Federal Employer Identification Number was provided at the time the account was opened. To avoid the withholding penalties required by this law, please fill in your Social Security or Federal Employer ldentlfica- ,n Number In Box 111 and check Box 112 if you are not subject to backup withholding under the notified payee under- porting provisions, thai is, either because you have not been notified by the Internal Revenue Service that you are sub- ~t to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has .tified you that you are no longer subject to backup withholding. If you are awaiting issuance of a Social Security or tderal Employer Identification Number from the IRS, write "Applied For" In Box 111. th boxes must be completed to avoid Il8ckup WIthholding. IX #1 Socia' Security or Employer Identification Number , ~.). . I c;r- Of , OK ,r ," ;; , '---- BOX 1/2 Not subject to Backup Wrthholdlng under the notified 0'underreporting provisions. ortify, U~IeS of perjury, that the informatiOn provided on this form Is true, correct and complete. lNATUB . J~ ACCOUNT NUMBER L.{ Ie - 013'7 /(" - otfl DATE f\.85B8 (7/"" REV. 1-93 Ju/X..- ~ 00 0;?V 6j LV -~ hv f) eu.J Of('d2{!l f ~_... ""----=-- .~-- ,;'J'-::" _-_'.~',,_,.'~.,j'u.-. ~ r-l o o ~~~~ o OUUUU IDOO ...,. lI>toooo r-l 1 <1;<1;0000 ........... O::;:E,'"" (y)oo~1I0000 N(Y)riI0 ......."'E-t N O~E-t .-iU CllOU ON <I; . Cl ~ E-t rilH H::O:Cl {/} ~Oril {/} Z ::x::~OZ O{/) Z UOO{/}HZ <I; >tHZE-tO riI <l;E-tOHH Cl ::O:HH{/}E-t o .......{/}E-t00" >to 0..0 0 0.. 0.. 0 ril0 >to 0..0 ....:lIDE-tZ E-tE-t Z<I;(9(9~~ <I; I !JZZOO E-t ~1I00::X::::X:: {/}oo<l;O....:l....:l{/}{/} (Y)....:l Z"'H <I; ....... (9~:> ~.-iZ 00l:) ::O:NII ~o.. ~ :>::{/} lflIDI-CO ......~ o O~ o ....... lfl o ....... \D Q) tJI III 0.. 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HN<I;<I; E-t r-l'r-l'r-l.r-l riI H :>.:> Cl Z lXl<l; E-<ri1 rilE-<E-<!JU H~UUOtx: <l;ZUU~ri1 :>l:)<I;<I;o..o..l {/} riI ~~tx:tx:~tx:HCl Cl Cl UUUUUUE-tZ Z Z Hl:) l:) l:) (y)COOr-lCO(y):>~ ~E-t~ IDO I-OIDH s: "'...,. (Y)...,.0"IE-tE-t E-<ClE-<riIE-t ...... ...... ...Util tElCJ)(iJ(iJ[J] (Y)...... lfl......(Y)<I;CIl CIl::>:{/}~CIl 0"1 0"10"1 {/}tx:{/} CIl {/} N NN E-<.x:riI.x:::;:.x:o...x: Z ~ 0 riI rilCl{/}Cl~Cltx:Cl UHZH~Ho..H rill:)<I;l:) l:) l:) ~~~~Qltx:QlClQlXQl coo...,. HE-tHrilH<I;H l......l~H H:>HE-<H E-< 1-+0"10 E-t H H 1 ID+ S:{/}~riIS:O"IS: (Jl O+rlo..Cl;:lClUClO"lCl o r-llfl-.x:{/)~(Jlrilc/}O"I{/} o..tx:+~{/}U::O:E-t::o:tx:::;:r-l::;: UO"IHClril H'+<I;ZO:O 'r-l .0 .0 c..<I;CllID:>l:) O'N'O'O I'(HCl+ ~ 10 ....,. .lfl .0 HCl lfl(Jl"'" ..... HO(9+(9ri1l E-<Zr-lCl....:l H(JlH~....:lCll I'(l:)Cl HO <I; CllUZ:>:X:E-< riI (Jl E-<Ho..E-<(9ri1 :>:;1'( UZ:> ::;::>HUOZ . I'(I'(....:lH >tE-<E-< Z:>::OOClCl ::;:::;:E-<E-<E-tE-t 1" i< O"IOrlN(Y).... n_rir-41"""'i~ o Z l:) ~ 1 1 ClHE-<ClOHO HZOZHZH (Jl!JlXlc..{/}!J{/) Nr-lrlOIDlflN OO(Y)(Y)NNO ......."",....... \DIDlfllfllfllf)Ll) 0000000 ~ <;)' \:L '''J- ~ y ~ '" \:j "'i-- </) ~ F: C) ~ ~ t ~~ \:l ~ ~ 'f-, "'" ~ '\J ~._\ '\, " e:. " '\:j ~ <<:::I :::,..... ~ 'Z\ ~ 11 '.f-.. ~ -:::: ~ N \.. ~ { ....( ~ " " IRREVOCABLE TRUST AGREF.MF.NT THIS IRREVOCABLE TRUST AGREEMENT, made and executed this "2" ~ day of 0 u,"'-l , 1997, by and between JOHN KOCH, - of Upper Allen Township, Cumberland County, pennsylvania, hereinafter called the Settlor, and DEAN WITTER REYNOLDS INC., with offices in Harrisburg, Pennsylvania, hereinafter called the Trustee. 1. TRUST ESTATE. The Settlor hereby assigns, transfers and delivers to the Trustee the property described in Schedule A, annexed hereto, all of which shall be subject to the reservations made by the Settlor in this instrument. As further evidence of such assignment, the Settlor has executed or will execute or cause to be executed such other instruments as may be required for the purposes of completing the assignment of transfer of title to such property to the Trustee. The Trustee accepts such transfer and assignment to itself as Trustee, and undertakes to hold, manage, and dispose of the trust property in accordance with the provisions of this Agreement. 2. TRUST PURPOSE. The Settlor has assigned the property described in Schedule A to the Trustee and has entered into this Trust Agreement for the purpose of securing professional management of his assets during his lifetime, and thereafter, until disposition of the trust assets, as hereinafter provided, EXHIBIT 117 has been made in accordance with the provisions of this Trust Agreement. 3 . MANAGEMENT DURING THE LIFETIMF: OF SETTLOR. During the lifetime of Settlor, the trust fund herein created shall be administered by the Trustee, subject to the following terms and conditions: A. The net income of the trust shall be paid to Settlor in quarterly installments, or shall be distributed to Settlor in such manner as he may from time to time specify in written or other directions delivered to the Trustee. B. Trustee shall have the power, exercisable in the sole discretion of Trustee, to make distribution of principal from the trust fund to Settlor from time to time for the purpose of enabling Settlor to continue to maintain the same standard of living which Settlor enjoys at the time of the execution of this Trust Agreement. C. In the event of the disability of Settlor, for any reason, as much of the income and principal