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Home My WebLink About09-28-06 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 PETERS SHARON 1 60 ASPEN DRIVE DILLSBURG, PA 17019 u____u fold ESTATE INFORMATION: SSN: 175-03-5896 FILE NUMBER: 2106-0856 DECEDENT NAME: BUSHYAGER GENEVIEVE M DATE OF PAYMENT: 09/28/2006 POSTMARK DATE: 09/27/2006 COUNTY: CUMBERLAND DATE OF DEATH: 07/01/2006 NO. CD 007265 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $23,885.83 I I I I I I I I TOTAL AMOUNT PAID: $23,885.83 REMARKS: BUSHYAGER GENEVIEVE M CHECK#1715 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WillS GLENDA FARNER STRASBAUGH REGISTER OF WILLS .1 1 ,i I ("') ~O()::o ::ozc:m ,mS:G) _()m- faom~ mc:::om ;,~>::o )>::I:ZO -,,0011 -...JC:()~ ~CI>O- wmc:F C1>zen D=<!O ~()=H ::00- mc:() ::om -t ::I: o c: en m :0 '. <:l~ 1-0.: 0:: - LL ~ C,) 090 L)O ~U)7- 0:- --- LtJ Z <'..~ -lS-- C> ...L L. 0- L-w a:o:::l 0::2 a ::c: D- ,:) co N 0- W (/) 1"'- i:~ ,.'? r:~5 l.U I:C '-oD c;.-:j co;) ("oo.J ~ 03 \.01 ~:t~ ~Z~ ~V1'" t=r1 ~ ~ ...... ~ ..... m :-0 '-'" = 9 ~ s: 8 '-'" S] 8 o::l s:::: z 0 = p:i :>< > ::>:l <.0 '"'::I ...... ::>'1 = ~ > <.0 en -l ::>:l t'I"1 ~ ." -- U1 ... o - D) tn tn s: D) -- - IW- .-:. d ~ 00 ~gN hi A.... 0(.0))> .,,0) ::000 o~ ~O) N =0 (J) ~ Om 0-0"- ~N JERRY R. DliFFIE RICHARD W. STEWART C. ROY WEIDNER. fR E[)!\ICND G. MYERS DAVID W DELuCE 1011'1 A. STATLER JEFFERSON J. SHIP!\IAN RAI.PH H. WRIGHT. JR MARK C. DUFFIE lOHN R. NINOSKY i\lICHAEL I CASSIDY MELISSA PEEL GREEVY ROBERT M. WALKER WADE D. MANLEY ELIZABETII D. S\JOVER KELI.Y L. BO!\iANNO OF COUNSEL HORACE A. JOHNSON LAW OFFICES JOHNSON DUFFIE F. LEE SHIPMAN (1965-2006) WrUTER'sEx'l'. No. 11.1 E'1\:1AIL dlwzii;jdsw.com September 26,2006 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 o S;o ~~~o ~: ~~ 93 ~C.?" (/) ~ '-.~J (; C) () 0" F)S5 -l ~ r-.....> c::::> c:::;> 0"' (/) rr1 -0 N co -0 :;: c-, ':::''''1 :'.~~I C) [II - .. -..# J N RE: Estate of Genevieve M. Bushyager Our File No. 11682-2 Dear Register: Enclosed for filing please find the following documents for the above referenced decedent: 1. 2 Original PA Inheritance Tax Returns showing tax due in the amount of $23,885.83. This payment also represents the three-month prepayment along with the filing of the Return, in order to qualify for the discount. 2. 2 copies of Pages 1 & 2 of the Pa Inheritance tax return, which we ask that you time..stamp and return to us in the enclosed envelope. 3. Check attached to this correspondence in the amount of $15.00 representing title filing fee for the Inheritance Tax Return. This Estate will need to be assigned a File No. There was no need to probate the decedent's Will due to all assets passing into a Trust. Should you have any questions, please do not hesitate to contact our office. Thank you for you assistance in this matter. Very truly yours, ~~~DNER Dana L. Wieseman Estate Administration Paralegal c: Sherry Peters, Trustee :283905 . 301 MARKET STREET PO. BOX 109 LEMOYNE. PENNSYLVANIA 17043-0109 WWW.JDSW.COM 717.761.4540 FAX: 717.761.3015 MAIL@JDSW.COM JOHNSON, DUFFIE, STEWART & WEIDNER, p.e. REV-1500 EX + (6..00) , , '. w .... :ll::!1Il Ull::ll: wILU :l:og Ufm IL ol( OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT .- z w o w (J w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Bushyager, Genevieve M DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) FILE NUMBER II 2006 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 175-03-58~6 NUMBER THIS RETURN MUST' BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o o o 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 301 Market Street P.O Box 109 Lemoyne, PA 17043 (1 ) (2) (3) (4) (5) (6) (7) None None None None None None 587,446.17 OFFICIAL USE ONLY (") c 'c.l--O ?iq~ :J~P .~:~~~ .:::J C) n ') 0 :'fl C)c: :.0 --/ 't> (8) (11 ) (12) (13) (14) 15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) z or transfers under Sec. 9116(a)(1.2) 0 (16) j:: 16.Amount of Line 14 taxable at lineal rate 558,732.94 x .045 ~ :;) 0. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :liE 0 (J 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18) )( x ~ 19. Tax Due (19) o 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) [!] 7. Decedent Maintained a Living Trust (Attach copy of Trust) D 10 SpOusal PovertY Credit (date of death between 0 11. Election to tax under Sec. 9113(A) (Attach Sch 0) . 12-31-91 and 1-1-M) THIS SECTION MUST BE COMPLETE[)~AL.I.CORRESPONt)ENCE ANocONFiDENTJAL.fAXiNFORNlA1l0NSHOULD E.OIRECTEOTO: NAME COMPLETE MAILING ADDRESS DAVID W DELUCE 07 -01-2006 02-21-1914 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) o 1. Original Return o 4. Limited Estate [!] 6. Decedent Died Testate (Attach copy of Win) o 9. Litigation Proceeds Received .... z W Q Z o IL 13 II: II: o U FIRM NAME (If applicable) Johnson, Duffie, Stewart & Weidner TELEPHONE NUMBER 717-761-4540 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o j:: S ::) .- a: 0( o w a::: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or l) 0 Separate Billing Requested 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (line 8 minus line 11) (9) (10) 14,800.98 13,912.25 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >> BESURErO AN$WE~AL.!;.QI.IES:T'I0NSON.~~VERSESIO~~",[)~ECHECI(MAT"'<< Copyright 2002 form software only The Lackner Group, Inc. ,....., <=) c..":::> c;:r, (/) fT1 -0 N CO -0 ----:::1" -lii.. (.oJ 587,446.17 28,713.23 558,732.94 0.00 558,732.94 0.00 25,142.98 0.00 0.00 25,142.98 Form REV-ISOO EX (Rev. 6-00: ~ Decedent's Complete Address: STREET ADDRESS Bridges At Bent Creek CITY Mechanicsburg ISTATE PA IZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 25,142.98 1,257.15 Total Credits (A + 8 + C) (2) 1,257.15 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 23,885.83 23,885.83 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.................................................................................. 0 ~ :: ~::::~ ~h~e~~:i~on:~:~~~:s~~~. .~.~.~.I~. ~~~. ~~~. :.~~.~.~.~ .~~~~~~~~~~. ~.~ .i.~~. ~~~~~~~:.':"""" ..........: ..:........ .......... .......... .............. B &J d. receive the promise for life of either payments, benefits or care?.............................................................. 0 D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............... ....... .... .... ... ................ ............... ..... ............ .... ........ .... ....... ... ...... ...... 0 [!J [!] D 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?..................................................................................................................... D [!] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that' have examined this return, including accompanying schedules and statements, and to the best of my knowledge and beNet, It is true, correct and complete. De.claration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Sharo l Peters DATE 160 Aspen Drive Dillsburg, PA 17019 Q~ou ADDRESS DATE ~ , ADDRESS 301 Market Street lemoyne, PA 17043 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of trans~ers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P .5. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or 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 deatM 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)[72P.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 ~) (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. R.v.1&10 EX+ (6-98) , *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Bushyager, Genevieve M FILE NUMBER 21-2096- ESTATE OF 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 DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APfI'lICABLE) VALUE THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE. THE GENEVIEVE M. BUSHY AGER REVOCABLE LIVING TRUST AGREEMENT DATED AUGUST 26,2002 1 First Commonwealth Bank - Savings Account 1.452.34 1.452.34 No. 2202-041506 2 First Commonwealth Bank - Certificate of 16.924.13 16.924.13 Deposit Account No. 0221-010-0000360 3 NationaJ City Bank of Pennsylvania - Classic 2.956.68 2.956.68 Choice Account 4 National City Bank of Pennsylvania - 18 Month 38.753.44 38.753.44 Certificate of Deposit Account 9025549288 5 National City Bank of Pennsylvania - 18 Month 38,753.44 38.753.44 Certificate of Deposit Account 9025549327 6 National City Bank of Pennsylvania - 18 Month 42.827.47 42.827.47 Certificate of Deposit Account 9025549369 7 National City Bank of Pennsylvania - 48 Month 7.301.43 7.301.43 Certificate of Deposit Account 9025583150 8 National City Bank of Pennsylvania -120 Month 1.278.59 1.278.59 Certificate of Deposit Account 8620003201 9 National City Bank of Pennsylvania - 120 Month 7.123.41 7.123.41 Certificate of Deposit Account 3995004383 10 Penn Trafford School Employees FCU 9.094.05 9.094.05 Total of Continuation Schedule(s) ~ee attached page TOTAL (Also enter on Line 7, Recapitulation) 587.446.17 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) Rev-1610 EX+ (6-98) , '* SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY continued COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Bushyager, Genevieve M FILE NUMBER 21-2006- ESTATE OF ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE. 11 PNC Bank Certificate of Deposit 9.230.95 9.230.95 12 PNC Bank Interest Checking Account 2.258.46 2.258.46 13 PNC Bank Performance Money Market Account 52.358.32 52.358.32 14 Residence located at 1021 N. 3rd Street, 86.000.00 86.000.00 Jeanette, PA - Property sold on July 7,2006. A copy of the Settlement Sheet is attached to this Return 15 4,992.253 units of State Farm Insurance Mutual 259.796.85 259.796.85 Fund Account - Growth Fund 16 Blue Cross Reimbursement 334.36 334.36 17 Medicare Reimbursement 465.98 465.98 18 Pension Payment 773.32 773.32 19 Reimbursement at sale of Residence for property 354.10 354.10 taxes paid - CitylTown Taxes and County Taxes Reimbursed 20 Reimbursement to Trust for Long Term Care 9.408.85 9.408.85 Insurance TOTAL (Also enter on Line 7, Recapitulation) 587.446.17 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1161 EX+ (12-89) , , *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bushyager, Genevieve M Debts of decedent must be reported on Schedule I. FILE NUMBER 21-20 6- ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 8,235.98 B. ADMINISTRA TIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees Johnson, Duffie, Stewart & Weidner 5,000.00 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 1,000.00 7. Other Administrative Costs 565.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 14,800.98 Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule H (Rev. 6-98) -1- , Rev-16D2,EX+ (6-98) * SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bushyager, Genevieve M FILE NUMBER 21-2006- ITEM NUMBER DESCRIPTION AMOUNT 1 Funeral Luncheon 518.32 2 Mason Gelder Funeral Home 6.836.16 3 Opening and Closing of Crypt at Mausoleum 590.00 4 Zanarini Posey Shoppe - Flowers for Funeral Service 291.50 Subtotal 8.235.98 Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule H-A (Rev. 6-98) , Rev.1602lX+ (6-9S) * SCHEDULE H.B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bushyager, Genevieve M FILE NUMBER 21-2006- ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland County Register of Wills Office - Filing Fees for Inheritance Tax Return 15.00 2 Reserves: Close out Costs 550.00 Subtotal 565.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1612 EX. (1-98' . '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bushyager, Genevieve M FILE NUMBER 21-2006- Inclllde IInrelmblll'lled medical expenses. ITEM NUMBER DESCRIPTION 1 Alleghany Power VALUE AT DATE OF DEATH 1.74 2 Apex Medical Services 75.80 3 Columbia Gas 24.21 4 Doerzbacher Lawn Service and Landscaping 69.00 5 Federal Express Charges for Sale of Property 77.39 6 PA Department of Revenue - Estimated Payment for 3rd Quarter 500.00 7 Radiologists Consultants, L TO 9.74 8 ROBC Limited Partnership - The Bridges at Bent Creek Assisted Living Facilities 151.16 9 Settlement costs against the sale of Decedent's Residence 9.503.21 10 U.S Treasury - Estimated Payment for 3rd Quarter 3.500.00 TOTAL (Also enter on Line 10, Recapitulation) 13,912.25 (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule I (Rev. 6-98) REV 1613 EX+ (1-00) , '*' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 1 Bushyager, Genevieve M NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS ~nclude outright spousal C1istributions, and transfers under Sec. 9116(a)(1.2)) The Genevieve M. Bushyager Revocable Living Trust 160 Aspen Drive Dillsburg, PA 17019 RELATIONSHIP TO DECEDENT Do Not LIIIt Trusteelsl FILE NUMBER 21-2006- SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) NUMBER I. Trust Total I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropnate, 