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HomeMy WebLinkAbout07-12-06 REV-1500 EX (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~L COUNTY CODE ~L 0035 ___ YEAR NUMBER w ~ ~~cn ulJ:~ wo..u J:~ uo..lD 0.. <I: I- Z W C W U w C DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) Pool Cham e DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) SOCIAL SECURITY NUMBER 233-14-5909 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C REGISTER OF WILLS SOCIAL SECURITY NUMBER 10/12/2005 3/7/1919 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) Marjorie K. Pool [i] 1. Original Retum D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Retum Required [X] 7. Decedent Maintained a Living Trust (Attach copy ofTrust) _ 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [X] 11. Election to tax under Sec. 9113(A) (Allaeh Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z W C Z o no (f) w a: a: o u Linda Lundberg FIRM NAME (If Applicable) PNC Bank, N.A. TELEPHONE NUMBER P.O. Box 308 717-730-2265 Camp Hill, PA 17001-0308 0.00 0.00 0.00 0.00 2,088.97 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) (2) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation. Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) (4) (5) z o i= ~ ::J l- ii: <t U w IX: 4,000.00 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 1,015,979.30 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (8) 12,622.22 10,297.93 1,022,068.27 8. Total Gross Assets (total Lines 1-7) 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) 22,920.15 999,148.12 0.00 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 999,148.12 15. Amount of Line 14 taxable at the spousal tax 305,682.38 x .0 L(15) z rate, or transfers under Sec. 9116 (a)(1.2) 0 i= 16. Amount of Line 14 taxable at lineal rate 693,465.74 x .0 ~(16) <I: ~ ::> 0.00 0.. 17. Amount of Line 14 taxable at sibling rate x .12 (17) :::!! 0 0.00 u 18. Amount of Line 14 taxable at collateral rate x.15 (18) >< <I: 19. Tax Due (19) ~ 0.00 31,205.96 0.00 0.00 31,205.96 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W46451.000 /" ESTATE OF CHAMPE C. POOLE FILE NO: 21-06-0035 DATE OF DEATH: 10/12/05 Champe C. Poole died Testate, naming PNC Bank, N.A. Executor. Since nearly all ofthe decedent's assets were held in either his Grantor Trust or in joint names with his wife, the Will was not probated. PNC Bank, N.A., as Trustee under the Champe C. Poole Trust dated 2/5/98, as amended and restated in its entirety under date of 2/12/02, and party in possession of his assets is filing the Pennsylvania Inheritance Tax Return. Decedent's Complete Address: SlREET ADDRESS 1000 Wesley Drive Cumberland County 17055 CI1Y I STATE I ZIP Mechanicsburq 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) 31,205.96 0.00 28,500.00 1,500.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 30,000.00 0.00 0.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 ;s greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,205.96 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (58) 1,205.96 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes [i] [i] D D without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 4. Did decedent own an Individual Retirement Account. annuity. or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 [jj IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1 . 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 No D D [j [jj [jj OJ Bank, N.A. \.c.l:- ~\q::.::~ ~ u- DATE '\}k) SIGNATURE OF PREPARER Oll-lER THAN REPRESENTAllVE DATE ADDRESS For dates of death on or alter July 1. 1994 and before January 1. 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. S 9916 (a) (1.1) (i)]. For dates of death on or alter January 1. 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S 9116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1. 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(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. S 9116(1.2) [72 P.S. S9116(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. 9 9116(a)(1 .3)]. A sibling is defined. under Section 9102. as an individual who has at least one parent in common with the decedent. whether by blood or adoption. 3W4646 1.000 REV.1508 EX + (6-98) COMMONWEALTH OF PENNSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Champe C. Pool FILE NUMBER 21 06 0035 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Bethany Village Refund 1,088.75 2 Commonwealth of PA Proceeds of previously unclaimed property 654.12 3 Orthopedaedic Surgeons of Central PA Refund of unused health insurance premium 305.60 4 Patriot News Refund due to cancellation of subscription 40.50 3W46AD 1.000 TOTAL (Also enter on line 5, Recaoitulation\ $ (If more space is needed, insert additional sheets of the same size) 2,088.97 REV-1509 EX + (6-98) COMMON\^JEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Champe C. Pool SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21 06 0035 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINTTENANT(S) NAME AOORESS RELA TlONSHIP TO DECEDENT A. Pool, James H 8923 Carlisle Road, Wellsville, PA 17365-9735 Son B. Pool, William C 207 N. 38th Street, Harrisburg, PA 17109-2506 Son c. JOINTL V-OWNED PROPERTY: lETTER DATE DESCRIPTlON OF PROPERTY %OF DATE OF DEATH ITEM FOR JOJNT MADE INCLUDE NAME OF FINANCIAllNSTlTUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF f'Uv18EROR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR NUMBER TENANT JOINT JQINTL Y -i-ELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1 BA 6/1/2000 Vintage Cessna 120 Airplane 12,000.00 33.3300 4,000.00 Appraised by Joseph Appleyard (Copy of Appraisal attached) TOTAL (Also enter on line 6 Recaoitulation\ $ 4,000.00 3W46AE 1.000 (If more space is needed, insert addrtional sheets of the same size) REV-1510 EX + (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Champe C. Pool FILE NUMBER 21 06 0035 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 NUMBER 1. 