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Home My WebLink About04-26-07 ----1 . REV-1500 EX (06-05) 15056051058 :~~~":"",'::\:':~'::'. ~~r~s~~~8~~0~712B_0601 ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 1206-16-4821 107/24/2006 Decedent's Last Name Suffix ISWARTZ I I (If Applicable) Enter Surviving Spouse's Infonnation Below Spouse's Last Name I INHERITANCE TAX RETURN County Code Year RESIDENT DECEDENT 121 LI06 OFFICIAL USE ONLY File Number L10716 Date of Birth 105/08/1925 Decedent's First Name IMARGUERITE MI ID Suffix I I Spouse's First Name I I MI In Spouse's Social Security Number I FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS xxx 1. Original Return C::::l 2. Supplemental Return = 3. Remainder Return (date of death prior to 12-13-82) = 5. Federal Estate Tax Return Required = 4. Limited Estate = 4a. Future Interest Compromise (date of death after 12-12-82) C::::l 7. Decedent Maintained a Living Trust (Attach Copy of Trust) = 10. Spousal Poverty Credit (date of death C::::l 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number IWILLlAM R KAUFMAN, ESQ [717-766-7702 Firm Name (If Applicable) I xxx 6. Decedent Died Testate (Attach Copy of Will) = 9. Litigation Proceeds Received -0- 8. Total Number of Safe Deposit Boxes REGISTER OF WILLSU$E ONLY First line of address /940 CENTURY DRIVE, SUITE B Second line of address I ~" I. ,I r',_'" DATE FILE~ . City or Post Office IMECHANICSBURG State IpA ZIP Code 117055-4376 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. OF PE DATE l TOfl-- 04/24/2007 wrkaufman. wrklaw@comcast.net DATE 04/24/2007 , SUITE B, MECHANICSBURG, PA 17055-4376 PLEASE USE ORIGINAL FORM ONLY L Side 1 15056051058 15056051058 --.J ~ -.J 15056052059 REV-1500 EX Decedent's Name: MARGUERITE L SWARTZ RECAPITULATION Decedent's Social Security Number 206-16-4821 1. Real estate (Schedule A) 1. $ 0.00 2. Stocks and Bonds (Schedule B) 2. $ 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. $ 0.00 4. Mortgages & Notes Receivable (Schedule D) 4. $ 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. $5,114.00 6. Jointly Owned Property (Schedule F) C::::l Separate Billing Requested 6. $ 13.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C::::l Separate Billing Requested 7. $ 0.00 8. Total Gross Assets (total Lines 1-7) 8. $5,127.00 9. Funeral Expenses & Administrative Costs (Schedule H) 9. $5,018.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10. $33,074.00 11. Total Deductions (total Lines 9 & 10) 11. $38,092.00 12. Net Value of Estate (Line 8 minus Line 11) 12. ($32,965.00) 13. Charitable and Governmental Bequests/See 9113 Trusts for which 13. $ 0.00 an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. ($32,965.00) TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X O. 16. Amount of Line 14 taxable at lineal rate X O. 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 16. 17. 18. 19. TAX DUE 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C::::l Side 2 L 15056052059 15056052059 REV'1500 EX Page 3 File Number EJ EJ 10716 Decedent's Complete Address: DECEDENrs NAME DECEDENT'S SOCIAL SECURITY NUMBER MARGUERITE L SWARTZ 206-16-4821 STREET ADDRESS 801 NORTH HANOVER STREET CITY I STATE IZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount $ 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) $ 0.00 Total Interest/Penalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) $ 0.00 (4) $ 0.00 (5) $ 0.00 (SA) (5B) $ 0.00 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 X b. retain the right to designate who shall use the property transferred or its income; 0 X c. retain a reversionary interest; or 0 X d. receive the promise for life of either payments, benefits or care? 0 X 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death 0 X without receiving adequate consideration? 0 X 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? 