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) ESTATE OF GENEVIEVE M. BUSHYAGER SCHEDULE OF EXHIBITS ExHIBIT A Copy of the Last will & Testament of Genevieve M Bushyager signed on August 26, 2002. This Will was not probated and was not required to be probated as all assets passed outside of the Will.. EXHIBIT B Revocable Living Trust Agreement signed August 26, 2002 with Certificate of Trust EXHIBIT C First Commonwealth Bank Value of Account at Date of Death. EXHIBIT D National City Bank of Pennsylvania Value of Account at Date of Death. EXHIBIT E Penn Trafford School Employees FCU Value of Account at Date of Death. EXHIBIT F PNC Bank Value of Account at Date of Death. EXHIBIT G Settlement Sheet for Sale of Decedent's Property located at 1021 North 3rd Street, Jeanette, P A. EXHIBIT H State Farm Insurance Mutual Fund Account Value of Account at Date of Death. :283771 EXHIBIT A LAST WILL AND TESTAMENT (pour-Over Will) OF GENEVIEVE M. BUSBYAGER IDENTITY I, GENEVIEVE M. BUSHY AGER, residing in the County of Westmoreland, Commonwealth of Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other former Wills and Codicils to Wills heretofore made by me. My Social Security Number is 175-03- 5896. I have the following children: Susan A. Jordan, born Deceased, and Barry J-: Bushyager, born August 23, 1942, and Sherry Peters, born July 9, 1949. DEBTS, TAXES AND ADMINISTRATION EXPENSES I have provided for the payment of all my debts, expenses of administration of property wherever situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other than any tax on a generation-skipping transfer that is not a liability of my Estate (including interest and penalties, if any) that become due by reason of my death, under THE GENEVIEVE M. BUSHY AGER REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust"). If the Revocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items from the residue of my Estate passing under this Will, without any apportionment or reimbursement. In the alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary to pay all or part of these items, plus claims, pecuniary legacies, and family allowances by court order. PERSONAL AND HOUSEHOLD EFFECTS It is my intent that all my personal and household effects were transferred to the Revocable Trust as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me this date in accordance with the provisions of the section titled "Residue of Estate." RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devices), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of the execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance with the provisions of the said Trust, including any amendments thereto made before my death. If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under POUR-OVER WILL Page 1 Testatrix said Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their substitutes and successors under the Trust, described herein above, to be held, managed, invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to the period beginning with the date of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any, hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. EXECUTOR I hereby nominate and appoint Barry J': Bushyager to serve without bond as my Independent Executor of this my Last Will and Testament. In the event the fITst named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint Sherry Peters to serve without bond as my Independent Executor. Whenever the word "Executor" or any modifying or substituted pronoun therefore is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally named herein. EXECUTOR POWERS By way of lllustration and not of limitation and in addition to any inherent, implied or statutory powers granted to executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind of partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry out the purpose of this my Will, without being limited in any way by the specific grants or power made, and without the necessity of a court order. My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others. In determining the Federal Estate and Income Tax liabilities of my Estate, my Executor shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my Estate shall be used as Federal Estate Tax deductions or as Federal mcome Tax deductions. POUR-OVER WILL Page 2 Testatrix SPECIFIC OMISSIONS I have intentionally omitted any and all persons and entities from this, my Last Will and Testament, except those persons and entities specifically named herein. If any person or entity shall challenge any term or condition of this Will, or of the Living Trust to which I have made reference in the sections "Household and Personal Effects" and "Residue of Estate," then, to that person or entity, I give and bequeath the sum of only one dollar ($1.00) only in lieu and in place of any other benefit, grant, bequest or interest which that person or interest may have in my Estate or the Living Trust and its Estate. S~TANEOUSDEATH If any other Beneficiary should not survive me for sixty (60) days, then it shall be conclusively presumed for the purpose of this my Will that said Beneficiary predeceased me. A A~ ~,,;v.7;7 7:: 1.-// /GENEVIEVE M. BUSHY AGER . Testatrix This instrument consists of 5 typewritten pages, including the Attestation Clause, Self-Proving Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at the bottom of each of the ACeding pages. This instrument is being signed by me on this 2.'~ day of a.A.l.. . l..O~ z.. POUR-OVER WILL Page 3 ATTESTATION CLAUSE The Testatrix whose name appears above declared to us, the undersigned, that the foregoing instrument was his/her Last Will and Testament, and he or she requested us to act as witnesses to such instrument and to his/her signature thereon. The Testatrix thereupon signed such instrument in our presence. At the Testatrix's request, the undersigned then subscribed our names to the instrument in our own handwriting in the presence of the Testatrix. The undersigned hereby declare, in the presence of each of US, that we believe the Testatrix to be of sound and disposing mind and memory. Signed by us on the same day and year as this Last Will and Testament was signed by the Testatrix. WITNESSES: ADDRESSES: ~,;f)J~(f;;~/tL/~J (it.A-I3--!J; ~~ t/ lS~ it/. LIl nted Na ofWltness) ///0 7l;;;~~ ~~,/l ~~</y ~ty, State, Zip ~ 6', ~/~ nQ /'IOZhv' 7-A E a.~ / .11-!1 (Printed Name clfWitness) 1..-,/7 w- . ~ L,/tf't: //'.