as the Trustee may deem proper for the welfare and support of the disabled Settlor, and his wife, Esther Martin Koch, shall be paid to or applied directly for the benefit of the disabled Settlor, and his aforementioned wife. 2 .' D. In the event of the disability of both Settlor and his wife, Esther Martin Koch, for any reason, as much of the income and principal as the Trustee may deem proper for the welfare and support of Settlor and his wife, Esther Martin Koch, shall be paid to or applied directly for the benefit of Settlor and Esther Martin Koch. 4. MANAGEMENT FOLLOWING THE DEATH OF SETTLOR. If, at the time of the death of Settlor, the wife of Settlor is surviving, Trustee shall continue to manage the trust fund, subject to the following terms and conditions: A. The net income of the trust shall be paid to or applied to or on behalf of the surviving wife of Settlor, Esther Martin Koch. B. In addition, if, in the sole discretion of Trustee it becomes necessary to invade the principal of the trust fund for the purpose of providing for the health, comfort, support and well-being of the wife of Settlor, Esther Martin Koch, Trustee is hereby authorized and empowered to invade and expend sums of principal for such purposes. 5. ADDITIONAL PROPERTY. In addition to the rights to receive income during his lifetime, as previously specified, the Settlor reserves to himself the right, at any time, to transfer during his lifetime, additional property to the Trustee 3 hereunder. 6. ADMINISTRATION FOLLOWING THE DEATH OF THE LAST TO DIE OF SETTLOR OR SETTLOR'S WIFE. Upon the death of the last to die of the Settlor or Settlor's wife, Esther Martin Koch, the Trustee may utilize the within trust assets for the purpose of paying any debts, claims, administration expenses, property and income taxes and taxes incurred as a result of the death of the last to die of the Settlor or Settlor's wife, if the separate estate of Settlor or Settlor's wife, whoever is the last to die, is insufficient to do so. 7. DISTRIBUTION. Upon the death of the last to die of the Settlor or his wife, Esther Martin Koch, such principal and accumulated income as may be remaining in the within trust shall be distributed and paid as follows: A. I direct that the cash sum of Ten Thousand ($~O,OOO.OO) Dollars be paid and distributed to ~ of my three grandchildren, to wit: Julie Hoyt, Amy Allen and Deborah Koch; and, B. I direct that the cash sum of Ten Thousand ($~O,OOO.OO) Dollars be paid and distributed to priscilla Rusnov Koch if she is living; and, C. I direct that the cash sum of Five Thousand ($5,000.00) Dollars be paid and distributed to Angela Camplese if she is living at the time of my death; and, 4 D. I direct that all of the remaining assets of the within trust be paid and distributed to my son, John W. Koch, or, in equal shares, to his issue, per stirpes. 8. TRUSTEE'S POWERS. Subject to the provisions of this Agreement relating to the powers reserved by the Settlor, the Trustee shall have and exercise exclusive management and control of the trust, and shall be vested with the following specific powers and discretion, in addition to the powers as may be generally conferred from time to time upon Trustees by law: A. To retain, indefinitely, any investments and to invest and reinvest in any and all stocks, bonds, mutual funds, notes, securities, and or other property constituting the trust fund, all of which shall be done at the discretion of Trustee. It is acknowledged that Trustee is an affiliate of Dean Witter Reynolds Inc. and that when Trustee exercises such discretion, Trustee is authorized to engage the services of Dean Witter Reynolds Inc. or any of its affiliates and to compensate them from the trust fund. Such services include, but are not limited to, management or advice with respect to investments in mutual funds or other accounts offered or managed by affiliates, acting as broker/dealer to execute transactions and purchasing any securities currently underwritten and/or issued by affiliated corporations. 5 B. The Trustee is specifically authorized to invest assets of the trust in mutual funds for which Dean Witter InterCapital Inc. ("InterCapital"), an affiliate of the Trustee, acts as investment adviser or investment manager and/or for which InterCapital and/or its affiliates provide services. It is specifically acknowledged that InterCapital, the Trustee and their affiliates receive compensation from such mutual funds and the receipt of such compensation by InterCapital, the Trustee and their affiliates in addition to the Trustee's fees is specifically authorized. C. To execute securities transactions without providing written confirmation thereof to any beneficiary and to execute securities transactions through any broker/dealer, including an affiliate of Trustee, at normal rates of commissions. D. To delegate discretionary power to agents (including those affiliated with Trustee); to employ and terminate the employment of legal counsel, accountants, brokers, investment counsel, custodians, managers and other agents and employees, and to pay them reasonable compensation and their expenses out of the trust fund. E. To retain investment advisers (including those affiliated with Trustee) and to pay the compensation and 6 fees of such investment advisors from the trust