HomeMy WebLinkAbout01-1026
H105.112 REV. 8188
(FEE FOR THIS
CERTIFICATE 52.001
WARNING: IT IS IllEGAL TO ALTER THIS COpy OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
. COMMONWEALTH OF PENNSYLVANIA .
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 4 8 0 6 3 4 0
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2-27-01
Date 01 Issue 01 This Certification
Name of Decedent HELEN
First
LONG
Middle
SMITH
Last
Sex
FEMALE
Social Security No.
158-20-3384
Date of Death
2-26-01
Date of Birth
5-14-13
Birthplace
PENNSYLVANIA
Place of Death MESSIAH VILLAGE
CUMBERLAND
MT. ALLEN TWP.
Pennsylvania
Facility Name
County
City, Borough or Township
Race WHITE
Occupation LIBRARIAN Armed Forces? (Yes or No)
Decedent's
WIDOWED Mailing Address 100 MT. ALLEN DR. MECHANICSBURG
Number Street City or Town
NO
Marital Status
PA
State
Informant KAREN BOYER
Name and Address of
Funeral Establishment BOYER FUNERAL HOME
Funeral Director
KRISTINE M. BOSTIAN
Part I:
I mmediate Cause
144 E. HIGH STREET ELIZABETHTOWN, PA
Interval Between
Onset and Death
(a)
SEPSIS
(b)
PNEUMONIA
(c)
(d)
Part II: Other Significant Conditions
NIDDM, PVD, SDAT, DYSPHAGIA
Manner of Death
Natural B
Accident D
Suicide D
Describe how injury occurred:
Homicide
Pending Investigation
Could not be Determined
o
D
D
Name and Title of Certfier
JAMES ALAN TYNDALL, M.D.
(M.D., D.O., Coroner, M.E.)
Address
10 B LOWTHER
LEMOYNE
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.
36-338
District No.
2-27-01
[)8tP Rer.ei\ied by' Local Registrar
25 IRIS CIRCLE
Street Address
ELIZABETHTOWN
City, Borough , Township
l,
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E-
--
IN RE:
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991. '
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
.
; FILE NO. A& () \ - t D2lp
It. ~
AND NOW, thi~ day of .
, 2001, upon consideration of
the foregoing Petition for Appointment of Successor Trustee, and pursuant to 20 Pa.C.S. ~7101,
it is hereby ordered that the relief requested in the Petition is granted, and that the Petitioner,
Karen L. Boyer, is authorized to serve as Successor Trustee, without the necessity of posting
bond.
BY THE COURT,
,1.
"
...
NOV 0 8 Z001 E:.
fL
)'
IN RE:
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991.
: IN THE COURT OF COMM:ON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DMSION
; FILENO. 21 -- Dl- ) D2~
PETITION FOR APPOINTMENT OF SUCCESSOR TRUSTEE
AND NOW, comes Karen L. Boyer (hereinafter "Petitioner"), by and through her
attorneys, Gates & Associates, P.C., and respectfully makes the following petition:
1. Petitioner is an adult individual residing at 1459 Mt. Gretna Road, Elizabethtown,
Lancaster County, Pennsylvania 17022.
2. Prior to her passing, Helen L. Smith was a resident of Messiah Village located at
100 Mt. Allen Drive, Mechanicsburg, Cumberland County, Pennsylvania 17055.
3. Helen L. Smith died on February 26,2001.
4. During her lifetime, Helen L. Smith established the Helen L. Smith Declaration of
Trust dated December 27, 1991 (hereinafter "the Trust"), by and between herself as Grantor and
Trustee. A copy of the Trust is attached hereto as Exhibit "A" and is incorporated herein by
reference.
5. Upon the death of the Grantor, the Trust is to be distributed in equal shares, per
stirpes, to the Grantor's cousin, Isabelle B. Bole, niece, Karen Boyer, niece, Sally Long, nephew,
Bruce Long, nephew, Robert Long, nephew, Gary Long, nephew, Bany Long, nephew, Dennis
Long, nephew, Peter Long, nephew, Walter Long.
2
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6. Article Eleventh of the Trust entitled "Appointment of Trustee", appoints Apollo
Trust Company, a Pennsylvania state-chartered trust company, having its principal offices at
201 North Warren Avenue and 308 North Second Street, Apollo, Armstrong County,
Pennsylvania 15613.
7. Apollo Trust Company has declined to act as successor trustee of the Trust and
has executed a Resignation of Trustee, a copy of which is attached hereto as Exhibit "B";
8. Upon the death of the Grantor, the Trust does not name a trustee to act in the
event of the resignation of the named successor trustee and does not give the successor trustee
the power to appoint a second successor trustee;
9. There is currently no individual or corporation acting as trustee of the Trust;
10. Petitioner acted as attorney-in-fact for Helen L. Smith prior to Helen's passing;
11. Petitioner desires to be and hereby accepts her appointment as Successor Trustee
of the Trust pursuant to the Acceptance of Appointment as Successor Trustee attached hereto as
Exhibit "C";
12. The beneficiaries of the Trust have been notified of this Petition by a copy
of the same, and have executed a Consent to the Petitioner being appointed as Successor Trustee
of the Trust and a copy of all Consents are attached hereto as Exhibit "D".
13. All parties to the Consents are sui juris.
14. This Court may approve the Agreement and authorize the appointment of
Petitioner as Successor Trustee of the Trust pursuant to 20 P.S. Sections 711(3) and 7101.
3
....
15. The third paragraph of Article Eleventh of the Trust, entitled '"Appointment of
Trustee", provides that no bond or other security shall be required of any Trustee.
16. Petitioner is not aware of any other parties who would be prejudiced by the relief
requested herein.
WHEREFORE, Karen L. Boyer, the Petitioner herein, respectfully requests that the
Court enter an order authorizing her to act as Successor Trustee of the Trust.
Dated:
N tJVefN1/~//V t, , 2001
4
-.
VERIFICATION
The undersigned hereby verifies that the facts averred in the foregoing petition are true
and correct to the best of her knowledge, information and belief. This verification is made
subject to the penalties of 18 Pa.C.S. 94904 relating to unsworn falsification to authorities.
Dated:
Ie) I~.ol
~~
. ar L. Boy~, Petition
5
It
DECLARATION OF TRUST
made as of December 27, 1991
by
HELEN L SMITH
GRANTOR
and
HELEN L SMITH
TRUSTEE
.
ARTICLE
FIRST
SECOND
THIRD
FOURTH
FIFTH
SIXTH
SEVENTH
EIGHTH
NINTH
TENTH
ELEVENTH
TWELFTH
THIRTEENTH
FOURTEENTH
FIFTEENTH
SIXTEENTH
TABLE OF CONTENTS
TITLE
Directions Of Grantor
Disability Of Grantor
Successor Beneficiaries
Minors Or Incompetents
Payment Of Debts
Life Insurance and Death Benefits
Right To Revoke Or Amend
Termination Of Trusts
Powers Of Trustee
Third Parties
Appointment Of Trustee
Simultaneous Death
Trustee Decisions Conclusive
Rights Not Assignable
Construction
Binding Effect
.
DECLARATION OF TRUST
DECLARATION OF TRUST, made as of December 27, 1991,
between Helen L. Smith, having an address at 119 North Paint
Boulevard, Shippenville, Pennsylvania 16254, as grantor (herein-
after referred to as the "Grantor"), Helen L. Smith, having an
address as aforesaid, as trustee (hereinafter referred to as the
"Trustee").
WIT N E SSE T H:
WHEREAS, the Grantor desires to create a revocable trust
of the property described in Exhibit A hereto, together with such
monies, securities and other assets as the Trustee hereafter at any
time may hold or acquire hereunder (said property, monies, secu-
rities and other assets, together with any additions thereto re-
ceived pursuant to the Grantor's Last will and Testament or as the
proceeds of insurance on the Grantor's life, or as death benefits
or otherwise, being hereinafter referred to as the "trust fund"),
for the purposes and upon the terms and conditions hereinafter set
forth.
NOW, THEREFORE, in consideration of the covenants herein
contained, and other valuable consideration, the receipt and suffi-
ciency of which hereby is ackno~lledged, the Grantor hereby trans-
fers, conveys, assigns and delivers to the Trustee as and for the
trust fund the property more particularly described in Exhibit A
hereto, to hold the same, and any other property which the Trustee
hereafter may acquire, IN TRUST, for the purposes and upon the
terms and conditions hereinafter set forth:
ARTICLE FIRST
Directions Of Grantor
The Trustee shall hold, manage, invest and reinvest the
trust fund, shall collect the income therefrom, and shall pay the
net income and any part or all of the principal thereof to whomever
the Grantor from time to time may direct in writing. Any income
not so paid or applied shall be accumulated and added to the prin-
cipal of this trust at least quarter-annually and thereafter shall
be held, administered and disposed of as part thereof.
1
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ARTICLE SBCOm>
Disabilitv Of Grantor
If at any time the Grantor, in the judgment of the suc-
cessor Trustee, shall be under any legal disability or shall be
unable to manage properly her affairs by reason of illness or
mental or physical disability, the successor Trustee may payor ap-
ply so much or all of the net income and the principal of the trust
fund as the successor Trustee deems necessary or advisable for the
health, education, maintenance or support of the Grantor, or for
the payment of insurance premiums on life of the Grantor. Any in-
come not so paid or applied shall be accumulated and added to the
principal of this trust at least quarter-annually and thereafter
shall be held, administered and disposed of as- part thereof. In
making any payment hereunder, the successor Trustee may consider,
but shall not be required to consider, the income and other resour-
ces of the Grantor. No such payment shall be charged upon a subse-
quent division of the trust fund against the principal of any share
which may be set apart for any beneficiary hereunder.
ARTICLE THIRD
Successor Beneficiaries
Upon the death of the Grantor, the Trustee shall pay and
distribute the trust fund at that time remaining to The Grantor's
cousin, Isabelle B. Bole, niece, Kar~n Boyer, niece, Sa~ly Long,
nephew, Bruce Long, nephew, Robert L~ng, nephew, Gary~Long, nephew,
Barry Long, nephew, Oennis......Long, nephew, pete.r Long, nephew, Walter
Long, if then living, in equal shares, per stiroes, discharged of
trust.
ARTICLE FOORTH
Distributions To Minors Or Incomoetents
In any case in which the Trustee is authorized or dir-
ected by any provision of this Agreement to payor distribute in-
come or principal to any person who shall be a minor or incompe-
tent, the Trustee, in its sole discretion and without authorization
of any court, may payor distribute the whole or any part of such
income or principal to such minor or incompetent personally, or may
apply the whole or any part thereof directly to the health, educa-
tion, maintenance or support of such minor or incompetent, or may
payor distribute the whole or any part thereof to the guardian,
committee, conservator or other legal representative, wherever ap-
pointed, of such minor or incompetent or to the person with whom
such minor or incompetent may from time to time reside, or in the
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case of a minor, may payor distribute the whole or any part there-
of to a custodian for such minor under any gifts to minors or
transfers to minors act. The receipt of the person to whom any
such payment or distribution is so made shall be a sufficient dis-
charge therefor, even though the Trustee may be such person.
The Trustee, in its sole discretion, may defer payment or
distribution of any or all income or principal to which a minor may
be entitled until such minor shall attain the age of twenty-one
(21) years, or to make such payment or distribution at any time and
from time to time, during the minority of such minor, holding the
whole or the undistributed portion thereof as a separate fund
vested in such minor but subject to the power in trust hereby given
to the Trustee to administer and invest such fund and to use the
income or principal thereof for the benefit of such minor as if
such fund were held in trust hereunder. The Trustee shall pay and
distribute any balance of such fund to such minor when such minor
shall attain the age of twenty-one (21) years. Except as is here-
inabove provided, if such minor shall die before attaining the age
of twenty-one (21) years, the Trustee shall pay and distribute such
balance to the executors, administrators or legal representatives
of the estate of such minor, or if there shall be no such legal re-
presentative, to such persons as would have inherited the same and
in the same proportions as they would have taken if such minor had
died intestate, unmarried, the absolute. owner thereof and a
resident of the state in which such minor shall die domiciled.
The word "minor", wherever used in this Article FOURTH,
shall mean any person who has not attained the age of twenty-one
(21) years.
ARTICLE FIFTH
PaYment Of Debts
Upon the death of the Grantor, the Trustee may pay from
the principal of the trust fund the amount of any estate or death
taxes, by whatever name called, imposed under the laws of any jur-
isdiction by reason of the Grantor's death, whether in respect of
property passing under this Agreement or the Grantor's Last will
and Testament or otherwise, and the amount of all of the debts
which the Grantor's estate must pay, the expenses of her last
illnesses and funeral, and the expenses of administering her
estate. The Trustee may rely upon the written certification of the
executors, administrators or legal representatives of the Grantor IS
estate as to the amount of any such tax, debt or expense, without
any duty to inquire as to the correctness thereof, and, in its dis-
cretion, may make payment thereof either to said executors, admin-
istrators or legal representatives or to the taxing authority or
person to whom such amount is owed.
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ARTICLE SIXTH
Life Insurance and Death Benefits
with respect to any insurance policies or employee death
benefits payable to the Trustee, the Trustee, upon being advised
that any sum is so payable by reason of the death of-the Grantor,
shall endeavor to collect the same, and may bring a suit or action
therefor, or may compromise, adjust, settle or submit to arbitra-
tion any claims therefor. The Trustee shall be entitled to reim-
bursement from the trust fund for all expenses incurred by the
Trustee in collecting or attempting to collect any such sum by
sui t, action or otherwise. The Trustee, however, shall be under no
duty to bring a suit or action unless the expenses of the Trustee,
including attorneys' fees, shall have been advanced or guaranteed
to the satisfaction of the Trustee. The Trustee may, out of the
trust fund, repay any advances made by the Trustee or reimburse the
Trustee for any expenses incurred in collecting or attempting to
collect any sum as aforesaid.
The Trustee in no case shall be under any duty or obliga-
tion to make any claim against the Grantor's estate, or take any
action against the executors, administrators or legal representa-
tives of the Grantor's estate, for reimbursement for any reduction
of the sums payable upon the death of the Grantor by reason of un-
paid premiums or for any other cause, including any loans and in-
terest thereto secured by any insurance policies.
During the life of the Grantor, the Trustee may, in its
discretion, apply the net income or principal of the trust fund to
the payment of premiums on any life insurance policy of which the
Trustee or any trust hereunder is beneficiary. If the net income
and principal is insufficient to pay such premiums, the Trustee may
notify the Grantor and the beneficiaries of the trust of such
insufficiency and give them the opportunity to furnish the neces-
sary funds. If neither the Grantor nor any of the beneficiaries
furnishes the funds necessary to pay the premiums, the Trustee may,
but shall not be obligated to, obtain the funds required to pay
such premiums by selling a portion of the principal of the trust
fund, by borrowing on the security of such principal, by borrowing
against the cash surrender value of the policy or by surrendering
some policies and using the proceedS to pay the premiums on other
policies. The Trustee also is authorized to convert such policies
to paid-Up or extended term insurance if the trust fund does not
have the necessary funds to pay the premiums. If no funds are
available for the payment of the premiums of any insurance policy,
the Trustee may assign ownership of such policy to any or all of
the then living income beneficiaries of the trust.
The Grantor retains, during her life, all of the rights,
options and privileges reserved to or conferred upon her by the
terms of said insurance policies or employee death benefit plans,
4
eluding without limitation the right to borrow upon and pledge
.le same, to change the beneficiary thereof, to convert the same
~nto other forms of insurance, to collect the cash value thereof,
to permit or direct the same to lapse, and to receive dividends and
other lifetime benefits of any kind payable to her by the terms
thereof. The Grantor may exercise the foregoing rights without the
consent of the Trustee or any beneficiary hereunder.
ARTICLB SEVENTH
Riqht To Revoke Or Amend
The Grantor reserves the right, at any time and from time
to time, and without the consent of any per$on or notice to any
person other than the Trustee, to amend or revoke in whole or in
part this Agreement or any trust created hereunder, or to change
the terms or beneficiaries thereof, by delivering to the Trustee
written notice of such revocation or change signed by the Grantor.