3W46AF 1.000 DESCRIPTION OF PROPERlY J.NClLOE TI-E t-WJIE OF T1-E TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND TH: DATE OF TRANSFER ATTACHACOPV OF THE DEED FOR REAL ESTATE Champe C. Pool created a Revocable Trust with PNC Bank, N.A. under date of 2/5/98, as amended and restated in its entirety under date of 2/12/02. The assets held in this trust are reported below as items #1-#26: 150 Shares Amgen Inc @ 75.51 CUSIP: 031162100 2 500 Shares Bellsouth Corp Conunon New York Stock Exchange @ 25.04 CUSIP: 079860102 3 163.816 Shares Calamos Invt Tr New Growth Fd Mutual Funds, Money Market Fds @ 50.88 CUSIP: 128119302 4 200 Shares Chevrontexaco Corp Common New York Stock Exchange @ 61. 695 CUSIP: 166764100 5 400 Shares Citigroup Inc Common New York Stock Exchange @ 44.755 CUSIP: 172967101 DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST 11,326.50 100.0000 12,520.00 100.0000 8,334.96 100.0000 12,339.00 100.0000 17,902.00 100.0000 Total from continuation sched les . . . . . . . . . (If more space is needed, insert additional sheets of the same size) TOTAL (Also enter on line 7, Recapitulation) $ EXCLUSION OF APPliCABLE) 0.00 0.00 0.00 0.00 0.00 TAXABLE VALUE 11,326.50 12,520.00 8,334.96 12,339.00 17,902.00 953,556.84 1,015,979.30 Estate of: Champe C. Pool Schedule G (Page 2) Item ~o. Description 6 400 Shares Conocophi11ips Common New York Stock Exchange @ 64.03 CUSIP: 20825C104 7 400 Shares Danaher Corp Shs Ben Int New York Stock Exchange @ 52.195 CUSIP: 235851102 Dividend accrued on 10/12/2005 8 100 Shares Dominion Res B1k Warrior Tr Un Ben Int New York Stock Exchange @ 79.81 CUSIP: 25746Q108 9 200 Shares Exelon Corp Common New York Stock Exchange @ 49.3050 CUSIP: 30161N101 10 50,000 Par Federal Farm Cr Banks Cons System Bond 3.7% Due 11/09/2007 @ 98.50 CUSIP: 31331smnO Interest accrued to 10/12/2005 11 50,000 Par Federal Home Loan Bank Cons Bd 3.25% Due 3/8/2006 @ 99.625 CUSIP: 3133XAQQ3 Interest accrued to 10/12/2005 Total (Carry forward to main schedule) DOD Value of Asset % Interest 25,612.00 100.0000 20,878.00 100.0000 8.00 100.0000 7,981.00 100.0000 9,861.00 100.0000 49,250.00 100.0000 791. 39 100.0000 49,812.50 100.0000 157.99 100.0000 Exclusion 0.00 0.00 0.00 0.00 0.00 0.00 233-14-5909 Taxable Value 25,612.00 20,878.00 8.00 7,981.00 9,861.00 49,250.00 791.39 49,812.50 157.99 164,351. 88 Estate of: Champe C. Pool Schedule G (Page 3) Item ~o. Description 12 100 Shares Fortune Brands Inc Common New York Stock Exchange @ 76.16 CUSIP: 349631101 13 300 Shares General Elec Co Common New York Stock Exchange @ 33.8150 CUSIP: 369604103 Dividend accrued on 10/12/2005 14 400 Shares Heinz H J Co Common New York Stock Exchange @ 36.435 CUSIP: 423074103 15 100 Shares Illinois Tool Wks Inc Common New York Stock Exchange @ 79.52 CUSIP: 452308109 Dividend accrued on 10/12/2005 16 300 Shares Intel Corp Common NASDAQ Stocks @ 23.04 CUSIP: 458140100 17 100 Shares International Business Machs Common New York Stock Exchange @ 82.44 CUSIP: 459200101 Total (Carry forward to main schedule) DOD Value of Asset % Interest 7,616.00 100.0000 10,144.50 100.0000 66.00 100.0000 14,574.00 100.0000 8,021.50 100.0000 33.00 100.0000 6,912.00 100.0000 8,244.00 100.0000 Exclusion 0.00 0.00 0.00 0.00 0.00 0.00 233-14-5909 Taxable Value 7,616.00 10,144.50 66.00 14,574.00 8,021.50 33.00 6,912.00 8,244.00 55,611.00 Estate of: Champe C. Pool Schedule G (Page 4) Item ~o. Description 18 328.746 Shares Janus Invt Fd Small Cap Value @ 30.44 CUSIP: 471023572 19 200 Shares Medtronic Inc Common New York Stock Exchange @ 54.24 CUSIP: 585055106 Dividend accrued on 10/12/2005 20 300 Shares Microsoft Corp Common NASDAQ Stocks @ 24.485 CUSIP: 594918104 21 200 Shares Paychex Inc Common NASDAQ Stocks @ 37.43 CUSIP: 704326107 22 300 Shares Sara Lee Corp Common New York Stock Exchange @ 18.565 CUSIP: 803111103 23 100 Shares Stryker Corp Common New York Stock Exchange @ 45.89 CUSIP: 863667101 24 100 Shares Zimmer Hldgs Inc Common New York Stock Exchange @ 64.085 CUSIP: 98956P102 Total (Carry forward to main schedule) DOD Value of Asset % Interest 10,007.03 100.0000 10,848.00 100.0000 19.25 100.0000 7,345.50 100.0000 7,486.00 100.0000 5,569.50 100.0000 4,589.00 100.0000 6,408.50 100.0000 Exclusion 0.00 0.00 0.00 0.00 0.00 0.00 0.00 233-14-5909 Taxable Value 10,007.03 10,848.00 19.25 7,345.50 7,486.00 5,569.50 4,589.00 6,408.50 52,272.78 Estate of: Champe C. Pool Schedule G (Page 5) Item ~o. Description 25 3,576.591 Shares Blackrock Fds Pa Tf Inc Instl Mutual Funds, Money Market Fds @ 10.37 CUSIP: 091928622 Dividend accrued on 10/12/2005 26 58,914.33 Shares Blackrock Liq Income @ 1. 00 CUSIP: 999527641 Dividend accrued on 10/12/2005 27 ING Variable Annuity Contract # 1070649-0W Payable to the Champ Pool Revocable Living Trust dated 2/12/02 (See letter attached) 28 New York Life Insurance Co Annuity Contract #58085661 Payable to Marjorie K. Pool (See letter attached) Total (Carry forward to main schedule) DOD Value of Asset % Interest 37,089.25 100.0000 60.51 100.0000 58,914.33 100.0000 71. 95 100.0000 488,199.88 100.0000 96,985.26 100.0000 Exclusion 0.00 0.00 0.00 0.00 233-14-5909 Taxable Value 37,089.25 60.51 58,914.33 71. 95 488,199.88 96,985.26 681,321.18 REV-1511 EX + (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Champe C. Pool ITEM NUMBER A. B. 2 3W46AG 1.000 FILE NUMBER 21 06 0035 Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: 1. William C. Pool Reimbursement for cremation expense and funeral flowers 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3. 