0 X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [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 zero (0) percent[72 P.S. ~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 death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-.1508 EX + (6-9l!l *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF MARGUERITE L SWARTZ FILE NUMBER 21-06-0716 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointry.owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. 5. 6. DESCRIPTION PREPAID BURIAL ACCOUNT, ON DEPOSIT WITH JAMES C MANEVAL FUNERAL HOME VALUE AT DATE OF DEATH $4,095.00 REFUND FROM JANETS FLORAL - FLOWERS NOT DELIVERED IN TIME FOR MEMORIAL SERVICE REFUND FROM AARP - UNEARNED MEDICARE SUPPLEMENT AND MEDICARE PRESCRIPTION DRUG INSURANCE PREMIUMS CUMBERLAND COUNTY VETERANS' ASSOCIATION DEATH BENEFIT 125.00 373.00 100.00 2006 FEDERAL INCOME TAX REFUND RECEIVABLE CLOTHING AND MISCELLANEOUS PERSONAL EFFECTS: 1.10 SWEATSHIRTS 2. 5 T-SHIRTS 3. 1 SWEATER 4.6 SETS OF FOUNDATION GARMENTS 7. 11 PAIRS OF SWEATPANTS 8. 7 FLANNEL NIGHTGOWNS 9. 1 LA-Z-BOY RECLINER 10.2 HANDMADE QUILTS 11. 1 BOX OF BOOKS ON TAPE (ON CD'S) 12. 1 PAIR OF SNEAKERS 13.1 PAIR OF BEDROOM SLIPPERS 14.1 SONY PORTABLE CASSETTE AND CD PLAYER 15.1 RADIO SHACK PORTABLE CASSETTE PLAYER 16.2 TALKING ALARM CLOCKS 17.40 BOOKS ON TAPE (ON CASSETTE) 18.1 xm RADIO RECEIVER 19.1 WIRELESS HEADSET 20. 2 HEARING AIDS 30.00 40.00 10.00 4.00 18.00 44.00 28.00 50.00 20.00 20.00 5.00 2.00 5.00 5.00 5.00 10.00 20.00 5.00 100.00 ALL ITEMS ARE IN FAIR TO GOOD CONDITION TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) $5,114.00 JAMES C. MANEVAL FUNERAL HOME, LTD. A 2~ ~elekaUO-n"' Home 500 West 4th Street Williamsport, PA 17701 Phone: (570) 322-3204 Fax: (570) 323-1233 Kevin G. Novotny, Supervisor Mrs. Judith Kaufman 345 E. Butter Road York, PA 17404 FOR THE FUNERAL SERVICE OF: M. LORRAINE SWARTZ, July 24, 2006 PROFESSIONAL SERVICE CHARGE: OTHER STAFF & RELATED FACILITIES CHARGE: TRANSPORTATION CHARGE: 1,475.00 745.00 125.00 MERCHANDISE: Aclmowledgement Cards Batesville, 1811, Alpine White Cultured Marble Urn. Cardboard Cremation Container. Memorial Folders I Prayer Cards Register Book Rockbay Urn Vault 55.00 305.00 125.00 55.00 55.00 405.00 3,345.00 435.00 60.00 220.00 25.00 131.80 125.00 72.60 1,069.40 4,414.40 4,095.41 318.99 $ 0.00 CASH DISBURSEMENTS: Total Funeral Charges Cemetery Certified Copies Crematory Cumberland County Cremation Authorization Harrisburg Patriot Janets Floral Williamsport Sun Gazette Total Cash Disbursements Balance Prepaid Funds Deposit I Payments Balance Due ******* PAID IN FULL ****** THANK YOU ***** James c. Maneval Funeral Home, Ltd. is a Proud member of the Life CelebrationN Provider Services Network www.lifecelebration.com UNiTEd1ealthcare" UNITEDHEALTHCARE SERVICES, INC (877) 620-6192. PO BOX 1459 MN008-W340 MINNEAPOLIS MN 55440-1459 Page 1 90-GO CHECK DATE 09-21-2006 CHECK NUMBER 02998897 !fll&!B_"-<<II__".~1 GPS0000000028340 09~20-2006 86420507 200.24 .00 200.24 YOUR ACCOUNT WAS PREVIOUSLY TERMINATED. THIS REFUND REPRESENTS FUNDS RECEIVED AFTER YOUR TERMINATION DATE. IF YOU HAVE QUESTIONS, PLEASE CALL 1-888-867-5575 (TTYl-877-730-4192). ':~i!i!:i.i:::!:::::i::':':'!:~!.:!!i.!:i:!.:i~:!::i::::i!M~i~~i.:'~!:~:::!:!:!i.i'!:::!!!!:~~':,:!!:'::::':::':~..':.:i.. OR00028340 $200.24 $.00 $200.24 000163 1000231 0001 02"'1" UNH571700-00000'62 O'/2aIOf 11.21 011000213400001 72~7.0001 50110 ~ ~ ~ '" ~ ... 8 ~ ~ ~ ~ """""= ~ - ~ ........ = ~ -- -.... ~ """"""'" ~ """"""" ~ ~ ~ - iii IiiIiIiliii!!! = -= - ~ Date: 11/15/06 Page 1 of 1 000428 WILLIAM R KAUFMAN 940 CENTURY DR MECHANICSBURG PA 17055 4376 IF YOU HAVE ANY QUESTIONS CONCERNING THIS REFUND, PLEASE CALL US TOLL FREE AT 1-800-523-5800. PAYEE: WILLIAM R KAUFMAN Check No. 0024546239 MRP Health Care Options~ ~ REG POLICY SYM INSURED ACCOUNT NUM CHECK AMOUNT POLICY NUM PROD CODE OBB KAU FMAN o 0220012991 CHECK DESCRIPTION YOUR ACCOUNT IS CANCELLED. THE REFUND CHECK BELOW REPRESENTS MONTHLY PAYMENTS PAID BEYOND THE CANCELLATION DATE. Form T-258-8 Printed in U.S.A. - .