fund, which compensation or fees shall not be charged against the compensation of the Trustee, and to delegate to investment advisors the authority to purchase and sell particular investments. F. To vote directly or by proxy at any election or stockholders' meeting, any shares of stock held hereunder including shares of any mutual fund for which Trustee, or its affiliate, is advisor. G. To hold any or all securities or property in Trustee's name, or as Trustee, or in the name of a nominee or nominee of an affiliate, and in accounts or deposits administered in any location by Trustee or any affiliate of Trustee. In the event the same are held in its own name or in the name of a nominee or nominees, suitable designation is to be made upon the books and records of Trustee that said securities or property are so held as part of any trusts hereunder. H. To divide or distribute principal in kind or in money, or partly in each, or by way of undivided interests, pro rata or non-pro rata, in such manner as Trustee shall deem advisable. 7 ." I. Notwithstanding the grant of powers herein to the Trustee, Settlor does hereby reserve unto himself the right to participate in the direction of the investment of any or all of the trust fund and Trustee agrees that the active participation of Settlor will be encouraged; however, in the event of disagreement in the direction of any investment, Trustee shall have the final authority and power to direct any such investment. 9. TRUSTEE COMPENSATION. Trustee shall be entitled to receive, out of the income and principal of the Trust fund, compensation for its services hereunder, to be determined from time to time by the application of the schedule of fees as published by Trustee and in effect at the time such fees are charged for trusts of a similar size and character, and in the event that Trustee shall be called upon to render any extraordinary services, it shall be entitled to additional compensation therefor. Receipt of a Trustee Fee Schedule and receipt of a current prospectus or disclosure document for one or more of the mutual funds or other investment accounts sponsored by Dean Witter Reynolds Inc. and/or its affiliates is acknowledged by the parties hereto. It is further acknowledged that Dean Witter Trust Company and its affiliates are compensated by such funds and/or accounts for services rendered as investment adviser. administrator, transfer agent and/or underwriter and that such 8 compensation is described in further detail in such prospectus or disclosure document and is in addition to compensation received by Dean Witter Trust Company in its capacity as Trustee hereunder. 10. SPENDTHRTFT PROVISION. No interest of any beneficiary of this trust either in income or principal, shall be subject to anticipation or to pledge, assignment, sale or transfer in any manner, nor shall any such interest be liable on account of the debts, contracts, torts, or other engagements of any beneficiary. 11. TRUSTEE RESTGNATION OR REMOVAL AND SUCCESSION. The Trustee may resign at any time upon written notice given to the Settlor if he is living, or in the event of his death, upon written notice to the current income beneficiary or beneficiaries hereunder. Settlor may, remove Trustee at any time upon giving written notice of such removal to Trustee. Any successor Trustee thus appointed, or if the Trustee shall merge with or be consolidated with another corporate fiduciary, then such corporate fiduciary, shall succeed to all the duties and to all the powers, including discretionary powers, herein granted to the Trustee. 12. AMENDMENT. Settlor may amend the provisions of the Trust Agreement from time to time, subject, however, to the following limitations: no amendment shall be effective until such amendment has been acknowledged in writing by the Trustee, and, 9 . no amendment shall be valid which has the purpose of revoking this Trust Agreement. IN WITNESS WHEREOF, the Settlor and Trustee have hereunto set their hands and seals this "'2. (,. ~ day of ~u 'l\~ , 1997. WITNESS: JO~- J& ~_. ATTEST: DEAN WITTER REYNOLDS INC. By 88773-1 10 FIRST AMENDMENT TO IRREVOCABLE TRUST AGREEMENT ,,:--1...... ~J e. THIS AMENDMENT, made and executed this ,[) day of C-L"- 1998, by and between JOHN KOCH, of Upper Allen Township, Cumberland County, Pennsylvania, Settlor, and DEAN WITTER TRUST COMPANY, with its principal office at Harborside Financial Center, Plaza Two, Jersey City, New Jersey, Trustee, shall be and shall constitute an amendment to the IRREVOCABLE TRUST AGREEMENT heretofore executed between Settlor and Trustee, dated June 26,1997, and is made in accordance with the authority to amend set forth in Paragraph 13 thereof. Settlor hereby amends Paragraph 7 of the IRREVOCABLE TRUST AGREEMENT, by eliminating the present language thereof and, instead, substituting the following new Paragraph 7, to wit: 7, DISTRIBUTION, Upon the death of the last to die of the Settlor or his wife, Esther Martin Koch, such principal and accumulated income as may be remaining in the within trust shall be distributed and paid 8S follows: A I direct that the cash sum of Ten Thousand ($10,000,00) Dollars be paid and distributed to each of my six grandchildren, to wit: Julie Hoyt, Amy Allen, Deborah Koch, Michael Stoner, Christopher Todd Stoner and Michael