~/L//~7k/"' ... ./ ~ ~ I ~pd.zY;'/ ~:. ./..~?1)4 Ci ,State, Zip / II POUR-OVER Wll..L Page 4 Testatrix COMMONWEALTH OF PENNSYLVANIA COUNTY OF WESTMORELAND SELF-PROVING CLAUSE BEFORE ME, the undersigned authority, on this day personally appeared GENEVIEVE M. IJUSHY AGER, (J1/d'1. L. U.I' (. L (.,/ L.,"l and D (3 tLC 'rii 7 rC-- € ,..J I J G- . known to me to be the Testatrix and the witnesses, respectively, whose names are subscribed to the foregoing instrument in their respective capacities, and all of them being by me duly sworn, GENEVIEVE M. BUSHY AGER, Testatrix, declared to me and to the witnesses, in my presence, that the instrument is his/her Will and that he or she had willingly made and executed it as his/her free act and deed for the purposes therein expressed; and the Witnesses, each on his or her oath, stated to me in the presence and hearing of the Testatrix, that the Testatrix had declared to them that the instrument is his Will and that he or she executed the same as such and wanted each of them to sign it as a witness; and upon their oaths, each witness stated further that he or she did the same as a witness in the presence of the Testatrix, and at his request and that he or she was at that time eighteen (18) years of age or over and was of sound mind, and that each of the witnesses was then at least fourteen (14) years of age. ;). ~~ _~1~ " ,,' ""'-J"/' r GENEVIEVE M. BUSHY AGE Testatrix L.J(~ a r j. e e of Witness) 4~~C' ~ Witness '. . ~ ~,() rd-th 1- 1;. E LtJ II} 3. 'nted Name of Witness) . SUBSCRIBED AND ACKNOWLEDGED before e by GENEVIEVE M. BUSHY AGER, Testatrix, a{td subscribed and sworn tq before me by ;1/l L d " I J' It' L l.( '- A and f( "0 6 ,( ~ 't1'I7 E... E tA.J {';6- , witness s, this the day of l..( ~ · ~c:)"2.. . 'OL,,,-... =t"'.IY~Y]:t!2~!;0~..Qp';we~!th~f Pennsyl ania [NOTARIAl SEAL -., JOSEPH G MARCOLY. NOTARY PUBliC INDIANA BORD.INDlANA COUNTY ~y., COMMISSION EXP'RE~ SEPT. 15 2003 , POUR-OVER WILL Page 5 EXHIBIT B REVOCABLE LIVING TRUST AGREEMENT A .:IPS AGREEMENT AND DECLARATION OF TRUST, made effective the .l (,crl.. day of ~ 20DL . by GENEVIEVE M. BUSHYAGER, Grantor, Settlor and Trustee, who resides at 1021 N 3rd Street, Jeannette, County of Westmoreland, Commonwealth of Pennsylvania, does hereby establish a Trust upon the conditions and for the purposes hereafter set forth. WITNESSETH: WHEREAS, in order to provide the future comfort and security to himself and the other beneficiaries hereafter mentioned, Grantor desires to create a revocable trust for the purposes hereinafter set forth; ARTICLE ONE Terms of the Trust Section 1.01 - Trust Estate Defined NOW, THEREFORE, in consideration of the premises and of the Covenants herein contained this Revocable Trust is formed to hold title to real and personal property for the benefit of the Settlor of this Trust and to provide for the orderly use and transfer of these assets upon the death of the Settlor. The "Trust Estate" is defmed as all property transferred or conveyed to and received by the Trustee held pursuant to the terms of this instrument. The Trustee is required to hold, administer, and distribute this property as provided in this Trust Agreement. The name of this Trust Agreement shall be: THE GENEVIEVE M. BUSHY AGER REVOCABLE LIVING TRUST AGREEMENT DATED --L1 u.' . 2,',20 " z..,. Section 1.02 - Definitions of Terms As used in this Trust Agreement: 1. The term "Settlor" shall mean GENEVIEVE M. BUSHY AGER. 2. The term "Descendant" shall mean the lawful issue of a deceased parent in the line of descent, but does not include the issue of any parent who is a descendant of the deceased person in question and who is living at the time in question. 3. The terms "Child" and "Descendant" include any issue born to decedent, a child legally adopted by the decedent, and a posthumous child of a decedent. A posthumous child is to be considered as living at the time of his or her parent's death. 4. The term "Survives" or "Surviving", unless otherwise indicated herein, shall be construed to mean surviving the decedent for at least sixty (60) days. lfthe person referred to dies REVOCABLE LIVING TRUST AGREEMENT Page 1 within sixty (60) days of the death of the decedent, the reference to him or her will be construed as if he or she had failed to survive the decedent; provided, however, that any such person will have, during such period, the right to the use and enjoyment as a life tenant of all property in which his or her interest will fail by reason of death during such period. 5. The term "Issue" will include all natural and adopted children, if applicable, and descendants and those legally adopted into the line of descent. 6. The term "Per Stirpes" means strict per stirpes and does not mean per capita with representation. Beneficiaries entitled to take under a "per stirpes" clause will include both natural and adopted children and their descendants. 7. The terms "Trust Assets" and "Trust Estate" include all assets of any trust created hereunder and income derived from such assets and all proceeds of any description derived from the sale, exchange, or other disposition of such assets. 8. When required to give reasonable effect to the context in which used, pronouns in the masculine, feminine, or neuter gender include each other, and nouns and pronouns in the plural or singular number include each other. Section 1.03 - Trustee Designation Settlor is hereby designated as Trustee. The term "Trustee" as used in this Trust Agreement shall refer to Settlor so long as he or she serves as Trustee, and/or to any successor Trustee who assumes the role of Trustee. These Trustees shall serve in the order as provided in Section 8.01 of this Trust Agreement. Section 1.04 - Additions to Trust Properties 1. The Trustee, at any time during the continuance of this Trust in his or her sole discretion after consideration of the possible tax consequences to all concerned, is authorized to receive into the Trust additions of cash and other properties from any source whatsoever, whether by gift, will, or otherwise. However, the Trustee shall accept all assets which any person or persons may give, devise, or bequeath by Last Will and Testament to this Trust, and shall accept all assets transferred to this Trust pursuant to the provisions of any other Trust document or documents. 