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HomeMy WebLinkAbout10-16-07THE MATTER OF GLAIR R. WELDON IN THE COURT OF COMMON PLEAS AN ADJUDICATED CUMBERLAND COUNTY, PENNSYLVANIA INCAPACITATED INDIVIDUAL ORPHANS COURT DIVISION NO. 21-07-0606 r,.~ r. "-, PETITION TO SELL REAL ESTATE/CORPORATE ASSE~ ,-'~ TO THE HONORABLE JUDGES OF SAID COURT: _. AND NOW, this 15th day of October 2007 comes the guardian, .. r~ Constance E. Stoneroad, of Keystone Guardianship Services, of the above-captioned incapacitated individual, petitions as follows: 1. Claire R. Weldon is presently a resident of the Sarah A. Todd Memorial Home, located at 1000 West South Street, Carlisle, Cumberland County, Pennsylvania. 2. Claire R. Weldon is receiving a monthly social security payment paid directly to the representative payee, Sarah A. Todd Memorial Home in the amount of $545.00 for her care and housing. (see copy of Social Security Representative Payee Statement attached as Exhibit "A"). 3. Claire R. Weldon is the owner of the Goldring & Lipman, Inc. Corporation, serving as the President, Secretary and Treasurer of the same. The purpose of said Corporation being to manage the Weldon Cafe and conduct all lawful business therein. (see copy of Pa Department of State Business Entity Filing History "B"). Page 1 of 5 Pages Estate Claire R. Weldon An Incapacitated Person 4. The U. S. Corporation Income Tax Return for 2006 for the Goldring & Lipman, Inc. - Weldon's Cafe shows a gross receipts of $236,386 cost of goods sold is $182,770, other income of $6,572, deductions of $49,757.00, leaving a taxable income of $10,431.00 (see copy of U. S. Corporation Income Tax Return 2006 attached as Exhibit "C"). 5. The U.S. Individual Income Tax Returns for 2004, 2005 and 2006 show no taxable income (see copies of the first two pages of the 2004, 2005 and 2006 U. S. Individual Income Tax Returns attached as Exhibit "D"). 6. Claire R. Weldon is the sole owner of the Real Estate located at 523 S. 19th Street, Harrisburg, Dauphin County, Pennsylvania 17104-2307 valued at $30,000 (see copy of statement of value attached as Exhibit "E"). 7. Claire R. Weldon has an outstanding claim from the Sarah A. Todd Memorial Home dated September 12, 2007 in the amount of $59,436.73, for care and housing. (see copy of statement attached as Exhibit "F"). 8. The Guardian has evidence of some of Claire R. Weldon's other outstanding debt. (see copy of list of some outstanding debt attached as Exhibit "G"). 9. Clair Weldon signed a Power of Attorney on December 10, 2003, naming Janice Young as her agent. (see copy of Power of Attorney attached as Exhibit "H"). Page 2 of 5 Pages Estate Claire R. Weldon An Incapacitated Person 10. Janice Young and her fiance, Eugene M. Gingrich deposited their personal funds into the Goldring & Lipman, Inc., Corporation to bring the Weldon Cafe to a standard to be reopened by the Department of Health and to assure the security of the Liquor License. (see copy of list of loans to corporation w/ Guardians notes and a few receipts attached as Exhibit "I"). 11. Janice Young, acting under her Power of Attorney, has managed the Weldon Cafe since December 10, 2003, to August 6, 2007; currently she is managing the Cafe for Keystone with oversight of the same. 12. Janice Young, acting under her Power of Attorney signed an agreement with John H. Brady, of Century 21 at the Helm, 717 Market Street, Lemoyne, Cumberland County, Pennsylvania 17043 to list the real estate, liquor license and business owned by Clair R. Weldon. (see copy of the MLS Listing Sheet attached as Exhibit "J"). 13. After several failed negotiations for sale of the real estate known as 523 S 19th Street, Harrisburg, Dauphin County, PA, license and equipment, on July 23, 2007, an offer totaling $140,000.00 for the real estate, license and equipment was presented to Janice Young, Agent, with a deposit of $5,000.00. (see copy of check attached as Exhibit "K"). 14. Keystone Guardianship Services has been presented an Agreement for Transfer of Liquor License owned by Claire R. Weldon and Goldring & Lipman, Inc. to sing on behalf of Claire R. Weldon and Goldring & Lipman, Inc. (see copy of Agreement for Transfer of Liquor License attached as Exhibit "L"). Page 3 of 5 Pages Estate Claire R. Weldon An Incapacitated Person 15. Keystone Guardianship Services has been presented Application for Transfer of License and Permit Goldring & Lipman, Inc. trade name Weldon's Cafe to sign on behalf of the Goldring & Lipman, Inc. (see copy of Agreement for Transfer of Liquor License attached as Exhibit "M"). 16. Keystone Guardianship Services met with Janice Young and is reasonably well-assured that she is acting in her mother's best. interest and not in an attempt to defraud here mother. 17. To support the sale as proposed Keystone Guardianship Services obtained a statement from John Brady, GRI., Century 21 at the Helm, values bread down of the License, Machinery, and Real Estate (see copy of copy of statement from John M. Brady, GRI, attached as Exhibit "N"). 18. A statement of value for a Dauphin County Liquor License was obtained from William Livingston, Partner, Livingston & MaGilton Realtors. (see copy of Livingston & MaGilton Realtors statemen attached as Exhibit "O"). WHEREFORE, the aforementioned guardian respectfully requests this Honorable Court enter an Order directing the following to provide funds from which to pay her debts and daily living expenses: Page 4 of 5 Pages Estate Claire R. Weldon An Incapacitated Person 1. Keystone Guardianship Services to sign a Corporate Resolution allowing the sale of the business and all related negotiations to complete the same, including but not limited to, the dissolution of the corporation; and, 2. Keystone Guardianship Services sign the Agreement to Transfer Liquor License and Application for Transfer of License and Permit preparing for the liquidation of the Goldring & Lipman, Inc. Corporation; and, 3. Keystone Guardianship Services to sign for the sale of the real estate owned individually by Clare R. Weldon, with the address of 523 South 19th Street, Harrisburg, Pennsylvania Respectfully Submitted J~r,.~`y~ ~ngl~, Esquire ID~#76644 Date : ~~/~~/0 7 Constance E. Stoneroad Keystone Guardianship Services 129 Market Street Millersburg, PA 17061 onstance E. Stoneroad KEYSTONE GUARDIANSHIP SERVICES 129 Market Street Suite "1" Millersburg, PA 17061 Office (717) 692-2345 Cell (717) 265-4056 Page 5 of 5 Pages Social Secu~~ity A~dinal~~,astratio~a ~~ti~~na~n~, S~rvliv~nlrs and Disabi~~ty ~nsuz'ance Important tn~ormation Mid-Atlantic Program Service Center 300 Sppringg Garden Stxeet Pla.ilade pltia Pennsylvania 19123-2992 Date: ~uly ~4, 2007 ._. Claim Numbex: 182-22-193SA 000003795 02 SP 0,58d T0157ZRMD4,0717,PC2,I,PH,076 ADM TOD[7 MCM 1-iC~M~ FOR CLAIRI/ R WrLllON 1000 W fiOUTI~t ST C:ARLI5I,F, PA 17013-2''22 ~.~, ~rn~llrr~l~lrrrrrrllrrl~ur~n11u4~rr1r1u0r}llgi~luul.~rl We have chosen you to be CLAIRE WfiLDON's representative payeE. 7h,e rest of. this letter w}}1 give you information about the checl~s you will recelvc whalE you a.re the pa,yce. Based on the information we have, we can pay benEfii~ beginning April 2007. Wllt~at We WiA Pay Aid When ~ You will recci~~c Sl,h3S.00 around August 1, 2007. ~ This is the money CLAIRE 'W)/I.I30N is due t1~,rough June 2007. ~ You will receivE SS4S.00 for July 2007 around August 3, 2007. ~ After tiaat you will receive $545.00 on or about. tlZe third of each month. >rr~fnx~tnataon ..bout IVl~dic.~ Since bcnefii~~ are again payable we will resume withholding CLAIRE WEIJDOI~t's medical prcmiurns clue to date. Any additional prerz,.i~.jms due will be deducted from her chock. Yoe~ur ~tespe-nsibilities >alease read the cnclo,ed pamphlet, "A Guide for Represcn.tative Payees." It lists the things you will need to know because you have been chosen as pa.yec. fit ~s X>napartant '1['0 ]Kea-p '1`'rack 4f Thes Money You will need to keep traclc oi' bow you use all of the money we served you for CLAIRE 'VVELI70N. Each yeax we will ask you to report on how you used the money, 'fie call this a rcpreseratative payEC accounting. Enclosure(s): EXHiB1T Pub 05-10076 Lu~iii~a~ i:,uu~y ra~c i ui ~ Corporations Corporations I Forms I Contact Corporations I Business Services Search Business Entity Filing By Business Name Date: 8/28/2007 HIStOry By Business Entity ID (Select the link above to view the Verify Business Entity's Filing History) Verify Certification Business Name History Name Name Type GOLDRING & LIPMAIV, INC. Current Name Business Corporation -Domestic -Information Entity Number: 608777 Status: Active Entity Creation Date: 1/7/1975 Principal Office Address: ROOM D-207 3300 UNION DEPOSIT RD HARRISBURG PA 0. -0 Mailing Address: No Address Officers Name: WELDON,CLAIRE R Title: President Address: C/O CLAIRE WELDON 5995 EBERLY RD MECHANICSBURG PA 17055-0 Name: WELDON,CLAIRE R Title: Secretary Address: C/O CLAIRE WELDON 5995 EBERLY RD MECHANICSBURG PA 17055-0 Name: WELDON,CLAIRE Title: Treasurer Address: C/O CLAIRE WELDON 5995 EBERLY RD MECHANICSBURG PA 17055-0 Home ~ Site Mao I Site Feedback I View as Text Only I Employment EXHIBIT http://www.corporations.state.pa.us/core/soskb/Corp.asp?386571 8/28/2007 __t, ....~.._v.... ..i, vrvaii vv..i vii i~vU\i11.J rage i or i Corporations Corporations ~ Forms ~ Contact Corporations ~ Business Services Search Search Type: Starting With Search Criteria: Goldring & Lipman, Inc. By Business Name By Business Entity ID Search Date: 8/28/2007 Search Time: 14:26 Verify Click on the Business Entity Name or Entity Number to view more information. Verify Certification Entity Entity Creation Business Entity Name Number Type Status Date GOLDRING & LIPMAN, INC. 60 Business A 1/7/1975 Corporation Records Returned 1 to 1 Home I Site Map I Site Feedback I View as Text Only I Employment x~,Orave ., Homs Copyright ®2002 Pennsylvania Department of State. All Rights Reserved. Commonwealth of PA Privacy Statement http://www.corporations.state.pa.us/core/soskb/SearchResults.asp?FormName=CorpName... 8/28/2007 Form ~ ~ 20 U.S. Corporation Income Tax Return OMB No. 1545-0123 ent of the Treasu D rt For calendar year 2006 or tax year beginning , 2006, end. , 20 206 ry epa m internal Revenue Service - See se crate instructions. P A Check f : 1 Consolidated return Name Number, street, room(suite no. City/town, state, & ZIP code B Employer identification number (attach Form 851) RS OLDRING & LIPMAN, INC. 23-1950903 2 Personal holding co. attach Sch. PH) label. Other- ELDONS CAFE C Date incor orated p 3 ~er$onal 8er. corp. seemstruceons) . WISe, 0 7 HUMMEL AVENUE 0 7 / 01 / 19 7 5 4 ch. M-3 r cared (attach Sch. M~ print or type. EMOYNE PA 17 0 4 3 -19 51 D Total assets see instructions ( ) $ 33,326. E Check if: (1) Initial return (2) Final return (3) Name change (4) Address change 1 a Gross receipts or sales 2 3 6, 3 8 6. b Less returns and allowances a ~~ 1 c 2 3 6, 3 8 6. 2 Cost of goods sold (Schedule A, line 8) ........................................................................ 2 1 8 2, 7 7 0. 3 Gross profit. Subtract line 2 from line 1 c ...................................................................... 3 5 3 , 616 . 4 Dividends (Schedule C, line 19) .............................................................................. 4 ~ 5 Interest ...................................................................................................... 5 $ 6 Gross rents ................................................................................................ 6 7 Gross royalties ....... ................................................ ..................................... 7 8 Capital gain net income (attach Schedule D (Form 1120)) ...................................................... 8 9 Net gain or (loss) from Form 4797, Part 11, line 17 (attach Form 4797) .......................................... 9 10 Other income (see instructions -attach schedule) ............................................................ 10 6 , 5 7 2 . 11 Total income. Add lines 3 through 10 .................................................................... - 11 6 0 , 18 8 . 12 Compensation of officers (Schedule E, line 4) ................................................................ 12 13 Salaries and wages (less employment credits) .............................................................. ' 13 __ ui c 14 Repairs and maintenance .................................................................................... 14 9 , 5 0 8 . 15 Bad debts ................................................................................................ 15 d .. 16 Rents ...................................................................................................... 16 9 , 5 00. ~° ~ .................................. 17 Taxes and licenses ........................................................ 17 8, 622 . a 18 Interest ...................................................................................................... 18 1, 3 0 0. c 19 Charitable contributions ...................................................................................... 19 10 20 Depreciation from Form 4562 not claimed on Schedule A or elsewhere on return (attach Form 4562) 20 2 7 51 . ' .. 21 Depletion .................................................................................................. 21 22 Advertising ................................................................................................ 22 23 Pension, profit-sharing, etc., plans ............................................................................ 23 'd 24 Employee benefit programs .................................................................................. 24 1 0 . to 25 Domestic production activities deduction (attach Form 8903) .................................................. 25 ~ 26 Other deductions (attach schedule) ............................................................................ 26 1 7 , 2 4 3 . 27 Total deductions. Add lines 12 through 26 .............................................................. - 27 4 8 , 9 3 4 . ' 28 Taxable income before net operating loss deduction and special deductions. Subtract line 27 from line 11 ...... 28 11, 2 5 4 . e 29 Less: a Net operating loss deduction (see instructions) ...... .,.,. b Special deductions (Schedule C, line 20) ..................:....... 29b 29c 8 2 3 . 30 Taxable income. Subtract line 29c from line 28 (see instructions) ............................................ 30 10 , 4 31 . 31 Total tax (Schedule J,line 10) .............................................................................. 31 1 , 5 6 5 . a 32 r ited to 2006 . . ment c ed a ver a 32 2005 0 Y P N .. .... 32b b 2006 estimated tax pay ...... ......................................................................... .>::>::>:>::< : ~ c 2006 refund applied for on Form 4466 .. 32c d Bal - 32d i a Tax deposited with Form 7004 .................................................. 32e t ~ f Credits: (1) Form 2439 (2) Form 4136 32f c0 g Credit for federal telephone excise tax paid (attach Form 8913) .................. 32g 32h x ~ 33 Estimated tax penalty (see instructions). Check if Form 2220 is attached .............................. - 33 34 Amount owed. If line 32h is smaller than the total of lines 31 and 33, enter amount owed ..................... . 34 _. , . 1, 5 6 5 . 35 Overpayment. If line 32h is larger than the total of lines 31 and 33, enter amount overpaid ..................... . 35 36 Enter amount from line 35 you want: Credited to 2007 estimated tax - Refunded - 36 Upder pena t es of p ryury, I eclare that I have examined this return, including accompanyin schedules and gtatements, nd to the best of my kno it is foie, correct, ano complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer~as any knowledge. wledge and belief, - .S I g n I M w ay the I ith the.p R discuss t is return reparer Titl D sh own be low Y 111 He re e ate Signature of officer s ee instr es uctions ? 0 Preparers' Date Check if self- Preparer's SSN or FxfIN " Paid signature 0 3 12 / 2 0 0 7 employed P O 014 0 6 6 9` Preparer's Rrm•sname(oryours MAXWELL ENTERPRISES Use Only if self-employed), ' 13 3 2 BRANDY AVENUE address, and ZIP code NEW _CUMBER.LAND PA 17 BCA For Privacy Act and Paperwork Reduction Act Notice, see the EXHIBIT 25-17010.68 hone no. 717-761-5274 Form 1120 (2006) Form 1120 (2006) GOLDRING & LIPMAN, INC . 23-1950903 Page 2 1 Inventory at beginning of year ................................................................................ 1 3 , 4 8 8 . 2 Purchases ................................................................................................ 2 1 2 9, 0 9 8. 3 Cost of labor ................................................................................................ 3 4 9, 1 3 6. 4 Additional section 263A costs (attach schedule) .............................................................. 4 5 Other costs (attach schedule) ................................................................................ 5 5, 8 5 5. 6 Total. Add lines 1 through 5 .................................................................................. 6 1 8 7, 5 7 7. 7 Inventory at end of year ...................................................................................... 7 4 , 8 0 7 . 8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on page 1, line 2 .............................. 8 18 2 , 7 7 0 . 9 a Check all methods used for valuing closing inventory: (i) Cost (ii) Lower of cost or market (iii) Other (Specify method used and attach explanation.) - b Check if there was a writedown of subnormal goods ............................................................................ - c Check if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970) ........................ - d If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing inventory computed under LIFO ...................................................................... 9 d e If property is produced or acquired for resale, do the rules of section 263A apply to the corporation? ...................... Yes No f Was there any change in determining quantities, cost, or valuations between opening and closing inventory? If "Yes," I~ k~I attach aYnlanatinn i I Voc IXI Aln - • - Dividends and Special Deductions (see instructions) (a) oividends received (b) % (c) Special deductions (a) x (b) 1 Dividends from less-than-20%-owned domestic corporations (other than debt-financed stock) .......................................................... 7 0 2 Dividends from 20%-or-more-owned domestic corporations (other than debt-financed stock) .......................................................... 8 0 3 Dividends on debt-financed stock of domestic and foreign corporations .......... see instr. 4 Dividends on certain preferred stock of less-than-20%-owned public utilities .. 4 2 5 Dividends on certain preferred stock of 20%-or-more-owned public utilities .... 4 8 6 Dividends from less-than-20%-owned foreign corporations and certain FSCs .. 7 0 7 Dividends from 20%-or-more-owned foreign corporations and certain FSCs 8 0 8 Dividends from wholly owned foreign subsidiaries ................................ 10 0 't ti . . 9 Total. t rou h 8. See instructions for Ilml a on Add Imes 1 h g ...... ............ ~~~~~~~%~~~~~~~'~~`~~`~ ~>~~~~~~~%~~~'~~'~~~~~~~~»~~^~'>~~~'>~ :»»::>::»::>::::::::»>:<:;::>::>::>::::::::>::>:::::»: ~~-'=~»~>~>~~~°~~°~~~~- z:>::>:;:>::>:>:>>::>:<:>::> 10 Dividends from domestic corporations received by a small business investment company operating under the Small Business Investment Act of 1958 ............ 10 0 11 Dividends from affiliated group members ........................................ 1 0 0 12 Dividends from certain FSCs .................................................... 1 0 0 ti in I on lines 7 8 11 r 12 13 f r i or ora ohs not c uded 3 6 0 .. Divi ends rpm foe n c d 9 P ~~~ r t' n r sub rt F ttach F rm 4 14 m ntr Iled forei n cor o a Ions u de a a o s 5 71 Income fro co 0 9 p P ( ( ) 15 F i n divid nd ross-u ...................................................... ore g e g p `:::<:::~::>::>:#>::':€: :::>::a:<::?~::'::>:>:»::<:::>:::::><:~::::: in a lin 2 r ...... 16 IC-DISC and former DISC dividends not clud don es 1 0 3 ........ ::<::::::::::'>:::'»::>::?:::<:> ::>::::>::::::<:::>:::::><::<:::»>::»:::<::::z:~z:#>~:~>::>:: 17 th rdividends ................................................................ O e ~>»>T>~~>'?»~ >'`''•>~•><?<~~[?'>~>~``: ..................,........ ....... .. . 18 t' f r Ivi ends aid on certain referred stock of ublic utilities Deduc Ion o d' d P P P ........ `~`'•`'~`'•`~''•~~'~~~~ ~~~'~'~~ ~ "'~ '~~~~`~~~~~~~"'~`'• >::>::»»>::>::::::»::><:>:~::»:::>;::>::::>::»:~::>::> ~~"°`~'~~ ~~~~~~~~~ ~`'~~~~~ :::>;:::::::>::»>:?:::'•» ... . . r an a e i line 4 - al dividends s 1 throw h 17. Ente here don .... 19 Tot Add Ilne P 9 9 20 Total special deductions. Add lines 9, 10, 11, 12, and 18. Enter here and on a e 1, line 29b ............ ........ - b7aiT~ ~i0ITlpenSBLIOn OT VTi1CerS (see instructions for page 1, line 12) Note: Complete Schedule E only if total receipts (line 1a plus lines 4 throuoh 10 nn nacre it are R5nn nnn nr mnra ( ) (b) Social security ~ Percent of ti d t d t Percent of corporation stack owned f Amount Name of officer a 1 number me evo e o business (d) Common (e) Preferred of compensation CLAIR WELDON 182-22-1935 100.0 % 100.0 % 0.0 0.0 % 0.0 % 0.0 0.0 % 0.0 % 0.0 % 0.0 % 0.0 % 0.0 % 0.0 % 0.0 % ~ 0.0 % 2 Total compensation of officers ...................................................................................... 3 Compensation of officers claimed on Schedule A and elsewhere on return ........................................... . 4 Subtract line 3 from line 2. Enter the result here and on oaae 1, line 12 ............................................. . Form BCA Copyright forth software only, 2006 Universal Tax Systems, Inc. All rights reserved. US1120$2 Rev. 1 Form 1120 (2006) GOLDRING & LIPMAN, INC. 23-1950903 Page3 rt - ~ TaX COmputatlOn (see instructions) 1 Check if the corporation is a member of a controlled group (attach Schedule O (Form 1120)) ............ - I I : ' .. .::.~.;: 2 Income tax, Check if a qualified personal service corporation (see instructions) .......................... - iL J1 2 1 , 5 6 5 . 3 Alternative minimum tax (attach Form 4626) ............................................................. ..... 3 4 Add lines 2 and 3 ....................................................................................... ..... 4 1, 5 6 5. 5 a Foreign tax credit (attach Form 1118) ................................................ 5a `~~~~~~~~'~~''•'~' .......... b Qualified electric vehicle credit (attach Form 8834) .................................. 5b ' ~''~'"~''~~~ :>:::>::>::>::: c General business credit. Check applicable box(es): Form 3800 ~~' ~~~'~`~~~ ~:z~>::: Form 6478 ~ Form 8835, Section B Form 8844 5c ~~~""~~' d P Y ( ) .............................. Credit for rior ear minimum tax attach Form 8827 5d ~""`~"~"" e Bond credits from: ~ Form 8860 ~ Form 8912 5e '"'`~ ~~" .:::::::::: 6 Total credits. Add lines 5a through 5e ................................................................... ..... 6 7 Subtract line 6 from line 4 ............................................................................... ..... 7 1, 5 6 5. 8 Personal holding company tax (attach Schedule PH (Form 1120)) ......................................... ..... 8 9 Other taxes. Check if from: B Form 4255 8 Form 8611 B Form 8697 .. ... Form 8866 Form 8902 Other (attach schedule) 9 10 Total tax. Add lines 7 throw h 9. Enter here and on a e 1, line 31 .......................................... 10 1, 5 6 5 . . - . Other Information (see instructions) 1 Check accounting method: a Cash b ~ Accrual c ® Other (specify)-MOD I F I ED AC 2 See the instructions and enter the: a Business activity code no. -7 2 2 410 b Business activity - TAVERN c Product or service - FOOD AND BEVERAGE 3 At the end of the tax year, did the corporation own, directly or indirectly, 50% or more of the voting stock of a domestic corporation? (For rules of attribution, see section 267(c).) ..I If "Yes," attach a schedule showing: (a) name and employer identification number (EIN), (b) percentage owned, and (c) taxable income or (loss) before NOL and special deductions of such corporation for the tax year ending with or within your tax year. 4 Is the corporation a subsidiary in an affiliated group or aparent-subsidiary controlled group? ................. . If "Yes," enter name and EIN of the parent corporation - 5 At the end of the tax year, did any individual, partnership, corporation, estate, or trust own, directly or indirectly, 50% or more of the corporation's voting stock? (For rules of attribution, see section 267(c).) .......................... . If "Yes," attach a schedule showing name and identifying number. (Do not include any information already entered in 4 above.) Enter percentage owned - 10 0 . 0 6 During this tax year, did the corporation pay dividends (other than stock dividends and distributions in ex- changefor stock) in excess of the corporation's current and accumulated earnings and profits? (See sections 301 and 316.) ........................................... If "Yes," file Form 5452, Corporate Report of Non- dividend Distributions. If this is a consolidated return, answer here for the parent corporation and on Form 851, Affiliations Schedule, for each subsidiary. 7 At any time during the tax year, did one foreign person own, directly or indirectly, at least 25% of (a) the total voting power of all classes of stock of the corporation entitled to vote or (b) the total value of all classes of stock of the corp.? If "Yes," enter: (a) Percentage owned - 0 . 0 and (b) Owner's country - c The corporation may have to file Form 5472, Information Retum of a 25% Foreign-Owned U.S. Corporation or a Foreign Corporation Engaged in a U.S. Trade or Business. Enter number of Forms 5472 attached - 8 Check this box if the corporation issued publicly offered debt instruments with original issue discount ........ - a If checked, the corporation may have to file Form 8281, Information Return for Publicly Offered Original Issue Discount Instruments. 9 Enter the amount of tax-exempt interest received or accrued during the tax year - $ 10 Enter the number of shareholders at the end of the tax year (if 100 or fewer) - 1 11 If the corporation has an NOL for the tax year and is electing to forego the carryback period, check here .......... - a If the corporation is filing a consolidated return, the statement required by Temporary Regulations section 1.1502-21T(b)(3) must be attached or the election will not be valid. 12 Enter the available NOL carryover from prior tax years (Do not reduce it by any deduction on line 29a.) - $ 823. 13 Are the corporation's total receipts (line 1 a plus lines 4 through 10 on page 1) for the tax year and its total assets at the end of the tax year less than $250,000? ............ . If "Yes," the corporation is not required to complete Sch. L, M-1, and M-2 on page 4. Instead, enter the total amount of cash distributions and the book value of properly distri- butions (other than cash) made during the tax year. - $ Note: If the corporation, at any time during the tax year, had assets or operated a business in a foreign country or U.S. possession, it may tie required to attach Schedule N (Form 1120), Foreign Operations of U.S. Corporations, to this return. See Schedule N for details. Form 1120 (2006) BCA Copyright form software only, 2006 Universal Tax Systems, Inc. All rights reserved. US1120$3 Rev. 7 Form 1120 (2006) GOLDRING & LIPMAN, INC. 23-1950903 Page4 - . - Balance Sheets per Books Beginning of tax year End of tax year Assets (a) (b) (c) (d) Cash ........................................ < »>»>:>: :>::»:::>;::>##?:'•»>'r>>?::>::s::; 12 442. , . ; :::::»::>::;::::»::»>::>:::;«:::>:<::<:::<:>:::>;: >;>::>:<:::>:s::>::»::>»»::>>:>ss>>::: 760 20 2a Trade notes and accounts rece a b Less allowance for bad debts ............... . Inventories ................................. • : ..... . »>::»::>::> :::<:::;::::>::>:•::>:.>::>::»::>::>::>:<•:>:: 88. 3 ~ : ~ :::»::::>::><:>::::>::>::.>.::»>':«:>:<:>::>::»::s:: 4 8 7 0 . 4 U.S. government ob g ......... ...............:.::................ ' .. instructions 5 Tax exempt securities (s ) >>»> '.»[>:<: ::?:;:>::`>:`::>:::: schedule 6 Other current assets (a ) ........ <::>~>::>::::;; ~;::::::>::» ::~:::<::>s>:<;::»:»>?:::<{:»:::::: ::»><::»::::>:::««:>::::>:::<:<:::<:::::>:: 7 Loans to sha ` ` :: ::::>::::>:::<:>:::i<:::><::::<::«:::>::::::>::: s ate .............. t loans 8 Mortgage and real e <>~>>s`• ::.;;:•;:.;;:• : : : ' :>:>:>:::>s€:>::>:#::>::>i'i<:: > :>` <:>::>:<:>:::::~>::>::»»::::::::>::><>::: <::::>::::>::: : : <: :> : : : : ~ : >::::> >:::>::>::<::::>::»:>:>::>::>:>:::s::::>::::>::>::»::::>::::: hedule ch sc 9 Other lnvestme is ( ) >:< >?: > ~: ;;:•;;;;: ......... : > :::::::.:::::::::»::> :> : : : : : : .;:.;;;;;:•;:•;:•:.;:.;;:.;:::.;:.;:.;:.;:.:;:.; ............. . assets ........ 10a Buildings and other depreciable 4. 0 49 2 , :>:»:»:>;<:::>:<:»z:>[:::>:::><<>::<:>: 0 494. >:<:::>?<::::>::»::>::>::>::>::::>::>::~:?::;»:?:>::: ................... ~ ~~~ .............. b Less accumulated depreciation 9, 984. 10, 510. 12, 735. 7, 759 . 11a Depletable a b Less accumulated depletion .................. 12 Land (net of any amort ) . ............ ........ 13a Intangible assets (amortizable only) .......... ..................................... b Less accumulated amortization ............. . 14 Other assets (attach sc d ) 5 ai assets .................................. : To «>>: ?<~`>~;»;<«?~~>> 2 440. 6 ~>>>»>`:>s`«<>»><:<: 2 . 33 3 6 E wit ders ehol S ar " ' sand h bilttte Lia Y 9 ............................. ......... .......... ................................ 16 t a able ............................ Accoun s p y :::':>:>:: ~>:<::><::~»:>`;>:~:>:::>::> ''a':>'s<>~><><> 7 e in a ab nds ntsbo oe rt a es Mo Y P 9 9 n 1 ear .............................. less fha y >::>::::>::<::> :<:;>»::>:>::><:>:::>::>~><:: 7 6 7 5 . > :>s:~::::>::>>::::>:<:::>::::>?::::>:::<:::::>::>::::>::::>::::>: 228. 8 ther current liabilities attach schedule) ...... ( ~> ::.:..~..x..:.;:.;:. > T ;;:~'~...:•;;:.:;. <•;;;;;:;;:.;:•;:<.:;:: 17. 2 9 ~ <:~:>s:`::>`<:'s<:::>::>::>>:'<:>:`:;:;: 1. 4 66 , 9 hare .................... holders Loans from ~[> :.:;:•;:•;:.;:.;:. «<:::>~':«:::>>:>~#~<:€:zs:?:s ;;:•;;::<:>::>::>::>:<:::s»::>:>::»>::: 3 6 5. ::::>:iz::::<::>::>:::>::>::>»#::::>::::::>:'.::>::::>::>:::>: 635. 0 2 I' b e in nd a a bo s notes es Mort a PY 9 9 . ....:..... ..:...::..................... ::»>::>::>•<::>:><::::>::>:=>:::><::<:»::>:<:::>::::::: ar or more Y <: : : : : ' : :> :>::>:<:: :»"~: :> : :> :> «: : ' > » ' 21 ... hedule Other Ilabllltles (attac ) >: : :> : :>? : ........... : : : : : : : : • : •: : ............................ 22 • f rred stock .......... Capital stock. a Pre e %:>:>'>:%:>::>'•»z:><~i> «::>:>'::>:>rr>`. : :::::>::>::>::>::» ............ ::»<>~::»:<:;>;>:<:::>::>::::<::>::>::: ................................ b Common stock .......... 1, 000. 1, 000. 1, 000. 1, 000. 3 id-Inc .................... Additional p p >::>::>:::»>: ::><::>::><::>.:> <:><>::»»::»:<:>: 100. :::>:::<:::::>::>::::>::»>:«>:>::::»::::»::>::::>::>::::> 1 0. 0 4 ri ted - r a I A o rn n s in d a eta e P PP attach sc ed 5 - na Retained ea n pp p i t ' h ltl ~ .......... ........... ................................ ............................... 5 013. 14 702 . 6 2 y r e u o e s s are is to tmen Ad us J q le h d tt >>` '>>>;;;<[ >:;;:::»::>s:<:s:::>::»::»:;»>::>::»::»»::>::> : e u (a ac ) 27 Less cost of treasurys o 8 otal liabilities and shareholde s .. _ ... .::.::.::.::.>:• :::>:<:>:<::<::<: :.;:.;:.;:.::.::.;:.;:.;:.;:::::::.::::: r;:»:<x::::>::>:<::«<:::>:>.:>:::<:»:<:>:: . 44 26 0. : :::>::s::>::::>::>:z:>:<:::::>:z:::>::>::>:<>.>::;::<:::>:» : 2 33 3 6. - . - Reconciliation of Income (Loss) per Books With Income per Return Note: Schedule M-3 required instea d of Schedule M-1 if total assets are $10 million or more -see instruc tions 1 Net income (loss) per books .................. 6 8 9 . 9 ~ 7 Income recorded on books this year not included on this return itemize): ~ ~`~'~`'`'~~~" '~'~`~~'~~~"~`~`'"'" ~'•"•'•'`~'"~`'" 2 ederal income tax per books ................ 5 1 5 6 , r t x-exem t inte es Ta P 3 ital ains .. Excess of capital losses over cap g .. ........ "'~'~"~`'" ................................. ""'~"""""~~"~`"`"'^'"'~` 4 not recorded on books this ear m sub'ect to tax Y Inco e i mize • to f ........ ............................. 8 hi r t h r d tions on t s e urn not c a e Deduc 9 . ... against book income this year (itemize): 5 Expenses recorded on books this year not deducted a Depreciation .... $ ..:............................. ........ m itemize n this retu 0 ( ) b h dt C a able a Depreciation ........ ::~::~>:~s:~~:»;<s:>:><~:<:«:>s:<x<:~>:sii:~>:~r::: contributions ...... :.:::::::.::: >::::::::::::::::::::::::::::::. b Charitable contributions .... ::::::::::::::::::::::::::::::::::::::::::. : ......... .... $ ~. ~ ::::::::::::::::::::::::::::::~::::.: r:::::. c Travel and entertainment ........ ~':::5::;:;:;:S::i~:<:<~:~ii:::::~:;:::::i:;:::5:~: 9 Add lines 7 and 8 .......................... 6 Add lines 1 throw h 5 ........................ 11, 2 5 4 . 1 o Income (page 1, line 28)-line bless line 9 .......... 11 , 2 5 4 . ~. -. - Analysis of Unappropriated Retained Earnings per Books (Line 25, Schedule L) 1 Balance at beginning of year .................. 5 , 013. 5 Distributions: a Cash ................. . 2 Net income (loss) per books .................. 9 , 6 8 9 . b Stock ................ 3 Other increases (itemize): c Property ............. . <: 6 er ecreas es itemize Oth d ( ::::::::::::::::::.:::::::::::::::::::::.... 7 Add lines 5 and 6 .......................... 4 Add lines 1, 2, and 3 ........................ 14 , 7 0 2 . 8 Balance at end of year (line 4 less line 7) 14 , 7 0 2 . Form 1120 (2006) BCA Copyright form software only, 2006 Universal Tax Systems, Inc. All rights reserved. US712054 Rev. 1 US 1120 Page 1, Line 26 - Other Deductions 2006 Name: GOLDRING & LIPMAN, INC. EIN: 23-19 50903 Type: Accounting ................................ ....................................................................... Amortization ............................... ....................................................................... Answering service ......................... ....................................................................... Auto and truck expenses ................... ....................................................................... Bank charges ............................. ....................................................................... 3 1 5 . Commissions ............................. ....................................................................... Computer expense ....................... ....................................................................... Delivery and freight ....................... ....................................................................... Dues and subscriptions .................... ...................................................................... Entertainment and promotion ............... ....................................................................... 1 , 1 2 6 . Gifts ...................................... ............... Insurance ................................. ....................................................................... Janitorial ................................. ....................................................................... laundry and cleaning ...................... ......................................... ............................. legal and professionalfees ....................................................................................... 2 , 6 1 0 . licenses and permits ...................... ...................................................................... 1 , 8 7 5 . Meals: at 50% at 70% -DOT hours of service at 100% -See instructions ....................................... . Miscellaneous .............................. ...................................................................... Office expense ............................ ...................................................................... 2 4 6 . Outside service ............................ ...................................................................... Parking fees and tolls ...................... .......................................................... Postage .................................... ...................................................................... Printing .................................... .................................................................... Sales expense .............................. ...................................................................... Secur'Ity .................................... .................................................................... 5 3 5 . Supplies .................................. .................................................................... 1 1 2 . Telephone .................................. ...................................................................... 5 3 4 . Temporary help ............................ ...................................................................... Tools ...................................... ...................................................................... Trade show expense ........................ ...................................................................... Training and seminars ...................... ...................................................................... Travel ...................................... ......................................................:............... Unfforms .................................. ...................................................................... Utilities .................................... ...................................................................... 8 , 9 6 2 . EXTERMINATION ................................................... . . . ........ . 6 2 3 . THEFT LOSS .............................................................. 305. .............................................................. .............................................................. .............................................................. . .............................................................. .............................................................. .............................................................. .............................................................. .............................................................. .............. Total ............................................................................................................ 17 , 243 . Copyright form software only. 2006 Universal Tax Systems, Inc. All rights reserved. USWCA$$1 Fom, 4562 Depreciation and Amortization (Including Information on Listed Property) Department of the Treasury Internal Revenue Service - See separate instructions. - Attach to your tax return. Name(s) shown on return Business or activity to which this form relates GOLDRING & LIPMAN, INC. AVERN Election To Expense Certain Property Under Section 179 Note: If you have any listed property, complete Part V before you complete Part I. 1 Maximum amount. See the instructions for a higher limit for certain businesses .................................. 1 2 Total cost of section 179 property placed in service (see instructions) ............................................ 2 3 Threshold cost of section 179 property before reduction in limitation ............................................ 3 4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- ... ................................... 4 5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing separately, see instructions ................................................................................ 5 (a) Description of property (b) Cost (business use only) (c) Elected cost 6 7 Listed property. Enter the amount from line 29 ...................................... I 7 ~ 8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 ............................ 8 9 Tentative deduction. Enter the smaller of line 5 or line 8 ...................................................... 9 10 Carryover of disallowed deduction from line 13 of your 2005 Form 4562 .......................................... 10 11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) .. 11 12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 .......................... 12 13 Carryover of disallowed deduction to 2007. Add lines 9 and 10, less line 12 ........ - 13 Note: Do not use Part II or Part III below for listed property. Instead, use Part V. Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instruction 14 Special allowance for qualified New York Liberty or Gulf Opportunity Zone property (other than listed property) placed in service during the tax year (see instructions) ........................................... . .... 14 15 Property subject to section 168(f)(1) election .................................................................... 15 16 Other depreciation (including ACRS) .......................................................................... 16 MACRS Depreciation (Do not include listed property.) (See instructions.) Section A 17 MACRS deductions for assets placed in service in tax years beginning before 2006 .............................. 