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 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Harrisburg Jet Center, lnc Appraisal fee re Cessna airplane PNC Bank, N.A. Fee for executorial type services Total from continuation schedules . TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ AMOUNT 217.47 2,000.00 100.00 10,000.00 304.75 12,622.22 Estate of: Champe C. Pool 233-14-5909 Schedule H Part 7 (Page 2) 3 william C. Pool Reimbursement for Patriot News obituary 304.75 Total (Carry forward to main schedule) 304.75 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Champe C. Pool SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 06 0035 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Associated Cardiologists Balance due for services on 9/19/05 69.79 2 East Pennsboro Ambulance Service Transportation to doctor's appointment on 10/4/05 50.00 3 Holy Spirit Hospital Professional services rendered 9/13/05 72.14 4 Internal Revenue Service Balance due u.S. income tax due for 12/31/05 8,396.00 5 PA Department of Revenue Balanced due PA state income tax for 12/31/05 1,710.00 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 10,297.93 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ChamDe C. Pool NUMBER I 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Clark R. Pool 701 Dunkirk Road Baltimore, MD 21212-2005 1/3 share of Trust Remainder 2 James H. Pool 8923 Carlisle Road Wellsville, PA 17365-9735 1/2 share of Joint Property 2,000.00 1/3 share of Trust Remainder 229,821. 91 FILE NUMBER 21 06 0035 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Son 229,821.92 Son 231,821.91 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 3W46AI 1.000 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, Insert additional sheets of the same size) Estate of: Champe C. Pool 233-14-5909 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 3 Marjorie K. Pool 325 Wesley Drive Apt 119 Mechanicsburg, PA 17055 Proceeds NY Life Annuity 96,985.26 Life estate in Champe C. Pool Trust 208,697.12 Surviving Spouse 305,682.38 4 William C. Pool 207 N. 38th Street Harrisburg, PA 17109-2506 1/2 share of Joint Property 2,000.00 1/3 share Trust Remainder 229,821. 91 Son 231,821. 91 COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN REV-1514 EX+ (12-U3) Check Box 4 on REV-1500 Cover Sheet FILE NUMBER Champa C. Pool 2106 0035 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. o Will [!] Intervivos Deed of Trust 0 Other LIFE ESTATE INTEREST CALCULATION NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE Marjorie K. Pool 12/02/1919 86 Term of Years Term of Years Term of Years Term of Years 1. Value of fund from which life estate is payable . . . . . . . 2. Actuarial factor per ap~riate table . . . . . . . . . . . . Interest table rate - U 3 112% 0 6% D 10% 3. Value of life estate (Line 1 multiplied by Line 2) ..... $ Term of Years 898,162.86 0.23236 [i] Variable Rate 5.00000% $ 208,697.12 ANNUITY INTEREST CALCULATION NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE Term of Years Term of Years Term of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . 2. Check appropriate block below and enter corresponding (number) . . . . . . Frequency of payout -0 Weekly (52) 0 Bi-weekly (26)0 Monthly (12) D Quarterly (4) 0 Semi-annually (2) D Annually (1) OOther~) 0 3. Amount of payout per period ............... 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate -0 3 1/2% 0 6% D 10% D Variable Rate 0 . 00000 % 6. Adjustment Factor (see instructions) ....................... 7. Value of annuity -If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3. . . . . . . . . . . . . . . . . . . . . . . . . o Life or $ o Term of Years 0.00 0.000 0.00 0.00 $ 0.00000 0.00000 . . . $ 0.00 . . . $ 0.00 NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) 3W46AJ 3.000 REV-1M9 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 0 ELECTION UNDER SEC. 9113(A) SPOUSAL DISTRIBUTIONS ESTATE OF FILE NUMBER Champe C. Pool 21 06 0035 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Champe C. Pool Trus t Trust (marital, residual, A, B, By-pass, Unified Credit, etc.) If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed in Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transfero~s personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or sim- ilar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113(A) trust or similar arrangement. Description VALUE Champe C. Pool Trust 898,162.86 Part A Total $ 898,162.86 PART B: Enter the description and value of all interests included in Part A for which the Section 91131A\ election to tax is beinq made. Description Value Champe C. Poole Trust 898,162.86 Part B Total $ (If more space is needed, insert additional sheets of the same size) 898,162.86 3W46E2 2.000 Estate of Champe C. Pool File No: 21-06-0035 Date of Death: 10/12/05 Calculation of Shares Gross Estate $1,022,068.27 Less: Schedules H & I ($22.920.15) Net Value of Estate $999,148.12 Less: Joint property ($4,000.00) Less: Property payable to directly to spouse ($96,985.26) (100,985.26) Residue 898,162.86 Marjorie K. Pool - b. 12/2/1919, age 86 AFR for October = 4.91. Round to 5.0 Table S (5.0) L.E. factor for person 86 is .23236. L.E. = Residue x L.E. factor = 898,162.86 x .23236 = 208,697.12 Remainder to Children = Residue less value of life estate = 898,757.22 - 209,067.59 68946574 Calculation of Shares Marjorie K. Pool NY Life Annuity $96,985.26 Life estate in Residue $208,697.12 305,682.38 Clark R. Pool 1/3 share of Remainder $229,821 .91 $229,821.91 James H. Pool 1/2 share of Joint Property $2,000.00 1/3 share of Remainder $229,821.91 $231,821.91 William C. Pool 1/2 share of Joint Property $2,000.00 1/3 share of Remainder $229,821.91 $231 ,821.91 Total 999148.12 METTE, EVANS & WOODSIDE ATTORNEYS AT LAW HARRISBURG, PENNSYLVANIA 17110-0950 mast mill aub westament OF CHAMPE C. POOL I, CHAMPE C. POOL, of Lower Allen Township, Cumberland County Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether payable by my estate or by any recipient of any property, shall be paid by the Executor out of the residue of my estate, as an expense and cost of administration of my estate. The Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. ITEM II: I direct the Executor to pay the expenses of my last illness and funeral expenses from the residue of my estate as an expense and cost of administration