2. In addition, any person or persons may designate this Trust as the Beneficiary, Primary or Contingent, of any death benefits to include insurance benefits, pension benefits, or other benefits. Until such benefits mature, the Trustee shall have no responsibility with respect to those benefits. Section 1.05 - Apportionment The Trustee of the Trust is directed to apportion receipts and expenditures of the types described below between principal and income as follows: 1. Whenever the principal, or any part thereof, of the Trust property is invested in securities purchased at a premium or at a discount, any premium will be charged against principal and any discount will be credited to principal; REVOCABLE LIVING TRUST AGREEMENT Page 2 2. Any stock dividends and rights to purchase additional stock issued on securities held in trust will be treated as principal. All other dividends, except liquidating distributions, will be treated as income; and 3. The amount of any applicable depletion allowance for federal income tax purposes will be treated as Income. Section 1.06 - Discretionary Termination The Trustee may terminate any Trust when, in the opinion of the Trustee, the principal is reduced to such an extent that it is not in the best interest of the Beneficiary or Beneficiaries to continue the Trust. The judgment of the Trustee with respect to this decision to terminate will be final and not subject to judicial review. If the Trustee terminates a Trust according to this Section, the date the Trust terminates will be deemed the date fixed for termination of the Trust, and the Trustee will distribute the assets of the terminating Trust to the Beneficiary or Beneficiaries pursuant to this Agreement. Section 1.07 - Amendment and Revocation At any time during the life of the Settlor, the Settlor may, by a duly executed instrument filed with the Trustee: 1. Amend this Trust Agreement in any manner; and/or 2. Revoke this Trust Agreement in part or in whole. If the Trust Agreement is revoked in whole, the Trustee shall transfer title to all Trust property of every kind and description back into the individual name of the Settlor. The instrument of amendment or revocation shall be effective immediately upon its proper execution by the Settlor, but until a copy has been received by a Trustee, that Trustee shall not incur any liability or responsibility either (i) for failing to act in accordance with such instrument or (ii) for acting in accordance with the provisions of this Trust Agreement without regard to such instrument. 3. Withdraw from the Trust Estate all or any part of the principal and accumulated income of the Trust to satisfy liabilities lawfully incurred in the administration of this Trust. Section 1.08 - Revocation or Alteration by Settlor Alone The rights of revocation, withdrawal, alteration, and amendment reserved in this Article may only be exercised by the Settlor and may not be exercised by any other person, including an agent, a guardian, or a conservator. Section 1.09 - Irrevocability Except as otherwise provided, on the death of Settlor, the designation of Beneficiaries of specific gifts in this Trust shall become irrevocable and not subject to amendment or modification. Section 1.10 - Settlor Powers The Settlor shall be the Trustee unless and until he or she resigns in writing or is determined incompetent under the terms provided herein. The Settlor shall retain all absolute rights to discharge or replace any Successor Trustee so long as the Settlor is competent. REVOCABLE LnnNG TRUST AGREEMENT Page 3 ARTICLE TWO Trust Administration Section 2.01 - Trust Income During the life of the Settlor, the Trustee shall at least annually, unless otherwise directed by Settlor in writing, pay to or apply for the benefit of Settlor, all of the net income from the Trust Estate. Section 2.02 - Protection of Settlor in Event of Incapacity During the life of the Settlor, should Settlor become incapacitated as defined in Section 2.03 below, the Trustee may, in the Trustee's absolute discretion, pay income and principal for the benefit of the incapacitated Settlor, and may pay to or apply for the benefit of that Settlor such sums from the net income and from the principal of the Estate of the Trustee, in the Trustee's absolute discretion, believes is necessary or advisable for the medical care, comfortable maintenance, and welfare of the Settlor. Section 2.03 - Incapacity In the event that any Trustee or any Beneficiary hereunder comes into possession of any of the following: 1. A jurisdictionally applicable court order holding the party to be legally incapacitated to act on his or her behalf and appointing a guardian or conservator to act for him or her; or 2. Written certificates which are duly executed, witnessed, and aclmowledged of two licensed physicians, each certifying that the physician has examined the person and has concluded that, by reason of accident, mental deterioration, or other cause, such person has become incapacitated and can no longer act rationally and prudently in his or her own financial best interest; or 3. Evidence which such Trustee or Beneficiary deems to be credible and currently applicable that a person has disappeared, is unaccountably absent, or is being detained under duress, and that he or she is unable to effectively and prudently look after his or her own best interests, then in that event and under those circumstances: a. Such person is deemed to have become incapacitated, as that term is used in this Trust agreement; and b. Such incapacity is deemed to continue until such court order, certificates, and / or circumstances are inapplicable or have been revoked. A physician's certificate to the effect that the person is no longer incapacitated shall revoke a certificate declaring the person incapacitated. The certificate which revokes the earlier certificate may be executed by either the original certifying physician or by two other licensed, board certified physicians. No Trustee shall be under any duty to institute any inquiry into a person's possible incapacity. The reasonable expense of any such inquiry shall be paid from the Trust Assets. Section 2.04 - Principal Invasion During the life of the Settlor, should the net income of assets contained in this Trust at the time of the Settlor's death be insufficient to provide for the care, maintenance, or support of the Settlor as herein defined, the Trustee may, in the Trustee's sole and absolute discretion, pay to or apply for the benefit of the Settlor or any of their dependents, such amounts from the principal of the Trust Estate as the Trustee deems necessary or advisable for the care, maintenance, or support of the Settlor. REVOCABLE LnnNG TRUST AGREEMENT Page 4 The foregoing instrument consists of , typewritten/handwritten pages including the signature of Witnesses, and acknowledgment of officer. I have signed my name at the bottom of each of the preceding pages. DATED this day of ~ ~" day of --L4 u, .. , 2.H & . J~. ~,--/~ .... ~:% /Il. ./ ~ "-'GENEVIEVE M. BUSHYAGER J (#f{ar~~~ Witness II/D - AL It 'rI~ 5,t Address .