Any such change, however, shall not increase the obligations, or
reduce the commissions,. of the Trustee without the consent of the
Trustee. Upon any such revocation, the Trustee shall deliver to
the Grantor all property in the possession or control of the Trust-
ee with respect to any trust which has been revoked and shall exe-
cute and deliver any instruments necessary to release any interest
of the Trustee in such property. The sale or other disposition by
the Grantor of the whole or any part of the trust fund held here-
under shall constitute as to such whole or part a revocation of
this Agreement and the trust or trusts affected thereby.
The Grantor reserves the power and right during the life
of the Grantor to collect any rent, interest or other income which
may accrue from the trust fund and, in her sole discretion, to ac-
cumulate such income as a trust asset or to pay such income to the
Grantor individually and not in any fiduciary capacity. The Grant-
or further reserves the power and right during life of the Grantor
to mortgage or pledge all or any part of the trust fund as colla-
teral for any loan.
ARTICLE EIGHTH
Termination Of Trusts
Notwithstanding anything to the contrary contained here-
in, if the principal of any trust created under this Agreement is
less than $1,000.00 at any time, the Trustee, in its sole discre-
tion, may pay and distribute the entire principal of such trust and
all accrued and undistributed income to the beneficiaries of such
trust, discharged of trust, and such trust thereupon shall termi-
nate.
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ARTICLE NINTH
Powers Of Trustee
In the administration of any property, real or personal,
at any time forming a part of the trust fund, including accumulated
income, and in the administration of any trust created hereunder,
the Trustee, in addition to and without limitation of the powers
provided by law, shall have the following powers to be' 'exercised in
the absolute discretion of the Trustee, except as otherwise ex-
pressly provided in this Agreement:
(a) To retain such property for any period, whether or
not the same is of the character permissible for invest-
ments by fiduciaries under any applicable law, and with-
out regard to the effect any such retention may have upon
the diversity of investments.
(b) To sell, transfer, exchange, convert or otherwise
dispose of, or grant options with respect to, such prop-
erty, at public, or private sale, with or without
security, in such manner, at such times, for such prices,
and upon such terms and conditions as the Trustee may
deem advisable.
(c) To invest and reinvest in common or preferred
stocks, securities, investment trusts, bonds and other
property, real or personal, foreign or domestic,
including any undivided interest in anyone or more
common trust funds, whether or not such investments be of
the character permissible for investments by fiduciaries
under any applicable law, and without regard to the ef-
fect any such investment may have upon the diversity of
investments.
(d) To render liquid the trust fund or any trust created
hereunder in whole or in part, at any time and from time
to time, and to hold cash or readily marketable securi-
ties of little or no yield for such period as the Trustee
may deem advisable.
(e) To lease any such property beyond the period fixed
by statute for leases made by fiduciaries and beyond the
duration of any trust created hereunder.
(f) To join or become a party to, or to oppose, any re-
organization, readjustment, recapitalization, foreclo-
sure, merger, voting trust, dissolution, consolidation or
exchange, and to deposit any securities with any
committee, depository or trustee, and to pay any fees,
expenses and assessments incurred in connection there-
with, and to charge the same to principal, and to exer-
6
.
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(1) To make distribution of the trust fund or of the
principal of any trust created hereunder in kind, and to
cause any distribution to be composed of cash, property
or undivided fractional shares in property different in
kind from any other distribution, without regard to the
income tax basis of the property distributed to a.ny bene-
ficiary of any trust.
(m) To allocate receipts and disbursements of the trust
fund between income and principal as the Trustee in its
discretion may determine.
(n) To execute and deliver any and all instruments or
writings which it may deem advisable to carry 'out any of
the foregoing powers. No party to any such instruments
or writings shall be obligated to inquire into its
validity.
(0) To exercise 'all such rights and powers and to do all
such acts and enter into all such agreements as persons
owning similar property in their own right might lawfully
exercise, do.or enter into.
No person who deals with any Trustee hereunder shall be
bound to see to the application of any asset delivered to such
Trustee or to inquire into the authority for, or propriety of, any
action taken or not taken by such Trustee.
Notwithstanding anything to the contrary contained here-
in, during such time as any beneficiary of any trust created here-
under (other than the Grantor) may be acting as a Trustee here-
under, such person shall be disqualified from exercising any power
to make any discretionary distributions of income or principal to
himself or to make discretionary allocations in his own favor of
receipts or disbursements as between income and principal.
No Trustee shall be liable for acts or omissions in ad-
ministering the trust fund or any trust created by this Agreement,
except for that Trustee's own actual fraud, gross negligence or
willful misconduct. If any Trustee becomes liable as Trustee to
any pther person who is not a beneficiary in connection with any
matter not within the Trustee's control and not due to the Trust-
ee's actual fraud, gross negligence or willful misconduct, such
Trustee shall be fully indemnified and held harmless by the trust
fund and any trust created hereunder giving rise to such liability,
as the case may be, against and in respect of any damages that such
Trustee may sustain, including without limitation attorneys' fees.
No successor Trustee shall incur any liability as a result of
qualifying as a Trustee hereunder before receiving an account of
the previous administration of the trust fund and the trusts creat-
ed hereunder.
8
cise conversion, subscription or other rights, and to
make any necessary payments in connection therewith, or
to sell any such privileges.
(g) To vote in person at meetings of stock or security
holders and adjournments thereof, and to vote by general
or limited proxy with respect to any stock or securities.
(h) To hold stock and securities in the name of a
nominee without indicating the trust character of such
holding, or unregistered or in such form as will pass by
delivery, or to use a central depository and to permit
registration in the name of a nominee.
(i) To pay, compromise, compound, adjust, submit to
arbitration, sell or release any claims or demands of the
trust fund or any trust created hereunder against others
or of others against the same as the Trustee may deem
advisable, including the acceptance of deeds of real
property in satisfaction of notes, bonds and mortgages,
and to make any p~yments in connection therewith which
the Trustee may deem advisable.
(j) To borrow money for any purpose from any source, in-
cluding any trustee at any time acting hereunder, and to
secure the repayment of any and all amounts so borrowed
by mortgage or pledge of any property.
(k) To possess, manage, insure against loss by fire or
other casualties, develop, subdivide, control, partition,
mortgage, lease ,or otherwise deal with any and all real
property; to satisfy and discharge or extend the term of
any mortgage thereof; to execute the necessary instru-
ments and covenants to effectuate the foregoing powers,
including the giving or granting of options in connection
therewith; to make repairs, replacements and improve-
ments, structural or otherwi.se, or abandon the same if
deemed to be worthless or not of sufficient value to
warrant keeping or protecting; to abstain from the pay-
ment of real estate taxes, assessments, water charges and
se~"'er rents, repairs, maintenance and upkeep of the same;
to permit to be lost by tax s'ale or other proceeding or
to convey the same for a nominal consideration or without
consideration; to set up appropriate reserves out of in-
come for repairs, modernization and upkeep of buildings,
incl uding reserves for depreciation and obsolescence, and
to add such reserves to principal and, if the income from
the property itself should not suffice for such purposes,
to advance out of other income any sums needed therefor,
and advance any income of the trust for the amortization
of any mortgage on property held in the trust.
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(1) To make distribution of the trust fund or of the
principal of any trust created hereunder in kind, and to
cause any distribution to be composed of cash, property
or undivided fractional shares in property different in
kind from any other distribution, without regard to the
income tax basis of the property distributed to any bene-
ficiary of any trust.
(m) To allocate receipts and disbursements of the trust
fund between income and principal as the Trustee in its
discretion may determine.
(n) To execute and deliver any and all instruments or
writings which it may deem advisable to carry 'out any of
the foregoing powers. No party to any such instruments
or writings shall be obligated to inquire into its
validity.
(0) To exercise all such rights and powers and to do all
such acts and enter into all such agreements as persons
owning similar property in their own right might lawfully
exercise, do or enter into.
No person who deals with any Trustee hereunder shall be
bound to see to the application of any asset delivered to such
Trustee or to inquire into the authority for, or propriety of, any
action taken or not taken by such Trustee.
Notwithstanding anything to the contrary contained here-
in, during such time as any beneficiary of any trust created here-
under (other than the Grantor) may be acting as a Trustee here-
under, such person shall be disqualified from exercising any power
to make any discretionary distributions of income or principal to
himself or to make discretionary allocations in his own favor of
receipts or disbursements as between income and principal.
No Trustee shall be liable for acts or omissions in ad-
ministering the trust fund or any trust created by this Agreement,
except for that Trustee's own actual fraud, gross negligence or
willful misconduct. If any Trustee becomes liable as Trustee to
any other person who is not a beneficiary in connection with any
matter not within the Trustee's control and not due to the Trust-
ee's actual fraud, gross negligence or willful misconduct, such
Trustee shall be fully indemnified and held harmless by the trust
fund and any trust created hereunder giving rise to such liability,
as the case may be, against and in respect of any damages that such
Trustee may sustain, including without limitation attorneys' fees.
No successor Trustee shall incur any liability as a result of
qualifying as a Trustee hereunder before receiving an account of
the previous administration of the trust fund and the trusts creat-
ed hereunder.
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The Trustee is authorized, but not required, to accept
ny property transferred to the Trustee by any person during such
~erson' s lifetime or by such person's Last will and Testament. Any
property so transferred by any person shall become a part of such
trust or trusts created by this Agreement as such person shall
direct and may be commingled with the other property in the trust
or trusts to which such property has been added and shall be held,
administered and disposed of as a part of such trust or trusts.
The Trustee, at any time and from time to time, may
render to the Grantor an account of its acts and transactions as
Trustee with respect to the income and principal of any trust
created hereunder, from the date of creation of such trust or from
the date of the last previous account of the Trustee. Such account
shall be rendered in any form acceptable to ,the Grantor and the
Trustee. The Grantor shall have full power and authority on behalf
of all persons interested in such trust, whether such interest
relates to income or principal, to settle and adjust such account.
Such settlement shall be final and conclusive upon all persons so
interested in such trust and the Trustee shall not be required to
obtain jUdicial approval of the account or accounts so settled.
Upon such settlement, 'the Trustee shall be fully and completely
discharged and released from all further liability, responsibility
and accountability for or with respect to their acts and trans-
actions as set forth in the account or accounts so settled.
Nothing herein, however, shall be construed as a limitation upon
the right of the Trustee to seek judicial settlement of their ac-
count or accounts whether or not such account or accounts are so
settled.
ARTICLB TENTH
Third Parties Not ResDoDsible For Administration
This trust is created with the express understanding that
each bank at which an account is maintained shall have no responsi-
bility or liability whatsoever to see to the proper administration
of this trust. Upon the transfer of the right, title and interest
in and to any account by any Trustee hereunder, the bank shall
conclusively treat the transferee as the sole owner of such
account. Until the bank shall receive from some person interested
in this trust written notice of any death or other event upon which
a right to receive income or principal may depend, the bank shall
incur no liability for payment made in good faith to persons whose
interests shall have been affected by such event. The bank shall
be protected in acting upon any notice or other instrument or docu-
ment believed by it to be genuine and to have been signed or pre-
sented by the proper party or parties.
This trust is created with the express understanding that
each issuer, transfer agent or custodian of any securities held
9
hereunder shall have no responsibility or liability to see to the
proper administration of this trust. Upon the transfer of the
right, title and interest in and to such account by any trustee
hereunder, said issuer, transfer agent or custodian shall con-
clusively treat the transferee as the sole owner of such
securities. until the issuer, transfer agent or custodian shall
receive from some person interested in this trust written notice of
any death or other event upon which a right to receive income or
principal may depend, the issuer, transfer agent or custodian shall
incur no liability for payment made in good faith to persons whose
interests shall have been affected by such event. The issuer,
transfer agent or custodian shall be protected in acting upon any
notice or other instrument or document believed by it to be genuine
and to have been signed or presented by the proper party or
parties.
ARTICLE ELEVENTH
ADDointment Of Trustee
The Grantor appoints herself as Trustee hereunder. The
Grantor hereby appoints Isabelle B. Bole, having an address at RD
3, Box 261, Valencia, Pennsylvania 16059-9123, as successor
Trustee hereunder, to serve in the event of the Grantor's physical
or mental incapacity. In the event that Isabelle B. Bole shall be
unwilling or unable to serve in this capacity, then the Grantor
appoints Karen Boyer, having an address at 1459 Mount Gretna Road,
Elizabeth Town, Pennsylvania 16022, to serve in her stead in the
event of the Grantor's physical or mental incapacity. The Grantor
appoints Apollo Trust Company, having an address at Box 247, 1(-
Apollo, Pennsylvania 15613-0247, to serve as Successor Trustee
upon the death of the Grantor.
The term "Trustee" wherever used herein shall mean the
trustee in office from time to time. Any such trustee shall have
the same rights, powers, duties, authority and privileges, whether
or not discretionary, as if originally appointed hereunder.
No bond or other security shall be required of any
Trustee acting hereunder for the faithful performance of the duties
of Trustee, notwithstandinq any law of any State or jurisdiction to
the contrary.
ARTICLE TWELFTH
simultaneous Death
If any beneficiary under this Agreement shall die
simultaneously with any other person upon whose death such benefi-
ciary shall become entitled to receive either income or principal
10
under this Agreement, or in such circumstances as to render it dif-
ficult or impracticable to determine who predeceased the other;
then for purposes of this Agreement such beneficiary shall be deem-
ed to have predeceased such other person. The death of a benefi-
ciary during the lifetime of the Grantor, or in a common accident
or disaster with the Grantor, shall revoke the designation of such
beneficiary as a beneficiary hereunder. The provisions of this
Agreement shall be construed as aforesaid, notwithstanding the pro-
visions of any applicable law establishing a different' presumption
of order of death or providing for survivorship for a fixed period
as a condition of inheritance of property.
ARTICLE ~IRTEENTH
Decisions Of Trus~ee Are Conclusive
The determination of the Trustee in respect of the amount
of any discretionary payment of income or principal from any trust
established hereunder, and of the advisability thereof, shall be
final and conclusive on, all persons, whether or not then in being,
having or claiming any interest in such trust, and upon making any
such payment, the Trustee shall be released fully from all further
liability or accountability therefor.
The right of any beneficiary to any payment of income or
principal shall in every case be subject to any charge or deduction
which the Trustee may make against the same under the authority
granted to the Trustee by any law or by this Agreement.
ARTICLE POURTEENTH
Riqhts Of Beneficiaries Are Not Assiqnable
No disposition, charge or encumbrance on the income or
principal of any trust established hereunder, or any part thereof,
by any beneficiary thereof by way of anticipation shall be valid or
in any way binding upon the Trustee. No beneficiary shall have the
right to assign, transfer, encumber or otherwise dispose of such
income or principal or any part thereof until the same shall be
paid to such beneficiary by the Trustee. No income or principal or
any part thereof shall in any manner be liable to any claim of any
creditor of any beneficiary.
ARTICLE FIFTEENTH
Construction
This Agreement and all trusts created hereunder shall be
construed and enforced in accordance with the laws of the Common-
11
,ealth of Pennsylvania, and the validity and effect of this Agree-
ment shall be determined in accordance with the laws of the Common-
wealth of Pennsylvania.
Wherever use in this Agreement and the context so
requires, the masculine shall include the feminine and the singular
shall include the plural, and vice versa.
The captions in this Agreement are for convenience of
reference, and they shall not be considered when construing this
Agreement.
If under any of the provisions of this Agreement any
portion of the trust fund would be held in trust for longer than a
date twenty-one years after the death of the ~ast survivor of the
Grantor and the beneficiaries hereunder, in being when this Agree-
ment becomes irrevocable; then upon such date the trust of such
portion shall terminate and the principal, together with any accru-
ed and unpaid income thereon, shall be paid and distributed to the
person or persons then living who would have been entitled to re-
ceive the income therefrom had the trust continued, in the propor-
tion in which they wouid have been so entitled.