of my estate. ITEM III: If I survive my wife, MARJORIE K. POOL, I give and bequeath my grandfather clock to my son, JAMES H. POOL. Page 1 /) L C #? ITEM N: If I die before my wife, MARJORIE K. POOL, I give to my wife all of my household furniture and furnishings, books, pictures, jewelry, silverware, automobiles, wearing apparel and all other articles of household or personal use or adornment and all policies of insurance thereon. If I do not die before my wife, MARJORIE K. POOL, I may leave a written list in my safe deposit box or elsewhere disposing of certain items of my tangible personal property. The Executor shall dispose of items of my personal property as specified in the written list. If no written list is found in my safe deposit box or elsewhere and properly identified by the Executor within thirty (30) days after the probate of my Will, it shall be presumed that there is no other statement or list. Any subsequent discovered list shall be ignored. I give to my children living at the time of my death any tangible personal property not set forth in a written list, to be divided among them as they shall agree. If my children are unable to agree, the Executor shall divide this property among my children in as nearly equal portions as the Executor, in the sole discretion of the Executor, deems practical, having due regard to the personal preferences of my children. ITEM V: I give the residue of my estate, not disposed of in the preceding portions of this Will, to PNC BANK, N.A., as Trustee, IN TRUST, to be administered and distributed in accordance with the terms of an Agreement of Trust executed by PNC BANK, N.A., as Trustee and by me as Grantor on the day of 2001. I confirm and ratify this Agreement of Trust in every respect. ITEM VI: In addition to powers given by law, the Executor shall have the following discretionary powers: (a) To retain any property received by the Executor; Page 2 /' (' /--') t.:: . ; -fJ -- (b) To sell real estate, publicly or privately, for prices and on terms as the Executor deems proper, without liability to the purchasers to see to application of the purchase moneys; (c) To compromise controversies; (d) To distribute income or principal in cash or in kind, or partly in each, at fair market value at the time of each distribution; (e) To hold investments in the name of a nominee; and (f) To undertake all other acts in the Executor's judgment deemed necessary for the administration and settlement of my estate. ITEM VII: Any person, other than my wife, who has died within thirty (30) days of my death, or under such circumstances that the order of our deaths cannot be established by proof, shall be deemed to have predeceased me. If my spouse and I die simultaneously, or under such circumstances that the order of our deaths cannot be established by proof, my spouse shall be deemed to have survived me. Any person (other than myself) who has died at the same time as any beneficiary under this Will, or in a common disaster with that beneficiary, or under such circumstances that the order of deaths cannot be established by proof, shall be deemed to have predeceased that beneficiary. ITEM VIII: I appoint PNC BANK, N.A. to be the Executor. The Executor is specifically relieved from the obligation of filing bond or entering security. Page 3 -; / --) t ,( () November 23, 2005 4& tHW. 2: g Z4Jtfh5 Linda J. Lundberg Asst. Vice President PNC Advisors PO Box 308 Camp Hill, P A 17001-0308 Dear Linda, Enclosed is an appraisal on one of my father's remaining assets, his Cessna 120. Most vintage airplanes don't have titles, but this plane is registered in his name (along with me and Brother James). Jim recently obtained an appraisal, because none had ever been done, and we thought it should be completed for estate purposes. Jim will also be changing the registration and insurance information. He has essentially cared for this craft, and paid all expenses, over the last several years since my father stopped flying. The value is $12,000. Also enclosed is a bill for the appraisal. Please issue a check to Jim for his expense in this matter. Thanks! Sincerely, ,brLc- HJC I!Lf A~ -,L...J. ~~!.!.! .n...~-, ~_:;:;~, _ '~~:~~.....-~'-"?: - ::;""~":-:"""":.'i'), //" ,/". //"/"':y/I/ ~ / ~/ Aircraft Sales Harrisburg Jet Center, Inc. 106 Airport Road New Cumberland, Pa 17070 Phone: (717) 909-8725 Fax: (717) 909-8726 j a@harrisburgjetcenter.com PN~EACEIVED DVISORS NOV 2 9 (UOO November 17, 2005 RE: Cessna 120, N2714N To Whom It May Concern: I hereby certify that I have personally inspected the above captioned aircraft, engines, avionics and the pertinent aircraft records and logbooks, finding them in order with the exception of a missing Airframe Log from 1947 to September 1959. Taking into consideration the results of said inspection and the general condition and appearance of the aircraft, it is my opinion that a fair retail market value of $ 12,000 would be appropriate as per the fall 2005 Aircraft Price Digest. Thank you, oseph Appleyard Harrisburg Jet Center, Inc. Aircraft Sales Manager Serving Central Pennsylvania Since 1953 www.harrisburgjetcenter.com Agreenlent afTrust THIS AMENDED AGREEMENT OF TRUST, made and entered into this ~day of J===€LLcit.Ly- ,2002, by and between CHAMPE C. POOL, as Grantor, hereinafter referred to as "Grantor",and PNC BANK, N.A., as Trustee. WITNESSETH: WHEREAS, Grantor and Trustee entered into an Agreement of Trust dated February 5, 1998; and WHEREAS, Paragraph 7 of said Agreement of Trust provides it may be amended by the Grantor; and WHEREAS, Grantor desires to restate the terms of said Agreement of Trust in its entirety; NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained, it is agreed by and between the parties hereto as follows: ARTICLE I: The assets presently held by the Trustee under the Agreement of Trust dated February 5, 1998, shall continue to be held IN TRUST and are hereinafter referred to as the "Trust", and Trustee, in consideration thereof, agrees to hold and administer said assets and any additions thereto, as Trustee, IN TRUST NEVERTHELESS, for the following uses and purposes: (a) Tru r shall have, hold, manage, invest anc .