17 18 If you are electing to group any assets placed in service during the tax year >::>::> into one or more general asset accounts, check here .... ................. - :~'<`•>: Section B-Assets Placed in Service During 2006 Tax Year Using the General Depreciation Sys b Month and c Basis for dept. (d) Recovery (e) (a) Classification of property year placed in (businessflnvestment use period Convention (f) Method SefVICB only-see instructions) 19a 3-year property b 5-year property c 7-year property d 10-year property e 15-year property f 20-vearproperty ........,............,,.:,,.. OMB No. 1545-0172 2006 Attachment Sequence No. 67 Identifying number 23-1950903 108,000. ,751. (g) Depreciation deduction g 25-year property ~. 25 yrs. S/L h Residential rental 27.5 yrs. MM S/L property 27.5 yrs. MM S/L i Nonresidential real 39 yrs. MM S/l. property 0.0 MM S/L ce~t•f.,., C-AsseYe Placed in Serviee During 2006 Tax Year Using the Alternative Deoreciation Svstem 20a Class life S/L b 12-year 12 yrs. S/L c 40-year 40 yrs. MM S/L S 21 Listed property. Enter amount from line 28 .................................................................. zi 22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnerships and Scorporations -see instructions ........ 22 2 , 7 51 . t renter the urren ea r'n the c is du I bove and laced in serv e , For assets shown a 9 Y 23 p 23 portion of the basis attributable to section 263A costs ~~~~~~~~ ~~~~^~•~~~•~~•~°•~°•~~'~~°~°~•~°•~°•~~~~•~~~~•~~~•~~° For Paperwork Reduction Act Notice, see separate instructions. Form 4562 (2006) BCA Copyright form software only. 2006 Universal Tax Systems, Inc. All rights reserved. US4662$t Rev. 1 Detail Sheet Name: GOLDRING & LIPMAN, INC. PAGE 1 - LINE 10 - OTHER INCOME 2006 ID: 23-1950903 Type Amount GAMING AND MUSIC MACHINES 6,561. COMMISSIONS AND DISCOUNTS 11. Total ..........................................................................................................~ 6 , 5 7 2 . Copyright form software only, 2006 Universal Tax Systems, Inc. All rights reserved. USWDET$1 Detail Sheet 2006 Name: GOLDRING & LIPMAN, INC. ID: 23-1950903 PAGE 1 - LINE 17 - TAXES - OTHER I YPB Amount MERCANTILE TAXES 376. PAYROLL TAXES 5,522. REAL ESTATE TAXES 1,517. PA CORPORATE LOANS TAX 62. Total ..........................................................................................................~ 7 , 4 7 7 . Copyright form software only, 2006 Universal Tax Systems, Inc. All rights reserved. USWDET$1 7~_~ ocnnn~ 1 J J V J V J US Schedule A: Line 5 - Other Costs, Cost of Goods Sold 2006 Type Amount OIL CLEANING 610. QUIPMENT RENTALS 1,206. INENS-GLASSES-DISHES 1,796. SUPPLIES 2,243. 5,855. Copyright form software only, 2006 Universal Tax Systems, Inc. Ali rights reserved USSTCA51 23-1950903 US Schedule L, Line 18: Other Current Liabilities 2006 Description Beginning of the year End of the year CCRUED PAYROLL TAXES 2,713. 1,293. CCRUED SALES TAX 204. 192. THER WITHHOLDING 404. CCRUED CORPORATE TAXES 2,772• 2,917. 4,661. Copyright form software only, 2006 Universal Tax Systems, Inc. All rights reserved. USSTC181 ~Z_-t a~nan~ US 1120 Schedule K: Question 5 2006 Identification Percent of Name number stock owned LAIR WELDON 182221935 100.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Copyright form software only, 2006 Universal Tax Systems, Inc. All rights reserved. USSTC3$1 M 0 rn 0 rn I M N H 0 a W a a H H W A H W O 0 N N [n rt v 27 I i ~ ~ I r6 0 I A u~ I U] O I N U I r-I -ri I ~ N I ~ a I I \ a~ I ~i U I •ri •ri I ~ ~ I t7 a I I ~ I to ~o d~ I ~ d~ r l ,--1 I r ~ i r N ~o ~ ~o rn~ I S I N ~ rl M N i l0 I 0p ~~ ~ I t N I N I N `~ U I I + r N M I N r r I ~ I ~ ~-1 I tb M N I d~ N l0 I In I Ol O H + M ~-1 M I W O l0 I r I Lf1 -'"I ~-I + 1 Lf1 I tfT I l0 a I I I r o w I M ~ r l ,-i l ~ N ri N I lD ~ l0 I ~ I N ~~ I M N I ~ I r 0 0 1 N I N I N z ~+ + I 1 ~ I ~ o ~ v + ~ M ~ c~ ~ o i rn ~ ~ ~ ~ u i ~ M N I l0 I r ~ ¢I I N I N I N ~ Q U I I rb 'd+ lO N I N r r I V+ t d+ 3-I I l0 W l0 r-I I l0 O l0 I l11 I O O F-I I r-i d' i-I d~ 1 0 0 lD I r I Ol -rl ¢I + M I r-I L(1 I L11 I Ol u ~ I a A I t U I x x x~ ~ x • I o 0 0 0 0 0 U }.I I N N i u~ r r r to to a ~ r-I I '~ I ~ ~ A A A ~ I o 0 0 ~ I (J1 N N N U~ Ul + OD M ri ~-1 1 L(1 r-I O I r-I I d~ W I l0 N r-1 N + Ul r 0 I r + 01 '~ I rl ~ N Lf1 I M 01 O I ~ I d~ ~ I M I r-I r-I ~ I Lf1 I O ~ I c-I I r-1 I N W I 1 t U I of N I r s~.l I ~ r~ I 1 N N I O 0 0 0 0 0 ~ ~ + O O O O O O PQ ~ + c~ r-1 c-i rl rl ~ + 07 M '-I r-I I t!1 ~-I O I rl I ~ + ~i ~ N ri N t Ln r 0 I [~ I 61 }J I \ In r-I r-I, l0 N U1 I M M Ol O I O1 I ~ ~ + 7.a l~ M O I r-I O r-1 c}~ I L!1 I O O t Ol O O ~-1 I r-I I N U I ry' •• ri N N + \ N z N 'Cj + RS 3-I Lfl Sd r-I rl ri Sd M M ~ CJi i ri f0 r (~ O O O b O O S. U N \ N ~\\ N \\ A~ i N ~o ~oo ~ ~ ~ ~ ~ ~ i~ i I GL -rl U U U Clt N Lam" I fri O 4~ .U •~i •'i •ri -rl .4J U1 -° ~ ;a -~ ~ boo ~'w v ~ ~ I I C1 -I H N U ~ ~ ~ C~ N O , r U ] W C F: -r1 I of ~I ~ W W W N '~ H Ul I ~ N A H ' H ~ ~ a 1-I v I oa A a o00 ~ f1+ ,~+~ ~ ~ o r-. LL 1040 Label (See in- structions) Use the IRS label. Otherwise, please print or type. Election Department of the Treasury•Intemal Revenue Service U.S. Individual Income Tax Return 2004 s9 IRS Use Onl -Do not write or sta le in this s ace For the year Jan. 1-Dec. 31, 2004, or other tax year beginning ,2004, ending ,20 OMB No. 1545-0074 Name Spouse's Name (if Joint Return) Home Address City, State, and ZIP Code Your social security number CLAIRE R WELDON 182-22-1935 Spouse's soc. sec. number 307 HUMMEL AVENUE LEMOYNE PA 17043-1951 Note. Checking "Yes" will not change your tax or reduce your refund. paign ns. Do ou, or ours ouse if filin a 'oint return, want $3 to o to this funs 1 Single 4 You Spouse ? •••••••••••••••••- nYes ~No nYes nNo Head of household (with qualifying person). (see instructions>. If the qualifying person is a child but not your dependent, enter this child's name here. - Filing Status 2 Married filing jointly (even if only one had income) Check only 3 Married filing separately. Enter spouse's SSN above One bOX. and full name here. - 5 with dependent child 6a Yourself. If someone can claim you as a dependent, Boxes Exemptions do not check box 6a .................................................................:::~ 6a and 6b n 1 b Spouse ............................................................................. No. of children If more than four depen- dents see instr. c De endents• P (1) First name Last name (2) De endent's P social securit number 3 Dependent's relatlonshipto ou 4g If qual- fo~cfriidhiax credit on 6c who. 0 • lived with you • did not live with you due to divorce orseparation 0 (see instr.) Dependents on entered above 0 Add r- umbe s on d Total number of exemptions claimed ................................................................................ ~ines af;ove - Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 7 Attach 8a Taxable interest. Attach Schedule B if required ............................................ 8a Forms W-2 here. b p .......... Tax-exem t interest. Do not include on line 8a Sb ~~~~~•~~>^• ,.,.. . Also attach Forms 9a ry q .......................................... Ordina dividends. Attach Schedule B if re wired 9a W-2G and 1099-R if tax b ........................ Qualified dividends (see instructions) 9b :.:::::::: •::.;:::;.t:: """" <.f~: .: .. was withheld. 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ........ 10 11 Alimony received .......................................... ................................ 11 12 Business income or (loss). Attach Schedule C or C-EZ .... ................................ 12 If you did not 13 Capital gain or (loss). Attach Schedule D if required. If not req uired, check here - ~ 13 get a W-2, see instructions 14 Other gains or (losses). Attach Form 4797 .................. ................................ 14 15a IRA distrlbutlOnS .......... 15a b Taxable amount (see instructions) 15b 16a Pensions and annuities .... 16a b Taxable amount (see instructions) 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .... 17 (7 9 6 . ) 18 Farm income or (loss). Attach Schedule F .................. ................................ 18 but do Enclose 19 Unemployment compensation .............................. ................................ 19 , not attach, any 20a Social security benefits ..... I20a~ 6 , 9 3 9 . I b Taxable amount (see instructions) 20b payment. Also, please use 21 Other income. List type and amount (see instr.) 21 Form 1040-V. 22 Add the amounts in the far right column for lines 7 through 21. This is your total income - 22 7 9 6 . 23 Educator expenses (see instructions) ........................ 23 :•> ''"''"'"' Ad jUSted GrOSS 24 Certain business expenses of reservists, performing artists, and fee-basis gov. officials. Attach Form 2106 or 2106-EZ ... 24 <' Income 25 IRA deduction (see instructions) 25 ~~~~~'~~~~~~~~~ 26 27 Student loan interest deduction (see instructions) .......... Tuition and fees deduction (see instructions) ................ 26 27 '~'''"'''"` +•::LS:i ~• ~ ••• 28 Health savin s account deduction. Attach Form 8889 ........ 9 28 ~:~:~~~~~': ~::~'.:::•: .: :: 29 9 P .................... Movin ex enses. Attach Form 3903 29 ... . ~'~~•~~~~ •'sss::::::• 30 31 One-half of self-employment tax. Attach Schedule SE .... Self-employed health insurance deduction (see instr.) .... 30 31 `"''"~~`'' 32 Self-employed SEP, SIMPLE, and qualified plans .......... 32 •'+•""""`' :...:.::::. 33 tY Y g .................... Penal on earl withdrawal of savin s 33 '~"~~'~•'~'~ •::;.:::•;:•:. Copyright form software only, 2004 Universal Tax Systems, Inc. All rights reserved. 34a 35 Alimony paid b Recipient's SSN - C~yyu~ GAf~~B~ Add lines 23 through 34a .......... .................... ~i' "`''''~'"" 35 usloao$1 Rev. 1 36 ~ ~ Subtract line 35 from line 22. This is .................... - 36 7 9 6 . BCA For Disclosure, Privacy Act, and Paperwork Reductio Form 1040 (2004) Form 1040 (2004) CLAIRE R WELDON 182-22-1935 Pana2 37 Amountfrom line 36 (adjusted gross income) .............................................. 37 (7 9 6 . ) Tax and 38a Check You were bom before January 2, tsao, Blind. Total boxes Credits If: 8 Spouse was bom before January 2, 1940, B Blind. }checked - 38a 1 Standard b If your spouse itemizes on a separate return or you were adual-status alien, Deduction ~ see instructions and check here - 38b for - ............................................. • People who 39 Itemized deductions (from Schedule A) or your standard deduction (see left margin)........ checked an box ~::~''~:<~' err?r .:.: ~~~' ~~`~'~`~~ ::{:::4::::: ~;:~:•<:: '::~~•'f':~':' •:;;::;:: ... 39 0 5 0 . y on line38aor38b 40 Subtract line 39 from line 37 ....................................... . •••••••••••••........... 40 6, 846. or who can be claimed as a dep- endent, see instr. 41 If line 37 is $107,025 or less, multiply $3,100 by the total number of exemptions claimed on line 6d. If line 37 is over $107,025, see instructions . ........................................ ~~~'"""~ 41 3 , 10 0 . • All others: 42 Taxable income. Subtract line 41 from line 40. If line 41 is more than line 40, enter -0- .... 42 0 Single, or Married 43 T0X (see instr.). Check if any tax is from: a ~ Form(s) 8814 b a Form 4972 ............ 43 filing separately, $4 850 44 Alternative minimum tax (see instructions). Attach Form 6251 .............................. 44 , ................ 45 Add lines 43 and 44 ................................................... - 45 Married filin 9 jointl or Qualif in 46 Foreign tax credit. Attach Form 1116 if required .............. 46 •::•>:::•::•:: :r::>::>::;: :::: y y g widow(er), 47 Credit for child and dependent care expenses. Attach Form 2441 .. 47 %•,c•: $9,700 48 Credit for the elderly or the disabled. Attach Schedule R .. 48 Head o household, 49 Education credits. Attach Form 8863 49 ~::r~::;::::<a •~•~~~~ •~~• $7,150 50 Retirement savings contributions credit. Attach Form 8880 .. 50 ~:~< ......:... 51 Child tax credit (see instructions) 51 ~~~~~~'`~~'•~~~ 52 Ado lion credit. Attach Form 8839 52 '~~~~~~~~~ 53 Credits from: a ~ Form 8396 b 8 Form 8859 53 +i 54 Other credits. Check applicable box(es): a Form 3800 b 0 Form 8801 c ~ specify ~~''>• ..~54'. •~>»# '<:?::in4::: :: ii:: 55 Add lines 46 through 54. These are your total credits ...................................... 55 56 Subtract line 55 from line 45. If Tine 55 is more than line 45, enter -0- .................... - 56 57 Self-employment tax. Attach Schedule SE ...... . ......................................... 57 Other 58 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 .. 58 Taxes 59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required .... 59 60 Advance earned income credit payments from Form(s) W-2 .................................. 60 61 Household employment taxes. Attach Schedule H .......................................... 61 62 Add lines 56 through 61. This is your total tax .......................................... - 62 Payments 63 Federal income tax withheld from Forms W-2 and 1099 ...... 63 64 2004 estimated tax pymts and amt applied from 2003 return 64 you aye a 65 a Earned income credit EIC .................. uall In child ~~•~•••••~~• 65a :.::::::::. •~~•~~~~~~• e%z:::::>;>: ~•`'"""• , q 9 b Nontaxablecombat 65b attach Schedule pay election ........ EIC. 66 Excess social security and tier 1 RRTA tax withheld (see inst) 6 ~• .:... '~"••~~`•" •::.::.~::. 67 Additional child tax credit. Attach Form 8812 .............. 67 :s::s:::::z:;;: '~""""• :::::<::::': 68 Amount paid with request for extension to file (see inst) ...... 68 ~'~~`•.>? 69 Other pymts. from: a ~ Form 2439 b ~ Form 4136 C ~ Form 8885 69 :.::::::::. 70 Add lines 63, 64, 65a, and 66 through 69. These are your tota l paym ents ................ - 70 Refund 71 If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid 71 Direct deposit? 72a Amount of line 71 ou want refunded to you ............................................ - See instructions ° 72a - b nu mtie XXXXXXXXXXXXXXXXXXX - c T e: ~ Checkin a Savin s and fill in 72b, Account g g 72C, and 72d. - d number XXXXXXXXXXXXXXXXXXXXXXXX 73 Amount of line 71 you want applied to your 2005 est. tax - 73 • A1110Unt 74 Amount you owe. Subtract line 70 from line 62. For details on how to pay, see instructions - YOU OWe 75 Estimated tax penalty (see instructions) ......... 74•:. .~. '"'"""' ' t rUra rGrly ~~ you warn w auuw anuuter person [o alscuss tn15 return Wlin the IrSS (See InStrUCtIOnS)? Zui YeS. Complete the following. NO Designee D mienee's-pREPARER Pohone- Personal identification number (PIN) - Slgn Under penalties of pequry, 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 complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Here Your signature Date Your occupation Daytime phone number Joint return? ET I RED 717 - 7 3 0 - 012 5 See instr. Keep a copy Spouse's signature. Ii a joint return, both must sign Date Spouse's occupation :~k.'•<'•'~~.':x%%h ~?•%~~>.:~ k~•~.~':•• • ` for your fi{;~:;4:~',4~:::.:w:;3fi.'•.•.~sr~.nveS'::a<:::`:.t,+.'r,~:,`t Preparer's Date Check if Preparer's SSN or PTIN Paid 5lsnawre 0 7/ 0 6/ 2 0 0 5 self-employed P O 014 0 6 6 9 Preparer's Finn's name (or MAXWELL ENTERPRISES EIN 2 5 -17 010 6 8 yours if self- USe Only employed), ' 13 3 2 BRANDY AVENUE address, and NEW CUMBERLAND PA 17 0 7 0 ZIP code Phone no. 717 - 7 61- 5 2 7 4 BCA Copyright fonn software only, 2004 Universal Tax Systems, Inc. All rights reserved. US1040$2 Rev. 1 Foml ~ ~4~ (2004) E t~ 1040 Label (See in- structions) Use the IRS label. Otherwise, please print or type. Presidential Election Cal Department of the Treasury-Intemat Revenue Service U.S. Individual Income Tax Return For tha year Jan. 1 •Dec. 31, 2005, or other tax year begin Name Spouse's Name (if Joint Return) CLAIRE R WELDON 2005 Home IRS Use ,2005, ending not write or ,20 in this s ace. OMB No. 1545-0074 182 -22-1935 Spouse's social security no. 3 0 7 HUMMEL AVENUE You must enter T ~EMOYNE PA 17 0 4 3 -19 51 • our SSN s above. • Checking a box below will not change your tax or refund. - Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see instructions) - You Spouse 1 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, enter 3 Married filing separately. Enter spouse's SSN above this child's name here. - and full name here. - 5 Qualifying widow(er) with dependent child (see instructions) Filing Status Check only one box. Exempt If more than fDUr depen- dents, see instr. IOnS 6a b Yourself. If someone can claim you as a dependent, do not check box 6a ................. . Spouse ................................................ ........................ ..... c Dependents: (1) First name Last name (2) Dependent's social security no. 3 Dependent's relationship to ou it4ing.cn9d~~ t ~.chila tax credit see lost Boxes checked on 6a and 6b 1 No. of children on 6c who: • lived with you 0 • did not live with you due to divorce or separation (sae mstc) Dependents on 6C not entered above Add numbers d Total number of exemptions claimed ................................................................................on lines above- (_1 7 Wages, salaries, tips, etc. Attach Form(s) W-2 Income 7 h Sa Taxable interest. Attach Schedule B if required ............................................ 8a Attac Form(s) W-2 here. bTax-exempt interest. Do not include online 8a ............ 8b ry q .......................................... Also attach Forms 9a Ordina dividends. Attach Schedule B if re uired 9a W-2G and 1099-R if tax b Qualified dividends (see instructions) ........................ 9b was withheld. 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ........ t0 i1 Alimony received .......................................................................... 11 12 Business income or (loss). Attach Schedule C or C-EZ .................................... 12 If you did not 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here - ~ 13 get a W-2, 14 Other gains or (losses). Attach Form 4797 .................................................. i 14 ons. see instruct 15a IRA distributions .......... 15a b Taxable amount (see inst.) .. 15b 16a Pensions and annuities .... 16a b Taxable amount (see inst.) .. 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .... 17 18 Farm income or (loss). Attach Schedule F .................................................. 18 Enclose, but do 19 Unemployment compensation .............................................................. 19 not attach, any 20a Social security benefits ..... ~20a1 7 , 13 0 . I b Taxable amount (see inst.) .. Al t 20b so, . paymen please use 21 Other income. List type and amount (see instr.) 21 Form 1040-V. 22 Add the amounts in the far right column for lines 7 through 21. This is your total income - 22 23 Educator expenses (see instructions) ........................ 23 Adjusted 24 Certain business expenses of reservists, performing artists, GrOSS and fee-basis gov. officials. Attach Form 2106 or 2106-EZ ... 24 Income 25 Health savings account deduction. Attach Form 8889 ........ 25 26 Moving expenses. Attach Form 3903 ...................... 26 27 One-half of self-employment tax. Attach Schedule SE .... 27 28 Self-employed SEP, SIMPLE, and qualified plans .......... 28 29 Self-employed health insurance deduction (see instr.) .... 24 30 Penalty on early withdrawal of savings .................... 3D 31a Alimony paid b Recipient's ssN - 31a 32 IRA deduction (see instructions) .......................... 32 33 Student loan interest deduction (see instructions) .......... 33 34 Tuition and fees deduction (see instructions) ................ 34 Copyright form soHware 35 Domestic production activities deduction. Attach Form 8903 only, 2005 Universal Tax 35 Systems, Inc. All rights 36 Add lines 23 through 31a and 32 through 35 ...................... reserved ......................... . 36 . usloao$1 Rev. 1 37 Subtract line 36 from line 22. This is your adjusted gross income ....................... - 37 BCA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions Form lO4O (2005) Form 10dO (2D051 CLAIRE R WELDON 182-22-1935 pa~o~ 38 Amount from line 37 (adjusted gross income) .............................................. 38 Tax and 39a Check ~ ~ You were born before Jan. 2, 1941, B Blind. ~ Total boxes CredltS if: Spouse was born before Jan. 2,1941, Blind. checked - 39a 1 Standard b If your spouse itemizes on a separate return or you were adual-status alien, Deduction see instructions and check here .. - 39b for - 40 Itemized deductions (from Schedule A} or your standard deduction (see left margin)........ 0 , 2 5 0 . • People who checked an .... 41 Subtract line 40 from line 38 ............................................................ 41 (6 2 5 0 . ) , y box on line 39a or 39b or 42 tf line 38 is over $109,475, or you provided housing to a person displaced by Hurricane Katrina, see instructions. Otherwise, multiply $3,200 by the total no. of exemptions claimed on line 6d 42 3 , 2 0 0 . who can be claimed as a 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- .... ' 43 0 dependent, 44 Tax (see instr.). Check if any tax is from: a a Form(s) 8814 b ~ Form 4972 ........ 44 see instr. 45 Alternative minimum tax (see instructions). Attach Form 6251 .............................. 