ARTICLE SIXTEENTH
Bindina Effect
This Agreement shall extend to and be binding upon the
heirs, executors, administrators, successors and assigns of the
undersigned Grantor and upon the Trustee acting hereunder.
IN WITNESS WHEREOF, this Agreement has been duly executed
as of the date first above written.
Jt:.L ~ kl-IJ
Helen L. Smith
Grantor
12
COMMONWEALTH OF PENNSYLVANIA)
) SS.:
COUNTY OF CLARION )
On this 27th day of December, 1991, before me,
, the undersigned officer, personally appeared Helen L.
smith, known to me to be the person whose name is subscribed to the
within instrument, and acknowledged that she executed ,the same for
the uses and purposes therein contained.
IN WITNESS WHEREOF I hereunto set my hand and official
. ,\s~C\.'l'~;,
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My commission expires on
NotaIiaI Seal
Mary K WerJ.ej, Notary Publ'1C
Salem TY4J., Westmoreland County
My COmmission Expires Jan. 31, 1994-
Member, Pe/1l'Jt1ylvot'llD ~itlCit1 of ~
15
. .
. .
EXlllBI'T "1\"
----
IN RE:
HELEN L. SMITH
DECLARATION OF TRUST
Dated December 27, 1991
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: FILE NO.
RENUNCIATION OF TRUSTEE
. THIS RENUNCIATION OF TRUSTEE isexecuted on this 31 st day of October in the
year TW0 Thousand One (2001), by APOIJ....O TRUST COMPA.:.~, aPennsy!vania trust
company with its principal offices at 201 North Warren Avenue, PO Box 247, Apollo,
Armstrong County, Pennsylvania 15613-0247.
WHEREAS., the Declaration of Trust (hereinafter referred to as the "'Trust") was signed
and executed on December 27, 1991, by and between Helen L. Smith as Settlor and
Helen L. Smith as Trustee;
WHEREAS, Helen L. Smith died on February 26,2001;
WHEREAS, pursuant to Article Eleventh of the Trust, entitled "Appointment of
Trustee," Grantor appointed Apollo Trust Company to serve as successor trustee upon the death
of the Grantor, Helen L. Smith;
WHEREAS, Apollo Trust Company does not wish to serve as the successor trustee of
the Trust;
NOW, THEREFORE, KNOW ALL MEN BY THESE PRESENTS, that Apollo Trust
Company, Trustee, hereby resigns as successor trustee of the Trust.
IN WITNESS WHEREOF, the Apollo Trust Company has hereunto set its hand and
seal the day and year first written above.
'\ 4J . j
ATTEST:
........ , .. Ii i'"
<::> \. ",\ ' .....
" . - - /..
4C:' I
\At'JJ~' ~ .
...~~~;b, ~~3~Q ~~~
BY:
COMMONWEALTH OF PENNSYL VANIA
SS:
COUNTY OF Armstrong
On this the 31st day of October 2001 before me a Not~Public the
, , , M l' , ,
undersigned officer, personally .pPR~fed James R. Drenning & ,e,' ~sWhcr4c& fldged
himself to be the President & Offieer of APOLLO TRUST COMPANY, a Pennsylvania
trust company, and that he as such officer, being authorized to do so, executed the foregoing
instrument for the purposes therein contained by signing the name of the corporation by himself
as such officer.
. ~ ' ., , .
IN WITNESS WHEREOF, I have set my hand and official seal.
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" ~..'
otary Public
y Commission Expires:
"
Notarial Seal
Rita T. Pencak, Notary Public
Apollo Boro, Armstrong County
My Commission Expires Nov. 8, 2003
Member, pennsylli anlJ Association of Notaries
IN RE:
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27,1991.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: FILE NO.
ACCEPTANCE OF APPOINTMENT AS SUCCESSOR TRUSTEE
TillS ACCEPTANCE OF APPOINTMENT AS SUCCESSOR TRUSTEE is
executed on this I Y day of October, 2001, by KAREN L. BOYER, an adult individual, now
of 1459 Mt. Gretna Road, Elizabethtown, Lancaster County, Pennsylvania 17022.
WHEREAS, the Helen L. Smith Declaration of Trust (hereinafter referred to as the
"Trust") was signed and executed on December 27, 1991, by and between Helen L. Smith as
Grantor and Helen L. Smith as Trustee;
WHEREAS, Helen L. Smith died on February 26, 2001;
WHEREAS, pursuant to Article Eleventh of the Trust, entitled "Appointment of
Trustee," Grantor appointed Apollo Trust Company to serve as successor trustee upon the death
of the Grantor, Helen L. Smith;
WHEREAS, Apollo Trust Company does not wish to serve as the successor trustee of
the Trust;
WHEREAS, Karen L. Boyer desires to be appointed as Successor Trustee with all the
duties and powers, including discretionary powers, granted under the Trust or by law;
WHEREAS, Karen L. Boyer has petitioned the Cumberland County Orphans' Court
Division for approval of her appointment as Successor Trustee;
WHEREAS, upon the Court's approval of Karen L. Boyer as Successor Trustee of the
Trust, Karen L. Boyer desires to accept such appointment;
NOW, THEREFORE, KNOW ALL MEN BY THESE PRESENTS that Karen L.
Boyer hereby accepts the irrevocable transfer, assignment and delivery to her and her successors
and assigns of the Trust assets, and undertakes to hold, manage, invest and reinvest such assets,
and to distribute the income and principal of the Trust, in accordance with the provisions of the
Trust.
IN WITNESS WHEREOF, the party hereto has hereunto set her hand and seal the day
and year frrst written above.
ss:
COUNTY OF
On this, the K day of October, 2001, before me, a Notary Public, the undersigned
officer, personally appeared KAREN L. BOYER, known to me (or satisfactorily proven) to be
the person whose name is subscribed to the within instrument, and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have set my hand and official seal.
$'~
My Commission Expires:
Notarial Seal
Karen Y. Boyer. ~ Public
MI..Jat Twp.,.~ County
My ComniJsSfOn Exptres July 11, 2002
IN RE:
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991.
: IN THE COURT OF COMM:ON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: FILE NO.
CONSENT TO APPOINTMENT OF SUCCESSOR TRUSTEE
1. I am an adult and I am not under any legal disability.
2. I have received a copy of the Declaration of Trust (hereinafter referred to as the
"Trust") which was signed and executed on December 27,1991, by and between Helen L. Smith
as Grantor and Helen L. Smith as Trustee;
3. I have been notified that Helen L. Smith died on February 26,2001;
4. I have reviewed Article Eleventh of the Trust entitled "Appointment of Trustee,"
and am aware that the Grantor appointed Apollo Trust Company to serve as successor trustee
upon the death of the Grantor, Helen L. Smith;
5. I have been notified that Apollo Trust Company does not wish to serve as the
successor trustee of the Trust and that the Trust does not appoint an alternate successor trustee to
act in the event of Apollo Trust Company's resignation;
6. I am a remainder beneficiary of the Helen L. Smith Declaration of Trust dated
December 27, 1991, under Article Third entitled "Successor Beneficiaries."
7. My interest as a remainder beneficiary in the trust and the need for the
appointment of a successor trustee have been explained to my satisfaction.
8. I have been provided with a copy of the Petition for Appointment of Successor
Trustee and have read and understand the request of the Petitioner, Karen L. Boyer.
9. Upon reviewing the Petition for Appointment of Successor Trustee, I hereby
consent to the appointment of Karen L. Boyer as successor trustee of the Trust, and in doing so, I
also hereby waive any right which I may have to being appointed as successor trustee of the Trust
as a remainder beneficiary.
.7
~~4 d:Li~~
Dated: October .l.!J-, 2001
.~.-1'-4?/4(/ ~~%.aL
v
Isabelle B. Bole, by and through her
Attorney-in-Fact, Lorraine Gestrich
) I
IN RE:
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: FILE NO.
CONSENT TO APPOINTMENT OF SUCCESSOR TRUSTEE
1. I am an adult and I am not under any legal disability.
2. I have received a copy of the Declaration of Trust (hereinafter referred to as the
"Trust") which was signed and executed on December 27, 1991, by and between Helen L. Smith
as Grantor and Helen L. Smith as Trustee;
3. I have been notified that Helen L. Smith died on February 26, 2001;
4. I have reviewed Article Eleventh of the Trust entitled "Appointment of Trustee,"
and am aware that the Grantor appointed Apollo Trust Company to serve as successor trustee
upon the death of the Grantor, Helen L. Smith;
5. I have been notified that Apollo Trust Company does not wish to serve as the
successor trustee of the Trust and that the Trust does not appoint an alternate successor trustee to
act in the event of Apollo Trust Company's resignation;
6. I am a remainder beneficiary of the Helen L. Smith Declaration of Trust dated
December 27, 1991, under Article Third entitled "Successor Beneficiaries."
7. My interest as a remainder beneficiary in the trust and the need for the
appointment of a successor trustee have been explained to my satisfaction.
8. I have been provided with a copy of the Petition for Appointment of Successor
Trustee and have read and understand the request of the Petitioner, Karen L. Boyer.
9. Upon reviewing the Petition for Appointment of Successor Trustee, I hereby
consent to the appointment of Karen L. Boyer as successor trustee of the Trust, and in doing so, I
also hereby waive any right which I may have to being appointed as successor trustee of the Trust
as a remainder beneficiary.
Dated: October ~, 2001
~~~~
IN RE:
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: FILE NO.
CONSENT TO APPOINTMENT OF SUCCESSOR TRUSTEE
1. I am an adult and I am not under any legal disability.
2. I have received a copy of the Declaration of Trust (hereinafter referred to as the
"Trust") which was signed and executed on December 27, 1991, by and between Helen L. Smith
as Grantor and Helen L. Smith as Trustee;
3. I have been notified that Helen L. Smith died on February 26, 2001;
4. I have reviewed Article Eleventh of the Trust entitled "Appointment of Trustee,"
and am aware that the Grantor appointed Apollo Trust Company to serve as successor trustee
upon the death of the Grantor, Helen L. Smith;
5. I have been notified that Apollo Trust Company does not wish to serve as the
successor trustee of the Trust and that the Trust does not appoint an alternate successor trustee to
act in the event of Apollo Trust Company's resignation;
6. I am a remainder beneficiary of the Helen L. Smith Declaration of Trust dated
December 27, 1991, under Article Third entitled "Successor Beneficiaries."
7. My interest as a remainder beneficiary in the trust and the need for the
appointment of a successor trustee have been explained to my satisfaction.
8. I have been provided with a copy of the Petition for Appointment of Successor
Trustee and have read and understand the request of the Petitioner, Karen L. Boyer.
9. Upon reviewing the Petition for Appointment of Successor Trustee, I hereby
consent to the appointment of Karen L. Boyer as successor trustee of the Trust, and in doing so, I
also hereby waive any right which I may have to being appointed as successor trustee of the Trust
as a remainder beneficiary.
Dated: October ft 2001
/3~ /)11 4
Bruce Long ,
, .
) .
IN RE:
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: FILE NO.
CONSENT TO APPOINTMENT OF SUCCESSOR TRUSTEE
1. I am an adult and I am not under any legal disability.
2. I have received a copy of the Declaration of Trust (hereinafter referred to as the
"Trust") which was signed and executed on December 27, 1991, by and between Helen L. Smith
as Grantor and Helen L. Smith as Trustee;
3. I have been notified that Helen L. Smith died on February 26,2001;
4. I have reviewed Article Eleventh of the Trust entitled "Appointment of Trustee,"
and am aware that the Grantor appointed Apollo Trust Company to serve as successor trustee
upon the death of the Grantor, Helen L. Smith;
5. I have been notified that Apollo Trust Company does not wish to serve as the
successor trustee of the Trust and that the Trust does not appoint an alternate successor trustee to
act in the event of Apollo Trust Company's resignation;
6. I am a remainder beneficiary of the Helen L. Smith Declaration of Trust dated
December 27, 1991, under Article Third entitled "Successor Beneficiaries."
7. My interest as a remainder beneficiary in the trust and the need for the
appointment of a successor trustee have been explained to my satisfaction.
8. I have been provided with a copy of the Petition for Appointment of Successor
Trustee and have read and understand the request of the Petitioner, Karen L. Boyer.
9. Upon reviewing the Petition for Appointment of Successor Trustee, I hereby
consent to the appointment of Karen L. Boyer as successor trustee of the Trust, and in doing so, I
also hereby waive any right which I may have to being appointed as successor trustee of the Trust
as a remainder beneficiaty.
Dated: October ~ 2001
/'ntU. <7-
Robert Long
I .. ,
. . j .
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DMSION
IN RE:
: FILE NO.
CONSENT TO APPOINTMENT OF SUCCESSOR TRUSTEE
1. I am an adult and I am not under any legal disability.
2. I have received a copy of the Declaration of Trust (hereinafter referred to as the
'''Trust'') which was signed and executed on December 27, 1991, by and between Helen L. Smith
as Grantor and Helen L. Smith as Trustee;
3. I have been notified that Helen L. Smith died on February 26,2001;
4. I have reviewed Article Eleventh of the Trust entitled "Appointment of Trustee,"
and am aware that the Grantor appointed Apollo Trust Company to serve as successor trustee
upon the death of the Grantor, Helen L. Smith;
5. I have been notified that Apollo Trust Company does not wish to serve as the
successor trustee of the Trust and that the Trust does not appoint an alternate successor trustee to
act in the event of Apollo Trust Company's resignation;
6. I am a remainder beneficiary of the Helen L. Smith Declaration of Trust dated
December 27, 1991, under Article Third entitled "Successor Beneficiaries."
7. My interest as a remainder beneficiary in the trust and the need for the
appointment of a successor trustee have been explained to my satisfaction.
8. I have been provided with a copy of the Petition for Appointment of Successor
Trustee and have read and understand the request of the Petitioner, Karen L. Boyer.
. .. I
9. Upon reviewing the Petition for Appointment of Successor Trustee, I hereby
consent to the appointment of Karen L. Boyer as successor trustee of the Trust, and in doing so, I
also hereby waive any right which I may have to being appointed as, suc7r trustee of the Trust
as a remainder beneficiary. '/
Dated: October 7, ~, 2001
. '. .
i " ~
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DMSION
IN RE:
: FILE NO.
CONSENT TO APPOINTMENT OF SUCCESSOR TRUSTEE
1. I am an adult and I am not under any legal disability.
2. I have received a copy of the Declaration of Trust (hereinafter referred to as the
'"Trust") which was signed and executed on December 27, 1991, by and between Helen L. Smith
as Grantor and Helen L. Smith as Trustee;
3. I have been notified that Helen L. Smith died on February 26,2001;
4. I have reviewed Article Eleventh of the Trust entitled "Appointment of Trustee,"
and am aware that the Grantor appointed Apollo Trust Company to serve as successor trustee
upon the death of the Grantor, Helen L. Smith;
5. I have been notified that Apollo Trust Company does not wish to serve as the
successor trustee of the Trust and that the Trust does not appoint an alternate successor trustee to
act in the event of Apollo Trust Company's resignation;
6. I am a remainder beneficiary of the Helen L. Smith Declaration of Trust dated
December 27, 1991, under Article Third entitled "Successor Beneficiaries."
7. My interest as a remainder beneficiary in the trust and the need for the
appointment of a successor trustee have been explained to my satisfaction.
8. I have been provided with a copy of the Petition for Appointment of Successor
Trustee and have read and understand the request of the Petitioner, Karen L. Boyer.
t I, .
. " ..
9. Upon reviewing the Petition for Appointment of Successor Trustee, I hereby
consent to the appointment of Karen L. Boyer as successor trustee of the Trust, and in doing so, I
also hereby waive any right which I may have to being appointed as successor trustee of the Trust
as a remainder beneficiaty.
Dated: October / ~ 2001
p: 7';7~
Barry Long
, ., .
. I I 4.
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DMSION
IN RE:
: FILE NO.