~. avest the same, collect the income and pay over the net income in quarterly installments to Grantor during the Grantor's lifetime. (b) During the lifetime of Grantor, Trustee shall pay to Grantor such portion or all of the principal of the Trust as such income beneficiary may from time to time request in writing. (c) Trustee may also expend so much of the principal of the Trust as, in its discretion, may be necessary and/or advisable to supplement all income of Grantor in order to provide support and maintenance, including medical, hospital, nursing and nursing home care for such beneficiary. (d) Upon the death of Grantor, Trustee shall pay over to the Executor of Grantor's estate, to the extent that probate assets of Granter's estate are not available, as much of the principal as shall be required to pay all specific bequests provided in Grantor's will and inheritance and estate taxes, funeral and administration costs which may be incurred with respect to Grantor's estate. Thereafter, Trustee shall, if Grantor predeceases Grantor's wife, MARJORIE K. POOL, divide the remaining assets, proceeds from or on account of insurance policies received by reason of the death of Grantor, and any other assets and funds (hereinafter referred to as the "principal") into two (2) parts, each of which shall be held in trust and constitute a separate Trust Fund, to be known as "Trust A" and "Trust B": -2- "Trust A": There shall be placed in "Trust A" that fraction of the total principal of which the numerator shall be a sum equal to the largest amount that can pass free of Federal estate tax by reason of the applicable credit amount and the state death tax credit (provided that the use ofthis credit does not require an increase in state death taxes) allowable to the Grantor's estate but no other credit and after taking account of property passing outside of this Agreement of Trust which does not qualify for the marital charitable deduction and after taking account of charges to principal that are not allowed as deductions in computing Grantor's Federal estate tax, and of which the denominator shall be the value of the total principal. For purposes of establishing such fraction, the values finally fixed in the Federal estate tax proceeding relating to Grantor's estate shall be used. Grantor recognizes that the numerator of such fraction may be zero (0), in which case no property shall pay under "Trust A" and that said numerator may be affected by the action of the Executor of Grantor's estate in exercising certain tax . elections. . "Trust B": The balance of the principal not placed in "Trust A" shall be placed in "Trust B". ARTICLE II: The following provisions shall apply to "Trust A": (a) The Trustee shall pay the net income in quarterly installments to Grantor's spouse, MARJORIE K. POOL (the "Beneficiary"), during her lifetime, commencing from the date of Grantor's death. The Trustee shall also, from to time, pay -3- ;"~.,,....,_.... .-..x........ _._ ~"'__...._~~__'" .~ -0:. to the Beneficiary such amounts of the principal of this Trust as is necessary for the proper support, maintenance and medical care of the Beneficiary. (b) Upon the death of the Beneficiary, or if said Beneficiary predeceases Grantor, then upon Grantor's death, the Trustee shall convey and pay over the sum of SEVENTY FIVE THOUSAND ($75,000) DOLLARS to each of Grantor's sons, WILLIAM CHAMPE POOL and CLARK R. POOL. (c) The Trustee shall distribute the remaining principal and any accretions thereto and any accumulations of income in equal shares to the Beneficiary's children. If any of the Grantor's children is not then living, his share shall be paid to his then living issue, per stirpes. If there is no such living issue, his share shall be paid to the survivors of them, or to the then living issue of the survivors of them, per stirpes, if none of them is then living. ARTICLE III: The following provisions shall apply to ''Trust B": (a) The Trustee shall pay the net in come in quarterly installments to Grantor's spouse, MARJORIE K. POOL (the "Beneficiary"), during her lifetime, commencing from the date of the Grantor's death. (b) During the lifetime of the Beneficiary, the Trustee shall pay to the Beneficiary such amounts of principal of this Trust as the Trustee, in the sole discretion -4- of the Trustee, deems necessary for the proper support, maintenance and medical care of the Beneficiary. (c) Upon the death of the Beneficiary, the Trustee shall pay over all of the accrued or undistributed income to the estate of the Beneficiary. All of the remaining principal shall be added to "Trust A", to be held, administered and distributed according to the provisions of ARTICLE II. (d) The Executor of Grantor's estate or the Trustee (hereinafter referred to as the "Executor" in this subparagraph (d)) shall be authorized in the Executor's sole, exclusive and unrestricted discretion to determine whether to elect (under Section 2056(b )(7) of the Internal Revenue Code of 1986, as amended, or any corresponding provision of the Federal estate law), to qualifY all, none or a fraction of "Trust B" for the Federal estate tax marital deduction. The decision of the Executor with respect to the exercise of the election shall be final and conclusive upon all persons whose interests in Grantor's estate or "Trust B" are directly or indirectly affected by the election. Only property which is fully eligible for the marital deduction under Federal estate tax law shall be assigned to this Trust. Notwithstanding anything to the contrary contained herein, the Trustee of this Trust shall not retain beyond a reasonable time any property which may at any time be or become unproductive, nor shall they invest in unproductive