Shawn Stoner; and, B. I direct that the cash sum of Fifty Thousand ($50,000,00) Dollars be paid and distributed to my daughter, Elizabeth K Stoner, if she is living; and C. I direct that the cash sum of Twenty Thousand ($20,000.00) Dollars be paid and distributed to Priscilla Rusnov if she is living; and, D. I direct that the cash sum ofTen Thousand ($10,000.00) Dollars be paid and distributed to Angela Camplese if she is living at the time of my death; and, E. I direct that all of the remaining assets of the within trust be paid and distributed to my son, John W. Koch, or, in equal shares, to his issue, per stirpes. In accordance with Paragraph 13 of the IRREVOCABLE TRUST AGREEMENT, this Amendment shall become effective upon the acceptance thereof by the Trustee. IN WITNESS WHEREOF, the Settlor and Trustee have hereunto set their hands -R- and seals to this Amendment on this g day of -:J (.t f\ L , 1998. WITNESS: ~~~ ~ {C:~ John Koch A~ f h- DEAN WITTER TRUST COMPANY Donald A. Fox Assistant Vice President By: '-fLCI. 0 P -P -i:t,/ t;, IWf ~J: -:;.ccXJ.W:- 'C ~ V p 100477-1 . - SECOND AMENDMENT TO IRREVOCABLE TRUST AGREEMENT THIS AMENDMENT, made and executed this LR~day of ,-) 11 ~ ' 1998, by and between JOHN KOCH, .of Upper Allen Township, Cumberland unty, Pennsylvania, Settlor, and DEAN WITTER TRUST COMPANY, with its principal office at Harborside Financial Center, Plaza Two, Jersey City, New Jersey, Trustee, shall be and shall constitute an amendment to the IRREVOCABLE TRUST AGREEMENT heretofore executed between Settlor and Trustee, dated June 26,1997, as previously amended by a First Amendment, dated June 8, 1998, and is made in accordance with the authority to amend set forth in Paragraph 13 thereof. Settlor hereby amends Paragraph 7 of the IRREVOCABLE TRUST AGREEMENT, by eliminating the present language thereof and, instead, substituting the following new Paragraph 7, to wit: 7. DISTRIBUTION. Upon'the death of the last to die of the Settlor or his wife, Esther Martin Koch, such principal and accumulated income as may be remaining in the within trust shall be distributed and paid as follows: A. I direct that the cash sum of Ten Thousand ($10,000.00) Dollars be paid and distributed to eacl1 of my six grandchildren, to wit: Julie Hoyt, Amy Allen, Deborah Koch, David Michael Stoner, Christopher Todd Stoner and Michael Shawn Stoner; and, B. I direct that the cash sum of Fifty Thousand ($50,000.00) Dollars be paid and distributed to my daughter, Elizabeth K. Stoner, but if she is not living, then equally to her sons, David Michael Stoner, Christopher Todd Stoner, and Michael Shawn Stoner; and C. I direct that the cash sum of Twenty Thousand ($20,000.00) Dollars be paid and distributed to Priscilla Rusnov but if she is living, payment and distribution shall be made to her husband, Donald Rusnov; and, D. I direct that the cash sum ofTen Thousand ($10,000.00) Dollars be paid and distributed to Angela Camplese if she is living at the time of my death; and, E. I direct that all of the remaining assets of the within trust be paid and distributed to my son, John W. Koch, or, in equal shares, to his issue, per stirpes. In accordance with Paragraph 13 ofthe IRREVOCABLE TRUST AGREEMENT, this Amendment shall become effective upon the acceptance thereof by the Trustee. IN WITNESS WHEREOF, the SettlorJ;d Trustee ~to set their hands and seals to this Second Amendment on this t day of , 1998. WITNESS: ~ tC:~-d John Koch ATTEST: DEAN WITTER TRUST COMPANY ~ 4.1,c B, ./LoJJfp~ /jUJ ~ 4. ~~~;,':: - ----K.-t:1t ~ , -,If 100477.1 Donald A. Fox Assistant Vice President THIRD AMENDMENT TO IRREVOCABLE TRUST AGREEMENT THIS AMENDMENT, made and executed upon the date set forth at the end hereof, by and between JOHN KOCH, of Upper Allen Township, Cumberland County, Pennsylvania, Settlor, and DEAN WITTER TRUST COMPANY, with its principal office at Harborside Financial Center, Plaza Two, Jersey City, New Jersey, Trustee, shall be and shall constitute an amendment to the IRREVOCABLE TRUST AGREEMENT heretofore executed between Settlor and Trustee, dated June 26,1997, as previously amended by a First Amendment, dated June 8, 1998, and a Second Amendment, dated July 28, 1998, is made in accordance with the authority to amend set forth in Paragraph 13 thereof. Settlor hereby amends Paragraph 7 of the IRREVOCABLE TRUST AGREEMENT, by elimin~ting the present language thereof and, instead, substituting the following new Paragraph 7, to wit: 7. DISTRIBUTION. Upon the death of the last to die of the Settlor or his wife, Esther Martin Koch, such principal and accumulated income as may be remaining in the within trust shall be distributed and paid as follows: A. I direct that the cash sum of Ten Thousand ($10,000.00) Dollars be paid and distributed 10 each of my six grandchildren, to wit: Julie Hoyt, Amy Allen, Deborah Koch, David Michael Stoner, Christopher Todd Stoner and Michael Shawn Stoner; and, B. I direct that the cash sum of Fifty Thousand ($50,000.00) Dollars be paid and distributed to my daughter, Elizabeth K. Stoner, but if she is not living, then equally to her sons, David Michael Stoner, Christopher Todd Stoner, and Michael Shawn Stoner; and C. I direct that the cash sum of Ten Thousand ($10,000.00) Dollars be paid and distributed to Angela Camplese if she is living at the time of my death; and, D. I direct that all of the remaining assets of the within trust be paid and distributed to my son, John W. Koch, or, in equal shares, to his issue, per stirpes. In accordance with Paragraph 13 of the IRREVOCABLE TRUST AGREEMENT, this Amendment shall become effective upon the acceptance thereof by the Trustee. IN WITNESS WHEREOF, the Settlor and Trustee have hereunto set their hands ;? ~ and seals to this Second Amendment on this day of , 1998. WITN~~ t:\njd,,- rn .CA,,^.pI~S e. ~/~ John Koch ATTEST: MO""'Cjah ~c3I1kyDEAN WITTER TRUST ~OMrAI4Yr'58 """ ~47y Donald A. Fox Assistant Vice President By: ~p ~A7 AVP --..