CONSENT TO APPOINTMENT OF SUCCESSOR TRUSTEE
1. I am an adult and I am not under any legal disability.
2. I have received a copy of the Declaration of Trust (hereinafter referred to as the
"Trust") which was signed and executed on December 27, 1991, by and between Helen L. Smith
as Grantor and Helen L. Smith as Trustee;
3. I have been notified that Helen L. Smith died on February 26,2001;
4. I have reviewed Article Eleventh of the Trust entitled "Appointment of Trustee,"
and am aware that the Grantor appointed Apollo Trust Company to serve as successor trustee
upon the death of the Grantor, Helen L. Smith;
5. I have been notified that Apollo Trust Company does not wish to serve as the
successor trustee of the Trust and that the Trust does not appoint an alternate successor trustee to
act in the event of Apollo Trust Company's resignation;
6. I am a remainder beneficiary of the Helen L. Smith Declaration of Trust dated
December 27, 1991, under Article Third entitled "Successor Beneficiaries."
7. My interest as a remainder beneficiary in the trust and the need for the
appointment of a successor trustee have been explained to my satisfaction.
8. I have been provided with a copy of the Petition for Appointment of Successor
Trustee and have read and understand the request of the Petitioner, Karen L. Boyer.
. c.. I
. If.
9. Upon reviewing the Petition for Appointment of Successor Trustee, I hereby
consent to the appointment of Karen L. Boyer as successor trustee of the Trust, and in doing so, I
also hereby waive any right which I may have to being appointed as successor trustee of the Trust
as a remainder beneficiaty.
Dated: October -1.2.-, 2001
/ /2 t
/!/D(P~ ,~.e)?? 7
Dennis Long /
. (, .
, .. (
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
IN RE:
: FILE NO.
CONSENT TO APPOINTMENT OF SUCCESSOR TRUSTEE
1. I am an adult and I am not under any legal disability.
2. I have received a copy of the Declaration of Trust (hereinafter referred to as the
"Trust") which was signed and executed on December 27,1991, by and between Helen L. Smith
as Grantor and Helen L. Smith as Trustee;
3. I have been notified that Helen L. Smith died on February 26,2001;
4. I have reviewed Article Eleventh of the Trust entitled "Appointment of Trustee,"
and am aware that the Grantor appointed Apollo Trust Company to serve as successor trustee
upon the death of the Grantor, Helen L. Smith;
5. I have been notified that Apollo Trust Company does not wish to serve as the
successor trustee of the Trust and that the Trust does not appoint an alternate successor trustee to
act in the event of Apollo Trust Company's resignation;
6. I am a remainder beneficiary of the Helen L. Smith Declaration of Trust dated
December 27, 1991, under Article Third entitled "Successor Beneficiaries."
7. My interest as a remainder beneficiary in the trust and the need for the
appointment of a successor trustee have been explained to my satisfaction.
8. I have been provided with a copy of the Petition for Appointment of Successor
Trustee and have read and understand the request of the Petitioner, Karen L. Boyer.
. 0( I .
. ., .
9. Upon reviewing the Petition for Appointment of Successor Trustee, I hereby
consent to the appointment of Karen L. Boyer as successor trustee of the Trust, and in doing so, I
also hereby waive any right which I may have to being appointed as successor trustee of the Trust
as a remainder beneficiary.
Dated: October~, 2001
p~~h
11 1(' .
. l I ..
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DMSION
IN RE:
: FILE NO.
CONSENT TO APPOINTMENT OF SUCCESSOR TRUSTEE
1. I am an adult and I am not under any legal disability.
2. I have received a copy of the Declaration of Trust (hereinafter referred to as the
"Trust") which was signed and executed on December 27, 1991, by and between Helen L. Smith
as Grantor and Helen L. Smith as Trustee;
3. I have been notified that Helen L. Smith died on February 26,2001;
4. I have reviewed Article Eleventh of the Trust entitled "Appointment of Trustee,"
and am aware that the Grantor appointed Apollo Trust Company to serve as successor trustee
upon the death of the Grantor, Helen L. Smith;
5. I have been notified that Apollo Trust Company does not wish to serve as the
successor trustee of the Trust and that the Trust does not appoint an alternate successor trustee to
act in the event of Apollo Trust Company's resignation;
6. I am a remainder beneficial)' of the Helen L. Smith Declaration of Trust dated
December 27, 1991, under Article Third entitled "Successor Beneficiaries."
7. My interest as a remainder beneficial)' in the trust and the need for the
appointment of a successor trustee have been explained to my satisfaction.
8. I have been provided with a copy of the Petition for Appointment of Successor
Trustee and have read and understand the request of the Petitioner, Karen L. Boyer.
11 (. .
. (, .
9. Upon reviewing the Petition for Appointment of Successor Trustee, I hereby
consent to the appointment of Karen L. Boyer as successor trustee of the Trust, and in doing so, I
also hereby waive any right which I may have to being appointed as successor trustee of the Trust
as a remainder beneficiary.
Dated: October I ')~ 2001
0/J-L-chr-v
Walter Long ~
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
GATES LOWELL R ESQ
1013 MUMMA RD
SUITE 100
LEMOYNE, PA 17043-1144
nn_n_ fold
EST A TE INFORMATION: SSN: 158-20-3384
FILE NUMBER: 21 - 2001 - 1 026
DECEDENT NAME: SMITH HELEN L
DA TE OF PAYMENT: 12/27/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/26/2001
NO. CD 000702
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
I I
101 $42,500.00 I
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$42,500.00
REMARKS: KAREN L BOYER TRUSTEE
SEAL
INITIALS: CW
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
\ /-?-c2-9- K3
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT1 ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
P 2 :/i 1 COUNTY
ACN
05-20-2002
SMITH
02-26-2001
21 01-1026
CUMBERLAND
101
.02
111J~Y 17
LOWELL R GATES ESQ
GATES ETAL
1013 MUMMA RD STE 100 'L,C::..
LEMOVNE PA 17B4t$l'n::..
*
REV-1547 EX AFP (01-02)
HELEN
L
Allount Rellitted
) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
3.736.82
313.153.75
(8)
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-v=is4"j-i3f-AFP--coi-:oz'r-No'Tici-oF-'rtiHEifiT;'Nci-y-AX-A-PPRA-isiMENT~--Ail-oWAiicE-oR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SMITH HELEN L FILE NO. 21 01-1026 ACN 101 DATE 05-20-2002
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. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
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
NOTE:
(9)
(10)
391287.00
NOTE: To insure proper
credit to your accountl
subllit the upper portion
of this forll with your
tax payment.
3161890.57
47.898 48
2681992.09
.00
2681992.09
(19)=
.00
.00
.00
401348.81
401348.81
8.611.48
(11)
(12)
(13)
(14)
.00 X 00 =
.00 X 045=
.00 X 12 =
2681992.09 X 15 =
TAX CREDITS:
. ... ,...... ....-..... . II (+ J AMOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
12-27-2001 CDOO0702 308.95- 421500.00
TOTAL TAX CREDIT 421191.05
BALANCE OF TAX DUE 11842.24CR
INTEREST AND PEN. .00
TOTAL DUE 11842.24CR
. IF PAID AFTER DATE INDICATED 1 SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDITwW (CR) 1 YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
\//-d9~ 13
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-UOl EX AFP [01-02)
'02 JUL-1
:07
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-03-2002
SMITH
02-26-2001
21 01-1026
CUMBERLAND
101
Allount Rulitted
HELEN
L
LOWELL R GATES ESQ
GATES ETAL
L'~
1013 MUMMA RD STE 1~~ij(~.,
LEMOYNE PA 17043
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
R"Ey=i6oj-Ex-AFP--lol-:02:f------...--xNHEiiiTANc'E-iAx-sTATEHE-Ni-OF-Accou'Nf--.-..---------------------
ESTATE OF SMITH HELEN L FILE NO. 21 01-1026 ACN 101 DATE 06-03-2002
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 DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-20-2002
P R I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
40,348.81
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-27-2001 CDOO0702 308.95- 42,500.00
05-15-2002 REFUND .00 1,842.24-
TOTAL TAX CREDIT 40,348.81
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. )
~
'\
!/
REV-1500 EX + (6-00) OFFICIAL USE ONLY
COMMONWEALTH OF PENNSYLVANIA REV-1500 I I -Ze; -/ L
DEPARTMENT OF REVENUE
DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 - 2001 - 1026
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Smith Helen L 158-20-3384
DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE
DENT
02/26/2001 05/14/1913 WITH THE REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
- -
3. Remainder Return
CHECK ~ 1. Original Return r Supplemental Return B (date of death prior to 12-13-82)
APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
PRIATE 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach a copy of Trust)
BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between 0 11. Election to tax under Sec. 9113(A)
12-31.91 and 1-1-95) (Attach Sch 0)
.....................-..............................................--.......................................................,........................................................................
...................................................................
THissectONM$tBEcOMptETmAtLcORRE~_ElldtONFitlENtiAtfAXtNf"dRMATfONSHdlJtb.aeblRltttSbf<)
<\.>. ...>LV. ....... .A}..>:}.\>> .....<..:.. .:'" ::: :0:. .:.... < :.... ':... ::::::::. ..:::.:.{:
NAME COMPLETE MAILING ADDRESS
COR- Lowell R. Gates, Esquire 1013 Mumma Road, Suite 100
RE- FIRM NAME (If Applicable) Lemoyne, PA 17043
SPON
DENT Gates, Halbruner & Hatch, P.C.
TELEPHONE NUMBER
717-731-9600 """", .-.
'- ~FFICIAL:US61 ONLY
1. Real Estate (Schedule A) (1) 0;00
2. Stocks and Bonds (Schedule B) (2) 0.00
3. Closely Held Corporation. Partnership or Sole-Proprietorship (3) 0.00
4. Mortgages & Notes Receivable (Schedule D) (4) 0.00 ,
5. Cash, Bank Deposits & Miscellaneous Personal \.:::'
Property (Schedule E) (5) 0.00
6. Jointly Owned Property (Schedule F)
0 Separate Billing Requested (6) 3,736.82 '-
~.
'-<"I
RECA-
PITULA- 7. Inter-Vivos Transfers & Miscellaneous
TION Non-Probate Property (Schedule G or L) (7) 313,153.75
8. Total Gross Assets (total Lines 1-7) (8) 316,890.57
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 39,287.00
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 8,611.48
11. Total Deductions (total Lines 9 & 10) (11 ) 47,898.48
12. Net Value of Estate (Line 8 minus Line 11) (12) 268,992.09
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) 0.00
has not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 268,992.09
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under Sec. 9116 (a)(1.2) 0.00 X .0 00 (15) 0.00
-
TAX 16. Amount of Line 14 taxable at lineal rate 0.00 X.O 0.045 (16) 0.00
-
COMPU- 17. Amount of Line 14 taxable at sibling rate 0.00 X .12 (17) 0.00
TATION 18. Amount of Line 14 taxable at collateral rate 268,992.09 X .15 (18) 40,348.81
19. Tax Due (19) 40,348.81
20. ~ lb-ledKBe:R~'fyQOAR~R~Ui$jING.i\.8$IDNQQ.fANpVElRMYM~t1tl
~;;:BESUA:f::tQANSWl:;fiALLQUE$tIQN$Oi'-fPAGf::2ANttRECHec.KMAtH<<(:'::>>
.. ................................................ .....-........................", ,..............................................................................
o PA 15001
NTF 29755
Copyright 2000 Greatland/Nelco LP - Forms Software Oniy
,
PA REV-1500 EX (6-00)
Decedent's Complete Address:
Page 2
STREET ADDRESS
100 Mt. Allen Drive
Cumberland
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
40,348.81
0.00
42,500.00
0.00
Total Credits (A + B + C)
(2)
42,500.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS. AGENT
(3) 0.00
(4) 2,151.19
(5) 0.00
(SA) 0.00
(5B) 0.00
'.'.................................,.,.,.................,............................'.'....................,..'.....'.................................................:...........:.................
......................'.....'.'.'.:...'....,..:....................................,.....,..:.....:.................'..,'.....'..,.....,.....,.........................................................
................................................................................................
.. ....... ........ ... ............. .................. ..... ..... ......................... ..... .......................... .......................................................................
............................
... ...... .............................. ...... ........ .......................,..,.................. ................................................,.............
..... .. .-......... . ..,................. .. .....-.......................................................
...... .............. ........................................................
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN
1.
...................... .... .. . ~ ... ...............,...... . .. ." ...................................................................
................... ...... ................................................,. .,...... . ... ....,... ............................. ....... .... ..-...............................-...................
..................
. ..... ........................... .............. ........ .............................................. ...................................................................,
......... . .. ............... . ..... ................. ..... .......................................... -.................................................................
.,.......... ......... ............................. ................................... ...........................
... ..................
......................
.......................
......................
......................
......................
.......................
......................
......................
......................
"XII
IN THE APPROPRIATE BLOCKS
Yes No
~ ~
B ~
Did decedent make a transfer and:
a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . .
c. retain a reversionary interest; or. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments, benefits or care? ..............................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ...................................................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................
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 periury, I declare that I have examined this return including accompanying schedules and statements, and to the best of my
knowledge and belief, It is true, correct and complete. Declaration of preparer other than the personal representative is based on information of
which preparer has any knowledge.
SI~:~:~R~ ~F :~~~~N RESPONSIBLE FOR FILING RETURN, ....(-0 C- ~ tY_ID~ L
ADDRESS ~ ~
1459 Mt. Gretna Road t"
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIV
Lowell R. Gates, Esq.
ADDRESS
1013 Mumma Rd., Suite
~
D
Elizabethtown, PA 17022
DATEU /'2./
---1--14--f?~
Lemoyne, PA 17043
on or on use spouse
[72 ps. ~ 9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995. the tax rate is imposed on the et value of transfers to or forthe use of the sUNiving spouse is 0% [72 P.S. ~ 9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, an the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficial)'.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72.P.S. ~ 9116(1.2) [72 P.S. %9116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~ 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individuai
who has at least one parent in common with the decedent, whether by blood or adoption.
o PA 15002
NTF 29756
Copyright 2000 Greatland/Nelco LP - Forms Software Only
\
REV-1509 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen L. Smith
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
21 2001 - 1026
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Karen L. Boyer
ADDRESS
1459 Mt. Gretna Road,
Elizabethtown, PA 17022
RELATIONSHIP TO DECEDENT
Niece
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
Include name of financial institution and bank
ITEM FOR MADE account number or similar identifying number. DATE OF DEATH DECO'S VALUE OF
JOINT
NO. TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
11. A. 12/30/1899 PNC Bank Checking Account
Account No. 50-7007-1886 7,473.64 50.000 3,736.82
TOTAL (Also enter on line 6, Recapitulation) $ 3,736.82
9 PA 15091
NTF 10876
(If more space is needed, insert additional sheets of the same size)
Copyright 1999 Greatland/Nelco LP - Forms Software Only
REV-1510 EX + (1-97)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen L. Smith
FILE NUMBER
21 2001 - 1026
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NO.
11.
DESCRIPTION OF PROPERTY
INCLUDE NAME OF THE TRANSFEREE, THEIR
RELATIONSHIP TO DECD & DATE OF TRANSFER.
ATTACH COpy OF THE DEED FOR REAL ESTATE.
During her lifetime, Helen L.
Smith established the Helen L.
Smith Declaration of Trust
dated dated December 27, 1991,
by and between herself as
Grantor and Trustee. Karen L.
Boyer was appointed Successor
Trustee of the Trust by Order
dated November 13, 2001, from
the Honorable George E.
Hoffer, Cumberland County
Orphans' Court Division. The
following Merrill Lynch CMA
Account No. 823-16762 was the
only asset transferred to the
Trust.
0.00
DATE OF DEATH
VALUE OF ASSET
2
122 Shares
122 shares of Verizon
Communications common stock;
date of death high $51.10 per
share; date of death low
$48.88 per share; date of
death AVG $49.99 per share.