property. Notwithstanding the provisions of subparagraph (c) of this Article, the Trustee shall pay to the Executor of Grantor's spouse's estate, out of the principal of this Trust upon the death of Grantor's spouse, an amount equal to the estate, -5- (~" inheritance, transfer, succession and other death taxes ("death taxes"), Federal, state and other, payable by reason'ofthe inclusion of the value of Trust property in Grantor's spouse's estate. Such payment shall be equal to the amount by which (1) the total of such death taxes paid by Grantor's spouse's estate exceeds the total of such death taxes which would have been payable if the value of the Trust property had not been included in such spouse's estate. The determination by Grantor's spouse's Executor of the amount payable hereunder shall be fmal. Grantor directs the Trustee to pay such amount promptly upon written request of Grantor's spouse's Executor. The fmal determination of the amount due hereunder shall be based upon the value as fmally determined for Federal estate tax purposes in Grantor's spouse's estate. After payment of the amount finally determined to be due hereunder, the Trustee shall be discharged from any further liability with respect to such payment. Grantor's spouse may waive the right of payment under this subparagraph by Will, in which such spouse specifically refers to the right to payment hereunder given to the estate of Grantor's spouse. ARTICLE IV: Grantor or any other party or person, from time to time, with the consent of Trustee, may made additional assets, by Will or otherwise, subject to the terms of this Agreement of Trust. ARTICLE V: Whenever and as often as any beneficiary hereunder, to whom payments of income or principal are herein directed to be made, shall be unable to act, or shall lack ability, or in the sole judgment of the Trustee, shall otherwise be unable to apply such -6- payments to the beneficiary's own_best interest and advantage, the Trustee shall make any portion of such payments in anyone or more of the following ways: (a) Directly to such beneficiary; (b) To the Legal Guardian of such beneficiary; (c) To a relative of such beneficiary, to be expended by such relative for the benefit of such beneficiary; or (d) By Trustee expending the same for the benefit of said beneficiary. Provided that this ARTICLE shall not apply to "Trust B". ARTICLE VI: No part of the income or principal of the property held under this Trust shall be subject to attachment, levy or seizure by any creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary prior to his or her actual receipt thereof The Trustee shall pay over the net income and the principal to the parties herein designated, as their interests may appear, without regard to any attempted anticipation, pledging or assignment by any beneficiary under the Trust, and without regard to any claim thereto or attempted levy, attachment, seizure or other process against said beneficiary. ARTICLE VII: The Trustee shall possess, among others, the following powers: (a) To vary or to retain investments, when deemed desirable by the Trustee, and to invest in such bonds, stocks, notes, real estate mortgages or securities or -7- ~- -."~ ..,,----..,....-...,~....----.:~ .. -----""-".--..:~.-~.(~~~~...-.--.--m--~ _ in such other property, real or personal as the Trustee shall deem wise, without being restricted to so-called "legal investments" (b) In order to effect a division of the principal of a Trust or for any other purpose, including any [mal distribution of a Trust, the Trustee is authorized to make said divisions or distributions of the personalty and realty, partly or wholly in kind, and to allocate specific assets among beneficiaries and Trusts created hereunder so long as the total market value of any share is not affected by such allocation, division or distribution. Should it appear desirable to partition any real estate, the Trustee is authorized to make, join in and consummate partitions of lands, voluntarily or involuntarily, including giving mutual deeds, recognizances, or other obligations with as wide powers as can be exercised by an individual owner in fee simple. (c) To sell either at public or private sale and upon such terms and conditions as the Trustee may deem advantageous to the Trust, any or all real sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see the application of the purchase money, or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds; assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon the Trustee in this paragraph or elsewhere in this instrument. -8- --rg'0~~~"7iJi~~~:"'r~~~',;f^:;"~"'::~"h~'Jd~.:..~~z.~"~1i'ii"",~T.;t1r:'_;".^':.'":,~_'_~..\ _ (d) To mortgage real estate, and to make leases of real estate, extending beyond the term of the Trusts hereunder. (e) To borrow money from any party, including the Trustee, to pay indebtedness of a Trust and taxes, and to assign and pledge assets of a Trust therefor. Provided, however, that this paragraph shall not authorize borrowing from "Trust B". (t) To pay all costs, taxes, expenses and charges in connection with the administration of a Trust, including a reasonable compensation to agents. If any estate or inheritance taxes are payable from the assets received by Trustee, such taxes shall be paid from "Trust A". (g) In the discretion of the Trustee, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of a Trust. (h) To vote any shares of stock which form a part of a Trust. (i) To assign to and hold in trust an undivided portion of any asset. (j) To place and carry any asset of the Trust in the name of a nominee. (k) To do all other acts in the judgment of Trustee deemed necessary or desirable for the proper and advantageous management, investment and distribution of the Trust. -9- --~-----~ ARTICLE VIII: No rule oflaw against self-deC~g, divided loyalty, or conflict of interest shall be applied" to render any transaction effected by the Trustee void, voidable, or