- ~.7(~ v-P 105008-1 FOURTH AMENDMENT TO IRREVOCABLE TRUST AGREEMENT THIS AMENDMENT, made and executed upon the date set forth at the end hereof, by and between JOHN KOCH, of Upper Allen Township, Cumberland County, Pennsylvania, Settlor, and DEAN WITTER TRUST COMPANY, with its principal office at Harborside Financial Center, Plaza Two, Jersey City, New Jersey, Trustee, shall be and shall constitute an amendment to the IRREVOCABLE TRUST AGREEMENT heretofore executed between Settlor and Trustee, dated June 26,1997, as previously amended by a First Amendment, dated June 8, 1998, a Second Amendment, dated July 28, 1998, and a Third Amendment, dated October 2,1998, is made in accordance with the authority to amend set forth in Paragraph 13 thereof. Settlor hereby amends Paragraph 7 of the IRREVOCABLE TRUST AGREEMENT, by eliminating the present language thereof and, instead, substituting the following new Paragraph 7, to wit: 7. DISTRIBUTION. Upon the death of the last to die of the Settlor or his wife, Esther Martin Koch, such principal and accumulated income as may be remaining in the within trust shall be distributed and paid as follows: A. I direct that the cash sum of Ten Thousand ($10,000.00) Dollars be paid and distributed to.eacl1 of my six grandchildren, to wit: Julie Hoyt, Amy Allen, Deborah Koch, David Michael Stoner, Christopher Todd Stoner and Michael Shawn Stoner; and, B. I direct that the cash sum of Ten Thousand ($10,000.00) Dollars be paid and distributed to my daughter, Elizabeth K. Stoner, but if she is not living, then equally to her sons, David Michael Stoner, Christopher Todd Stoner, and Michael Shawn Stoner; and C. I direct that the cash sum of Ten Thousand ($10,000.00) Dollars be paid and distributed to Angela Camplese if she is living at the time of my death; and, D. I direct that all of the remaining assets of the within trust be paid, in equal shares, to my son, John W. Koch, and my daughter, Elizabeth Koch Stoner, or to their respective issue, per stirpes. In accordance with Paragraph 13 of the IRREVOCABLE TRUST AGREEMENT, this Amendment shall become effective upon the acceptance thereof by the Trustee. IN WITNESS WHEREOF, the Settlor and Trustee have hereunto set their hands and seals to this~d~ent on this J.;;J day of ).j () u-< .u be r' ,1998. WITNES~ k ~e fee M . (Al'1.pl f>R ~t~ John Koch ATTEST: MORGAN STANLEY DEAN WITTER TRUST FSB, tJ~n YSf)( By: I ;t01 fJ<2t> AlL:!? ~~ vP 105008-1 FIFTH AMENDMENT TO IRREVOCABLE TRUST AGREEMENT THIS AMENDMENT, made and executed upon the date set forth at the end hereof, by and between JOHN KOCH, of Upper Allen Township, Cumberland County, Pennsylvania, Settlor, and DEAN WITTER TRUST COMPANY, with its principal office at Harborside Financial Center, Plaza Two, Jersey City, New Jersey, Trustee, shall be and shall constitute an amendment to the IRREVOCABLE TRUST AGREEMENT heretofore executed between Settlor and Trustee, dated June 26, 1997, as previously amended by a First Amendment, dated June 8, 1998, a Second Amendment, dated July 28, 1998, a Third Amendment, dated October 2, 1998, and a Fourth Amendment, dated November 12, 1998, is made in accordance with the authority to amend set forth in Paragraph 12 thereof. Settlor hereby amends Paragraph 7 of the IRREVOCABLE TRUST AGREEMENT, by eliminating the present language thereof and, instead, substituting the following new Paragraph 7, to wit: 7. DISTRIBUTION. Upon the death ofthe lastto die ofthe Settlor or his wife, Esther Martin Koch, such principal and accumulated income as may be remaining in the within trust shall be distributed and paid as follows: A. I direct that the cash sum of Ten Thousand ($10,000.00) Dollars be paid to Doris Fishel, and the sum ofTen Thousand ($10,000.00) Dollars be paid also to Lloyd Fishel, both of these folks residing in Bowmansdale, and the gift being made to them on account of their supportive services rendered to me and, previously, to my deceased wife; and, B. I direct that the cash sum of Ten Thousand ($10,000.00) Dollars be paid and distributed to each of my six grandchildren, to wit: Julie Hoyt, Amy Allen, Deborah Koch, David Michael Stoner, Christopher Todd Stoner and Michael Shawn Stoner; and, C. I direct that the cash sum of Ten Thousand ($10,000.00) Dollars be paid and distributed to my daughter, Elizabeth K. Stoner, but if she is not living, . then equally to her sons, David Michael Stoner, Christopher Todd Stoner, and Michael Shawn Stoner; and D. I direct that the cash sum ofTen Thousand ($10,000.00) Dollars be paid and distributed to Angela Camplese if she is living at the time of my death; and, E. I direct that all of the remaining assets of the