6,098.78
3
3,040.391 Shares
3,040.3910 shares of Templeton
World Fund - Class A; date of
death high $17.12 per share;
date of death low $16.14 per
share; date of death AVG
$16.63 per share.
50,561. 70
4
3,158 Shares
3,158 shares of SBC
Communications, Inc., common
stock; date of death high
$50.30 per share; date of
death low $49.20 per share;
date of death AVG $49.75 per
share.
157,110.50
Total from continuation pages
%OF
DECD'S
INTEREST
100.000
100.000
100.000
100.000
EXCLUSION
(IF APPLICABLE)
0.00
0.00
0.00
0.00
9 PA 15101
NTF 10877
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
Copyright 1999 Greatland/Nelco LP - Forms Software Only
TAXABLE VALUE
0.00
6,098.78
50,561. 70
157,110.50
99,382.77
313,153.75
Schedule G (Page 2)
Estate of: Helen L. Smith
Item
No.
Description
5
300 Shares
300 shares of Equity Income
Fund First Exchange common
stock; date of death high
$142.30 per share; date of
death low $138.00 per share;
date of death AVG $140.15 per
share.
6
400 Shares
400 shares of Energy East
Corp., common stock; date of
death high $19.00 per share;
date of death low $18.40 per
share; date of death AVG
$18.70 per share.
7
600 Shares
600 shares of PPL Corporation;
date of death high $46.15 per
share; date of death low
$44.99 per share; date of
death AVG $45.57 per share.
8
668 Shares
668 shares of American New
Economy mutual fund; date of
death high $23.18 per share;
date of death low $21.85 per
share; date of death AVG
$25.515 per share.
9
850 Shares
850 shares of Mercury Asset
Management, Inc. Global
Holdings mutual fund; date of
death high $9.03 per share;
date of death low $8.56 per
share; date of death AVG
$8.795 per share.
Total (Carry forward to main schedule)
DOD Value
of Asset
42,045.00
7,480.00
27,342.00
15,040.02
7,475.75
% Int.
100.000
100.000
100.000
100.000
100.000
Exclusion
0.00
0.00
0.00
0.00
0.00
Taxable
Value
42,045.00
7,480.00
27,342.00
15,040.02
7,475.75
99,382.77
REV-1511EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen L. Smith
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 2001 - 1026
Debts of decedent must be reported on Schedule I.
ITEM
NO.
A.
1.
1
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Boyer Funeral Home, LTD.
Funeral Goods and Services
9,808.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN No. of Personal Representative(s)
Street Address
City State
Zip
Year(s) Commission Paid:
2.
3.
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
14,500.00
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Karen L. Boyer, Trustee
14,500.00
2
McKonly & Asbury, LLP
Certified Public Accountants
Fee for preparation of
Decedent's 2000 Income Tax
Returns
435.00
Total from continuation pages
44.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
39,287.00
9 PA15111 NTF10878
Copyright 1999 Greatland/Nelco LP - Forms Software Only
Schedule H part 2 (Page 2)
Estate of: Helen L. Smith
Item
No.
Description
Amount
3
Register of wills
Filing Fee for Petition to
Orphans' Court for Appointment
of Successor Trustee
4
Register of wills
Filing Fee for PA Inheritance
Tax Return
Total (Carry forward to main schedule)
19.00
25.00
44.00
REV-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helen L. Smith
Include unreimbursed medical expenses.
ITEM
NO.
1.
1 Internal Revenue Service
Decedent's 2000 income tax
liability
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 2001 - 1026
DESCRIPTION
AMOUNT
1,994.00
2 Internists of PA
Medical Bill
55.96
3 Merrill Lynch CMA Account
Account No. 823-16762
Debit Balance on Account at
Date of Death
1,186.00
4 Messiah village
Final Nursing Home Bill for
February 2001
3,750.00
5 PA Department of Revenue
Decedent's 2000 income tax
liability
582.00
6 Pharmerica
Pharmacy Bill
961. 52
7 Pinnacle Health
Hospital Bill
82.00
9 PA 15121
NTF 10874
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
8,611.48
Copyright 1999 Greatland/Nelco LP - Forms Software Only
REV-1513 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Helen L. Smith
No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 1. Isabelle B. Bole
c/o Lorraine Gestrich
863 Venus Drive
Green Bay, WI 54311
2 Karen L. Boyer
1459 Mt. Gretna Road
Elizabethtown, PA 17022
3 Barry Long
325 Courtland Avenue
Harleysville, PA 19438
4 Bruce Long
1095 Copenhaffer Road
York, PA 17404
FILE NUMBER
21
2001 - 1026
AMOUNT OR
SHARE OF ESTATE
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Cousin
Niece
Nephew
Nephew
26,525.53
30,262.32
26,525.53
26,525.53
Total from continuation pages 159,153.18
ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
9 PA 15131
NTF 10880
TOTAL OF PART II u 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)
Copyright 1999 Greatland/Nelco LP . Forms Software Only
0.00
Schedule J part 1 (page 2)
Estate of: Helen L. Smith
Item
No. Description
Relation
Amount
5 Dennis Long
19 Beechwood Avenue
Frazer, PA 19355 Nephew 26,525.53
6 Gary Long
14451 Columbia Court
Adelanto, CA 92031 Nephew 26,525.53
7 Peter Long
4450 Horshoe Pike
Honeybrook, PA 19344 Nephew 26,525.53
8 Robert Long
1170 Rhoda Boulevard
Mechanicsburg, PA 17055 Nephew 26,525.53
9 Sally Long
211 Myers Lane
New Cumberland, PA 17070 Niece 26,525.53
10 Walter Long
327 Lyster Road
Oreland, PA 19075 Nephew 26,525.53
Total (Carry forward to main schedule)
0.00
DEATH CERTIFICATE
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
. ':OMAU~WI'~ {1 or f:N"";'.l't..'JI, .
DEi>AIHMENfr ":!lL t- VI'i,L ,.,:::1 o 'DO;
LO('~\,~ I F;,\.STflAFl :; ::E\~"IF!CAlION OF DEATH
CERT. NO. T 4 8 0 6 3 41
Ii ,r; I.'I/f' ''',>....
,:,0": \,\ H DF ftA;'c.,
,;." '!-J.....':. '. "1' ,;2,
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$~? ~.'f"~.'.\
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\~':":'" < _ ,.~t~ ,,'. ': - h'li
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~~, <~/
ie. 4tl{.~'~'
"", " (J. c, ~i\ '- ,,' '
":..,.~,,..:r;,~ ~n \;\"f~I_I'
'., !.:::' '! I!..~ "!!.! !! '
2-27-01
---- Date of Issue -;;t-l~is Cerlifu;atio~--
Name of Decedent __.____. HELEN, -- -.---.-
>-",1
_ _.L.QNG__n_.___~.
SMITH.
11(loir
Leist
Sex ~___F~~____ Social Security No. _____~_:J,;;.?_=~Q.-3_~~_4_._..____.__ Date of Death __~~-:-26-01
Date of Birth...5..-:J..A-13 _____ Birthplace .___________._.._l'ENNSYLVANIA
Place of Death . MESS_JAIL VILLA.Q~________C~E~Dn.._~.MT~.ALLEN..- TW~___.__._Pen!:1~lvania
1,1.;,1;1',' ~~il':"k ":(' ,"'/ ell', BO'Ci'.iqt: l'\f\.'l~hif)
Race_.__ WHJT~______. Occupation ~__._...1,.lBRl\RI~- ~_'______ Armed Forces? (Yes or No) -..~-~--
Decedent's
Mantal Statusn___WW.QjYEIL- Mailing Address _:J,_O Q.MT .__ ALLEN DR. MECHANICSBURG PA
'j':I"'_" :',:;f''': Ci:,; ,p'-:r SLl!.c
Informant__J<AREIi..~9YE..R--_~._--~----- Funeral Director ____._ KRISTINE M. BOSTIAN
Name and Address of
Funeral EstalJlishment _...BOYER FUNERAL HOME 144. E.. HIG_H STREET ELIZABETHTOWN, PA
Interval Between
Onset and Death
Part I:
Immediate Cause
(a)___________ SEPSIS
(b) _____.__ PNEYMONIA
..__.L___~_._.___.._~_.
,
_...._.~.~_.__._~--_._._.__._-----------"--~_._-_._----_._-~_._+--_._--~-------_._~----
(c).
-_..~----_._.._~-~-~--_._--~~-_.._- --.,-..-----. .....,._-~-----_._-------,-----_._--_._-----_._--_.----'--_.._---------------~_.._'~
Part II.
(d)____ _______
Other Significant Conditions
NIDDM, PVD, SDAT, DYSPHAGIA
_______.______._.__._______________~_~_~___~_'___~__.______._.__.__.__________~~.___..___L_._~________~._.~
I
.---,---.---.------~..-.. ...-..-"---.---~.~-~.-.--.___r.-~--.--'----.-~-~-.-
Manner of Death
Describe how injury occurred:
Natural
Accident
}{-!
Homicide
Pending Investigation
Could not be Determined
o
-,_..._.._-----------_.__._--~---"._-------_.._-~-----~-
SUicide
Name and Title of Certfier
JAMES ALAN TYNDALL, _ M ._p~____________.__________~_._
(M.D., D.O., Coroner, ME)
Address
____. ____ _ _. ____ ___l!LB LO.wTHE~__ L~()Yl'!~___
-~------- --~---- - - ------~--- -~-~
This IS to certify that the information here given is correctly copied from an original CE~rtificate
of death duly filed with me as Local Registrar. The original certificate will be for'warded to the
State Vital Recocds Office for permanent filin~~X~~___. 3~:.~~,8_.
2-27-01- 2.5. I~CIRc.LE_._.__ ELIZABETHTOWN
-:-;:-;-~-~-'";"':,:;L:7~n::~~--------- A_-,-;' Tr"A''-c>-',,;-,
LAST WILL AND TESTAMENT
OF
HELEN L. SMITH
,
,
, .
LAST WILL AND TESTAMENT OF
HELEN L SMITH
I, Helen L. smith, of 119 North Paint Boulevard,
Shippenville, pennsylvania 16254, make and declare this my last
will, revoking any prior will or codicil made by me.
SECTION I
I direct .that the expenses of my last illness and of my
funeral be paid by my executor.
SECTION II
I give all property that I possess at my death, of any
kind and wherever located, to the Trustee of my trust dated
December 27, 1991, as amended at any time prior to my death, or if
said declaration of trust is no longer in effect, to hold in trust
on the terms and conditions specified in said agreement on the date
of this will or of its last codicil, with the same force and effect
as if they were set forth in this will verbatim.
SECTION III
I appoint the Trustee of my Trust dated December 27,
1991 as the executor of my will. In the event that he or she fails
to qualify by reason of death, resignation, incapacity or
otherwise, I then appoint the successor Trustee of the said Trust
dated December 27, 1991 to serve as the executor of my will
instead.
No executor or duly appointed administrator of this will
shall be required to give bond or other security for the faithful
performance of his or her duties to administer my estate according
to 13>;.-/.
My executor or administrator shall have all rights and
powers invested by law, and in addition, shall have all rights and
powers provided to the Trustee in my Trust dated December 27,
1991.
IN WITNESS WHEREOF, I affix my signature this December
27, 1991.
~7~ r;7) ~~ I-IJ
Helen L. Smith
( SEAL)
Signed, sealed, published and declared as the last will
and testament of Helen L. Smith, in our presence, and we
accordingly affix our signatures as witnesses to this will this
December 27, 1991. ~ .' J ;,1
~Cf--zv./1~ !1a{ ~... /~()s-l (signature)
(address)
_4--1J.n)J (' C J"J (signature)
"13 f' J2f'~CCd j}~/~~ J IJ~/laj A /J'13 (address)
(signature)
(address)
ACKNOWLEDGEMENT AND AFFIDAVIT OF WITNESSES
COMMONWEALTH OF PENNSYLVANIA)
) ss:
COUNTY OF CLARION )
We, the undersigned witnesses and Helen L. smith, whose
names are attached to the foregoing instrument, being first duly
sworn according to law, do depose and say that Helen L. smith
signed and executed the said instrument as Helen L. Smith's last
will willingly and voluntarily, that each of the witnesses were
present when Helen L. Smith signed the said instrument, that each
of the witnesses then immediately and in the presence of Helen L.
Smith affixed his or her signature, and that Helen L. smith was at
that time eighteen years of age or older, of sound mind, and under
no undue influence or constraint.
(Testator)
(Witness)
(Witness)
(Witness)
SUBSCRIBED, sworn to and acknowledged before me by Helen
L. smith, and by the witnesses whose signatures appear above on
December 27, 1991.
... '1/'1.
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~~%li? ~ f~
Notari;:>j Seal
Marv K. 'N~~CY. Notary Public
Salem nvp.. \II<GSl111(ltek'lnd !?OOnty
My Commission Exr;ires Jan. .) '. '994
M'lm':!er. Fllnn:;yiVOlT1lG /I,;;.;:;CQDUon 01 NotarieS
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27, 1991
DECLARATION OF TRUST
made as of December 27, 1991
by
HELEN L SMITH
GRANTOR
and
HELEN L SMITH
TRUSTEE
IN RE:
HELEN L. SMITH
DECLARATION OF TRUST
dated December 27,1991.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
.
; FILE NO. ,;) -01 - JO;}t:,
ORDER
CG(Q)[P'V
'tL
AND NOW, this /3 day of
'n{)f)
, 2001, upon consideration of
the foregoing Petition for Appointment of Successor Trustee, and pursuant to 20 Pa.C.S. ~7101,
it is hereby ordered that the relief requested in the Petition is granted, and that the Petitioner,
Karen L. Boyer, is authorized to sezve as Successor Trustee, without the necessity of posting
bond.
BY THE COURT,
IS!
~n~ ~. tl1Jh
,0>>.
,J.
A TRUE COpy FROM RECORD
In Testimony wherot, I hereunto set my hand
and the seal of said Court at Carlisle. P A
This,-.,-J day of --YIIil ., 20Ql.
ARTICLE
FIRST
SECOND
THIRD
FOURTH
FIFTH
SIXTH
SEVENTH
EIGHTH
NINTH
TENTH
ELEVENTH
TWELFTH
THIRTEENTH
FOURTEENTH
FIFTEENTH
SIXTEENTH
TABLE OF CONTENTS
TITLE
Directions Of Grantor
Disability Of Grantor
Successor Beneficiaries
Minors Or Incompetents
Payment Of Debts
Life Insurance and Death Benefits
Right To Revoke Or Amend
Termination Of Trusts
Powers Of Trustee
Third Parties
Appointment Of Trustee
Simultaneous Death
Trustee Decisions Conclusive
Rights Not Assignable
Construction
Binding Effect
DECLARATION OF TRUST
DECLARATION OF TRUST, made as of December 27, 1991,
between Helen L. smith, having an address at 119 North Paint
Boulevard, Shippenville, Pennsylvania 16254, as grantor (herein-
after referred to as the "Grantor"), Helen L. smith, having an
address as aforesaid, as trustee (hereinafter referred to as the
"Trustee").
WIT N B SSE T H:
WHEREAS, the Grantor desires to create a revocable trust
of the property described in Exhibit A hereto, together with such
monies, securities and other assets as the Trustee hereafter at any
time may hold or acquire hereunder (said property, monies, secu-
rities and other assets, together with any additions thereto re-
ceived pursuant to the Grantor's Last will and Testament or as the
proceeds of insurance on the Grantor's life, or as death benefits
or otherwise, being hereinafter referred to as the "trust fund"),
for the purposes and upon the terms and conditions hereinafter set
forth.
NOW, THEREFORE, in consideration of the covenants herein
contained, and other valuable consideration, the receipt and suffi-
ciency of which hereby is acknowledged, the Grantor hereby trans-
fers, conveys, assigns and delivers to the Trustee as and for the
trust fund the property more particularly described in Exhibit A
hereto, to hold the same, and any other property which the Trustee
hereafter may acquire, IN TRUST, for the purposes and upon the
terms and conditions hereinafter set forth:
ARTICLE FIRST
Directions Of Grantor
The Trustee shall hold, manage, invest and reinvest the
trust fund, shall collect the income therefrom, and shall pay the
net income and any part or all of the principal thereof to whomever
the Grantor from time to time may direct in writing. Any income
not so paid or applied shall be accumulated and added to the prin-
cipal of this trust at least quarter-annually and thereafter shall
be held, administered and disposed of as part thereof.