--." .-.. "-~--'--- -- --- -.-.----.-------.----....------...-------.--.-.-- ____u___. ....__._----_.._--_._.__.._---~- .--.----.-.----. '--...-._- -- _..-... .._~.. . $AAAAAAAAAAA172.75 I No. 12317103 ..-,.. ...-. ---"--. ....-.. -- -.......--.--.---... --- ..--. Deceased: M LORRAINE SWARTZ 7/24/06 O Department of the Treasury - Internal Revenue Service Form 1 04 A. u.s. Individual Income Tax Return (99) 2006 IRS Use Only - Do not write or staple in this space. label Your first name and initial Last name OMS No. 1545-0074 (See instructions.) Your social security number M LORRAINE SWARTZ 206-16-4821 Use the If a joint return, spouse's first name and initial Last name Spouse's social security number IRS label. Otherwise, please print Home address (number and street). If you have a P.O. box, see instructions. Apartment no. . A or type. You must enter 345 EAST BUTTER ROAD your SSN(s) above City, town or post office. If you have a foreign address, see instructions. State ZIP code Checking a box below will YORK, PA 17404 not change your Presidential Election Campai n Filing status Check only one box. Exemptions If more than six dependents, see instructions. Income Attach Fonn(s) W-2 here. Also attach Fonn(s) , 099- R iftax was withheld. If you did not get a W-2, see instructions. Enclose, but do not attach, any payment. Adjusted 9ross Income tax or refund .. Check here if you, or your souse if filin jointl 0 to this fund see instructions) . .." You Spouse 1 X Single 4 Head of household (with qualifying person). (See instructions.) 2 Married filing jOintly (even if only one had income) If the qualifying person is a child but not your dependent, 3 Married filing separately. Enter spouse's SSN above and enter this child's name here. .. full name here" 5 0 Qualifying widow(er) with dependent child (see instructions) 6a ~ Yourself. If someone can claim you as a dependent, do not check box 6a . . . . . . . . . . . . } Boxes ~:~c,.~e:b~ . . . . 1 No. of children on 6c who: . lived with you .. .. .. · did not live with you due to divorce or separation. . . . . b n Spouse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Dependents: (2) Dependent's (3) Dependent's (4) \I' if socia security relationship qualifying child for (1) First name Last name number to you child tax credit Dependents on 6c not entered above. . d Total number of exem tions claimed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. :~~i:::::or:e .. 7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8a Taxable interest. Attach Schedule 1 if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a b Tax-exempt interest. Do not include on line 8a . . . . . . . . . . . . . . . . . . . . . 8b 9a Ordinary dividends. Attach Schedule 1 if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .'. . . . 9a b Qualified dividends (see instructions). . . . . . . . . . . . . . . . . . . . . . 9b 10 Capital gain distributions (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 10 11 a IRA distributions. . . . . . . . . . . . .. 11 a 11 b Taxable amount. . . . " 11 b 12a Pensions and annuities. . . . . . .. 12a 4,653. 12b Taxable amount. . . . " 12b 13 Unemployment compensation, Alaska Permanent Fund dividends, and jury duty pay. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 13 14a Social security benefits. . . . . . . . . . . . . . . . . . . . .. 14a 9,030. 14b Taxable amount. . . . .. 14b 15 Add lines 7 through 14b (far right column). This is your total income. . . . . . . . . . . . . . . . . .. .. 15 16 Penalty on early withdrawal of savings (see instructions) . . . . 16 17 IRA deduction (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 17 18 Student loan interest deduction (see instructions). . . 18 19 Jury duty pay you gave your employer (see instructions). . . . . 19 20 Add lines 16 through 19. These are your total adjustments. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 20 57. 