-1lA-;.)/oJ t:rt-t) A. J s-l if1 AH~-'7 e. ~LbYf Witness / //t7r:7;J'..%'~-1 \1~~d-.. Address ~:? /S~fL.1- COMMONWEALTH OF PENNSYLVANIA COUNTY OF WESTMORELAND This instrument was acknowledged before me on the .z t 'Il day of ----A.. Lt 6 · , Z e () 2.. , by GENEVIEVE M. BUSHY AGER as Settlor and Trustee to certify which witness my hand and seal of office. 1=0,',=,",,,- .... -- . NOTARIAl SEA'l"""'" ~.,~,_.~, JOSEPH G MAACQlY, NOTARY PUBliC INDIANA BORD.INDIANA COUNTY lAY.90ilI,lISSION EXPIRES g)'T. 15, j REVOCABLE LnnNGTRUST AGREEMENT CERTIFICATE OF TRUST THE GENEVIEVE M. BUSHYAGER REVOCABLE LIVING TRUST AGREEMENT DATED A &4'. '-~ . 20 ~ Z. The undersigned hereby certifies that I created a Revocable Living Trust. This Trust is known as THE GENEVIEVE ~ BUSHYAGER REVOCABLE LIVING TRUST AGREEMENT, dated the 2~ Y't.day of ~ ~. , z.o~ z... GENEVlEVE M. BUSHYAGER, Grantor, Settlor and Trustee, resides at 1021 N 3rd Street, Jeannette, County of Westmoreland, and Commonwealth of Pennsylvania. IT IS AGREED BETWEEN THE PARTIES HERETO AS FOLLOWS: Description of Trust The party hereto desires to confirm the establishment of a Revocable Trust on this date for the benefit of the Settlor and containing herein the following provisions: TERMS OF THE TRUST 1. The Settlor is designated as the Trustee to serve until her death, resignation, or incompetence. 2. Upon the end of the terms of the original Trustee, Barry v.: Bushyager is designated as First Successor Trustee. Sherry Peters is designated as Second Successor Trustee. TRUSTEE POWERS . 3. Any Trustee/Settlor has the power and authority to manage and control, buy, sell, and transfer the Trust property in such manner as the Trustee may deem advisable, and shall have, enjoy and exercise all powers and rights over the concerning said property and the proceeds thereof as fully and amply as though said Trustee were the absolute and qualified owner of same, including the power to grant, bargain, sell and convey, encumber and hypothecate, real and personal property, and the power to invest in corporate obligations of every kind, stocks, preferred or common, and to buy stocks, bonds and similar investments on margin or other leveraged accounts, except to the extent that such management would cause includability of an irrevocable trust in the Estate of a Trustee. TRUST ADMINISTRATION 4. Following the death of Trustee, the Trust will continue or be distributed in whole or in part for the benefit of other named Beneficiaries according to the terms of the Trust. 5. While Settlor is living and competent, except when there shall be a Corporate Trustee, Trustee may add money to or withdraw money from any bank or savings and loan or checking account owned by the Trust. CERTIFICATE OF TRUST Page 1 6. Unless otherwise indicated to a prospective transferee, the Trustee has full power to ~ansfer assets held in the name of the Trust. Subsequent transferees are entitled to rely upon such transfers provided that the chain of title is not otherwise deficient. 7. The Trust Agreement also states that any bank, corporation, brokerage firm, or other entity or individual, may conclusively presume that the Trustee has full power and authority over the Trust Assets and such person or institution shall be held harmless and shall incur no liability by reason of so presuming. 8. The situs of the Trust is the COMMONWEALTH OF PENNSYLVANIA. 9. The use of this Certificate of Trust is for convenience only and the Trust solely controls as to provisions and interpretations. Any conflict between this abstract and the Trust shall be decided in Favor of the Trust. IN WITNESS WHEREOF, the party has hereto executed this Summary of Trust this date. SETILORffRUSTEE ~ l . . ~ : z~~~/i2 ~, .~/ GENEVIEVE M. BUSHY AGER -;; COMMONWEALTH OF PENNSYLVANIA} COUNTY OF WESTMORELAND} ss. On this, the 2'...( day of ~ U, . '!A' &-, before me, a Notary Public, personally appeared GENEVIEVE M. BUSHY AGER, personally known to me to be the person whose name is subscribed on this instrument, and acknowledged that he/she executed it for the purposes herein expressed. otary Public, Commonwealth ofPennsyl i, NOTARIAL" SEAL , '; JUSEPH G MAACOLY, NOTARY PUBUC ; INDIANA BORO.INDlANA COUNTY J MY C9MMISSION EXPIRES SEPT i 5 1QQ3 CERTIFICATE OF TRUST Page 2 EXHIBIT C ..~ 'd ~ i a ~.ga ~ ~~ i a .. ~ - ~ n~~ ~ ~ ~g.Q ~ ~ .. "I!S S ~\ ;; ~ to ~ 8 9 ~~ ~(') leg ~~ '2. ~ i ~ \ - \. ~ { F> ,.. 1 ( >- a~~ .-.j loa \ ~a ~ t...l d ~ -J ~~d ~ c ~ a t7:1 r-' Mts1 ~ r- > ;Co (5) "'1 '\ , ~ -- I S .s- o'" ~ -C. -.-0 ~~~ \)\ ~ '" \ 0 - ;~Q \) - \S ~ ~t; x- CI ~~ -C:> c:'i.-\~ ~ a !!-~~n -.CI- ~ ~ 0 ~ a'~d ~'6'~ 'dS- ~~::! ~al ~S~ gO 90 I S2180 \10\1' 1 EXHIBIT D . en co "It ..J 0 ... ... ... N "It X 0 0 0 0 0 0 0 ~ ~ - - - - ~ it) CO) CO) CO) 0 ...... 0 0 0 - ~ 0 ~ 25 25 - - - - - 0 ... ... N 0> ... ... ... 0 0 0 "'0 ~ CO a. CI) .... a.. G) G) ,.... G) "It CI) CO) CO) CD "It .... "": ~ cD cD a) ,... co N N CO) cD N ... a ... N ... ... ... ~ .,. ~ ~ .,. ~ '> '-> ~ '> ~ -,.. 3 3 ,.... CO) G) ... ~ ~ It) "It cwi cwi ....: cD cwi It) It) N ... ,.... ,... Cll) 0 ,... N CO) N ... r;O r;O N ,..: ... ,..: CO) CO) ~ .,. .,. ~ ~ .,. ~ Z 0 ~ <C w w w w w w :E w w w w w w t; ~ ~ ~ ~ ~ 0:: en en en en en ~ ~ ~ ;:) ~ ~ 0 0:: 0:: 0:: 0:: 0:: 0:: LL ~ ~ ~ ~ ~ ~ Z - :I: ...... I- ~ - <C 0 w ...... w C) C NO:: NO:: NO:: NO:: NO:: ~ oW oW oW oW oW LL CDe" CDe" CD(!) CD(!) CDe" 0 ::c ~<( ~<( ~<( ~<( ~<( en o~ o~ o~ o~ o~ 0> X X X X X X W ~ CenwCenwCenwCenwCenwCenw ?- m ~~w~;:)w~;:)w~~w~~w~;:)w Cm~Cm~Cm~Cm~Cm~Cm~ <C :E ~~en~~en~~en~~en~~en~~en C en ~en ~en ;:)en ~en ~en ~ W co co ~wa::~wa::~wa::~wa::~wo::~w~ > 0') 0 o::>~o::>~o::>~o::>~o::>~o::>~ ~w ~w ~w ~w ~w ~w W CD 0 (!)> (!)