1
ARTICLE SECOND
Disabilitv Of Grantor
If at any time the Grantor, in the judgment of the suc-
cessor Trustee, shall be under any legal disability or shall be
unable to manage properly her affairs by reason of illness or
mental or physical disability, the successor Trustee may payor ap-
ply so much or all of the net income and the principal of the trust
fund as the successor Trustee deems necessary or advisable for the
health, education, maintenance or support of the Grantor, or for
the paYment of insurance premiums on life of the Grantor. Any in-
come not so paid or applied shall be accumulated and added to the
principal of this trust at least quarter-annually and thereafter
shall be held, administered and disposed of as part thereof. In
making any paYment hereunder, the successor Trustee may consider,
but shall not be required to consider, the income and other resour-
ces of the Grantor. No such payment shall be charged upon a subse-
quent division of the trust fund against the principal of any share
which may be set apart for any beneficiary hereunder.
ARTICLE THIRD
Successor Beneficiaries
Upon the death of the Grantor, the Trustee shall pay and
distribute the trust fund at that time remaining to The Grantor's
cousin, Isabelle B. Bole, niece, Karen Boyer, niece, Sa~ly Long,
nephew, Bruce Long, nephew, Robert Long, nephew, Gary.Long, nephew,
Barry Long, nephew, Dennis,Long, nephew, Peter Long, nephew, Walter
Long, if then living, in equal shares, per stirpes, discharged of
trust.
ARTICLE FOURTH
Distributions To Minors Or Incompetents
In any case in which the Trustee is authorized or dir-
ected by any provision of this Agreement to payor distribute in-
come or principal to any person who shall be a minor or incompe-
tent, the Trustee, in its sole discretion and without authorization
of any court, may payor distribute the whole or any part of such
income or principal to such minor or incompetent personally, or may
apply the whole or any part thereof directly to the health, educa-
tion, maintenance or support of such minor or incompetent, or may
payor distribute the whole or any part thereof to the guardian,
committee, conservator or other legal representative, wherever ap-
pointed, of such minor or incompetent or to the person with whom
such minor or incompetent may from time to time reside, or in the
2
case of a minor, may payor distribute the whole or any part there-
of to a custodian for such minor under any gifts to minors or
transfers to minors act. The receipt of the person to whom any
such payment or distribution is so made shall be a sufficient dis-
charge therefor, even though the Trustee may be such person.
The Trustee, in its sole discretion, may defer payment or
distribution of any or all inco~ or principal to which a minor may
be entitled until such minor Shall attain the age of twenty-one
(21) years, or to make such payment or distribution at any time and
from time to time, during the minority of such minor, holding the
whole or the undistributed portion thereof as a separate fund
vested in such minor but subject to the power in trust hereby given
to the Trustee to administer and invest such fund and to use the
income or principal thereof for the benefit of such minor as if
such fund were held in trust hereunder. The Trustee shall pay and
distribute any balance of such fund to such minor when such minor
shall attain the age of twenty-one (21) years. Except as is here-
inabove provided, if such minor shall die before attaining the age
of twenty-one (21) years, the Trustee shall pay and distribute such
balance to the executors, administrators or legal representatives
of the estate of such minor, or if there shall be no such legal re-
presentative, to such persons as would have inherited the same and
in the same proportions as they would have taken if such minor had
died intestate, unmarried, the absolute' owner thereof and a
resident of the State in which such minor shall die domiciled.
The word "minor", wherever used in this Article FOURTH,
shall mean any person who has not attained the age of twenty-one
(21) years.
ARTICLB FIFTH
Payment Of Debts
Upon the death of the Grantor, the Trustee may pay from
the principal of the trust fund the amount of any estate or death
taxes, by whatever name called, ~osed under the laws of any jur-
isdiction by reason of the Grantor's death, whether in respect of
property passing under this Agreement or the Grantor's Last Will
and Testament or otherwise, and the amount of all of the debts
which the Grantor f s estate must pay, the expenses of her last
illnesses and funeral, and the expenses of administering her
estate. The Trustee may rely upon the written certification of the
executors, administrators or legal representatives of the Grantor IS
estate as to the amount of any such tax, debt or expense, without
any duty to inquire as to the correctness thereof, and, in its dis-
cretion, may make payment thereof either to said executors, admin-
istrators or legal representatives or to the taxing authority or
person to whom such amount is owed.
3
ARTICLE SIXTH
Life Insurance and Death Benefits
with respect to any insurance policies or employee death
benefits payable to the Trustee, the Trustee, upon being advised
that any sum is so payable by reason of the death of the Grantor,
shall endeavor to collect the same, and may bring a suit or action
therefor, or may compromise, adjust, settle or submit to arbitra-
tion any claims therefor. The Trustee shall be entitled to reim-
bursement from the trust fund for all expenses incurred by the
Trustee in collecting or atteJIpting to collect any such sum by
sui t, action or otherwise. The Trustee, however, shall be under no
duty to bring a suit or action unless the expenses of the Trustee,
including attorneys. fees, shall have been advanced or guaranteed
to the satisfaction of the Trustee. The Trustee may, out of the
trust fund, repay any advances aade by the Trustee or reimburse the
Trustee for any expenses incurred in collecting or attempting to
collect any sum as aforesaid.
The Trustee in no case shall be under any duty or Obliga-
tion to make any claim against the Grantor's estate, or take any
action against the executors, administrators or legal representa-
tives of the Grantor's estate, for reimbursement for any reduction
of the sums payable upon the death of the Grantor by reason of un-
paid premiums or for any other cause, including any loans and in-
terest thereto secured by any insurance policies.
During the life of the Grantor, the Trustee may, in its
discretion, apply the net income or principal of the trust fund to
the payment of premiums on any life insurance policy of which the
Trustee or any trust hereunder is beneficiary. If the net income
and principal is insufficient to pay such premiums, the Trustee may
notify the Grantor and the beneficiaries of the trust of such
insufficiency and give them the opportunity to furnish the neces-
sary funds. If neither the Grantor nor any of the beneficiaries
furnishes the funds necessary to pay the premiums, the Trustee may,
but shall not be obligated to, obtain the funds required to pay
such premiums by selling a portion of the principal of the trust
fund, by borrowing on the security of such principal, by borrowing
against the cash surrender value of the policy or by surrendering
some policies and using the proceeds to pay the premiums on other
policies. The Trustee also is authorized to convert such policies
to paid-up or extended term insurance if the trust fund does not
have the necessary funds to pay the premiums. If no funds are
available for the payment of the premiums of any insurance policy,
the Trustee may assign ownership of such policy to any or all of
the then living income beneficiaries of the trust.
The Grantor retains, during her life, all of the rights,
options and privileges reserved to or conferred upon her by the
terms of said insurance policies or employee death benefit plans,
4
eluding without limitation the right to borrow upon and pledge
.le same, to change the beneficiary thereof, to convert the same
~nto other forms of insurance, to collect the cash value thereof,
to permit or direct the same to lapse, and to receive dividends and
other lifetime benefits of any kind payable to her by the terms
thereof. The Grantor may exercise the foregoing rights without the
consent of the Trustee or any beneficiary hereunder.
ARTICLE SEVENTH
Riqht To Revoke Or Amend
The Grantor reserves the right, at any time and from time
to time, and without the consent of any person or notice to any
person other than the Trustee, to amend or revoke in whole or in
part this Agreement or any trust created hereunder, or to change
the terms or beneficiaries thereof, by delivering to the Trustee
written notice of such revocation or change signed by the Grantor.
Any such change, however, shall not increase the obligations, or
reduce the commissions, of the Trustee without the consent of the
Trustee. Upon any such revocation, the Trustee shall deliver to
the Grantor all property in the possession or control of the Trust-
ee with respect to any trust which has been revoked and shall exe-
cute and deliver any instruments necessary to release any interest
of the Trustee in such property. The sale or other disposition by
the Grantor of the whole or any part of the trust fund held here-
under shall constitute as to such whole or part a revocation of
this Agreement and the trust or trusts affected thereby.
The Grantor reserves the power and right during the life
of the Grantor to collect any rent, interest or other income which
may accrue from the trust fund and, in her sole discretion, to ac-
cumulate such income as a trust asset or to pay such income to the
Grantor individually and not in any fiduciary capacity. The Grant-
or further reserves the power and right during life of the Grantor
to mortgage or pledge all or any part of the trust fund as colla-
teral for any loan.
ARTICLE EIGHTH
Termination of Trusts
Notwithstanding anything to the contrary contained here-
in, if the principal of any trust created under this Agreement is
less than $1,000.00 at any time, the Trustee, in its sole discre-
tion, may pay and distribute the entire principal of such trust and
all accrued and undistributed income to the beneficiaries of such
trust, discharged of trust, and such trust thereupon shall termi-
nate.
5
ARTICLE NINTH
Powers Of Trustee
In the administration of any property, real or personal,
at any time forming a part of the trust fund, including accumulated
income, and in the administration of any trust created hereunder,
the Trustee, in addition to and without limitation of the powers
provided by law, shall have the following powers to be exercised in
the absolute discretion of the Trustee, except as otherwise ex-
pressly provided in this Agreement:
(a) To retain such property for any period, whether or
not the same is of the character permissible for invest-
ments by fiduciaries under any applicable law, and with-
out regard to the effect any such retention may have upon
the diversity of investments.
(b) To sell, transfer, exchange, convert or otherwise
dispose of, or grant options with respect to, such prop-
erty, at public. or private sale, with or without
security, in such manner, at such times, for such prices,
and upon such terms and conditions as the Trustee may
deem advisable.
(c) To invest and reinvest in common or preferred
stocks, securities, investment trusts, bonds and other
property, real or personal, foreign or domestic,
including any undivided interest in anyone or more
common trust funds, whether or not such investments be of
the character permissible for investments by fiduciaries
under any applicable law, and without regard to the ef-
fect any such investment may have upon the diversity of
investments.
(d) To render liquid the trust fund or any trust created
hereunder in whole or in part, at any time and from time
to time, and to hold cash or readily marketable securi-
ties of little or no yield for such period as the Trustee
may deem advisable.
(e) To lease any such property beyond the period fixed
by statute for leases made by fiduciaries and beyond the
duration of any trust created hereunder.
(f) To join or become a party to, or to oppose, any re-
organization, readjustment, recapitalization, foreclo-
sure, merger, voting trust, dissolution, consol ida tion or
exchange, and to deposit any securities with any
committee, depository or trustee, and to pay any fees,
expenses and assessments incurred in connection there-
with, and to charge the same to principal, and to exer-
6
,
(1) To make distribution of the trust fund or of the
principal of any trust created hereunder in kind, and to
cause any distribution to be composed of cash, property
or undivided fractional shares in property different in
kind from any other distribution, without regard to the
income tax basis of the property distributed to Ciny bene-
ficiary of any trust.
(m) To allocate receipts and disbursements of the trust
fund between income and principal as the Trustee in its
discretion may determine.
(n) To execute and deliver any and all instruments or
writings which it may deem advisable to carry.out any of
the foregoing powers. No party to any such instruments
or writings shall be obligated to inquire into its
validity.
(0) To exercise "all such rights and powers and to do all
such acts and enter into all such agreements as persons
owning similar property in their own right might lawfully
exercise, door enter into.
No person who deals with any Trustee hereunder shall be
bound to see to the application of any asset delivered to such
Trustee or to inquire into the authority for, or propriety of, any
action taken or not taken by such Trustee.
Notwithstanding anything to the contrary contained here-
in, during such time as any beneficiary of any trust created here-
under (other than the Grantor) may be acting as a Trustee here-
under, such person shall be disqualified from exercising any power
to make any discretionary distributions of income or principal to
himself or to make discretionary allocations in his own favor of
receipts or disbursements as ?etween income and principal.
No Trustee shall be liable for acts or omissions in ad-
ministering the trust fund or any trust created by this Agreement,
except for that Trustee's own actual fraud, gross negligence or
willful misconduct. If any Trustee becomes liable as Trustee to
any pther person who is not a beneficiary in connection with any
matter not within the Trustee's control and not due to the Trust-
ee's actual fraud, gross negligence or willful misconduct, such
Trustee shall be fully indemnified and held harmless by the trust
fund and any trust created hereunder giving rise to such liability,
as the case may be, against and in respect of any damages that such
Trustee may sustain, including without limitation attorneys' fees.
No successor Trustee shall incur any liability as a result of
qualifying as a Trustee hereunder before receiving an account of
the previous administration of the trust fund and the trusts creat-
ed hereunder.
8
cise conversion, subscription or other rights, and to
make any necessary paYments in connection therewith, or
to sell any such privileges.
(g) To vote in person at meetings of stock or security
holders and adjournments thereof, and to vote by general
or limited proxy with respect to any stock or securities.
(h) To hold stock and securities in the name of a
nominee without indicating the trust character of such
holding, or unregistered or in such form as will pass by
delivery, or to use a central depository and to permit
registration in the name of a nominee.
(i) To pay, compromise, compound, adjust, submit to
arbitration, sell or release any claims or demands of the
trust fund or any trust created hereunder against others
or of others against the same as the Trustee may deem
advisable, including the acceptance of deeds of real
property in satisfaction of notes, bonds and mortgages,
and to make any payments in connection therewith which
the Trustee may deem advisable.
(j) To borrow money for any purpose from any source, in-
cluding any trustee at any time acting hereunder, and to
secure the repaYment of any and all amounts so borrowed
by mortgage or pledge of any property.
(k) To possess, manage, insure against loss by fire or
other casualties, develop, subdivide, control, partition,
mortgage, lease or otherwise deal with any and all real
property: to satisfy and discharge or extend the term of
any mortgage thereof; to execute the necessary instru-
ments and covenants to effectuate the foregoing powers,
including the giving or granting of options in connection
therewith: to make repairs, replacements and improve-
ments, structural or otherwise, or abandon the same if
deemed to be worthless or not of sufficient value to
warrant keeping or protecting; to abstain from the pay-
ment of real estate taxes, assessments, water charges and
sewer rents, repairs, maintenance and upkeep of the same;
to permit to be lost by tax sale or other proceeding or
to convey the same for a noainal consideration or without
consideration: to set up appropriate reserves out of in-
come for repairs, modernization and upkeep of buildings,
including reserves for depreciation and obsolescence, and
to add such reserves to principal and, if the income from
the property itself should nat suffice for such purposes,
to advance out of other income any sums needed therefor,
and advance any income of tie trust for the amortization
of any mortgage on property held in the trust.
7
(1) To make distribution of the trust fund or of the
principal of any trust created hereunder in kind, and to
cause any distribution to be composed of cash, property
or undivided fractional shares in property different in
kind from any other distribution, without regard to the
income tax basis of the property distributed to any bene-
ficiary of any trust.
(m) To allocate receipts and disbursements of the trust
fund between income and principal as the Trustee in its
discretion may determine.
(n) To execute and deliver any and all instruments or
writings which it may deem advisable to carry 'out any of
the foregoing powers. No party to any such instruments
or writings shall be obligated to inquire into its
validity.
(0) To exercise all such rights and powers anq to do all
such acts and enter into all such agreements as persons
owning similar property in their own right might lawfully
exercise, do or enter into.
No person who deals with any Trustee hereunder shall be
bound to see to the application of any asset delivered to such
Trustee or to inquire into the authority for, or propriety of, any
action taken or not taken by such Trustee.
Notwithstanding anything to the contrary contained here-
in, during such time as any beneficiary of any trust created here-
under (other than the Grantor) may be acting as a Trustee here-
under, such person shall be disqualified from exercising any power
to make any discretionary distributions of income or principal to
himself or to make discretionary allocations in his own favor of
receipts or disbursements as between income and principal.