4,644. O. 4,701. 21 Subtract line 20 from line 15. This is your adjusted gross income. . . . . . . BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. .. 21 o. FDIA1312L 11/13106 4,701. Form 1040A (2006) Form 1040A (2006) Tax, credits, and payments Standard Deduction for - · People who checked any box on line 23a or 23b or who can be claimed as a dependent, see instructions. · All others: Single or Married filing separately, $5,150 Married filing jointly or Qualifying widow(er), $10,300 Head of Household, $7,550 If you have a qualifying child, attach Schedule EIC. Refund Direct deposit? See instructions and fill in 45b, 45c, and 45d or Form 8888. Amount you owe Third party designee Sign here Joint return? See instructions. Keep a copy for your records. Paid preparer's use only M LORRAINE SWARTZ 22 Enter the amount from line 21 (adjusted gross income). . . . . . . . . . . . . . . . 206-16-4821 "'"'''''' 22 Page 2 4, 701. 23a Check {[R] You were born before January 2, 1942, [R] Blind } Total boxes n If: DSpousewasbornbeforeJanuary2,1942, DBlind checked. ~ 23aUj b If you are married filing separately and your spouse itemizes deductions, see Instructions and check here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ~ 23b 0 24 Enter your standard deduction (see left margin). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . .. 24 25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0. . . . . . . . . . . . . . . . . . . .. 25 26 If line 22 is over $112,875, or you provided housing to a person displaced by Hurricane Katrina, see instructions. otherwise, multiply $3,300 by the total number of exemptions claimed on line 6d. . . . . , . . . . . . . . .. 26 Zl Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-. This is your taxable income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " ~ Zl 28 Tax, including any alternative minimum tax (see instructions). . . , . . . . . . . . . . . . . . . . . . . . . . . , . , . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 28 o. 7,650. O. 3,300. O. 29 Credit for child and dependent care expenses. Attach Schedule 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 29 30 Credit for the elderly or the disabled. Attach Schedule 3. . . . . 30 31 Education credits. Attach Form 8863 . . . . . . . . . . . . . . . . . . . . . . 31 32 Retirement savings contributions credit. Attach Form 8880. . . 32 33 Child tax credit (see instructions). Attach Form 8901 if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 34 Add lines 29 through 33. These are your total credits. . . . . . . . . . . . , . . . . . . . . . , . . . . . . . . . .. 34 35 Subtract line 34 from line 28. If line 34 is more than line 28, enter -0-. . . . . . . . . . . . . . . . . . .. 35 36 Advance earned income credit payments from Form(s) W-2, box 9 . . . . . . . . . . . . , . . . . . . . .. 36 '37 Add lines 35 and 36. This is your total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ '37 38 Federal income tax withheld from Forms W-2 and 1099. . . . .. 38 39 2006 estimated tax payments and amount applied from 2005 return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 39 40a Earned income credit (EIC). . . . . . . . . . . . . . . . . . . . . . . . . 40a bNontaxable combat pay election. 40b 41 Additional child tax credit. Attach Form 8812. . . . . , . . . . . . . . . 41 4Z Credit for federal telephone excise tax paid. Attach Form 8913 if required. . . . 4Z 30. 43 Add lines 38, 39, 40a, 41, and 42. These are your total payments. . . . . . . . . . . . . . . ' . . . . . . . . . . . ~ 43 44 If line 43 is more than line 37, subtract line 37 from line 43. This is the amount you overpaid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 44 45a Amount of line 44 you want refunded to ou. If Form 8888 is attached, check here.. ~ 0 45a ~ b Routing number. . . . . . . . . . 