> C>> C>> C)> C)> :> 10 N . ZW zw zw zw zw zw M ... >z -z -z >z -z -z w 0 ~ -w ~w ~w -w ~w ~w Z I ~ ..J(!) ..Je" ..Je" ..J(!) ..JC) ..Je" W 10 ..... ~ C) ~ ~ 6:::i: WJ- m<( Cll) .... G) 0 - CO) - ..:2!:~ Cll) N CD It) 0 CD .~ N CO) CO) ... N CO) J-:::l G) G) G) CO) CO) "It m "It "It ~ CD 0 0 '0 ~ ZZl.1.. It) It) It) It) 0 0 It) It) It) It) 0 It) m ~ w~o N N N N N CJ) a. o UJ 0 0 0 0 CD CJ) en G) G) G) G) CD CO) .- .! Z-J- c: 0 0 WC::<( ~ C U:::lo co ('G u - enu i+= CU > WW LL LL LL LL LL LL .;:: ~ 000 a a a a a a l~...... C f/) u.-J W W W W W W ~U)CO 0 C ~ ~ ~ ~ ~ ~ ucN 0<( <( .- c o~ o~ o~ o~ o~ o~ omf';- .... G) wU iLii) iLii) i:i:ii) iLii) i:i:ii) i:i:ii) mE"" -..cco CU D.. ~O Fa Fa Fa Fa Fa Fa mua;> <(en 0::0.. a:: 0.. a:: 0.. a:: 0.. 0::0.. 0::0.. Eco~ Z 'I- WW WW ww ww ww ww ._ :t:: ...... 0 Z OC OC OC oc oc oc ~<(co EXHIBIT E . , , PENN-TRAFFORD SCH 558-B HARRISON C OOL EMPLOYEES FCU T ITY RD RAFFORD, PA 15085 08/23/2006 11:19 GENEVIEVE M BUSH 160 ASTEN DRIVE YAGER,TRUSTEE UDT 02 DILLSBURG, PA ~Main Savings 17019 DATE TOTAL AMT INT/FEE AMT D'II.T n.T ~'fCE 3/31/06 6/30/06 30.07 30.51 9063.54 9094.05 TRANSACTION DESCRIPTION DIVIDEND DIVIDEND ~j/~" \ ~ k. [v~ I ~f ~ ~.fz,~ ~ d-r-- ~ 30 I ].rv ~ ~ ~ ~ <: L...r..- ~ ~ ;;dv. ~ ~ ~ ~~F-: -rL~ ~~~ .h-~4 ~ ~. ~~ ).,J ~ ~. -tt ~ ~ j;idJ#A- ~ ~ ~ T~f IJ"7'o...- ~ f n I ], IV).' -It 7-"";""'f ~/1'l. r""", i.kl w-...-- ~ V. ~ o-rI- ~ ~'d.,f ~", 7Mr~w--- c:;~ '1~. :/6't^'L 0 r~ r jJ ~ Iv 6-..W~' j/ I ~t(j · ?i/ EXHIBIT F PNC Bank Online Banking Page 1 of 1 Account Detail I Pertormance Money Market XXX6275 ~' View All Accounts Edit Account Nickname Summary Current Activities Transaction History_Online Statements AutoAlertssm Detail by Date II Detail by Type i I Search Transactions ~ I I i . I All Deposits, Checks and Deductions ..... ';j;jf,;~P.2!,!j:;h;"" I i iDate Description Withdrawals Deposits Balance : i 07/0712006 ACH DEBIT 175035896A SSA US TREASURY ><XXX $1,912.00 1$52,358.32 ! REVERSAL I i 07/03/2006 ACH CREDIT 175035896A SSA US TREASURY ><XXX ! I i I $1,912.00 I $54,270.32 i Isoc SEC I ' ' ,- I $149.74 ~2j35&a'" I 06/26/20061 INTEREST PAYMENT j 06/0212006 I ONLINE TRANSFER TO XXX5463 $3,000.00 i $52,208.581 I 06/0212006 ACH CREDIT 175035896A SSA US TREASURY ><XXX $1,912.00 $55,208.581 i ! SOC SEC I ! I OS/24/2006 INTEREST PAYMENT I $134.40 $53,296.58) 105/05/2006 ONLINE TRANSFER TO XXX5463 $3,000.00 1$53,162.181 105/03/2006 ACH CREDIT 175035896A SSA US TREASURY ><XXX I 1$1,912.00! $56,162.181 i soc SEe I ! i @ Copyright 2006. The PNC Financial Services Group, Inc. All Rights Reserved. https:/ /www.accountlink.pncbank.com/alservlet/ AccountSwitcherServlet 7/22/2006 PNC Bank Online Banking Page 1 of 1 III ., . Account Detail I Interest Checking XXX5463 View All Accounts I Edit Account Nickname I Help? .!i Available Balance: $39,521.68 AutoAlertssm Transaction History_Online Statements Current Activities Summary Detail by Date II Detail by Type II Search Transactions IAII Deposits, Checks and Deductions .:=:l' i i I I ! Date Description I 07/20/2006 Q~Q_$.lT X)Q\X~34e 07/13/2006 OI;PQ$IT)QQ~Q~44 06/30/20061 ACH CREDIT XXXXXXXXXXX5532 PA TREASURY DEPT ANNUITANT - 06/26/2006 INTEREST PAYMENT I 06/08/2006 CHI;CK_166Q.QQ~~43447 i 06/0212006 j CHI;CK 1Q79 OQ4Z01~49 i 06/0212006 ONLINE TRANSFER FROM XXX6275 I 06/01/2006 C.H~GK.1 679 QQ~Q613Q7._ 106/01/20061 CH!;.CK 197~QQ~O~1GJ3 106/01/2006 REVERSE DEPOSIT T040011202 106/01/2006 Qf;PQSITXX)()(,3007 i 05/31/2006 CHI;CKJ677 QZ~Z~O~ 105/31/20061 DEPOSIT T040011202 i 05/31/2006/ ACH CREDIT XXXXXXXXXXX5535 PA TREASURY DEPT ! I ANNUITANT . ! OS/24/2006 INTEREST PAYMENT ! 05/11/2006 CHI;CK 167Q 00!;5~~~~7Q_ i 05/05120061 ONLINE TRANSFER FROM XXX6275 I i 04128/2006 11 ACH CREDIT XXXXXXXXXXX5500 PA TREASURY DEPT I . ANNUITANT !lI.~i;,.~R~1!02J1 Deposits Balance $9,408.85 $89,521.681 $77,854.37 $80,112.831 $786.76 - Withdrawals $1,471.701 I $1,471.42 j $5,714.65 ! $3,000.00 $5,956.95 j $2,956.95 ! $2,966.951 $3,008.59 i $350.281 $3,358.871 I $3,008.591 I i $350.281 $3,161.24; $786.761 $2,810.96 j I i I $0.521 $2,024.20 $2,023.68 I $3.000.00 $6,268.98\ I $786.76 j $3,268.98) I $4,243.23 $242.30 I $10.00 $41.641 $350.28 I I $152.65 j I i i 1 I I $4,245.30 @ Copyright 2006. The PNC Financial Services Group, Inc. All Rights Reserved. https://www.accountlink.pncbank.comlalservlet/DepositAccountDetailByDateServlet?acco. .. 7/22/'2006 EXHIBIT G . . A. B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVElOPMENT 1.QFHA 2. o FmHA 3. DCONv. UNINS. 4. OVA 5. DCONv. INS. 6. FILE NUMBER: 17. LOAN NUMBER: SETTLEMENT STATEMENT GAINFORT #521 8. MORTGAGE INS CASe NUMBER: C. NOTE: This form is flJmished to give you I statement of actual setJJsment com. Amounts paid to and by the settlement agent are shown. ~ms marked "fPOCr were paid outside the closing; they are shown hare for informational purposes end are not inctuded in the totals. 1.0 3IllII (lWNFORT r.i21 .llfd/GAIIFORT r.i2113O) D. NAME AND ADDRESS OF BUYER: E.. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Lewis R. Gainfort Genevieve M. Bushyager Trust G. PROPERTY lOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE: 1021 N. 3rd Street Stewart, McArdle, Sorice. et al., LLC Jeamelte. PA 15644 July 7. 2006 Weslmoreland County, Pemsytvania PLACE OF SETTLEMENT 229 South Maple Avenue Greensburg. PA 15601 J. SUMMARY OF BUYER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BUYER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 86.000.00 40 1. Contract Sales Price 86.000.00 102. Personal Prooertv 402. Personal Prooertv 103. Settlement Charaes to Bwer IUne 1400) 2,073.25 403. 104. 404. 105. 405. Adiustments For lIems Paid Bv Seller in advance Adjustments For Items Paid Bv Se/Jer in advance 106. CitvrtlMn Taxes 07107/06 Ie 12131106 216.74 406. CitvfT awn Taxes 07107106 Ie 12131106 216.74 107. Countv Taxes 07107106 Ie 12131106 137.36 407. CounlYTaxes 07107106 Ie 12131106 137.36 108. SchooITaxes to 408. School Taxes Ie 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BUYER 88,427.35 420. GROSS AMOUNT DUE TO SELLER 86,354.10 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 500. REDUCTlONS IN AMOUNT DUE TO SELLER: 201. DeDOSIl or earnest money 1,000.00 501. Excess Demsit (See Instructions) 202. PrinclP8I Amount of New Loanlsl 502. Setllement Charaes to Seller (Line 14001 8.484. n 203. Exima Ioan(s) taken subiecl to 503. Existina Ioan(s\ taken subiecl to 204. 504. Payoff of first MortaaaelNONE 205. 505. PavoII of second Mortaaoe 206. 506. OeIlosit retained by broker 1.000.00 207. 