45 • All others: 46 Add lines 44 and 45 ................................................................... - 46 Single, or Married filing 47 Forei n tax credit. Attach Form 1116 if required .............. g 47 separately, 48 Credit for child and dependent care exp. Attach Form 2441 .. 48 $5,000 49 Credit for the elderly or the disablad. Attach Schedule R .. 49 Married filing ...................... 50 Education credits. Attach Form 8863 50 jointly or Qualifying 51 Retirement savings contributions credit. Attach Form 8880 .. 51 widow(er), 52 Child tax credit (see inst.). Attach Form 8901 if required .. 52 $10,000 53 Adoption credit. Attach Form 8839 ......... . •••••••••••••• 53 Head of household Form 8859 54 Credits from: a ~ Form 8396 b 54 , $7,300 ~ 55 Other credits. Check applicable box(es): a Form 3800 b ~ Form 8801 c ~ Form 55 56 Add lines 47 through 55. These are your total credits ...... ...... .......................... 56 57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0- .................... - 57 58 Self-employment tax. Attach Schedule SE ................................................ 58 Other 59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 .. 59 Taxes 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required .. . 60 61 Advance earned income credit payments from Form(s) W-2 .................................. 61 62 Household employment taxes. Attach Schedule H .......................................... 62 63 Add lines 57 through 62. This is ;our total tax .......................................... - 63 Payments 64 Federal income tax withheld from Forms W-2 and 1099 ...... 64 65 2005 estimated tax pymts and an.t applied from 2004 return 65 If you have a -L 66 a Earned income credit (EIC) .............................. 66a attaahlSohedudle bpayelectoncombat 666 EIC. 67 Excess social security and tier 1 I1RTA tax withheld (see inst) 67 68 Additional child tax credit. Attach Form 8812 .............. 68 69 Amount paid with request for extension to file (see inst) .... 69 70 Payments from: a a Form 2a3s b] Form 4136 c ~ Fom, sass 70 71 Add lines 64, 65, 66a, and 67 through 70. These are your total pay ments ................ - 71 Refund 72 If line 71 is more than line 63, suLtract line 63 from line 71. This is the amount you overpaid 72 Direct deposit? 73a Amount of line 72 ou want refunded to you .. ........................................ - 73a See instructions - b nu°mee XXXXXXXXXXXXXXXXXXX - c T e: ~ Checking a Savings and fill in 73b, Account 73C, and 73d. - d number XXXXXXXXXXX _XXXXXXXXXXXX 74 Amount of line 72 you want applied to /our 200b est. tax - 74 Amount 75 Amount you owe. Subtract line ;'1 from line 63. For details on how to pay, see instructions - 75 YOU OWe 76 Estimated tax penalty (see instructions) .................... 76 Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? UX Yes. Complete the following. NO Desi nee Designee's pREPARER Phone Personaiidentitication 1332 g name - no. - number (PIN) - Sign Under penalties of perjury, I declare that I have examine~f this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparar (other than taxpayer) is based on all information of which preparer has any knowledge. Here Your signature Date Your occupation Daytime phone number Joint return? ET I RED 717 - 7 3 0 - 012 5 See instr. Keep a copy Spouse's signature. It a joint return, both must sign Date Spouse's occupation for vour Preparers Date Gheck if Preparer's SSN or PTIN Paid signature ' 0 3~ 2 4~ 2 0 0 7 self-employed P O 014 0 6 6 9 Preparer's Firm's name (or MAXWELL ENTERPRISES EIN 2 5 -17 010 6 8 yours it sett- 13 3 2 BRANDY AVENUE Use Only employed), zla ~ aea"d NEW CUMBERLAND PA 17 0 7 0 Phone no. 717 - 7 61- 5 2 7 4 BCA Copyright form software only, 2005 Universal Tax Systems, Inc. All rights reserved. US1040$2 Rev. 1 Form ~ 04~ (2005) E Department of the Treasury-Internal Revenue Service ,~ 1040 u.s. Individual Income Tax Return 2006 99 IRS Use Onl -Do not write or Label L For the year Jan. 1-Dec. 31, 2006, or other tax year beginning ,2006, ending ,20 (see in- B Name Spouse's Name (if Joint Return) Home Address City, State, and ZIP Code structions) CLAIRE R WELDON Use the L IRS label. Otherwise, E please print 3 0 7 HUMMEL AVENUE or type. E LEMOYNE PA 17 0 4 3 -19 51 Presidential Election Cal Filing Status Check only one box. Exempt If more than four depen- dents, see instr. in this s ace. OMB No. 1545-0074 182-22-1935 Spouse's social security no. ~ vour 8SN(s) above. ~ Checking a box below will not change your tax or refund. - Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see instructions) - I I You I I Spouse 1 Single 4 U 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, enter 3 Married filing separately. Enter spouse's SSN above this child's name here. - and full name here. - 5 Qualifying widow(er) with dependent child (see instructions) IOnS 6a b Yourself. If someone can claim you as a dependent, do not check box 6a ................. . Spouse .......................................................................... ...... c De endents: P (1) First name Last name (2) De endent's p social security no. 3 Dependent's relationship to ou 4 it ual- io ~c~iia9d credit see~nst Boxes checked on 6a and 6b 1 No. of children on 6c who: • lived with you 0 • did not live with you due to divorce or separation 0 (see instr.) Dependents on 6c 0 not entered above Add numbers d Tntal number of exemptions claimed ................................................................................on lines above- C 7 Wages, salaries, tips, etc. Attach Form(s) W-2 Income 7 8a Taxable interest. Attach Schedule B if required ............................................ 8a Attach Form(s) W-2 here. bTax-exempt interest. Do not include on line 8a ............ 8b ............. Also attach Forms 9a Ordinary dividends. Attach Schedule B if required ............................. 9a W-2G and ~ b Qualified dividends (see instructions) ...... 9b ~~ 1099-R if tax .................. :: credits, or offsets of state and local income taxes (see instructions) ........ was withheld. 10 Taxable refunds ::;::;;:.;;:.: ~•~~•~~~~•~~ »::::;::»:~: 10 , 11 Alimony received .......................................................................... 11 12 Business income or (loss). Attach Schedule C or C-EZ .................................... 12 If you did not 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here - ~ 13 get a W-2, 14 Other gains or (losses). Attach Form 4797 .................................................. 14 see insVuctions. 15a IRA distributions .......... 15a b Taxable amount (see inst.) .. 15b 16a Pensions and annuities .... 16a b Taxable amount {see inst.) .. 16b royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .... 17 Rental real estate 17 9 , 2 31. , 18 Farm income or (loss). Attach Schedule F .................................................. 18 ............... .......... Enclose, but do 19 Unemployment compensation ••••••••••••••••••••••••••••••• 19 not attach, any 20a Social security benefits ..... I20a1 7 , 4 2 2 . I b Taxable amount (see inst.) .. 20b payment. Also, please use 21 Other income. List type and amount (see instr.) 21 Form 1040-V. 22 Add the amounts in the far right column for lines 7 through 21. This is your total income - 22 9 , 2 31 . 23 Archer MSA deduction. Attach Form 8853 .................. 23 Adjusted 24 Certain business expenses of reservists, performing artists, ~'af'OSS and fee-basis gov. officials. Attach Form 2106 or 2106-EZ ... 24 ' Income 25 Health savings account deduction. Attach Form 8889 ........ 25 ::::<:::::ss ::: °"'~'""'' 26 Moving expenses. Attach Form 3903 ...................... 26 '`~<<>> 27 One-half of self-employment tax. Attach Schedule SE .... 27 28 Self-employed SEP, SIMPLE, and qualified plans .......... 28 "'"'`"'~`' 29 Self-employed health insurance deduction (see instr.) ...... 29 .:::::::::: 30 Penalty on early withdrawal of savings .................... 30 31a Alimony paid b Recipients ssN - 31a 32 IRA deduction (see instructions) .......................... 32 '>i:3:::`•:~:~> 33 Student loan interest deduction (see instructions) ......... . 33 ~~~"'~''•`~`` 34 Jury duty pay you gave to your employer ................. . 34 35 Domestic production activities deduction. Attach Form 8903. . 35 ,,,.. :... . . 36 Add lines 23 through 31a and 32 through 35 ...................... ......................... . 36 37 Subtract line 36 from line 22. This is your adjusted gross income ....................... - 37 9 , 2 31 . For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Form 1040 (2006) BCA Copyright form software only, 2006 Universal Tax Systems, Inc. All rights reserved. US1040$1 Rev. 1 ' Form 1040 2006 CLAIRE R WELDON 18 2- 2 2 - 19 3 5 Pa e 2 38 Amount from line 37 (adjusted gross income) .............................................. 38 9 , 2 3 1 . You were born before Jan. 2,1942, 8 Blind. ~ Total boxes Tax and 39a Check ~ ~ Credits if: Spouse was born before Jan. 2, 1942, Blind. checked - 39a 1 Standard b If your spouse itemizes on a separate return or you were adual-status alien, ...... Deduction see instructions and check here ................ - 39b ::;<•;;;;:: for - 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin)........ 40 6 , 4 0 0 . • People who k d h 41 Subtract fine 40 from line 38 ................................................................ 4t 2 , 8 3 1 . any c ec e box on line 42 If line 38 is over $112,875, or you provided housing to a person displaced by Hurricane Katrina, 39a or 39b or see instructions. Otherwise, multiply $3,300 by the total no. of exemptions claimed on line 6d 42 3 , 3 0 0 . who can be i d l 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- .... ' 43 0 as a me c a dependent, 44 Tax (see instr.). Check if any tax is from: a ~ Form(s) 8814 b ~ Form 4972 ........ 44 see instr. 45 Alternative minimum tax (see instructions). Attach Form 6251 .............................. 45 • All others: ....................................................... 46 Add lines 44 and 45 ............ - 46 Single or d fili M i 47 Foreign tax credit. Attach Form 1116 if required .............. 47 ng arr e separately, 48 Credit for child and dependent care exp. Attach Form 2441 .. 48 $5,150 49 Credit for the elderly or the disabled. Attach Schedule R .. 49 Married filing 50 Education credits. Attach Form 8863 ...................... 50 jointly or Qualifying 51 Retirement savings contributions credit. Attach Form 8880 .. 51 widow(er), 52 Residential energy credits. Attach Forrn 5695 .............. 52 $10,300 y3 Child tax credit (see inst.). Attach Form 8901 if required .. 53 Head of h ld h 54 Credits from: a Form sass b Forrt sa3s c Form sass 54 ouse o , $7,550 55 Other credits: a Form 3800 b ~ Form 8801 c Form 55 ••... ::: • :.:. 56 Add lines 47 through 55. These are your total credits ...... ...... .......................... 56 57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0- .................... - 57 58 Self-employment tax. Attach Schedule SE ................................................ 58 Other 59 Social security and Medicare tax on tip income not reported to employer. Attach Fonn 4137 .. 59 T3XeS 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required .... 60 61 Advance earned income credit payments from Forms} W-2, box 9 .......................... 61 62 Household employment taxes. Attach Schedule H .......................................... 62 63 Add lines 57 through 62. This is your total tax .......................................... - Payments 64 Federal income tax withheld from Forms W-2 and 1099 .... . 64 65 2006 estimated tax pymts and amt applied from 2005 return 65 If you have a 66 a Earned income credit (EIC) .............................. 66a ' attaoh ISChedlul'e b pay a ecboncomhat 66b EIC. 67 Excess social security and tier 1 RRTA tax withheld (see inst) 67 68 Additional child tax credit. Attach Form 8812 .............. 68 69 Amount paid with request for extension to file (see inst) .... 69 70 Payments from: a ~ Form 2439 b ~ Form 4136 ca Form sass 70 71 Credit for federal telephone excise tax paid. Attach Form 8973 if required 71 72 Add lines 64, 65, 66a, and 67 through 71. These are your total payments ................ - Refund 73 If line 72 is more than line 63, subtract line 63 from line 72. This is the amount you overpaid Direct deposit? 74 a Amount of {ine 73 ou want refunded to you. tf Form 8888 is attached, check here - See instructions - b numee XXXXXXXXXXXXXXXXXXX - c T : ~ Checking ~ Savings and fill in 74b, Account XXXXXXXXXXXXXXXXXXXXXXX 74c, and 74d, - d number or Form 8888. 75 Amount of line 73 you want applied to your 2007 estimated tax -I 75 A1710Unt 76 Amount you owe. Subtract line 72 from line 63. For details on how to pay, see instructions - You Owe 77 Estimated tax penalty (see instructions) .................... 77 Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Designee Dem'enee'S-pREPARER Pohone- 717 - 774 - 715 0 ~~ Sign Here Under penalties of penury, I declare that I have examined this return and belief, they are true, corcect, and complete. Declaration of preparer (othe Your signature Date Joint return? See instr. Keep a copy for your records. Spouse's signature. Ir a joint return, both must sign. Date 63 72 73 74a 76 Complete the following. ~ ~ NO schedules and statements, and to the best of my knowledge and 1 is based on all information of which preparer has any knowledge; Your occupation Daytime phone number ~ETIRED ~ 717-730-0125 Spouse's occupation Preparer's ' Date Check if Preparer's SSN or PTIN Paid signature 0 3/ 2 4/ 2 0 0 7 self-employed P O 014 0 6 6 9 Preparer's Fan's name (or MAXWELL ENTERPRISES EIN yours if self- Use Only employedi, , 13 3 2 BRANDY AVENUE 2 5 -1 address, and NEW CUMBERLAND PA 17 0 7 0 -15 3 3 Phone no. 717 - 7 61- 5 2 7 4 ZIP code BCA Copyright form software only, 2006 Universal Tax Systems, Inc. All rights reserved. US7040$2 Rev. 1 Form ~ ~4~ (2006) From: Jbradyc2l@aol.com [mailto:Jbradyc2l@aol.com] Sent: Thursday, October 04, 2007 3:34 PM To: Connie Stoneroad Subject: Weldon's Bar 523 S. 19th Street Harrisburg, Pa. Ms. Connie E. Stoneroad As per our telephone conversation of this morning I estimate the values of the Real Estate, Equipment and Liquor License as follows: Real Estate $30,000 Equipment $10,000 Liquor License $100,000 Total Value $140,000 The above is based on my experience as a Real Estate Salesperson for the past 24 years an experience in the construction business. The real property is structurally in poor condition due to movement to the left wall of the building which may have been caused subsidence of the foundation, the two apartments need extensive remodeling before they soul become inhabitable. The location of the bar is in an area that is less than desirable due to functional obsolescence. Among other needed repairs City inspection will require complete rewiring if not condemnation of the property. The only real value of this property is in the Liquor License I hope the above is of help to you. John H. Brady, GRI. Century 21 At The Helm See what's new at AOL.com and Make AOL Your Homegage D(HIBIT ~ E Statement United Church of Christ Homes Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Statement Date: 09/12/200' Claire Weldon c/o Keystone Guardian Services 2941 N. Front St, Suite 112 Due Date: 09/25/2007 Harrisburg, PA 17110 Re: Claire R Weldon Account Nr: 101815 Date Description Days Rate Charges Payments Balance Quant BALANCE FORWARD. 52,123.48 52,123.48 08/08/07 Oral Function Evalu 1.00 104.50 20.90 .52,144.38 08/08/07 Oral Function Thera 1.00 75.70 15.14 52,159.52 08/09/07 Oral Function Thera 1.00 75.70 15.14 52,174.66 08/10/07 Oral Function Thera 1.00 75.70 15.14 52,189.80 08/13/07 Oral Function Thera 1.00 75.70 15.14 52,204.94 08/14/07 Oral Function Thera 1.00 75.70 15.14 52,220.08 08/15/07 Oral Function Thera 1.00 75.70 15.14 52,235.22 08/16/07 Oral Function Thera 1.00 75.70 15.14 52,250.36 08/17/07 Oral Function Thera 1.00 75.70 15.14 52,265.50 08/20/07 Oral Function Thera 1.00 75.70 _ 15.14 52,280.64 08/21/07 Oral Ftu-zction Thera 1.00 75.70 15.14 52,295.78 08.%22/07 Oral Function Thera 1.00 75.7.0 15.14 52,310.92 08/23/07 Oral Function Thera 1.00 75.70 15.14 52,326.06 08/24/07 Oral Function Thera 1.00 75.70 15.14 52,341.20 08/27/07 Oral Function Thera 1.00 75.70 15.14 52,356.34 08/28/07 Oral Function Thera 1.00 75.70 15.14 52,371.48 08/29/07 Oral Function Thera 1.00 75.70 15.14 52,386.62 30/07 08/ Oral Function Thera 1.00 75.70 15.14 52,401.76 . 08%31/07 Medical Suppl ies 1.00 76.15 76.15 52,477.91 08/31/07 Oral Function Thera 1.00 75.70 15.14 52,493.05 08./31/07 Incontinence Suppli 1.00 60.15 60.15 52,553.2.0. E7WIBR ~ F Statement United Church of Christ Homes Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Statement Date: 09/12/200' Claire Weldon c/o Keystone Guardian Services 2941 N. Front St, Suite 112 Due Date: 09/25/2007 Harrisburg, PA 17110 Re: Claire R Weldon Account Nr: 101815 -------------------------------------------------------------------------------- Date Description Days Rate Charges Payments Balance Quant -------------------------------------------------------------------------------- 08/31/07 Personal Supplies 1.00 13.53 13.53 08/31/07 Personal Laundry Se 1.00 30.00 30.00 09/01/07 Room & Board - Semi 30 228.00 6,840.00 52,566.73 52,596.73 59,436.73 NOTE: ***** PAYMENT IS DUE UPON RECEIPT ***** BUT NO LATER THAN THE 25TH OF THE MONTH ***** Please remit the LAST AMOUNT printed on your statement. Include the ACCT# from the statement on the MEMO LINE of your check. Payments after 9/10/07 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.25% LATE CHARGE PER MONTH ** A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** Outstanding debt of Clair Weldon Creditor Midland Credit for Emerge Mastercard ProLine Solutions Group for Crescent Recovery Financial Recovery Services for Collect America Asset Acceptance for Maryland National Bank NCO Financial for Capital One Paragon Way for Palidades Acquisition Commercial Recovery for Maryland National Bank National Recovery for Central Medical Equipment Holy Spirit Hospital Millennium Pharmacy Systems County of Frederick Virginia PharMerica Peerless Credit Services for Belveder Medical West Shore Anesthesia Mobile X-Ray Imaging CCS Financial for West Shore Emergency West Shore EMS Commercial Acceptance for Camp Hill Fire Co. Ancillary Management Solutions Penn Credit Corp for Cumberland County Statewide Tax Recovery for W. Shore SD Pinnacle Health Hospitals True Logic for Lowe's Credit Card D(HIBR G Amount Owed $ 18,677.76 $ 12,818.50 $ 2,754.11 $ 3,864.45 $ 1,883.00 $ 7,799.89 $ 6,635.66 $ 29.89 $ 953.76 $ 1,266.93 $ 1,184.75 $ 153.95 $ 86.64 $ 24.48 $ 47.50 $ 87.20 $ 623.94 $ 650.00 $ 753.62 $ 68.00 $ 31.00 $ 840.00 $ 559.63 $ 61,794.66 As of 10/15/07 uu/ Vl! LuCJ f 1G. LCJ ! i ! L't:J7! JJ 51iKW'I I UL1J h1UlYlt I''Al~t YJ4! G7 N ~~~ ~~ d, '#'HE ~'URP~SiE (,2F "('(-1DS POU1>~EB2 t~F AT"T'r~F-1~t~' !S TCA G}i/E `I"lL1t= C~~RSG9~ ~c"~~„y d~~~'~~~fiA7E (Y013F~ ",P~S~EhdT") BP~AAD3 Pt7-'VI/ERS TO I-IAi~dD~'~''~i„D9~ D~(~,~C-#~T'~", VV~IIDD ,,,i~~t.''~`' lt+1~~.t~~3E ~QV~ID=D~a l'C~ SELD. G.~R ~'T"DiI~FZU-1lISE If~1~I''4~5~ ~D= ,~&~(~!' A~, t~t~ D;~'E~Sd)IeDAR. f'IR(~F'E a ~ITHC?UT AD1fAP~CE IVt~TICiC ~'~ 1f+C~IJI taD~ R1P'PRE?~d.~,~ ~1F YE"~~I. '6E-t(S EC?~d'E6~ ~1~ A'~TC?f~f~lElt' la~ES SOT tfW{I~'®SE A DrM~T'4'' ~B`~('4''tJ(.6R;AC~~S'~T "6't~l E?i~~1SE GF-ANl'6'EkA &~C,~'iRVV~RS, S~iT V1t~-~EM t~C3VilEF~S ,+D= EISEI~, ~'~i4~(~ A(;Eh(T I'~~,lST' 9JSE D.l~,DE ~Al4E ~"C~ ~+~T FC?!~ "~~1~6~ i~~lVED~tT 1~('~6.~ dB~ A~~C~dD~A [~~CE !~6(TP-~ lf~•(QS YQ~~R ~~G'iD;P~lT D~AV' ~C~!~ISE THD= ~'OIEVEI~S ~DVED~D Hiram TH~~~~~H{~D~T `Y"I~r~~ k.lD~~TlME, ~1/EM AD~1"~D~ Y'~+l1 ~~~MD; pq~~A{~',R>,~1~"O~TE~, 9.(['~D"ESS'~'t7~1..6 E~rfr"B~.ES';,~D.''~'' @..I~DT "~FdE ~?U4~A'V"lf)!'+I '~(^ 1`D-IIE,SE R~W'ERS ~C~. V'~!3 RE".V~i~fE THESE €]`t~V1l EIS ~?~ .~ G~71LB6~.'~' A~1'Il~~ ~~ Yt~UF~ ~3EHA~..D=1'EF~+I-1~D~,TES'tr'(~R.lFZ A.f~Ei'~"fi S !~{.~"(°~-~Qi9~~T"r'', YCaE.E~ A~Et~1' IUID,l~'~"6` C-~E~''t`"~E.1[~, D=UE~1®S SED~AF~ATE FF~QIlr~•~(flrtJD~. Afi~fi~T'~ F~,.~Itilf~S, A ~~71.,Dl~T ~A~ TA&~E Fi1fUA~ T!•(D» D~~1Al~ CAD" "~f+~f.(~ AGED'"~" IF IT FfiTBUS 1F+~t~~ A~E~D~' IS l~9~T AGTDi~c~ PlRC3P'1~6~B,.Y'. T~-(E I~~WE1;S ,A~ait~ ~~T(D~S +dl~ 141~D'k'' 1~1,CEh,DT 4.3~(&3E~ A ~C.~~~. OD; ATTt~D~fi~DE1' ASE E~I~I.ADD~l 11tDC3FtE F~.(D..L.'°a`' (I~ ~p P'a.~.S. ~~~ ~6. IF THERE !S AAI~'t~-dD~(G AF~U~1l"'I~DIS Ft~D;:6ttl "8"MP-T °A`'~7U ~]'~+ ["~DC.'~T 9J(~DI~D" D~~TAI~~, ~*t~t~ S~iQUU~ ASK A, D..A'fr'~i'^~ED~ QD= ~''~1(~D~ ~WD~ ~HC~t~S11~~'6"+Q ~If~l D"f` ~'G'~'~C1U-. i (-LAVE D~FAC1 [7-R t-DAD~ f~4PI~,,INEL3 T~ IVlF THIS DWQTI~>~ ,~lB] I fJN~EI~STAhJ~ DTS ~:~D~D7'~iD~TS. h ~~~~~ ! n+ww.~w.r~..r'-~ --- -- - (~~Y~:~ ~$ 'Lr 1~'tTt1T.N:i'l^[r3t3~T.1 0 Z ~~: ~ r ~ ~~~~~: ~ i. _ _ ~i;1i_Il~~~ tat _.~i=~f-l~,~i~t,~~i. ~iwD~~~,,,,,~ r~~ty~ ~ent~.syltraa~l~l, ~{p f~reby 6~~11'~4~61~~ ,„ ~ ~1~A ~R°~f,lll~l~ ~ ~.