0 Savings ~ d Account number. . . . . . . . .. XXX XXXXXXXXXXXXXXXXXXXXXXXXXXX 46 Amount of line 44 you want applied to your 2007 estimated tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 46 47 Amount you owe. Subtract line 43 from line 37. For details on how to pay, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ~ 47 48 Estimated tax enal s instructions. . . . . . . . . . . . . . . . . . " 48 Do you want to allow another person to cuss this return with the IRS (see instructions)? . . . . . . . . . . Yes. Complete the following. X No o. o. 30. 30. 30. ~:~~nee's ~ Personal Phone identification ~ no. ~ number (PIN) - Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge. ~ Your signature Ci?J f \, ___ Date ;~r;~c;~~n Daytime phone number Spouse's signature. If a joint return, bOth must sign. Date Spouse's occupation Firm's name (or yours if self. :;r!r~i:,d~~d ZIP code PA 17055-4376 EIN Phone no. 23-2871292 (717) 790-9001 Farm 1040A (2006) FDIA1312l 11/13/06 REV.1509 EX + (6-llB) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF MARGUERITE L SWARTZ FILE NUMBER 21-06-0716 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. JUDITH M KAUFMAN ADDRESS RELATIONSHIP TO DECEDENT 345 E BUTTER ROAD, YORK, PA 17404 DAUGHTER B. c. JOINTLY-OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH NUMBER FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. DATE OF DEATH DECO'S VALUE OF TENANT JOINT Attach deed for joinfly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 0411999 MEMBERS 10' FEDERAL CREDIT UNION, MECHANICSBURG, PA $25.00 50% $13.00 TOTAL (Arso enter on line 6, Recapitulation) $ 13.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF MARGUERITE L SWARTZ FILE NUMBER 21-06- 0716 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. JAMES C. MANEVAL FUNERAL HOME, LTD. - SEE ATTACHED INVOICE $4,414.00 PASTOR JAMES MOSS, JR - FUNERAL OFFICIATION HONORARIUM 250.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney Fees 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 CUMBERLAND COUNTY REGISTER OF WILLS 97.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. THE PATRIOT NEWS - ESTATE ADVERTISEMENT - SEE ATTACHED INVOICE 182.00 8. CUMBERLAND LAW JOURNAL - SEE ATTACHED INVOICE 75.00 TOTAL (Also enter on line 9, Recapitulation) $5,018.00 (If more space is needed, insert additional sheets of the same size) lAME.S C. MANEVAL FUNERAL HOME, LTD. A 2'~ Weleha4<m'. Home 500 West 4th Street Williamsport, PA 17701 Phone: (570) 322-3204 Fax: (570) 323-1233 Kevin G. Novotny, Supervisor Mrs. Judith Kaufman 345 E. Butter Road York, PA 17404 FOR THE FUNERAL SERVICE OF: M. LORRAINE SWARTZ, July 24, 2006 PROFESSIONAL SERVICE CHARGE: OTHER STAFF & RELATED FACILITIES CHARGE: TRANSPORTATION CHARGE: 1,475.00 745.00 125.00 MERCHANDISE: Acknowledgement Cards Batesville, 18J1, Alpine White Cultured Marble Urn. Cardboard Cremation Container. Memorial Folders / Prayer Cards Register Book Rockbay Urn Vault 55.00 305.00 125.00 55.00 55.00 405.00 3,345.00 435.00 60.00 220.00 25.00 131.80 125.00 72.60 1,069.40 4,414.40 4,095.41 318.99 $ 0.00 CASH DISBURSEMENTS: Total Funeral Charges Cemetery Certified Copies Crematory Cumberland County Cremation Authorization Harrisburg Patriot J anets Floral Williamsport Sun Gazette Total Cash Disbursements Balance Prepaid Funds Deposit / Payments Balance Due ******* PAID IN FULL ****** THANK. YOU ***** James C. Maneval Funeral Home, Ltd. is a Proud member of the Life CelebrationN Provider Services Network www.lifecelebration.com ~. CUMBERLAND LA W JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, P A 17013 September 8, 2006 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: William R. Kauffman, ESQUIRE Lorraine M. Swartz, ESTATE RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. --------------------------------------------------------------------- --------------------------------------------------------------------- Advertisement inserted on following dates: August 25,2006 & September 1, 8, 2006 Advertising Cost Second Proof Request 75.00 $ 0.00 $ 0.00 $ 75.00 ------------- Proof of Publication Payment received Total Amount Due $ 00.00 --------- ------ Becky H. Morgenthal, Executive Director ~t patriot-NtWs Now you know . .... .' . . .. 