within trust be paid, in equal shares, to my son, John W. Koch, and my daughter, Elizabeth Koch Stoner, or to their respective issue, per stirpes. In accordance with Paragraph 13 of the IRREVOCABLE TRUST AGREEMENT, this Amendment shall become effective upon the acceptance thereof by the Trustee. IN WITNESS WHEREOF, the Settlor and Trustee have hereunto set their hands and seals to this Second Amendment on this ~ 1~ day of ~ l..t I- 'I ' 2000. WITNESS: ~A_ Jy}( 1'1~ 8-e:- /~ John Koch ATTEST: MORGAN STANLEY DEAN WITTER TRUST FSB ~;;:U(.J clJr/!J/fl. I J By: 12887 .MORGAN STANLEY DEAN WITTER TRUST FSB KOCH, JOHN IRREV T /U/ A DTD 6/26/97 Account Number: Statement Period: 43-0262-00-6 04/01/01 - 06/30/01 ANGELA CAMPLESE MORGAN STANLEY DEAN WITTER FOURTH AND WALNUT STREETS HARRISBURG P A 17 1 0 1 1",lIIu,I",IIII",. ..1111..,11...11".11.. .11,.,1 Personal Trust OffIcer- ,'. ,,<!0c...'~ ,-,~ti:.......L"-.?-~l!i')h",- :z:;" , 'c:~~era;~:i)JIiJlIfU;-<'''~i@~,j''~'; ~ - ~~~BOO-55i-3326:Ex '^ '. "'''':-'''''''"'"''','''"-''''''',,'' ''(",:,'" ',>,...', , ;';~J_~~J.;'~":;:;;?:??:9~i~~~;;' .. . Portfolio' sUnimarY' ,":~. va~~~/:;;;;f6~~ " ~.. Market % of Value Account --<"-,,,' :":\~~~{~t; ;.',,<->.,;, Description CASH & EaUIV FIXED INCOME Cash & Equiv Fixed Income Equities 11,137.16 57.498.95 159,839.09 4.9'. 25.2% 70.0% Total Portfolio 228,475.20 100.0% Total Valuation 228.475.20 QUITlES :.:'i:-~~i,~~~)~'I{~~~j,,: ~';. '~":~~',:i.;;1:;~:>::;:' ':": "";;';'<;'j''i;:'':,:<:..:'i:':~:,'''~ ~'-L:~J~:'~~1i;'~-;:;~;~~;~ .. <".,~..~.."....y . . "',\,' ~.: _,,' _' :. .,' "'.r:"."":.,,,;.:, :0y,.:,^):;,?~j~!:;;~~, ..ij\;;~,::{:;r~ Beginning Market Value Current Period $ 226,573.89 Year To Date $ 254,140.78 Income Dividends................................................................................................................................................ Disbursements To/For Beneficiary ....._............................................_.............................................................. Fees/Expenses................................................................................................................................... Realized Gains/(Lossesl................................................,.................................................................... Unrealized Appreciation/(Depreciation) ..............................................................,............... 1,865.45 -4,000.00 -1,594.00 1.701.17 3,928.69 3,933.72 -16.000.00 "'2,229.35 1,701.17 -13.071.12 Ending Market Value $ 228,475.20 $ 228,475.20 EXHIBIT fl8 187 Page 1 0 ~ \ \ ' \\ \ ' , ' \\ ,\ '\ ' \\ \\ \\ " ,\ \, " ,\ 11 \ \ "\ , , \ ~, ~\ C?...\\ "" " ~\\ Y'" , \ J~, \ v.:,.,\ '6\\ "f'\\ J'\ '&\, \)0 \\ " ~,\ "" \ \ ~\, \l!: \\ .... ,\ 0.'\ .\ ~\~\ ~,\ ~\\ . , A~., ~~\\ yo;,' \ -', .... , ~...\\ ~\\ \ \ ~\~ \\ \\ \\ \\ ~\\' \\' \\ ,\, .... \\ ~~ ,\\ ." \\- ~>\\ \\ _\~ V' ,,, ~\ y\ ~ ~ ~ ~ ~ ~ ~ '=& ~ ;s.,n ~ ~~ ~ ~~ ~ ~~<e-> >S' ~ A' ~ ~ 0. 4- ~ ~ d> ",; '...J ~.,. I.) 0.- ~ ""~~~ ~ 0'> ~ ~ ~ ~ <:> J:) .> "" ~ .of. 41. 4:t;,): ~ ~~~~~\\ "'i.~~~ ~ ~~~~~\~ ~ ~ ~ 01=:ct f"''=&...... 1>. ~~ V ......U>S'~ ~ ~I.) ~~<:> D r ~~ .~ ~~ ~~ ~ ~~ ~~~"f'~ ~~t ., 't> ~ ~ ':i: 't ~ ~'&~ ~ ~~~$4S. ~ ~~~'!}. 4. ~ "" D ~>~- ~~\~ ~~~\)o T:~';) ~~U P ~ "'? .... .-~~ ~~ ~~~~ 't 't> ,~~~ ~ yo ~....'t. ., ~ ,&:lA..di~ ~~ 'f>~~ -i~ ~,~~ V! 4S. ~~~ ,~ ~'& Qp ~ ~. ~'& "b. .... D ~ ~ ~ ~ .... V" ~ ~1> c:: ~"j, ~ ~~;.o. .... ~~ t;. ~p '" Q.~ 0- ~"'~.i ~~,~ '0 ~ f> '6> ~~.~ ~\";,~ ~~~'So lJ:' ~ <:> ~ 4- 0.- .> ~~ ~~ ~ \)oo~ ~ ~~~ ~.,t:~ .,.~~ ~ "" ()~ ~~o.- ~ ~ /b-~~..y-/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENTL ALLONANCE OR DISALLOWANCE OF DEDUCTION~. AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ReCOraedU;,;d of Register of Wills BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 om DIe -7 All :34 DORIS FISHEL 101 W LISBURN RD PO BOX 43 BOWMANSDALE Clerk-C) C,ourt PA l~tmberland Co., PA * REV-1548 EX AFP 112-001 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 12-10-2001 KOCH 05-21-2001 21 01-0666 CUMBERLAND 172-01-1605 01147333 JOHN Allount Rellitted 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 ~ Rifv=isiri-E)f-AFP--ri2~ool------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 12-10-2001 ESTATE OF KOCH JOHN CUMBERLAND DATE OF DEATH 05-21-2001 FILE NO. 21 01-0666 TAX RETURN WAS: COUNTY S.S/D.C. NO. 172-01-1605 (X) ACCEPTED AS FILED (> CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACN 01147333 ACCOUNT NO. 31800207864 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ()() TIME CERTIFICATE DATE ESTABLISHED 04-03-2001 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.500 .00 .00 .00 .15 .00 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT." 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 FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS_RE~L~c:;gD_~~uA_~!:R~~!!:..L~!!.t. Y~U HAY BE DUE A REFUND. \. /~-~~~- / COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEKENT~ ALLOHANCE OR DISALLOHANCE OF DEDUCTION~, AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-15~1 EX iFP 1l2-001 Recoraed C;' ,~~~ of Register WiHs DORIS FISHEL 101 W LISBURN RD PO BOX 43 BOWMANSDALE om me -7 All :34 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSNI'DC ACN 12-10-2001 KOCH 05-21-2001 21 01-0666 CUMBERLAND 172-01-1605 01147328 Allount Rellitted JOHN C. k <>, i'i',. 