otherwise subject to attack solely for violation of such rule, nor shall the Trustee incur any liability, nor shall any Trustee commissions for acting hereunder be reduced, solely for violation of such rule. Any transaction which involves self-dealing, divided loyalty, or conflict of interest by the Trustee shall be judged by the rules of law which would apply to the same transaction at ann's length between strangers free of any element of self-dealing, divided loyalty, or conflict of interest. Thus, by way of illustration and not of limitation, the Trustee is authorized, without giving any notice required by statute, to: (1) Employ and compensate the Trustee or any affiliate as broker, agent, or professional advisor for any purpose. (2) Borrow from the commercial department of its Trustee or any affiliate at current interest rates. (3) Buy, retain, and sell any debt or equity security issued or underwritten by the Trustee or any affiliate and any debt security secured, supported, and/or otherwise enhanced by a letter of credit issued by the Trustee or any affiliate. (4) Buy, retain, and sell any security of any investment company or trust registered under the Investment Company Act of 1940 to which the Trustee or any affiliate renders services for compensation. -10- "".~IN" .. . . .~- " . .. \f;o'.' ~t;~' ~ ';l ;;i!t.;it1,"~.'.. "'f~s ~<~~ ; ~ >. ..': ~ f:r--.. . ~ " ~". / ~ - ~,"..: ,,-:~. --;: ~..~ ~~. ..a:.!- ._J.,,,"", _..".._~:;J~J_.........~~...>"",-, -..... :t;.~ (5) Buy property from or sell property to any beneficiary or Trustee acting hereunder or otherwise on arm's length terms. An "affiliate" means any entity which owns, directly or indirectly, an interest in the Trustee, any entity in which the Trustee owns an interest, directly or indirectly, and any entity in common control with the Trustee. ARTICLE IX: It is agreed that the Grantor during the Grantor's lifetime ARTICLE X: Trustee is authorized and directed to pay from the assets of "Trust A" all state and Federal estate, inheritance or succession taxes, together with all interest and penalties arising from said taxes, to the extent that the principal of this Trust is subject to any such taxes upon Grantor's death. ARTICLE XI: Any person who shall have died at the same time as Grantor, or under such circumstances that the order of deaths cannot be established by proof, or within thirty (30) days of Grantor's death, shall be deemed to have predeceased Grantor. Any person (other than Grantor) who shall have died at the same time as any then recipient of income or under such circumstances that the order of deaths cannot be established by proof, shall be deemed to have predeceased such beneficiary. -11- ----- . ~;' ~J .~ // ARTICLE XII: The Trustee shall be compensated for its services hereunder in accordance with its published fee schedule as in effect from time to time. Without the permission of any court the corporate trustee acting hereunder may resign by a writing lodged with the permanent records hereunder, effective (1) after thirty days' written notice to each adult income beneficiary and (2) a successor Corporate Trustee's execution of acceptance of appointment to act hereunder following the resignation. Such a successor corporate trustee may be located in or out of Pennsylvania and shall be appointed by the then acting trustees, including the corporate trustee who wishes to resign, even if such corporate fiduciary is then acting alone. IN WITNESS WHEREOF, CHAMPE C. POOL, has hereunto set his hand and seal, and PNC BANK, N.A. has caused this Agreement of Trust to be signed by its (Vice) President and its seal affixed, attested by its Assistant Secretary, and all on the day and year first above written. GRANTOR: d ~L~L U Am J;b- Witness ~~ e~(SEAL) CHAMPE c. OOL TRUSTEE: ATTEST: V~~ t. U (Assistant) Secretary B~~ (Vice) President (SEAL) -12- )l")-/ll'8 ~RUST~SE"AGREEMENT {;(Q)~~ I, Champe C. Pool, hereby create a trust with PNC Bank, National Association. as Trustee, and direct that the Trustee shall hold and invest the assets of this trust upon the following terms: 1. Payments of Income and Principal: -A. During my lifetime, Trustee shall pay the net income to me, quarterly, and Trustee may use all or part of the principal for my benefit or for the benefit of my wifelhusband andlor children. Trustee shall have no liability for any such payment made in good faith. B. On my death all undistributed principal and income shall (select one by placing your initials in box before clause desired): o be paid to my wife/husband, or if shelhe does not survive me, in equal shares to my children living at my death and to the issue living at my death of any of my children who predecease me, such issue to take the equal share my deceased child would have received if living. For the purpose of this paragraph. my wifelhusband shall be deemed to have survived me if the order of our deaths is not clear. or C c..f W be paid to my estate 2. Minors and Incapacitated Persons: Trustee need not pay income or principal to any person who is a minor or who Trustee believes is incapable of managing his or her own affairs. Instead, Trustee may use the income or principal to pay that person's expenses directly and, except for any trust held for my wifelhusband, may make payments without further responsibility to anyone having the care of control of that person. Trustee may hold unexpended funds payable to minors until they reach majority. Notwithstanding the above, all Income payable to my wifelhusband must be paid to, or applied directly for, herlhim at least quarterly. 3. Protective Provision: No interest in income or principal shall be subject to anticipation or assignment by a beneficiary, or available to anyone having a claim against a beneficiary, before actual payment to the beneficiary. 