~ 1(.~..~~~~~~i~}f~~~f~1h~E ~a!~n$y, €~e~rartsylvartia as. rrty ~tite end la~.~a.E! ,~~mey-in-f=act vvi~ ~Il, ci~,r~blrr y awl' $r~Ptsact w ~~ artd al{ bus~lrat3ss in my name ~S #hQUgl~ i rnyse!$ were awing. ~"f8~ i~~~ in~iu+des, but is rac-# 111711#~!C4 #ca, tfte tc~llovdin~: '~. ~ica write cheol~, grid ~aa~ ex~tc~ aradl ~ieEiveq' pay~ten# and v~rithcfrawar~¢ cas~ien3 ran ~y ~r~t,at1~ ttaati ! mey have wry an~r bank or rsa° sir~u"f~r ins~CO#ian, a~ to r~aflvcr tlae ^..Pta3'cfC~+ ~~ s7'1onay pald car lA~irh~~Vrt ~o any p4lr+a~A1r ~rt=T9JE~? Q~' ~3~.r8+~iy $]Ir ~~'1'~oL''E21~;f~R'6~a~ aa~d tta ri1tlCat:y~ clue car Qthec Iris#rc~menis tcrr del~a:asi$ or ccc~l~l~on; ~'. "1'o tvl:e ell lawful stirs ~ re~rrt<r, a:afle~, and rec,;elve arty arraouet ti cat rr2o~rEey n~a~ ~r; ~aer~a'~t' owing .car pet~~laie ~ me; and to rrtpl~art71'se and e~;~te ~:i~t car cater :~S,if~iCi~7hf rlisc~t~r~ farFE" tflE~at"Sr; ~~. ~'o vdrthdl~aw algid receive t11e ir¢caa~rne ar corp~t~s o~ arlyt cawarr vrhlch ! may g1ev,~ ~~ ~Cg!'ut of wi~Clrawal, ent~ $~ r~et~t arsd teca~iv~ ~E inrxamn or c°xYr}~4,~, ~'~ stay tat Stith respect #d vitElitzh ~ tr~tste~ #hEreot h~ 'hha cI`rs~rtfionary~ pouver to meFa`e a~islrii~axtic~rts #o oa' can tray ~~ehalf, and io execrate a r~eipt a~~d release cad such slrrtflar ryoc:u€~tenG: for #ha props ~ sa r~:~ a"toad; ~~. Parr sutra and settle! s~tfts of any lcfrEd lt't rrgY Warne ~rfa~• t~p~ honeEr#; fir. ~o baay, cell, rxtaage, hypotlZet~#e or grant s~ue~,y lnterfi,,; it1 any f;in~ t~tllgil~la~ or intan~lblt: pc~r` onal pl'Opet#y; ~. ~"o sfgtl, vaslgn, or vndot~e any aveurliy issu~l ~~,. espy t'xa~a~sr:r#iot~h, A?~r1f~, car athvr a~t~erd'~t#isarn, and fv e~erCise anx Ct~hts wi#E"a P~(aec# #l~terartca ~tl1~t. i ~7~~ have; '~. T© f®asv, sell, release, con~ney, extiinyeria~h, ear ~r+o>~~~c~v aEty inger~# in t~a~l properly o~ scrch #~ as rzaay be cleer~ted advisable; arod to rn~artage, r+~pafa', 6~farrao~v, rrrairttaiirgT restraraa, build, car devgtaop such ~o~opedy; . ~. Trr pua~ehase car +a#h:~rv-naa aaquit~ any In#a~res# ia,, and ac~gr~lre pc~sses~ora o€ real prcapcrly, arad #a accept ail deeds and c~tC~er a.^x~lUr~I~IC~ In ~e law fvr ;~aartt propet~ipy; ~. ~'o eacerASte, Clallyer, artd et~cn~iwlerl~o de~ais, dereds of tt-tts#, Cfyvendria~, It~det~.9res, 2~~I~rraat3ts, rncart„gs~~, hypctht~tion" lzllls of fading, i'iga, bonds, tlo't~5, t'~e~€p~, evir;lonces far defats, CLIQ~~wr''S, aid s~rtlsFact'icrrts of tsavrtgagt33, ja~dgrk~tei-al, c~roura+d reir~~, and gather de~bls; 9 q. To enter tray sate deposi# fyoaces and to open new safe dep®sffi b~Gs, and t® add to, and to remavQ stay ~ ttaa3 contents of any sfaaah sate deposit bay; .and tca cfosa ottk ~rt~~ c~ the faoxes; ~~L~(a 94~1'~Firt fi~1.G~.t. AT.S2~'^,'.~:;.J.T.? -az~~r a~ TJ x~IITRT:7'ti-t.tnssa r^. ~r.r~ ~~ _~,,-_ ,.a 1'i, 'frs ~~++t r~ya~rlr-~y fur amt ~+csar~a~nt of wh~~slr~r ~ec~a~s ~n~ ai~ndB~r~rt~ yr~a~r is~ ,~~~I ~,t~ris€~F~ie, ~ia7ciudia 't{~~ ricittit .fu r~vv rraans~r ura ~ri~ a€~sr~rn puliri~,~ i,.t ot~ ray @~~ fGS 71ri~' ~1-~r~oJ~G d~-d ~ ~l~Cs~~', d,:~~,3tf~fll; ~3'icf f4F*Ji100C" the (:'iii QF' pQ1iC~d~ aa~ t;~&~. 'i ~". "i'r~ pe.archass ilrtited Std#~~ `~ra~r~ "fl~vrt~i" t~ndW ei~t ~y Ibehaif, grad I~rraa+u ma~~y spsciii~all~-'[~, srYak~le file ~purc~aasc~ mf tR-i ~R~n~1s; ~ ;~. 1"~ preper~, exewte, ~ra~l frl~ III t~ rattans re;i>.airact R~ ~ rPtadt~ }ay n~~^~= to RAY ire '~-;";4~-~ dtiit~, tci c~ails~t arB~ a~f~nds, t~ sic, tn~h4vea ~ ~c4encli~~~ t1~~ p~rie~d f'oc a~s~ss~~erat ~~E: sum PaS" €xf [iefT+~rEr era ~'tL?ra'ta ter sign corisQrr~ #Ci the 4~~'r~~~~ia' ~ssessmeir$ of ~lsflci~^no aa~d as~.aa~ptanra of ~rapused Q~tsa• ~ss~s~i~erp~„ ~ c~x~u~a•~e ~i~Bd~~ ae~rPerr-~:nts, to engage and ~appoir~f ~t~rrieys ~ rcpr~~sc~r:t ~~e urT ~~r~r~~~Bun ;~~,~ ~n,y rrnati:~~ ~r~ing B,~Fc~re~ eriy federal, she, ur l+aoa6 t;~cirtg ag~~~ A °f~':. "~~ dis+~aiera any irrrr~,,.~ err prerpczrE,1+,.~ ~eercisc ti;~B~~t t~ oiaina en ~Brt~ siv~rc~ u1' .~,Y esi~f,:~ a~~' ~rtV spa~tasaw, a~a~ to ~is~ iii aGtiorTS t rrt~a <~-rr~ay-~i~•f~ri: ~#ee;•ras ~~aprupriate ttr efi~~tt;~te tfi~ eeeo~icarn; ~~~. 'i'a t~raocrnoe gray fiduciary i~©siYlor;s ~ whicR'r a h~ ire ®f r^na~f ~e apl,~-ir~tad, irer.6t~eBie~c,~' , b<1t rroi' limited icy, persurtal r~preserlt~, trus-tes, guai~dia~rp, a~orney~d~ ~c~, end r~f~c~r ~z,r ciireu~r of a roa•poratiori; to r~sigr~ suc~T pgci~i~ons in wrhich oapa~it}~ 6 a~ pr~~r•rfi~- serrrinc~, ~rsd to ~iBe ~M ac~u6li':ir-~ th ~ C:c+ut~ arF ~rppeterat j~rtisdiut6os~, a¢- sells oe~ a r~ppt ~~ }-~leas~ c~~r atiyer ar~~rznal math~d as my aliinmey~il~~F~ d~:a'r'rs aa~wrrsablc~; 'f~. ~~r arr.+,r-~~c fear my era•I~rot~ tt~, end ,.~~ ~t, asny hospii~e, rt~a-~~~tl ~a~aw, h~~altl•a ~a"6~Q~v conv2klc~i'Tt ei+crr{as, ra~;''a2nfi e~r~rrrae:, or sirxtilar Bns~at;.~tc~ra, aaa~i t.~a ar.~hrs~~~~, arxan~e bra and i'c+ ccsrt:~n# tsa arty aild ali ~ed'a~ae aryr~ ~iJE`~'i~l prac~d~arc~ orr sry i~ah~lf, ~r--d tQ p,a~ ail {~siRs iva• tvty ; 'i~. ~o sx~*cs,~t~ ;~ ~voc~.bie ,~g;~1'tq~:'It o€ trust wi~-r ~~k ~~ ~rusfie~ ~ e•~;c~~yr~ ~ir~ rah: seluc~.s and whic.~z pre~~id~ tl~a4 ail irl~mab arltt prir~c~pa1 slyail Rai ~aod to mG gar the c~e,;at~diar~ of rr;y ~fu, ar applied far Cttiy benei"ri ire sucY~ ar-na~r ~a I, or ~y a~~~1a~-jn- faet, shall ;~cta.;est ar as tiae trus'tc~aa ar trustees sf,~6E cie~r~ra6ne:, anst tkY~tt can my +~e;~th gray rnrr;air*inr~ ev~cc-rrae and prinoRpai sh~l} lee paid fio my perst~raai rspre~k~t~ta"~~. sroci tl the rust E-raay be t~~®l~.ed or emends ~y me or rny~ atfraane}~-Ira i'~~t at aesy firm ~,rd f~ar4~ •#irn~ ttx ~It1~e, Rarx^+~rided. B~nrev'ea; mat ~ a~e~tii vaent I~~r my a~.amay~irg-feit ~rr;~t ~~ sa~c~ th~3f ~it~ i~Ta~+a, key ice; deiiv~.r ar^rd r..~rrt~rd any ur sll +~f p'~'ty~ ifs ~u te~~ t~-ta:e a~a- i~~tees, and f'o add .ar:y ©i- aIR of rriy asp to s~~ a i~st aBread~t an +iersue ~t ~s tasaae s~f ~'~teorti of 4~is l'c~rc~r. ' ,~irtd Q dca ~er~l~r ratif~r and rx-rst~rrat all that my a~arn~'y-ire faol: sale iat~i'rc~li~ derp csr uae,a~ to he done, ~Y' viri~ae ~ tR~ais !~`annrer o~g A~i~arl`~sy. ~ . This F"'o- cai Atta~rraay shaiB nAt lea arffsc~ted I,y i'r!~ dis~tbi4rajr ~-r iracap~cr:~€ or by un~rte~irtt~ as to ~e#her i at~rt dead yr arve, and li; a~~ay ~ acrmpted and r~liad up~~r~ {~~,+ aaByor3e. to whcrnx it is presa'ant~r~ 4lrtkil s~t~ch perratart raith~g~ .(4,~ res~a'~es ~nvritier ~ r~t~tir.E a~f' a~,vao~ti~arz Icy ryas or ~ c~~aardian ~~or :;ia~6Rar Yidt;~iarY) a~f cn~~ estate, ~c ~~) f'~i~rs actual kncs~iedge ~ a~f dt~atl~. Ply a~cry-gri-gam ahaai 1~ entiteed to -ro~r~~nalaBas ~mpsa•asa~Eirre~ fur services per~nt't~c8 i'erettndEr. . ~~L-•(1 9-JJ9Qd ~L5-Z 8T,8~.~FLI.T.,~. ;F1'S~H a~ r~ ~,Sdrt.t.ttiia~i,r.tnsta~ ca : r.,r ~,r~ _~.r_, ~ rr-~~ u r ~ r~~ ~h~ ~I"li~'~'A~dL~.' ~'I-~~i~l~pf~e ~t~~d i~t~c~t~iing ~~r kie lc~~dt~ b~aa~s~a~ h~r~br, t h~`F~ ~ign~~l tt1i~ f7r,t' 05,AfE:c~en~y ;~i~ ~,.!~~ day cif ~?~~~~P,t~,~,,.,, w~~. _.......~....~~, ~....__.__~.T.~,.,..~_........._....,.~, ~~t~tess: ~~t~I~I~I~C~e~..'~'a~ i3~ ~i;.Ra9~i'L~~~A ~s. ~~n ~l~is, ~~~~ „~ ~'~ - - d~g+ m~ ..._.,..~._..~...~~...~1~ _~~3€~~ ia~iic~~~ nom, ~ i~~a'~9`~ ~'~~iic, !~~ ~n~ car .~'~iti ~-raznrt~nvnit?~i~th ~~d ~:~ra;a~~r. t(n~ t~tl~c~t'~i~f`c# r~~`i~,~r, Y`~~an~lt~ ~g~i;~t~cf l~er~~uR~ fc~ mc~, ,.._.~ ~4 fil~~iL.fl~~~Q 'cat" ~~#~~~.cartiy' prc~u~~~ try b~ ~~~ pscxsrran ~{~~~~ name ~ ~tebsc~bec~ •~~s ttte 1~ui'f~a6~ F~csin~- ofi Aftorryt~;~, ~~~ a~icii~dg~l ~{~~~ lie ~~e~ ~~: ~~~ ~r tha pt~rpc~sc~s ~~reira ~r~t~ra~d. il''+i ~l~9`f-"h~li~,.'fal9lf~~l~~~~, i l~aW+~ he~o.tnt~r ~~t n1~ f~~od ~~c~ i~4+~t~~ai tel. ~./ ~r AEfeit Fintp., C~3x~b~1Tlr~ Go., W~ ~Ay Gbt'r*m~sfon F_"x~i~~• f~o1r 't~, $Oat3 THl~ ~7©CUPd1EN'i~.l~ C'~tL~VtDEO ~1~3 A MEl`fTEF~ Off' i:OUIS"1` A~SQ l~ ~~ 'f'O ~;_ ~TJa'i'R,t.J~P~ ~wi LFt~Ai~ 1~,3VtCC. `~t7U Rf~E ~NCQUFiAGEE~ Ta 8~~~ f.>r~~ COU~~~L. i{~ Af~SW~~, ~C»UFZ C~f,JldrSi'tC31V:.'+ tw1<'1'3,if=i~ `t1-tROUC~H .R. f't~fV'At"f'f A"t'~C'~t,'M1L~l', C~ COIVITACT 1Il'!TH f.EC,4L ~F2Vf(11;~ A'~' ~79F~ 7'~7~. .~ ~,. ~, v~T."[~ g~l'~~~Ci ~.~~"~1. fi~T.f2fi1.~:1.1 TI fl'Ta'C7 m1 T'3 XS.Tn ihT^..f~1_f.'Insr.T f+-r ~ r-r za ~r ~ rs • N• rr~uc uo~ r~~ - .~~'~W{8~i~ 'tl'~9~Pd~ ty~~~ r~~d fee ar~&~o+~i~rt~d ~o~~° ~~ ~t'~~a'~+~~ ~~ae~ ~~ t-~~r ~~re idet~~;8~f~d ~s~ ~h~ ~~~~~ ~'c~a° ~~~ ~t"as~~Ri, P ~e~Ir~~~r ~+~i~a~~-a~-ed~~ i"~az~ Qa~ # ~aa~s"z~~ ~x ~~~~~ ~trr~ti~~tcat~ ~.~~ ~~ ~~ara~ ~ ~t$~ ~aava+e~ ~~ +sa~~~ +~' a~, ~~ ~~.~.~,. ~i~e~ - ~~ ~~ ~~a~ - ~E~aBB ~~~~•~Q, ~i~s~ ~ac~~v~~~ ~~a>r ~Q>ec~ i~~n+t ~~ ~~~ ~~i-~ - a~~C~iB Q~e~ir ~i~~ ~~ a~~ ~i7f~ ~r-~~-~~i ~a;u~~ ~o~ a~~ ~. - ~9a~t8 -~~~~0 ~ f~e1Q ~>~e~ :a~~atc~ 1~~ ~~' ~Qi ~~~e~~~x a ~au~ac~ ~@~~~+~rart~aro~r~~ ~rr~ II~h~Q~s~'~~ite~ isa~maa:~~a-, 9 ,/ ~~,;6(I6~iNt~t'~PV~~.Tt-- a~~ P'~9~&Inl!~..'6{'e~rt°~Q,~ Y.kl,r9N~8V A 11 Rr~~ 0.YF. IlfAt~~F~..~i6oYlk~~ .. W~~a C3r~ ~Ei'ti~, YtzA ~W. ~~ d~~+ ~i' _ ~t=~~~8~,,,v~`~'~9~ ~~~Q~e rs~, ~ i~oi;~~~ ~-~~tati~ in aid oe• sold ~al~rncanw~ati~h ar~d ~a~st~~, ~ ~a'td~~9c~Kv~d o'~tr, ~c-~t`~ ~~r~t• i~•,~ao~vra tea s-rtQ, ,~_~ ~....._ ~#~Bi~-iw'~~Q.e-~ (ar° ~~isfac~osity ~r~~a~~ to ~~ ~h~ ~~r~c~r~ ~i1c~s~ ~a~-ra~ i~ ~ui,'~s~ri~+~d "io ~ wQ~.i,i~t ~~an+r ~f A~~kt~mey, aid ~~Ecs'tr.i~dg~d titi~~~ tae vxc~.a~~cd ttro~ s~~~a~ ~c~r 4t~ r~~~ -+~I ~:irr ~~i~all7~+d. Dk~ ~Ni " ~6'i'iliwi~~e~'IFP I irp her~vr~~ sQ~ m~ han~4 ~r'r~ ~49~aiarpi~a8 ~~:~i. ,~ '~,.~ NO~'t{Rr,q~, wry i~ t t~'A#~t~ ~ STftOH, d+Jarat~r Fi1~k; FlS ,A iW0.'I•TEFt Lyfi G©IJI~'~~=~~Y Ar9l? !~ 6t1CY';" TU BE CUNSTRUEI~ .A~ ~a~ At~n,-rc~ YOU ARC i N+CC~tlF~c~17 To sr~ac !.L-GAL CUU1VS~f. TC3 AN~VV'IF~F. YOUR QQ.lES'I•i©hES, ~F'fl-IER T'r-O~.aa3Ca~-1 A PRIV,ckTE A770R1~9E'~'~ OR CONT.A~T WltH r~GPd. S~'~(GE.u AST' (Z97~ 76fT-{3~?~. FAT-t1 9CI,'fiQct C=Ly~.1. ~~G$~LB~~T~, W7~~ ~ ~?, n~,C~~LN3~t-6dU3:I r~ ~ ~T ~0 ,-•~~T.~.i:,t~ Lipman~Ciofdtring, tnc. .. Expensa5 paid by Ike Sanice MIKI:_ ~~AI~ICIc ' 364.09 /' 123.40 15.69 ' 26.86 34.40/ 119.04 ~ ~ ~ ~, ~~s \ 438.73 ''~ b50.00 ~V l J ~~ ti' ~ ,~ ~,e~aES ~ 3,154.b9 °' 650.OD ~~ ~ tS ~~'~ ~-~ 64.63' 2,86Q.00--- ~c..t~KZ ~ rt? G- ~ ~ ~ ~>~ ~' ~ 75.09 v' 122 67+ 75.OQ 37 y 4 ~~~ . . ,~ ~ ~ Lt 5 -~- _ 53.83 / ' 68.00 ,,~ n.~ ~ - ~ 3 ~ o ~y' o ~ ~9 ~ ~ ~ 278.b6r/ , .25.30+% 54.10 97.89 D~~ ~ ~~ ~~ b~ ~ ®~ ~ 21776/ ~*y car-- l~.bs --373.99 ii (~ ~ ~ Q~j t ~ I ~ b f b ~ 14 ccvc; ti~ fis~,~/-~ -- 300.00 Y - ~~'~X ~_S l ~~~5 a3 ~ ~ ((~ .7~ ~ 50.00' 1 20 81 ~ ~~C~ ~5 5 ~l ~ o J ~~ I °3 r ~ . '~~ ~+~~+.~ --100.57 . ~"G2V~ ~A-~v~ " 43.27 ~R~ ~'~~ ~ ~ ..~ , 5 582:20 t . ~ 3 ~ 79.28/ ~~ es ~ ~~~b(~ ~ ~ ~ ~Z 36.5G~ See feceiQ~- .~J ~ ~~ ~ _,3 .00/ / ~~ ~, ~ ~~ ~ ~ i o.oo 26 00/ ~~~~ . - 27.S6 ~ ~?© ~,~G~7-!~ :~~G~1-~,D t r~~~ 787.80' 787 80 ~ . 787:80 ~ 72.80 /~ . 72.80 ~ 72.80/ 65.92' 270.37 ~6b.77 - 66.26 VaQ'i0U5 in 10,727.98 4,761.43 10/31/03 12131/43 e~ ~ ~ ~ ~-~ ~' ~~ ~ ~ 1,5oa.oo - ~ ~ Di e~ ._ A- .. .. 2113/03 ~ ~®.®3~ o2123ro4 X214.55) 06/25/05 2003 paids ~"^'o" ~s to corpxls .. ,. Form. 94~ ' E~nptoyer's Quarterly Federal Tax Return (Rev :January 2003) - See separate instructions revised January 2003 fur information on completing this return, Department of the Treasury Inlelnal Revenue Service (99) Please type or print. Enter state ~ ~ OMB No. 1545-0029 Code for state ~ Name (as distinguished from trade name) , . Date quarter ended in which ~ L I PMAN GOLI7RING , INC , MAR 2 0 0 3 deposits were T made only if Trade name, if any Employer identfcatibn number FF different from WEZiDONS CAFE 2 3 -19 5 0 9 0 3 t=D state in Address (number and street) City, state, and ZIP code pp address to r---~~ . MECHANI CSBURG P1~ 17 0 5 0 - 2 0 4 5 ' .. ~ ,.: .. _ r,. ~ - .. ~ T ~~t~ rrtr ~ . ' .._ . I. ~ .,.. . 3 ~ ~in~rirl~ 13 9 2 .~ . 44.38 ,~T ~tatatina it:ttnr -' . .,.. ff _'"~ x~. . ~larrfattttrg ~,Z~ I71f14.431t8' . :: •. DATE 6' ~~ Sx "~,,/ ~i): 717-545-78&I .. '. 4 4 4 5 b 5 60=6099/2313 PAY TO THE ,~ • '-` ... ,... ,,.p...:,~::r-.~ e ORDER OF ~4.L~ ~~~~ /~ ~ ~`~ ~ . ~"'y~.::>,.::.,1~. I ~~~ f'^" j~'~"`l ., -''^L~~>~,,,~~ '""` _ F ~ 'l0 10 10 10 10 10 10 10 . BELCO COMMUNITY `~~` '` ..)- gErcc~ CREDIT UNION '~- (717) 232-3526 ~ ' .t60o) 642-4482 ........ _..... ,('' ~.. . N_ .,,..-.. ~ 1' ~ 1 - ~yi ,,-.ts~ +ti.. r MEMO -~~ - ~~~~ ~ ~G~ ~,.a ..... .k . ~t f~-- ... 2 2 , F) O 0 0 OM1 am 2 3 ~ 3>~0'~ 9 7a® :-rpp0~.~'L~6Q"0~4:!t®~y' ~;~ q.2, _ , ... .. 4 P I_SIN . , °° 5 390.00 • 6 Taxable social security wages':°~=._: ~ ;~.:= os ~ ~ ' ~ ' ~ ' ;, ,; „ _ 4 - 6b 3 2 2 .4 0 Taxable social security tips~':-~.~::' .... 6c 0 . 0 0 x 12.4% .124 = lid 0 . 0 0 7 Taxable Medicare wages and tips,-: '.::_':.• . ~.: "7a 2 6 0 0 . 0 0 x 2,9% .029 = 7b 7 5 .4 0 8 Total social security and Medicare taxes (add.l(nes iit,:6cl;~.arid 7b). Check here if wages are not subject to social security andlor Medicare tax ....... • ................... - [] 8 3 9 7 . 8 0 9 Adjustment of social, security arid Medicare taxes (see instructions for required explanation) Sick Pay $ ± Fractions of Cents $ ' ± Other $ .` ~ - g 10 Adjusted total of social security and Medicare taxes (line 8 as adjusted byline 9) ..... ..... 10 3 9 7 . 8 0 11 Total taxes (add lines 5 and 10) ....................... . ,1~.'4~ ~,[~ , 11 7 8'7.8 0 12 Advance earned income credit (EIC) payments made to employee ~~~G~+~ , . 12 13 Net taxes (subtract line 12 from line 11). If $2,50Q or more, tf~il~t'~ie the 17, • column (d) below (or line D of Schedule B (From 941)) .:...... ,. ,.. r 13 787 , 8 0 14 Total de osits for uarter, including ove a ment a lied froth a riot ~ ~ ~'~~~ ' R q rp Y PR p (~~~r ........... 14 a~ ttevenue Se~~~ 15 Balanrre due (subtract line 14 from line 13). See instructions . ~Tl..~~zl?~, . ~~ ,(Y~~~ . , , 15 '7 8 7 . 8 0 16 Overpayment, if line '14 is more than line i3; enter excess her~p AS~S~~N. 0 • 00 -" add check if to be: [~ Applied to next return or ^ Refunded. s All filers: If line 13 is less than $2,500, do not complete line 17 or Schedule B (Form 941). _ • Semiweekly schedule depositors: Complete Schedule 8 (Form 941) and chec~C here :........... . .............. - U • Monthly schedule depositors: Complete line 17, columns (a) through (d), and check here ....... . .:............. 17 Monthly Summary of Federal Tax Liability fComDlete Schedule B (Form 9411 insfearl. if vnu wam a sarni,nraotrlu ~~t,~l, ~fo ;to;,,,~tt„r ~ (a), First month liability (b) 5ecbnd month liability (c) Third month liability. . (d) Tgtal liability for quaner Third Do you want to allow another person to discuss this return with the IRS (see separate instructions)? 0 Yes;. Complete the following. ~ No Party Designee Designee's Phone Personal identification name- EDWARD MAXWELL no. - 717 - 7 61- 52 74 number (Pw) - 13 3 2 ~~ U nder penattie~ of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and beI ief, a~, Ian it is true~ao,FrOia, and complete. CLAIRE R . WELDON 1„lele „~ Print Your , ~/ Signaure- ~~,~-~1 ~~ Name andTitle- PRESIDENT Dat~/. d` ..~ ,C~ y' For Privacy Act and Paperwork Reduction /Act Notice, see back of Payment Voucher. ISA STF FED1725F.1 Form 941 (Rev 1-2003) Form 94 1 (Rev. January 2003) Department of the Treasury Enter state code for state in which deposits were made only if . different from : state in address to ~~'""~~''~ the right - l 1 (see page 2 of separate instructions). If address is H different ~ from prior W ' return, check ^ ~ - here - employer's Quarterly Fed~rai Tax Return - See separate instructions, revised January 2003 for irtfgrmat[on on completing this return. Please type or print. Name (as distinguished from trade name) Date quarter ended -LIPMAN GOLDRING, ZNC: JUNE 2003 Trade name, if any Employer identification number WELD'ONS CAFE 23-1950903 Address (number and street) City, state, and ZIP code . MECHAnTTCSBURG PA 17Q50-2045 OMB No. 1545-0029 T FF FD FP I ,. 1 1 1 .1 1 1 1 1 1 1 2 3 3 3 3 3 3 3 3 4 a a g a s 6 7 8 8 8 8 8 8 8 8 (~9~~ ~ ~~~~ X10 10 10 10 10 i0 10 10 10 10 A If you do not have to file returns in_the future, check here - t' ~; td ~js B if you are a seasonal employer, see Seasonal employers oo pale 1 of the in t~ti~nd~i~~~l:~.... )s . 1 Number of employees in the pay period that includes March 12th . ~R` ~ a r ~` ; ~.~, ~,,~; 2 Total wages and tips, pies other compeitsatit~xt....,.. ....................... . .... 2 2 6 0 0 . 0 0 3 Total income tax withheld from ~N.ages, ti.ps,.,and sick pay . I~~erria,1.1{~V~t7le •SB~'J'.i<~tr , . , 3 _ 3 9 0 ..0 0 4 Adjustment of withheld income•tax for: preceding quarters (~~~~k _ CE . fy~~~. , .... , 4 - 5 Adjusted total of income tax withheld-(line°8.as adjusted by line 4) ....... ............ 5 3 9 0 . 0 0 - 6 Taxable social security wag,asr::~:; ~ =•:-'::: ~~,':::?:.:. -6a • ~ ~' ~2. 6 0"0 . 0 0 x 12.4% .124 = 6b 3 2 2 .4 0. Taxable social security. tips°:":-:" :.:.: . ........'. 6c' ~ 0.00 - x 12.4% .124 = Gd 0.00 7 Taxable Medicare wages and tips .:::." ;'.... 7a - 2 6 0'0 , 0 0 . x 2.9% .029 = 7b 7 5 .4 0 8 Total social security and Medicare taxes.~(add :lines 6b;..hdx'°and 7b). Check here if wages - :-^ 8 3.97.80 ,. . • ~u~rnr ~d ~tn~ri<r~ ' - ~ .. .9.. 3 91 - ' 4238 ~ ~Itttttlttitt lrittttr ; .., ;., ~~ ~~ ~ ~~~: ~ 9 aQierriffhttrg ~.1171It9-43it5 _ DATE ' ~ ~J • .~' .... 1 t) 3 9 7 . 8 0- ~I). 717-545-7BEi1 : so.aosalz3t3 ~ .... 11 7 8 7 . 8 0 PAY TO THE •t ___...~. ~ ; :.•~~:~-.. ~..s~,.: • 1 t^ ORDER OF S./~--~Ci,.~t-~~.~ZY ~~~~~ 1~+~•LPt, `a' ~a:r-.F3:~,/•:,,-.~:?..-rc~t''','~'l~; .. . • .,.•.. 73 787 80 . za•-' ~.h "`~•~•--DOLLARS t51 ~a~ BELCO COMMUNITY ~ ' 15 7 8 7. 8 0 Befco CREDIT.UNION '• ~ 0 (717) 232.3526 ,. '~M (a00)~ya~~r42.448¢2} a0 23 ~-3~09~i~7om 00044 ~600M11® - 137 b ~ _ .. 17 IVlonthl Summa of Federal TeX Liability. (Complete Schedule B (Form 941j instead, if ou were a semiweekly schedule depositor.) (a) First month liability (b) Second month liability (c) Third month liability (d) Total liability for quarter t~ f ~~1 •~~f ~„J ~ n our Here Signature ~•'' ~~, ~/ V ~' tr" Name and77tle) Under penalties of perjury, I declare that I have examin d this return, including accompanying schedules and statements; and to the best of my know $Ign it is true, correct, d omplete. ~~2_ CLAIRE R . WELDON Prl t Y Do'you want to allow another person to discuss this return with the IRS (sae separate instructions}?' Lj Yes. Complete the following. ^ No Third Party Designee Designee's Phohe Personal identification 13 3 2 name- EDWARD MAXWELL no. - 717 - 7 61- 52 74 number (PIN) - ~_` For Privacy Act and Paperwork Reduction Act Notice, see back of Payment Voucher. ISA . STF FED1725F.1 ' r~_ Form ~1 (Rev.1-200 Form 941 . (Rev. January 2003) Department of the Treasury Enter state code for state in which deposits were made only if different from state in address to 1----~ pate quarter ended SEPT 2003 Employer identification number 23-1950903 City, state, and 21P code DATE ~I "'. L ~ .~.+ • P 139 • 60-8099/2313 DCSLL•ARS lg '~° BELCO COMMUNITY" '''•. •~ j3rtco CREDIT UNION x :~,...., , t71 ~ 232-3528 . ~ ~ ., t (800) 642-4482 ~ ~ . - , MEMO - - .. ,., „ . ~'yf f--~~ef~,___~~ . a 0 2~ 13 ~ 0 9~? a o~ ,r, •.Q,0.0 ~n~ 4 L 6 0 0..4,1im. : i ~:8 9 _. OMB No. 1545-0029 T FF FD FP T 4 4 4 5 5 5 10 10 10 10 10 10 10 10 tl.:: n .... 14 6 Taxable social security vvag~es,~:.:... _...... ~ tia ~ ~ ~ v:~ .., „ _ -_ ?4 - 61 Taxable social security.tips :~ ~ ~: 6c' 0 . 0 0 x 12.4% .124 = 6t 7 Taxable Medicare~wages and tips .:~ :` . ~. ~.:. ~...~ 7a - 2 S 0 0.. 0 0 x 2.9% .029 = 7i 8 Total social security and Medicare.taxes.(add liges.5b.;.Frd; and 7bj. Check here if wages are not subject to sociat~security and/or.Medicare ta~c .....:.......:............ - ^ 8 9 Adjustment of social security and Medicare taxes (see instructions for required.explanation) Sick Pay.$ ± Fractions of Cents $ ± Other $ = g 10 Adjusted total of social security and Medicare taxes (lina 8 as adjusted by line 9) :............. .10 11 Total taxes {add lines 5 and 10) .... . ................. • . ~.. ....:................. 11 12 Advance earned income credit (EIC) payments made to empl~e~ ~t~t~tn~ ......... ~ 12 13 Net taxes subtract line 12 from line 11 . If $2,500 or m u column (d) below (or line D of Schedule. B (From 941)) .. _ ..... .............~ :~.... 13 14 Total deposits for quarter, including overpayment applied from a j~~r'gt~tl~er~~~~.:......... •14 15 Balance due (subtract line 14 from line 13). See instruc$i>;nal.,kwetiue• S~U'~ ~ • 18 1v , vVvr~wjiiicrit. jE jtiiE 14 is.mcr+„ tliali line 13; erttGr GxCG.70'T@CS~G~ T"P!t„~~~ ~• OO add check if to be: ^ Applied to next return or ^ Refunded. ~ ' ~YS ' 397.80 397.80 787.80 787.80 787.8C 2 , 600 .•E)0 390.00 • ,4[I filers: If line 13 is less than $2,500, do not complete line 17 or Schedule B (Form 941 j. • Semiweekly schedule depositors: Complete Schedule B (Form 941) and check here ........:.................. ® [ • Monthly schedule.depositors: Complete line 17, columns (a) through (d), and check here .......... .............. ® [ 77 Mnnthiv Summary of Federal Tax Liability (Complete Schedule B (Form 9411 instead- if vnu warn a aamiwaakhr schorhdn ricr,nci+n~ 1 390.00 322.40 0.00 75.40 .