'rt ter-.~" "J' , ,jv.... PA ~rland Co., PA 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 .. Rifv=i5~8-E)f-AFii-(i1f:oo)------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 12-10-2001 ESTATE OF KOCH JOHN DATE OF DEATH 05-21-2001 COUNTY CUMBERLAND FILE NO. 21 01-0666 TAX RETURN WAS: S.S/D.C. NO. 172-01-1605 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 01147328 FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 31000190407 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ()() TIME CERTIFICATE DATE ESTABLISHED 07-07-2000 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 1. 000 .00 .00 .00 .15 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." 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 FOR CALCULATION OF ADDITIONAL INTEREST. · ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl, YOU MAY BE DUE A REFUND. ___ ________ ____ __ _..__ .._...... r_.. ......r-....B.....TTn...r- , \. 16-C:;~~- / COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEKENT~ ALLOHANCE OR DISALLOHANCE OF DEDUCTION~~ AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS Recoroea' ,"'rH:r.c: of .......'",L~Q Reg. 1stH ('it \I\/<ills ..... -.-... ..~# . 'I ' .' ,. .' REY-1548 EX aFP liZ-DOl '01 Die -7 All :34 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSNI'DC ACN 12-10-2001 KOCH 05-21-2001 21 01-0666 CUMBERLAND 172-01-1605 01147337 JOHN DORIS FISHEL 101 W LISBURN RD PO BOX 43 BOWMANSDALE Ciork-.C' <.- ...., _ inU..IT' v _ .....-..... ',.J'I.' PA f1-tr6l>eriand Co., - PA Allount Rellitted 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 ~ iifi=is4-i-EX--AFP--fi1f=ooi------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 12-10-2001 ESTATE OF KOCH JOHN DATE OF DEATH 05-21-2001 COUNTY CUMBERLAND FILE NO. 21 01-0666 TAX RETURN WAS: S.S/D.C. NO. 172-01-1605 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 01147337 FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 31500206206 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ()() TIME CERTIFICATE DATE ESTABLISHED 02-01-2001 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.500 .00 .00 .00 .15 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT~ SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS~ AGENT." 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 FOR CALCULATION OF ADDITIONAL INTEREST. · ( IF TOTAL DUE IS LESS THAN $l~ NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR) ~ YOU HAY BE DUE A REFUND. _.... .....,....~r r>-r_r ....r "UTr- rftD.. I:'na T...~,.DII....TTn...~ 11 /~'-o2c.;<-I - J COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z8D6Dl HARRISBURG, PA 171Z8-D6Dl NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-31-2001 KOCH 05-21-2001 21 01-0666 CUMBERLAND 101 Recore'} Reg,sI'''i . CARL G WASS ESQ CALDWELL 8 KEARNS 3631 N FRONT ST HBG '02 JAN -4 P12 :06 Clerk-C PA 17a1nbena<u I PA *5(. REV-1547 EX AFP elZ-DDI v JOHN Allount Rellitted 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 ~ REY=iS"4j-ix-AFP-n2"=OOY-NOYiCi--OF-YtiHiifiTAifCi-YAX-A-PPRA-isiirEN:r,--AL"rOWAifci-ifi-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KOCH JOHN FILE NO. 21 01-0666 ACN 101 DATE 12-31-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 82.655.55 63.331. 33 228.475.20 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 9,221.79 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 374,462.08 15.?08 6? 359,253.46 .00 359,253.46 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 326,171. 94 X 045 = 14,677.74 .00 X 12 = .00 33,081. 52 X 15 = 4,962.23 (19)= 19,639.97 5,986.83 (11) (12) (13) (14) PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-20-2001 CDOOO179 736.84 14,000.00 11-13-2001 CDOO0513 .00 4,939.97 TOTAL TAX CREDIT 19,676.81 BALANCE OF TAX DUE 36.84CR INTEREST AND PEN. .00 TOTAL DUE 36.84CR . 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 Dl'l'lINn 4::.1'1' DI'UI'D4::.1' 4::.Tnl' 01' THTc::. FORM FOR TNc::.TRlJCTTONc::._l IN RE: ESTATE OF ) IN THE COURT OF COMMON PLEAS ) CUMBERLAND COUNTY, PENNSYLVANIA ) ORPHANS' COURT DIVISION ) ) NO. 2 1 - 01 - 0666 JOHN KOCH RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, whether indi vidual or corporate, does hereby acknowledge receipt from Elizabeth Koch Stoner and John W. Koch, co-administrators of the Estate of the above-named Decedent, of the following assets: Full ownership of all previously co-owned assets he held with John Koch; All assets from the inter vivos trust of John Koch to which he is entitled; and One-half of the residuary assets of the estate. IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remlse, quitclaim and forever discharge the said co-administrators of and from all action, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the Estate of the said Decedent. THE undersigned further agrees to indemnify and hold harmless Elizabeth Koch Stoner and John W. Koch, their successors and assigns, from and against any and all claims, loss, liability or damage which it may suffer or to which it may be subjected by reason of the settlement of its account and the distribution of assets of the said estate without approval of the court having jurisdiction. In consideration of the distribution to the undersigned of the property described above, the undersigned agrees to pay the fiduciary any amount up to the value of the property ACKNOWLEDGMENT STATE OF PENNSYLVANIA COUNTY oFACvvtCI1S~L v' SS: On this, the dl'7' day of ICi./vlUC<A(j-' 200t, before me, a J Notary Public, the undersigned officer, personally appeared JOHN KOCH, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Receipt and Release and acknowledged that he executed the same for the purposes therein contained and desires that the same be recorded as such. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. ~'" 1 ill /~C.. / G.._- Notary Publ ic 01-324/34547 Notarial Seal Christine M. Urbina, Notary Public Elizabethtown Boro, Lancaster County My Commission Expires Mar. 28, 2005 IN RE: ESTATE OF ) IN THE COURT OF COMMON PLEAS ) CUMBERLAND COUNTY, PENNSYLVANIA ) ORPHANS' COURT DIVISION ) ) NO. 21-01-0666 JOHN KOCH RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, whether indi vidual or corporate, does hereby acknowledge receipt from Elizabeth Koch Stoner and John W. Koch, co-administrators of the Estate of the above-named Decedent, of the following assets: Full ownership of all previously co-owned assets she held with John Kochj All assets from the inter vivos trust of John Koch to which she is entitledj and One-half of the residuary assets of the estate. IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remlse, quitclaim and forever discharge the said co-administrators of and from all action, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the Estate of the said Decedent. THE undersigned further agrees to indemnify and hold harmless Elizabeth Koch Stoner and John W. Koch, their successors and assigns, from and against any and all claims, loss, liability or damage which it may suffer or to which it may be subjected by reason of the settlement of its account and the distribution of assets of the said estate without approval of the court having jurisdiction. In consideration of the distribution to the undersigned of the property described above, the undersigned agrees to pay the fiduciary any amount up to the value of the property that may be necessary in the future to discharge any liabilities of the estate. to IN WITNESS WHEREOF I the undersigned has caused this instrument this ;)Isr day of ~ I 2002. &o~t ( t-UL J\ crc.i.. $~ ELIZABETH KOCH STONER (SEAL) WITNESS: Social Security No. 207-34-6224 Cf2,,-o<~"7:t... k<-<,-<_~ ~S-Il<""-",<.,,----, ACKNOWLEDGMENT STATE OF PENNSYLVANIA COUNTY OF Lc.,t/1,{./' J~V1_ SS: /"j J:'{ On this, the ~ day of Ji/Oh.~A\/y 2001, before me, a Notary Public, the undersigned officer, personally appeared ELIZABETH KOCH STONER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Receipt and Release and acknowledged that she executed the same for the purposes therein contained and desires that the same be recorded as such. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. ~~~ 4 . 01-324/34547 Notarial Seal Philip G. Weaver, Notary Public New Holland Boro. Lancaster County My Commission Expires June 17.2002 Member, Pennsylvania Associal!"" (If N"!f}rl!l!j /~-d'/i/.-/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CARL G WASS ESQ CALDWELL & KEARNS 3631 N FRONT ST HBG .02 ~li\R 18 P 2 :15 *Cy REV-1U7 EX AFP 112-DD) 02-11-2002 KOCH 05-21-2001 21 01-0666 CUMBERLAND 101 JOHN l";}.E:...i AIIount Rellitted P A O\lll1lk MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLEI PA 17013 NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R"EV=i6Cfj-EX--AFP-nZ-.:ocir------...--iNirEiiTANC'E-fAX--STAfEME-tif-o-F'-AC-couiif--.-..--------------------- ESTATE OF KOCH JOHN FILE NO.21 01-0666 ACN 101 DATE 02-11-2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUEl APPLICATION OF ALL PAYMENTS I THE CURRENT BALANCEI ANDI IF APPLICABLE I A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT: 12-31-2001 P R I NC I PAL TAX DU E : ...................................___............................................................................._................................................................................_................. PAYMENTS (TAX CREDITS): 191639.97 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-20-2001 CDOOO179 736.84 141000.00 11-13-2001 CDOO0513 .00 41939.97 01-28-2002 REFUND .00 36.84- TOTAL TAX CREDIT 191639.97 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE .00 . SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ""CREDIT"" (CR) I YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) STATUS REPORT UNDER RULE 6.12 Name of Decedent: John Koch Date of Death: 5/21/01 Will No. 21 01-0666 Admin. No. Pursuant to Rule 6. 12 of the Supreme Court Orphans I 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. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3 . If the answer to No. 1 is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No X b . The separate Orphans I Court No. (if any) for the personal representative I s account is : c . Did the personal representative state an account informally to the parties in interest? Yes X 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 attached to this report. -Qo-kQ~~ ~ Signature Date: IDV02 8 '~'" met a: ......... ~i Carl G. Wass. Esauire Name (Please type or print) 3631 North Front Street Harrisbura PA 17110 Address r....] p (232 ) - 7661 Tel. No . Capacity : Personal Representative X Counsel for personal representative s/, c