No Trustee shall be liable for acts or omissions in ad-
ministering the trust fund or any trust created by this Agreement,
except for that Trustee's own actual fraud, gross negligence or
willful misconduct. If any Trustee becomes liable as Trustee to
any other person who is not a beneficiary in connection with any
matter not within the Trustee's control and not due to the Trust-
ee's actual fraud, gross negligence or willful misconduct, such
Trustee shall be fully indemnified and held harmless by the trust
fund and any trust created hereunder giving rise to such liability,
as the case may be, against and in respect of any damages that such
Trustee may sustain, including without limitation attorneys' fees.
No successor Trustee shall incur any liability as a result of
qualifying as a Trustee hereunder before receiving an account of
the previous administration of the trust fund and the trusts creat-
ed hereunder.
8
The Trustee is authorized, but not required, to accept
ny property transferred to the Trustee by any person during such
?erson I s lifetime or by such person's Last Will and Testament. Any
property so transferred by any person shall become a part of such
trust or trusts created by this Agreement as such person shall
direct and may be commingled with the other property in the trust
or trusts to which such property has been added and shall be held,
administered and disposed of as a part of such trust or trusts.
The Trustee, at any time and from time to time, may
render to the Grantor an account of its acts and transactions as
Trustee with respect to the income and principal of any trust
created hereunder, from the date of creation of such trust or from
the date of the last previous account of the Trustee. Such account
shall be rendered in any form acceptable to the Grantor and the
Trustee. The Grantor shall have full power and authority on behalf
of all persons interested in such trust, whether such interest
relates to income or principal, to settle and adjust such account.
Such settlement shall be final and conclusive upon all persons so
interested in such trust and the Trustee shall not be required to
obtain judicial approval of the account or accounts so settled.
Upon such settlement, the Trustee shall be fully and completely
discharged and released from all further liability, responsibility
and accountability for or with respect to their acts and trans-
actions as set forth in the account or accounts so settled.
Nothing herein, however, shall be construed as a limitation upon
the right of the Trustee to seek judicial settlement of their ac-
count or accounts whether or not such account or accounts are so
settled.
ARTICLE TENTH
Third Parties Not Responsible For Administration
This trust is created with the express understanding that
each bank at which an account is maintained shall have no responsi-
bility or liability whatsoever to see to the proper administration
of this trust. Upon the transfer of the right, title and interest
in and to any account by any Trustee hereunder, the bank shall
conclusively treat the transferee as the sole owner of such
account. Until the bank shall receive from some person interested
in this trust written notice of any death or other event upon wh~ch
a right to receive income or principal may depend, the bank shall
incur no liability for payment made in good faith to persons whose
interests shall have been affected by such event. The bank shall
be protected in acting upon any notice or other instrument or docu-
ment believed by it to be genuine and to have been signed or pre-
sented by the proper party or parties.
This trust is created with the express understanding that
each issuer, transfer agent or custodian of any securities held
9
,
,
hereunder shall have no responsibility or liability to see to the
proper administration of this trust. Upon the transfer of the
right, title and interest in and to such account by any trustee
hereunder, said issuer, transfer agent or custodian shall con-
clusively treat the transferee as the sole owner of such
securities. Until the issuer, transfer agent or custodian shall
receive from some person interested in this trust written notice of
any death or other event upon which a right to receive income or
principal may depend, the issuer, transfer agent or custodian shall
incur no liability for payment made in good faith to persons whose
interests shall have been affected by such event. The issuer,
transfer agent or custodian shall be protected in acting upon any
notice or other instrument or document believed by it to be genuine
and to have been signed or presented by the proper party or
parties.
ARTICLE ELEVENTH
ADoointment O~ Trustee
The Grantor appoints herself as Trustee hereunder. The
Grantor hereby appoints Isabelle B. Bole, having an address at RD
3, Box 261, Valencia, Pennsylvania 16059-9123, as successor
Trustee hereunder, to serve in the event of the Grantor's physical
or mental incapacity. In the event that Isabelle B. Bole shall be
unwilling or unable to serve in this capacity, then the Grantor
appoints Karen Boyer, having an address at 1459 Mount Gretna Road,
Elizabeth Town, Pennsylvania 16022, to serve in her stead in the
event of the Grantor's physical or mental incapacity. The Grantor
appoints Apollo Trust Company, having an address at Box 247, ~
Apollo, Pennsylvania 15613-0247, to serve as Successor Trustee
upon the death of the Grantor.
The term "Trustee" wherever used herein shall mean the
trustee in office from time to time. Any such trustee shall have
the same rights, powers, duties, authority and privileges, whether
or not discretionary, as if originally appointed hereunder.
No bond or other security shall be required of any
Trustee acting hereunder for the faithful performance of the duties
of Trustee, notwithstanding any law of any State or jurisdiction to
the contrary.
ARTICLE TWELFTH
simultaneous Death
If any beneficiary under this Agreement shall die
simultaneously with any other person upon whose death such benefi-
ciary shall become entitled to receive either income or principal
10
under this Agreement, or in such circumstances as to render it dif-
ficult or impracticable to determine who predeceased the other;
then for purposes of this Agreement such beneficiary shall be deem-
ed to have predeceased such other person. The death of a benefi-
ciary during the lifetime of the Grantor, or in a common accident
or disaster with the Grantor, shall revoke the designation of such
beneficiary as a beneficiary hereunder. The provisions of this
Agreement shall be construed as aforesaid, notwithstanding the pro-
visions of any applicable law establishing a different presumption
of order of death or providing for survivorship for a fixed period
as a condition of inheritance of property.
ARTICLE THIRTEENTH
Decisions Of Trus~ee Are conclusive
The determination of the Trustee in respect of the amount
of any discretionary payment of income or principal from any trust
established hereunder, and of the advisability thereof, shall be
final and conclusive on. all persons, whether or not then in being,
having or claiming any interest in such trust, and upon making any
such payment, the Trustee shall be released fully from all further
liability or accountability therefor.
The right of any beneficiary to any payment of income or
principal shall in every case be subject to any charge or deduction
which the Trustee may make against the same under the authority
granted to the Trustee by any law or by this Agreement.
ARTICLE fOURTEENTH
Riqhts Of Beneficiaries Are Not Assiqnable
No disposition, charge or encumbrance on the income or
principal of any trust established hereunder, or any part thereof,
by any beneficiary thereof by way of anticipation shall be valid or
in any way binding upon the Trustee. No beneficiary shall have the
right to assign, transfer, encumber or otherwise dispose of such
income or principal or any part thereof until the same shall be
paid to such beneficiary by the Trustee. No income or principal or
any part thereof shall in any manner be liable to any claim of any
creditor of any beneficiary.
ARTICLE FIFTEENTH
Construction
This Agreement and all trusts created hereunder shall be
construed and enforced in accordance with the laws of the Common-
11
.ealth of pennsylvania, and the validity and effect of this Agree-
ment shall be determined in accordance with the laws of the Common-
wealth of Pennsylvania.
Wherever use in this Agreement and the context so
requires, the masculine shall include the feminine and the singular
shall include the plural, and vice versa.
The captions in this Agreement are for convenience of
reference, and they shall not be considered when construing this
Agreement.
If under any of the provisions of this Agreement any
portion of the trust fund would be held in trust for longer than a
date twenty-one years after the death of the last survivor of the
Grantor and the beneficiaries hereunder, in being when this Agree-
ment becomes irrevocable; then upon such date the trust of such
portion shall terminate and the principal, together with any accru-
ed and unpaid income thereon, shall be paid and distributed to the
person or persons then living who would have been entitled to re-
ceive the income therefrom had the trust continued, in the propor-
tion in which they would have been so entitled.
ARTICLE SIXTEENTH
Bindinc:r Effect
This Agreement shall extend to and be binding upon the
heirs, executors, administrators, successors and assigns of the
undersigned Grantor and upon the Trustee acting hereunder.
IN WITNESS WHEREOF, this Agreement has been duly executed
as of the date first above written.
~~~/-l!
Helen L. Smith
Grantor
12
COMMONWEALTH OF PENNSYLVANIA)
) SS.:
COUNTY OF CLARION )
On this 27th day of December, 1991, before me,
, the undersigned officer, personally appeared Helen L.
Smith, known to me to be the person whose name is subscribed to the
within instrument, and acknowledged that she executed the same for
the uses and purposes therein contained.
IN WITNESS WHEREOF I hereunto set my hand and official
. .,'S~~'l'~,.
. .' t 'f.., .(('~"""
,,'. ''''''~''''~'.::':,..:,( ~';.
.: -)- .,' ,,:''''''~f-/ '. \~~
:: :' ,~:~., .*~..; v ". ~
: :....: .... "ll'~' ~ 1:
- .. 0 F - .... ~
- ~...'..- ..'..,..' j !
~ " <,,:,,~t.'; .A.~! :
.., ."f, . +, ......... tl ~
':::. 0 .... 'I'SY\.~ yo ."" i
~ ).... ... '" ~ "
........,'4 ......... ~ -...., ..v-
'" I? 'f P \) ,."
"" ,,\'
""""'"',, .
-/lla::xa~~cf~
My commission expires on
Notariaf Seal
Mary K Weg.~, Nola'Y Public
Salem Twp., Wes1mOreIand County
My COmmission Expires Jan. 31, 1994
Member, Pern:yl\lot'llQ ~G1lgn 0/ NQt;ries
15
PA REV-1500
SCHEDULE F
JOINTL Y OWNED PROPERTY
Pliority 50 Plus Accoun~u~tatement
PI"C Bank
0. PNCBAl\K
Primary account number: 50-7007-1886
Page 1 of 2
For the period 01/18/2001 to 02113/2001
Number of enclosures: 1
N
HELEN L SMITH
KAREN LONG BOVER
1459 MT GRETNA RD
ELIZABETHTOWN PA 17022-9580
12' For 24-hour customer service or
current rates: Call 1-888-PNC-BANK
t3I Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
B Visit us at www.pncbank.com
I
TOO terminal: 1-800-531-1648
For hearing impaired clients only
Take a Bite Out of Taxes--Consult a PNC Drollerage Corp
Investment Consultant Today_
Get a free, no obligation ("onsultation. PNC Brokerage Corp offers a wide range of non-bank investment products and services,
su("h as non-FDIC insured stocks, bonds, mutual funds, unit hwestment trusts, and other products which ma)' be able to help you
increase your income, reduce ta.xes, prepare for college, or plan for retirement. PNC Brokerage Investment Consultants can be
rea("hed through our Customer Senice Center at 1-800-762-6111, our website at www.pncbrokerage.com or at an}' PNC Bank
branch office.
Priority 50 Plus
Interest Checking Account Summary
Account number: 50-7007-1886 Account link 1Il number: 0158203384
Helen L Smith
Karen Long Boyer
Balance Summary
9.83
Ending
balance
7,473.64
Please see the Activity Detail section for
additional information.
Beginning
balance
5,340.75
Deposits and
other additions
2,142.72
Checks and other
deductions
Average monthly
balance
6,358.95
Charges
and fees
.00
Transaction Summary
Checks paid/
withdrawals
Bank card/POS Account Information
transactions assistance calls
Teller
transactions
1
o 0
o
Total ATM
transactions
PNC Bank MAC Other MAC ATM
ATM transactions transactions
Other ATM
transactions
o
o 0
o
Interest Summary
As of 02/13, a total of $5A2 in interest was
earned this year.
Annual Percentage
Yield Earned (APYE)
0.45%
Number of days
in interest periOd
Average collected
balance for APYE
Interest Earned
this period
27
6,358.95
2.13
Activity Detail
Dep~sits and Other Additions
Date Amount Description
01/31 937.59 Direct Deposit - Annuit:mt
PA Tno-asury Dept 158203384
02/02 1.203.00 Dit-eet Deposit - Soc See
US Treasury 303 159126920D
There were 3 Deposits and Other Additions
totaling $~ 142.72.
Deposits and Other Additions continued on next page
Pliority 50 Plus Accoun.l- ~tatement
0,PNCBAN<
t,-o the period 01/1812001 to 02113/2001
HELEN L SMITH
Primary account number: 50-7007-1886
Page 2 of 2
'!r For 24-hour customer service:
Call: 1-888-PNC-BANK
Account number: 50-7007-1886 - continued
Deposits and Other Additions - continued
Date Amount Description
02/13 2.13 Intet"est Payment
Checks
Check
number
950
Amount
7.83
Date
paid
02/07
Reference
number
022005570
There is 1 check listed totaling $7.83.
There was 1 Online or Electronic Banking
Deduction totaling $2.00.
Online and Electronic Banking Deductions
Date Amount Description
0~05 2.00 Di.-ect Payment - Feb Dues
Pl-io.-ity 50 Plus 019072100000
Da;;y Balance Detail
Date Balance
01/18 5,340.75
01/31 6,278.34
Date
02/02
02/05
Balance
7,481.34
7,479.34
Date
02/07
02/13
Balance
7,471.51
7,473.64
.
PA REV-1500
SCHEDULE G
INTER-VIVOS TRANSFERS and
MISCELLANEOUS NON-PROBATE
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Historical Prices - ATF (Equity Income Fund First Exchange)
As of 26-Feb-01
More Info: Quote I Chart I News I Profile I SE:C I Msgs I InSider
Month Day Year
Start: I Feb~ I?Ei Ip1..
End: tFe~mm I?Ei.IO 1m
(i Daily
r Weekly
(" Monthly
r Dividends
Ticker Symbol: l~tf
Date Open High Low Close Volume Adj.
Close*
26-Feb-Ol 138.00 142.30 138.00 142.11 7,200 139.07
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Historical chart data and daily updates provided by Commodity Systems.Jllc.(CSll.
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Historical Prices - EAS (Energy East Corp)
As of 26-Feb-01
More Info: Quote I Chart I News I profile I Research I SEe I Msgs I Insider
Month Day Year
Start: I ~ebJjf 12fS.. .101...
End: IFeb..::{ 126m 101.
(i. Daily
(' Weekly
(' Monthly
(' Dividends
Ticker Symbol: leas
Date Open High Low Close Volume Adj.
Close*
26-Feb-0 1 18.50 19.00 18 .40 18.84 243,000 18.00
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* adjusted for dividends and splits, please see FAQ.
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Historical Prices - PPL (PPL Corp)
As of 26-Feb-01
More Info: Quote I Chart I News I profile I Research I SEC I Msgs I Insider
Month Day Year
Start: I Fe~H 126 ....101... .
End: IFeblll26 101...
Ci' Daily
r Weekly
r Monthly
r Dividends
Ticker Symbol: Ippl
Date Open High Low Close Volume Adj.
Close*
26-Feb-0 1 45.00 46.15 44.99 45.58 418,900 44.05
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Historical Prices - SSC (SSC Communications Inc)
As of 26-Feb-01
More Info: Ovate I Chart I News I Profile I Research ISEC I Msgs I Insider
Month Day Year
Start: IFeb.!1f 1?E5m 191.....
End: IFebm.~ 126.......191.....1
(i. Daily
(' Weekly
(' Monthly
r Dividends
Ticker Symbol: h~c.
Date Open High Low Close Volume Adj.
Close*
26-Feb-Ol 49.72 50.30 49.20 50.30 5,063,500 49.10
J Vb
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Data and information is provided for informational purposes only. and is not intended for trading purposes. Neither Yahoo nor any of its data or content
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Historical Prices - VZ (Verizon Communications) As of 26-Feb-01
More Info: Quote I Chart I News I profile I Research I SEC I MS9S/ Insider
Month Day Year
Start: IFebill26 .101
End: IFeb . zl'126 ..... 101 .
(i Daily
r Weekly
r Monthly
r Dividends
Ticker Symbol: Ivz
Date Open High Low Close Volume Adj.
Close*
26-Feb-Ol 50.1 0 51.10 48.88 50.95 4,238,000 49.46
Download Spreadsheet Fonnat
* adjusted for dividends and splits, please see FAQ.