507. 208. 506. 209. 509. AdiUstments For Items Unpaid By Seller Adjustments For Items Unpaid By Se/(er 210. CitvlTown Taxes to 510. CltvfTawn Taxes Ie 21,. CountvTaxes Ie 511. CounIY Taxes Ie 212. ScrooITaxes 07101106 to 07107/06 18.44 512. Schoo/Taxes 07101106 Ie 07107106 18.44 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. I 220. TOTAL PAID BY/FOR BUYER 1,018.44 520. TOTAL REDUCTION AMOUNT DUE SELLER 9,503.21 300. CASH AT SETTLEMENT FROM/TO BUYER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From BlNer (Une 120) 88 427.35 601. Gross Amount Due To Seaer (Line 4201 86.354.10 302. Less Amount Paid BvlFor Bwer (Line 2201 ( 1.018.44 602. Less Reductions Due Seller (Une 520) ( 9,503.21 303. CASH ( X FROM) ( TO) BUYER 87.408.91 603. CASH ( X TO) ( FROM) SELlER 76,850.89 OMS NO. 2502-0265 :.tr The undersigned hereby acknowledge receipl of a completed copy of pages 1 &2 of this statement & any attachments referred Ie herein. ~ ~ a.~~ Lewis R. Gainfort SeJIer Genevieve~. Bushyager Tnm..? .--, By:'--~/-HT</) t/u~ . , L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ 86,000.00 ll!1 5.0000 % 4.300.00 PAID FROM PAlO FROM Division of Commission (line 7001 as Follows: BUYER'S ~ 701. $ 4.300.00 to BiI Anderson & Associales Auctioneen; Less Deposit Retained 1.000.00 FUNDS AT FUNDS AT 702. $ to 5ET1\.EMENT RmEMEKT 703. Commission Paid al Settlement 3.300.00 704. to BOO. ITEMS PAYABLE IN CONNECnON WITH LOAN 801. Loan Orioination Fee % to 802. lDan Discount % to 803. ADpralsal Fee to 804. Credit Report to 805. Lander's Inspection Fee to 806. Mor1aaae Ins. Arm. Fee to 807. Assumption Fee 10 808. 809. 810. 811. 812. Water biD to MAWC J 212 04200 201.27 813. Inheritance Tax Esaow 4.5% to Stewart. McArdle. Sorice. et al. LLC 3,870.00 814. 815. 816. 817. 818. 819. 820. 900. rTEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to (if! $ Iday ( days %) 902. MIP lotlO5. for UIeOIloan lor monlh& to 903. Hazard Insurance Premium for 1.0 years to 904. 905. 1000. RESERVES DEPOSrTED WITH LENDER 1001. Hazard Insurance months $ oer month 1002. Marttlaae Insurance months $ oermonth 1003. Citv/Town Taxes months $ oer month 1004. Countv Taxes months $ oar month t005. School Taxes months $ per month 1006. months S .,..,. month 1007. months @-$ per month 1008. A""""'"te Escrow Adiu<:tment months @ $ oermonth 1100. TITLE CHARGES 1101. SetIIemenl or CIosino Fee to 1 102. Abstract or Tille Search to 1103. Tille ~",,",inaIlOn to 1 104. Title Insurance Binder to 1 1 05. DoaJment PrP.ruIration to Stewart. McArdle Sorice el aI.. LLC DEED 125.00 1106. NolaN Fees to 1107. Attomev's Fees 10 Stewart. McArdle. Sorice. et al.. LLC 400.00 (includes IIboIle item numbers: ) 1108. Tltl.. I"".....n.... to Chica.." TtIle In.'",rance CoIMic:hael J StI>Wart 774.7~ (inc/ude$,bolleitemnumbers:11021103.1104 11071109.1110 . ) 1109. Lender's Coveraae $ 1110. Owner's CoveI1Ige $ 86.000.00 1111. Endorsments 100. 300. 900 1112. WII'e Fee Stewart. McArdle. Sorice. et al.. LLC 1113. Federal Express Fee to Stewart, McArdle. Sorice. et al.. LLC 20.00 1114. Closing Service Letter Chicago Title Insurance company 1115. E-Mail Fee Stewart, McArdle. Sorice. eI aI.. LLC Sank Pkg 1116. Tax Claim Bureau Cert to Stewart. McArdle, Sorice. et aI.. LLC 5.00 1117. 111B. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordina Fees: Deed $ 38.50 ; Mortaaae S ; Releases S 38.50 1202. Citv/Counlv T axlSlamr;;<: Deed 860.00' MorIOaoe 860.00 1203. State TaxlStBrnos: Revenue Stamos 860.00; MOrtQaQB 860.00 1204. FIUnn Power of Anv-Advanced to Stewart McArdle Sorice eI al. LLC 18.50 1205. RaIease of Mortoaae 1300. ADDmONAL SE'I'Tl.EMENT CHARGES 1301. Survey to 1302. Pest Ins....dion 10 1303. 1304. 1305. See addlt'l disb. exhibit to 85.00 1400. TOTAL SETTlEMENT CHARGES rEnter on Lines 103. Section J mid 502, Section Kl 2.073.25 8.484.77 Elvoigningll8l1'" r1I__IlleIill-'-1lO-ptr1l'~COPfof_2oflhlolWOpog7~~ ,""""",~"LLC Setllament Agent Certified to be a true copy. I Page 2 ( GMWORT 11521 I GAlNFOR'T 11521 /30 ) EXHIBIT H SEP-15-06 09:04AM /.:~~ . . \ ~/ State FROM- 1-417 P.DD1/DD2 F-264 SA Mutual ,....~"..,,~ Fund~ Farm VP Management Corp. July 13,2006 P.O. Box 2'9548 Kansas City, MissOlJrl 641.21.9548 , -800-447-4930 ... ... Genevieve M Bushyager Rev Liv Tr Agreement Dtd 08/26/2002 Attn: Successor Trustee 160 Aspen Dr Dillsburg PA 17019-9621 STATE FARM MUTUAL FUND ACCOUNT We recently received notification of Genevieve M Bushyager's death. We are sincerely sony for your loss. At this time, we have an account registered to the Genevieve M Bushyager Revocable Living Trust Agreement DID 08/2612002. Please forward the following items to us at your convenience. Once they are received, we will be able to make any necesSaI)' changes to the account. 1. An official certified death certificate with a raised seal (a copy will not be accepted). 2. A copy of the trust to verify that it is stm in effect 3. A Tax Identification Number for the trust. If the Genevieve M Bushyager Revocable Living Trust Agreement DID 08/26/2002 is cUITently being reported under Genevieve M Bushyager' 5 social security nwnber, a trUst TIN must be obtained. 4. A letter of direction signed by you, the successor trustee. requesting the account is to be re-titled in accordance with the enclosed Application. Or S. A letter of direction signed by you, the succesSOr trustee, requesting the account be redeemed. Note: Redemptions ex~eeding 5100,000 require a signature guarantee. The value of the account as of July 1, 2006 was as follows. Please Note: The share price varies from day to day. Fund #; of Shares Price per Share Value State Farm Growth 4,992.2530 $52.04 $259.796.85 Fund We have enclosed a return envelope for your convenience. You may wish to consult your tax advisor in reference to the above account(s). State Farm Mutual Funds lIJ'e not insunmce products and are offerQd by State Farm VP Management Corp., One Stale Farm PI8za. Bloomington, blinois 61710-0001, 1-800-A47-4930. SEP-15-06 09:04AM FROM- 1-417 P.002/002 F-Z64 t . State Fann~ appreciates your business and looks forward to assisting you with your future financial needs- If you have any questions, please calJ 1~800-447-0740 between the hours of8:00 a.m. and 6:00 p.m., CTMonday through Friday. Sincerely, ~^~~n Traci A. S. Monson STATE FARM SECURITiES PRODUCTS, Director ~f~ce:00288078 Enclosure(s): Associate Funds Application (non fid) Associate Funds Prospectus W-9Form