(a) First month liability (b) Second month liability (c) Third month liability . (d) Total liability for quarter Third Do you want to allow another person to discuss this return with the IRS (see separate instructions)? U Yes. Complete the foliowing. U I Party ~ • Designee Designee's Phone Personal identification name - EDWARD MAXWELL no. - 717 - 7 61- 5 2 7 4 dumber (PIN) - 13 3 2 Under penalties of perjury, i declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and be; ~Igtl it is true, corr Et, and complete. CLAIRE R . WELDON l-~ere (~, Print Your signat - •~,~lG•t'il~(/~/f ~ 0~~ Name and Title - PRESIDENT _ Date - ~ / •~ ~ L `='' For Privacy Act and Paperwork Reduction Act Notice, see back of Payment Voucher. Form 941 (Rev. 1-2t Name (as distinguished from trade name) ~ • - LIPMAN .GOLDRING, INC. Trade name, if any •WELDONS CAFE ;Address (number and street) MECHANICSBURG PA 17050-2045 employer's Quarterly Federal Tax Return ® See separate instructions revised January 2003 for information on completing this return. Please type or print. ISA STF FED1725F.1 3Eu~rnr +~~.(~in ricif _ ... 4238 iii. f((tt~Iina ~tinr ~tttrifelrurg ~.lt 171lt8_43i1& ... _, ,. . ~I7.717-545-7881. N ff a v °~ 0 N vJ G vn ~~, H n~~~ d nrozo ~~,~,r ~~ C7 H ~ O ~ ~ b~ ~- ~ Q' F o ~ Q 1 fl ~ Y' 9 . Z .,.-y m m ~ 4 ~~ ~ ~ i®H N ~ ~ ~ ~ ~~ S,i ~+ ~ ~ ~ o ~ ~• fl -~ N ~ q ~ ~ N ~ ~~.,3 • ~ ~ N ' ~ ~ ~ W FG` ~S `Y (f1 ~~~ m v ~ m ~ ? ~~ ~ Y r ,' 0 Q ~ y ~~ ~a m i ~~ O ~ r¢ O ~ ~ ~,' N ~ C7 ~ro~Gr ~~ a ~ y r n ~.. v-~t~~, '3. C C~ 1 ~ O t3 rn ~ ~ ~+rn~ ~ CQ p mi-`n ca ~ ~~ ~ .. ~9 o. o ~~ .. ~ C'> z ~- y =~ ~ ~ Q N ea „~, ~, ~ ~ ~, "•~ ~ ~ ~ Z ~~ ~~ m g ~ ~ ~' °~ 1 -- .. ~ ~ N s ~_ ~ W° a ~~ ~ . _. ~~ a y ~~, g~O ~ ~'~ ~ ~ O ~~ ~ ~ c ~~; ~ ~~ ~n ~ ~ O ~N 3 `{ ~. ~o ~ ~ o C . m fi N ~ ~ O O ~ ~ O ~ 0 0 O d *s m ~ o ~ W .- ~ ~~ y ~n,o ~ a C] ~ '-~O W N N C Y1 ' 1 _• N ~ " x 1 r t., ~"' fl Q 0 _ ~ ~ '' d I ° _~ (` ar' W '"~. ~ 1' o'~ ~ { .. a Y xl0 ~~m ~~s K a'f ^~ K tS\ i31is~- fS1 -_ Y -'~ °t1 ~- o "Y `S N ~a ~~4~~~~~~~~~~ ~~~ ~ ~ ~ X~ ~~~ ~~ ~ ~~ ~ ~~ 4 C7 "" _~ ~* ~ ~ ~ a ..~. ern{ ~ ~ t~Q Q~ '~ -c? a. ici ~ ., .~ A ~ Vi . ~ ~ ~:.. , F,, . a ~ ~ .O~ ~ . ~~~~ t.~ "~ ~~ ~,~ ~. t;;:;i, !. :~ 1 N ~ l.i~ ~p ~ ~ hr ~ ~' ~ o. ~~ ~" ~ 8~v. b- - ~ ~: o~N=izi1 . ~ ~ ~rnZ3 N Nmpc -,a a: a * 4 ' ~ ~ ~ p ``~ 0 d ~ O w r . a- ~- m m ~ $ o. -o ,. u ~r' C3 O ~~ ~ ~ ~,. ~ ~, Q o ~ ~' v ~' ~ z~ . ~~ ~ ''~ t i 4 y . ~ :~; ~ .r n ~n~: ~ ~~ ~.'; '""'' ~~ R .~ . ~~ °A O $, ~~t7. 47 ~ ~ ~ ~ a ~~~ ~~~ ~ ~ ~ ~ _. ~ ~~ N W~m N $ x ~ ~ m tri ~ m p y °v v ~ p 4 ~ W ~ H o, ~ U ~' ~ ~ "~ ~ tin a W ,.a m c ~ Q v r °v ~. _. w ~ ~ ~ ~ > ~m~ a ~^~ vC! ~ m~ ~ ~ ..D c ~ Lx+ C m }-1 v y "O ~" ~ 3 ~ y _'' ~ ~ ~- coo ~ ~ ~ s g . 4 ~..1 ~ ~ ~ I ~ ~ ~ . , ~~. ~ m rte... m a: ~' ~ s~ ~ v O v ~ Z ~ ~ N~ ~N~t Q 0 v Y GS ~ ~ a ~: o • Z; ' G Ca D v ~ © ny" - ~' ~, s, 0~ tCq ~ ~ „~ n m ~ ~ ~ ~ ~ ~ z ~o ~ a o ~ ~~~ ~"o T C O ° ~o ® M ~~ Via ~x 0 ~~_ .~ ~q ~ o ~ a ` ~ ~ ~ ~ ~ ~ o ~, z i ~ 'b ~ ~ O ~' ~ ~~ N r!" -~' °v N o ° o~ Q i W m ~ o'' ~r ~ ~ ~~ '' C '~ . ti~ 1 }~ o~ ~~ v ,~ 9~ 0 m ~ r- «s ~~ %~.t ~~ ~a4 .~ C O O ~~ '~~ ry -.1 ..~ N W ,F ~a Q' -.l ~ ~~ _ 4G..~ ~.. U ~ ~ tci ~i ~ cr ~ C t ~' ~ ~ ~-` 9 m ~, ~ ~ ~- ~ 'G'w';' c~ , i~ C' ~ ti ~ f*1 ~o ri _ ~ S"~~ -a ~ ° .~ (~ ~ y. 1ST ° c*~ N ~ uy .~ ~ ~ v .~ a w ~ ~ .~, a `~. L3'1 O O t-' N a a . ~ N N • m p ~, a 3 p a o 2 ~ m '.3` o y-^ m y--1 o -~ 3 n O~ o ~., ~ U ~© ~i~.~ ~WH s Z »~ ~ ° H ~~`• " ~ flA ~ Z ~~ n o ~a ~ ~ ~ . ~ ~ ~ ~ ' c i+:.. r ~ ~, ammo ~° `" Q d ~ "A ° '~ ~ ~ N ~C3c O O ~ Z ~ '.li' '~ o~ C © a2 t7 Q O • Q ~ ~ n o ° ~ ° F y ~ y n ~ ~ c o a cs~ ~' ~" ~' .~ o ~ c o N O ~ . ~~' ~ ~ =m ~ p r nn W t ~°n o 3 N r„ ~ $ o• -~~ w~q ~ ~ ~ ~ 'c ' .<' Li ~ ~ ~ am n ~o ~ O a ~ ~ o ~ ~ n S - ~q (~~ ~ ...yy in O T ~ ~? T`~ .. ~ m~ ~ O N ~ 0 ~ r qQ D jj p 7~ m~ ~ ~ ~ ~~ M ~ ~~ t m ~ ~ ~ '' <m~ ;.. ~ a ~~x m o o ~ _ 3 °^~ ~ N o ~ ~' o. ~ ~ p ~ a N ~ :~ ~ _N ~ ~ ~ Q C] ~ © o ~ Q ?~ ;`: r -o :. r 00 ~ ~ _ ~ LI1 v~ ~~ '~ ~ ~ . X~ Z 4 1 o-~ as p0 ~m ~. ' ~~ .: t ~~ ~~~ Y 4.` ~Y+ . ti1~ ~~ :,~ +~, ffi ~~ ~,, .y 5 1...-- {¢~' 4 77 ~i [~ e~Ar ` ~~~ This form recommended and approved for, but not restricted to use by, the members of the Pennsylvania Association of REALTORSe (PAR). BROKER (Company) t. C fK 7 [' !, ADDRESS L T LICENSEE(S) ~!~/ BROKER IS THE AGENT FOR SELLER OR (if checked below): Broker is NOT the Agent for Seller and is a/an: ^ AGENT FOR BUYER WITH PA LICENSED BROKER , ` v L~~ PHONE ~ ~ '' Z' ~~ Y ~ ' ~ /)lam ~" i'~~ FAX ~ .3 7 ~- ~ .~/ Designated Agent? ^ Yes ^ No ^ TRANSACTION LICENSEE BUYER'S BUSINESS RELATIONSHIP WITH PA LICENSED BROKER BROKER (Company) PHONE ADDRESS FAX LICENSEE(S) Designated Agent? ^ Yes ^ No BROKER IS THE AGENT FOR BUYER. OR (if checked below): Broker is NOT the Agent for Buyer and is a/an: ^ AGENT FOR SELLER ^ SUBAGENT FOR SELLER ^ TRANSACTION LICENSEE When the same Broker is Agent for Seller and Agent for Buyer, Broker is a Dual Agent. All of Broker's licensees are also Dual Agents UNLESS there are separate Designated Agents for Buyer and Seller. If the same Licensee is designated for Seller and Buyer, the Licensee is a Dual Agent. 1 z 3 4 S s 8 9 i0 11 12 13 to 15 16 17 18 is 20 21 zz 23 24 z5 2s ~."5 29 30 31 32 33 34 35 36 3i 38 39 40 41 1 ~C~ji~ Mgr SELLER(S): S BUYER(S): 2. PROPERTY. Seller hereby agrees to sell and convey to Buyer, who hereby agrees to purchase: ALL THAT CERTAIN lot or piece of ground with buildings and improvements thereon erected, if any, known as: is between ~ /1!~ z called "Seller," and 3 4 ,called "Buyer." 5 6 7 a 9 te) 10 r~/7 / 12.u. f 'tv 11 3. TERMS (10-06) ,,~, _ 1z ~ ~ t r- (A) Purchase Price ~'ti'/•- I~'Lf'/'.!/~;h~ L ~~ ! "' C.' ~~, ~ i• ,l l•~ C`` L_" '~~ ~- ~/ /.~ U.S. Dollars, i3 which will be paid to Seller by Buyer as follows: 14 t . Cash or check at signing this Agreement: $ ;~ , C/ ("~ f'i 15 2. Cash or check within days of the execution of this Agreement: $ 16 3. $ n 4. $ 18 5. Cash or cashier's check at time of settlement: $ ~~y5 , (;~ ~/ 19 TOTAL $ ~ ~L31 ~?('`i~7 20 (B) Deposits paid by Buyer within ~_ DAYS of settlement will be by cash or cashier's check. Deposits, regardless of the form of payment and e1 the person designated as payee, will be paid in U.S. Dollars to Broker for Seller (unless otherwise stated here), 22 who will retain deposits 23 in an escrow account until consummation or termination of this Agreement in conformity with all applicable laws and regulations. Any check 2.1 tendered as deposit monies may be held uncashed pending the acceptance of this Agreement. 25 (C) Seller's written approval to be on or before: ~~%)~,,Sr f ~~ ~ l:li? /.~N;S is. .~ t/•' /.J +~. t f). /• j } zs (D) Settlement to be on 'v'l~' I i f~~11~ ~ 1,~~' 7 ~T ~^r/."f/~ C/:~f ~!/V /N~f F~~^ L-~ , or before if Buyer and Seller agree. 27 (E) Conveyance from Se/ller will be by feJ/e simple deed of special warranty unless otherwise stated here: %8 / 29 --f~~''. (F) Payment of transfer taxes will be divided~ually between Buyer and Seller unless otherwise stated here: 3C' (G) At time of settlement, the following will be adjusted prtrrata on a daily basis between Buyer and Seller, reimbursing where applicable: taxes 32 (see Notices and Information Regarding Real Estate Taxes); rents; interest on mortgage assumptions; condominium fees, if any; water and/or 33 sewer fees, if any, together with any other lienable municipal service. All chat•ges will be pro-rated for the period(s) covered. Seller wilt pay up 34 to and including the date of settlement and Buyer will pay for all days following settlement, unless otherwise stated here: 35 36 (H) Buyer will reimburse Seller for the actual costs of any remaining heating, cooking or other fuels stored on the Property at the time of settlement, 3i unless otherwise stated here: 3s 39 ~., 40 -~ ~~J Buyer Initials: . Seller Initials• ~~ ai °' EXHIBR r' ~~'~ Pennsylvania Assodatlon of PYRIGHT PENNSYLVANIA ASSOCIATtO OF REALTORS® 2006 REA~TORS® t o/06 rtrnuotrs rh.vre.b.x.rw~rv~.r«.+. 4'L 4, 43 44 45 46 a7 ae 49 50 51 52 53 $, 54 55 56 57 58 59 60 61 s2 63 (, s4 65 66 s7 68 69 70 71 72 ~, 73 74 'r5 76 77 79 79 60 81 82 63 64 65 96 67 A3 89 90 s1 92 93 9a 95 ss 97 sa 99 100 101 102 103 104 1,~ix~1~URES & PERSONAL PROPERTY (i-00) az (A) INCLUDED in this sale are all existing items permanently installed in the Property, free of liens, including plumbing; heating; HVAC equip- 43 ment; lighting fixturess (including chandeliers and ceiling fan~sj); and water treatment systems, unless otherwise stated below. Also included: 44 ~-- ~- ,G.. / /~ ~ ~+ ~ l ;111 ~~ /.~ Z.=3'' L~ ~,%'' ~ ~~ /ll .T 45 (B) LEASED items (not owned by Seller): (C) 46 47 4s 49 50 51 52 POSSESSION ($-O1) 53 (A) Possession is to be delivered by deed, keys and: ~ 1. Physical possession to vacant Property free of debris, with all structures broom-clean, at day and time of settlement, unless otherwise s5 stated here: ~[~~ f'~.~ ~~ ~ ~ ~ ©~~ 5s AND/OR 57 2. Assignment of existing lease(s), together with any security deposits and irnte/r~est, at day and time of settlement, if Property is leased at the 56 execution of this Agreement, unless otherwise specified here: ~/ /fit 5g 60 (B) Buyer will acknowledge existing lease(s) by initialing the lease(s) at the execution of this Agreement, unless otherwise specified. st (C) Seller will not enter into any new leases, extensions of existing leases, or additional leases for the Property without the written consent of Buyer. s2 DATES/TIME IS OF THE ESSENCE (9-0~ s~ (A) The settlement date and all other dates and times referred to for the performance of any of the obligations of this Agreement are of the essence s4 and are binding. ss (B) For the purposes of this Agreement, the number of days will be counted from the date of execution, excluding the day this Agreement was exe- s6 cuted and including the last day of the time period. The Execution Date of this Agreement is the date when Buyer and Seller have indicated s7 full acceptance of this Agreement by signing and/or initialing it. All changes to this Agreement should be initialed and dated. 66 (C) The settlement date is not extended by any other provision of this Agreement and may only be extended by written agreement of the parties. s9 (D) Certain time periods are pre-printed in this Agreement as a convenience to the Buyer and Seller. All pre-printed time periods are negotiable ~~~ and may be changed by striking out the pre-printed text and inserting a different time period acceptable to all parties. 7 FINANCING CONTINGENCY (10-06) 7f WAIVED. 'This sale is NOT contingent on financing, although Buyer may still obtain financing. 73 ^ ELECTED. ~" (A) 'This sale is contingent upon Buyer obtaining financing as follows: 75 I. Amount of loan $ 7s 2. Minimum Term years 7 ~ 3. Type of loan 7a 4. Buyer agrees to accept the interest rate as may be conunitted by the lender, not to exceed at maximum interest rate of "/o. 7s (B) Within _ days (10 if not specified) from the Execution Date of this Agreement, Buyer will make a completed, written application for the 60 financing terms stated above to a responsible lender(s) of Buyer's choice. Broker for Buyer, iff any, otherwise Broker for Seller, is author- s~ ized to communicate with the lender(s) to assist in the financing process. 3? (C) Should Buyer furnish false or incomplete information to Seller, Broker(s), or the lender(s) concerning Buyer's legal or financial status, ss or fail to cooperate in good faith in processing the financing application, which results in the lender(s) refusing to approve a financing s4 commitment, Buyer will be in default of this Agreement. ss (D) 1. Upon receipt of a financing commitment, Buyer will promptly deliver a copy of the commitment to Seller. sss 2. Financing commitment date a7 Unless otherwise agreed to in writing by Buyer and Seller, if a writte~t commitment is not received by Seller by the above date, this as Agreement will be VOID, with all deposit monies returned to Buyer according to the terms of paragraph 20. Buyer will be responsible s9 for any premiums for mechanics' lien insurance and/or title search, or fee for cancellation of same, if any; AND/OR any premiums for o0 flood insurance and/or fire insurance with extended coverage, insurance binder charges or cancellation fee, if any; AND/OR any apprais- 91 al fees and charges paid in advance to lender. `~~ 8. STATUS OF WATER ($-01) ' s3 Seller represents that Property is served by: 94 Public water 9s ^ On-site water 9s ^ Community Water _ °7 ^ None s6 ~ 99 Seller warrants that the system(s) are fully paid for as of the Execution Date of this Agreement. 100 101 102 Buyer Initials: ~ A/S-C Page 2 of 7 uo.,taoa tnm~ 103 Seller Initials: .-~ j ~ _ io4 .~ ~-- i ulAI VIJ Vl' U1J •I L'1\ ~J-V l~ ~V5 1os Seller represents that Property is served by: tos to7 ~,. Public Sewer to7 1os ^ Community Sewage Disposal System 108 109 ^Off-Property Sewage Disposal System 109 t1o ^ Individual On-Lot Sewage Disposal System (See Sewage Notice 1) 11a 1t1 ^ Individual On-Lot Sewage Disposal System in Proximity to Well (See Sewage Notice 1; see Sewage Notice 4, if applicable) 111 112 ^ Ten-acre Permit Exemption (See Sewage Notice 2) 112 113 ^ Holding Tank (See Sewage Notice 3) 1 t3 11a ^ None (See Sewage Notice I) 114 tt5 ^ None Available/Permit Limitations in Effect (See Sewage Notice 5 or Sewage Notice 6, as applicable) 11s 116 ^ 116 1 t7 Seller warrants that the system(s) are fully paid for as of the Execution Date of this Agreement. t 17 11s 10. ZONING CLASSIFICATION (5-01) 11a 119 Failure of this Agreement to contain the zoning classification (except in cases where the properly {and each parcel thereof, if subdividable} is zoned 1 is tzo solely or primarily to permit single-family dwellings) will render this Agreement voidable at the option of the Buyer, and, if voided, any deposits 1za t2t tendered by the Buyer will be returned to the Buyer without any requirement for court action. tz1 tzz Zoning Classification: t22 123 11. ZONING CONTIlVGENCY (10-06) 123 124 ~ WAIVED. 1za 125 ^ ELECTED. Contingency Period: days (15 if not specified) from the Execution Date of this Agreement, 12s 12s (A) Within the Contingency Period, Buyer, at Buyer's expense, may verify that Buyer's proposed use of the Property as 126 1z7 is permitted under the current zoning classification for the Property and 1z7 1za is not prohibited by any other governmental land use restrictions. tea t2s (B) If Buyer's proposed use of the Property is not permitted, Buyer will, within the Contingency Period, notify Seller in writing that the pro- 1z9 t3o posed use of the Property is not permitted, and Buyer will: 130 i3t ^ Option 1 131 132 1. Accept the Property and agree to the RELEASE in paragraph 25 of this Agreement, OR 132 133 2. Terminate the Agreement of Sale by written notice to Seller, with all deposit monies returned to Buyer according to the terms of para- 133 t34 graph 20 of this Agreement, OR 1 ^,a 135 3. Enter into a mutually acceptable written agreement with Seller. 135 136 If Buyer and Seller do not reach a written agreement during the Contingency Period and Buyer does not terminate the 1,i6 137 Agreement of Sale by written notice to Seller within that time, Buyer will accept the Property and agree to the RELEASE in 1S7 t3a paragraph 25 of this Agreement. 13a 139 ^ Option 2 139 tao 1. Within the Contingency Period, Buyer will make a formal written application for zoning approval, variance, non-conforming use, tao 1 a1 or special exception from (municipality) to use the Property as ~ a1 i42 (proposed use). Buyer will pay for _ 1+?2 143 applications, legal representation, and any other costs associated with the application and approval process. tai 1aa 2. Ifthe municipality requires the application to be signed by the current owner, Seller agrees to do so. t<ea 1a5 3. If final, unappealable approval is not obtained by ,Buyer will: ta5 1as (A) Accept the Property with the current zoning and agree to the the RELEASE in paragraph 25 of this Agreement, OR tas ta7 (B) Terminate the Agreement of Sale by written notice to Seller, with all deposit monies returned to Buyer according to the terms 1a7 tae of paragraph 20 of this Agreement, OR ~,t,' ia9 (C) Enter into a mutually acceptable written agreement with Seller. 1't`+ 150 If Buyer and Seller do not reach a written agreement before the time for obtaining final approval, and Buyer does not t~~o 1s1 terminate the Agreement of Sate by written notice to Seller within that time, Buyer will accept the Property and agree t51 1sz to the terms of the RELEASE in paragraph 25 of this Agreement. t`2 t63 12. PROPERTY DEFECTS DISCLOSURE (10-O1) 153 15a (A) Seller represents and warrants that Seller has no knowledge except as noted in this Agreement that: (1) The premises have been contaminated 'i5a 1s5 by any substance in any manner which requires remediation; (2) The Property contains wetlands, flood plains, or any other environmentally 155 ts6 sensitive areas, development of which is limited or precluded by law; (3) The Property contains asbestos, polychlorinated biphenyls, lead= tss 157 based paint or any other substance, the removal or disposal of which is subject to any law or regulation; and (4) Any ]aw has been violated in t57 15a the handling or disposing of any material or waste or the discharge of any material into the soil, air, surface water, or ground water. 1sa 15s (B) Seller and Buyer acknowledge that any Broker identified in this Agreement: (1) Is a licensed real estate broker; (2) Is not an expert in con- 159 tso struction, engineering, or environmental matters; and (3) Has not made and will not make any representations or warranties nor conduct inves- 160 161 tigations of the environmental condition or suitability of the Property or any adjacent property, including but not limited to those conditions list- 161 ts2 ed in paragraph 12 (A). 1s2 1s3 (C} Seller agrees to indemnify and to hold Broker harmless from and against all claims, demands, or liabilities, including attorneys fees and court 1sa t64 costs, which arise from or are related to the environmental condition or suitability of the Properly prior to, during, or after Seller's occupation t64 1s6 of the Property including without limitation any condition listed in paragraph 12 (A). 1ss tss (D) The provi 'ons `this paragraph will survive settlement. 1ss i67 Buyer Initials: A/S-C Page 3 of 7 Seller Initials: ' y~ ~ 167 - Revised 10/06 .. v a~vrv a~ .r a-~v~vva.aa~~, a v ~-r vat I Vc ' S3 (A) Seller represents, as of the date Seller signed this Agreement, that no public improvement, condominium or owner association assessments have lss t7a been made against the Property which remain unpaid, and that no notice by any government or public authority has been served upon Seller or t7t 171 anyone on Seller's behalf, including notices relating to violations of zoning, housing, building, safety or fire ordinances that remain uncon-ect- 171 17z ed, and that Seller knows of no condition that would constitute a violation of any such ordinances that remains uncorrected, unless otherwise t72 173 specified here: 173 1'74 174 i?~ (B) Seller knows of no other pote~r-tial notices (including violations) and assessments except as follows: t?5 i 76 i~; ~ ~`~ ,~./ l~- 17E t77 (C) Any notice of improvements or assessments received on or before the date of Seller's acceptance of this Agreement, unless improvements con- 177 17a sist of sewer or water lines not in use, shall be the responsibility of the Seller; any notices received thereafter shall be the responsibility of the 17t 179 Buyer. 17°_ taa (D) If required by law, Seller will deliver to Buyer, on or before settlement, a certification from the appropriate municipal department or depart- lac ts1 ments disclosing notice of any uncorrected violation of zoning, building, safety, or fue ordinartces. tat 1sz (E) Access to a public road may require issuance of a highway occupancy permit from the Department of Transportation. tss 1sa 14. TITLE AND COSTS (10-06) 1as is4 (A) The Property is to be conveyed free and clear of all liens, encumbrances, and easements, EXCEPTING HOWEVER the following: existing 1aa 1a,i deed restrictions, historic preservation restrictions or ordinances, building restrictions, ordinances, easements of roads, easements visible upon 1a: 186 the ground, easements of record, privileges or rights of public service companies, and land use restrictions pursuant to property enrollment in tae 1s7 a preferential tax program if any. tai 1as (B) Buyer will pay for the following: (1) Title search, title insurance and/or mechanics' lien insurance, or any fee for cancellation; tat 183 (2) Flood insurance, fire insurance with extended coverage, mine subsidence insurance, or any fee for cancellation; (3) Appraisal fees and 1as i9U charges paid in advance to mortgage lender(s); (4) Buyer's customary settlement costs and accruals. 