08/01/2006 - 08/31/2006 WILLIAM R. KAUFMAN . . . . .. . . -. $ 181.59 $ 0.00 Net 30 Days . . I .. . I .. . ... I .. ADVERTISING INVOICE / STATEMENT # : $ 181.59 $ 0.00 $ 0.00 $ 0.00 0000267639 -. : . . : . . . I .. I .. - . I I .. 1 08/31/2006 WILLIAM R. KAUFMAN THE PATRIOT-NEWS ATTORNEY AT LAW P. O. BOX 2066 : . . . . 940 CENTURY DRIVE MECHANICSBURG PA 17055-0996 Mechanicsburg, PA 17055 USA 93620 . . . . - 93620 o Address changes on back o Credit Card Payment on back . .." I.. .. .1. . .. ~~....... NEWSPAPER . ,:;,..':, '<' """"<<'1' SAUSIZE, . ,}"'i:.... TIMESR~N)( "',,;;." MO T DATE REFERENCE DESCRIPTION-OTHER COMMENTS/CHARGES . ',. ... ,r....,~,.. BILLED UNITS ~";;,\)<,,*,\.,, RATE '.', A .~N 08/30 0001555468 ESTATE OF SW ARTZ/800P-Main Legals NOTICE Letters DA PennLive, PNCO, Start Date: 8/16/2006 1.00 x 13 Li 39 CL Amount to Pay: 3 181.59 4.6562 $181.59 5T A TEMENT OF ACCOUNT AGING OF PAST DUE AMOUNTS . . 30 DAYS . t .. . .... I. .. . . . . . $ 181.59 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 181.59 ([be patriot-News All Billing Inquires (717) 255-8213 Now you know Fed. ID # 23-1304402 :sarMi . * UNAPPLIED AMOUNTS ARE INCLUDED IN TOTAL AMOUNT 0000267639 1M Rey-1512 EX + (1~'()3) * ESTATE OF MARGUERITE L SWARTZ SCHEDULE I DEBTS OF DECEDENT, ,MORTGAGE LIABILITIES. & LIENS I FILE NUMBER 21-06-0716 COMMONWEALTH. OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Record debts incurred by the decedent prior to death which remained unpaid as of the date of death, include unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, ESTATE RECOVERY AMOUNT $33,074.00 TOTAL (Also enter on line 10, Recapitulation) $33,074.00 (If more space is needed, insert additional sheets of the same size) *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 August 15, 2006 WILLIAM R KAUFMAN ATTORNEY AT LAW WILLIAM R KAUFMAN ESQUIRE 940 CENTURY DR MECHANICSBURG PA 17055 Re: MARGUERITE SWARTZ CIS #: 790179681 SSN: 206-16-4821 Date of Death: 07/24/2006 Dear Attorney Kaufman: Please be advised that the Department of Public Welfare maintains a claim in the amount of $33,073.59 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $20,382.24, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $12,691.35, is to be entered as a priority Class.6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, &~I\L~ Elizabeth M. Wilson TPL Program Investigator 717-214-1868 717-772-6553 FAX Enclosure RE.V.1513 EX +.(9-{)O)) * COMMONWEAL TH.OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF MARGUERITE L SWARTZ FILE NUMBER 21-06-0716 RELATIONSHIP TO DECEDENT AMJlNfOR NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) SHARE OFESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and I transfers under Sec. 9116 (a) (1.2)] 1. ROBERT E SWARTZ, 1203 WOODSIDE DRIVE, JOHNSON CITY, TN SON 25% 37604-2926 2. JUDITH M KAUFMAN, 345 E BUTTER ROAD, YORK, PA 17404 DAUGHTER 25% 3. WENDEL R H SWARTZ, 1203 WOODSIDE DRIVE, JOHNSON CITY, TN GRANDSON 25% 37604-2926 4. JAMES R CAMPBELL, 466 E CANAL ROAD, YORK, PA 17404 GRANDSON 25% ENTER OOlLARAMOUNTS FOR DISTRIBUTlONS SHONN ABOVE ON UNES 15 TI-lROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. . B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART IT - 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) I, MARGUERITE LORRAINE SWARTZ, also known as M. LORRAINE SWARTZ, of Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II. I give, devise, and bequeath all of my possessions and estate of every nature and wherever situate as follows: A. Twenty-five (25%) percent thereof to my son, ROBERT E. SWARTZ, provided he survive my death by sixty (60) days and, in the event that he does not so survive my death, to the other persons taking under this Item II of this my last will, in