4. Trustee's Powers: In addition to the powers granted to Trustee by law, Trustee shall have the power to retain any property it shall receive hereunder; to invest as it sees fit in all forms of property Including any common trust fund operated by Trustee or an affiliate of the Trustee; to make distributions in cash or in kind; to borrow or pledge assets at my request; to settle disputes; to exchange or sell real or personal property publicly or privately for such prices as it deems proper and to hold investments in nominee name. S. Death Taxes: Unless my Will provides otherwise, any death taxes on my estate, including Interest and penalties, attributable to the principal of this trust shall be paid from that portion of such principal subject to the particular tax. 6. Additions: With the approval of Trustee, property may be added to this trust. .; ~.-= -E '/I Securi tit S Americ, l :&~ -~ ~ ~ovember 2,2005 Ms. Linda Lundberg, A VP =~ ~ J PNC Advisors - ~ E PO Box 1308 Camp Hill, PA 17011-0308 "Re: Champe Pool Dear Linda: As per our discussion, helow please find the information as requested. 1. ~~ 2. 3. Owner of Annui1y Date of Death Value of Annuity Beneficiary Champe Pool $488,199.88 Please see attached letter - _ .. If you have any questions, please do not hesitate to contact our office at (71 "2. 652-4965. "' Be~reg~~~~. Co. ~. Weaver, Sr., CFP - .~~ ~ _€- Certified Financial Plantler - Corporate Securities Representative Certified Fund Specialist -~- SC\Y/de Attachment .-..;: E ,.~; Scott C. Weaver, Sr., CFS, (:FplIlI Broncll Manager SecurItIes AmerfCz, Inc:. .3511 North Front 51 .- reet. HamsbufT} PA 77110. ~ . (717) 652.4965. (88B) 545-8764 F. ' r;;-mall: sdanl182@aol Com . JK: (717) 652-3955 .' Membflr NASDIS/PC if ....;IJ. ';.f~.~:,1:....2...._~05 . ..C'.~ ..E:=- , '.. .- , ~ ',' (J'J~Jc. r=",. .i-~~ ---- i .:.~ ..... a... ~ =.,' C '-'~.:' -- .- - . .:.- ..?IF . :.~ f it:; j#q ~ c# ....& .; .~.. ~':'.'.'." ..... - - , - . - -- -.. 10:16 71 76523965 SCOTT WEAUER PAGE 02/02 ING~) '-'., - .::= ~4 4/17/02 ~. . Champe C. Pool 514 Albright Drive :.. Mechanicsburg, P A 17055 -:!L '. Scott C. Weaver Sr Securities America, Inc 3820 Walnut Street Harrisburg, PA ) 7i09 .:. ~'- -:".:' ,# ;, ~F ff~ f:. . ~.contract Number: 1070649-0W ~~ . '-'~", '" Name jFC '.C: - '. .~. ~ Trust of Champc C. Pool Dtd = 3 ~ 2/12102 Rev Liv Trost - c,.~ ~.~ #23-7949226 - - .~./ William C. Pool .~, Clark R. Pool James H. Pool :~/ :#- ~~ -:.~ -:::. ..;.;..:..--~. - "". ~';O .~ . -- '- ",,'~ dE' . ';f# - r.# ~ --- ..::: =.. +K~ ~ F ~._;=. :C~)-- Dear Mr. Pool, ::.. We'd like to le(yc.u know that your beneficiaries have ~?cn changed according to your request '" ~ Percentage 100% Desigii'ation Primary 33 1/3% 33 1/3% 33 1/3% Contingent Contingent Contingent ~ ""~= 'c..:e' We appreciate the opportunity to serve your investment needs and loole forward to a long F" ~.. and successful relationship with you. If you have any questions or comments, please call ~ % .~ '0 ~F"- our Customer ConJ:act Center, toll-free, at 1 (800) 366 - 0066, Monday through Friday, i' ~.~ 8:00 a.m. to 8:00 p.m. (5:30 p.m. on Fridays), Eastern Time. . c; _ .....,..,. ~ .. :if , ~ _ -.:-- .. F ~..;E"#, ,'jT .,. .~ "f<:; ~~<; ; ~tY'~. .. ;;c ~ ..... ,/ ~.- *'..l-~ 75 Dunwoocly Drive ~ :;. Wesl Chcsrc:r. ?A 19380.,478 .",.';.d~ .-2 Ie .::- i"E -=- ~ ~- t:i E_k ~ . Sincerely, ~. //1 Zach Martin ~. Variable Post Issue Customer Service Dept clientscr,yices@ingva.com ~# ':';:- .ft' IN(; hrl'eSf1III,nl PrOdIlC{I' tli~l)'i.bu'ed lTy Dil'caed ServicC!.~. In.c.,memo NASD 17/t' (-"ltlll'/JII)' } '(IJI "f(,l'~ !)ecL'l1lhLT I. ='IJ(J) \JarioriL' K. Pool (() P!\(' Bank. Trustee P{) Bo\~ OR ((lfl1pllill.J>,\ 17001 Annuitv #:'iSC)85(l61 Deceased: ('h,lmpe Pool rkar [VII's. Pool r am pleased to reply to your request For tax information on tht.' above annuity. Since Form 712 is not applicable for a contract other than life insurance. the I'ollowing should be of assistance to you: Annuity #: 58085661 Issue Date of Annuity: 02/17/1998 Cash Value as of date of death: 10/1212005 $ 96.985.26 This Deferred Retirement Annuity was issued to the decedent providing for life income payments to commence at a future elate of maturity. I hope this information \vill be helpful to you. If you l1(\ve any questions. please cont,lct our VariabJc Product Service Center at 1-800-598-2019 Sincerely. ~va Ma Eva Ma Senior Service Associate VarIaole products are offered through properly licensed registered representatives of NYLlFE Securitle.s Inc (memoer NASD/SIPC). 'i I Madison Avenue. New York. NY 100 I () l~~ NEW YORK LIFE INS. AND ANNUITY 51 MADISON AVENUE NEW YORK, NY 10010 EXPLANATION OF BENEFITS PLEASE DETACH AND SAVE FOR YOUR RECORe 0780 CHECK NO: 0001604882 NOVEMBER 29, 2005 /... /I /.11/" III" 1111111/ /I 1111111 III 1111111. 11111/.1/1111.1/ MAJORIE K. POOL 151 C/O PNC ADVISORS, PO BOX 308 CAMP HILL, PA 17001-0308 POLICY NUMBER: 58085661 CLAIM NUMBER: 911190 INSURED: POOL CHAMPE PAYEE MARJORIE K. POOL 325 WESLEY DR. APT 119 MECHANICSBURG PA TAXABLE GAIN 72,362.99 TOTAL AMOUNT DUE PAYEE 97,362.99 FEDERAL TAX WITHHELD 0.00 STATE TAX WITHHELD 0.00 PAYMENT AMOUNT 97,362.99 IF YOU HAVE ANY QUESTIONS OR REQUIRE FURTHER ASSISTANCE, PLEASE CONTACT OUR VARIABLE PRODUCT SERVICE CENTER AT 1-800-598-2019 ..~~~~.........................................................................................................................................................................................................................................- ,',I," J<""' <)i>-" NEW YORK LIFE INS. AND ANNUITY ' 51 MADISON A Vf:NUE ~~~- ~:i-:> NEW YORK, NY 10010 ''tv if; .. FGAur; ;-C";::-;,.i , 'Z~; s:-: , ,.;- :,; <__"-~:~:i".""~~~'i:,,}^~:i:€;;';';",l'_:i;,;.~~~j',:~;,:,,,c: ,',-" ~ A Y THIS MOUNT AYTO RDER OF: ,/<'" ,,,;,:,i',:';,',':,)" '" ,;);:::.,,1:,.:,,:',;:, :;;?'ii;'.":' ':1"::';;'::':;':' NINETY-SEVEN THOUSAND THREE HUNDRED SIXTY- MARJORIE K. POOL 325 WESLEY DR. APT 119 MECHANICSBURG PA 17055 JP Morgan Chase Bank, N.A.6040 Tarbell Road, Syracuse, NY 13206 11.000 . bO ~88 211. 1:0 2 .:l0 ~:l7 ~I: bO .8807 b811.