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Historical Prices - ANEFX (New Economy Fund) As of 26-Feb-01
More Info: Quote I Chart I Profile I Insicjer
Month Day Year
Start: IF~b.. i.l126 ..Iql... .....
End: IFeb2:J I?Ei.lq~.
(e. Daily
r Weeldy
(" Monthly
r Dividends
Ticker Symbol: l~.~~f~u
Date Open ffigh Low Close Volume Adj.
Close*
26-Feb-0 1 21.85 23.18 21.85 21.85 0 21.85
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Qu.e~!iQffiJ)IJ:&.T'!lm!ill..l!>..1
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Historical Prices - MHDIX (Mercury Asset Management Inc
Global Holdings Fund)
As of 26-
Feb-01
More Info: Quote I Chart I Profile I Insider
Month Day Year
Start: t~e~.if 126m: 101
End: I~ebif 126m 101m:
(e Daily
r Weekly
r Monthly
r Dividends
Ticker Symbol: Irnhdixm
Date Open High Low Close Volume Adj.
Close*
26-Feb-0 1 8.56 9.03 8.56 8.56 0 8.56
fLUb
~g, 7QS
'I- ?sC s h~ -=-
Download Spreadsheet Format
* adjusted for dividends and splits, pleaseseeFAQ.
q 1, '--I 7 S-. 7 ~- . .
Questions or Comments?
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Historical Prices - TEMWX (Templeton Funds Inc World Fund) As of 26-Feb-01
More Info: Quote I Chart I Profile /Insider
Month Day Year
Start: IFe~ It:1126 101.
End: IFeb..1:1f 126Ig1......
(i Daily
r Weekly
r Monthly
r Dividends
Ticker Symbol: Itel11viXm.
Date Open High Low Close Volume Adj.
Close*
26-Feb-Ol 16.14 17.12 16.14 16.14 0 16.14
DownloadSpreadsbeet..Fmormat
* adjusted for dividends and splits, please see FAQ.
11\)6
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IJ 3-0/ h-~ /, 70
QI,l~stiOI1S QrCQmm~I1~?
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MERCURY GLOBAL HOLDINGS I
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MHDAX Qqot" I Ch<lrt I A<:!oJoPortfoliq
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, ,\ .
PA REV-1500
SCHEDULE H
FUNERAL EXPENSES and
ADMINISTRATIVE COSTS
717-653-6357 PHILHAVEN
478 P02
MAR 21 '02 13:21
" .
/ "
BOYER
FUNERAL HOME, LTD.
MRS Karen Boyer
1459 Mt. Gretna Road
Elizabethtown, P A 17022
FOR THE FUNERAL SERVICE OF:
HELEN LONG SMITH, February 26, 2001
PROFESSIONAL SERVICE CHARGE:
OTHER STAFF & RELATED FACILITIES CHARGE:
TRANSPORTATION CHARGE:
2085.00
650.00
966.00
MERCHANDISE:
BalesviHe. Sutler Bronze/Sutter. 18 Gauge, Monoseal. Steel Casket.
Evans/Clark 12Ga Steel
Memoria) Group
3 195.00
I 595.00
165.00
Total Funeral Charges
8 656.00
CASH DISBURSEMENTS:
Cemetery
Certified Copies
Church
Engraving
Musician
Oil City
Shannondale Cemetery Assoc.
Tent
250.00
40.00
400.00
100.00
200.00
52.00
20.00
90.00
Total Cash Disbursements
1 152.00
-~. 808.00
8 606.78
I 201.22
Balance
Prepaid Funds
Deposit / Payments
Balance Due
******* PAID IN FULL ***... THANK YOU *"'***
$
0.00
144 East High Street. Elizabethtown. PA 17022
717-367.1380 · FAX 717-367-3040
Kristine M. Bostian, SlIpervisor
. .. .
McKoNLY ~AsBURY LLP
Cl-\RE,,"CE E. -\SBL.:RY. CP-\, C\'.-\
TERRY L. H-\RRIS, CP-\
ROBERT-\. RO,\\AKO. CP-\
GARY I. DUB-\S, CP-\
SCOTT -\. HEIi';TZEL.\1A:-.i. CP-\, C'"I.-\. CFE
TRACEY L. RASH. CP-\
CERTIFIED PUBLIC ACCOUNTANTS
.',,\E',,\BERS
.-\,\\ERIC-\:-.i -\.';0 PE'\JNSYLVA:-.iIA
INSTITUTES OF CERTIFIED PUBLIC
ACCOU NT-\NTS
I t INTERNATIOr'';AL GROUP OF
... ACCOUNTING FIRMS
MRS KAREN BOYER
1459 MT GRETNA RD
ELlZABETHTOWN PA 17022-9580
Invoice No.
Date
Client No.
9413
02/28/2001
S1 000. 0024
RE: HELEN L. SMITH
Preparation of individual income tax returns for the year
ended December 31 , 2000
$
435.00
DUE UPON PRESENTATION
A FINANCE CHARGE OF ONE AND ONE-HALF (l'h) PERCENT per month (ANNUAL
RATE OF 180'0) will be added to any account balance which remains outstanding for
more than THIRTY (30) DAYS from the date such balance is rlrst invoiced.
N
I
.'v1AILlNG ADDRESS: P.O. BOX 1331
HARRISBL:RG. P-\ 17105
WEB SITE: W\\\\.m,lCp.Js.com
, .., .
PA REV-1500
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES
and LIENS
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PLEASE MAKE CHECK PAYABLE TO:
03/07/01
,.r ~ ,
INTERNISTS
of Central Pa.
LTD
Peter ~!. Brier. ~I.D.
~lichael L. Gluck. ~!.D.
James A. Tyndall. ~I.D.
Ira J. Packman, M.D.
Richard Schreiber. ~!.D.. F.A.CP.
L. Lynne Britton. ~!.D.
La'\Tence B. Zimmerman. ~!.D.
~Iichae1 .-\.. De~lichele, ~!.D.
Carla J. Dente. ~I.D.
R. George Azizkhan. D.O.
Dean L. Lehman, PA.C
IRS# 23-2146427
HARRISVlEW PROFESSIO~.-\.L CE~TER . :08 LOWTHER ST. . PO BOX 107. LE~IOY"'E. P.-\.I7043.0I07' ,717) 774-1366 F.-\.X '717177404232
~:.~"~7~"::'::;1-J.T;ll_
HELEN L SMITH
C/OKAREN BOYER
1459 MT. GRETNA ROAD
PLEASE DETACH AND RE-
TURN THIS PORTION WITH
YOUR PAYMENT. PLACE IN
ENVELOPE PROVIDED.
WE WILL GLADLY BILL YOUR
CREDIT CARD. SEE OTHER
SIDE.
ELIZABETHTOWN
PA
17022
L
J
.. .-..:~ '"
. I
8350
. to .
345.00
. .
55.96
CHARGES OR PAYMENTS MADE
AFTER CLOSING DATE WILL
APPEAR ON NEXT STATEMENT.
~
o PLEASE CHANGE ADDRESS IF INCORRECT DETACH THIS STUB AND RETURN WITH PAYMENT
ATE DR# DESCRIPTION CHARGE ADJUSTMENT RECEIPTS BALANCE
01/23/01 16 NURSING HOME VISIT LEVEL 2 65.00 20.96 .00 44.04
99312 250.00 331.0
02/07/01 16 NURSING HOME VISIT LEVEL 2 65.00 20.96 32.12 11.92
99312 599.0
02/09/01 10 NURSING HOME VISIT LEVEL 2 65.00 20.96 .00 44.04
99312 331.0 707.10
02/15/01 7 NURSING HOME VISIT LEVEL 2 65.00 .00 .00 65.00
99312 250.00
02/19/01 7 NURSING HOME VISIT LEVEL 2 65.00 .00 .00 65.00
99312 250.00
02/20/01 16 NURSING HOME VISIT LEVEL 2 65.00 .00 .00 65.00
99312 786.2 780.6
02/22/01 7 NURSING HOME VISIT LEVEL 1 50.00 .00 .00 50.00
99311 599.0
** STATEMENT DUE UPON RECEIPT * THANK YOU **
* Insurance Pending
CURRENT
OVER 30 DAYS
TOTAL
ACCOUNT BALANCE
OVER 60 DAYS
OVER 90 DAYS
OVER 120 DAYS
.00
345.00
CLOSING
DATE: 03/07/01
ACCOLNT
NUMBER 8350
,--'
:"'Jl
'. I ..
INSURANCE
PENDING
289.04
55.96
MESSIAH VILLAGE
lob Mt."Allen Drive
P.O. Box 2015
Mechanicsburg, PA 170552015
(717) 697-4666
Resident: HELEN L SMITH
B
I KAREN BOYER
L 1459 MT. GRETNA ROAD
L ELlZABETHTOWN, PA 17022
T
o
Date Description
02/01/2001
Beginning Balance
ROOM & BOARD - SEMI-PVT
25 DAYS AT 150.00 PER DAY
PAYMENT RECEIVED - THANK YOU!
PAYMENT RECEIVED - THANK YOU!
PAYMENT RECEIVED - THANK YOU!
PAYMENT RECEIVED - THANK YOU!
02/16/2001
02/16/2001
02/22/2001
02/22/2001
Current
Past
Due
91-120 Days
31-60 Days
61-90 Days
1% FIN
0.00
0.00
STATEMENT
Resident Number Date
000039201 02/28/2001
Page Amount Due
1 3,750.00
Discharge Date 02126/2001
CharQes Credits Total
10,024.22
3,750.00 13,774.22
-3,022.00 10,752.22
-2,000.00 8,752.22
-3,002.22 5,750.00
-2,000.00 3,750.00
Over 120
ELEN L SMITH
Total Due
3,750.00
Statement End Date:
0212812001
PHAAMERICA ClIIP
, , .
~
\J:> t - '11.'1 \p v~.h...
\
,
For Comments and lor Concerns:
111 RUTHAR DRIVE
NEWARK. DE 19711
CUSTOMER NAME
SMITH HELEN
For Payment:
PO Box 6176
Carol Stream, IL 60197-6176
IF YOU HAVE ANY QUESTIONS CONCERNING THIS STATEMENT OR WISH TO PAY WITH YOUR VISA OR
MASTERCARD, PLEASE CALL A BILLING REPRESENTATIVE AT 717-795-9606 J> girJ. .
STATEMENT
DATE ACCT. NO.
02/28/01 5711-01 00151
PHYSICIAN NAME
ZIMMERMAN LAWRENCE B
-
FROM THRU DATE! DOLLAR
DATE RXNO. DESCRIPTION QTY. CODE AMOUNT
01/31/01 BALANCE FORWARD 87.39
02/02/01 (Y'OA.Y 0025618.02 NYbIUt"' 100 OOOU/GM P 25.25
02/05/01 COPAY 0030969.00 MACROBID 100MG CAPSU 16.26
02/05/01 ~ COPAY0030974.0n CIPHU 250MG TARI FT -', .25..48
02/05/01 30989 T ROCEPHIN 1 GM VIAL t'o.. ,\.;, h~ RX 5 D ( 273.90)--- -
02/05/01 30990 XYLOCAIl\lF 1 0/\"1 VlAL RX 20 0 8.40
02/06/01 ./ ...... PAYMENT - THANK YOU - 7.83 CR /
02107/01 31139') ROCEPHIN 1GM VIAL RX 10 I D ( 543.75')
02/08/01 27660- DOCUSATE SODIUM 100MG CAP OTC 60 ~ 5'.40
02115101 CO PAY 0031383.00 NOVOLlN R 100U/ML VI 22.97
02/15/01 26482 THERA-M TABLET OTC 30 5.25
02116/01 COPAY 0025618.04 NYSTOP 100 OOOU/GM P 25.25
02/16/01 COPAY 0031457.00 NOVOLlN N 100U/ML VI 22.97
02119/01 COPAY 0031562.00 SULFATRIM SUSPENSION 5.95
02/19/01 31548 HYDROCOL THIN 4X4" DRESSING OTC 10 37.70
02/23/01 COPAY 0031562.01 SULFATRIM SUSPENSION 5.95
02/26/01 PAYMENT - THANK YOU 79.56 CR
02126/01 COPAY 0031793.00 LORAZEPAM 1MG TABLET 19.65
DISCOUNT 82.61 CR
AMOUNT DUE $961.52
CV=CONVERT TR=TRANSFER CR=CREDIT RX T=TAXABLE D=DISCOUNTED N=NON-COVERED
('O\...~~\N f'Jl\~~ ~L(6<;
..\ \. - + tA..}-N.,- dJ
~.D c.... N'v'\r...'-'-'. ~
PLEASE RETURN BOTTOM PORTION WITH PAYMENT - Retain top portion for your records
400
PHARMERICA <ll~ PLEASE DO NOT STAPLE CHECK TO STUB OIC 328
AMOUNT
30 60 90+ STMT. ACCOUNT DUE UPON AMOUNT
CURRENT DAYS DAYS DAYS DATE NUMBER RECEIPT ENCLOSED
$961.52 $15.99 $0.00 $15.99CR 02128/01 5711-01-00151 $961.52
Based on Date of Service
CUSTOMER NAME
SMITH, HELEN
FACILITY NAME
MESSIAH VILLAGE
TO:
HELEN SMITH
PO BOX 2015
MECHANICSBURG, PA 17055-2015
111.11\.1111111..1.1..1.1.111.11\'1111.11.1.1'11.11.1.1.1..1,1
PHARMEAICA
PO Box 6176
Carol Stream, IL 60197
OIC 328
5711010015100096152000005
J i.- . ..
PINNACLE HEALTH HOSPITALS
BOX 2353
HARRISBURG, PA 17105
I
82.00 : 03/16/01
AMOUNT PAID ~ I $
I
WE ACCEPT VISA,M/C
DISCOVER & AMER.EXP
ACCOUNT NUMBER AND NAME
SEND
PAYMENT
TO
PINNACLE HEALTH HOSP
P.O. BOX 2353
HARRISBURG, PA 17105
429376633
SMITH ,HELEN
FOR INFORMATION ON ACCOUNT, PLEASE CALL
(717) 230-3717
FADM DT:
~DSH DT:
, H SB:
: oHOSP SVC:
s
p
020301
*NONE*
NOOOO
REF
1...111...111....1.1..1.1..11.....111...1...111.1..1.1..1.1..1
429376633
HELEN SMITH
100 MT ALLEN DR
MECHANICSBURG PA 17055-6171
u
~DX CD: 780.6
PINNACLE HEALTH HOSPITALS
P.O. BOX 2353
HARRISBURG, PA 17105
Account Number: S M 4I T2 H9 3 7 H6 E6 3L E3 N
Panent Name: ,
Service Start: 0 2/0 3/0 1 Service Ene:
Statement Date: 0 3/0 2/ 0 1 Last Statement Date:
Page No. 1
02/10/01
QUESTIONS? Please Call:
(717) 230-3717
Contact:
ACCOUNT BALANCE
ESTIMATED INSURANCE DUE
TOTAL PATIENT CREDITS
I ~i_CJ I \\J ,'~,;
82.00
.00
82.00
TRANS DATE
DESCRIPTION
AMOUNT
.
02/03/01
02/03/01
02/03/01
02/03/01
PREVIOUS BALANCE
1 URINE CULTURE
1 GRAM SMEAR
1 SENSITVITY
1 URINALYSIS W/MICRO
87086
87205
87184
81001
.00
25.00
9.00
42.00
6.00
R 0 R PO MB 1 000047019
ACCOUNT BALANCE
82.00
C99 COMMERCIAL OT .00
FC=S PT TYPE=R
CUSTOMER SERVICE HOURS
MON-WED-FRI 7:00AM TO 4:00PM
TUES-THUR 7:00AM TO 6:00PM
CALL 717-230-3717 LOCAL OR 1-800-603-6064 OUT OF AREA
. I.... .
Until your insurance has paid, the PLEASE PAY THIS AMOUNT represents the balance we estimate you owe.
Any balance unpaid b our insurance will be due from QU... Thank QU.