19t 131 (C) Any survey or surveys required by the title insurance company or the abstracting attorney for preparing an adequate legal description of the 1st 112 Property (or the correction thereof] will be obtained and paid for by Seller. Any survey or surveys desired by Buyer or required by a lender will 19S 1s3 be obtained and paid for by Buyer. i9: 134 (D) If Seller is unable to give a good and marketable title and such as is insurable by a reputable title insurance company at the regular rates, as specified 13; '195 in paragraph 14 (A), Buyer will: l9t t 96 l . Accept the Property with such title as Seller can give, with no change to the purchase price, and agree to the RELEASE in paragraph 25 of this 13f 137 Agreement, OR 19. i93 2. Terminate this Agreement by written notice to Seller, with all deposit monies returned to Buyer according to the terms of paragraph 20 of t9F 139 this Agreement. Upon termination, Seller will reimburse Buyer for any costs incurred by Buyer for any inspections or certifications obtained 13` :'oa according to the terms of this Agreement, and for those items specified in paragraph 14 (B) items (1), (2), (3) and in paragraph 14 (C). zat 1'31 15. COAL NOTICE (Where Applicable) zap ?a2 THIS DOCUMLNT MAY NOT SELL, CONVEY, TRANSFER, INCLUDE OR INSURE THE TITLE TO TI{E COAL AND RIGHTS OF SUPPORT UNDERNEATH THE SURFACE LAND tat 203 DESCRBED OR REFERRED TO HEREIN, AND TFIE OWNER OR OWNERS OF SUCH COAL MAY HAVE THE COMPLETE LEGAL RIGHT TO REMOVE ALL SUCH COAL AND 2a; ?R4 IN THAT CONNECTION, DAMAGE MAY RESULT TO THL' SURFACE OF 'rHE LAND AND ANY HOUSE, BUILDING OR OTHER STRUCTURE ON OR IN SUCH LAND. (Th15 2a' ~.as notice is set forth in the manner provided in Section 1 of the Act of July 17, 1957, P.L. 984.) "Buyer acknowledges that he may not be obtaining the zFls ?!~ ~ right of protection against subsidence resulting frorn coal mining operations, and that the property described herein may be protected from damage zeF za7 due to mine subsidence by a private contract with the owners of the economic interests in the coal. This acknowledgement is made for the purpose za; eat; of complying with the provisions of Section 14 of the Bituminous Mine Subsidence and the Land Conservation Act of April 27, 1966." Buyer agrees zai fII~' to sign the deed from Seller which deed will contain the aforesaid provision. za! zla 16. TAX DEFERRED EXCHANGE (10-O1) z1F all ;~(,. NOT APPLICABLE. 2t' 1.t2 ^ APPLICABLE. If Seller wishes to enter into a tax deferred exchange for the Property pursuant to Section 1031 of the irttetnal Revenue Code, z1; ?.t3 Buyer agrees to cooperate with Seller in connection with such exchange, including the execution of such documents as may be reasonably nec- zt, z11 essary to conduct the exchange, provided that there shall be no delay in the agreed-to settlement date, and that any additional costs associated zl' z15 with the exchange are paid solely by Seller. Buyer is aware that Seller anticipates assigning Seller's interest in this Agreement to a third party z1' z1G under an Exchange Agreement and consents to such assignment. Buyer shall not be required to execute any note, contract, deed or other doc- 21i z17 ument providing any liability which would survive the exchange, nor shall Buyer be obligated to take title to any property other than the 21' z1s Property described in this Agreement. Seller shall indettulify and hold harmless Buyer against any liability which arises or is claimed to have zl~ al ~ arisen from any aspect of the exchange transaction. z1 szo 17. COMMERCIAL CONDOMINIUM (10-O1) zz~ zzl ~ NOT APPLICABLE. z2 zzz ^ APPLICABLE. Buyer acknowledges that the condominium unit to be transferred by this Agreement is intended for nonresidential use, and zz; z?3 that Buyer may agree to modify or waive the applicability of certain provisions of the Uniform Condominium Act of Pennsylvania (68 Pa. C.S. 2z: zz'{ §3101 et seg.). z2 zz:, 1$. RECORDING (9-0S) This Agreement will not be recorded in the Office of the Recorder of Deeds or in any other office or place of public record. 22. z18 If Buyer causes or permits this Agreement to be recorded, Seller may elect to treat such act as a breach of this Agreement. 22 zG7 19. ASSIGNMENT (9-05) This Agreement is binding upon the parties, their heirs, personal representatives, guardians and successors, and to the extent 22 22a assignable, on the assigns of the parties hereto. Buyer will not transfer or assign this Agreement without the written consent of Seller unless other- zz 2z•°• wise stated in tJ is A ,e~ement. -y ~ 2z zaa Buyer Initials: A/S-C Page 4 of 7 Seller Initials: ' 1A 23 Revised 10/06 zit 20. ,TERMINATION & RETURN OF DEPOSITS (9-OS) zit 33z (A) Where Buyer terminates this Agreement pursuant to any right granted by this Agreement, all deposit monies paid on account of purchase price 232 233 will be returned to Buyer and this Agreement will be VOID. The broker holding the deposit monies may only release the deposit monies accord- 233 zaa ing to the terms of a fully executed written agreement between Buyer and Seller and as permitted by the Rules and Regulations of the State zaa 235 Real Estate Commission. 235 23s (B) If there is a dispute over entitlement to deposit monies, a broker is not legally permitted to determine if a breach occwred or which party is enti- 23s 237 tied to deposit monies. A broker holding the deposit monies is required by the Rules and Regulations of the State Real Estate Commission to 237 238 retain the monies in escrow until the dispute is resolved. In the event of litigation over deposit monies, a broker will distribute the monies 23a 239 according to the terms of a final order of court or a written agreement of the parties. Buyer and Seller agree that, if any broker or affiliated 239 zw licensee is joined in litigation regarding deposit monies, the attorneys' fees and costs of the broker(s) and licensee(s) will be paid by the party 2ao eat joining them. eat zaz 21. REAL ESTATE RECOVERY FUND (9-05) 2az z43 A Real Estate Recovery Fund exists to reimburse any persons who have obtained a final civil judgment against a Pennsylvania real estate licensee zaa zaa owing to fraud, misrepresentation, or deceit in a real estate transaction and who have been unable to collect the judgment after exhausting all legal 2aa 2a5 and equitable remedies. For complete details about the Fund, call (717) 783-3658 or (800) 822-2113 (within Pennsylvania) and (717) 783-4854 (out- 2a5 24s side Pennsylvania). gas 2a7 22. MAINTENANCE AND RISK OF LOSS (10-06) 2a7 zaa (A) Seller will maintain the Property, grounds, fixtures and personal property specifically listed in this Agreement in its present condition, normal zaa zas wear and tear excepted. gas zso (B) Seller will promptly notify the Buyer if, at any time prior to the time of settlement, all or any portion of the Property is destroyed, or damaged z5o 25t as a result of any cause whatsoever. 251 z52 (C) Seller bears the risk of loss from fire or other casualties until settlement. If any property included in this sale is destroyed and not replaced, z52 :.~53 Buyer will: 253 254 1. Accept the Property in its then current condition together with the proceeds of any insurance recovery obtainable by Seller, OR zsa zss 2. Terminate this Agreement by written notice to Seller, with all deposit monies returned to Buyer according to the terms of paragraph 20 of 2s5 25s this Agreement. zss z57 23. CONDEMNATION (10-06) 257 zss Seller has no knowledge of any current or pending condemnation or eminent domain proceedings that would affect the Property. If any portion zss %5s of the Property should be subject to condemnation or eminent domain proceedings after the signing of this Agreement, Seller shall immediately 259 %sp advise Buyer, in writing, of such proceedings. Buyer will have the option to terminate this Agreement by written notice to Seller within 2so zat days (I 5 days if not specified) after Buyer learns of the tiling of such proceedings, with all deposit monies returned to Buyer accord- zst 2sz ing to the terms of paragraph 20 of this Agreement. Buyer's failure to provide notice of termination within the time stated will constitute zt;z 253 a WAIVER of this contingency and all other terms of this Agreement remain in full force and effect. zsa 2s4 24. WAIVER OF CONTINGENCIES (9-05) zsa 2,, If this Agreement is contingent on Buyer's right to inspect and/or repair the Property, or to verify environmental conditions, boundaries, zss 2ss certifications, zoning classification or use, or any other information regarding the Property, Buyer's failure to exercise any of Buyer's 2s~ =`s? options within the times set forth in this Agreement is a WAIVER of that contingency and Buyer accepts the Property and agrees to the 2s. 25a RELEASE in paragraph 25 of this Agreement. 2ss 'zas 25. RELEASE (9-OS) 2s° z7o Buyer releases, quit claims and forever discharges SELLER, ALL BROKERS, their LICENSEES, EMPLOYEES and any OFFICER or sou 2'~'t PARTNER of any one of them and any other PERSON, FIRM or CORPORATION who may be liable by or through them, from any and zit ~• - all claims, losses or demands, including, but not limited to, personal injury and property damage and all of the consequences thereof, <%~ <~?~ whether known or not, which may arise from the presence of termites or other wood-boring insects, radon, lead-based paint hazards, mold, 273 ~~'%'t fungi or indoor air quality, environmental hazards, any defects in the individual on-lot sewage disposal system or deficiencies in the on-site 274 ~'~~ water service system, or any defects or conditions on the Property. Should Seller be in default under the terms of this Agreement, or in via %15 275 cation of any seller disclosure law or regulation, this release does not deprive Buyer of any right to pursue any remedies that may be avail- z;~ 27i able under law or equity. This release will suhvive settlement. 277 ==a 26. REPRESENTATIONS (9-05) z7s %t' (A) All representations, claims, advertising, promotional activities, brochures or plans of any kind made by Seller, Brokers, their licensees, employ- J7° Zan ees, officers or partners are not a part of this Agreement unless expressly incorporated or stated in this Agreement. This Agreement contains the zaa "at whole agreement between Seller and Buyer, and there are no other terms, obligations, covenants, representations, statements or conditions, oral eat 2s2 or otherwise, of any kind whatsoever concerning this sale. This Agreement will not be altered, amended, changed or modified except in writ- 2az 2+t3 ing executed by the parties. zaa aj't (B) Unless otherwise stated in this Agreement, Buyer has inspected the Property (including fixtures and any personal property specifical- 2aa 2r:5 ly listed herein) before signing this Agreement or has waived the right to do so, and agrees to purchase the Property IN ITS PRESENT zas zaF CONDITION. Buyer acknowledges that Brokers, their licensees, employees, officers or partners have not made an independent exam- zss ze7 ination or determination of the structural soundness of the Property, the age or condition of the corltponents, environmental conditions, zs7 zaa the permitted uses or of conditions existing in the locale where the Property is situated; nor have they made a mechanical inspection zsa zas of any of the systems contained therein. gas z9e (C) Any repairs required by this Agreement will be completed in a workmanlike manner. 290 z9t (D) Broker(s) have provided or may provide services to assist uluepresented parties in complying with this Agreement. 29t 292 ~".a --- A 292 293 Buyer Initials: ~ A/S-C Page 5 of 7 Seller Initials: /r zsa 295 296 297 298 2ss 300 30f 3oz 303 304 305 3os 307 28, 308 30a 3t0 311 312 313 3'( 4 315 Sts 3i7 3t8 310 320 29. 321 322 323 324 3~5 32s 30. 327 3zo 3;r `s30 'tat 33 333 334 31. a35 33r; 337 3J;t 3aa 32. aan 341 342 34? '4a 33. 3as 3%i6 3a7 348 349 350 351 352 353 354 355 (A) Seller has the option of retaining all sums paid by Buyer, including the deposit monies, should Buyer: 295 i. Fail to make any additional payments as specified in paragraph 3, OR 29s 2. Furnish false or incomplete information to Seller, Broker(s), or any other party identified in this Agreement concerning Buyer's legal or 297 financial status, OR 2ss 3. Volate or fail to fulfill and perform any other terns or conditions of this Agreement. zss (B) Unless otherwise checked in paragraph 27 (C), Seller may elect to retain those sums paid by Buyer, including deposit monies: 300 1. On account of purchase price, OR Sot 2. As monies to be applied to Seller's damages, OR 3oz 3. As liquidated damages for such breach. 303 (C) ~ SELLER IS LIMITED TO RETAINING SUMS PAID BY BUYER, INCLUDING DEPOSIT MONIES, AS LIQUIDATED DAMAGES. 304 (D) If Seller retains all sums paid by Buyer, including deposit monies, as liquidated damages pursuant to paragraph 27 (B) or (C), Buyer and Seller 305 are released from further liability or obligation and this Agreement is VOID. 3os CERTIFICATION OFNON-FOREIGN INTEREST (10.01) 307 ^ Seller IS a foreign person, foreign corporation, foreign partnership, foreign trust, or foreign estate subject to Section 1445 of the Internal 3os Revenue Code, which provides that a transferee (Buyer) of a U.S. real property interest must withhold tax if the transferor (Seller) is a foreign 3os person. 310 ~, Seller is NOT a foreign person, foreign corporation, foreign partnership, foreign trust, or a foreign estate as defined by the Internal Revenue 31t Code, or is otherwise not subject to the tax withholding requirements of Section 1445 of the Internal Revenue Code. To inform Buyer that the 312 withholding of tax is not required upon the sale/disposition of the Property by Seller, Seller hereby agrees to furnish Buyer, at or before clos- 313 ing, with the following: 314 ^ An affidavit stating, under penalty of perjury, the Seller's U.S. taxpayer identification number and that the Seller is not a foreign person. 315 ^ A "qualifying statement," as defined by statute, that tax withholding is not required by Buyer. Sts ^ Other: 3t7 Seller understands that any documentation provided under this provision may be disclosed to the Internal Revenue Service by Buyer, and that any 31a false statements contained therein could result in punishment by fine, imprisonment, or boot. 3t9 ARBITRATION OF DISPUTES (1-00) Buyer and Seller agree to arbitrate any dispute between them that cannot be amicably resolved. After writ- 320 ten demand for arbitration by either Buyer or Seller, each pazty will select a competent and disinterested arbitrator. The two so selected will select a 32t third. If selection of the third arbitrator cannot be agreed upon within 30 days, either party may request that selection be made by a judge of a court 322 of record in the county in which arbitration is pending. Each pazty will pay its chosen arbitrator, and bear equally expenses for the third and all other 3z~' expenses of azbitratiott. Arbitration will be conducted in accordance with the provisions of Pennsylvania Common Law Arbitration 42 Pa. C.S.A. 3za §7341 et seq. This agreement to azbitrate disputes arising from this Agreement will survive settlement. 3z5 BROKER INDEMNIFICATION (10-O1) 3as Buyer and Seller represent that the only Brokers involved in this transaction are: ~ ~. ~ ~- l ~]'~~ ~ ~~~~ ~j 327 , 328 and that the transaction ltas not been brought about through the efforts of anyone other than said Brokers. It is agreed that if any claims for broker- 329 age commissions or fees are ever made against Buyer or Seller in connection with this transaction, each patty shall pay its own legal fees and costs 330 in connection with such claims. It is further agreed that Buyer and Seller agree to indemnify and Bold harmless each other and the above-listed ''31 Brokers from and against the non-performance of this Agreement by either party, and from any claim of loss or claim for brokerage commissions, 332 including all legal fees and costs, that may be trade by any person or entity. This paragraph shall survive settlement. 333 GOVERNING LAW, VENUE & PERSONAL JURISDICTION (9-OS) 334 (A) The validity and construction of this Agreement, and the rights and duties of the parties, will be governed in accordance with the laws of the ~~;t5 Commonwealth of Pennsylvania. 336 (B) The parties agree that any dispute, controversy or claim arising under or in connection with this Agreement or its performance by either party 337 shall be decided exclusively by and in the state or federal courts sitting in the Commonwealth of Pennsylvania. 338 NOTICE BEFORE SIGNING (5-Ol) 332 Buyer and Seller acknowledge that Brokers have advised them to consult and retain experts concerning the legal and tax effects of this Agreement San and the completion of the sale, as well as the condition and/or legality of the Property, including, but not litnited to, the Property's improvements, Sat equipment, soil, tenancies, title and environmental aspects. Return by facsimile transmission (FAX) of this Agreement, and all addenda, bearing the .3<t2 signatures of all parties, constitutes acceptance of this Agreement. 343 NOTICE 3aa All notice requirements under the provisions of this Agreement or by application of statutory or common law will be addressed to the appropriate 345 party, at the addresses listed below via any means of delivery as mutually agreed upon by the pazties and stated here: 3as 347 If to Seller: 34s 349 With a copy to: 3sa 351 If to Buyer: With a copy to: 35s Buyer Initials: A/S-C Page b of 7 Revised 10/Ob 352 353 354 355 Seller Initials: - ~' 356 r 3 35e (A) The following are part of this Agreement if checked: 3 359 ^ ^ 3 360 ^ ^ 3 36i ,,, (B) SPECIAL PROVISIONS (IF ANY): 35z ~ p~C? ~ ~~~ `~ l S Q ,~1 u C S ~~ ~ ~ I~ S 1~. r'- ~`A~C~ f~-~ ~ `''A S _ ~ 3, 363 ~\~`•,.~ ,y~ n y~ / ~~ ~ ~ ~~ / /'T ` ~ 1 /U ~ (i t'~! /7 3 364 ~ U C~~,/~/V'c 1 S ~"G ~~ ~/~J~~ ~ /~ /r) !.^Cn~ ~C ~ /~ /1/{',/J~~Y 3 365 j',;11 ~ ~/~ ! f ~ /) ~~-~ /-f'" 1.- ~- `^ ~ CI~•~l ~~~ f ~/~ ~ ~J T ~ ~N~ ~~J/" ~3- f!~,~' 366 I ~ ~! ~Nl~ 367 ! 3t 368 3i 359 3t 370 3'. 371 3. 372 3. 373 3. 374 ~ Buyer has received the Consumer Notice as adopted by the State Real Estate Commission at 49 Pa. Code §35.336. 3+ 375 [~ Buyer has received a statement of Buyer's estimated closing costs before signing this Agreement. a7 37s [F Buyer has read and understands the notices and explanatory information in this Agreement. a~ 377 "Y Buyer has received the Deposit Money Notice (for cooperative sales when Broker for Seller is holding deposit money) before signing 3i 376 this Agreement. 3i 379 3i 3a0 Buyer acknowledges receiviag?a y of this Agreement at the time of signing. ~^-~ 3e 381 f / ~ ~ 35 3s2 WITNESS/ATTEST '~ ; + BUYER ~ J ~ DATE _ %-~ , j t:~ ~ 3e 383 Buyer(s)Name ,u ~ ~ E : ~ 38 384 Mailing Address / ~ L ~ . / •. c ~ 35 355 Phone ~7 % '7 ~{ 7 ~ ° `~ ~ ~~ °~ FAX 7 t ~~~i ~ `> ~r• ~t c~ E-Mat ! /e , ~ ,J.r ~. <a. /t 3s 385 , <~ ~^ 38 ae7 WITNESS/ATTEST BUYER DATE 38 385 $uyer(s)Name ~ 389 Mailing Address 38 39o Phone FAX E-Mail 39 391 39 392 WITNESSIATTEST BUYER DATE 39 393 Buyer(s)Name 39: 39a Mailing Address 3s 395 Phone FAX E-Mail a9: 396 3~' 397 ^Seller has received the Consumer Notice as adopted by the State Real Estate Commission at 49 Pa. Code §35.336. 39 ass ^ Seller has received a statement of Seller's estimated closing costs before signing this Agreement. 39' 393 ^ Seller has read and understands the notices and explanatory information in this Agreement. 39• aoo am 401 VOLUNTARY TRANSFER OF CORPORATE ASSETS (if applicable): The undersigned acknowledges that he/she is authorized by the Board of 4a' 442 Directors to sign this Agreement on behalf of the Seller corporation and that this sale does not constitute a sale, (ease, or exchange of all or substantially aos aU3 all the property and assets of the corporation, such as would require the authorization or consent of the shareholders pursuant to 15 P.S. § 1311. aos ao~ 404 ~ '~'.1 ~ ^, /`- 4os WITNESSIATTEST SELLER- / r _ • , ! ~•.s'y DATE ~ 4a`• aos SELLER(S) NAM ~' t. ~ - 1 ' ~_ r, , aof ao7 Mailing Addres ~r1 l ~ /.'" = ~ ~ i `" . F ^~ '~ ao; 408 Phone'`" f^ ~ ` ~ ~-- ~ ~ } • FAX ~ E-Mail 4oE aa9 `~ '`y! `y -iy:.~'~ '~~'"'~C:~~~ SELLER DATE ~t a1o WITNESS/ATTEST 411 SELLER(S) NAME 411 a12 dt2 Mailing Address FAX E-Mail a13 413 Phone 414 414 a15 WITNESSlATTEST SELLER DATE 415 ale SELLER(S) NAME 415 417 417 Mailing Address a18 Phone FAX E-Mail 418 A/S-C Page 7 of 7 Revised 10/06 -- - _.... 13385 PHILIP J. DOBSON 445 SOUTH CAMERON STREET HARRISBURG. PA 17101 ©M~TBank w-zssr3~s 7/23/2007 PAY TO THE Century 2l at the Helm ORDER OF **5,000.00 Five Thousand and 001100********************************s************r*****************************~**************~*** DOLLARS Century 21 at the Helm ..~ ~' MEMO: II'OL338511' ~:0331302955~: 344001?8?311' ~~ #6~ DEPOSIT TICKET ~~ CENTURY 21 AT THE HELM os/s7 ~~ ESCROW ACCOUNT ~~ 717 MARKET STREET ~~ LEMOYNE PA 17043-1489 ~~ ~~ DATE July 31 , 2007 ~~ DEPOSITS MAY NOT BE AVAILABLE Fdi IMMEDIATE WITHDRAWAL ~g 523 South 19th Street, Hbg, PA ?