equal shares; B. Twenty-five (25%) percent thereof to my daughter, JUDITH M. KAUFMAN, provided she survive my death by sixty (60) days and, in the event that she does not so survive my death, to the other persons taking under this Item II of this my last will, in equal shares; C. Twenty-five (25%) percent thereof to my grandson, WENDEL R.H. SWARTZ, provided he survive my death by sixty (60) days and, in the event that he does not so survive my death, to the other persons taking under this ~ Item II of this my last will, in equal shares; and WILL OF MARGUERITE LORRAINE SWARTZ Page 1 of 4 D. Twenty-five (25%) percent thereof to my grandson, JAMES R. CAMPBELL, provided he survive my death by sixty (60) days and, in the event that he does not so survive my death, to the other persons taking under this Item II of this my last will, in equal shares. ITEM III. I appoint my daughter, JUDITH M. KAUFMAN, executrix of this my last will. Should my said daughter predecease me or otherwise fail to qualify or cease to serve as executrix of this my last will, I appoint my grandson, JAMES R. CAMPBELL, executor of this my last will. ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. ITEM V. In addition to the other powers and authorities granted to my personal representative by Pennsylvania Law and by the other terms and provisions of this will, I hereby give to my personal representative the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representative may determine al"}d at valuations finally o be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representative deems proper, without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personql, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representative deems proper; and to allocate receipts Page 2 of 4 and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM VI. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any ~Sdiction. IN WITNESS WHEREOF, I have hereunto set my hand this J 3 day of d"'v:x-f\~~ , 2001. ~5~ A ERI~E LORRAINE SWARTZ The preceding instrument, consisting of this and two other typewritten pages,each identified by the signature of the testatrix was on the date thereof signed, published, and declared by MARGUERITE LORRAINE SWARTZ, the testatrix therein named, as and for her last will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. ~~ n >>11 I 7-f(JAb /lIJ ~kins Page 3 of 4 COMMONWEALTH OF PENNSYLVANIA ) ( 55.: ) COUNTY OF CUMBERLAND The undersigned, being the testatrix whose name is signed to the attached or foregoing instrument, having been' dUly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that J signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. . Sworn ~:>raffirmed to and acknowledged ./ before me' by the testatrix named above . ,-this \ 3-t+-___day of 0 ecet'lAber ,2001. ~ .-' L,- .~ " . Notary, ublic ~ - NOTARIAL SEAL LEMOYN~Rg~kg~.Dca~~~~~~B~W MY COMMISSION txPIRES AUG. 17 2004 COMMONWEALTH OF PENNSYLVANIA ) ( 55.: ) COUNTY OF CUMBERLAND WE, SAMUEL L. ANDES and AMY HARKINS, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last will; that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge, the testator was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. ~~.~ I . Andes . Sworn or affirmed to and ackn.owledged before me this .: -:131'~- d.ayof f)ec~M b~r, 2001. '-... ~--- :, "...,... "tJotar .-".. N01ARIALN~1~~Y PUBLIC HRENFELD. 8ERLAND CO. LEMOYNE BORNO~~~~S AUG. 17 2004 MY COMMISSIO rJ\ Page 4 of 4 III~ ~ ~ ~l~; ~ /,,\<)(,1 ~ ~ R' ." CtJ ~ \~ ~~} ,.:{ ~A.. ~ :r.: '<5'~, r- t1 lJ11 I~i'. '0 " f: (9 ....- N'\ .... f'. lI'I '" ,,~'O I") .. ,- l1'. N an an ; ~~ 8 x .~ .... \00< l::l l. < ;~~~ ~~C-~ ~ ~.e 5 :::: = .Q 8 a.. ~ .." ~.;:: u.~ .-.... - = -......-~ ::: ""'T-= ~ "" ~ '~ Q) Ea('<') U) ;:j ~ _ 0"0 ::::=rf1r---- ~Q)~ c.....~< o 0 p.. I-<..c ~ Q)t~ ti ;:j.~ .~ 0 ~ ~u Ea o:::~u -........ _..... --.. -...-.. --..... '-. ....... -.. _. --.-. -::: -.. -.. _. -..-... -... -. -. ..~