~ SION HERE IF CASH RECEIVED FROM DEPOSIT 0 q, ~~ Commerce :~ Bank Amxrca's Most Convenient BanltA "£ 7-888-937-000Q ',~'~ 60-184/313 of CASH Phi l i ~, Dobson I 5 0 0 0 0 0 E C K • S CHECKS OR TOTAL FROM OTHER SIDE ITEMS` SUB TOTAL ~ _ LESS CASH OEP031T ~ ~ 5 O O O •0 0 ~: 50 2 L~~LO L8 4~: S L 00 1 L 3 9 811' A X~Q ~:,~ ~ k ~~='~ ,x ~: -° ' ,~ MLS # 10145~C17 .~ ~ ': ~ ~..;~ ~; ~ - Type offices Address 523 S 19th ~~~ j~~ " ~ ,~ City Harrisburg t ~., ~'' ~ ~ ~ t ,_~~ State PA ~ ' ~ ~ ~ `" .rot :, Zip Code 17104 ._.. > ~ .. County Code Dauphin Municipality Hamburg x' _ _, Subdivision General Information Virtual Tour Commercial/Industrial uick Links ,'~y ff .©-© 1Y:' Status Active Area 2 List Price $160,000 Original Price $160,000 Listing Date 4/30/2007 Update Date 4/30/2007 List Type Exclusive Right DOM 0 Associated Document 0 arcel # Map Page Total Tax 1845 wner Name Map Coordinate Tax Year 2005 wner Phone Possession Settle Year Built 1920 Building Description Square Feet onthly Rent scant Suite 1 090 0 Suite 2 090 00 es Suite 3 090 0 0 Suite 4 dotal Square Feet 3270 # of Units Seating Capacity 40 ~'otal Available Sq Ft # of Parking Spaces 2 # of Restrooms 2 .ease IOny (Y/N) Yes Percent Leased Lease Price Features cceprao~e rmancmg ~unvenuonai, ~asn, rnva~e snowing Instructions Call List Office ccupied Owner, Tenant Current Use Apartments, Tavern ossible Use Apartments, Investment Only, Retail, Service Improvement Heights 3 Story Directions ntersection of 29th and Derry Public View Remarks ale includes Real Estate, Business, Hotel Liquor License..First floor is Bar/Restaurant,2nd Floor is apartment/ Kitchen, Living Room, 2 edrrooms and Bath. 3rd Floor is apartment/ Kitchen, Living Room i Bedroom and Bath. Listing is being sold as a package, As-Is fisting Office ntury 21 AT THE HELM Office (717) 737-4444 717 MARKET ST LEMOYNE, PA 17043 fisting Agent OHN BRADY (717) 737-5426 jbradyc2l@aol.com fisting Agent 2 fisting Agent 3 Date 3.5 Comm 3.5 Other A~ Selling Agent osing Date DOM 0 FINC Code Sold Price Information provided is deemed reliable but not guaranteed. 04/30/2007 09:09 AM CST 13385 PHILIP J. DOBSON 445 SOUTH CAMERON STREET HARRISBURG, PA 17101 PAY TO THE Century 2l at the Helm ORDER OF Five Thousand and 00l100*:s*****************s*****»*********** v******s***~x*I><******************•******:************DOLLARS Century 21 at the Helm MEMO: li'OL338511' 1:033029551: 34400L787311' ~~ #61 DEPOStTTICKET ~~ CENTURY 21 AT THE HELM o3JS7 _~ ESCROW ACCOUNT ~~ 717 MARKET STREET ~~ LEMOYNE PA 17043-1489 Ws ~,~ DRTE July 31 , 2007 DEPOSRS MAY NOT BE AVNLABLE FOR IMMEDIATE WITNDRAWAL ~~ 523 South 19th Street, Hbg, PA ~~ SIGN HERE 1F CASH RECEIVED FROM DEPOSIT O L,~ ~~ Commerce Amence's Most Convenient Benk°R ~~ C~c7nk 1-BBB-937-eD06 ~t~~ 60-184/313 of CASH Phi 1 i ~, Dobson E K S CHECKS Oq TOTAL FROM OTHER SIOE ... 17E3 SUB TOTAL ~ LESS CASH ~. DEPOSIT 1:502L~~1Oi841: 5~ OOL~39 811' EXHIBR ~_ QMBTBank 60-295!313 7J2312007 **5,000.00 5 0 0 0,0 0 5 0 00,0 0 AGREEMENT FOR TRANSFER OF LIQUOR LICENSE THIS AGREEMENT, entered into this ~ day of ~~~ 2007, by and between Goldring & Lipman, Inc., a Pennsylvania business corporation with its principal office at 523 S. 19th Street, Harrisburg, PA 17104 ("Seller"), and PJD Entertainment, Inc., or its assigns, a Pennsylvania corporation with its principal office at 445 S. Cameron Street, Harrisburg, PA 17101 ("Purchaser"). WHEREAS, Seller is the Licensee of Pennsylvania Liquor Control Board (PLCB) Eating Place Liquor License No. R-11870 and Amusement Permit No. 11870 (the "License"), and as to which Seller has or will continue to make proper application to the PLCB to keep the license renewed through the fmalization of this sale; and WHEREAS, Seller and Purchaser desire to provide for the transfer of the License from Seller to Purchaser. WHEREAS, Purchaser intends to retain the License at 523 S. 19th Street, City of Harrisburg, Dauphin County, Pennsylvania (subject real estate), or such other lawful location as the PLCB may approve at Purchaser's election; NOW THEREFORE, for and in consideration of the promises and the mutual covenants herein contained, Seller and Purchaser agree as follows: 1. Sale and Purchase Price of License. Seller agrees to sell the License to Purchaser, and Purchaser agrees to purchase the License from Seller, subject to the conditions set forth in Paragraph 4 hereof, for the consideration of $75,000.00, plus $25,000.00 for the machinery, equipment, furniture and other personal property as hereinafter described, and $40,000.00 for subject real estate for a total consideration of $140,000.00, to be paid according to the terms set forth in Paragraph 5 hereof. Upon execution of this Agreement, Purchaser shall deliver to Yoffe EXHIBIT & Yoffe, P.C., License Escrow Agent, the sum of $100.00 as a down payment- on the full purchase price as aforesaid, pending settlement, or other disposition, pursuant to the terms of this Agreement, and in addition thereto shall execute and deliver to Escrow Agent a Promissory Judgment Note for $134,900.00, payable without interest to Seller on demand following PLCB approval of the aforesaid transfer. Century 21 At The Helm, (Real Estate Escrow Agent), 717 Market Street, Lemoyne, PA shall hold an additional $5,000.00 escrow down payment pertaining to the sale of subject real estate, the same provided for in a contract between Seller and Philip J. Dobson on July 23, 2007 and incorporated herein by reference thereto. 2. Representation and Warranties of Seller. Seller, knowing that Purchaser is relying thereupon, represents and warrants the following, which representations and warranties shall survive the transfer of the License contemplated hereunder: (a) Seller is duly incorporated as a Pennsylvania business corporation under the laws of the Commonwealth of Pennsylvania. (b) Seller has duly authorized execution of this Agreement by proper corporate action. (c} None of Seller's officers, directors or shareholders has ever been convicted of, or is currently charged with having committed, a crime. (d) Seller is the Licensee of the License, which has been or will be renewed as required by law through finalization of the sale. (e) Seller holds the License free and clear of any liens, encumbrances, or claims of any person. 2 (f) Seller has received no notice of alleged violation(s) or Citation(s) relative to the License and such that there are currently pending with respect to either disposition or penalty enforcement. (g) Seller confirms that the License is not subject to suspension, revocation or payment of a fine. (h) Seller has filed all tax returns required to be filed and has paid all taxes required to be paid through the date of this Agreement. (i) Seller shall file all tax returns required to be filed and pay all taxes required to be paid to permit the Pennsylvania Department of Revenue and the Pennsylvania Department of Labor and Industry to issue the Tax Clearance Certificates required by Section 477 of the Pennsylvania Liquor Code and which will permit the transfer of the License from Seller to Purchaser. (j) Seller shall (1) perform all acts; (2) execute or cause to be executed all papers and documents; and (3) provide any and all information required by the PLCB in connection with the transfer of the License. 3. Re resentations and Warranties of Purchaser. Purchaser, knowing that Seller is relying thereupon, represents and warrants the following, which representations and warranties shall survive the transfer of the License contemplated hereunder: (a) Purchaser is an individual residing at the address heretofore stated herein; (b) Purchaser has duly authorized execution of this Agreement by proper corporate action. (c) None of the Purchaser's officers, directors or shareholders, has ever been convicted of, or are currently charged with having committed, a crime. 3 (d) Purchaser has filed all tax returns required to be filed and paid all taxes required to be paid through the date of this Agreement. (e) Purchaser shall file all tax returns required to be filed and pay all taxes required to be paid in order to permit the Pennsylvania Department of Revenue and the Pennsylvania Department of Labor and Industry to issue the Tax Clearance Certificates required pursuant to Section 477 of the Liquor Code and which will permit the transfer of the License from Seller to Purchaser. (fj Purchaser shall (1) perform all acts; (2) execute or cause to be executed all papers and documents; (3) provide any and all information required by the PLCB in connection with the transfer of the License, and (4} pay all fees and costs required by the PLCB concomitant to the transfer application. (g) The funds to be paid under this Agreement are from sources acceptable to the PLCB. (h) Purchaser knows of no reason why its application for the transfer of the license should be denied or why the transfer herein should not be approved by the PLCB. 4. Conditions of Sale. Completion of the sale under this Agreement is conditioned upon the following: a) Approval by the PLCB of the transfer of the License from Seller to Purchaser. Purchaser shall forthwith make application to the PLCB after receiving a fully executed copy of this Agreement, paying alt required fees therefor and submitting to the PLCB all required concomitant forms. 4 b} Purchaser shall diligently follow-up on the submitted application by furnishing to the PLCB any additional information or documents by it requested and fully cooperating with that Agency in its investigation of the Purchaser. c) If the PLCB fails to approve Purchaser's application for license transfer after a reasonable period of time due to its fault or some deficiency in its application or ineligibility to hold such a license, or for some cause attributable to Purchaser, or if Purchaser is otherwise unwilling or unable to settle pursuant to Paragraph 5 of this Agreement, or is otherwise in default of this Agreement, then the aforesaid down payments shall be forfeited to Seller as liquidated damages. In this instance, the Escrow Agents shall pay-over their respective $100.00 and $5,000.00 down payments without interest to Seller and the Purchaser's Judgment Note and this Agreement shall thenceforth be void and of no effect, with respect to any future performance by any party. 5. Upon approval of the License transfer by the PLCB, the parties shall schedule a settlement at which time Purchaser and Yoffe &Yoffe, P.C. Escrow Agent, shall pay to Seller the $134,900.00 balance due on the purchase price (after receiving the aforesaid amount from Purchaser upon his redemption of its Judgment Note), and the $100.00 dawn payment, without interest, and the Real Estate Escrow Agent shall pay to Seller its $5,000.00 escrow without interest and Purchaser shall additionally pay to Seller the pro-rated amount, figured to date of settlement of all PLCB license or validation fees for license/validation year ending February 29, 2008 and for the succeeding year, as applicable. 5 6. No liability shall exist against the Escrow Agent in favor of Purchaser, nor may any suit or legal action of any kind be maintained against it by Purchaser based upon a claim by Purchaser that Escrow Agent has made or is about to make an improper transfer of the down payment money provided: 1. Escrow Agent gives a written notice to Purchaser of such intended transfer at least twenty (20) days in advance of such transfer, by certified mail to Purchaser at his address as hereinabove set forth, and 2. No suit is commenced by Purchaser against Escrow Agent and process therefor served upon Escrow Agent prior to the transfer by Escrow Agent. 7. Settlement: Settlement shall occur within ten (10) business days of the license transfer approval of the PLCB (not withstanding the lesser 5 days provided in the aforesaid Agreement of 7uly 32, 2007). 8. Successors in Interest: This Agreement shall be binding upon and shall inure to the benefit of the parties hereto, their respective successors and assigns. 9. Default: If, prior to PLCB license transfer approval, Purchaser becomes in default of this Agreement, or otherwise, Seller is authorized by Purchaser to notify the PLCB that the inchoate PLCB Form #21 purchase agreement has been terminated and that Seller's execution of the same has been rescinded, and seller may execute said recission notice to the PLCB ors behalf of both parties to this Agreement. 10. Duty of Cooperation: It is agreed that each of the parties shall cooperate fully and act in good faith in the performance of their respective duties with regard to securing the approval of the PLCB to transfer the License as aforesaid, time being of the essence to this Agreement. The parties agree to execute and deliver, without further consideration, all 6 documents and instrument, to furnish any and all information, and to take any and all action as either party may reasonable request from time to time in order to effectuate the transfer of the License to the Purchaser and to convey, transfer and vest in Purchaser, and to put Purchaser in possession of, the License and the other assets being conveyed hereunder. The parties shall cooperate fully with each other in connection with any steps required to be taken as part of their respective obligations under this Agreement. The parties shall exercise due diligence with respect to their respective duties under the Agreement, time being of the essence to this Agreement. 11. No commission due as a result of this sale shall be paid by Purchaser. A commission shall be paid by Claire R. Weldon, the owner of the real estate and Seller to the aforesaid realtor, which shall be paid at closing. 12. Anything herein to the contrary notwithstanding, subject real estate is being purchased by Philip J. Dobson individually, who shall pay the allocated purchase price therefor from his own separate funds, and the same is being sold by Claire R. Weldon, individually, both of the foregoing joining as parties in this Agreement solely because of the separate nature of the real estate ownership. 13. It is specifically provided herein that the consummation of this Agreement; i.e., the licensees, personal tangible property now located in subject real estate and the real estate shall be completed and settled for as a single package, and that the consummation of the transfer of each element of said package is conditioned and contingent upon the consummation of the transfer of each other element. 7 14. The tangible, personal property which is being sold pursuant to this Agreement and as heretofore referred to is depicted in the 14 photographs attached to this Agreement and collectively marked Exhibit "A". 15. This Agreement maybe signed in counterpart by the parties. 1N WITNESS WHEREOF, Seller has caused this Agreement to be executed and attested by its proper officers, and Purchaser has caused this Agreement to be executed and attested by the proper officers, each party intending thereby to be legally bound. ATTEST: SELLER: GOLDRING & LII'MAN, INC. By: President ATTEST: PHILIP J. DOBSON, Secretary PURCHASER: PJD ENTERTAINMENT, INC. By: JOSH KESLER, President PHILIP J. DOBSON CLAIR R. WELDON (single person) dobson~523 S. l9th~agreement g PLCB-21 „ios r APPLICATION FOR TRANSFER COMMONWEALTH OF PENNSYLVANIA PENNSYLVANIA OF BUREAU OF LICENSING LIQUOR CONTROL BOARD LICENSE AND PERMIT (SEE INSTRUCTIONS ON REVERSE) I hereby agree to the transfer of my license and permits, if any, to the applicant named in Block 6 and to the premises shown in Block 8 and 9. I guarantee to make no other attempt to transfer said license and permits until this application has been definitely acted upon. INFORMATION AS TO PRESENT LICENSEE AND ADDRESS OF LICENSED PREMISES ,. NAME OF LICENSEE LICENSE NO. AMUSEMENT PERMIT Goldring & Lipman, Inc. R11870 ^/ YES ^ NO 2. TRADE NAME (IF ANY) Weldon's Cafe 3. ADDRESS OF PREMISES (STREET, RURAL ROUTE, P.O. BOX NO.) (POST OFFICE) (STATE) (ZIP) 523 S. 19th Street Harrisburg PA 17104-2307 4. NAME OF MUNICIPALITY TYPE OF MUNICIPALITY INC. COUNTY Harrisburg /^CITY ^BORO ^TWP. ^TOWN Dauphin 5' RESOLUTION At a regular or special meeting held on ~1 ' , 20 by the licensed corporation, it was resolved that said application be filed with the Pennsylvania Liquor Control Board, and that ~~ ~ and/or ~~~ is/are (NAME/TITLE) (NAME/TITLE) hereby authorized to execute said application, and any other papers required by the Board. INFORMATION FOR APPLICANT AND ADDRESS OF PREMISES TO BE LICENSED 6. NAME OF APPLICANT IS AMUSEMENT PERMIT TO BE TRANSFERRED? PJD Entertainment, Inc. N/A YES ^ NO 8. ADDRESS OF PREMISES (STREET, RURAL ROUTE, P.O. BOX NO.j (POST OFFICE) (STATE) (ZIP) 523 S. 19th Street Harrisburg PA 17104-2307 9. NAME OF MUNICIPALITY TYPE OF MUNICIPALITY INC. COUNTY Harrisburg ^/ CITY ^BORO ^TWP. ^TOWN Dauphin I swear or affirm, subject to the penalties provided by 18 Pa. C.S. §4904 and 47 P.S. §4-403(h) and/or §4-436(j) and/or §5-504(b) and/or §7-704, that the foregoing answers and statements provided herein are true and complete to the best of my knowledge and belief. GNATURE OF PRESENT LICENSEE ~.4 TITLE t~b1~r(n d~(~~rn~ ~{~L- ~I,g'. President PRINT -;~' l ING DATE OF EXECUTION HOME ADDRESS OF PRESENT LICENSEE 523 S . 19th Street, Harrisburg, PA 17104 PHONE This application for transfer must be accompanied by the following supporting papers and requisite fee(s): A. Application and other supporting documents as instructed on the accompanying application for type of license and permits desired. B. Check or money order made payable to the PLCB or the Commonwealth of Pennsylvania for license transfer fee of $650 for person to person, or $550 for piace to place, or $700 for BOTI ~ parson to persor, and place to place. This fee is not refundable. C. Additional fee of $10.00 if the current Amusement Permit is to be transferred. D. If an inter-municipal transfer of a retail license, written approval from the governing body of the receiving municipality if the retail municipal quota is met or exceeded. E. If the transfer is for a retail liquor or retail malt beverage dispenser license from a city of the 1st class to a county of the 2nd class A or 3rd class designated as a Mixed-Use Town Center Development Project, the following is required: 1. Municipal approval as described in "D." 2. Resolution or Ordinance stating the municipality has designated the location aMixed-Use Town Center Development Project. 3. $50,000 surcharge fee along with the transfer fee as described in "B." 4. Intra-County Affirmation stating the applicant has exhausted reasonable means for obtaining a suitable license within the county. 5. Affidavit from a real estate agent, license broker or other similar professional attesting to the unavailability of a liquor license at a relative market price. DO NOT WRITE BELOW THIS LINE LID_____ CO/MNCPCODE __-___ ZIP_____-____ EXHIBIT Page 1 of 1 Connie Stoneroad From: Jbradyc21 @aol.com Sent: Thursday, October 04, 2007 3:34 PM To: Connie Stoneroad Subject: Weldon's Bar 523 S. 19th Street Harrisburg, Pa. Ms. Connie E. Stoneroad As per our telephone conversation of this morning I estimate the values of the Real Estate, Equipment and Liquor License as follows: Real Estate $30,000 Equipment $10,000 Liquor License $100,000 Total Value $140,000 The above is based on my experience as a Real Estate Salesperson for the past 24 years an experience in the construction business. The real property is structurally in poor condition due to movement to the left wall of the building which may have been caused subsidence of the foundation, the two apartments need extensive remodeling before they soul become inhabitable. The location of the bar is in an area that is less than desirable due to functional obsolescence. Among other needed repairs City inspection will require complete rewiring if not condemnation of the property. The only real value of this property is in the Liquor License I hope the above is of help to you. John H. Brady, GRI. Century 21 At The Helm See what's new at AOL_com and Make AOL_Yo_.ur_Hom.epage. EXHIBIT 10/15/2007 ., ~. x ... ~~.~ r "~, . ~-: ;~: 9>~~~~ 2941 North Front Street Harrisburg, PA I7I10 September 18, 2007 Keystone Guardianship Services To Whom It May Concern: Phone: (7I7) 236-3900 Fax: (717) 236-7139 The last Dauphin County Liquor license, that I'm aware of, sold three months ago for approximately $120,000. There is presently one for sale for Dauphin County with an asking price of $125,000. Sincerely, /' w 4 Vl .i/ _ ` William Livingston, Partner Livingston & MaGilton Realtors 717-236-3900 or 717-571-8897 www.livingstonmagilton.com 0 Www. THE MATTER OF GLAIR R. WELDON IN THE COURT OF COMMON PLEAS AN ADJUDICATED CUMBERLAND COUNTY, PENNSYLVANIA INCAPACITATED INDIVIDUAL ORPHANS COURT DIVISION NO. 21-07-0606 VERIFICATION I verify that the averments in this Petition to Sell Real Estate and Corporate Assets are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. JP~r~ B . ID#7664 Esquire KEYSTONE GUARDIANSHIP SERVICES Date : I D ~-~ 0' Constance E. Stoneroad